Mother’s Intention:

How Belief Shapes Birth

A Commonsense Guide to Safer, More Comfortable, Guilt-free Birth

By

Kim Wildner, CCE, CHt, HBCE

Copyright 2003 Kimberly K. Wildner

This page contains the first three chapters free of charge.

For more information, please see one of the following websites:

To order directly from the publisher, go to http://www.freewebs.com/harborandhill/order.htm

To contact the author: P.O. Box 265, Ludington, Mi 49431 or email: hypnotips@chartermi.net

Order forms are also available at any of the following websites: www.realsideofbirth.com and click on ‘past shows’

www.hypnobirthing.com click on ‘annual conclave’ and follow the link provided, or www.womanswisdom.info.

What people are saying about this revolutionary work:

“This book presents complicated information into a useable format. The information in this book is based on fact, not medical fiction, as are too many birthing books available.

The up to date scientific knowledge presented in this book will allow you to be well informed about the information that matters to you during pregnancy. By using the information in this book, you can plan to have a healthy pregnancy and a beautiful, comfortable birth.

I highly recommend this book for all my patients, all women contemplating pregnancy and all obstetrical medical providers.”

Lorne R. Campbell Sr. M.D.

Associate Professor Department of Family Medicine

State University of NY Buffalo School of Medicine

"In Mother’s Intention Wildner has given to all women who are pregnant and to all who wish to be pregnant an honest, accurate and clearly marked roadmap for their journey toward achieving safe and comfortable birthing.  It is a must read!”

Marie F. Mongan, Founder HypnoBirthing® Institute

www.hypnobirthing.com

“If everyone were to read this book and honestly venture into their own beliefs regarding pregnancy, birth and parenthood, great things would happen! Our country’s infant mortality rate would drastically decline, women would fully embrace the power of their femininity, and best of all, the act of birth would no longer be feared. It would be anticipated with joy, engaged in totally, and treasured as the miracle it is!”

Lynette M. Prentice A.A.H.C.C.

Birth Instructor and Mother of three

“This book provides pregnant families with an opportunity to explore their beliefs and feelings around pregnancy and birth. Opportunities for contemplation and journaling thread throughout the book, helping families clarify their own thoughts and feelings with a fresh perspective.”

Pat Sonnenstuhl, CNM, HBCE, CPPI
http://home.attbi.com/~prebirthhealth/

“It's time to quit the whining, and take our births back. No more "I didn't know",  "Where were you when I had my baby",  "Nobody told me".  Here it is. It IS possible for birth to be a peak experience, and it's worth working for.  Ms. Wildner provides both theory and tools to help women shape this amazing event. So read the book, do the thinking, and create the framework for the experience you want for yourself, your baby and your life.”

Kip Kozlowski, RN, CNM, CHt.

Director, Greenhouse Birth Center

“Wildner has a very special way of putting down information that is not agenda based or negative. Her work will be used in training doulas as well as expectant mothers. You will have a new outlook on life and birth when you are done with this book.”

Dee Nipper, Doula and Executive producer and host of The Real Side of Birth,

A positive radio show about birth and your choices.

www.realsideofbirth.com

Introduction

Before I even begin to explain who I am and how this book came about, I feel it may be helpful to the reader if I explain the motivation for writing it.

Childbirth books are plentiful. Many on gentle birth have been dismissed out-of-hand by the very persons who need them most, with amazing rationalizations.

How and why have some women dismissed books that held the key to better birth?

One way is that even though women want gentle birth, many do not believe it’s really possible. Avoiding concepts that challenge core beliefs is a coping mechanism. Therefore, experts in natural childbirth have been labeled ‘naturalists’ or ‘alarmists’, which makes them easy to write off. Some women insist that to suggest birth can be joyful or comfortable is to be deceitful; to suggest our current system has flaws is seen as nearly heretical, or at the very least a negative thing. This is, basically, ‘shooting the messenger’.

This book puts forth some very concrete and positive steps to creating the best birth possible for the reader. In order to implement these steps, the rationale for them needs to be established. This means it’s imperative to first acknowledge, then define, the problems that currently exist so that the solutions make sense. I have struggled with how to do this in the most positive way, and what I have come up with is to simply rely on the results—scientific evidence--to speak to the success or failure of what is currently considered the ‘norm’ and let the individual decide what makes sense.

To a reader who has been tempted to disregard other works, I would ask “What would be the ulterior motive behind the ‘breast is best’ or ‘natural birth is preferable’ message? I have actually read articles, full of animosity, declare that breastfeeding advocates are ‘nipple-nazis’ with an agenda. What would that be, exactly? I implore the readers of this book to consider that maybe, just maybe, there is truth in these messages. Act ‘as if’ there might be legitimacy to the idea that nature has a plan that allows you to have your cake and eat it too, so to speak. If, after you are finished with the book and actually done the work, you still don’t believe that birth can be wonderful, that’s fine. I have no problem in agreeing to disagree. It’s your birth to do your way. However, I would speculate that you’ve picked up this book to help you create a better birth. That goal is attainable if you go into this with a willing heart.

My childbearing days are done, so that fact that childbirth options are eroding at an appalling pace is of no personal concern to me. Stop. Did you inwardly scoff at the thought that women currently don’t have control over their births? Were you tempted to reject the very idea? Was your first reaction to rationalize that maybe other women don’t have options, but you certainly do? Then you need this book. Or, did you nod your head in agreement that certainly, you have no choice but to do whatever your care-provider tells you, even if it’s contrary to common sense? Then you need this book more.

Why do I passionately advocate for gentle birth? Believe me, I ask myself that question on a regular basis! Why have I put the time and energy into your babies by writing, lecturing, and teaching? There’s always a pay-off. What’s mine? I don’t own a breast-milk bank. I don’t hold stock in endorphins or prolactin (a couple of the body’s natural ‘feel good’ hormones). The fact that my husband calls this my ‘expensive hobby’ may indicate what the financial reward has been. I don’t get a fiscal incentive for ‘converting’ someone to a midwife-attended birth, nor am I rewarded with expensive gifts for support of holistic doctors (though, hey, I’m open to the possibility). I am very proud of the mothering decisions we’ve made, confident that they were right for us, so there is no emotional motivation in the ‘bad company is better than no company’ sort of way. I will admit to living vicariously through mothers who glowingly rave about the birth they originally thought impossible. I experience again the wonderment of my own birth. I also like being around these gently born children who exhibit impulse control, compassion and empathy, just as scientists researching undisturbed brain development suggested they would. I feel good knowing these kids will impact my world, and the world my child inherits, in a positive way.

Every time I’ve been ready to just tap out, someone has told me I helped them change their life. Someone told me the day I sat down to write this introduction. When I know that someone’s birth was an act of empowerment that helped a family bond into a beautiful thing, because of something I shared, it keeps me going.

My objective is to reduce irrational fear so that women can have the best birth they can have. A fear that is disproportionate to the actual risk is irrational. Fear of birth is completely out of proportion, as you will see if you do the journal exercises in this book, agreeing to keep an open mind about the facts you will read.

They may seem implausible with the current thinking of the average parent-to-be, but by the end of the book you should be seeing the possibilities that are available to you in a whole new light.

Entire chapters are devoted to issues of fear, guilt and motivation behind many controversies within the ‘birthing community’. I ask that the reader move through the book sequentially, taking a few days to mull over what they’ve read in each chapter and to do the work. The material is nothing new, but it may be new to you. It asks, for your own health and well-being and that of your baby, that you entertain thoughts you may never have considered. Some thoughts are contrary to popular belief. I will ask you to look deeply into beliefs you may currently hold as self-evident truths.

You can take control of what is controllable in birth, which is a great deal. This is how guilt is avoided…by being secure in the knowledge that you’ve made decisions based on all of the information available and with the best of intent. If you want a great birth, do what those who tell great births stories do. If you want to be one of the ones telling horror stories, do what everyone else does. It’s that simple.

During pregnancy and in the early years of parenting, if you don’t become knowledgeable it could affect your life in a big way. When you are knowledgeable, no one can take advantage of you. It’s much easier to do the work ahead of time. By reading this book you won’t be one of the increasing numbers of women asking, “Why didn’t anyone tell me?” I’m telling you, right now.

The question is, are you willing to listen?

PART ONE

Inspiration

Are your beliefs about birth constructed of perceptual reality or factual reality? How do you know the difference? How does what you believe about birth affect your birth? What can you do to bring your beliefs in line with science so that you might be inspired to reach higher? Is it possible to enjoy giving birth?

Clearing the Way

We all have a common objective...healthy, happy mother-babies. Used to it’s highest good, this book can save you time, effort, money, embarrassment, injury and maybe even a life.

Clear communication is essential if the reader is to maximally benefit from this work, so I would like to clarify some terminology that’s often tossed about quite casually.

Because it is human nature to assume others are like ourselves, we talk about birth with the assumption that we are all talking about the same experience. Differing birth philosophies mean we may not be, making for emotionally charged exchanges if we don’t first take this step.

Even though the majority of birth professionals go out of their way to use neutral language, inevitably miscommunication develops around such personal issues if terminology is not defined. It’s human nature to become defensive if a dearly held belief is being challenged. Nowhere are our beliefs held as deeply as those relating to childbirth and childrearing.

Certain terms are inappropriately applied to natural birth advocates on a regular basis. This misuse of language has even spawned new, judgmental terminology, which is interesting, because they stem from the charge that natural birth advocates are ‘judgmental’.

I offer the following dictionary definitions for a few of the most common of these characterizations, with discussion of the misapplication of each.

balanced: to make two parts exactly equal; a means of judging or deciding; counter balancing with force or influence; to equalize in weight, number or proportion; weigh; to bring into harmony or proportion. Common use regarding childbirth and parenting information: “I chose the hospital class because they provide balanced information”.

biased: to give a bias to; prejudice. (prejudice: preconceived judgment or opinion; a favoring or dislike of something without just grounds or before sufficient knowledge; an irrational attitude or hostility directed at an individual, a group or race; to cause or have prejudice: bias.) Common use regarding childbirth and parenting information: “I didn’t find that book useful because it was so biased”

judge/judgment/judgmental: to form an authoritative opinion by discerning or comparing; an opinion so formed; the capacity for judging; discernment. Common use: “Women on the natural childbirth message boards are so judgmental! What a bunch of birth nazis (or “naturalists” or other, ironically, judgmental labels)”.

natural: born in or with one; innate; being such by nature; existing or used in or produced by nature; having or showing qualities held to part of the nature of man; conforming to the laws of nature; not made or altered by man; marked by simplicity or sincerity; not affected. Common debate: What constitutes ‘natural childbirth’?

objective: existing outside and independent of the mind; treating or dealing with facts without distortion by personal feeling or prejudice. “I would like objective information about my birthing options.”

Which words accurately describe natural birth and parenting advocates? More importantly, which apply to the information about to be presented in this book? How are these words used in heated debate and who does it harm?

Let us look at “balanced” first…“to make two parts exactly equal.” What if the two parts are not equal? What if a parent will be making decisions that will affect her and her baby with both short and long term consequences. Is it fair to distort reality so that the information she has to choose from seems ‘equal’, even though it really isn’t? Why would a parent want information that appears balanced, but isn’t factual?

“a means of judging or deciding; counter balancing with force or influence; to equalize in weight, number or proportion; weigh; to bring into harmony or proportion” Using this definition, it would be reasonable to find the following in the hands of those that claim to seek “balance”:

Gentle Birth Choices, by Barbara Harper (which gives equal time to all options)

Five Standards for Safe Childbearing, by Stewert (which weighs all existing data on what makes birth safe)

The Thinking Woman’s Guide to Better Birth or Obstetric Myths versus Research Realities, by Henci Goer (both weigh current practice against the scientific literature)

However, that’s not usually the case. The books most often found maintain the status quo and are not supported by one bit of evidence…do not give “equal force or influence to” proven safe options such as homebirth or freestanding birth centers. By “informing” women that they can expect substandard care, women accept substandard care.

If asked why they chose a childbirth class at the hospital instead of an independent class, parents maintain it’s more “balanced”.

Consider this:

In a hospital class the childbirth educator (CBE) is an employee of the hospital. She may only teach pre-approved material. She may not be able to fully answer questions posed by parents if the response contradicts the protocols of the hospital, or even one doctor, no matter if she can provide scientific evidence for her answer and the doctor cannot. An instructor in an institution cannot give unbiased, balanced information that includes any providers other than those who sign her checks. Think about it from the hospital’s point of view…would you hire someone who would provide information that might help parents take their dollars elsewhere? As a doctor, would you send your patients to a class where they might learn there are other caregivers who practice under safer guidelines?

Classes in the hospital are actually more affordable because of the bias they operate under. Formula and drug companies subsidize these classes. The content of the class can be determined in large part by how involved other parties are. The ‘free’ gifts are not always ‘free’.

An independent instructor is not subsidized. Her passion for birth usually happened one of two ways—either she had such a horrible birth experience she went on a mission to discover what went wrong and now wants to spare you her anguish, or she had such a wonderful birth experience she wants to share the steps to better birth she used. I’m the latter, in case you wondered.

With an independent instructor, you sign her paycheck. She can fully, and honestly, answer any question you ask. She works as a CBE because she wants to make a difference, not because she’s grudgingly been assigned the task on top of her long OB nursing shift.

In fact, she may not even be a nurse, which is to your advantage. Nursing is a highly skilled profession requiring an enormous amount of knowledge from pediatrics to geriatrics; surgical to pharmaceutical. Normal labor and birth are a very small part of what they learn in their extensive training, and an even smaller part of their experience if the only births they ever witness are medically managed.

An independent CBE is an autonomous practitioner who only studies pregnancy, birth and (sometimes) early parenting. Because her specialty is quite narrow, she knows more about what you need to know. Her education likely included study of all birth options, as does her continuing education.

An independent instructor has compared and contrasted every option available to pregnant mothers. Having done so, her classes are most likely ‘natural childbirth’ classes.

Parents often think that’s what their hospital class is. If it’s called a ‘prepared childbirth’ class or an ‘expectant parent’ class, it’s not.

Even a class billed ‘natural childbirth’ may not be what it seems. There is confusion over what ‘natural childbirth’ means, which is why I included it in the list of terms to clarify. We can’t have a discussion about birth if we are not on the same page, so to speak.

There is a trend deeming any vaginal birth ‘natural’. Going back to our dictionary definition, “born in or with one; innate; being such by nature; existing or used in or produced by nature; having or showing qualities held to part of the nature of man; conforming to the laws of nature; not made or altered by man; marked by simplicity or sincerity; not affected”, what can logically be called ‘natural’?

“born in or with one; innate; being such by nature; existing or used in or produced by nature” could include a vaginal birth with natural (produced by nature) interventions such as nipple stimulation, herbs, positional changes or relaxation techniques that trigger the “relaxation response”, an innate biological state of being that counters the affects of the ‘fight or flight response’, which inhibits natural labor.

Is pitocin made by nature? No. Does it affect the natural process of birth? Yes. Are drugs such as stadol, nubain or Demerol made in nature? No. Do they affect the natural process? Yes. Are epidural drugs made by nature? No. Do they affect normal labor progression. Yes.

It would stand to reason then, that while a vaginal birth is possible with such alterations of the birth process, natural birth is not.

Please note that restoring the term ‘natural childbirth’ to it’s actual meaning does not ‘take’ anything away from anyone who wishes to reframe their experience. It simply brings the term back into compliance with the definition of ‘natural’ for the sake of clear communication. Perception is reality. Some prefer to call surgical births ‘natural’, which is their prerogative. I am choosing to use natural in the literal sense.

Also note that in doing so, no judgment has been implied. Distinction of natural birth, vaginal birth and surgical birth simply means they are dissimilar. There is no doubt that they are different experiences. Not better or worse, just different.

Even having taken great pains to use neutral language and explicitly state that different only means different, I know from experience that there will be a few people who will read ‘better/worse, good/bad, always/never’ where it does not exist. If your initial reaction is to do so, please take a moment to consider why. Is there a subconscious need to claim this rite of passage? Is there underlying self-doubt or low self-esteem issues? Is there inner conflict over the intent behind past decisions?

Birth does not place us in competition with other women. We do that to ourselves. Birth is the most singular experience with our true self that we can have. In the following examples, see how removal of the personal element by using a different experience shifts perception, thus reality.

Weight loss is very hard for some. One person may entirely change their diet and exercise twice a day to reach their goal. One person may take prescription drugs. Another may choose herbal, over-the-counter assistance. Yet another might have gastric by-pass surgery to achieve the same goal.

Each person reaches their goal, but they all have different experiences. We don’t define them with judgment words of ‘better’ or ‘worse’, nor do we judge the people themselves. What if we decided to call all of these experiences ‘natural weight loss programs’? Does deciding it make them so?

How about if we take it out of the medical realm? Since birth is not a medical event or illness, it may be more appropriate to use an example of marathon participants, where the objective is to test one’s endurance, finishing the race, but not necessarily first. Pride comes from the accomplishment of working hard to achieve a goal. There are no losers.

• One person trained hard all year, eating well and exercising daily.
• One person does the same, with the addition that he requires insulin for a diabetic condition (or any medication for any medical condition).
• One person does the same, aided by a prosthesis replacing a lost limb.
• One person does the same from a wheel chair due to paraplegia.
• One sort of prepares, but decides part way through the race that it’s too hard, and so catches a ride to the finish line.

All the same experience? No. There is no shame in finishing a race assisted by modern medicine when necessary. Indeed, those people must overcome obstacles others never even face. Should the person who could not have functioned without assistance of wheels be viewed the same as someone who chose them? How fair is it to the person who worked so hard to be put in the same category as someone who makes the decision not to? If the only goal is to cross the finish line, who is to judge how one gets there? The only opinion that matters is the participant’s. Who is to determine how a participant should feel? Who decides who will be allowed to say they did it ‘on their own’? Must we all agree on a definition of ‘success’, or is realty wholly the participant’s perception?

It’s obvious that ‘natural childbirth’ is a coveted experience, but how did it come-to-pass that the definition of ‘natural’ included the very antithesis of ‘natural’?

Intentionally. By manipulating language, we manipulate experience. ‘Natural’ should mean ‘normal’. By calling the obstetrically managed experience ‘normal’ despite the many non-medially indicated, inappropriately applied interventions used, those interventions then come to be seen as ‘natural’. This is the progression of how flat-on-the-back births with IVs, drugs, inductions and episiotomies came to be accepted as ‘normal’. Birth has been re-conceptualized, re-labeled and remarketed. It’s up to mothers to reclaim natural birth.

In order to do that, mothers have to stop arguing over what is ‘natural’. I propose the following commonsense definitions:

· Natural birth-Birth not made or altered by man; being such by nature.

· Vaginal birth-Birth wherein the baby passes though the birth passage, regardless of interventions used. A natural birth is a vaginal birth, but a vaginal birth may not be a natural birth.

· Surgical birth-Birth wherein the baby is surgically removed from the mother’s uterus.

All terms use the word ‘birth’; no term is inflammatory or derogatory; all are accurate and honest.

Honesty is frequently (and erroneously) called ‘judgmental’ when the subject is birth or parenting. There are two important components to this identity crisis.

One must first ask, “Was the intent malicious or benevolent?” then “Did the language actually contain judgment words, or did I hear judgment words?” and finally “If no judgment was intended or implied, why did I hear it? Is there self-judgment, or am I projecting judgment?”

Actual ‘judgmental attitudes’, the negative meaning usually ascribed to the term, are easy to spot and quite different from simple honesty when the two are compared and contrasted. I don’t know a childbirth professional who would ever make judgmental comments to any mother like those found in the second group that follows, though I know many who have been accused of saying those things when what actually they said was something similar to the neutral comments first presented. I won’t claim that no one, professional or not, ever passes judgment in a negative way, only that the accusation is most often unfounded.

Judgmental statements use judgmental words and blanket statements…bad, good, crazy, idiot, horrible, selfish, always, never. Shoot, just typing them made me feel bad. Please be aware that I do not hold the opinions given as ‘judgmental’! I do not know anyone who does. I have heard them mistaken for the honest statements, which is why I chose to use them as examples!

Honest phrases:

· There is no medical reason for routine circumcision.

· There is no artificial mother’s milk substitute that is good for babies.

· Epidurals have short and long-term negative effects on both mother and baby.

· Natural birth means “as nature intended.”

Judgmental phrases:

· Genital mutilation is never justified.

· Women who don’t breastfeed are selfish.

· Mothers who need epidurals are wimps.

· It’s idiotic to call an induced or epidural birth “natural”.

Who talks to other people that way? Not many, though, countless give themselves such harsh assessments.

Judgments are based on opinion and therefore cannot be substantiated. Anyone who hears them would be offended. Honest statements, on-the-other-hand, are made with neutral language. They contain verifiable truth. Honest statements do not hold judgment, though the judgmental may hold some truth, which is where people may get confused.

Honest statements may be heard as judgmental by someone who is judgmental, but not by everyone. An objective bystander hearing an honest statement might wonder why it would upset anyone.

An objective bystander would be hard to find, though, since we all see the world through the lens of our personal experience. We all form opinions from the time we begin absorbing our environment. Some of our opinions we have formulated on our own through experience, some we have inherited. This colors incoming messages. If we hear malice or judgment where it does not exist, it is the lens we currently use that distorts what we allow into our reality construct.

What if there is malice intended? What if a truly vicious person makes a comment with the sole intent of making another person feel badly for no reason?

It’s still all about the malicious person holding the judgment, whose reality is created by the lens that distorts their perception. Their judgment has nothing to do with anyone but them. Even if the judgment is directed at me, I know the person holding the judgment feels that way about everyone, all the time. If I don’t take it personally, it doesn’t have to hurt me. I can choose to ignore it, realizing it has nothing to do with me. Only you can decide if you will choose to let it mean anything to you.

Do you care what a stranger thinks about your birth? Do you care what anyone thinks about your choices? Why? How liberating it is to be able to step back and not take someone else’s perception of reality personally. It takes an awful lot of energy to be offended by comments with no offense behind them, and isn’t it also a little arrogant to think that the choices we make regarding birth are of concern to anyone but ourselves? By making assumptions and taking things personally, we only hurt ourselves.

Every person has a lens. Every opinion is biased, including the ones you hold. The question is, what created the perception leading to a particular bias? Does the bias benefit you or not? Is the bias warranted? Does your own bias prevent access of information that might benefit you? Is your bias based on fact?

When it comes to childbirth and parenting, when someone dismisses information as ‘biased’, what it actually means is the information does not fit with their already held biases. It is the things we feel insecure about that bring up defensiveness in the face of judgment, or perceived judgment, as the case may be.

If someone were to pass judgment on you for something you didn’t do or something you felt confident about, do you think you’d feel defensive or hurt? Not likely. You would simply shrug off the comment or the person making it.

This work and the works listed as resources are very much unbiased as they are based on scientific and experiential knowledge. In fact, the most common selections currently passing for “balanced” or “unbiased” childbirth information are actually very biased and highly prejudicial, based on nothing more than a slick PR campaign.

Judgmental? Let’s see: judge/judgment/judgmental: to form an authoritative opinion by discerning or comparing; an opinion so formed; the capacity for judging; discernment. By this definition, yes, it could be called judgmental as this information is very carefully weighed and considered. I will not own the term ‘judgmental’ in the way it is usually used, however.

One last human tendency that gets in the way of clear communication is making assumptions, especially from a ‘right’ or ‘wrong’, ‘good’ or ‘bad’ mind-set. This has created an enormous chasm between those of us trying to help women create better births and the women themselves.

Is ‘better’ a judgment word? Only if it is applied in the context of ‘my birth was better than your birth’. Current birth management leaves us with 27 countries with fewer babies dying than the US. (March of Dimes Perinatal Data Center, August 2002) This is worse than when I began teaching 10 years ago. Current birth management is leaving mothers feeling that they can’t cope, with war stories instead of joyful birth stories. Current birth and parenting advice, in the noble attempt to not offend anyone, gives advice that helps no one. We can do better. That is how I use the term.

In any case, assuming one personal choice makes another one wrong distorts communication about the choices themselves.

· It is assumed that if a mother has a homebirth she hates doctors and hospitals.

Truth: Homebirth mothers recognize that hospitals and doctors are necessary in special circumstances. If they were sick or injured in pregnancy, they would not hesitate to gratefully utilize technology.

· It is assumed that because natural birth advocates want parents to have truthful information about labor drugs they are against compassionate use of, or medically indicated pharmaceuticals.

Truth: Not so…only unnecessary or inappropriate used, without full disclosure of risk.

These are personal examples. I have faced judgmental attitudes for my choices many times. No one can make me feel anything I do not choose to feel. The judgment I’ve encountered doesn’t phase me because I am confident that I’ve made the best choices for myself and my family with the information I had at the time. I’m not concerned if anyone agrees with me or how they feel about what I do. At times I’ve attempted to explain my decisions, until I realized that the people making assumptions and judgments don’t actually want to hear about solid decision making strategies if it conflicts with what they already believe to be true. They don’t even hear, much less listen or consider.

As you work through this book and start making decisions that may be different from what our society considers the norm, you may hear comments with a lot of anger and hurt behind them, seemingly directed at you. Comments like, “Well I did [such and such] and my kids are just fine!” when you never implied that they weren’t. You may never even had a thought in your head that the other person could have or should have done anything differently, but they are seeing your actions though their own lens and making assumptions. It doesn’t have anything to do with your choices or why you made them.

In fact, if you tried to explain why you made a particular decision, they probably won’t even hear you because they aren’t upset about you and your decision…they have issues with their own decisions. They are stuck in an either/or mind-set.

If you think your decision is right, the assumption is you think their decision was wrong. It’s best to just let it go. We are only responsible for our own heath and well-being.

It is true that those of use who have been trying to improve the safety and experience of birth for decades get frustrated when we hear horror story after preventable horror story.

We want so much better for women and babies, not because we’re judgmental or think that every birth can (or should) be the same, but because we’ve seen so much sorrow that didn’t have to happen!

If you were psychic and could foretell a train wreck about to happen, would you be frustrated that a person ignored your warning and was hurt?

If your adult self could go back and tell your child self what you know now so that her life could be better, would you? Would you be aggravated if she didn’t listen?

Natural birth supporters aren’t trying to scare you by telling you what you don’t want to hear, we are trying to help you! What you don’t know can hurt you! If you don’t know your options, you don’t have any. If you make decisions that net the expected, with all the unhappiness mothers now complain of, we are sad that you have to endure that…not judgmental. Closing one’s eyes to the truth does not make it cease to exist…it only makes one powerless to deal with the reality.

Which brings us to ‘objective’. Natural birth advocates are often passionate about natural birth. Passion does not preclude objectivity. If a person’s personal opinion is based on emotion alone, then obviously they are not objective. However, if their passion arises from facts ‘existing outside and independent of the mind” and there is no distortion of the facts ‘by personal feelings or prejudice’, then the information is quite objective. How does one know the difference? Test the validity of the assertion. In this work, I have provided the resources to do just that in the notes. Yes, I’m passionate. I’m also objective.

So who am I and why would what I have to tell you matter?

I am you. I am a daughter, a wife, a mother. I grew up in the Midwest in the typical American family with 2.2 children. I was influenced by the same cultural ideas about pregnancy and birth that most people have.

The ‘point two’ child came into my family when I was 13. As a strong willed child prone to testing the data, I questioned everything my mother went through. I wanted to know ‘why’ to everything. I found it strangely disconcerting that there were no logical answers to my questions. Even the answers that were supposed to be logical didn’t compute.

Why would a woman need to be cut (an episiotomy) to get a baby out? If nature were so incompetent as to make the birth passage inadequate to birth a baby, why weren’t all mammals walking around with damaged vaginas? As it seemed to me, only human mothers were…due to the episiotomy! There were dozens of other illogical (to me) rituals in becoming a mother. Often the only ‘reason’ for them was because “That’s what they do.” (Ah! The ubiquitous they!)

My husband and I were faced with infertility when we decided to start our family. In researching reproduction, I began to learn that my instincts about birth were right. Not only was there no good reason behind much of the technology routine in modern birth, but much of it was actually proven harmful. I began a path toward midwifery, certain that with all of the information available…information that eventually enabled me to have a wonderful, safe birth without being cut, poked or drugged once we finally conceived…women would soon be looking for ways to have empowering births like mine.

That didn’t happen. In fact, in the 80’s and 90’s a plethora of unproven technologies continued to be unleashed on women with no improvement in outcomes(1), many with serious questions of not only efficacy but safety. Women became more fearful than ever. The harder those of us in the know tried to impart vital knowledge, the faster women ran toward the burning barn. I couldn’t figure out why women were rushing out to learn what to expect instead of learning to expect better. It took me years to figure out the reason. It had nothing to do with facts and everything to do with belief.

I set aside my midwifery aspirations to concentrate on what had, at first, been a steppingstone to midwifery...education. I focused my attention on writing and teaching. Still, the ones who ‘got it’ were few-and-far-between. I felt like I was spinning my wheels. Why couldn’t I get through to these intelligent parents?

I couldn’t get around their fear.

Whether consciously acknowledged or unconscious in nature, until the fear is dealt with, the belief holds firm. I educated myself on how to release false assumptions and applied critical thinking skills to our common cultural beliefs about birth. Mother’s Intention and Woman’s Wisdom sprang to life.

If used in pregnancy, birth and early parenthood, success—and by results this means the safest birth possible for you and the easiest transition into parenthood—is inevitable.

You will find that this material is based on evidence-based care…and that what you think you know just isn’t so when it comes to maternity care in the US. I feel a duty to use my life to educate women on evidence-based care, which they believe is what they are getting. Women in America today are basing life-altering decisions on belief that they think is fact. Each subsequent decision is affected by that very first belief. Everything I share will be substantiated so that the reader can research the data. Not only do I encourage it, I expect it.

Sometimes wisdom comes from odd sources…I live by this little gem I found on a tube of lip balm years ago, “Examine everything you’ve been told. Reject what insults your soul.”

Being Honest about Motherhood

Recently Dr. Phil and Oprah(2) have done shows on the difficulties mothers face today, from dealing with postpartum depression and the loss of ‘self’ to not wanting to be mothers at all.

Mothers are in crisis. They are having trouble coping. Many are disillusioned that no one told them how hard this job was.

Some are angry at the discovery that it’s not a task that fits neatly between day jobs and isn’t even a simple day job itself.

They feel unable to deal with the problems and challenges they are faced with, assuming they are somehow deficient. They wonder how other mothers do it, or they insist the mothers who say they love it are lying. Some may be faced with challenges they didn’t sign up for. Even more have created problems where none would have existed but for the choices they made, yet our ‘feel good’ society is loathe to point that out for fear of seeming to ‘mother bash’. How can anyone learn from their mistakes if everyone is too afraid point out that the mistakes exist?! The emperor is naked, people!

If you are one of the mothers feeling overwhelmed, you may feel it’s unfair that your life seems out of control. Maybe it is. I don’t want to minimize the magnitude of the job. It is enormous. It’s the best job in the world, but that doesn’t mean you’ll love doing it 24/7. The fact remains that it is what it is and you need to find a way to manage it. You need to know what you are culpable for so that next time around you don’t make the same mistakes. Most women will only get a couple of cracks at this motherhood thing.

This book won’t tell you what to expect. What you can expect will change based on your own actions. Without action behind intent, there is no growth…no change. You get what you put into it, for better or for worse.

An open mind is essential for creating the birth you want. Letting go of resistance is imperative. Believe me when I say that there will be long held ideas that will be challenged. Give the new ideas a fair chance. Test their accuracy and validity.

For most parents-to-be, someone else is controlling your outcome. Parents are just rolling along with no plan, leaving the most important work with which they’ll ever be entrusted to chance. These parents will live with the consequences of their choices for a lifetime, yet decisions are made without true informed consent or worse, under duress as their fear and love for their baby is played upon.

Are you holding yourself, or those making life-and-death decisions for you, to the same standards to which foster or adoptive parents are held? What’s in “the best interest of the child.” Or, are you doing what ‘everyone else’ does just because everyone else does?

How did we get here?

We didn’t arrive by accident at this place where common sense is uncommon in obstetrical care. The progression is easy to dissect and examine.

Human behavior in obstetricians is the same as in the rest of us. Some of the traits we will explore in ourselves (and in these human beings who have bore the weight of our perceptions) are not pleasant to face.

It is necessary though, because nowhere else are they more damaging than in our experience as parents. For as a parent, you are not only accountable for your own life, but the life you have created, and, by extension, all the lives that life touches. Talk about a ripple effect!

Very pulled together people, people who excel in every other area of their lives, still will not ask themselves the questions that beg to be asked regarding parenthood. Mothers are drowning in guilt already, so it’s become politically incorrect to talk about accountability. “Of course, it’s a choice” we say of so much of parenting, and of course it is. But few are willing to say there might be better choices. This is unfair to the mothers who are yet to come, for implying that all choices are equal when they simply are not cheats them out of the opportunity to make the better choice. It is a symptom of a destructive human trait…denial.

Parents are not immune to the tendency to make assumptions without testing their integrity or accuracy. Every choice made from an erroneous assumption is then flawed. In pregnancy and birth, the consequences can be fatal. Shutting out additional possibilities because of the ‘rightness’ of what you believe means you fail to see what is. Thinking that stems from this may seem logical, but the conclusions are wrong. Just because you want something to be true doesn’t make it so.

Many obstetricians are stuck in this place. They’d rather be right than be safe. Show them the evidence that ‘standard of care’ is ineffective or harmful and they will dismiss it, or even manipulate the data to substantiate their position. Most of the time they aren’t questioned. The media carried the ‘news’ that a study now confirmed that VBAC(3) is dangerous. They didn’t say that it was the same study that ACOG(4) used to support VBAC just a few years ago, or that there are a multitude of better designed studies that also say VBAC is safer than repeat cesarean(5). It didn’t take long…not even weeks…for this recommendation to become ‘we need to support elective cesarean”. Watch the numbers of surgical births…they are about to skyrocket. This is not a good thing. I hope that by the end of this book you will understand why.

Then the companion book, Woman’s Wisdom, can help you avoid being a statistic.

I must state here that the human tendency to assume can color how the above information and that which follows is interpreted.

Therefore, I need to make clear from the outset that when I provide information on evidenced-based care and the dangers of ‘obstetrical management’, I am critical of a broken system that is statistically, scientifically and experientially not working.

I am not condemning the doctors within that system, nor do I have comment on particular institutions within that system. There are shining stars trying to fix what’s broken from the inside, and their work is difficult. If you are one of the fortunate that cannot reconcile your experience with what you are reading, you have probably found one of them. Reward them with a Certificate of Commendation from the Association of Nurse Advocates for Childbirth Solutions or nominate the institutions in which they work for Mother-Friendly Childbirth Initiative designation through CIMS, the Coalition for Improving Maternity Services. (See notes for further information)

Unfortunately, these special people are all too rare. Results don’t lie. Again, unfortunately, I have to say that this book will benefit those that think they are in the ideal situation, but may not be.

Maybe they are, but I’ve seen far too many women who loved their doctors because they were ‘nice’, assuring them they would not do anything that wasn’t medically necessary, only to end up with the same unacceptable results so many women face everyday. Lulled by a caregiver’s reassurance that “of course pregnancy and birth are a natural process, but…” throughout pregnancy, they are blindsided in the last 6 weeks with one (or more) of those “buts”. There are a multitude of reasons, it seems, to ‘get that baby out of there’…baby is too small, baby is too big; premature labor threatens, mom is ‘overdue’; too much amniotic fluid, too little fluid. These are all very real concerns…in an extraordinarily small percentage of pregnancies. Yet, an alarmingly high number of women are ‘diagnosed’ with these conditions. What’s a parent to do?

I am encouraging healthy skepticism, not fostering distrust. Asking for evidence beyond “Because I say so” is reasonable adult behavior when adults must make important decisions. If results back up the words, your relationship improves…your trust grows.

An example of this is that there are doctors and nurses attending homebirth as well as midwives.

There are many within the current non-functioning system that have done their homework and will tell you, if you ask, that it is a viable option if you are healthy and have a skilled attendant.

Still, the ‘official’ opinion, and the one you will hear most often from doctors is that homebirth is not safe. What is that based on? Two ‘studies’ done by…doctors. They don’t usually share that these ‘studies’ are virtually identical in their questionable methodology and stand in lonely opposition to every other independent study indicating homebirth is as safe (or safer) as hospital.

Also not mentioned is that the studies did not compare hospital to planned homebirth with midwives. In order to get the results they included abortions, stillbirths, infanticide and unplanned out-of-hospital births…i.e. taxicabs and elevators(6). Not quite a fair representation.

Lack of critical thinking isn’t questioned by many within the profession or without. (Please notice I didn’t say all. A good OB who practices evidence-based care with an open mind is worth her weight in gold…keep her!)

Another example is that gestational diabetes testing is routine for most women, devoid of symptoms or any risk factors what-so-ever. The American Diabetes Association does not advise this, and for good reason. It’s not reproducible 70 out of 100 times! It’s not accurate, it’s harmful to women, yet it is the ‘standard of care.”(7 8)

Yet another example: I have a friend who broke her tailbone four days past her estimated due date. It hurt like crazy.

At the hospital, she was told all they could give her for the pain was a commonly available pain reliever because anything stronger would be bad for the baby. BUT…if she went into labor, (or if they just would let them induce her), she could have an epidural or Demerol. Excuse me? Why is it not OK to relieve the pain of a pathological condition that is by it’s very nature painful, but it is OK for a normal, physiological process that can be quite comfortable without drugs? (more on that later) If she went into labor in 10-minutes she could have it, but not now? How does the difference of 10 minutes make it less dangerous? The same rational makes it not ok for a mother to have narcotics or a ‘caine derivative in her system if she puts it there, but it is OK if the anesthesiologist does? (I am not advocating illicit drug use here…simply pointing out that epidurals, which an estimated 90% of our babies are born under the influence of nationally, are comprised of narcotics and ‘caine drugs.)

Why are women undergoing painful obstetrical procedures often scolded for complaining, or told their pain is imaginary and that it’s ‘not so bad’, but it’s considered ‘cruel’ to encourage birthing without drugs?

Our faulty logic regarding pain, labor and women’s capabilities has led to some truly convoluted thinking about what is ‘normal’ in the postpartum period. Our double standard concerning labor drugs vs. other applications of use has required that we distort what is considered ‘normal’ newborn behavior, with disastrous consequences to the mothers who based their decisions on misinformation without question.

Mothers may not want to consider that a simple uninformed decision had consequences for their child that might have been avoided, such as a continuous ear infection since birth, deathly food allergies or diabetes relating to artificial infant feeding (9). They may choose to believe that their child’s neurological challenges couldn’t possibly be due to the non-medically indicated, repeated ultrasound exposure (10), the epidural exposure (11) or a combination, despite the studies that suggest these technologies should be used sparingly. Our wondrous brains provide us this natural, protective mechanism to help us avoid agonizing over things we cannot change.

However, if we chose to resist the notion that choosing the behavior is choosing the consequences, mistakes are repeated and blame continues, improving nothing. I can only help those that expect more of themselves and for their children.

Have you made choices that might be setting you up for an unintended outcome? Is this a second child and you wonder if something you did, or didn’t do, created a problem with your first child? Do you wonder if yours was an unnecessary cesarean, or if jaundice was a result of the labor drugs that your baby had to try to process with an immature liver? Angry that no one told you what you didn’t dream you would need to ask? You shouldn’t have to, but until overall outcomes improve, you do. It’s a lot of work you shouldn’t have to shoulder, but you do if you want to be safe. You have no choice at this time in history.

If you are angry about that, I feel the need to say very clearly, find a way to process that anger. I’m not here to judge, but to support and educate. I am here to tell it like it is, which means some people will be facing some painful epiphanies. However, guilt and shame will paralyze you. That’s not its purpose. It’s an internal emotion meant to help us modulate our own behavior in a positive way. No one can ‘make’ you feel guilty if you do not choose to hook into that. If you feel good about your choices, knowing in your heart that your intent was well-meaning and you did the best you could, there is no purpose in feeling guilty. If you did make the best choice you could with the information you had, and later find out there was a better choice, you need to ask yourself, “Would I make the better choice next time?” If the answer is ‘yes’ the feeling of guilt has done what it was meant to do. If the answer is ‘no’ and rift with excuses or justifications, then it’s supposed to nag you.

Either way, what is, is. All you can do is deal with what’s before you. You can’t change the past. You may be able to compensate or you may need professional help to let it work through your feelings, but holding on to it will eat at your soul.

If you are feeling over-whelmed, that’s understandable. We should learn all of this in college, or better yet in high school, so we can enter this most important transition with calm confidence and joy. I’m trying to build that reality for my daughter. I hope you’ll help me for the sake of your own daughters as well as yourselves.

After you’ve done the work in this book, you may wonder how anyone could make decisions you now see as clearly unfortunate. You’ve done the work, you’ve stepped through the looking glass, and it’s painfully obvious that others haven’t. You are free of the cascade of deficits that handicap those working from faulty assumptions and are confident in your ability to be the best parent you can be. It may feel lonely until they catch up.

Parenthood is the toughest job that you’ll ever do. It’s also the most rewarding. It begs us to stand alone sometimes, even when we are uncomfortable with it, because our children expect us to be the best we can be. Their lives are in our hands.

Journal Exploration:

What assumptions or beliefs regarding birth are you willing to challenge? What might be a problem not acknowledged or too painful to face? Is there something you fear about birth and labor? Are there concerns about new motherhood?

There is a high probability that what made this list are things over which you have at least some control, through your thoughts, choices or actions, even if that seems unlikely with your current thinking. Are you afraid of complications in birth? Most preventable complications, and many are preventable, are related to nutrition. Have you learned about how you need to eat to grow a healthy baby? Have you stopped smoking?

Some complications are seen almost exclusively in obstetrically managed births…have you interviewed midwives, made a birth preference list or do you need to find an ob that shares your birthing philosophy? If you avoid the non-medically indicated intervention, you avoid the complication. Do you know what would constitute a medical indication for specific interventions likely at your place of birth or with your current caregiver? Do you know what complications are common to certain interventions?

Knowing what you have control over allows you to be more accepting of what you don’t.

How Important are Parents?

Many of the choices parents make on behalf of their baby with little or no conscious thought, from the childbearing year through the first 3 years, will set the stage for the life the child for as long as they draw breath.

There has been a five-fold increase in childhood diabetes in the last 10 years (12) that many logically attribute to low breastfeeding rates in the US. (13 14 15) Autism has increased by at least 400% in the last 10 to 15 years which some speculate may be due to vaccinations (16) and others to mothers who smoke or inappropriate birth technology. (17) Other autoimmune disorders, like MS, are also on the rise, with suspected origins in infancy or early childhood. Life threatening allergies are such a problem that schools have ‘peanut free’ zones. Is it coincidence that the first four ingredients in formula are four of the top ten allergens, including peanut oil?

Children with no attachment skills, empathy or sympathy are becoming so dangerous that my fourth grader had to have practice ‘lock downs’ with her tornado and fire drills. In her second grade class, if the timing was off it was impossible to even get into the classroom until the line of kids waiting for their a.m. Ritalin had been dosed and cleared away. I had home-schooled for a while and people asked me if I wasn’t concerned about socialization…what socialization would that be? What she got from the kid who tried to stab her with a pencil? Or, the kid who pushed her face into the pavement on the first day? (18) Or maybe the ‘socialization’ she got that had her vomiting for days and spiking a temp. of 103 degrees? The child that shared that with her told her mother she didn’t feel good as she was dropped off at school and her mother told her ‘when you start puking, call me.’

We’ve lowered the bar on ‘normal’ so that we can feel good about what can, not should, be expected of our children. Mothers of gently, naturally born, attachment parented, breastfeed babies are often told “I could never take my kid everywhere! They would drive me nuts!” or “Wow! Your baby is so smart! Good genes!” or “How lucky you are that you ‘get’ to stay home.” That last comment made to a mother who gave up a lucrative teaching position for a few years to stay home with her children, by a mother who then went on to talk about the liposuction on her butt and the new home she was having built, which she “had” to work to pay for!

Postpartum depression (PPD) got a lot of press after the Yates case, in which a mother murdered her five children due to postpartum psychosis. PPD got some much needed attention, but it wasn’t long before it was deemed ‘normal’ as long as it didn’t degrade into psychosis. Why? Because so many women experience it. Is what they experience due to birth? Or what has become of birth when all of the natural mechanisms in place for the perpetuation of the species are tampered with?

Finally, some researchers are looking into that and wondering if maybe what American women are experiencing isn’t postpartum depression (PPD), but posttraumatic stress disorder (PTSD)(19). Listen to mothers of the typical American birth tell their ‘war stories’ as they show off their scars and it’s an easy leap to make. If the process of birth were the cause, it would stand to reason that other cultures would be experiencing the same rise. That doesn’t seem to be the case. Plenty of mothers here and around the world aren’t experiencing PPD or PTSD at the rates seen in obstetrically managed mothers in the US.

It would be ridiculous to insinuate that any one thing is responsible for all of societies ills, yet there is undoubtedly a cumulative effect on health and emotional well being when brain development is disrupted due to poor nutrition, smoking, drugs (including non-medically indicated labor drugs), lack of brain stimulation and/or lack of mother’s milk. The majority of these things also disrupt the bonding process, which leads to other problems in the mother-baby dyad. Thus, mothers begin their new relationship in the red and wonder why they are having a rough time!

Mothers need to know what true ‘normal’ is and where ‘average’ lies so they know when to ask for help. They need to know what choices or actions can contribute to ‘abnormal’ so they can avoid them. Instead, growth charts for babies are printed by formula companies, with ‘average’ determined by children who have never had a drop of milk that their mother’s body made specifically for them! Mothers who do feed their babies human milk are being told their children fall outside of the ‘norm’! It doesn’t seem to occur to many people to ponder the fact that cows milk is made for baby cows with four stomachs, weighing over 100 pounds at birth. Mothers are instructed not to give babies under 12 months cow’s milk because of the allergenic properties, yet most formula is made from, you guessed it, cow’s milk. If not cow’s milk, soy, which is also on the list of top ten allergens.

The corruption of the natural processes meant to ensure the continuation of the species can only go so far. We are only glimpsing the ramifications of our actions. Women who have had, or are having, empowering experiences, who are making choices that bring themselves and their families peace and health, need to pass on their wisdom.

This is a book about how we all contribute to or diminish, the world we live in. It’s about fact gathering and basing decisions on solid evidence instead of belief.

It’s about judging success by results. How’s the current system working?

· 25-30% of babies are cut out

· In a recent Harris Poll conducted by the Maternity Center Association, there were NO natural births in the study, despite the fact that 45% said they agreed with the statement that “giving birth is a natural process that should not be interfered with unless medically necessary”.

· Women are so afraid of birth they are fueling these insane trends themselves.

· Women are forming support groups to ‘get through’ the weeks or months it is taking them to love their babies, declaring that bonding is a myth because they didn’t experience it.

· Women are saying their breasts are bleeding due to normal usage in the physiological function for which they were designed, as all other mammals use them without incident.

Folks, this is NOT NORMAL or healthy.

Journal Exploration:

Take a serious look at excuses you might give yourself to justify failing to make meaningful changes to improve your birth outcome. Be honest about ways you might sabotage yourself. If your caregiver is leading you down the path of cascading intervention that leads to an unnecessary cesarean, will you make a stand? Why or why not? If you leave his office in tears, unsure, confused, angry or afraid, will you fire him? Why or why not? Have you quit smoking? Are you eating healthy? If not, what do you tell yourself to make that ok?

Is what you’re doing working? If you say the thing you are most afraid of is a cesarean and your doctor insists that you will need one because your baby is breech, do you seek out a caregiver skilled in breech, knowing that a cesarean for breech is five times more dangerous for the mother with no improvement in outcome for the baby(20)? Do you try any of the known successful techniques for turning a breech to head down(21)? Why or why not?

If you desire a VBAC and your doctor will only allow it if you have an epidural and augmentation, do you gather the evidence against such dangerous protocol? Do you insist he follow evidence-based practice or let him know you plan to find a provider who will?

Are you happy, empowered, healthy? Do you feel confident, knowledgeable and safe? Be honest with yourself. Is every visit a confrontation or exercise in futility? Are you heard? Really heard.

Are your provider’s actions and words saying the same thing? “Oh, we only use intervention when it’s necessary” doesn’t hold water when you are routinely given every non-medically indicated test in the book.

If coercion is used to manipulate you in pregnancy, why would you expect different at your birth? If intimidation seems second nature, pay attention. A good doctor never says, “Am I the only one that cares about this baby?” Good doctors react in a reasonable manner to reasonable requests. They appreciate a parent responsible enough to participate in their own good health. They see the wisdom in a good working relationship with actual informed consent. Find those doctors…or a good midwife. Not doing so means that you have agreed to the outcome, good or bad.

A picture paints a thousand words, so let’s paint…

A woman comes to an independent childbirth class. She takes everything she is learning to her care provider, expecting to be able to talk about her concerns. Her provider refuses to look at the material from her class, with the comment that it’s all garbage because the instructor ‘didn’t bother to get an education’. (I’m not sure if this means her knowledge isn’t relevant because it didn’t come with a nursing degree or what, but it certainly shows ignorance over what certification to become a autonomous childbirth educator entails.)

The mother keeps going, keeps pushing for care that is individualized to her. He continues to become more irate with each visit, with each question, until finally, he (fairly) tells her, “If you don’t like the way I do things, find another doctor!”

For whatever reason, she doesn’t.

Her biggest fear is of episiotomy and the affect it could have on her life. She shares this with her doctor, who tells her that he will only do it if he has to. He become irritated that she asks how often he finds it’s necessary.

His actions become increasingly punitive, yet she keeps going back.

Her birth includes a huge episiotomy that extends into a 4^th degree laceration (when the tear extends through the rectum…seen almost exclusively with an episiotomy). She is told that it’s a good thing that episiotomy was done because her baby’s shoulders were stuck and would have died without it.

The medical term is shoulder dystocia. It is a real condition, happening primarily to larger babies (and by larger I mean 11 or 12 lbs., not 8 or 9) in which the shoulder of the baby becomes wedged behind the mothers pubic bone. There are classic signs of shoulder dystocia that a care-provider looks for. None were present at this birth. There was video showing a perfectly normal 2^nd stage. (This is why so many hospitals now ban video recording of the birth.)

While there are certain instances when an episiotomy might be helpful in rectifying shoulder dystocia, it is not what resolves the situation. Think of it like this…if you were trying to walk through a full screen door that is 4 ft. wide, while carrying a 6 ft. long board, parallel to the floor, would cutting the screen make it possible? No. You would have to turn the stick 90 degrees, break the stick or break the doorframe. The screen is pretty much irrelevant. Remember, however, there was no dystocia. The birth team was simply unaccustomed to physiological 2^nd stage. If all they’ve ever seen are babies shooting out because mom is purple pushing with a big slice to her bottom, the relaxed pace of ‘breathing the baby down’ can be misinterpreted as the mom being ‘too tired’ or the baby being ‘stuck’.

The mother wants to blame the doctor for everything gone wrong in her life since the birth by suing the doctor and she asks the childbirth educator to help her.

If the CBE subscribes to the philosophy of responsible decision- making I’m talking about here, how do you think she would respond to such a request? She refuses, of course and reminds the mother that she chose the care-provider and the birth location with full knowledge of the probabilities. The outcome is her responsibility alone.

Alternatively, if you find yourself saying, “It’s the price you pay for a good doctor” kick yourself…and then find a new doctor. I’ve got news for you. Good doctors charge paper money for office visits—they don’t demand pieces of your broken soul or abused body.

You deserve better. Your baby deserves better. Husbands, your wives…the mother of your children…deserve the best. However, no one can change a situation like those above but you. Mind you, these are all real examples and sadly they aren’t all that uncommon. The above examples happen so often because they can.

Good physicians know all this is true and try to provide safe and effective care. They have formed groups Physicians for Midwifery(22) and the peer pressure they face is incredible. They will be the first to tell you that good care does not mean bad treatment. That’s why this book is so important…it helps you spot the good guys.

Notes on Chapter One

1 “Maternal mortality statistics have not improved since 1982.

The Safe Motherhood Quilt Project is an effort to bring attention to this fact and find solution. www.rememberthemothters.org/inamay.html

World Health Organization, revised 1990 statistic (published in 1996) put the US at 24 in maternal mortality, which had dropped from 21 in previous years. Efforts to find a more current published report were unsuccessful.

US infant mortality rating (1998, March of Dimes) is 28th in the world.

2 September, 2002

3 Vaginal Birth After Cesarean

4 “What Every Midwife Should Know About ACOG and VBAC: Critique of ACOG Practice Bulletin No. 5, July 1999. Vaginal Birth After Previous Cesarean Section” by Marsden Wagner, MD, MSPH “ACOG is not a college in the sense of an institution of higher learning, nor is it a scientific body. It is a ‘professional organization’ that in reality is one kind of trade union. Like every trade union, ACOG has two goals: promote the interests of its members, and promote a better product (in this case, well-being of women). But if there is a conflict between these two goals, the interests of the obstetricians come first.”

5 The Assault on Normal Birth: The OB Disinformation Campaign, by Henci Goer©2002 Midwifery Today, Issue 63, Autumn 2002.

6 “Out-of-hospital births pose a 2-5 times greater risk to a baby’s life than hospital births”,1978 news release passed off as a ‘scientific study’ by ACOG.“Outcomes of Planned Home Births in Washington State: 1989-1996. Pang, J., Heffelginger, et al. August 2002 100 (2): 253-259 Basically, the same poor science dressed up, claiming the same outcome.

Fifteen scientific studies that refute the above findings, http://www.qis.net/~mfm/studies.htm.

Detailed account of the problems with the Journal of Obstetrics and Gynecology report: Obstetricians Use Dubious Method In Attempt to Discredit Homebirth, Motives Questioned by Parents, Midwives, and Public Health Researchers, February 11, 2003 http://www.ican-online.org/news/headlines.htm

7 Understanding Diagnostic Tests in the Childbearing Year, Anne Frye, Labrys Press

8 American Diabetes Association, www.diabetes.org

9 Breas milk prevents Childhood Diabetes, 1999, Dr. Gabe Mirkin

Breastfeeding and Allergies: Protection Now and for the Future, P. Christine Smith

www.breastfeed.com

10 Ultrasound Unsound? Beech & Robinson 1996, Association for Improvments in the Maternity Services, London.

Ultrasound: More Harm Than Good? Midwifery Today, Issue #50, Summer 1999, Dr. Marsden Wagner, neonatologist, epidemiologist.

11 The effects of Maternal Epidural Anesthesia on Neonatal Behavior During the First Month, Sepkoski, Lester, Osthemimer, Brazelton, Dev. Med Child Neurol 1992 Dec: 34(12); 1072-80

12 http://outreach.rice.edu/~trsler/nurse/2002/obesity_diabetes_article.pdf

13 www.drmirkin.com/diabetes/D216.htm

14 E.J. Mayer et al. “Reduced Risk of IDDM among breastfed children” Diabetes 37 (1988): 1625-1632

15 www.midwiferytoday.com/articles/foodforthought.asp

16 www.909shot.com/Diseases/Autism.htm

17 www.no-smoking.org/july02/07-30-02-1.html www.garynull.com/Documents/autism_99.htm

18 Ghosts from the Nursery: Tracing the Roots of Violence, Robin Karr and Meredith S. WileyAtlantic Monthly Press, New York, 1997

19 Birth 28:2 June 2001, “Do Women Get Postraumatic Stress Disorder as a Result of Childbirth? A prospective study of incidence”. Susan Ayers, PhD and Alan D. Pickering, PhD.

20 Mode of Delivery for Breech Presentation, a bibliography,

www.childbirth.org/section/vagbreech.html

21 Hypnosis and Conversion of the Breech to the Vertex Presentation, Lewis E. Mehl, MD, PhD, Dept. of Psychiatry Univ. of Vermont College of Medicine, Burlington Arch. Fam. Med. 1994; 3:881-887

22 www.well.com/user/zini/pfm.html

Birth Beliefs

It’s easy to tell the women who’ve done the work from those that took the ride.

Those who’ve done the work are enjoying the path of parenting, whatever has befallen them along the way. They are informed and confident in their decisions. These mothers can’t wait to tell you about their incredible labors, drug free, ecstatic, pain free, or at least manageable births. They are so blissful they seem almost evangelical in their zeal to share the joys of motherhood, even if Mother Nature tosses them a few challenges. Because they have more good days than bad, these challenges are met head on and probably soon forgotten. They forgive themselves when they mess up.

Those who took the ride feel ripped off, assuming the joyful mothers aren’t for real, that such an ideal doesn’t exist. Others are angry and bitter. They believe great births exist, but believe they can’t have them, as illustrated by the following mother, reviewing Naomi Wolf’s book, Misconceptions: Truth, Lies and the Unexpected on the Journey to Motherhood:

“…all the happy-earth-mama books about midwifery and doulas and all those candlelit bonding moments with a new squealing infant are put in their place---as happy fairytales that happen to a few women in America.”

The irony is, it happens to so few women because so few women make the choices that result in those births…not because they aren’t possible! The ‘fairy tale’ births should be the norm!

The women who have been ‘lucky’ enough (who might argue that luck was just a small part of their experience) are women with imperfect lives—nobody is perfect—but they educate themselves, they have a support system and they operate from a place of empowerment. Their convictions are strong because they are sure they are doing what works for themselves and their babies.

These happy mothers, because they want others to be able to enjoy the journey as much as they do, are often accused of trying to make other mothers ‘guilty’ for making different choices, when what they are trying to do is share the choices that brought them joy. Of course, in any population there will be a few judgmental people, but in my experience, most of the time, it’s not the happy parent that is doing the judging, but the unhappy parent. The happy parent’s only mistake is assuming that when women say they wish their lives could be like theirs, they really mean it. Knowing it can be, they give advice they thought was solicited, puzzled by the ‘yeah, buts…’ that follow.

Naomi Wolf, in Misconceptions, doubts the existence of these happy moms who face few challenges in their new role. (Note that I did not say ‘no challenges’.) While her book is an excellent read with invaluable information, she draws some interesting conclusions that I didn’t expect from such a smart woman.

Pages and pages are devoted to exposing the detriments of the current system and praising the possibilities if we where to adopt something closer to the midwifery model of care. She concedes that homebirth is as safe or safer than hospital and backs it up. She also concedes that VBAC is preferable to repeat cesarean. Being a mother who felt cheated by the system the first time around, she does make somewhat different choices with her second baby, still ending up with a cesarean. Her reasoning for not having the homebirth that she admits might have had a different outcome? Birth is so excruciating (another belief that pervades the book is that this must be so without the aid of drugs) that if she wants an epidural she can’t have one at home. True. She can’t. Why? Because it carries such risks that they can’t be dealt with at home.

However, that’s not the part that made me go ‘huh?’. If a woman is laboring at home with a qualified midwife or competent doctor and there is a complication or she decides she just can’t manage without an epidural, she’s free to get up and go to the hospital for any assistance she may need. The odds are that at home neither she nor her baby will need medical assistance or experience the sort of pain that she felt in the hospital the first time (1). If she does, it’s a short trip to most hospitals. However, I’d like to see a women in active labor at the hospital declare that she’s feeling good and wants to go home to push out her baby!

At first glance, her reasoning seems logical, but it stems from a faulty belief, which makes it illogical. This is also an example of what I pointed out in the last chapter about smart women making bad choices. I admire Naomi Wolf immensely. She’s written a scathing expose’ on American obstetrical care that’s cuttingly witty and strong on data. She seems to get it, at least on paper. Yet, she makes choices contrary to what she knows intellectually. She makes many faulty assumptions based on fear. She says the words, but her actions say something else entirely. It’s the unconscious nature of the fear allowing so many women to coast through pregnancy without questioning much because, after all, they feel fine and they aren’t scared. Some women will freely admit they are terrified, but many more fall into the ‘see no evil’ category.

Illustrating that Wolf really doesn’t get it is that her book is heavy on blame and short on responsibility. At one point, she blames her hospital childbirth class and the books she read for not being truthful. She contends they misled her into making bad choices. She admits that independent childbirth classes do give more useful information, and that yes, there are books out there that actually do give solid strategic planning advice, just as there are caregivers available that have proven to have better outcomes. She doesn’t go to those classes, or use the information in the books, or seek out the caregiver with the best outcomes.

She’s angry that the classes she chose didn’t tell her the ‘truth’. Would she have wanted to hear the documented risks of epidurals? Of course not, that’s why she didn’t go to the other classes. It’s a moot point anyway because her hospital class very probably could not have given her that information. Her hospital CBE probably was not free to share that the studies the friendly visiting anesthesiologist used to support non-medical use of medications was conducted by anesthesiologists and funded by drug companies!

Hm…no conflict of interest here. For a childbirth educator to even let on that she possesses such information is cause for termination. Why? Remember who signs her check? When you are low man on the totem pole it isn’t wise to expose the great and powerful Oz. I’m not being cynical, I’m being brutally honest. I’ve been there, I know. I have also been fortunate enough to teach in a hospital where evidence and result-based success is valued, so I know those exist as well. However, they are a rarity.

Ms. Wolf dismisses all of her admittedly better options for a variety of reasons…all based on her beliefs and fears about birth…yet somehow the fact that she deems other options not credible is somehow their fault. A childbirth educator that claims birth can be comfortable without drugs and doesn’t use the ‘p’ word (pain) is “lying”?

Thousands of women are giving birth quickly and painlessly though Mongan Method HypnoBirthing®, thousands more are doing the same spontaneously. Some women even give birth orgasmically. Because she doesn’t believe it can be anything other that what she experienced…and what her friends have experienced…she insists painless birth can’t possibly be true. It never occurs to her that she and her friends have made the same choices and got the same outcomes.

Those that get the good births are the ones who don’t allow fear to rule their thinking. Fear that ‘something’ will go wrong. Fear of how they might look to others. Fear that they’ll make a wrong decision.

Those that don’t ‘get it’ base their decisions on fear. They operate from a ‘just in case’ mentality, yet they have no firm idea of what the actual possibility of ‘just in case’ is. When I was pregnant and people learned I was having a planned homebirth with a midwife they would exclaim in horror “What if something happens?!” I’d ask, “Like what?” “What if the cord is wrapped around the neck and chokes the baby?” they would say, as if I was an idiot for not considering that.

Very rarely the cord will be very short or wrapped more than once, which makes it tight enough to restrict the oxygen exchange through the cord or impedes descent…then it needs to be cut and the baby born quickly. At that point though, the baby’s head is already born so it’s rarely a problem. In utero, babies don’t breathe through their windpipe…they get oxygen through the umbilical cord. 30% of the time, there is a loop of cord around the baby’s neck. It’s a variation of normal, not a complication. There actually was with my baby. Midwives either un-loop it over the baby’s head, loosen it so that the baby can be born through the loop or ‘somersault’ the baby through. No big deal.

Of course, it only sounds prudent to approach birth ‘proactively’… except that the ‘proactive’ approach currently in use isn’t working. Parents don’t realize or won’t admit that fear is actually the motivating force behind their decisions. Most of the time my request for specific ‘what ifs’ are met with either stunned silence because they can’t come up with something, or the story of their own birth with some tragic complication. A large percentage of the time, said complication was iatrogenic (doctor caused) or nosocomial (hospital caused)…not common in natural (and what should be ‘normal’) birth. Fear of the unknown is at the bottom of it all…irrational fear not substantiated by fact.

Those that don’t get it are the ‘blamers’. They blame doctors for not giving them the perfect experience or the perfect child. It’s someone else’s fault when bad things happen. Someone always has to pay for their misfortune. These people drive the malpractice rates up and create the current environment in which defensive medicine thrives…creating the vicious cycle of overused and abused technology.

Fear rules these people. They insist pregnancy and birth are rift with calamity. This fear has permeated the caring professionals within the broken system. They aren’t being mean…they are very afraid! According to the World Health Organization, at least half of all cesareans (at least 500,000 a year) are unnecessary and it all comes back to fear.

Fearful parents will torture themselves with guilt, second-guess themselves at every turn…and then make the same decisions again, and again. This reinforces their belief that they can’t get a break because choosing the same actions results in the same consequences. They may spiral into severe PPD or even PTSD, all the while demanding to know ‘why me?’ Women who have done their homework, will sometimes be able to see ‘why’, but they will be hesitant to volunteer what they know, lest they be labeled ‘judgmental’ for pointing out that there were a multitude of choices that, by virtue of commonsense and evidence, might have netted a different outcome.

To break out of this vicious cycle, we have to challenge what we know that isn’t really so about the current maternity care system in the US. How effective is it at improving the lives of mothers and babies? Not very as the statistics in the previous chapter pointed out. What perpetuates it? Are there better alternatives to the choices that ‘everybody else’ makes? Failing to investigate these questions means you can’t possibly make educated choices. If you don’t know this stuff you are operating without the necessary information and skills to create the results you want.

I hear examples of unintentionally created results so often I can finish a mother’s story before she does.

I’ve been accused of being psychic ‘cause I beat them to the punch-line. I’m not psychic, it’s just that predictable.

A woman goes in for ‘her’ (because it’s ‘standard of care’ it’s just part of this right of passage deserving of a personal pronoun) gestational diabetes test. She’s labeled gestationally diabetic and put on a low salt, low calorie, and yes low-sugar, restricted diet. (Not the commonsensical and healthy low sugar diet recommended by the American Diabetic Association that is similar to what midwives recommend) This leads to pre-eclampsia, which necessitates an emergency cesarean.

The shortcomings of this particular test were presented in the last chapter. (2) None-the-less, it is standard of care that often leads questionable treatment, which leads to unnecessary surgery.

Another woman, laboring quite nicely, is ‘too comfortable’. Her caregiver is afraid that her labor has petered out since she looks too calm and relaxed. He suggests that they break her water to ‘speed things up’.

She doesn’t know that studies show no significant difference in length of labor(5) with amniotomy (breaking the water). She doesn’t know that if a baby is high in the pelvis when water is artificially ruptured, there is a high likelihood that her baby will drop down malpositioned. The fancy term is “transverse arrest”, which basically means the baby is stuck. This is a situation that was created, not encountered.

Amniotomy also accounts for the largest portion of cesareans for infection, failure to progress and cord prolapse (when the cord is washed down with the tide of water ahead of the baby…remember, the baby gets oxygen from the cord)(6). Ask ten women to tell you about their births and nearly all of them will contain the words “…and then they broke my water.” Interesting terminology, instead of “…and then I let them break my water”, considering this action requires someone’s fingers having access to the mothers vagina.

“Birth” is blamed for these frightening situations. We don’t have such high cesarean rates, or some of the worst mortality and morbidity rates, in the developed world because birth is dangerous, but because obstetrically managed birth is. Countries with better outcomes know better than to have surgical specialist dealing in pathology care for healthy women for a normal physiological process.

The idea of surgical specialists being the preferred caregiver for a normal, physiological process is analogous to a cardiovascular surgeon doing all routine exams on men over 50 or orthopedic surgeons for skinned knees!

Sure it sounds ridiculous, unless it were introduced the way obstetrics was, over 80 years, with powerful spin-doctors. (Ha!)

After all, a fall bad enough to break the skin could cause a broken bone. Sometimes falls in the elderly required specialist care because their bones are brittle, and the very young because their bones are still growing. If it’s good for them, think how we can help everyone else!

Some people would resist, of course. Then word would get out that those seeing specialists got strong pharmacological pain relief! A sprain hurts really bad, even if it’s not a break…but without going to the specialist, one can’t get the drugs…and gee, maybe there could be something worse wrong.

It might not even take 80 years for people to start imagining that there is no safe fall to handle at home. Band-aids would seem primitive. “You didn’t take your kid to the doctor for that banged-up knee?! Don’t you want the best for him? What if there is something wrong you can’t see just by looking! You know, my nephew would have died if he hadn’t been in the hospital after his skiing accident! He thought it was just a sprain, but good thing he went because he almost bled to death during the knee replacement!”

This is essentially how the normalcy of birth turned into a medical event.

Fear of birth, and fear of pain in birth, has created such panic that women prefer elective paraplegia to being an active participant in the most amazing event in their lives. They submit unquestioningly to rituals with no basis in reality. Statistically, they have a better chance of dying on the way to the hospital (20 in 100,000 for car accidents in women of childbearing age) than they do during a normal, natural birth (6 in 100,000) yet IVs aren’t standard issue in cars. Of course, if they are one of the 1 in 3 or 4 women who will get a cesarean their odds of dying are highest of all, 35 in 100,000.

As for pain, there are plenty of women giving birth comfortably, even painlessly, so it is possible to do it without drugs and there are ways to learn how.

Where does the fear that allows this madness to continue come from? Is it misinformation or lack of information? Is it that we’ve given up making decisions for ourselves altogether?

Please bear in mind as you read examples of how choices in the childbearing year have gone awry, that I speak in generalities, though I use specific, real-life examples. I am using the most common stories I hear, so they may very well seem familiar. They are what has become ‘the norm’. This may bring up issues from previous births that should be explored in a journal or a support group like ICAN (7).

No matter what choices you make, they are yours to make. If you want every intervention, useful, dangerous or just plain nonsensical, go for it. Just know what the consequences of your actions are so you can own them when the inevitable happens. If somehow you cheat the statistics, great, thank your lucky stars. At least you will have made your decisions consciously and with purposeful intent.

My primary goal is to improve birth outcomes. To help women have safer births that are unique, rewarding and dignified, if that’s what they want. Somehow, women have gotten the idea that safety and emotionally satisfying are mutually exclusive in birth, which is patently false.

You don’t need to give up your power and autonomy to have a safe birth. There are cause and effect relationships every step of the way to motherhood that influence the experience. Knowledge makes you the one in control, which is where you need to be. You are the one that will live with the consequences of your actions—or non-actions as the case may be. You sign the check, either directly or through a proxy in the form of your insurance provider. Your caregiver works for you. You have the right, and the responsibility, not to be a spectator. If your insurance company is owned by doctors, it still comes down to you and how hard you are willing to fight for the safety of your baby. No one said this tangled mess would be easy to unravel, but no one should invest what they can’t afford to lose. In this case, the investment is your baby’s life. Will you trust that to luck and bad information?

A healthy relationship must meet the needs of both people. This is a universal truth that applies to more than just your primary love relationship. It applies to your relationship with your care provider and later to the mother-baby relationship.

In the US we are not taught to take responsibility for ourselves or the condition of our relationships. We are not taught how to parent. We are not encouraged to question authority. We assume our care providers always have a good reason for doing what they do and that it’s for our own good. We tend to do what our own parents did or what our friends do, assuming there is a good reason they do what they do.

This reminds me of a story I read once about a young woman making her first holiday ham. When her husband saw her cut the ends off the ham, he asked her why she did that. She pondered a moment and replied “I don’t know. That’s just how my mom always did it.”

She called her mother to ask her what the purpose was in cutting off the ends of the ham. Her mother told her she wasn’t really sure why…it was just how her mother did it.

So the mother called the grandmother and asked, “Why do you cut the ends off the ham? Does it make it juicier? Does it cook faster?”

“Not that I know of.” replied the grandmother. “I always do it because the ham never fits in my pan!”

There was a time when an elite few held all information. In my mothers day, it wasn’t an easy feat to compare and contrast the incoming data, what little of it there was. Today, books like The Thinking Woman’s Guide to Better Birth and Obstetrical Myths versus Research Realities(8) should be on the bestsellers list. They aren’t, not because they aren’t useful, but they don’t tell women what they want to hear. They only tell the truth.

My mother’s generation should feel good about doing the best they could with what they had. They should not feel it’s an indictment of their choices if their daughters know more and do better. “I didn’t know” is not an excuse anymore.

We spend four to twelve years in college learning to do a job that may last 40 years if we’re lucky. We will hold a position that, when we leave, will be filled by someone new in a matter of days.

We will work with people who, for the most part, know nothing of our hopes, dreams or fears even though we will spend more time with them than our own children.

Yet, I have parents from my classes complain that eight hours of childbirth preparation classes takes up too much of their time. Parents are parents for life. Mothers hold generations within them. Your children will never forget you and cannot replace you. Through them, you either make the world a little better…or a little more scary. It’s my own personal opinion that three semesters of ‘Parenting’ ought to be a mandatory in every high school diploma or college degree.

Journal exploration:

Who will you allow to shape your future? What are their motivations? What are their biases? Their beliefs? How might their beliefs color what they experience as real or possible? Are their beliefs, or yours, based on fact? Personal experience? History? Are you open to the idea that perception is reality? Is it time that some concepts be modified or abandoned in order for you to create a better birth experience and smoother postpartum transition?

This is a crash course in responsible parenting. You must be willing to gather data every day staring right now. Make a commitment to your baby and yourself because there are no ‘do-overs’. You get one chance to grow this baby the body it will inhabit for a lifetime. You may only get to experience birth once or twice in your life. Make those memories precious. In 50 years do you want to be swapping horror stories with your bridge club, or will you be misty eyed with joy as you pass empowerment on to your granddaughter?

Talk to women in nursing homes. Ask them which they remember better, the births of their children or the amounts of their bonuses? Do they recall their first promotion with the same sweet sadness as the first time their nursling gave them a milky smile?

Sure, there are women who thrive on the accolades of the competitive business world. More power to ‘em! I’m all for women’s empowerment in all forms. I believe in having it all, maybe just not all having it all at the same time.

However, if you are reading this book because you are pregnant, you volunteered for mom-duty…make every effort count. You won’t get another chance to shape your baby’s life in such a profound way.

People spend more time shopping for a car or home than they put into their births. They sacrifice years and thousands of dollars to go to college while they live on boxed macaroni and cheese, but balk at the investment of a couple of years of love and maybe some penny pinching during their children’s most important developmental years.

Whether you’ve looked at mothers and thought “I hope it’s that easy for me” or “Boy, is she lucky she can stay home.” Or, even “What a brat that kid is!” know that coincidence and luck play a very small part. Ask the mothers who loved giving birth, and love being a mom why they do what they do. Ask mothers who like to be around their kids, and who’s kids you like to be around what they did or didn’t do and why. Then emulate their success.

Notes on Chapter Two

1 Mehl, L, Peterson, G., Shaw, N.S., Creavy, D. (1978) “Outcomes of 1146 elective homebirths; a series of 1146 cases.” J Repro Med. Neonatal Outcomes: In the hospital, 3.7 times as many babies required resuscitation. Infection rates of newborns were 4 times higher in the hospital. There were 2.5 times as many cases of meconium aspiration pneumonia in the hospital group. There were 6 cases of neonatal lungwater syndrome in the hospital and none at home. There were 30 birth injuries (mostly due to forceps) in the hospital group, and non at home. The incidence of respiratory distress among newborns was 17 times greater in the hospital group than at home. The factors that make home birth more comfortable by maintaining the relaxation response will be covered in some detail in later chapters. For now, a couple of web sites that expand on reasons to choose homebirth (including safety) are:

http://www.gentlebirth.org/ronnie/homesafe.html

http://www.goodnewsnet.org

2 For more information see Understanding Lab Work in the Childbearing Year, Anne Frye

3 Expecting Trouble, Dr. Thomas Strong

A Guide to Effective Care in Pregnancy, based on the Cochran Data Base, the most comprehensive collection of information on what works and what doesn’t in medicine.

4 Terbutaline or not Terbutaline, Kim Wildner, Midwifery Today, Fall 2002

5 Fraser WD et al. Effects of early amniotomy on the risk of dystocia in nulliparous women.

N Engl J Med 1993;22;328(16):1145-1149.

Seitchik J, Holden AE and Castillio M. Amniotomy and the use of oxytocin in labor in nulliparous women. Am J Obstet Gynecol 1985;153(8):848-854.

Rosen, MG and Peisner DB. Effect of amniotic membrane rupture on length of labor. Obstet Gynec ol 1987;70(4):604-607.

6 Kariniemi V. Effects of amniotomy on fetal heart rate variability during labor. Am J Obstet Gynecol 1983;147(8):975-976.

Levy H et al. Umbilical cord prolapse. Obstet Gynecol 1984;64(4):499-502.

See Obstetrical Myths versus Research Realities by Henci Goer for abundant resources on this and other birth intervention.

7 International Cesarean Awareness Network, www.ican-online.org Phone: (310) 542-6400

9 The Thinking Woman’s Guide to Better Birth is also by Henci Goer and indispensable.

Mother Guilt

This book will not cheat you by telling you what you want to hear, sacrificing what you need to know. Too many books out there are telling you what to expect, but so few are telling you that you should expect more.

I believe it’s time to be honest about some of our collective sacred cows. We have been politically correct about so many things for so long that we’ve lost sight of common sense. Many women come to their transition into motherhood confused and afraid instead of strong and excited to be a part of the Mystery. Many spend their lives feeling guilty for what they could not control, others, conversely, not taking the responsibility for what rests squarely on their shoulders.

Discussion of mothering has become as taboo as discussing religion or politics. Women have so many ‘choices’ now that to suggest one choice is better for babies than another is to risk offense. We tip-toe around certain things under the guise of ‘being sensitive’.

What has happened is that in our attempt to be sensitive to mothers who can’t make the choices they know are best for their babies, we have made all options seem equal when in reality they simply aren’t.

The problem with this is two-fold. First-of-all, it doesn’t shield the mother who is truly, unequivocally unable to give her child what she knows is best. What it does do is put women who can but won’t in the same category, providing an excuse to take the path of least resistance instead of putting the best interest of the child first. The courts use the willingness of a custodial or adoptive parent to put ‘the best interest of the child first’ as a measure of good parenting. Examples abound of natural parents not being held to the same standard.

I know for a fact that there are women who’ve lost their breasts to cancer who are very envious and a more than a little angry with women who have perfectly functioning breasts that refuse to feed their baby the milk made specifically for him because they say they ‘can’t’ when they really mean ‘I don’t want to’.

There are single mothers, with no support system, who cry every morning when they have to leave their child with an allomother(1), working two jobs and going to school with their only reward watching their child sleep in the moonlight with the hope that their hard work will eventually allow them to spend time with their child when he’s awake. How do they feel when they hear a fellow working mother say she works because she couldn’t stand to be with her whining, teething baby…a baby obviously in need of mothering. (I am not talking here of a mother who has just had enough for that day or that week and needs a break, as all mothers do, but of a ‘mother’ who dislikes the very act of mothering on-the-whole.)

How does the mother who lives on a restricted budget, who has put a lucrative career on hold to cherish the few precious years her little ones will be little, feel when a past co-worker comments on how ‘lucky’ she is to be able to stay home? How does the stay at home mother feel when the working mother explains that she “just couldn’t afford to stay home”, she has to work…then in the next breath talks about her new car and upcoming Caribbean cruise for two? Who considers how diminishing their willingness to mother well affects these mother’s feelings?

Consider the woman who has eagerly anticipated her labor and birth as rite of passage but must have a cesarean due to cord prolapse or some other real medical indication. Grateful for the surgery that saved her child’s life, or her own, she still grieves the loss of her dream. How might she feel when she hears about a woman who could have birthed naturally, but instead chose surgery for something as trivial as knowing the birth date in advance to plan around it. The surgery that is used with medical indication to save a life is the same surgery that carries a five times greater mortality (death) rate when it’s done in the absence of a medical reason. How can anyone seriously say that to point this out is in any way, shape, or form a disservice to the woman did what she had to do to save her child?

To put these mothers all in the same category isn’t fair. To suggest that fathers (or co-parents) are superfluous, or that it doesn’t matter whether a mother or substitute mother raises their baby, or that the stay at home mother is ‘lucky’ is an insult.

Are there ‘stay-at-home’ mothers who don’t actually mother at all? Of course. Are there very loving corporate mothers who are able to organize their time so that their baby never has an allomother? Naturally. Are there mothers who are the primary bread winners or who have functional insurance through work that the family needs, who go to extraordinary measures to ensure that even though the situation isn’t their ideal, it has minimal impact on their children? Absolutely. Remember...no all or nothing thinking. There are always exceptions to the rule.

However, the way that this wide range of parental personal philosophy is dealt with is that it isn’t. Certain topics are approached with prefaced with ‘Of course it’s a mother’s choice, but…’ or not considered at all. I don’t sit on the fence and I don’t see the value in avoiding the truth just because someone, somewhere might not what to hear it. Does that mean I have the right to judge anyone for making different choices than I?

I don’t have the right because I don’t have the power. And quite frankly, it makes absolutely no difference in my life if you, in Wooskerpoot or Topeka, choose to use what I’m about to share or not. I don’t know what’s best for your child, in your circumstance. I know what’s probably best for most children in most circumstances. I know what’s possible for most moms when they are determined to do their best. Only you know what is best for you…if you’ve made your decisions with the best of intent, or if guilt is an appropriate, self-imposed emotion.

Yes, a self-imposed emotion. No one can make you feel guilty unless you agree to feel it. The purpose of guilt is that it guides us to aspire to “do the best we can with what we have, and when we know better we do better” (Maya Angelou). We must learn to distinguish true guilt as a message from our conscience from the useless punishment we heap on ourselves mistakenly labeled as guilt. Language often reveals the difference. Using the breastfeeding analogy again, an adoptive mother does not apologize for bottle-feeding her infant. She has no reason to and she knows it. (I know that someone will write to tell me that some adoptive mothers are able to breast feed. I am aware of that, but not all, and even those that do probably won’t do so exclusively. Artificial baby milk originated out of orphaned baby situations so it’s a valid analogy) A mother who made the choice not to breastfeed is likely to say “I really wanted to breastfeed, but…” Anytime “but” is in a sentence, everything that comes before is negated for what comes after it. Try it. Ok, now reverse it. Have you ever heard a breastfeeding mother ever say “I really wanted to formula feed, but…”?

At least a woman who says, “I know that the milk from my own body is the best for my baby that grew in my body. I still didn’t want to breastfeed” is being honest. I may disagree with the intent behind the decision, but I respect that she’d have the bold ovaries to stand up to it. A mother that is defensive or makes excuses knows in her own heart that her intent is less than noble, and isn’t even brave enough to take responsibility for it. She does a fine job of judging herself. Of course, often that is externalized so her perception will be that others are judging her, but that doesn’t change that it really is a reflection of what she knows in her heart.

I can speak on this subject of mother-guilt with certainty because as a mother I have had nearly every single action I’ve taken on behalf of my child, from birthing at home to vegetarianism to my spiritual path, questioned and judged. Sometimes quite vocally and with great hostility. I feel no guilt for my choices, even when they are different from most of the people I know. I am confident that I had the information I needed to make the best choices for my child and hold dear my right to do so.

I can count on one hand the number of times that I have felt even a moment of regret when information came to light that might have altered a past course of action. In that moment, I had a couple of options. I could feel guilt and punish myself indefinitely, but make the same choices I’ve made in the past, or I could use the new information to make a different choice, forgiving myself for the past that I cannot change. I chose the latter.

Sometimes the truth is painful, but I can only speak the truth as I know it. I feel it is important to be impeccable with my word and use my life to a greater good. I share this information with compassion and the best intent. I have no control over how the facts are received or perceived.

I share it because of the many mothers who have regrets these days. Things they wish they knew then that they know now. It is those mothers I write for.

Like the mother who smoked like a chimney, as did her husband, who got defensive during class when smoking was discussed. The parents who didn’t want to hear about the effects of smoking on pregnancy, birth and babies. The parents who didn’t appreciate people ‘making them feel guilty’ for their choice to smoke, insisting it’s no one’s business to judge their lifestyle.

The very same parents who lost their baby to SIDS, and upon researching ’why’ as part of their healing, found that smoking parents(2) are much more likely to lose babies to SIDS (only one among many issues regarding smoking mothers). The parents who wanted to know ‘Why didn’t anyone tell us!” instead of “Why didn’t I listen?” As a mother, defensiveness and avoidance of information that evokes feelings of guilt can be deadly.

The mom did choose to stop smoking eventually. She was a good mom…just a mom who paid a terrible price for not being able to look at a hard truth. Hindsight is always 20/20.

There are too many women living with the ‘what ifs’. The stakes are too high to be worried about egos.

This book is not about ‘you should’. It asks ‘should you’? It gives you ‘the rest of the story’ and demands that you compare, contrast, and check in with your own heart. Granted, this carries a certain amount of courage, and it demands that we take back responsibility for our own choices. Our children deserve no less.

How does one know what is ‘right’? The answer lies inside you, with your conscience and that ‘wiggly’ feeling in your stomach, as my daughter calls it. However, if following your intuition and your body’s innate wisdom is a new concept, ask yourself these questions when you are faced with making a decision that will affect both yourself and your child.

1.) If someone else makes a different choice, how does that make you feel?

2.) Is this choice in the best interest of your baby? How do you know? How much do you know about the ramifications of both of (or all of) your options? What does common sense logic tell you? Intuition? Science?

3.) If there is a doubt about whether this decision is in the best interest of your child, what have you done to make a better choice more attainable?

4.) If you look into the future at the possible and probable consequences to you, your family and your baby for this choice, what do you see? Could you live with the worst case scenario with a clear conscience?

5.) What sacrifice is being asked of you? Do you make it for your child willingly? How does it compare for the sacrifice your baby is being asked to make? If your child were able to speak, what do you think he or she would choose? Why?

6.) In a perfect world, would this be your choice? If not, why? What can you do to make it perfect enough for this choice to happen?

7.) Is this choice irreversible?

8.) Is this a life decision? Does it contribute or contaminate your relationship with your baby? Does it contribute to or contaminate your baby’s health? Do you like yourself for making it?

9.) Do you feel the need to make excuses or defend your choice?

10.) If you are aware that there is an option that is better and/or safer for your baby in the short or long term, why do you choose not to consider it? It is because you can’t or because you won’t?

11.) Does this act, above all, give expression to the words “I love you.” Does it show your baby or child that you love him or her above all else?

12.) If your baby could speak, would you make this same decision? Would you want someone to make this decision for you if you were unable to communicate your wishes? If your life were recorded, would you do the same?

13.) Would your actions be any different toward an adult that you love if they were helpless and totally dependant on you? Does your baby deserve at least that much?

Choosing a Care Provider for Your Pregnancy and Birth

At the first sign of pregnancy, many women automatically make an appointment with their primary care physician or obstetrician. Some, aware that the birthing philosophy of their ob/gyn is different than their own, or who realize that adequate well-woman care does not necessarily translate into good maternity care, will seek out a different doctor for their pregnancy and birth.

Individual circumstance and personal preference play a large role in whether parents will look outside of their geographical area, or if the experiences of friends and family members influence their choice of provider.

In other cases, fear is a silent participant in the process of selection. Fathers-to-be rarely give a second thought to who will care for the love-of-their-life at her most vulnerable time. At this stage of the game, it’s still in the realm of ‘women’s business’ that they’ve never been involved in before. Before now, it’s never been about who will be the first person to meet their child. A child who is still very much ‘abstract’ at this point.

Early pregnancy is a very emotional time. Even if the pregnancy has been planned for, or possibly orchestrated with intensive reproductive technology, there may be a moment or two of ambivalence…a feeling of “Oh no! What was I thinking?!” With unplanned pregnancies, there may be a sense of panic or fear. In any scenario, there is a sense of the world shifting with the emotional enormity of how life will change. Sometimes, it’s a confusing, emotional feeling that begs for stability and familiarity to balance the excitement and the mysterious unknown.

The fierce protectiveness of mother-love hasn’t usually kicked in. Mom doesn’t necessarily feel any different physically just yet. Because she feels so ‘normal’, it may seem quite logical to make the call to someone who’s been part of her ‘normal’ life. It may be the wise choice…or it may not.

This first choice as a parent may make the difference between life and death for you or your baby. Sound dramatic? It is. The sad part is that American mothers aren’t even aware that they have choices to make, much less that their empowerment in making those choices could very well change the direction of the rest of their lives.

Knowledge is power. How well do you know your doctor? Do you know his cesarean rate? Do you know the infant mortality (death) rate for your state? For your county? For your hospital? Do you know what routine practices your doctor has as part of his standard protocol? Do you know if those practices are supported as safe and effective by scientific evidence? Does it sound overwhelming that one should even have to consider all this stuff?

Again, it is. However, it’s very important. It’s not as intimidating to gather this data as it sounds, for the most part. As a researcher and author, it took me a couple of hours to look up the information for my own region on the internet. If I were pregnant, I would have considered it a small investment in the safety of my child. Instead, it was a small investment in yours.

I simply started out with the big picture and narrowed the field. Using my home state for this illustration (3), I began at the national level so that I’d have the ability to compare my state’s outcomes with other’s. I already knew that international statistics from previous research(4) show that plenty of other countries have few mothers and babies die than the US and that at least 25% of the baby deaths in the US are preventable. The recommendations from The World Health Organization for improving outcomes include…choice of caregiver.

So first, I looked up US infant mortality rates with the Centers for Disease Control (CDC)(4). For vaginal birth its 5.7 per 1,000 births for white babies. For African-American babies, the rate is 14.1 per 1,000.

Next, I went to state statistics (7) to determine state, then county mortality rates. The World Heath Organization recommends a 12-15% cesarean rate for optimum outcomes (the most live babies and mothers). Once the rates rise above that rate, the balance of this life-saving technique of last resort shifts so that more lives are lost than saved…hence at least a few preventable deaths. Statistics from countries with the best outcomes bear this out, as do statistics of midwifery communities where cesarean rates are kept low (8).

The graphic on the facing page shows which counties have the best (shaded gray-fewer than 6 deaths per 1,000 births) and worst (shaded black-9.9-22.2 deaths per 1,000 births) mortality rates for Michigan counties at the time of my research.

(The original graphic had five categories. I have only listed the highest and lowest rates for simplification. The non-shaded counties in this example fall somewhere between.)

What might this information tell me? For one thing, I know the most dangerous places in the state to give birth and the safest, but there are a number of variables to consider.

Since we know that more black babies die than white, usually born to inner-city mothers with few resources and many challenges, we would expect to find that the counties with bigger cities including this population to have higher mortality rates. It’s also important to recognize that counties that report the least deaths may be quite rural and have a large number of mothers delivering in neighboring counties, where the deaths might be reported. We also must consider that some counties have a high proportion of midwives, who have much better outcomes than obstetricians on the whole.

A county with active midwives may have a better rating than the hospitals within it. For some women trying to use this formula to determine the safety of birth in their area, there may even be out-of-the ordinary circumstances like a particular sort of pollution or other environmental factor that leads to higher infant mortality…but that would be unusual. Finally, some counties have many hospitals, others just one. In order to utilize the information you’ve gathered, there must be some small amount of familiarity with your own county resources and population. Once these things are considered, we are left with an educated guess that must be weighed along with the information gathered at the personal level.

For this I had to check into cesarean rates, which are an indicator of appropriate birth technology. If I were pregnant and had regular visits with my doctor, I could simply ask for his or her rate, but since I’m not I had to go searching. Because individual doctors and hospitals are not required to divulge mortality, morbidity (injury) or cesarean rates, patients may not get the answers they seek, but there are other sources, like the ones I used (9). Doctors and hospitals with low rates are very proud of that accomplishment, so if you can’t get the data, you actually are getting some very important information.

In a large community, sorting this out may require help from organizations existing solely for the purpose of helping mothers make wise choices. Groups of other mothers, like Le LeLeche league (a breastfeeding support group) or ICAN (a cesarean prevention group) can be valuable resources (10). Friends and family are another. Just listen carefully to what they really say. If most of them have had the same doctor and they all rave about him, but most of them have had cesareans, episiotomies, postpartum depression that seems to boarder on post-traumatic stress disorder, sick babies, premature births or some other catastrophe or another, there’s a problem. Birth just doesn’t carry that much risk!

If it does with that particular doctor, there’s something wrong with that picture. You’ve already read the mortality rate for vaginal birth and for car accidents for women of childbearing age. If a particular automotive company’s cars were involved in far more than the statistical average of deaths, most people would refuse to buy cars from them…even if they came equipped with standard issue IV bags.

Dawn’s (11) doctor was honest with her. When she asked what his cesarean rate was he replied “Oh, quite a few.” But she liked him. “He sits by the bed with his hand on your belly.” She explained. He also used inappropriate and dangerous technology routinely when all of the other doctors in his hospital had abandoned them for more evidence-based care. When she asked about this, he promised that even if he disagreed with her, it was her birth and he’d only use interventions if he had to. He ‘had to’ a lot.

One of these interventions was routine episiotomy (12). “My postpartum period was a nightmare” said Dawn. “Feeding the baby was hard because I was just in too much pain to get comfortable, and forget sex! The pain lasted for months! My husband tried to be patient, but he couldn’t understand that even sitting and walking hurt long after the cut healed.” She justified the pain she suffered, defending her doctor by saying “Well, I guess that’s the price you pay for a good doctor.”

Good doctors charge standard currency for good care…not body integrity or first-born child. This doctor came highly recommended by friends who also found justifications for his actions instead of questioning his actions. His words reassured her all along the way, but his actions were always contrary to his words. He said he believed that pregnancy and birth were natural events, yet test after non-medically indicated test was ordered. He said he believed birth was safe, yet ‘just-in-case’ technology was employed, revealing his real fears.

Another example of how important it is to pay attention to non-verbal cues and intuition is Phoebe. Her doctor was very personable. She searched long and hard using many of the methods here. She and her husband were smart, savvy parents who weren’t willing to settle for second best. Once they found the doctor they liked, subtle changes started to take place. Where they had been told that this doctor believed in minimal technology in the absence of medical indication, new tests were ordered at every visit. Being an informed consumer, Phoebe did her homework.

Often she would find that a test was either not medically necessary or that it was useless…not accurate or developed for women with illnesses she did not have. She would bring in the information. Faced with evidence contrary to his practice, he’d get angry. Phoebe and Ted would leave feeling stressed, often Phoebe in tears and coerced into taking yet another test.

Still they went back. “At each visit, they’d try to tell me I was sick. I did the research, I knew I wasn’t. I’m very healthy! But they kept trying to label me ‘high risk’ even though I’d go back with information proving them wrong.” Her doctor would get defensive, then concede that maybe she didn’t have that particular condition, but the latest test showed she did have another one that would require further testing. The entire pregnancy was wrought with frustration and far more work than any woman should have to do in pregnancy. These parents were not displeased with their experience. I was, only because I could conceive of so much better and wanted more for them. What matters is their perception, not mine. They had their best birth.

Had they listened to this doctor’s actions instead of his words, and listened to that small voice inside that cried out after every visit, how much more might they have enjoyed their journey? Ironically, the reasoning behind seeking out this doctor and consenting to all of the testing was to get reassurance that everything was ‘alright’ so they’d feel safe.

If you want a comfortable, empowering, safe and joyous birth, but all of your friends have to tell are horror stories, pain, and sick babies, don’t do what they did! Doing the same thing over-and-over but expecting a different outcome is the definition of insanity! Talk to women who rave about their births, who had alert babies that nursed with no problems, who talk about how wonderful it was, who had smooth postpartum transitions…then find out who their caregiver was!

In smaller towns, it may be easier to discern who the safest providers are. Say in one of our sample counties there is only one hospital with three obstetricians. If said hospital has a nearly 30% cesarean rate we already know one thing…that at that hospital twice as many mothers will face a surgical birth than WHO recommends. Surgical births have a greater mortality rate than natural births. Knowing, as we do now, that such high cesarean rates means preventable deaths, we can see that there are many problems with choosing to give birth here.

Inadvertently, our map tells us something else. It illustrates the safety of birth and how irrational our fear of birth actually is.

Counties on the map listed as 9.8 to 22.2 baby deaths per one thousand births have higher infant death rates than Cuba, Kuwait, Hungary, Bulgaria, Russia and Romania. Simplifying then, in a county with one hospital delivering only one hundred or so babies a year, it would take about 10 years to compile the data on a per/1,000 basis. On the low end, (9.8/1,000) that would be only one or less baby deaths a year. That doesn’t seem like much…unless it’s your baby (as caregivers like to point out to justify inappropriate technology).

However, not all doctors practice the same. Many are working diligently to bring their practices in line with evidence-based care recommendations. What if one doctor in our example uses a non-invasive approach when possible, utilizing integrative therapies, and has brought her cesarean rate down to 12%. If this is your doctor, your work is done. Happy birth-day! When this doctor says “I may not agree with you, but we’ll do it your way unless there is a medical indication for intervention.” She means it. How do you know? Her numbers don’t lie. Her actions back up her words.

If this is not your doctor, you still have gained a lot of insight into the other two doctors. If the above physician has a 12% cesarean rate and the hospital has only two other doctors but a nearly 30% cesarean rate, how high are the rates of the other doctors? So now, you have several options:

Do nothing, keep with your original choice and hope nothing bad happens. This basically means you are playing the odds. Don’t wager more than you can afford to lose. If you had a million dollars, would you bet on 1 in 3 or 50/50 odds that you’d lose? Your child’s life is more precious than a million dollars. As with any choice, ask yourself, is it in the best interest of the child? Am I making this choice because it’s just easier to do nothing or out of fear? If so, that might be something to explore before the birth.

Stay with this doctor but research every recommendation, fighting for evidence-based care at every visit. Do-able, but exhausting. In a relationship of equals this is more likely to be a workable solution, but doctor-patient relationships are seldom equal. If the relationship is based on a power struggle, someone must lose. Usually the least powerful. Wouldn’t a win/win, cooperative relationship be more desirable?

Change caregivers. Maybe more than once. Possibly extending out of a convenient geographical area. In a bigger city where a woman is probably a faceless chart this may not be difficult. In a small town, uncomfortable social moments may crop up from such a decision. When the subject is the life of a child vs. saving face, again, the question is, “What is in the best interest of the child?” We pay our caregivers a lot of money to work for us. It is reasonable to expect well-researched care. It is responsible parenting to seek it elsewhere if caregiver is unwilling to provide it. Good doctors have already taken the initiative to keep up on the scientific literature…reward them for their efforts and it’s a win/win situation.

Another option is hiring a midwife. Ask the same questions of a midwife that you would of a physician attending your birth. Frequently you won’t have to ask…midwives often provide their statistics at the initial visit without needing to be asked. If the midwife determines at that visit that for some reason you are a poor candidate for a homebirth, she may be able to refer you to a sympathetic doctor. Think about what it is you want at a birth.

Find a freestanding birth center. This is a birth center independent from and outside of a hospital. Some consider this a compromise for those that don’t want to be at home, but don’t want to be in the hospital either. Others choose freestanding birth centers on any of their own plentiful merits. They provide a homey atmosphere within the midwifery model of care, usually with physician backup.

There may come a time when all birth providers share important information voluntarily as providers, proud of their stats, do now. Or, other states may enact laws to protect the consumer, wherein the health department collects the data and provides it to mothers in a brochure so that mothers can make informed decisions as New York has.

No one would dispute that safety is first-and-foremost in choosing a pregnancy care provider, but there are other considerations.

One concern is financial. One questioned often asked at an initial visit with a midwife, or during a phone pre-interview is “Do you take insurance?” Insurance companies that aren’t owned and operated by doctors are seeing a financial motive for covering homebirth and birth centers, albeit at a snails pace, as more women choose these options.

Parents need to look at the higher short-term cost of inappropriate technology as well as the long-term financial picture use of these technology paints. With a higher number of birth injuries and cesareans in what we think of as ‘usual’ care, parents may well be paying a co-pay on major abdominal surgery instead of a vaginal birth. Many midwives charge about what parents would end up paying out-of-pocket for their hospital birth insurance co-pay for a vaginal birth. For the uninsured or underinsured, the financial choice is easy…physician at an exorbitant price or midwife at a fraction of the cost. My baby’s safety was worth what I’d spend on a vacation or save by not smoking…and then some. I know people whose children are starting school who are still paying on their births!

The other problem is of an emotional/relational nature.

Human nature dictates that if I say, “Michigan is a great place to live!” someone will take that to mean that that some place else isn’t and reply, “What’s wrong with Ohio?”

When we make a choice that might be different from what our peers are doing, it can seem to them as if we are questioning their choices, even though it has nothing to do with them.

When all of my choices were different from that of my mother, her response was to ask questions and often she’d say “If I had known that, I would have done a lot of things different.” No guilt required on my part or hers. I was doing the best I could with what I had and so did she.

Some with friends or family who are unfamiliar with alternative options will opt to educate them by sharing what they learn along the way. Very often, objections are simply due to ignorance of why parents are making a particular choice or of the facts pertaining to that choice. I have seen families firmly opposed to homebirth become homebirth advocates once they were assured of its safety. Often fathers and grandfathers become the biggest advocates, taking great pride in their wife’s, or daughter’s, empowerment.

In my lifetime I hope to see evidence-based care become the norm, midwives become better utilized and the US one of the top three safest countries in which to give birth. Unfortunately, if you are in your childbearing years now, that is not your reality. In fact, without your help, it won’t be the reality of your children either. Here are some concrete things you can do to ensure safer care for you and your baby.

Yes No

1. Do you utilize prenatal testing

only when medically indicated? ___ ___

1. Are you supportive of dialog

regarding my care? ___ ___

2. Do you encourage

evidence-based childbirth education? ___ ___

3. Is your cesarean rate

under 15% ___ ___

4. Is your episiotomy rate

under 10% ___ ___

5. Is your induction rate

under 10% ___ ___

6. Is your VBAC rate

at least 70% ___ ___

7. Do you ‘allow’ pregnancy

to go past 42 weeks

if baby and I are healthy? ___ ___

8. May I labor without a time limit

if both my baby and I are tolerating labor well? ___ ___

9. Do you allow vaginal birthing

of babies deemed “large” via ultrasound? ___ ___

10. Do you discourage

routine circumcision? ___ ___

11. Do you support breastfeeding

by not giving out formula samples? ___ ___

12. Will you support requests

that are not standard protocol

as long as they are reasonable

and not medically contraindicated? ___ ___

13. Will you allow me to

video tape my birth? ___ ___

14. Can I be sure

that you will be attending my birth? ___ ___

15. If not, would the attending provider

share your philosophies? ___ ___

If your provider responded ‘yes’ to all 15 questions, you have found a responsible, safe and respectful caregiver. Your own best birth can be expected.

If your provider responded ‘yes’ to at least 10 of the above question, your caregiver might be willing to work with you, but a pathological view of birth may be unconsciously be under that willingness. Clear communication and a little more work on your part may be required for an optimal experience. Give them a month or two. If, after attempts at being a partner in your care, you are not being met halfway, find someone who is willing to meet you there.

If your provider responded ‘yes’ to 5 or less, 6 or 7 months is simply not enough time to bring this caregiver around. Remaining with this caregiver means there is a high probability you will be a statistic in the sad state of American maternity care. The chance that you will have a safe, dignified and empowering birth is next to nil.

Also, keep in mind that underreporting, not just of mortality and morbidity rates, but of certain procedures, is the norm in our health care system, as evidenced by a quick web search of the word ‘underreporting’. Verify ‘internal sources’ with independent sources of information. There are often huge discrepancies between the two statistics.

Finally, remember to be sure words and actions say the same thing.

Notes for Chapter Three

1 Allomother is a term used in Mother Nature: A History of Mothers, Infants, and Natural Selection by

Sarah Blaffer Hrdy, Pantheon Books, 1999 in reference to mother substitutes.

2 Smoking and SIDS, www.motherisk.org/updates/Spring2002.php3

3 The research for this book began in early 2002, through 2003

4 March of Dimes Perinatal Data Center, Aug. 2002 shows that the US has fallen from 21st place it held in previous years to 28th. Cuba, Spain, Portugal and Ireland now have better outcomes than the US.

World Health Organization, www.who.org

5 Centers for Disease Control, www.cdc.gov/nchs/fastats/pdf/nvsr50_15tb34.pdf

6 The socio-economic reasons for this discrepancy are beyond the scope of this work. However, the differences are relevant for the purposes putting the statistic in your own geographical are to use.

7 www.michigan.gov/documents/InfantMortalityFEb00_10492_7.pdf

8 www.thefarm.org.charities/mid.html

9 Michigan Hospital Report, www.mha.org/mhr6/

10 Le Leche Legue International, www.lalecheleague.org/

11 Not a real name. All mothers are composites.

12 A cut between the vagina and anus (or into the leg) to enlarge the birth canal. Almost never required.