Luna Maya

Three last things to say

2009-12-26T16:20:00.000-08:00

As the year draws to a close and we focus on drawing the light back I want to say more about what I know right now:

Your birth is yours. Make sure you know that and understand the dark and light side of that. The light side of that is that you are responsible for it, that it is YOUR BIRTH. If your husband wants a cesarean and you want a homebirth, then he can go and have his cesarean. The light side is that you MUST choose wisely and on your own that where you birth is where you will birth the best and that is nonnegotiable. The dark side of that is that your birth is your responsibility. Whatever happens in your birth is your creation. You called it, you created it, you are responsible for it. That includes unexpected outcomes and death as well.

Women need Women. It is absurd to expect men, who have never been with us through the blood mysteries, move into them in the 1970's and know how to behave. It is absurd to retreat in the postpartum into a home occupied only by your husband, a man whose father barely survived by smoking cigarettes outside the labor room when his mother was knocked out for his birth, or maybe learned some Lamaze style labor coaching. It is absurd to expect this man, with all of his well intended heart to help you negotiate your shadow through breastfeeding, meeting yourself as a mother and understanding that you- YES YOU, your body, made and pushed this little baby out. It is absurd that the first and only time that women are at birth is their own birth (as a baby and as a mother) and that we expect women to be able to birth learning through classes and books. It is absurd that women are expected to peel their babies off their dripping breasts at 6 weeks, 6 months or any time, and drop them off in an institution overcrowded with other babies, bacteria and strange young "infant development experts". It is absurd that women are expected to concentrate at work knowing that their baby in day care may be screaming and in nobody's arms. It is absurd that women complain ALL THE TIME about how they don't have time for themselves, for their relationships, for their children, for anything, as they excel as mothers, leaders, goddesses, dominatrix's and more. It is absurd that women break down in Childbirth Education Class saying, "I've never told anyone this but....". Where are the other women??? They are all alone, as well, at home! Can someone please put women together??? PLEASE!

The government needs to get out of our bodies. This means that they need to stop telling us whether or not to do things (birth, mammograms, abortions), how, where, at what age, and under what conditions. It means that they need to listen to us and ask us what we want. It means they need to take us seriously. It means they need to stop assuming that because they think they can control our uterus', they know what's best for it. It means that they need to acknowledge our diversity as women and support the health of that. That means everything- abortions, homebirths, mammograms, maternity leave, equipped neonatal intensive care units... Whatever it takes to keep our mother's healthy and our communities healthy, because our new members are coming in THROUGH our mothers, and our mothers are welcoming them (or not). And how a mother and a community welcomes a new baby has everything to do with how things will go for that child later.

And may 2010 listen to me carefully, me and all other women!!

A message for this Winter Solstice

2009-12-19T15:59:00.000-08:00

This is the time of darkness, the longest night. This is the darkest place in the year, in your life. This is that transition in labor, where you are somewhere between 7 and 8 centimeters and you are not seeing "the light at the end of the tunnel" yet. You aren't feeling like pushing and you don't feel like you've gotten anywhere in the last few hours. Its quiet, its dark, you are alone. It may feel like it will be this way forever, but it won't. You must call the light in.

You must call the sun back.

We must call the sun back.

As we prepare for the darkest night it is an opportunity for us to retreat within and think about the year. Where do we stand in our greatest darkness? How do we feel right now, right here?

I've had, as usual, an intense year. They always are. I've had moments of the brightest, most brilliant light. And that has been accompanied by the darkest, most bleak dark. This year I witnessed three little ones decide that their brief time with us was enough. This year I witnessed the closest I've ever felt to many beloved people. This year I witnessed several family's throw their anger and fury at me. This year I witnessed my increased ability to understand what I am responsible for and be honest about that. This year I was disillusioned by some people close to me who didn't meet my expectations. This year I was guided to look within myself and release my high expectations of myself.

This has been a year of dark and light.

And as I retreat to the cave of my winter wonderland, I am called to ask myself three questions which apply daily and they apply to any withdrawal or retreat. These are sublime questions that any couple pondering labor should ask themselves, that any woman contemplating motherhood should ask herself. And in the meantime, if you aren't a mother, or if you have been one for a while, this also applies:

1. What image have you, or others created about yourself that keeps you in fear to break?
2. Can you disappoint another to be true to yourself?
3. How responsible do you feel for your own creation?

Thank you for walking with me this year and as the light returns to our world, I hope you are still in it.

Why Homebirth reduces Carbon Footprint

2009-12-15T13:26:00.002-08:00

As the leaders convene in Copenhagen to dice out our future, a homebirth midwife in southern Mexico convenes under the rain- (it never rains in December) to ponder the carbon footprint of her life. Recently someone close to me decided to birth in the hospital and digesting that along with watching the daily updates on the Climate Summit in Copenhagen, I decided to ponder why homebirth is more environmentally sound.

To begin with you go to the hospital IN A CAR. Now, that for starters is a massive carbon footprint. What if you get stuck in traffic? The Carbon footprint of just driving to the hospital is immense.

Next you check in to the hospital, they look for your chart, take you, probably in a wheel chair to a room made of plastics. Plastics? Yup, all kinds that are washed down with very toxic antibiotic chemicals. Then you take off your clothes and put on a robe. A robe made in a factory. More carbon. Then someone will come in and check all your vital signs using more tools and toys made in a factory. Then someone will come and check your dilation. Using a plastic, disposable glove that will go to a landfill and sit there for about 100 years before it disintegrates, maybe. And the plastic glove was made with rubber in a factory in Indonesia and imported, using a boat or a plane to somewhere else where it was distributed by a truck to somewhere else before it finally made it to the hospital. If you are at a teaching hospital 2 or 3 more people will also check your dilation. More rubber gloves in the trash.

Then they will probably set you up with an IV. This means using a rubber (again, from Indonesia) tourniquet, rubber tubing, using rubber gloves, rubber, rubber, rubber. The needles are made of stainless steel that was extracted from the earth somewhere where people are probably lacking food and drinkable water. They will probably set you up to the fetal monitor which is a machine created in China with all kinds of copper and stainless steel tubing and parts, imported from the US and Europe, reassembled into a doppler type machine that is strapped to your body. That strap was probably made in the Phillippeans and taken to China to attach itself to the fetal monitor which was then imported to the US, again like the gloves. More Carbon.

If you are wise at this point you will call your Doula, who will get in her car and drive across the city to meet you at the hospital. Again, she may also get stuck in traffic. In her Birth Bag she will probably carry homeopathic medications made in California (you are in New York), herbs harvested in Colorado, tinctured in New Jersey and purchased in Virginia. She probably carries Ayurvedic Massage Oil imported all the way from India.

The the ritual continues- dilation checks with more rubber gloves every two hours, opinions, consultations, more gloves, more machines, more technology imported from China. By the way, if it is December the entire hospital will need to be heated. Oil from....??? Venezuela (right)

Eventually someone will suggest a series of medications: Epidural made from coca from Bolivia, Pitocin extracted from cows in New Zealand, Prostaglandin gel made from some bizarre sea urchin in the North Sea and antibiotics extracted from the Amazon Rain Forest (hey, you are in a Hospital, who knows what infections you might get!).

If you are lucky enough to push your baby out vaginally, then a Pediatrician will drive (more driving, more traffic) to the hospital to check your baby out. If you end up in a Cesarean like most women (don't kid yourself, despite your birth plan, you aren't that special to the HMO), that involves ridiculous amounts of rubber, stainless steel, vicryl (a plastic used to sew your guts back together), all sterilized with bleach which is then dumped into the sewage which goes into the water systems and bleaches bacteria from our soils.

After all at that your in laws and parents will drive (yet again) to the hospital and eventually you too will drive home. Only to drive to the hospital in a weeks time for your stitches to be removed, baby to be weighed and all those other postpartum rituals.

So think about it, you may eat locally grown produce and bike to your Yoga Class, but your hospital birth may be worth considering. Consider homebirth, for more reasons than you ever thought!

The Community of Motherhood

2009-12-12T15:14:00.000-08:00

This month what has most struck me is that women are talking about community. They are happy with their care, the one hour prenatals where we pick an issue and talk about it indepth; they like the library where they can browse or borrow a book; they like how their muscles feel after yoga class, but most of all, they LOVE their community.

Through the different spaces offered at Luna Maya- yoga, childbirth education, mother's group, workshops such as infant reflexology and just our physical space, women are talking, talking and talking. And through all that talking comes bonding. And it turns out that pregnant women, even though one may be indigenous and struggling to understand our imposed rituals, another may be mestiza and struggling to understand why a scheduled cesarean might not be the safest choice, and another may be a women's rights advocate who never really considered what might happen when a woman "chooses" motherhood- have a lot in common. Almost everything really.

What I most love to watch is how racial, economic, social and tribal lines that have divided us over centuries start to dissolve as the belly's stretch forward. It turns out that we are all secretly, or vocally, pretty scared of labor pain. It turns out that during pregnancy we all have a day where we feel that no one understands us, not even ourselves. And it turns out that when we sit in circle with other women in that same place, we don't feel as lonely anymore. And we aren't expected to fix it all by ourselves either.

Denying community to pregnancy is denying a basic physiological reality. Until recently babies were always born to a community. There was a tribe waiting on the other side of the woman's skin to welcome the baby in, teach important rituals, pass on tradition and name and honor the child. Nowadays we sometimes are lucky enough to be able to "hire" a doula- a surrogate sister who will walk us through the steps of the postpartum shadow until we know it won't go away and we know it is part of us. Nowadays women are tired and alone and drop their babies off at the day care "community" as quickly as possible. This is absurd. And its not community.

So, I've been thrilled to hear the women lingering, chatting, walking out together to get a coffee, or making plans to walk together. This is community. A community who cares that your baby was born and will hold you through it. Just as we can't expect women to birth alone, we can't expect women to mother alone.

It turns out that ACOG supports VBAC

2009-12-05T16:47:00.000-08:00

http://www.childbirth.org/section/VBAC1.html

Well, Who knew??? Who would've ever thunk it?? I'm stunned!!!

THE AMERICAN COLLEGE OF OBSTETRICIANS AND GYNECOLOGISTS SUPPORTS VAGINAL BIRTH AFTER A CESAREAN!! Not just ONE!!! TWO OR MORE!!!

Get out!!

I can't believe it!!

But they do. Read this:

"In the absence of contraindications, a woman with one previous cesarean delivery with a lower transverse uterine incision is a candidate for VBAC and should be counseled and encouraged to undergo a trial of labor (A: II-2).
A woman who has had two or more previous cesarean deliveries with lower transverse uterine incisions, who has no contraindications, and who wishes to attempt vaginal birth should not be discouraged from doing so (B: II-2)."

I didn't write that, ACOG did.

Now, go out and tell your obstetrician that the American College- HIS (or HER) American College has stated that women with one or two or more previous cesareans who wishes to attempt vaginal birth should be supported, encouraged, accompanied, loved, protected, through it.

And guess who is really good at supporting, encouraging, accompanying, loving, protecting women through spontaneous vaginal births.......

MIDWIVES!!!!

Why I love Conferences

2009-11-28T09:14:00.000-08:00

I have a very strange job. I honestly believe that women who are totally out of control and submerged in an incredibly painful experience are the funnest people to hang out with. I admit, I am addicted to crowning and I love watching women's faces when the placenta comes out. I am happy to leave my warm bed with a gorgeous man in it at 3.00am to go hold a woman who is throwing up.

I spend countless hours discussing pain, body fluids, bone mechanics and change. I spend a lot of my free time reading more books about how to approach these. I love listening to women making decisions and watching men's eyes get bigger than the room as their watch their women stretch and stretch and stretch.

My hours are really strange, I spend most weekends at a birth and I rarely take vacation. I am an average homebirth midwife. And once or twice a year I am lucky enough to join 3 or 4 hundred other women that honestly believe it is normal to live like this. Not just normal, thrilling amazing and orgasmic. We love our lives.

I remember when this clicked in my mind, I was standing in a hall with about 500 other midwives singing our hearts out, having spent all night talking about births, and positions and juicy, fluid filled moments. We were dancing through a red tube that was supposed to represent a very large yoni. It is my sacred, special time where I'm not an expert, where I don't have to explain why homebirth is actually SAFER than other kinds of birth, where women don't look at me and say, "but I'm really scared of some fantasy I have created in my mind". It is a time where I am honored and my tradition is honored. Where I can look around and thing, wow, we all do the same thing. This is incredible. It is a time to know that I'm not the only nutter who is addicted to crowning, there are actually thousands of us across the world and we are watching a LOT of babies crown every day.

I love conferences because they are my pilgrimage. They are where I understand deeply that I am part of something huge that is changing the world, making it safer and more peaceful. One birth at a Time. All over the World.

Formula Fed America

2009-11-24T09:27:00.000-08:00

Babies experience of Birth

2009-11-20T09:33:00.000-08:00

I just finished reading Wendy Ann McCarty's book, "Welcoming Consciousness, Supporting Babies Wholeness from the Beginning of Life". I first heard her speak at a conference three years ago and she deeply moved my approach to birth and babies.

The book stands for the experience of the baby. Please note as you read this that I am clear about the fact that the baby emerges from the mother and that supporting a healthy mother is essential to babies well being.

At the end of the book she describes specific therapy cases where she has worked with babies who have had difficult gestation, birth and immediate postpartum experiences. She describes how she listens to the baby react and re-enact their experiences. As I read this I think about the fact that most births completely disregard the woman's experience, thus clearly there is absolutely no context for understanding the baby's experience.

The way I see it, your birth, which is recorded in your implicit memory is your introduction to your parents, your world and your country. We are now aware of the long term impact of this on babies mental and physical health. I used to teach a workshop where someone was asked to leave the room and told to come back in. Upon entry we would treat them the way babies are taught in traditional Mexican hospitals. As beings with no feelings, no capacity and on the brink of death. We would rub them, aspirate their mouths with a bulb syringe, move them from place to place measuring body parts, etc. It was a traumatic experience for all involved. We would then ask the person to describe how they wanted to be greeted upon entry and we would participate in enacting this for them.

We often ask parents in our practice, how do you think your baby wants to be received? This is a very useful question for moving beyond the fear of "Will the baby actually breathe f there is no doctor to stimulate that?".

I challenge you then to ask yourself, as a parent or as a midwife, if I were to be born, what would be really important to me, and what would not? What would make me feel welcome and safe? What would help me breathe and encourage me to want to stay in this place?

Deliver me from Pain

2009-11-17T18:34:00.000-08:00

This is a MUST READ for anyone interested in Birthwork and the history of obstetrics. The book is broken down into questions, which I thought was a brilliant way of indulging into the issue of anesthesia in obstetrics. The first chapter is called: The Question of Necessity. This chapter maps out how anesthesia became an issue within obstetrics to begin with. What is most fascinating about this story is that although women have always stated that first stage (dilation), particularly late first stage (8 to 10 cms) as being the most painful, because of the vocal and physical intensity of second stage (pushing) the medical community (new to birth!) got the impression that second stage was the moment of worst pain. So doctors started to anesthetize during pushing. Now thats going to make those forceps pretty handy!

What is fascinating about this chapter is how anesthesia became necessary and considered liberating, necessary or appropriate (depending on the historical times and jargon). From then on, pain became inappropriate in labor and unnecessary for birth; which brings us to where we are now- grand-daughters of women who were delivered under twilight sleep, daughters of women who "can't remember" how it was because they were over-dosed with scopolamine interlaced with their spinal and ourselves discussing with our obstetrician at what point in labor should we get our epidural.

What is interesting for me, as someone who listens and tries to answer women's questions, is: how do we talk about birth after not feeling it for 150 years? How do we tell women that natural birth at home, where we are free to FEEL ALL the pain and "become empowered" by it is better?? Please!!! I almost feel absurd.

What this book illuminated for me is that, after 150 years of first explaining to women to labor pain is SO unbearable that high doses of dangerous drugs, limp, breathless babies, detached families are not only necessary, but beneficial, and secondly eliminating therefore the collective memory of what labor pain feels like, but also our collective capacity to deal with labor pain. It is no wonder that grandmothers look at me and say- "I can't bear to see her in all this pain".

Funny thing is, I can. And so can she.

Homebirth Obstetriciians?

2009-11-17T09:00:00.000-08:00

An interesting discussion emerged from the AMAYAL Humanized Birth Conference carried out conference in October 2009 in Monterrey, Mexico. It is important to note that Monterrey Mexico holds one of the highest cesarean rates in the world. In this context, Nacer Renacer, as the perinatal education branch of Amayal works through prenatal education and support to inform and educate women on natural birth. They are working with a male obstetrician who attends homebirths and natural births at the hospital working alongside a Doula.

The issue I am pondering is the emergence of “humanized” obstetricians attending home and water births. In this situation, male (mostly) obstetricians work alongside female doulas to increase access to normal birth. Midwifery is declining across the country and many countries lack midwifery training systems and recognition, for example Mexico only has one officially recognized midwifery school. In the north of Mexico there are very few traditional or formally educated midwives. The positive aspect of this diad is obviously increased access to care. However as a midwife many questions emerge, such as where do midwifery skills go within this practice? What are the outcomes? How is fetal positioning addressed? Are natural remedies used? My sense, from conversation with “humanized” obstetricians and doulas is that practice, like with any midwife is particular to each obstetrician. Some are much more open to learning from midwives and others feel that as obstetricians they have the knowledge they need. The general sense (not confirmed by data) is that cesarean rates are much higher. Barbara Katz Rothman suggested to a Venzuelan obstetrician that he should leave the births to the midwives and focus on providing humanized obstetric services. However, how many practicing midwives are there in urban Venezuela? Not many.

Although on one had I do believe that this diad is necessary and I am strongly in favor of increased access to normal birth. However, this diad emerges in the absence of midwifery. Where are the midwives? Some of these doctors have explained to me that they attend over 15 births a month. Can this replace midwifery care? 15 births a month?? When are home visits done?! Again, this clearly demonstrates the need to have more midwives. My concern about this diad is that it may imply that midwives are not necessary, that its sufficient for an obstetrician to attend homebirth in order to protect the space of normal birth. As midwives we know that our skills extend further than protecting normal birth and our outcomes are so good because of our skills in counseling, nutrition, herbs and homeopathy, fetal positioning and many more.

From informal conversations with the obstetricians I often get the sense that they don't feel that midwifery has much to teach them. They sometimes (please do not get the sense that I am generalizing) give me the sense that they insist upon the hierarchy within which they were trained and that their skills are sufficient. They state proudly that one of the benefits of their care is that is they transport, care is continued. Where I can see the benefits of this, it also makes me wonder, well how often do you transport?

Another issue that I see in this diad is almost a mind/body split. Seeing it physically I imagine that midwives have clinical and decision making skills that work within our intuition, nurturing and continuity of care. Within the obstetrician/doula homebirth model, it seems as through the midwives right and left brains are split into two people: an obstetrician who can diagnose, run an IV and make a difficult decision and a Doula who provides continuity of loving care. I have observed my reaction to this and I'm not sure if my skills and intuition could be split. So many times in prenatal or postpartum care the attention given is based on a sage combination of these skills.

I am curious to have more conversations with women who are attended by the obstetrician/doula, curious to see their results and outcomes and curious to ask them many, many questions. I also curious about whether or not midwives see this as an opportunity to stand in our ground as the experts in normal birth, as that is what we are trained for, and to train more midwives.

International Birth and Midwifery Conference

2009-10-05T19:13:00.001-07:00

the BIG announcement!

International Midwifery and Humanized Birth Conference

June 11 to 13 2010

San Cristobal de Las Casas

soon to come, all the information on our webpage:

www.lunamaya.org/congress

See you there!!!

We are searching for workshop facilitators and key note speakers, if you want to or know of anyone who would like to participate, let us know!

Births that remind me why I love Birth

2009-09-25T15:49:00.000-07:00

Some births are exceptionally special. They are undisturbed, physiological and divine. These are the births where I show up and the woman and her husband are loving each other secretly... where the lights are off. Births where the woman moves as she needs to and no one needs to talk or even whisper. Birth where the sounds remind us of Whales, swimming together.

These are births where the mother opens herself, emotionally, physically, spiritually... all of herself, to receive her newborn. Where when she touches fear she looks deep into her lovers eyes and says, "I can't do it anymore". and he says, "yes, you are doing it". Enough said.

These births remind us that birth is trusted when the midwife has nothing to do. Births where you are almost embarrassed from the intrusion on the sexual ritual that the couple is undergoing.

Births where the baby is born and the mother sings to her newborn, who just stares at her in recognition. Births where the baby didn't have to brake the mother to get through her and where everybody cried except for the baby.

I hope every woman can find this birth. Within herself.

These are the births that remind me of why I love Birth.

Reaching for straws

2009-09-25T15:43:00.000-07:00

I heard this this week:

In an ultrasound exam a baby was detected to have femurs that are two weeks short. The physician therefore explained to the woman that they might as well schedule a cesarean because due to the short legs the baby wouldn't be able to push himself out of his mother's uterus when it came time for pushing- or stretching as this case might be.

Now thats really REALLY getting desperate.

The Post Partum War

2009-09-04T14:57:00.000-07:00

Its 2.30 am and she hasn't slept since about three days before her birth. Which was about 3 days ago.

The baby is screaming.

Her breasts are screaming.

She cannot tollerate another hour of the baby hanging from her nipple, sucking the life out of her. She can barely sit because the stiches have swollen. Her arms are sore. Her back aches.

All day long her family has sat around her, passing the baby around and thinking of creative new ways to shut the screaming up. They've given their expert opinion on her milk making capacity, they've commented on the babies weight less (apparent, they say) and question on whether she is really going to wait five days for the milk to come in??? is she sure???

2.30 am and she is alone. The family has dissappeared with their expert opinions and their wisdom and their oatmeals and fennel teas. Her mother appears at the door and looks at her, "Is there anything I can do dear?" "No Mom." "Why is the baby crying again?" "I don't know mom". "Here, give me the child...."

The post partum war has established itself deeply in the folds of the bedroom curtains. It hides in the bed sheets jumping out everytime someone rustles the covers. It hides behind the door jumping out at her everytime she, or someone else opens or closes the door.

Its either me or the baby. And since I'm bigger and older, its going to be me who wins this one.

Despite our childbirth preparation, parenting classes, women's groups, feminism, blogging and midwifery model of care, as new mothers we are completely unprepared for the postpartum war. And we think we won't fight it. And time and time again, I walk into a woman's home postpartum and find her thick in the battle.

So what is the postpartum war?

1. It is our intuitive mothering skills that we inherit from our mother. This is beyond reading and reason. This is the basic, unconditional, completely dedicated love that our mother gave to us during our post partum period. Yes, that was the 70's wasnt it? Mom was in some purple post-anesthesia haze, with some bizarre formula instructions in one hand and the absolute urgency to train us, 5 day old women, to be independent and assertive. 30 years later, with a Masters degree and 5 years of therapy to heal mom's deep mistakes, we find ourselves wondering why the baby won't just shut up and go to sleep and stop being so dependent on us for every little thing!!!!!

Regardless of what we have learned, we learned to mother during our first two years post partum. We learned that from mom, who did the best she could. But also was fighting a war with us. Because she, like us, was told that babies need to be disciplined, managed, not spoiled. That we must set boundaries and not lose our independence. That life is too complex for unconditional dedication. There's too much to do. And babies need to learn independence and rules. Get them out of the bed and off the breast or they will be there for 38 years!!!

2. We honestly believe that two needs and desires cannot live in one space. You want milk and I want to sleep. You want attention and arms and I need to go to the bathroom (and I've been constipated ALL WEEK!!!). You need me to stare at you in bed all day and I have about 56 emails to answer right now. You need my completely undivided 24 hour attention and I need a breast pump so I can get out of this trap as soon as possible and regain the independence that it took me 33 years to achieve!!!

The truth is, as mothers we can and must learn to live with two needs and desires in one space. It doesn't have to be one or the other, as long as we are completely, totally dedicated to our baby when it is time to do that. As skilled as we are, we cannot multi-task when it comes to giving our baby undivided attention, which is what our babies need. Even if it is only a few hours a day. No one needs to win this war. We need to stop thinking we need to fight it.

3. The baby doesn't need to shut up, the baby needs to be heard. If the baby is screaming, the mother is screaming. The mother and baby are so fused during the first two years that it is impossible for the baby not to manifest the mother's emotions. As polite women, we keep our emotions within. Only to find that after all the lactation experts have left our bed-side, our baby screams for about four hours. The baby needs to be heard and the mother needs to listen. The mother needs to talk and state her needs and the rest of us need to listen. The rest of us need to listen to the baby and attend to its needs. And baby needs are pretty simple. LOVE. Pure, Genuine, oxitocin induced, dedicated, unconditional, focused love.

Eventually a baby who is never heard will shut up. And 30 years later she will wonder why her beautiful postpartum bed has become a war.

Re-Virgination

2009-09-04T14:42:00.000-07:00

I am writing about this for several reasons:

When men began to attend births (and other body issues) they would write about their findings and other men would discuss them.

I would like to know if anyone has ever seen this and what their thoughts are

A woman birthed with me (a normal homebirth). She incurred a small anterior tear which was not repaired and she was advised sitz baths with healing herbs (calendula, malva, rosemary and aloe) and to keep her legs closed. About one month ago at a post partum visit she stated that she felt her yoni had "closed". Assuming I understood what she was talking about I discussed pelvic floor with her and "things coming back together".

She was in fact right.

She came in for a pap smear one month after that conversation and I found that she had a "closed" yoni. She had grown a spider web type tissue across her inner labia leaving her introitus about the size of my pincky finger (which is by the way, very small). The tissue is very thin and only covers this area, from below her urethra to half way down her yoni introitus. I consulted our pediatrician who observed the woman and explained that this was a "Synercky" (sp. Sinerquia) and she had seen it in newborns, who are born with an overdeveloped hymen. She explained that basically this woman had revirginated. We giggled and stood in awe around her.

So we discussed a de-virgination plan between the three of us: she should come back without her baby, a bottle of wine and some romantic CDs and we would romantically "release" her of her new found virginity.

What is so stunning about this to me is the power of the mind and psyche to heal the body. The woman is question is a single mother with deep concerns about the fact that she became pregnant "out of wedlock". Her family had a hard time integrating the news as they are conservative and catholic. So this woman is a Saint?! She regained her virginity though a gentle postpartum after a beautiful homebirth. And through intention.

Now that may just be one more reason why homebirth is so special! And why women are so magical.

Once again, Science proves what Nature knows

2009-09-04T14:25:00.000-07:00

Last week a study was published out of Canada comparing homebirth rates with midwives to hospital births with midwives and physicians. What is so good about this study is that is compares and compares and compares (three times because of the three factors it studies!). The study carefully looks at outcomes among Canadian women over four years within a common health care system, which means that in general these women can be compared. Also important to the study is that those who birthed at home had planned to do it- it wasn't an accident. The results show, as you will read below, that results of midwives are comparable to those of a physician. If you read the results of the study you will find that the results of the midwife attended homebirth are BETTER. Not just similar, B.E.T.T.E.R. This includes perinatal mortality (who new? in fact it appears in Canada LESS babies die at home). Homebirths also incurred LESS interventions (thats a no-brainer) or adverse maternal outcomes, which are defined as third and fourth perineal tear and post partum hemorrage.

So my question is- if the midwives are proving far better outcomes consistently then why is the research so controversial? Is it because women still have to work three times as hard to get half the recognition? Why is it that women's choice in birth is so controversial and questioned? Why is it that so few Maternal Health organizations recognize the Midwifery Model of Care?

How ss it that if midwives have BETTER outcomes than physicans, they are COMPARABLE?

If physicans had better outcomes than midwives than wouldn't they be deemed safer? So why doesn't someone just stand up and say it? OK, I will....

HAVING YOUR BABY AT HOME WITH A MIDWIFE IS SAFER THAN HAVING IT AT THE HOSPITAL.

GOT IT??????

now, read the study! and congratulate the authors, they did a fantastic job.

Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician

Patricia A Janssen ¹, Lee Saxell ², Lesley A Page ³, Michael C Klein ⁴, Robert M Liston ⁵, Shoo K Lee ⁶

¹ School of Population and Public Health, the Department of Obstetrics and Gynecology, Faculty of Medicine, University of British Columbia, Vancouver, BC; the Child and Family Research Institute, Vancouver, BC
² Division of Midwifery, Faculty of Medicine, University of British Columbia, Vancouver, BC
³ Nightingale School of Nursing and Midwifery, King's College, London, UK
⁴ Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, BC; the Child and Family Research Institute, Vancouver, BC
⁵ Department of Gynecology, Faculty of Medicine, University of British Columbia, Vancouver, BC; the Child and Family Research Institute, Vancouver, BC
⁶ Department of Pediatrics and the Integrated Centre for Care Advancement Through Research, University of Alberta, Edmonton, Alta.

	Abstract

Background: Studies of planned home births attended by registeredmidwives have been limited by incomplete data, nonrepresentativesampling, inadequate statistical power and the inability toexclude unplanned home births. We compared the outcomes of plannedhome births attended by midwives with those of planned hospitalbirths attended by midwives or physicians.

Methods: We includedall planned home births attended by registered midwives fromJan. 1, 2000, to Dec. 31, 2004, in British Columbia, Canada(n = 2889), and all planned hospital births meeting the eligibilityrequirements for home birth that were attended by the same cohortof midwives (n = 4752). We also included a matched sample ofphysician-attended planned hospital births (n = 5331). The primaryoutcome measure was perinatal mortality; secondary outcomeswere obstetric interventions and adverse maternal and neonataloutcomes.

Results: The rate of perinatal death per 1000 birthswas 0.35 (95% confidence interval [CI] 0.00–1.03) in thegroup of planned home births; the rate in the group of plannedhospital births was 0.57 (95% CI 0.00–1.43) among womenattended by a midwife and 0.64 (95% CI 0.00–1.56) amongthose attended by a physician. Wo men in the planned home-birthgroup were significantly less likely than those who planneda midwife-attended hospital birth to have obstetric interventions(e.g., electronic fetal monitoring, relative risk [RR] 0.32,95% CI 0.29–0.36; assisted vaginal delivery, RR 0.41,95% 0.33–0.52) or adverse maternal outcomes (e.g., third-or fourth-degree perineal tear, RR 0.41, 95% CI 0.28–0.59;postpartum hemorrhage, RR 0.62, 95% CI 0.49–0.77). Thefindings were similar in the comparison with physician-assistedhospital births. Newborns in the home-birth group were lesslikely than those in the midwife- attended hospital-birth groupto require resuscitation at birth (RR 0.23, 95% CI 0.14–0.37)or oxygen therapy beyond 24 hours (RR 0.37, 95% CI 0.24–0.59).The findings were similar in the comparison with newborns inthe physician-assisted hospital births; in addition, newbornsin the home-birth group were less likely to have meconium aspiration(RR 0.45, 95% CI 0.21–0.93) and more likely to Abstractbe admitted to hospital or readmitted if born in hospital (RR1.39, 95% CI 1.09–1.85).

Interpretation: Planned homebirth attended by a registered midwife was associated with verylow and comparable rates of perinatal death and reduced ratesof obstetric interventions and other adverse perinatal outcomescompared with planned hospital birth attended by a midwife orphysician.

Birth Camp!

2009-08-07T18:35:00.001-07:00

This week Brenda and I created Birth Camp! This is the Spanish version of Mayan Moon Retreat Week directed at Mexican midwives, students, doulas, mothers and plain ol' curious passionate birth workers.

The week will take place during the Mexican independence celebrations, so mid-week we will have a break from intensive workshops.

The schedule includes working with the pelvis- both our own and the women who with acompany during birth, incorporating grief, exploring homeopathy as well as Mayan ritual and sacred space.

I am excited about this space because I constantly recieve emails from Mexican women who want to study at Luna Maya and sadly we cannot take on all the apprentices we hear from. This week long intensive is a way for us to circle together and share all we know about birth to renew our ancestral wisdom and commitment to our path.

If you love the idea, but don't speak spanish, stay tuned and check our webpage because I have already posted the dates for Mayan Moon Retreat Week in February 2010.

At the end of the day the students asked me for the second time, why dont you start a midwifery school? Well, I'll try to come up with an answer for that.

In the meantime, show your interest and commitment to continued growth and the profound importance of re-birth through intensive circle and join us for Birth Camp! See you in September!

Universal Standards for Midwifery Education

2009-08-04T10:34:00.000-07:00

Last month, the World Health Organization published the "Global Standards in Nursing and Midwifery Education". In this document the WHO suggests universal standardization of midwifery education, and raising the standard to university level education. Below you can read the MANA Board response to this document, which you can read at:

http://www.who.int/hrh/nursing_midwifery/hrh_global_standards_education.pdf

As someone who works in a region where female education is complicated, stressful, financially straining and a far priority from cultural values I am curious about the realistic application of these standards. I'd love to hear comments about this initiative.

August 1, 2009

Task Force on Global Standards in Nursing and Midwifery Education

Nursing and Midwifery Resources for Health

World Health Organization

Dear Sirs,

Attached you will find the CPM Issue Brief which we are sending to you for your consideration in response to the “Global Standards for the Initial Education of Professional Nurses and Midwives.” This document was developed by a coalition of four midwifery organizations, including the Midwives Alliance of North America describing the role, expertise and educational

model of the Certified Professional Midwife. This competency based model of Direct Entry Midwifery has been developed successfully in a country noted for its economic, social, racial and geographic disparities in access to health care services and perinatal outcomes.

Certified Professional Midwives have proven to be a viable, safe and cost effective route of not only competency-based midwifery education but also for providing evidence-based care with excellent outcomes. This model is currently being replicated or considered for replication in a number of countries including Germany, Australia, New Zealand, Mexico and Guatemala.

We would like to point out that, although you state that the Standards were developed by a long list of experts in the field, there is a surprising lack of midwives on the Task Force. Most notably there is a blatant lack of participation of the International Confederation of Midwives, as well as a lack of participation from other midwifery councils including the Midwives Alliance of North America, the American College of Nurse Midwives, the Royal College of Midwives among others.

We question why internationally established and recognized councils were not consulted and included within the task force created by an organization that represents global health interests. We would also like to point out that most members on the Task Force are not midwives themselves.

Another important concern we have with the document is regarding the standards themselves. Global Standards in midwifery education assume global standards in opportunity. Our countries and regions are a far cry from being able to offer women equal access to educational and economic opportunities. Global Standards also assume a global standard in health,

reproductive history and risk. The World Health Organization is fully aware that many women in rural indigenous communities lack access to educational opportunities and to the economic resources to complete formal and university level education. It is completely unrealistic to expect women from poor, marginalized and indigenous communities from around the world to be able to complete a university degree in nursing and midwifery. It is also known that health providers who complete university degrees generally do not serve poor and marginalized communities, especially if these are rural.

Around the world in developed and developing nations, successful models of inter-cultural and integrated care have proven positive outcomes. Within the U.S. for example, the Certified Professional Midwife is skilled at attending normal, low risk, out of hospital births, and is skilled at referring to specialized care when the need arises. In rural Guatemala and Mexico, traditional midwives learn to refer high-risk women to professional midwives and family physicians who in turn may refer to specialized care. Diversity in economic and cultural realities requires diversity in health care provision.

We are concerned that the standardization of Midwifery education to a University level would leave millions of women around the world without access to skilled birth attendants, resulting in an immediate impact in the increase of maternal and infant mortality and morbidity rates. Furthermore, this would leave the poorest, most marginalized and most vulnerable

women and infants far from care provided by competency based care providers. Through the implementation of the Standards of Education health promoters, trained traditional midwives, direct entry midwives and Certified Professional Midwives would be left outside of the health system leaving millions of mothers and babies vulnerable to unassisted birth and no primary care at all. We do not believe this is in the interest of the World Health Organization or of the general public.

We hope that you will appreciate and embrace the important contributions to accessible high-quality maternity care provided by competency based health care providers. In addition, we encourage you to carefully consider the low cost model that has been successfully developed by the Midwives Alliance of North America and our partner organizations to enhance

our vision of “one midwife for every woman”.

Sincerely,

Geradine Simkins, RN, CNM, MSN

President

Midwives Alliance of North America

MANA Board of Directors

Maria Iorillo CPM, 1st Vice President

Christy Tashjian CPM, 2nd Vice President

Angy Nixon CNM, MSN, Secretary

Audra Phillips CPM, Treasurer

Pam Dyer Stewart CPM, Region 1

Regina Willette CM, Region 2

Tamara Taitt DEM, PhDc Region 3

Sherry DeVries CPM, CNM Region 4

Elizabeth Moore CPM, Region 5

Colleen Donovan-Batson CNM, Region 6

Dinah Waranch CNM, Region 9

Cristina Alonso Midwife, Region 10 Mexico

Michelle Peixnho CPM, Midwives of Color Section

Open Letter to the ACNM Board of Directors and Executive Director

2009-07-19T11:23:00.000-07:00

Think together, no.

Pull together, yes.

-Michelle Ellsworth

TO: Open Letter to the ACNM Board of Directors and Executive Director

FROM: Geradine Simkins, CNM, MSN, MANA Board President

RE: ACNM Opposition to Federal Recognition for the CPM

DATE: July 16, 2009

I am a CNM and a member of the ACNM and I say very emphatically—not in my name! I do not support your recent decision to publicly and aggressively oppose the efforts of a broad-based coalition of six national midwifery and consumer organizations to seek federal recognition of the Certified Professional midwife. Your position, to me, is indefensible.

Lack of Evidence

For an organization of professionals that values evidence, we find it inexcusable that you have chosen an action that the evidence does not support.

There is not evidence to support your claim that the majority of CPMs are not properly qualified to practice.
There is no evidence to support the position that CPMs in general have poorer outcomes than CNMs or CMs.
There is no evidence to support the position that CPMs trained though apprenticeship and evaluated for certification through he Portfolio Evaluation Process (PEP) of NARM have different outcomes than CPMs trained in MEAC-accredited schools.
And there is no evidence to support the notion that a midwife with a Master’s Degree has better outcomes than one without that level of higher education.

The evidence we do have on the CPM credential indicates that the midwives holding this credential are performing well, have good outcomes, and are saving money in maternity care costs. The growing number of women choosing CPMs suggests that women value the care provided by CPMs. If research in the future demonstrates that the PEP process is not safe or is not cost-effective, then that is the time to reassess and restructure the process.

Differing Values

We, as midwives, have values that underpin our professional practice. We cherish and honor those values. You have stated that your board made its decision because ACNM strongly values formal standardized education, and opposes federal recognition of CPMs who have not gone through an accredited program. We can accept that you strongly value standardized education. However, we strongly value multiple routes of midwifery education for a variety of reasons.

There is something important, powerful and valuable in a training process in which the student midwife or apprentice is educated in a one-on-one relationship with a preceptor and her clients in the community, as opposed to the tertiary setting where student midwives don’t follow women throughout the childbearing year, and may never experience continuity of care or individualized care. In addition, by preserving multiple routes we are able to educate more midwives, not fewer. We need more midwives! If health care reform were to turn around and adopt the midwifery model of care as the gold standard this year, we could not possible supply “a midwife for every mother”.

Impact of Taking a Stand

By publicly and actively opposing federal recognition of CPMs as Medicaid providers, in addition to taking a stand about formal education, you are also taking a stand (willingly or inadvertently) for decreased access to midwifery care, diminished choice for women to chose maternity care providers and place of birth, and restricted access to the profession by potential candidates. Is it worth it to sacrifice several things that you value, just so that you can take a stand for one thing that you value? Is it possible for you as an organization to value something, but also realize that it is not the only valid way? Is it possible for you to respect the diversity of pathways to midwifery that the CPM represents? It does not require the ACNM to sacrifice its own standards. It simply requires the ACNM to respect the standards of another part of the profession of midwifery.

Disingenuous Claims

It is disingenuous of ACNM to state in its Special Alert to ACNM Members on July 15, 2009, “ACNM’s decision to oppose this initiative followed unsuccessful attempts by ACNM and MAMA Campaign leaders to reach a compromise that both organizations could support…” There was no formal process or interaction, no back and forth negotiations, no attempt at collaboration that occurred between ACNM leaders and MAMA Campaign leaders. There was one phone conversation in which the ACNM representative stated that there was only one compromise that they would accept: federal recognition only for gradates of MEAC-accredited programs. While there are multiple educational paths to achieve it, the CPM credential embodies a single standard body of knowledge and experience. It cannot be split into parts. Therefore, the MAMA Campaignis promoting all CPMs to receive federal recognition as Medicaid providers, not some CPMs. There is no room for compromise when one side gets everything they want and the other side does not get what they want at all.

It is also disingenuous to suggest the World Health Organization (WHO) document sets a standard that has been embraced around the world. In fact, the WHO developed global standards for midwifery education without the input of the International Confederation of Midwives (ICM), an international partner of the WHO. The majority of members of the task force that developed the standards were not midwives. There was not widespread input regarding the document. In response to this oversight, the ICM passed a resolution at the June 2008 Council meeting in Glasgow Scotland (I was there!) to develop global midwifery standards. A task force has since been convened and all member organizations (which includes MANA and ACNM) will be able to give input to the standards developed by the ICM. Generally, when the ICM develops a document that might supplant an existing WHO document (as was the case in the international definition of a midwife), the ICM document is eventually incorporated by the larger international community. This will be a long process and any new document will not be ratified by ICM until the next Council meeting in 2011.

Lack of Vision

What offends me as a CNM, an ACNM member, a member of the MANA/ACNM Liaison Committee, and the President of the Midwives Alliance is the lack of vision that your decision represents.

Why not embraces diversity and support innovation? Why not bring the turf wars to an end? Why not unite under the banner of midwifery and the values that we share in common? Why not set aside our differences and recognize that we are all midwives? Why not recognize that the work we do is more important than the credentials we hold? Why not support one another within the profession, because diversity is our strength not our weakness?

What We Do Matters

The healthcare debate has been in progress in Washington DC for over a decade. But never before has the possibility of real change been so promising as it is now. Now is the time when we may have a real opportunity to impact changes in maternal and child health care that will have long-lasting affects for mothers, infants, families and communities. Women deserve high quality maternity care, affordable care, and equal access to care. Women deserve a variety of maternity care choices in providers and place of birth. Vulnerable and underserved women deserve to have disparities in health care outcomes eliminated, and they deserve to have barriers removed that limit services, providers and reimbursement for maternity care.

Expanding the pool of qualified Medicaid providers to include CPMs will help address the plight of so many women around the county who receive poor quality maternity care or do not have access to care at all. We need to lower the C-section rate and increase VBACs. We need to lower infant and maternal mortality and morbidity rates in the US. We need to offer women the opportunity to believe in their bodies again and to give birth powerfully and in their own time. We need to welcome babies gently into the world. We need to give the experiences of pregnancy and birth back to families. We need to support women to breastfeed and help shelter the process of maternal-infant bonding. These are the real issues. These are the things we deeply value. Midwives are the solution that can address each of these vital issues. For all midwives and midwifery organizations to be united under this banner is what is really important, not a continuation of turf-war battles that distract us from reaching our common goals. We do not have to think together; but we must pull together!

In Conclusion

I repeat to you—not in my name. As an ACNM member, your actions this week do not represent what I value, what I hope for, and what I work untold hours to achieve, nor do your actions represent what my Board of Directors values. I have written this letter at the urging of my Board of Directors. There are 14 members of the MANA Board —seven CPMs, four CNMs, one CPM/CNM, one CM and one DEM; truly a cross-section of the midwives that practice in this nation. What we stand for is diversity, tolerance and unity among midwives and within the profession of midwifery. What we advocate and work for is a midwife for every mother, in every village, city, tribe and community in the country and across the globe.

Sincerely,

Geradine Simkins CNM, MSN, President

MANA Board of Directors

Maria Iorillo CPM, 1^st Vice President

Christy Tashjian CPM, 2^nd Vice President

Angy Nixon CNM, Secretary

Audra Phillips CPM, Treasurer

Pam DyerStewart CPM, Region 1

Regina Willette CM, Region 2

Tamara Taitt DEM, Region 3

Sherry DeVries CPM, CNM Region 4

Elizabeth Moore, CPM, Region 5

Colleen Donavan-Bateson CNM, Region 6

Dinah Waranch CNM, Region 9

Cristina Alonso Midwife, Region 10 Mexico

Michelle Peixnho CPM, Midwives of Color Section

Where there is No Neonatologist

2009-07-16T11:43:00.000-07:00

Q: What is a Neonatology?

A: Neonatology is a subspecialty of pediatrics that consists of the medical care of newborn infants, especially the ill or premature newborn infant. It is a hospital-based specialty, and is usually practiced in neonatal intensive care units (NICUs). The principal patients of neonatologists are newborn infants who are ill or requiring special medical care due to prematurity, low birth weight,intrauterine growth retardation, congenital malformations (birth defects), sepsis, or birth asphyxias. (Wikipedia)

Q: What does a Neonatologist do in a hospital?

A: Supervises and works in the Neonatal Intensive Care Unit making decisions about unwell and premature infacts.

Q: How many neonatologists are there at the Regional hospital that attends to San Cristobal and the Highlands of Chiapas?

A: One

Q: And how many shifts are there?

A: 5. Morning, afternoon, night. Weekend day and weekend night.

Q: And when does the Neonatologist work?

A: Morning shift from monday to friday

Q: When do most births occur?

A: At night and on weekends

Q: So, who monitors the Neonatal Intensive Care Unit at the Hospital on weekends?

A: A Pediatrician

Q: Is a pediatrician qualified to manage an NICU and make decision regarding neonates in intensive care?

A: Not unless he or she has done specific certified training on this issue

Q: So basically you are saying that aside from mornings from mondays to fridays the NICU is not run by qualified staff?

A: Exactly

Q: At what consequences does that bring?

A: That over the weekend babies die that should not die because they are not intubated, ventilated or recieve appropriate treatment.

Q: And what is being done about this?

A: For the moment, nothing.

Q: So babies are dying over the weekend at the Regional Hospital because there is no qualified personel. Is there another hospital that has an NICU in the area?

A: No, the nearest one is the pediatric hospital in Tuxtla Gutierrez.

Q: So what would your advice be?

A: I would suggest that babies born on weekends make sure that they are at term, suffer no asphyxia, do not aspirate meconium or amniotic fluid, do not have any congenital anomalies because they have a very low probability of making to to monday.

Q: Thank you.

Intimacy

2009-07-09T15:24:00.000-07:00

This week in Family Circle we talked about intimacy. The family's had asked to talk about sex, but I thought before talking about sex life after the baby, perhaps we should talk about intimacy first. We sometimes give sex and our sex life a lot of weight and consider that either we have a sex life or we don't. That if we have sex, we have intimacy as a couple and if we don't we don't. And this is a measurement of our relationship.

What we challenged the families is to think of Areas of Intimacy, as gradients, or degrees, instead of an all or nothing. As a couple we can look into these areas of intimacy and think about how we are doing within them. Perhaps we will find that one area is really strong and another is really weak. Then what we can do is put more effort into re-inforceing certain areas.

Consider these areas of intimacy:

As Parents: How we make decisions as parents (not the time we spend with our kids, but as a couple talking about how we parent)

Spiritual: We may share a religion, or a sacred process or thought or ritualize certain events or moments

Recreational: How we share having fun, what we like to do together

Asthetic: Our appreciation of what is beautiful to us

Crisis: Walking together through crisis, either an external crisis where we lean on the other or an internal relationship crisis where we are pulled together by our effort to reconcile and heal

Emotional: How we share, live and communicate our emotions

Sexual: How our sex life is lived, discussed and felt

When we consider intimacy by areas we can assess our balance or imbalance on a qualitative scale. We can work on enforcing certain areas and we will find that the better our intimacy gets in one area, the better it gets in another area. For example, if we agree that on saturday mornings we will bike ride together because we enjoy doing that, we will probably find that on saturday nights our sex gets better!

What we discussed in Family Circle (the first tuesday of every month at Luna Maya) was that during pregnancy couples can work on improving specific areas of intimacy so that when baby comes we can communicate our needs for intimacy as a couple, separate from the all consuming parenting.

If a couple has already had a baby and the couple feels astranged, perhaps they can check out these areas and see where there is possibility for improvement. Sometimes, its ok to pump milk, leave baby with grandma for a saturday morning so that mom and dad can have a bike ride and share some intimate time together.

It is important to remember that the new baby lives with two (sometimes) adults, and these two have a relationship that will immediately affect the baby. Lets give ourselves time as a couple to work on our areas of intimacy. We will teach our kids the importance of this and foster intimacy and communication among our newborns.

When you leave before it was expected

2009-06-30T18:18:00.000-07:00

Dear Baby,

For some mysterious reason you chose me to be at your birth. And you chose me to be at your death.

For some mysterious reason your mother and father chose me to be at your birth. And they chose me to be at your death.

For some mysterious reason I chose to be at your birth. And I chose to be at your death.

Dear baby, who am I to judge whether a shorter life is worth any less than a longer life?

Who am I to decide that the minutes, hours, days, you spent on our earth were too little? They were enough, for you, they were enough.

For some mysterious reason, your short time with us was all that you needed.

I honor your life and I bow before you, honoring your destiny.

I place you in my heart and I bring you into my life, through your life, through your death.

I honor your life, as short as it was.

I honor your destiny.

(To those who left before their time, to the mothers and fathers who watched them and to the midwives who held witness)

Vaginal Breech Birth

2009-06-30T18:09:00.000-07:00

The Society of Obstetricians and Gynecologists of Canada recently revised their practice guidelines on breech birth.
As of this week (June 2009) They no longer recommend routine cesarean for breech babies! This is a huge step forward as it was precisely the Canadian society and research from Canada that originally published and pushed material that deemed vaginal breech birth unsafe.

The announcement from the SOGC is here:

http://www.sogc.org/media/advisories-20090617a_e.asp

The guidelines:

http://www.sogc.org/media/pdf/advisories/CpgBreechJune09_e.pdf

At Luna Maya we have always supported women's right to chose the birth that she feels works best for her. This sometimes has included a breech vaginal birth. For any midwife who has attended home breech births, we know that it is safe, gentle and usually pretty straightforward.

One of the most important statements in my mind of the announcement and guidelines is the acknowledgement that there are very few providers (in hospital) who know how to attend a safe breech vaginal birth. I would like to offer the skills of myself and other homebirth midwives who how centuries have been safely attending breech births at home.

May this be the beginning of the extension of equal opportunity for birth and the extension of rights to ALL childbearing women, regardless of the position the baby is in!

Risks of Cesarean

2009-06-14T15:28:00.001-07:00

Please check out this Blog entry regarding cesareans:

http://mannursediaries.blogspot.com/2009/05/nearly-bleeding-to-death-from-cesarean.html

I would love to read your comments on the story.

Notes on Prematurity

2009-05-31T17:55:00.000-07:00

Midwives have very little experience with preterm labor, not so much because we are supposed to refer it, but because it rarely happens with women in midwifery care. This has to do with 1 hour prenatals that focus on emotional support, nutritional advice and holistic care. So my first note regarding prematurity would be that every woman get a midwife. Even if she ends up with a medicalized birth and a baby in intensive care she would probably benefit on someone to guard the normal- go to her house every day and listen to her, hold her, help her figure out why her baby is feeling like she needs to get out of her mothers safe womb. A midwife can help be an advocate if they end up in a pre term birth, helping the woman keep up some sort of milk production, advocating for kangaroo care and skin to skin contact which have been proven to improve outcomes for premmies. And long term support as well. Moms often talk about how estranged they feel from their baby who spent her first few weeks in the Neonatal Intensive Care Unit with a team of experts and all of a sudden mom is home with this fragile stranger. Its hard!!!

Last year I heard a midwife who works with a group of women who have really high rates of premature birth. She talked a lot about the "toxic womb", a place so stressful and malnourished that babies have to leave them before their time. She talked about 2 important aspects- stress... what are we passing to our babies- what messages, what hormones, what thoughts.... what is the burden of continuing the pregnancy for another 2 months on the mother- exhaustion, financial drama, career stuff, on and on. Each woman needs to define deeply why it is best for her to have her child out sooner than what should be. These questions are hard and challenging, but when women identify their responsibility in that and talk to their baby and understand that finally baby in or out, those stressors are still there.

Then nutrition- its very hard to improve nutrition in adults and in women at the end of their pregnancy, however right now baby needs a lot of nourishment. Omegas, protein, liquid, etc... she must eat and eat and eat. But she needs to eat from the Earth.

I just finished reading a book about nourishment and moms and babies (Laura Gutman, La Revolucion de las Madres, 2008). The thesis of the book is that nourishment is our relationship to being loved and giving love. The womb is the epitome of nourishment, 24 hours a day of food and love and warmth. Why would anyone want to leave that?? This author talked out premmies as starting their life immersed in high technology- their existence depending on that. She works with women to help them grasp that their bodies are sublime technology and irreplaceable. All the tubes in the world will never replace the placenta!

At Luna Maya when we have had moms in this position we recommend bed rest, nutrition and hydration and the midwives and family therapist visit her at home to clarify what is going on. Recently a woman in her 33rd week of pregnancy called to say she thought she was going into labor. I gave her Aconite (homeopathic) for her fear. Her issue was that during her pregnancy she had come to realize that her boyfriend not available to her and her pregnancy and she couldn’t count on him for fathering her child and supporting her. So she had decided to say goodbye to him.

We talked about the difference between expelling her man from her life and expelling her child from her womb. Everyone has their place in the family and that needs to be honored. Within 24 hours of intensive midwifery care and some support from the therapist she was a whole different woman with a quiet uterus. She finished the week thanking us for how safe and comfortable she feels with us. I finished the week thanking her for opening her heart so gently and taking such good care of herself and her baby.

There is a reason why we shouldn’t be born before 36 weeks and every mother facing a premature birth needs to connect deeply with that. The mother, more than her doctor or midwife needs to know that she will carry this baby to term and take her baby back to the family bed hours after birth where she belongs for delicious honey momma nourishment. And we, as those who hold moms need to provide mom with delicious honey momma nourishment. Moms who nourish their little ones need to be nourished by the rest of us. Prematurity is our responsibility.

Induction of Labor

2009-05-22T07:32:00.000-07:00

Cristina's Handy Guide To Surviving the Induction of Labor

Im due for March 13th.... it's now March 15.... Do you think the baby is ok?... You are now 41 weeks... I will send you for a non-stress test.... Your placenta seems to be aging... your fluid levels are decreasing.... The head is still high.... Any contractions?.... You are now at 41.3 weeks.... If you pass 40 weeks we will have schedule an induction... We must induce.... We will induce... You will be induced on Friday.... We will induce on Monday.... You should have the baby within 12 hours.... Induction....

SOUND FAMILIAR???

Seems like we have gone from "pregnancy can last anywhere between 38 and 42 weeks to"... "you are an oven and if your bun is in there for more than 40 weeks it will be horribly burnt and thus useless"...

Outside of out of hospital midwifery, the induction epidemic is rampant. I will not go into the dangers of induction in this entry. You can learn all about those in books, movies and webpages and by asking midwives. Instead I have created a list of questions to ask your doctor or midwife when they schedule or suggest an induction. I'd love to hear your comments:

10 Questions to Ask your Inducing Provider:

1. How many more years might I be pregnant?

2. If I am pregnant for another year will my child learn to walk and garble in the womb?

3. If my pregnancy lasts 3 years will my child learn to identify colors in the womb?

4. After you put the artificial oxitocin in my vein how do you expect to compensate for the other hormones that won't be naturally produced by my body that are necesary for labor, such as endophines, prolactin, catacolmines, prostaglandins.... and won't be produced by my body because of the artificial oxitocin.

5. How do you feel about the fact that I will be expereincing contractions that are about 3 times stronger than natural contractions? Does that matter to you at all? Will you be there to hold my hand and help me breathe?

6. How do you feel about my chances of me ending up in an emergency cesarean? Does that make you nervous at all? Are you pretty good at doing emergency cesareans?

7. After my baby is in intensive care for meconium aspiration, will you have any trouble sleeping at all? Do you think you might have nightmares?

8. After my baby comes home from the NICU and feels like a complete stranger to me, can you recommend where I can find my "maternal instincts" and "innate ability to breastfeed"?

9. What are your thoughts on the fact that, if my baby hasn't initiated labor maybe its not ready to be born, may be too small, not ready to breathe, not ready to handle extrauterine life, and may need another week to mature?

10. So, can you, once again, really clearly explain to me why it is dangerous for my baby to stay within MY womb, where it has lived its ENTIRE life for another week?

How's is Everything? How are you?

2009-05-11T09:45:00.000-07:00

Would you describe this day as SUNNY or CLOUDY? does it look like it might rain?

Im in a situation (or several situations) in my life right now that are more than just good and bad. They are dense and thick and complicated. They are situations that people ask me about, hows it going with.....? How are things with....? How is it?

And I have no idea how to answer. Some parts are good, some parts are bad, some parts require knowing me for 30 years and understanding how I think, some parts require listening for 5 minutes without stopping or judging, some parts require silence, a little bit of this and a little bit of that. In short, I wish people wouldn't ask me.

So this situation made me think of when we ask women, "How was your BIRTH?". Well it was good because no one died. It was bad because my husband is an idiot and he behaved like one during the birth. It was good because I didn't have surgery. It was bad because I didn't think I would make it. I was good because my mother caught the baby. It was bad because there was meconium adn the baby was aspirated. It was good because my midwife was wonderful. It was bad because she wouldn't stop asking me how I was doing and what I needed. and on, and on, and on.

It made me realize what a rediculous question this is and how it is so hard to answer. I imagine its a bit like, how was your marriage? (after 50 years). How was your relationship with your mother (a bit of everything??)

Anyway, in the end I think that what I am getting at is that I wish people would just listen to what I want to say and stop asking questions. I wonder if thats what women want in Maternal care. Perhaps, instead of asking questions in the Prenatal room we should start by saying "What do you want to talk about today?". And when we ask about MAJOR life experiences we should ask "If there anything you want to tell me about? How can I best listen to you?"

When women have hard births, for example a transport in a homebirth, a cesarean when that wasn't the intention, a cold provider when we wanted some more support, how can we ask women about that and listen to what they have to say without saying: AT LEAST NO ONE DIED.

So anyway, its a bit like this picture. Yes the sun is out, yes the clouds somewhat cover it. Theres a lot to say about the weather in this picture. There's a lot to say about us. And theres a lot that can go unsaid, just by observing.

La Luz de tu Vientre

2009-05-11T06:01:00.000-07:00

Ive been off line for a month because I was in Spain teaching and Fundraising. This song was created in a workshop I gave in Galicia with a group I've been working with for several years now. The lyrics are:

Tierra, Tierra, Tierra

Tierra Viva

Tierra Madre

Tierra Amada

Esa soy yo

Esa eres tu

Somos una

Soy rio que fluye

Agua de la fuente

Fruto que alimenta

La luz de tu vientre

Gracias a las Meigas Gallegas por compartir tu Magia!!!

We are made of what we eat- Pesticides and Pregnancy

2009-04-11T18:48:00.000-07:00

This week I was sent the following study:

"Conception Timing Associated With Birth Defects

Deborah Brauser

Medscape Medical News 2009. © 2009 Medscape

April 2, 2009 — Elevated concentrations of agrichemicals in surface water from April to July coincide with a higher risk for birth defects in the United States when maternal last menstrual periods (LMPs) are between those same months, according to the results of an ecological study reported in the April issue of Acta Paediatrica.

Results showed a significant association between the months of increased risk for a birth defect and increased levels of agrichemicals in surface water.

Mean concentrations of agrichemicals were found to be highest in April to July. Birth defect rates for April to July LMPs were significantly higher than birth defect rates for other LMP months (1621/100,000 vs 1573/100,000 live births; P < .01).

In addition, 11 of 22 birth defect subcategories were also significantly higher when maternal LMPs were between April and July than in other months of the year. These were spina bifida, circulatory/respiratory anomalies, tracheo-esophogeal defects, gastrointestinal defects, urogenital defects, cleft lip, adactyly, clubfoot, musculoskeletal anomalies, Down's syndrome, and other birth defects."

These results are sad, enfuriating and I could continue with a long list of adjectives, but I'd rather give more information. My heart goes out to the families of babies who, despite their best intention, their utmost love and care of the pregnancy recieve the news or the body of a baby with a major malformation, or minor, or any, period. It is not a question that of course this child will be loved just the same and that families will learn and adjust, but it is cruel that this would occur because the agricultural and food industry has deemed that this practice is necesary and we as family have to completely change our lives to hold and care for a child with a disability or malformation. Because here are some facts:

Within one field, the aplication of pesticides will reduce but not eliminate pests. Some pests will die immediately and some who did not recieve a full on or are resistant to the chemicals will survive.
Those who survive will breed and pass on genetic material to their young in order to resist chemical pesticides.
Continued spraying increases population resistance to a certain pesticide and over time a whole population will evolve to be resistant to a certain chemical.
More than 500 species of insects and mites, 150 viruses and 300 weeds now resist chemicals.
In 1948 US farmers used 50 million pounds of pesticides and lost 7% of crops to pests
In 2000 US farmers used almost a Billion pounds of pesticides and lost 13% of crops to pests

(Source: Animal, Vegetable, Miracle by Barbara Kingsolver, Harper Perrenial 2007)

I took statistics in graduate school, and even if I had stopped at first grade addition- I'm sorry but these numbers DO NOT WORK OUT. This is terrifying to me- I live in a planet, and more specifically in a region where pesticide use is widespread and unregulated and as a practicing midwife in southern Mexico I can say that in spring we always get a couple of an-embrionic pregnancies (these are pregnancies where the bag develops without an embryo) and that in the fall we always attend the birth of one or two babies with some sort of malformation. Am I seeing the effects of this study in my own practice? Probably.

Pesticide companies don't really care about the birth and childhood experiences of indigenous women in Southern Mexico, but they do care about your purchasing power. If we, as a people stop buying food that comes from anywhere except for our local organic farmers, we are supporting the widespread use of pesticides. Therefore we are participating in babies developing with an open spine.

I know that anyone reading this does not want to participate in fetal malformations. The choice is yours, inform yourself. If you are pregnant or planning on being pregnant inform yourself and advocate for your new baby's health. If you are part of a community, protect your young from malformations and help them develop as strong perfect beings that they are.

We are lucky that we live in a world now where every day we can access more information and ask more questions. Ask your locals produce store where they get the food, support your local organic market, grow your own food. And demand that your government ensure clean, pesticide free water.

2009-04-02T15:38:00.000-07:00

Joni Nichols, good friend and sister birthworker in Guadalajara sent this link:

….a midwifery like approach to birth in a hospital resulting in far fewer cesareans (close to 10%)

http://www.berkshireeagle.com/ci_11982902

The article continues:

"C-section births fall

By Jennifer Huberdeau, New England Newspapers

Tuesday, March 24

NORTH ADAMS — While more and more women choose to undergo Cesarean section births despite a national push by the federal government to decrease the number, the local rate has declined and is well below the state average.

North Adams Regional Hospital performs significantly fewer c-sections than other hospitals around the state — an average of 18 percent of all births at the hospital compared to the state average of 34 percent, according to reports released by the state Department of Public Health.

The hospital also has a better prenatal care record, according to the reports: 94 percent of women giving birth have had nine or more prenatal care visits versus the state average of 87 percent having that many visits.

"I think what is being reflected in our numbers is that we are taking a more 'midwifery' approach with our practice then before," Robin Rivinus, a certified nurse midwife with Northern Berkshire Obstetrics & Gynecology at the hospital, said last week. "It means that we do fewer unnecessary interventions — inductions, Cesarean sections, episiotomies. We treat childbirth as the normal, natural thing that it is. We only step in when it's medically necessary, which is much better for both the mother and the baby."

In 2004, federal health officials, after seeing a 40 percent increase in c-section births between 1996 and 2004, announced a goal of decreasing the total percentage of c-section births in the county from about 30 percent to 15 percent or below by 2010.

"We usually have a rate of about 16 percent, which is a pretty good range to be in," Dr. Charles O'Neill, an obstetrician/gynecologist with Northern Berkshire Obstetrics & Gynecology [at North Adams Regional Hospital], said.

"I think there are several things that conspired to push the number of c-sections up over the years," he said. "There has been a trend away from offering vaginal births after c-section (familiarly known as VBAC) because of several high-profile malpractice suits and a trend to deliver most twins by c-section."

During 2008, the hospital performed 29 first-time c-sections out of 207 births or 10.7 percent, which is well-below the state average of 20 percent. It had 20 repeat c-sections — 7 percent of the births versus the state average of 13 percent.

"Recently there have been several high-profile studies done that conclude there is overuse of high-tech interventions," Rivinus said. "The conclusions have been that all women should be offered a midwifery model, or a 'back-to-basics' approach to childbirth, where spontaneous, natural birth is the focus."

While some may find a planned Cesarean to be more convenient for the practitioner and family, Rivinus said there are several significant high-risk complications that come with c-sections: infection, uncontrolled bleeding, respiratory distress for the infant and increased risk of the placenta detaching from the uterine wall in future pregnancies.

"Vaginal births are a very natural process," she said. "I think births have become very clinical and sterile, which they shouldn't be. We strive to have personal relationships with our patients and treat the whole individual, not just the pregnancy."

O'Neill said that while he and Dr. Susan Yates have always offered a 'patient-centered' practice, subtle differences have evolved with the addition of two full-time and one part-time certified nurse midwives to the practice.

"To me, the take-home message is that our collaborative practice has made an impact on our overall rates in the end," O'Neill said. "They've helped us improve our standards with the progress of labor and help to remind us and the patients that patience is always a virtue."

Northern Berkshire Obstetrics & Gynecology plans to have two additional obstetrician/gynecologists on staff later this year."

And I wonder, why is this revolutionary? We know all this! Why aren't all hospitals like this?

When are women going to demand that this be standard of care?

I'm Pregnant, Again!!

2009-03-22T20:57:00.000-07:00

Something very very special, although obvious is happening at Luna Maya. Women come back!! They come back for a pregnancy test, or for a prenatal... and I have to retrieve their charts from two years ago, or from last year, because they are pregnant... again!!!

Very recently I was very honored to tell a two year old whose entry to the world I had witnessed that he was going to be a baby brother. Also very recently I received a call from a couple saying, you will be around in August right? because we are having another!!

This seems like the most obvious thing in the world, yes, most of us have siblings and most of the time they are just irritating and force us to learn sharing (groan), but this isn't about that. Its about a door, a womb, a family, a ritual.

For some reason, as a midwife I am still completely in awe of the fact that we make babies in our uterus'. I watch the bellys stretch and sometimes am the first to point out- feel here, the head! a knee! This is a miracle... but to make TWO, or THREE or even TEN children. Now that is just pushing the miracle envelope.

The way I see it is, here I was, two years ago, watching a woman open up, discover herself, her strength, work with her little one, hold her man tight; and here she is AGAIN, doing it with another little one. Another little one that will stretch her, open her up and slide down and push him or herself out, following the path of his or her sibling before her. Perhaps since I was the first to pass through my mother I am amazed that my brother did it two years later. Might I have left little yellow arrows (and maybe a "haha" at the cervix??)?

I am honored, after spending almost six years in Chiapas of having accomanied several women through several pregnancies. Last week I attended a sibling. This time labor was different, This time it was Longer, This time the baby was born in water, This time in the middle of the night, This time is was a girl, This time an entirely different person came out of the same woman. Amazing.

What is most special to me is that women once again ask me in, they ask me to be there, again. I think about hospital birth and wonder what its like for a woman to show up and have a random person pass her her new baby each time... almost like having an orgasm with a different person each time, you don't get a chance to get really GOOD at it ;)

So heres to siblings, to the fact that their life starts staring at the same walls, hearing the same heart, passing through the same passage and into the same arms. Heres to midwifery for walking with women as they birth all their children and being with them for each. And heres to Moms who are wise and magical, make siblings and are grounded in having beautiful birth experiences again and again.

New York City Fundraiser

2009-03-10T11:39:00.000-07:00

This week I am preparing for the Fundraising party we will be holding in New york City on Monday March 16th at 6.30pm in Brooklyn. For details on the location, please email me!

This is a hard year for many, we are all in the wheel and less money is coming in and therefore less is available to go out. However the good thing is that its really really easy to support Luna Maya. Our annual budget is only around US$60,000 and with the peso currently at 15 pesos to the dollar I believe we can achieve this goal.

Funding agencies that have previously supported us, such as Kellogg, Seva and MacArthur Foundation have incurred budget cuts this year and are unable to provide full support. Which is why we are asking the people who believe that natural birth and humanized care for all is a right, even in Chiapas. This morning I read in the Newspaper- Quarto Poder- that 96% of indigenous people in Chiapas lack access to healthcare. We can, and must lower that figure and expect not just healthcare, but excellent, safe, intimate, loving care.

It is really important to keep in mind that 20% of our clients cannot pay for fees and 40% pay partial fees. Our fees are low- US$10 a consultation or prenatal and US$400 a birth but in Chiapas this is to much for some women. We work with the local women's shelter that houses women expelled from their communities and families because of their pregnancy and provide them with loving care and beautiful births ending long cycles of violence.

Another important aspect about our fundraiser is that it will be a Lot of Fun! We will have a raffle, the Luna Maya movie- Nacer Renacer will be showing as well as a presentation and printed photographs of our work. More than anything I am really excited about meeting the Luna Maya community in the North and bridging women's lives and stories.

I really enjoy working with the women of Luna Maya, I learn so much from their kindness, generosity and strength. Each woman that opens her heart to trust us and invites us into her birth is opening a secret door to healing and consciousness. Jenny Blythe, in her book "Birthwork" writes: "Experience being lovingly present opens us to the possibility that working with love is something within our control. Rather than an expendable commodity for a select few, it is the force of attraction and connection that builds and sustains all relationships. At any moment we can choose to close ourselves to love, or open to love- giving and recieving love consciously". In exchange for the support that New Yorkers will provide, we offer this equal commodity of loving care to all mothers and babies- and their papas of course!

Another Frontal with the Hospital

2009-03-05T18:48:00.000-08:00

I have spent the last three days with-woman in and out of the Regional hospital in San Cristobal. This is the public hospital in the town where I work.

A traditional midwife referred a woman who had been pregnant for more than 9 and a half months and still no birth pains. I checked her and couldn't feel a baby or hear a heart beat. This is out of my league... So we went to our back-up gynecologist who carried out an ultrasound and diagnosed a molar pregnancy (this is where the baby doesn't develop, instead little bubble balloon type masses form). A molar pregnancy needs to be terminated and could be cancerous. This woman has a 9 month belly. The gynecologist referred us immediately to the Regional hospital for dilation and cutterage with blood bank close by, in case of hemorrage.

So we went.

The first day the hospital was full. No beds. The other IMSS (Social Security hospital) had no doctor, so all the patients had been referred to the Regional. So we went again the next day. After waiting for two hours we were finally admitted to the ER. We waited 45 minutes until a resident checked her.

Resident: Whats wrong with you?

Woman: I've been told I have a molar pregnancy (hands referral letter over, again)

R: When was your last period?

W: 15th of May

R: WHAT?

W: 15th of May

R; Are you sure?

W: Yes

R: thats not possible

W: thats when it was..... (this continues for about 10 minutes)

Resident brings over ultrasound machine.

R: There seems to be something in there... not a baby... maybe a mole... maybe a cyst... you have to go get an ultrasound for a diagnosis.

W: I already did (hands referral letter over, again)

R: Right, but, this isn't enough. We need another diagnosis. Go home and get another diagnosis tomorrow and then come back.

Its Midnight and I'm standing in the ER after 36 hours of no sleep (had a birth the previous night). OK, I guess we'll be back tomorrow. Maybe tomorrow there will be a gynecologist in the Hospital, or maybe there might be a bed. Maybe the Gods and Godesses will help this woman if she starts to bleed and maybe they will protect me from losing my mind. Maybe she will get some care, and then again, maybe she won't.