Saturday, April 14, 2012

Letter to the Editor: Sarasota Herald Tribune

Thank you to the Sarasota Herald Tribune for publishing my letter this morning.

Recently, Gov. Rick Scott signed the Healthy Pregnancies for Incarcerated Women Act (SB 524) into law. I applaud Sen. Arthenia Joyner, Rep. Betty Reed, Gov. Scott, and all who championed this legislation.

The practice of shackling incarcerated pregnant women (the overwhelming majority of which were arrested for nonviolent crimes) is barbaric, inhumane, and dangerous to the health of the mother and the baby. It interferes with the work of her health care provider, and makes the labor process more painful and more difficult than necessary. It increases trauma, and subsequent post-traumatic stress and post-partum depression, both of which increase rates of recidivism, drug use, and suicide. Conversely, when a woman gives birth with dignity and compassion, attachment to her baby is facilitated, giving that baby the greatest chance of physiological and emotional success in those first critical hours of life.

I strongly encourage the Florida Legislature to examine a prison nursery system, much like the ones in place in New York, Nebraska, California, Washington, Ohio and Indiana. Healthy maternal infant bonding strengthens a healthy society.

Laura Gilkey, Sarasota
Gilkey is the co-hostess of "Maternally Yours" on WSLR 96.5.

Monday, March 12, 2012

Sarasota Mayor to Share Birth Stories on WSLR

On March 20th, Sarasota Mayor Suzanne Atwell will join Sarasota’s Conversation about Pregnancy, Childbirth, and Early Motherhood. Maternally Yours, a weekly radio show on Sarasota’s Community Radio Station WSLR 96.5 LPFM, will welcome the Mayor to share the stories of the births of her children during the station’s biannual membership drive.

“I feel that women of my generation can offer a unique perspective regarding childbirth and family issues,” said Mayor Atwell. “We stood at the forefront of a growing movement that embraced education, choice, and respect in reproductive decisions.”

Atwell will be joined in the studio by Mommy Magazine editor Sara Malone, who will also share her birth stories, as well as the four co-hostesses of Maternally Yours, Laura Gilkey, Cheryl Kindred, Carmela Pedicini and Ryan Stanley. Since its launch in October 2011, the program has covered a wide range of topics and has welcomed such guests as 2011 Right Livelihood Laureate Ina May Gaskin, 2011 CNN Hero of the Year Robin Lim, Florida Senator Arthenia Joyner, Congressional candidate Keith Fitzgerald, and many others.

To hear the exclusive Maternally Yours interview with Mayor Atwell and Sara Malone, please tune into WSLR 96.5 LPFM Tuesday evening, March 20, at 6:00pm. The program is also available via live streaming on, and podcast at For more information, please contact the hostesses of Maternally Yours at, or call (941) 915-8115.

Monday, February 20, 2012

BIRTH STORY: Supported, Empowered Birth

(written by Lorna Reid Fleener about the birth of Sebastian Alistair, born February 19th, 2009)

I get so moved reading various birth stories on this site for many reasons, but 2 resonate with me in particular. As I was risked out of midwifery care due to my large uterine fibroids, I cry whenever I read of a beautiful home-birth, as that is what I had always wanted. And then when I read of terrible hospital experiences, I once again cry for these women, as although I did not have fully the birth I had dreamed of, the hospital worked with me and allowed me to have as close to what I wanted to have.

I had lived part of my life, both in childhood and as an adult, in the UK, where midwifery is normal practice; and I had gone through school with Heidi, founder of the Rosemary Birthing Center, as my friend, therefore, for me, the midwife birth was the natural choice. On top of this in 2007 I was birth partner for my niece when she had my great-nephew at home, with Harmony as her mid-wife, and it cemented my decision. So, when my husband and I became pregnant 2 years later I was excited to see Harmony and begin my pregnancy journey with her. However, it was not to be, as the estrogen from my pregnancy had already made one of my uterine fibroids grown to 7 inches, at 7 weeks pregnant my uterus already measured 24cm. So I began my adventure with Dr Cohen, recommended by Harmony and Heidi…

Dr C listened to me and my desires and spent a long time with us, we began calling my uterus “the duplex”, baby down one side and my now approx. 10” mass of fibroids down the other. I saw Baron and Hill as I was high risk and had many ultrasounds to check the fibroids as they grew. The pregnancy went well, the only incident was when I had one fibroid degenerate (baby won out and was taking more of my blood supply than one of my fibroids causing it to die) and after 24 hours spent on the couch unable to move due to the pain, I requested my husband take me to hospital. This occurred at 24 weeks and after enduring that pain where I was unable to even move and my husband had to carry me to the bathroom I knew that childbirth was going to be something I could handle. Once I got through this 2 weeks of on and off pain I was officially declared ‘normal’ at 26 weeks and no longer high risk and Dr Baron said no reason to not have a vaginal delivery… so excited…

Amazing things happen during pregnancy – what an amazing time of getting in touch with your body and soul… we had opted not to find out the sex as I had always imagined the joy of the announcement as the baby appeared… However, the universe at other plans for me… It was one week before my due date and Alex and I had gone with some friends to see the wonderful Willie and Lobo play. As I sat listening in the dark I placed one hand on my husband’s knee and one on my fabulous bump and into my mind came the thought ‘I’m here with my two boys’ and I knew from that instant I was having a boy… but I told no one! 

After all the drama and constant monitoring of the first 26 weeks it was great to sit back and just be pregnant, I did my birth plan with my doula Laura, whose Bradley birth classes we attended. We had pictures taken, I got a belly cast and we got the house ready. Dr Cohen and Dr Sullivan were great about my birth plan and me having a doula and I got to meet with both of them so we were all comfortable with each other… and after being so high risk I ended up going 2 weeks overdue…

As a result I did end up getting induced… here is where the clamoring starts and I know – we tried many other methods of getting things going – membrane stripping, stimulation, acupuncture, sex, black cohosh, and even the day I was kept in for inductions we ruptured the sack () and all sorts – to no avail – unfortunately with my fibroids they had acquiesced and let me go 2 weeks over and that was it - Dr Sullivan kept me in after my stress test on February 18th, 2009. This was when the issues everyone brings up started… and we gently asserted ourselves. As I was getting settled into my room two nurses came in with the IV (at which point I lost it and bawled) and told me no more food or drinks allowed, I said but why not – and they both actually stood silent and finally said ‘well, that’s just what we do’… so my husband went off and found Dr S… who came back with him and told the nurses ‘Lorna is healthy and the baby is healthy she can eat and drink what she wants and no IV’ – although I did agree to a stint… I was so glad we had constantly been vocal and open with our doctors during the whole pregnancy and worked as a team. At that Dr S turned and told Alex to go get me whatever I wanted to eat (mmm, portabella and veggie wrap – still remember it) –I think it was around 11.30 a.m. at this point…

The nurses they assigned to me were all excited upon reading my birth plan and bustled about getting me a rocking chair and a yoga ball – and thankfully I was in one of the 2 birth rooms with a shower, at this point Laura, my doula, had not yet arrived. This is the point where there was a blip in the day when we had a slight turning point in the late afternoon when my supportive nurse got called away and we ended up with ‘nurse evil’. When she came in she scoffed at my birth plan – showed me the pain chart and told me that by the time I reached the level of the smiley face in the middle I would demand an epidural, then as she exited the room – she looked at me perched on my yoga ball and told me to try not to fall off… on top of this we had heard Dr S instruct her not to put my Pitocin over 6 – this was at around 3 p.m.… when my doula, Laura, arrived at 5.40 I knew I was having contractions, however, nurse evil kept arguing I was not – I kept telling her I knew what was happening and I was pretty sure I was having contractions and that as she kept sticking the monitor on my fibroid she was not picking them up… Laura (formerly an RN at SMH) checked my Pitocin which nurse evil had sneakily put up to 14… she asked nurse evil is shift change occurred at 5.40 and she said yes – so Laura said Lorna – she leaves in 20 minutes, let’s just sit it out… although I did complain about her after the birth.
It was also at around this point that Dr S came in and said – ‘I am leaving and Dr Cohen is coming in – he will be so happy that he is here delivering your baby’ – how awesome is that!! And my Pitocin got turned down… At 6 my new nurse came on… the wonderful Christine… she told me immediately they put her on the natural births – she had all hers that way and breast fed for 3 years… oh what a sigh of relief did I let out… from here on out I walked, I ate and I swayed… I found sitting too hard at this point and labored always standing in a lunge position holding Laura’s arms… unfortunately thanks to the joy of Pitocin overload from nurse evil I had only 40 seconds between each contraction… according to Alex I made the most of each 40 seconds – I just shut down and retreated and gathered strength – that is how it feels in reflection… there were moments I remember thinking I can’t do it, I need something, and then looking up at Alex and Laura and just meeting their eyes and realizing I could and if I would just wait – it will end - and you will have your 40 seconds… and I remember transition – dashing between the room and the bathroom with Alex running behind me with a basin, feeling like I had to pee and then vomit – and never actually doing either!

Apparently I then collapsed… I remember the lights coming on… being lifted onto the bed and Dr Cohen yelling “she has had too much Pitocin’ and Alex yelling back at him about nurse evil… and then the IV of fluids going in to rehydrate me… both my heart rate and baby’s had dropped… Dr. Cohen had them put an oxygen mask on me and I freaked out –claustrophobia… ugh… so he and I yelled at each other – and he said in his sternest Jamaican accent ‘woman – if you don’t put that mask on I will C-section you’. He did not really mean it, he told me the next morning he knew what to say to make me listen and stop arguing, so we compromised and ended up with Alex intermittently holding it to my face and taking it away.

…And then it was fine – I was fine – the lights dimmed again… and I was having 5 mins between my contractions and starting to do involuntary curls… my uterus was pushing, although I was not yet actually pushing I was curling up involuntarily… Laura and Christine told me what this is called, I can’t remember now…

At this point my mother appeared, when I collapsed I gather I did the normal thing and asked for my Mum… I had originally said only Laura and Alex were to be in the room with me… and my mother who adopted both my sister and I and has NEVER attended a birth said – I’ll come in when the baby is born if that’s okay. Well I wanted my Mum now… so Alex called my sister and said get your Mum and bring her in now… so at some point they both appeared in the room – and I then said to Alex to go get his Mom who was sitting in the waiting room – we can’t have one grandma and not the other. And so it was, as it was meant to be… Alex, Laura and Mum on one side and my ma-in-law, Carola, and dear Sister, Jackie, on the other… they all played a role in some way and were a great source of strength…

In my head I was making a lot of noise as my uterus pushed and curled me up, but apparently I was moaning low – very low and was completely in a zone. My sister held one hand and my mother the other… when the contraction ended I sat back and closed my eyes and just rested. Alex and Laura stood next to my mother – my silent support and Carola kept cool cloths on my neck and back… Christine spent ages oiling and stretching my perineum and then I felt it – my baby did a flip – he had been so quiet, gathering his energy and then he flipped and rolled around and I thought this is it… and the final stage began… at some point after this Sebastian Alistair made his way into the world – one hour and 19 minutes into Pisces (the sign I hoped for)... all 8lbs 4oz and 21 inches… apparently my first question was to inquire if he had hair… then when I saw him I wailed ‘It’s a baby’… I have no idea how long I pushed or how many times, I only know that the entire labor took approximately 10 hours and my mother – she who had never felt a need to see a birth - turned to me and said ‘wow, you made it look so easy’!

They did all the Apgar and baby checks in the room right beside me as requested – and the wonderful pediatric resident stayed until Sebastian latched on, and there we stayed skin to skin in the birth room for an hour or so… and as Dr Cohen sewed me up, he told me later most of the tear was from Sebastian’s hand as he came out…

Everyone there with me was were totally behind me each step of the way and with each choice I made, I was blessed to have the team I did with me that night… there were things that were hospital driven vs. what I would have experienced with a midwife, but in general I held strong and with the help of Laura we advocated for what we wanted and needed.

Once Sebastian had latched on and I was put back together they gave me drinks and got me in the shower and Christine washed me while Alex held Sebastian. Then I was put into a wheel chair and we headed up to mother and baby… the nurses at the birth station all stopped to talk to me… one told me as I went past that she had gone to the Rosemary Court birth center to have hers. Another told me that it was women like me that kept a lot of them still working. It was amazing I felt so empowered, like a rock star! When I got to my room in the mother and baby unit they said let’s get you showered – I said, but they showered me downstairs… she looked at me for a minute and said ‘they NEVER do that’… I said well they did…

Wednesday, January 18, 2012

Anonymous Donor Helps Healthy Start's "Save My Life" Program Combat Racial Birth Disparities

Maybe guns aren’t the biggest threat in Newtown.

Perhaps the biggest threat is the area’s staggering rates of poor birth outcomes, such as premature birth, fetal mortality, and infant mortality. Despite a statewide decrease in deaths among children younger than one year old, the infant mortality rate for African-Americans in Sarasota County has continued to creep upward. And disparities between rates of fetal mortality, infant mortality, and prematurity between blacks and whites continue to be alarmingly present. Sarasota County’s most recent 2008-2010 rolling average data indicates the African-American rates for fetal mortality is more than twice as high as whites; infant mortality is 3.5 times as high; and preterm birth is 1.7 times as high.

Aimed at reversing this alarming trend, the Healthy Start Coalition of Sarasota County created the “Save My Life” Program in 2008, an education and support-based Childbirth and Parenting Education program centered in the Newtown area. The Save My Life Program offers small group and individual classes on the importance of health during childbearing years and during pregnancy, stress reduction, childbirth education, breastfeeding education, in-home support for breastfeeding, and safe sleep practices for infants. Outreach efforts, education, and classes are offered by the only African-American Childbirth Educator in Sarasota County, Beverly Phelps.

“Early intervention to begin reversing this cycle must begin prior to pregnancy, and continue throughout pregnancy and after pregnancy. The early experiences of any human, from the beginning of pregnancy into the first few years of life are crucial,” said Jennifer Highland, Executive Director of the Healthy Start Coalition of Sarasota County. “By focusing on education, support, and prevention, we aim to improve chances young families will stay healthy.”

Funding for this vital program comes from donations and grants, both of which are currently threatened. After 3 ½ successful years, this program will end in spring of 2012 without additional funding. However, the Healthy Start Coalition has been presented with a unique opportunity to continue funding this important program: an anonymous donor has come forward with a $10,000 Challenge. If $5,000 is raised by the community before February 15, the donor will match it with another $5,000.

“This is an important opportunity for our Community to get involved in the health of our youngest citizens”, continued Highland, “It is time for us to rally as a community to save our babies!”

For more information, contact

Wednesday, January 4, 2012

An Evening for Healthy Start

On Thursday, January 26th, from 6 to 9 pm, Sarasota Architectural Salvage will host the 3rd Annual “An Evening for Healthy Start” Fundraiser to benefit The Healthy Start Coalition of Sarasota County. The event will be emceed by former Sarasota Mayor Kelly Kirschner, and will feature live music by local Latin, Caribbean, Funk and Motown dance music band, Big Night Out.

The event comes at a critical time in the Healthy Start Coalition’s fiscal year, when funding for critical programs threatens to expire. This year’s event has the potential to raise more money for Sarasota’s pregnant women, infants and young children than in previous years, due to the generosity of several local business members and individuals, including those from the fields of obstetrics, perinatology, midwifery and pediatrics.

Sarasota Architectural Salvage paints an eclectic and distinctive backdrop for “An Evening for Healthy Start,” making it one of the most unique fundraising events of the season. Guests will be treated to light fare provided by local restaurants, including Nancy’s BBQ, Caragiulo’s, Nellie’s Deli, Carrs Corner Café, The Lollicake Queen, Gold Coast Eagle Distributing, Vin Cella and Local Coffee and Tea. The event will also feature a raffle and silent auction, featuring an exquisite pendant necklace from world-famous jewelry designer Ned Bowman of Bowman Originals in Sarasota.

Tickets are $20 in advance and $30 at the door, and include two beverage tickets and a coupon for Sarasota Architectural Salvage. To purchase tickets, call (941) 373-7070, or

The Healthy Start Coalition of Sarasota County is a non-profit, 501 (c)(3) organization dedicated to improving the health and well-being of pregnant women, infants, and young children in the community. Healthy Start coordinates a variety of specialized programs to serve high-risk groups and address specific risk factors that contribute to fetal death, prematurity, low birth weight, and infant death. For more information, please call (941) 373-7070 or visit

Monday, December 12, 2011

Maternally Yours to Air Exclusive Interview with CNN Hero of the Year Robin Lim

Last night, international midwife Robin Lim was named the 2011 CNN Hero of the Year, accepting an award of $250,000 for her non-profit birth clinic Yayasan Bumi Sehat in Bali, Indonesia. Maternally Yours, Sarasota’s Conversation about Pregnancy, Childbirth and Early Motherhood, recorded an exclusive interview with Robin just days before her win, and will air the interview on Tuesday, December 13th, on Sarasota’s community radio station, WSLR 96.5 LPFM.

“To say I am thrilled for her is the understatement of the century,” says Maternally Yours co-hostess Ryan Stanley. “This win will make real change for mothers and babies in Indonesia and worldwide—mothers and babies will live and thrive because of this award.”
Since 2005, Robin Lim’s clinic Bumi Sehat (translated as Healthy Earth) has treated nearly 113,000 patients and delivered nearly 4,000 babies for free in Bali, where rates of postpartum hemorrhage and maternal and infant mortality are among the highest in the world. “Ibu” (Mother) Robin is a midwife, well-known author and talented poet who has dedicated the last 13 years of her life to this clinic, despite constant financial, cultural and geographic challenges.

“The earthquake that we just had last month…was big enough that we have cracks in the building. The floor started to rise up in one of the birth rooms because of the movement underneath the ground. About twenty minutes after one of our moms gave birth, the floor actually exploded,” Robin told Maternally Yours last Wednesday. “When that happened, I committed in my heart to winning. Should we be gifted that money…from CNN on Sunday night, it will go toward building that clinic.”

Speaking from the Texas home of her daughter Deja Bernhardt (who directed the film Guerrilla Midwife about Robin’s work), Robin told Maternally Yours how she was feeling en route to Los Angeles to find out if she would be named CNN Hero of the Year. “I would say that nervous is one good word; I think it’s because it’s so much bigger than me,” said Robin. “I feel like this is the time for people to come out and vote for the concerns of mothers and babies and children, and that woman-to-woman, midwife-to-mother model of care.”

And, for eleven weeks straight, people voted.

During her acceptance speech last night, Robin Lim made a tearful plea for the world’s help in reducing maternal and infant mortality.

"Today on our Earth, 981 mothers in the prime of their life will die—and tomorrow again, and yesterday," said Robin. "We don't even know how many babies are lost, but all of us can help change that. The very best way that I know is to support your midwifery to mother care, so that the midwives can help lower the risks of motherhood, and we can save lives together—mothers and babies.”

Robin Lim is a friend and listener of Maternally Yours, which seeks to educate and inform women and families about the options, support, and evidence-based best practices available to them in maternal-child healthcare. “What you’re doing…is an exciting thing,” said Robin. “In this day and age, we’ve lost that radio medicine. You’re bringing it back in a beautiful way.”

To hear the exclusive Maternally Yours interview with 2011 CNN Hero of the Year Robin Lim, please tune into WSLR 96.5 LPFM Tuesday evening, December 13, at 6:00pm. The program is also available via live streaming on, and podcast at For more information, please contact the hostesses of Maternally Yours at

About Maternally Yours: Maternally Yours is Sarasota's Conversation about Pregnancy, Childbirth and Early Motherhood. The Conversation airs on Tuesday nights at 6:00pm on YOUR Community Radio Station, WSLR 96.5 LPFM. The hostesses of Maternally Yours are Cheryl Kindred, Carmela Pedicini, Ryan Stanley and Laura Gilkey. The mission of Maternally Yours is to educate and inform our community about the options, support, and evidence-based best practices available to them in maternal-child healthcare.

About Bumi Sehat: Founded in 1995, Bumi Sehat is a non-profit, village-based organization that runs two by-donation community health centers in Bali and Aceh, Indonesia. We provide over 17,000 health consultations for both children and adults per year. Midwifery services to ensure gentle births is at the heart of Bumi Sehat and our clinics welcome approximately 600 new babies into the world each year. For more information, please visit

About WSLR 96.5 LPFM: WSLR is an innovative, listener-supported, non-profit, non-commercial FM radio station dedicated to serving the Sarasota community. WSLR features locally produced programming and presents cultural, artistic, and political perspectives currently underrepresented in the media. Our goal is to inform and empower listeners to play an active role in WSLR and in their community. WSLR’s programming promotes equality, peace, sustainability, democracy, and social and economic justice. For more information, please visit

Wednesday, December 7, 2011

Ina May Gaskin's Acceptance Speech: The Right Livelihood Awards, 2011

It is a great honor to have been chosen as the first midwife to receive the Right Livelihood Award. In accepting this award, I feel a deep sense of responsibility to my fellow midwives throughout the world. Most of us necessarily share an awareness of powerful forces that now threaten the continued existence of the profession of midwifery in many parts of the world.

Rates of cesarean section are rising rapidly in most countries, far beyond the upper limits recommended by the World Health Organization. As cesarean rates increase, rates of maternal death and serious injury rise as well, and women’s fears of birth increase. At the same time, time-honored knowledge and skills begin to vanish. I have visited private hospitals in Brazil where the cesarean rate was 95%, because women (and their doctors) had become so afraid of the normal process of birth that the cesarean became the default.

When surgical and technological interventions in birth become the norm rather than the exception, the profession of midwifery loses its basis for existence, and obstetrics itself no longer encompasses the skills and knowledge that were once considered essential competencies of the profession. I’m speaking of the skills and knowledge necessary for assisting vaginal breech birth, the birth of a second twin, the ability to manually assess fetal weight, to distinguish between normal labor pain and pain that warns of complication, to determine the position of the baby in the womb, to change it when it is unfavorable, and even to accurately diagnose pregnancy. To explain what I mean by this last-mentioned skill, we in the U.S. have already come to the point of discovering several cases of false pregnancies diagnosed only after a woman’s abdomen was opened for a cesarean, an order of mistake that could hardly have been imagined two or three decades ago, when physicians’ education in manual skills was still considered important. The shrugging off of traditional knowledge in the U.S. had progressed to the point that by the 1990s, the two major obstetrics textbooks no longer included any reference to the phenomenon of false pregnancy (pseudocyesis), even though it has always been known to exist in humans, as well as other mammals. Only a country which has become superstitious in its use of technology could imagine that the use of imaging technologies could eliminate the need for teaching traditional manual diagnostic skills and all of the phenomena that occur in women’s reproductive lives.

The history of birth in the U.S. during the 20th century illustrates well how essential a strong midwifery profession is if women are not to be held within a web of fear concerning their bodies’ supposed defects when it comes to giving birth. The elimination of the profession of midwifery in the U.S. in the early 20th century paved the way for a factory model of hospital-based maternity care that by the mid-century had two-thirds of all babies pulled from their mothers’ bodies with forceps. Such a radical overuse of forceps did not happen in countries in which the value of a strong midwifery profession was recognized. With no midwives present in hospitals to instruct medical students in the wise ways of nature, men with the least understanding of the conditions necessary for women to give birth in a humane way soon came to believe that birth was necessarily a brutal and bloody affair and that human females actually represented a serious failure on the part of nature – one that could only be remedied by routine use of technology and medication. Now the profit motive really began to emerge vis-à-vis birth, and fear, greed, and ignorance have combined to make a nasty brew, as well as a witch-hunt against midwives who work according to the rhythms of nature.

The belief soon grew that babies would be most safely born when the mother’s body was intentionally injured in order to free the baby, with the further rationale that such an injury would prevent worse injuries that would otherwise occur. Such myths, unfortunately, are perpetuated through Hollywood films, which usually focus on birth complications for dramatic value, while physiological birth is not depicted because of taboos against showing the relevant portions of the female body.

As one of the mothers who knew there was nothing wrong with my body and that the birth of my first child by forceps had been unnecessary – risky for me and my baby, with no discernible benefit, and psychologically harmful as well – I was left to find an escape route for myself for my next pregnancies. This dilemma prompted me to arrange for my own midwifery education (as I was unaware of that any other way was available), an arrangement that I was able to accomplish with the timely help of four physicians who also saw the need for midwives in our country. Free to learn from any sources I considered relevant, I learned from non-literate traditional midwives, from old books, and animals, as well as from kind physicians.

From the beginning of the Farm Midwifery Center, my colleagues and I placed women’s needs at the center of our policy-making and found that this way of organizing care yielded huge benefits for our babies as well as their mothers. We learned how to prevent complications by providing good antenatal care and we developed practical methods for preventing unnecessary cesareans and inductions of labor.

Looking around, I found some other midwifery services backed by supportive physicians in other parts of the world with outcomes that were nearly identical to ours. The midwives who worked with the late Dr. John Stevenson in south Australia, those who worked with Dr. Alfred Rockenschaub in Vienna between the mid-60s and the mid-80s, and those still working with Dr. Tadashi Yoshimura in Okazaki City, Japan, all reported cesarean rates well under 5% with good newborn outcomes – just like ours. This was especially interesting, since we hadn’t previously been aware of each other’s existence. Unfortunately, in each case, these physicians – instead of being saluted by their peers – were treated as if they were hopelessly out of tune with the times and therefore irrelevant. We need to honor these men, who are still writing and teaching anyone willing to listen.

Now that many industrialized countries are reporting cesarean rates of 30% or more, despite the fact that midwives have always been accepted members of maternity care staff, it’s important to recognize other factors that drive up rates of intervention in birth. Popular culture, the profit motive, fear, prudery, and ignorance all play a role and should be addressed.

What is often missed is that excessive cesarean rates have other negative consequences than the loss of midwifery and obstetrical knowledge and skills. Simply put, as rates rise beyond 15-20%, more women die from complications such as pulmonary embolism, infection, hemorrhage, and a sharp increase in placental complications in subsequent pregnancies. None of the countries with
the highest cesarean rates can report on low maternal death rates. This is especially true of the U.S., where women now face at least twice the chance of dying from pregnancy-related causes as their mothers did. In California, between 1996 and 2006, the maternal death rate tripled, with much of the increase being attributed to an excess of cesareans. Don’t expect the U.S. to report these telling facts with any accuracy, though, because the current lack of an infrastructure that requires and produces accurate and consistent reporting, and analysis of maternal deaths, means that the official maternal mortality figures represent possibly only a third to a half of the actual numbers.

To avoid facing the problems that we are now experiencing in my country, I have some recommendations to propose:

Countries with increasing cesarean rates should consider taking positive steps to reverse this trend, including stepped up efforts if rates rise about established limits. Midwives should be placed at the gateway to maternity care, instead of being introduced to women late in pregnancy and grudgingly if at all. This model of care recognizes that a woman’s confidence and ability to give birth, care for, and breastfeed her baby and the baby’s ability to feed effectively can be enhanced or diminished by every person who gives them care and by the birth environment. Because of this, all care given during the time surrounding birth should give the needs of the mother-baby pair precedence over the needs of caregivers, institutions, and the medical and insurance industries. Individual hospitals should consider implementing the 10 Steps to Optimal MotherBaby* Maternity Services (

Midwives must have an important say in the formation of maternity care policy. Care should be individualized and founded upon consideration and respect for every woman. When not under
threat of a dominant medical profession, which is itself dominated by a powerful insurance industry or a powerful hospital industry, midwives can provide care that is organized around the principle that women’s and children’s rights are human rights and that access to humane and effective health care is a basic human right. Independent midwives must be able to make a living from their work, which means that insurance companies should not be permitted to charge such high premiums that it becomes impossible for them to make a living.

We must wake up to the fact that it is easy to scare women about their bodies, especially in countries in which midwives have little or no power in policy-making, relative to physicians and the influence of large corporate entities. This takes no real talent. Given such imbalance, fear, ignorance, and greed begin to reinforce each other, and rates of unnecessary intervention soar, with women and the babies suffering the consequences. Birth care must not be profit-driven. This makes incentives to cause problems, not prevent them.

For this reason, there should be no more fee-for-service payment – for instance, financial reward for the unnecessary use of a vacuum extractor.

If all countries put the welfare of mothers and babies at the center of maternity care policy, midwifery would have to grow strong again. In some countries, such as my own, it will be necessary to greatly increase the number of midwives as just one of the ways to prevent complications and to reduce rates of medical intervention in birth. We’ll need lots of doulas as we make this transition. Midwives need to have a say in the major issues surrounding birth. In countries where they currently work under the intense domination of obstetricians, the work will be to bring the relationship back to one of balance. Midwives cannot allow obstetricians to bully them, because doing so is almost certain to mean that laboring women will be the next ones to be bullied.

Attempts to make home birth illegal in any country will only distract from the real problems and exacerbate them, since planned home birth for healthy women provides a necessary safety valve for women who want a wider range of choice than their hospital might offer and a learning opportunity for midwives to learn about women in their natural state. Home birth midwives must be able to make a living from their work, and insurance companies should not be permitted to keep home birth midwives from being compensated for their work. Home birth midwives are being persecuted in almost every country, even in The Netherlands, where home birth services have a long and honorable tradition. I believe the development of a country can be measured by the degree to which it respects the right of a birthing mother to receive a woman centered birthing experience, whether the birth occurs in a home or hospital setting. In this regard the current situation in Hungary greatly disturbs me. There, the failure to fully provide and protect this important right is highlighted by the prolonged discrimination and mistreatment of the independent midwife Dr. Agnes Gereb. Agnes has spent more than 20 years trying to defend the fundamental rights of mother and child and in doing this she has been imprisoned, recently received a further 2-year prison sentence and has been held under house arrest for the past year. I now ask the Hungarian government to intervene to stop the abuse and unjust treatment of this internationally respected homebirth expert.

Birth shouldn’t be thought of as money-making commodity or condition in which large institutions or governments control and dictate how women will give birth, ignoring individual mother’s wishes and needs. Inevitably, this too often puts bullies in charge of women’s bodies, something no other mammalian species allows. Some countries have midwives who are totally subordinate to physicians. In these countries, it’s typical for very harsh methods of birth care to be applied, and outcomes show this. It’s time to stop this sort of behavior. Traditional peoples, indigenous people don’t permit such behavior. We need to learn from them.