Three last things to say

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!!

Why Homebirth reduces Carbon Footprint

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

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

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

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.

Babies experience of Birth

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

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?

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.

The Post Partum War

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.

Intimacy

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

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

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!