What Women Want

December 8, 2009, University of Maryland School of Nursing, Baltimore, MD
Amy Polk spoke to nursing students about the consumer's perspective on birth. The students were all studying to be either labor and delivery, neonatal intensive care unit (NICU), or post-partum nurses. Amy based her talk on the results of a request for comments put to two parents' groups in the Washington, DC area, with the simple question: "What do you want maternity ward nurses to know?"

The response was immediate and substantial: over 25 women wrote back in less than 24 hours. From these comments, Amy compiled a list of Do's and Don'ts, grouped into several categories: patient interaction, your legacy, labor and delivery, NICU, breastfeeding, post-partum sleep, learning more, and final thoughts.

Patient Interaction

Do interact with your patients in a respectful manner. Treat them like rational adults.
“If you sound like you are talking to a first grader in a high pitched sing-songy voice, then you are doing the opposite of empowerment.” –MM
“’That's just your hormones speaking.’ is not a helpful phrase to hear.” -BI

Don’t talk about your patients in their presence as if they aren’t there.
“We mothers in labor can hear you! Our ears still work!” -NE

Don’t assume that patients know everything you know.
“Remember that even an experienced mother probably won't be familiar with the policies and services at your particular hospital. She shouldn't need to ask to find out what's available to her.” -TL
“If there's a cart with supplies next to the mom, remember to orient her to it. Years after that birth, I think about the cold packs in that cart drawer.” -MB

Don’t make assumptions about teen moms, especially about breastfeeding.
Teen moms are “often treated like they don't want information about what's going on, since they are hesitant to ask, but most often they really do want to know and to have a voice in their treatment.” -FE
“More often than not, it's assumed that [teen moms] will bottle-feed and are given very little guidance in breastfeeding.” -FE

Do ask moms about their vision of birth.
“Take time to ask her what her vision of her birth is.” -MN

Don’t attend a birth whose vision you cannot support.
“If [your patient wants] a natural unmedicated birth, and you prefer attending women who have medication, then please ask another nurse who does like to be with women who labor naturally.” -MN

Your Legacy

Do remember that birth may be routine for you, but not for the parents.
“Please try to remember that while L&D will become your day-to-day job, a trip to the maternity ward is a life-changing event for the parents.” -KE
“Remember that the new mom has never done this before, even if you have done this thousands of times.” -FC
“Treat each mom as a person going through a normal life process instead of as a medical condition.” -MN

Do know that you will be remembered!
“You are part of a birth story that may be told over and over again as well as remembered by the birthing mother for her lifetime.” -DD
“I can still remember all seven of my L&D nurses' names and faces. They were way more consistent and supportive than the docs.” -CD
“Even years later, women remember the kindness and understanding of particular nurses.” -MB
“I still remember the name of the L&D nurse who was with me for the end of my first labor, though I have no idea what the OB's name was.” -BE

Do go the extra mile.
“One of [the nurses] even stayed way after her shift had ended so that I wouldn't have to change to a totally new person in the middle of pushing.” -CD

Do remember that you can be an advocate for the mom, even to her husband or partner.
With my first child, “the L & D nurse actually just placed her body between [my husband] and me” which gave him space to respect my wishes for no pain medication. -NC

Labor & Delivery

Don’t treat the parents like freaks when:
The couple brings a doula.“Doulas can be [nurses’] allies, not competition.” -MN
The mom doesn’t want pain medication.“Please do not assume that all women feel pain while birthing. Some really do not code the sensations as such.” -MN
The mom uses a way of dealing with the pain other than drugs.“When a woman says that she is using a particular technique, please ask questions instead of turning up your nose.” -MN“I didn't care for the nurse who brought me oxycontin because she ‘couldn't keep getting more ice.’” -TQ
The mom wants to eat and drink during labor.
The mom questions a procedure or intervention.
The mom wants some time (e.g., 30 minutes) to consider an intervention or other difference from what she envisioned.
The mom refuses a procedure or intervention.“Recognize that when a woman refuses a procedure that she still does have the right to do that, and do your best to let it go.” -MN
The mom labors and/or gives birth in unusual positions: standing up, squatting, etc.“My L&D nurse somehow did all of the things she had to do while I was in some very contorted positions. It really helped.” -NS
The mom wants the baby placed on her chest immediately after birth for skin-to-skin contact.“Please realize that skin on skin is essential and that does not mean putting a towel on the mom then putting a baby on top of the towel.” -MN
The parents want to wait until the umbilical cord stops pulsing before it’s cut.
The parents want their baby with them, not in the nursery.“Some [nurses] strongly disagreed with my wish to keep my baby in the room with us. I had to struggle with them at midnight over not taking him away from us.” -KX
The parents focus on their own needs rather than yours.“When a mom comes in and has to answer questions, it is frustrating as she has answered these before and just wants to focus on her body and her baby.” -MN

Don’t ask routine questions of a mom in active labor, especially if this information has already been collected before.
“I wanted to do something very mean when I was asked for the date of my last menstrual cycle, my weight, my address for the third time at 5 cm dilated.” -MR
“Late stage labor is not the time to insist that the mother, not the husband, give the intake nurse your Social Security number a dozen times to fill out in the computer.” -NE

Don’t freak out about tearing or aggressively push for episiotomies.
“The only thing that the L&D nurse did during my first delivery was she kept talking about how I was tearing, and it made me really afraid to push. She kept saying I should just get and episiotomy.” -XT

Do perineal massage.
“My second delivery the nurse did a lot of perineal message and I didn't tear at all.” -XT

Do understand the Sphincter Law.
“Sphincters function best in an atmosphere of intimacy and privacy.”
“Sphincters cannot be opened at will and do not respond well to commands, such as ‘Push!’ or ‘Relax!’”
“When a person’s sphincter is in the process of opening, it may suddenly close down if that person becomes upset, frightened, humiliated or self-conscious.”
From Ina May’s Guide to Childbirth (Ina May Gaskin, 2003), p. 170

Don’t give up on teaching effective pushing.
For my second child, “the nurse-midwife said one thing that made it click, and it went fine with my 9-pound son.” -MB

NICU

Do remember that you can be an advocate for the parents to pediatricians and other specialists.
While my baby was in the NICU, “there was so much new information coming at me at once, it was the nurses who helped me understand which orders from doctors were standard and probably necessary and which decisions made sense to question.” -LI

Do help new parents feel like parents, even in their baby is in the NICU.
“The nurses who treated me and my partner like we were the most important caregivers for our baby were lifesavers for me.” -LI

Do welcome parents into the NICU as a way of teaching them how to handle a newborn.
“If possible, invite the first mom(s) or dad(s) to come to the nursery when the baby goes for routine stuff. Not only does it support the bond that is occurring in those first special hours/days but it also helps the parents to see someone experienced handling the baby.” -KK

Breastfeeding

Do arrange for the lactation consultant to visit the new mom right away.
“Lactation and nursing can get lost in the shuffle which may bring about problems later that could have been avoided with some simple attention.” -KK

Do recognize how difficult breastfeeding can be, especially at first.
“Have empathy and patience.” -LO

Don’t make the mother feel guilty about breastfeeding if the baby has lost a little weight.
“Every single baby loses a small amount of weight after birth.” -KX

Post-Partum Sleep

Do let mom sleep.
Recognize “the profound effects of sleep deprivation” can have on moms who have just given birth. -LO
“Don't wake up a mom with questions that are not urgent.” -FC
“I had a maternity nurse who quickly realized that I was being awaken every hour on the hour, i.e., meds, nursing, changing my dressing, etc. She quickly combined what she could to minimize the number of times she needed to wake me.” -NB
“It would be nice if they didn't take the baby out in the middle of the night to get weighed.” -DD

Do help mom sleep.
“A wonderful nurse finally sat me down and said that she was not going to wake me to go nurse [my daughter in the NICU], that I needed to rest. She then gave me a sleeping aid to assist me.” -OC

Learning More

Do read birth books.
The Doula Guide to Birth by Ananda Lowe & Rachael Zimmerman (2009)
Your Best Birth by Ricki Lake and Abby Epstein (2009)
Our Bodies, Ourselves: Pregnancy and Birth by Judy Norsigian (2008)
Cesarean Voices by the International Cesarean Awareness Network (ICAN) (2007)
Pushed by Jennifer Block (2007)
Born in the U.S.A. by Marsden Wagner (2006)
Baby Catcher by Peggy Vincent (2003)
Ina May’s Guide to Childbirth by Ina May Gaskin (2003)
Spiritual Midwifery, 4th Edition by Ina May Gaskin (2002)
The Thinking Woman’s Guide to a Better Birth by Henci Goer (1999)

Do see birth movies.
The Business of Being Born
Home Delivery
It’s My Baby, My Body, My Birth
Laboring Under an Illusion
Orgasmic Birth
Singing the Bones

Do see birth in out-of-hospital settings.
Attend births in birth centers.

Bay Area Midwifery - Annapolis, MD
BirthCare - Alexandria, VA
Family Health and Birth Center - Washington, D.C.
Marshall Midwifery Birth Center - Marshall, VA (opened December 1, 2009)
Special Beginnings - Arnold, MD

Attend home births.

Talk to and “shadow” doulas. Take doula training.

List of birth centers, home birth midwives, and doulas available at Birth Options Alliance website http://www.birthoptionsalliance.org/.

“We need as many angels in the hospital as we can get.” -NC

Final Thoughts

PN (mother of two) says:
“Give new mamas support rather than judgment. Give information rather than directives.”
“Remember that laboring and recent postpartum mamas are at their most vulnerable.”
“Never assume that you know what is best for baby or mama. Remember you are part of a team that has the responsibility to get mama and baby off to the best start both physically and emotionally.”

MM (childbirth educator) says:
“Women can be strong if you teach them how and empower them to do so.”

MN (doula) says:
“The birthing mom looks to you for guidance since you are the caregiver in the room most of the time.”
“Trust the birthing process and recognize that birth is not cookie cutter.”
“Please bring positive energy to the mom and her partner.”
“Trust your instincts as a woman.”

Unitarian Universalist Sermon on Birth Part 5: Sermon

Let’s start with a survey. Raise your hand if you:

* Have given birth?
* Been there when your partner gave birth?
* Seen another person besides your partner give birth?
* Seen an animal being born?

Many of you are ahead of me on this journey. The only birth I have ever witnessed was our class pet Carmel the Guinea Pig during a math test in fifth grade.

Now let me give you the results of some surveys. But before I do that, I wanted to give a little disclaimer. Birth is messy and bloody and often painful. So in this sermon about birth I’m going to talk quite a bit about medical conditions and women’s body parts and maybe even touch on how babies are made in the first place. So you might not hear the paralyzed “paralyzed bowel” in a typical sermon, but this is not your typical sermon.

Back to the first survey. According to the Listening to Mothers survey conducted by the advocacy group Citizens for Midwifery in 2006 (1):

* Electronic fetal monitoring, what Monty Python called “the machine that goes ‘Ping!’” in the movie The Meaning of Life, is used in almost all (94%) births, despite being classified as having “a trade-off between beneficial and adverse effects” in a review of medical literature. (2)
* Epidural anesthesia is used in three-fourths (76%) of all births, despite also being classified as having “a trade-off between beneficial and adverse effects” by the same study. (2)
* Hooking the mother up to an intravenous drip (IV) for delivery of nutrients is used in 83% of all births, despite being classified by the same study as being “unlikely to be beneficial”. (2)
* Episiotomy is used in one-third (33%) of births, despite being classified as “likely to be ineffective or harmful” when used routinely. (2)
* And the mother of all birth interventions, the cesarean section, is used in 31% of all births. (3)

Here are the results of another survey. (My husband wanted me to include this statistic because it’s so powerful.) According to the Centers for Disease Control, babies are more than half again (1.6 times) more likely to be born on a weekday than a weekend. The CDC even has a name for this phenomenon. They call it “the weekend deficit” (4) as in "the weekend deficit keeps going up" or "the weekend deficit is more pronounced for c-sections than vaginal births".

So what does this survey tell us? That, in this country at this time, a lot of women are having highly medicalized births even though the medical evidence says that it might not be the best for their health or the health of their babies.

Now for some women, “highly medicalized” is exactly what they need. In fact, CDC data analyzed by the advocacy group Childbirth Connection (5) say that nearly one a fifth (17%) of women fall into the “high risk” category and need these interventions.

For other women, these interventions are not what they need, but they’re what they want. I don’t know if you’ve heard this, but childbirth can be quite painful. And for the benefit of pain relief that an epidural brings, many women will happily make the trade-off.

But for other women, the consequences of these interventions can be disastrous.

Take, for example, cesarean sections. And I don’t mean to pick on cesarean sections, but there are a lot of data on their risks, yet often these data are not presented to women when they are making their choices.

Oh, and all of the numbers that I’m giving you today come from either government vital statistics data or peer-reviewed articles published in medical journals. So I have a more rigorous standard than “I read it on the Internet. It must be true!” And you can look up these studies yourself because I’ve included all the references for all these numbers in the written version of my sermon, which will be posted on the church website and on my own blog.

Where was I? Ah, yes, caesarean sections, which is how nearly one-third of babies in the U.S. enter the world. Yet with c-sections, there is a 4.5% rate of major complications for the mother, which include severe hemorrhage, need for another surgery to find out what’s causing the severe hemorrhage, pelvic infection, pneumonia, blood poisoning, blood clotting too much and blood clotting too little. In addition, there is a nearly one-third rate of minor complications for the mother, which include fever, hemorrhage, blood-filled swelling, urinary infection, uterine infection, leg clots, and paralyzed bowel or bladder. (I don’t know why paralyzed bowel or bladder is classified as a minor complication. It seems pretty major to me.) There is even a 1% rate of the baby being cut by the surgeon’s scalpel. (6)

In addition to physical wounds from this type of intervention, psychological wounds can be just as profound, if not more so. Problems include difficulty caring for the newborn; difficulty caring for older siblings; disappointment, anger, frustration and sadness at the missed opportunity for a vaginal birth; a feeling of being disfigured; and painful intercourse or a lack of interest in sex that often contributes to marital stress. For some women, the psychological problems are so bad that they experience post-traumatic stress disorder (PTSD) with symptoms of nightmares, flashbacks, a deep fear of getting pregnant again, and difficulty forming an attachment to the new baby.

Plus, many women who have these problems experience a trivialization of their physical and psychological pain by medical professionals and well-meaning family and friends. One woman writes in the book Caesarean Voices (7): “They all think you are just lucky to have a healthy baby and you should count your blessings.” So in addition to all these other negative feelings, you can add guilt to the list.

Our country’s over-medicalization of birth is one of many factors in another alarming statistic: maternal death. More women are dying in childbirth in the U.S. than they used to. Let me say that again, because most people don’t believe it because they think it cannot possibly be true. But this is what the data show: both the rate and the absolute number of women dying in childbirth in this country has doubled over the past decade. (8)

The alarming rise in maternal deaths prompted Ina May Gaskin, who wrote the mediation from Spiritual Midwifery that I read earlier, to launch the Safe Motherhood Quilt Project. Similar to the AIDS Quilt, the Safe Motherhood Quilt is comprised of panels, each commemorating a woman who died of pregnancy-related causes in the U.S. since 1982. The quilt now has almost 200 panels online and even more as part of the physical quilt. (9)

So why should we, as Unitarian Unviersalists, care about these births? Why should you care? Especially if you have no children and have no plans to, or are done having your babies? Because respect for birth is yet one more way to manifest the Seven Principles. And lack of respect for birth is yet one more way that the Seven Principles are violated.

The women who tell their stories in Cesarean Voices, for example, were not treated with inherent worth and dignity of every human being (the First Principle). They did not have a voice in their own care (the Fifth Principle). Because of the lack of information or misinformation they were given, they were denied their right to search for their own truth and decide what option was right for them (the Fourth Principle).

We should care about these women because they are in the interdependent web of which we all are a part (the Seventh Principle). That’s why I asked John to give his perspective on our son’s birth. Because the birth experience is important not just to the mom, but to per partner, the children she gives birth to, her family and her entire community.

Now at this point, I want to stop and make something very clear. If you had a highly medicalized birth (whether by medical necessity or your own choice or both) and you have no physical or psychological wounds, consider yourself blessed. The last thing I want to do in this sermon is to cause anyone to feel bad because of the choices they’ve made.

But what I do want to communicate to you is that other women are not as blessed. These women are wounded, and they need your help.

But don’t despair, because help is on the way.

One form of help is a group called Birth Options Alliance, which was founded six years ago in nearby Takoma Park by playwright Karen Brody and has now grown to over 600 members. The group educates expectant parents on their choices, provides support to expectant parents through monthly meetings and an active e-mail group, fights against threats to birth options in the DC area, and works to expand options. You can join Birth Options Alliance, anyone can, for free, simply by signing up for the Yahoo group. (10)

Another form of help is the effort to start a birth center in Takoma Park on the campus of Washington Adventist Hospital, which will be relocating in 2013. And, as many of you know from my relentless e-mail campaign, I am leading this effort. (11)

Believe me, when I was giving birth to my babies on those warm summer nights in 2002 and 2005, I never expected that that this would become, as I described in my e-mails, “my new mission in life”.

But I feel that I have been called to do this. Most women who become birth activists do so because of a horrible birth experience (like those described in Caesarean Voices). But not me. I had two great births at the Maternity Center.

But the Maternity Center closed in May 2007. And, that same month, a midwife practice in Takoma Park that delivered babies at Sibley Hospital, called Takoma Midwives, also closed.

So the option that I had for my babies’ births has been taken away. So I feel that I have been called to restore that option to women here in this area.

But I’m not the only one at UUCSS working on this issue. Our Youth Coordinator Dawn Star Borchelt teaches childbirth preparation classes. Former UUCSS member Carolyn Dutcher was a midwife at Takoma Midwives, and delivered quite a few children of this congregation who are downstairs in RE right now. Church members Meredith Massey, Kathryn Leete, Alexa Fraser and Sarah Torrell have all pledged some combination of their time and their talent and their money to support the new birth center.

I even got the idea for the name “Seasons of Life Women’s Health and Birth Center” from the quilts that you’re looking at right now in this sanctuary. I wanted a name that would reflect the breadth of the center’s mission, that it would provide care for all phases of a woman’s life: from the onset of menstruation (including teen sexuality issues), through the childbearing years (including birth, birth control and fertility assistance), to elder years (including menopause).

This church and this congregation have supported me in my “new mission in life”. So I just wanted to say thank you. But, you know, from the eight years that I’ve been a part of this church and the eight years that I’ve been a Unitarian Universalist, I’m actually not surprised. Making the world a better place is what we UUs do. It is the Sixth Principle, after all.

Ina May Gaskin wrote in our meditation that “each and every birth is the birth of the Christ child”. And Mary McAnally, in our poem of opening words, equated each laboring woman to the Great Mother Goddess.

So let us embrace the sacredness of each and every birth. Do it for yourself, for your wife, for your partner, for your daughters and sisters and neighbors and co-workers and friends. Do it for the woman who gave birth to the child you adopted, even if you never met her, even if you never even knew her name.

Ina May Gaskin also wrote in our meditation that “Each birth is holy.” and that those who attend births have a “daily acquaintance with miracles”.

So miracles really do happen every day: 11,000 miracles every day in the U.S. on average. Some are empowering and life-changing. Some are terrible. Some are tragic. But they all are miraculous.

So let us all try to be more reverent of those miracles. The Great Mother Goddess within us all deserves no less.

-Amy Polk

Endnotes:

(1) Listening to Mothers II Survey (Citizens for Midwifery, 2006) http://www.cfmidwifery.org/
(2) A Guide to Effective Care in Pregnancy and Childbirth, Third Edition (Oxford University Press, 2000) http://www.childbirthconnection.org/article.asp?ClickedLink=194&ck=10218&area=2
(3) 2006 data. Centers for Disease Control and Prevention, National Vital Statistics System http://www.cdc.gov/nchs/births.htm.
(4) National Vital Statistics Report, Volume 65, Number 6 (Centers for Disease Control and Prevention, December 5, 2007) http://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_06.pdf.
(5) 2006 data compiled by Childbirth Connection. Presentation at the American Association of Birth Centers (AABC) 2007 Annual Meeting.
(6) The Thinking Woman’s Guide to a Better Birth by Henci Goer (Penguin Putnam, 1999), p. 23.
(7) Caesarean Voices (International Caesarean Awareness Network, 2007), p. 56. http://www.ican-online.org/.
(8) Maternal Mortality and Related Concepts, Series 3, Number 33 (Centers for Disease Control and Prevention, National Center for Health Statistics, February 2007) http://www.cdc.gov/nchs/data/series/sr_03/sr03_033.pdf
(9) Safe Motherhood Quilt Project http://rememberthemothers.net/.
(10) Birth Options Alliance http://www.birthoptionsalliance.org/.
(11) Seasons of Life Women’s Health and Birth Center http://www.seasonsoflifebirthcenter.org/.

Unitarian Universalist Sermon on Birth Part 6: Closing Words

From Birth, a play by Karen Brody

My pregnancy and birth mantra was, My Body Rocks! Maybe it wasn’t realistic to so profoundly believe “My body rocks,” but I grew up with strong female role models. Being a woman means… being strong. So when I went into labor, whenever my uterus felt like two cymbals had just smashed up against its sides during a contraction and I couldn’t see the finish line, I’d think: “My body rocks… my body rocks!”

Unitarian Universalist Sermon on Birth Part 4: The Seven Principles of Unitarian Universalism

Unitarian Universalists do not require conformance to a creed, i.e., there is not one set of beliefs about God and spirituality that we recite each Sunday as something we all believe. Instead, each person is encouraged in a life-long search for spiritual truth. However, there are Seven Principles that we affirm and promote (Source: Unitarian Universalist Association, http://www.uua.org/visitors/6798.shtml). I refer to these principles in my sermon. -Amy Polk

* First Principle: The inherent worth and dignity of every person
* Second Principle: Justice, equity and compassion in human relations
* Third Principle: Acceptance of one another and encouragement to spiritual growth in our congregations
* Fourth Principle: A free and responsible search for truth and meaning
* Fifth Principle: The right of conscience and the use of the democratic process within our congregations and in society at large
* Sixth Principle: The goal of world community with peace, liberty, and justice for all
* Seventh Principle: Respect for the interdependent web of all existence of which we are a part

Unitarian Universalist Sermon on Birth Part 3: The Story of a Birth

Amy's husband John Robinette gives his perspective on the birth of their second child.

On our way through Silver Spring, up Georgia Avenue and to the beltway, I timed the contractions. They were coming quickly, lasting over a minute, and were intense. This was not, repeat, not a drill. We arrived at the Maternity Center.

It was 10:30 p.m.

The Maternity Center was a midwives practice, in Bethesda, for low-risk pregnancies. The mom gives birth in a regular bed; in a regular bed room. Parents typically spend the night together with the new baby. Not only do Dad's and partners get to spend the entire time with the mom, they are active participants in the various birthing methods taught and supported through the center.

Anne Seifert, our midwife, greeted us and showed us to our room. Amy was having steady, very strong contractions. She didn't want to be touched or moved during a contraction which was now most of the time. Amy was in a good deal of pain. It took a couple minutes to get Amy to the bed. Once in bed, Anne checked Amy's vitals and listened to the baby's heart beat with an external monitor. All were normal.

"You're eight centimeters dilated, Amy,” Anne announced, “this baby is coming soon."

She turned to me.

"I paged the on-call assistant but she won't get here in time. You,” she declared with her figure pointing at my chest, “are going to be my assistant."

I don't remember being nervous. But I also don't remember not being nervous.

"Um, should I wash my hands?"

"It's your germs, your baby and your choice," replied Anne.

Lacking any better ideas, I went to the bathroom to wash my hands.

As I finished, Amy let out a rather forceful groan. Her water broke.

It was 10:45 p.m.

There was meconium in the amniotic fluid. Not much but enough that Anne announced we'd have to suction out the baby's lungs for any fluids. Meconium is a combination of the baby's stool and the amniotic fluid. The first stool usually passes after birth, but sometimes before. But what this means for me, Anne explained, is as the assistant I get to work the suction pump. We'll suction the lungs after the head emerges, but before he is completely birthed, before he takes his first breath. She'd feed the tube down his little nose and tell me when to apply suction. She told me all this as she demonstrated the process. Simple enough.

Events unfolded rapidly. With each contraction Amy would push and plant her right foot on my left thigh. Anne, now playing catcher and coaxing us along, kneeled with her right knee up so Amy could plant her other leg on Anne’s thigh. Playing umpire I was able to position myself above and behind Anne, reach over, and let Amy grab my hands. The real pushing started.

With each contraction Amy would bear down; we'd plant ourselves and Anne would guide us. Between contractions, as Amy would try catching her breath, Anne monitored the baby's heart rate with the portable ultrasound heart monitor. Anne would hold the probe end while I'd turn it on and off. Then another contraction; then we'd do it again.

I don't remember how many times Amy pushed. Four, maybe five times? With each successive push a little more of the baby's head would appear. And between each push we’d monitor the baby’s heart rate. The baby's heart rate had dropped from 150 beats per minute down to the 70-80. As stressful as all this is on us, the stress on the baby passing through the birth canal is tremendous. This is critical time.

A baby gets all nutrients, and oxygen, from the placenta through the umbilical cord. During a contraction, oxygen from the mother to the placenta is temporarily cut off. The baby is essentially holding its breath. The baby is designed for this and between contractions the oxygen flow is restored. With long contractions the first indication that the baby is not getting enough oxygen is a drop in heart rate.

"Amy you are doing great and you need to push that baby out now," Anne firmly but calmly directed. I don't know if the heart rate was getting too low at 70 beats per minute, but clearly no one was interested in prolonging this.

The next contraction came. We were in position. Amy bore down hard and groaned loudly with the push. This was going to have to be it. Bryan's head, coaxed by Anne, slipped through. Now we had to pause quickly to suction the lungs before the next contraction. Had this been my first child, I imagine I'd have been quite distressed. When the baby's head comes out, he isn't breathing yet and the skin color isn't pink. It's gray. It doesn't look so good. But the placenta is still running the show, so no need to panic, but events are moving quickly. I turned on the pump and Anne fed the thin hose through each nostril and instructed me when to apply suction. It all went as Anne described. Then with one final push, Bryan Joseph Robinette was born.

As miraculous and awesome as Adam's birth was, our first child, in some ways Bryan's was more so. I had already seen how Adam had grown in the three years prior and the total joy he brought to our lives. Having this precognition for Bryan's birth elevated the experience to a profound level. In the moment I was overcome. Amy and I held each other, now with a new little creature on her belly, and wept. What an incredible experience.

The time was 11:12 p.m.

-John Robinette

Unitarian Universalist Sermon on Birth Part 2: Meditation in Words

From Spiritual Midwifery by Ina May Gaskin

Every birth is holy. I think that a midwife must be religious because the energy she’s dealing with is holy. She needs to know that other people’s energy is sacred.

Spiritual midwifery recognizes that each and every birth is the birth of the Christ child...

By religious, I mean that compassion must be a way of life for her. Her religion has to come forth in her practice, in the way she makes her day-to-day, her moment-to-moment decisions. It cannot be just theory. Truly caring for other people cannot be a part-time job.

During a birthing, there may be fantastic physical changes that you can’t call anything but miraculous. This daily acquaintance with miracles – not in the sense that it would be devalued by its commonness, but that its sacredness be recognized – has to be a part of the tools of the midwife’s trade. Great changes can be brought about with the passing of a few words between people or by a midwife’s touching a woman or the baby in such a way that great physical changes can happen.

For this touch to carry power that it must, the midwife must keep herself in a state of grace. She has to take spiritual vows just the same as a yogi or a monk or a nun takes inner vows that deal with how they carry out every aspect of their life. A person who lives by a code that is congruent with life in compassion and truth actually keys in and agrees with the millions-of-years-old biological process of childbirth.

Unitarian Universalist Sermon on Birth Part 1: Opening Words

Our Mother’s Body Is the Earth by Mary McAnally
From the anthology The Book of Birth Poetry edited by Charlotte Otten

Our mother’s body is the earth,
her aura is the air, her spirit
is in the middle, round like an egg,
and she contains all good things in herself,
like a honeycomb.
She squats and the rivers flow;
her breasts are the hills,
her nipples the trees.
Her breath scatters leaves
on the shifting sands of her belly,
and her knees roll out caverns and canyons below.
Her menses make the ocean floor shift,
and tidal waves proclaim her pain.
When we, her children, return to her,
in ash or in dust,
her flesh is scarred with accepting us back,
and her intestines growl at our death.
Mountains erupt with her agony
and pour us back into the sea
to hiss and spume her convulsions.

Note: The final word of the poem is actually "orgasm", but I couldn't bring myself to say the word "orgasm" in a church service, even a Unitarian Universalist one. -Amy Polk

APHA Annual Meeting Recap

Seasons of Life Women's Health and Birth Center board member Kandra Strauss Riggs attended the American Public Health Association (APHA) Annual Meeting November 7-11 in Philadelphia and offers her observations.

The American Public Health Association annual meeting is always an uplifting experience for me. Rooms are packed with public health advocates, nurses, students, doctors, educators – all of us with a passion to improve the health and well being of others. At APHA, I feel that I am surrounded by, “my people.” I proudly wore my “Listen to Women” blue button distributed by the American College of Nurse Midwives and had an opportunity to tell many public health advocates about our plans for Seasons of Life – everyone I met was very impressed. Some highlights that can inform our work in establishing Seasons of Life include:

* Meeting Dr. Miriam Labbok who leads the Carolina Breastfeeding Institute at the University of North Carolina – the nation’s only academic institute dedicated to the promotion and research of breastfeeding. They are hosting a conference entitled Breastfeeding and Feminism in March, 2010.

* Learning about a pre-conceptional health promotion program that is helping to improve the infant mortality rates in central Pennsylvania and could be replicated in a more urban setting.

* Hearing about the Text4Baby initiative which is launching in 2010. It is a free texting service that sends pregnant women and new mothers a weekly text health message.

* Amazingly, Georgetown University has a maternal and child health library: http://www.mchlibrary.info/ where we can find all kinds of data to support our work.

I was very proud and happy to distribute information about Seasons of Life at this year’s APHA meeting. Many thanks for the opportunity.

- Kandra Strauss-Riggs, MPH

Perinatal Symposium Recap

On Wednesday, October 7, I attended the Perinatal Symposium (http://www.birthsymposium.com/) at George Mason University in Fairfax, VA. The event is the brainchild of GMU graduate student Jessica Clements and offered an incredible opportunity to engage with nationally known speakers… all for free.

I was privileged to be on a panel with Karen Brody, author of Birth in a discussion moderated by Sheryl Rivett, founder of the birth consumer advocacy group Birth Matters Virginia, which represented consumers in the successful effort to license certified professional midwives (CPMs) in that state. I talked about my journey from a clueless consumer to birth activist, with both my feminist upbringing and my deep fear of needles being contributing factors. I was also fortunate enough to have my mother attend the session, so I could thank her publicly for making sure that I had the most current copy of Our Bodies, Ourselves on my bookshelf when I first got pregnant in 2001. When I read in the Our Bodies, Ourselves Pregnancy and Birth chapter about the cascade of interventions with conventional birth settings and providers, I realized I wanted nothing to do with any of these interventions, if at all possible. That’s what got my husband and me looking at alternatives such as a birth center, the first step on my long journey of birth activism that continues today. My presentation is on the symposium website at http://www.birthsymposium.com/assets/polk.pdf.

During the Q&A session following Karen’s and my presentations, someone in the audience lamented that all too often expectant parents, both men and women, who seek alternative birth settings and providers are shunned as pariahs in their own communities. They cannot go to family, neighbors, co-workers or friends for support of their birth choices. That’s when I mentioned how proud I was of the great work that Birth Options Alliance (http://www.birthoptionsalliance.org/) is doing through its active Yahoo e-mail discussion group and monthly meetings in Takoma Park. When people find their way to BOA, its more than 600 members provide the informative answers, advice when asked, and loving support that expectant parents crave.

Following Karen’s and my session, there was an audience-lead reading of the one-act version of Birth (http://www.boldaction.org/theplay/play.html). I had seen the two-act version of the play in 2006 and knew that it was an extremely powerful work. Following the performance, I chatted with Karen Brody and local director Angela Lauriam about the possibility of staging the two-act version of the play as a fundraiser for the birth center in 2010.

Following the audience-lead reading, there was one great keynote and panel discussion after another. Shel Lyons, president of the Mother’s Rights Network, discussed how birth rights can be seen as a subset of women’s rights and consequently human rights, as enumerated in the United Nations’ Declaration on Human Rights. Anthropologist Robbie Davis-Floyd gave a fascinating keynote presentation on successful midwifery practices that she had observed around the world. Shafia Monroe, founder of the International Center for Traditional Childbearing, talked about the importance of diversity in midwifery providers. J.D. candidate Lisa Pratt gave a history lesson in vaginal birth after caesarian (VBAC) and how a high rate of primary c-sections and restrictive VBAC policies in many hospitals is causing some women to choose “birth on the black market”.

Henci Goer, author of one of the first birth-related books I read during my first pregnancy – The Thinking Women’s Guide to a Better Birth published in 1999 – gave an update on how far we have come since then. When I first read The Thinking Woman’s Guide, I remember that it made me depressed and then angry that so many birth practices not only are non-beneficial and some ever harmful when used routinely, but continue to be widespread despite medical evidence to the contrary. Sadly, Henci Goer’s keynote presentation at the symposium revealed that, not only has progress not been made on many fronts – such as episiotomies (still used in 33% of births as of 2006) – but that things have actually gotten worse on others – such as the ever-rising caesarian sections (used in 31% of births as of 2006).

The daytime portion of the symposium concluded with a roundtable discussion that further explored the ideas raised by Shel Lyons earlier that day: Are women’s rights in birth human rights? And, if so, what can we do to address the threats to these rights? The discussion ended with names being taken and a new effort being formed to work on this important issue.

But the symposium wasn’t all talk, talk, talk. There were showings of the films Laboring under an Illusion and Orgasmic Birth, an exhibition of paintings of birth scenes by symposium organizer Jessica Clements, as well as a performance by my own belly dance troupe Triple Goddess Tribal (http://www.triplegoddesstribal.com/). In our performance, members of Triple Goddess Tribal showed the celestial, silly and sacred sides of birth. In our finale piece, my teacher Maya Taahira and I played the role of midwives as a birthing mother (played by DC area midwife Karen Klauss in her belly dancing debut) undulated through contractions to the tune of “Bascha” by the band Domba from the album Evocation. Earlier, I had given the audience a quick lesson on how to undulate their bellies and encouraged them to stand up and undulate to commiserate with the birthing mother and foil the Evil Eye. The sight of everyone in the theater moving their bellies during our performance moved my teacher Maya to tears. It was a great ending to a great day for me, and hopefully an event that will move birth forward in the DC area.

-Amy Polk

AABC Annual Meeting Recap

I just returned from the American Association of Birth Centers (AABC) Annual Meeting in Savannah, Georgia. It was quite an investment but well worth every penny, as I came home with ideas, connections and inspirations for how to make the birth center a reality. Some highlights:

• I attended the Commission for the Accreditation of Birth Centers’ (CABC) “Preparation for Accreditation” workshop , learning how to apply for CABC’s provisional accreditation so that the Seasons of Life Women’s Health and Birth Center can be accredited from Day 1 of its operation.



• During the opening ceremonies, each of the 150 or so attendees introduced themselves. When I stood up and said I was not a midwife, but “just a mom” who will open a birth center in Takoma Park, MD in 2014, the whole room applauded. I was inspired by these supporters of birth centers who were cheering me on. I was also reminded by many that a mother is never “just a mom”, no matter what her passion or profession.



• I got a great suggestion on how to obtain recent safety data on birth centers, in absence of an updated National Birth Center Study. (The most recent national study was conducted 20 years ago!) Ann Sober of Special Beginnings in Arnold, Maryland said that I could obtain data on infant mortality, maternal mortality and birth location from the Maryland Vital Records Office and crunch the numbers myself. It took a journey of 600 miles to get this great suggestion from Ann, who is only 30 miles away near Annapolis. Go figure.



• I talked with a representative from the Centering Healthcare Institute and learned that the company is developing a Centering Menopause program. This could be the way to “do for menopause what we did for birth” by offering humanistic care of this natural life transition, supplemented by medical intervention when warranted.



• I talked with Farah Diaz-Tello from the National Advocates for Pregnant Women (NAPW) about an issue that is near and dear to my heart: birth options as a women’s rights issue. The NAPW has achieved the seemingly impossible: getting conservative pro-life activists to join forces with pro-choice feminists to advocate for birth options.



• I talked with Susan Hodges, president of Citizens for Midwifery, the only other “just a mom” in this sea of midwives and other birth professionals. Susan gave me a lot of useful advice about how to identify and join forces with other birth consumer advocacy groups, such as regional Birth Networks.



• I toured the Family Health and Birth Center in Savannah, Georgia’s only birth center. Business is booming there, with people driving from up to two hours away just to give birth at the center. There were even two clients in labor while we were taking our tour.



• I watched two great DVDs on the train ride home: Laboring under an Illusion and Orgasmic Birth, making interesting viewing for the people in the seats behind me who could see my laptop. This lead to some interesting discussions with people from very different walks of life.



• The personal highlight of the trip may have been when I ordered a beer at a Savannah restaurant and was asked for my ID! The thought that I could be mistaken for a 20-year-old trying to scam a beer made this 41-year-old “just a mom” very happy.

-Amy Polk

Our Next Steps

Washington Adventist Hospital is in the process of determining what medical uses will remain on the Takoma Park campus, such as emergency care. After these decisions are made, it can be determined how much space, and what kind of space, will be available to non-profit organizations.

In the meantime, our next steps are to:

• Incorporate as a non-profit in Maryland and file for 501(c)3 status
• Refine our business plan
• Continue discussions with hospital administration and medical staff

We are scheduled to complete non-profit incorporation, 501(c)3 filing and our business plan by the end of 2009.

Our History

2007 was a sad year for birth options in the Washington, D.C. area. In April, Takoma Midwives, a hospital-based midwife practice with a devoted following in Takoma Park, Maryland, closed. And only one month later in May, the Maternity Center, a freestanding birth center with a 30-year history in Bethesda, Maryland, closed as well.

At the same time, Washington Adventist Hospital, which has been at its Takoma Park location for over 100 years, announced that it was relocating out of Takoma Park in 2013. The hospital's relocation created the question of what would go in its place on the vacated campus. We put these two crises together and created an opportunity: include a birth center on the Takoma Park campus!

We see Takoma Park, with its reputation as a place willing to try health alternatives, as the perfect location for such a center. We also see Washington Adventist Hospital, with its long history of respecting connections between mind, body, spirit and health, as a natural fit as a partner and backup hospital.

Initial discussions with Washington Adventist Hospital were very positive and they continue to move forward.

In 2008, funded by Birth Options Alliance, a consumer group in the Washington, D.C. area that advocates for the expansion of birth choices, we joined the American Association of Birth Centers (AABC) and took its acclaimed "How to Start a Birth Center" workshop. We toured birth centers around the country, talked with their staff, and reviewed their materials. We became very smart very quickly about what it will take to open a center here in Takoma Park.

Our Vision

The Seasons of Life Women's Health and Birth Center will provide care to women in all seasons of life, from the onset of menstruation, through the childbearing years (including pre- and post-natal care, birth, birth control, and fertility), to menopause and beyond (including gynecological care for post-menopausal women).

The center will be a non-profit organization. All profits from the center will be reinvested in patient care, community education, and other public service activities.

More about Birth Centers

What is a birth center?
A birth center is a home-like setting where women receive care and give birth assisted by midwives.

Who provides care at birth centers?
Midwives provide pre-natal, post-natal and well-woman care at birth centers and attend births. Midwives follow the Midwives Model of Care, which provides the woman with "individualized education, counseling, and prenatal care" and has been proven to reduce "the incidence of birth injury, trauma, and cesarean section" (Source: Citizens for Midwifery).

Where do birth center midwives attend births?
Birth center midwives attend births at home, in their centers and in hospitals.

How is giving birth in a birth center different from giving birth in a hospital?

• Labor is typically allowed to unfold at its own pace.
• Pain relief typically emphasizes immersion in water, changing positions, and the mother's own internal psychological resources, instead of drugs (although some pain relief drugs are available).
• Mothers are typically encouraged to eat and drink during labor to keep up their strength. Most birth centers have kitchens on-site where the mother's family can prepare this food.
• Mothers are encouraged to walk around and try different positions (standing, sitting, leaning, squatting, etc.) to ease pain and facilitate birth.
• Midwives and birth assistants attend births in long shifts, striving to provide the mother with continuous support from the same people throughout her entire labor.
• Birth centers typically put the mother in greater control of her environment, allowing the mother to choose her own clothes, light level, music, aromatherapy, etc.
• The mother is typically allowed to have whomever she wants to support her in labor, without a restriction on the number of people or relationship to the mother. Husbands, partners, friends, relatives, children, doulas... all are welcome if invited by the mother.
• Mothers, their partners and their newborns typically all stay together, without the baby being separated from parents in a nursery. Mothers are encouraged to breastfeed immediately after birth and are given help getting started.
• Stays in birth centers are typically short, with most families going home the next day.

Who uses birth centers for childbirth?
Birth centers are able to serve the vast majority of pregnant women who are classified as low risk; 83% of women are low risk at the end of pregnancy, according to data from the Centers for Disease Control and Prevention's National Center for Health Statistics (Source: Childbirth Connection).

How do I know if I'm low risk?
Birth centers have clinical practice guidelines that specify under what conditions the center can accept a woman as a patient and under what conditions the woman should be transfered to the care of an obstetrician. Midwives use their guidelines, combined with years of experience and judgment, to identify, to the greatest extent possible, the need to transfer before it becomes an emergency. The backup hospital for the Seasons of Life Women's Health and Birth Center will be Washington Adventist Hospital's new location in Silver Spring, Maryland, which is 8 miles away from the birth center's location in Takoma Park. This meets the common standard for emergency cesarean sections: "30 minutes from decision to incision".

Are birth centers safe?
Yes. The seminal study on outcomes in birth centers appears in a 1989 New England Journal of Medicine article. The article concludes: "Birth centers offer a safe and acceptable alternative to hospital confinement for selected pregnant women, particularly those who have previously had children, and that such care leads to relatively few cesarean sections." A new study with more recent data is expected later in 2009.

Are birth centers just for pregnant women?
No. Women of all ages can receive individualized care from skilled midwives at birth centers. Seasons of Life Women's Health and Birth Center will provide care to women throughout the life span, from the onset of menstruation, through the childbearing years (including pre- and post-natal care, birth, birth control, and fertility), to menopause and beyond.

Do birth centers take insurance?
Yes. Most birth centers take insurance. In a national survey of birth centers conducted by the American Association of Birth Centers, major insurance companies that cover birth centers included Aetna/US Healthcare, Blue Cross/Blue Shield, CHAMPUS and Humana. Seasons of Life Women's Health and Birth Center will strive to negotiate contracts with numerous insurers, including Medicare and Medicaid, so that as many women as possible can use the center.

How common are birth centers?
There are about 200 birth centers in the U.S. There are two birth centers in Maryland, both in the Annapolis area: Special Beginnings and Bay Area Midwifery. There are two other birth centers in the Washington, D.C. area: BirthCare in Alexandria, Virginia and the Family Health and Birth Center in Washington, D.C.

Do birth centers have to be licensed?
Licensing requirements vary from state to state. Birth centers in Maryland are required to be licensed. Maryland's requirements are set by the Department of Health and Mental Hygiene's Office of Health Care Quality. Seasons of Life Women's Health and Birth Center will be licensed.

Do birth centers have to be accredited?
About 25% of birth centers earn accreditation through the Commission for the Accreditation of Birth Centers (CABC). The Commission offers a one-year provisional accreditation for new birth centers, so that they can be accredited from Day 1 of operations. Seasons of Life Women's Health and Birth Center will seek this accreditation for new centers. Some of us recently took the Commission's "Preparation for Accreditation" workshop to begin this process.

Do birth centers offer water births?
Yes. Many birth centers offer water births, in which the mother gives birth in a tub specially made for this purpose. Her partner can also be in the tub, supporting her in labor. Some birth centers charge a modest fee (about $150) for water births, due to the non-reusable equipment involved. Seasons of Life Women's Health and Birth Center will seek to offer this highly popular birth option.

Do birth centers offer VBACs - vaginal births after cesarean section?
Yes, to an extent. Birth center midwives use their clinical practice guidelines to determine if a woman is a good candidate for a VBAC. If this is the case, then the woman can proceed with a VBAC either in the hospital assisted by midwives or in the birth center, under certain circumstances. Seasons of Life will seek to offer VBACs, both at the center and at the hospital, in compliance with CABC standards. VBAC is a subject of much debate at this time, and CABC standards regarding VBAC are currently under review.

Are birth centers usually public non-profits or privately owned businesses?
Most birth centers are privately owned businesses, but about 25% are non-profit organizations run by either community boards or public agencies. Seasons of Life Women's Health and Birth Center will be a non-profit organization. All profits from the center will be reinvested in patient care, community education, and other public service activities.

Who else is opening birth centers?
According to the American Association of Birth Centers, there are over 20 centers that plan to open their doors in the next few years, including one in Baltimore.

I'm pregnant now and can't wait until 2013. Or I have other health needs and want to be seen by a midwife right away? What are my options?
The local consumer advocacy group Birth Options Alliance maintains an online directory of Washington, D.C. area options to see a midwife. If you are currently pregnant, keep Seasons of Life Women's Health and Birth Center in mind for your post-baby health needs, such as birth control and menopause. Join our Yahoo group to stay informed of developments.

Welcome

Welcome to the Seasons of Life Women's Health and Birth Center blog. Through this blog, as well as our website (http://www.seasonsoflifebirthcenter.org/) and Facebook group (coming soon), supporters of the birth center can keep up to date on developments.