On Sunday, the Sarasota community has an opportunity to improve the health of our pregnant women. "Maternal Health Care in the 21st Century: Sarasota and Beyond" is a free discussion featuring leaders in the fields of obstetrics, midwifery, public health and public policy. This balanced panel will create a forum for much-needed dialogue about the state of maternity care in Sarasota.
The distinguished panelists for Sunday's program are Dr. Washington Hill, M.D., FACOG, medical director of labor and delivery at Sarasota Memorial Hospital; Ina May Gaskin, CPM, founder and director of The Farm Midwifery Center; Jennifer Highland, executive director of the Healthy Start Coalition of Sarasota County; and Rep. Keith Fitzgerald, District 69, Florida House of Representatives. The discussion will be moderated by Sarasota Vice Mayor Kelly Kirschner.
Each speaker will offer his or her unique expertise with regard to the current condition of maternal health care and what we can do to improve it. Attendees will have the opportunity to ask the panelists questions immediately following the discussion. There will also be several guests in attendance with expertise in different areas of maternal health care, to whom questions can be directed as well.
The American obstetric model is being replicated worldwide, yet we are failing our pregnant women. According to a World Health Organization report released this July, America ranks 35th in maternal mortality and 33rd in infant mortality, two widely recognized barometers of public health.
We cannot improve America's maternal and child health status without making changes in our own community that ensure that prenatal care is available for all of our women and families, and that modern medicine and technology are being used appropriately.
While obstetric interventions like labor induction and cesarean section surgery are absolutely necessary and even lifesaving for some, they can be detrimental and life-threatening for others, and are extremely costly for taxpayers (Medicaid covers about half of all births).
It is our responsibility as maternity-care consumers to become educated about all options available to us. This education is a key objective for the planners of "Maternal Health Care in the 21st Century: Sarasota and Beyond." Each attendee will leave the program with a resource guide outlining available prenatal and maternity-care services in Sarasota, a glossary of terms and explanations of different models of care.
One possible way to improve outcomes for mothers and babies is to increase access to, and education about, midwifery care for low-risk, healthy pregnant women, and to encourage a collaborative model of care, whereby midwives and obstetricians work together to give each woman the most appropriate care for her specific set of risk factors.
Pregnant women in our community are very fortunate to have options within both the obstetric and midwifery models of care. Sarasota is home to two free-standing birth centers, four licensed midwives, several certified nurse midwives, many obstetricians, perinatologists and a hospital with the only Level III intensive- care nursery in this four-county region. There are options for low-income and uninsured families to receive quality prenatal, childbirth and postpartum care, regardless of income.
Improving Sarasota's maternal health care will take a collaborative effort by individuals and organizations in many disciplines working together to provide affordable care based on the best evidence available.
However, no advances can be made without the effort and participation of concerned and informed consumers. By attending "Maternal Health Care in the 21st Century: Sarasota and Beyond," Sarasota's women, families and maternity-care practitioners will be on their way to positive change in our community.
Laura Gilkey, vice president of Florida Friends of Midwives, is co-planning "Maternal Health Care in the 21st Century: Sarasota and Beyond" with Sonia Pressman Fuentes, co-founder of the National Organization for Women.
When Jennifer Petroskey was planning for the birth of her third child, she hoped she would be able to have a natural delivery. Her twins, born four years earlier, had to be delivered by Cesarean section.
Her doctor, however, ruled out the natural birth, following a widely-held view among obstetricians: “Once a c-section, always a c-section.” Her doctor cited the potential for complications -- primarily, uterine rupture, resulting from pressure where her uterus had healed.
“I was basically told that this was how it was going to be,” the North Port mother said, “although I wanted the experience of a vaginal birth.”
Petroskey’s experience is the norm, and illustrates a significant trend in how babies are delivered. C-sections accounted for 38.2 percent of all births in Florida in 2008 -- up almost 50 percent from the rate in 2000 and the second-highest rate in the country.
It also highlights how rifts can develop between women, their doctors and other providers of maternal health care. In this case, obstetricians are following their profession’s guidelines for minimizing risk, while more women are embracing the trend of less invasive medical care.
Those are the issues behind a conference Sunday in Sarasota, titled “Maternal Health Care in the 21st Century: Sarasota and Beyond.”
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The conference was born out of a presentation by Laura Gilkey, who delivered her two children at her Sarasota home with the aid of midwives. She is vice president of the Florida Friends of Midwives.
In July, she spoke before the Sarasota Memorial Hospital Board, laying out a slew of statistics in her six-minute talk -- such as Florida’s high c-section rate, studies showing higher neonatal ICU (or NICU) admissions and death rates for babies delivered by c-section, and that c-sections cost nearly twice as much as a vaginal birth.
In Florida, a c-section cost about $14,458, compared to about $7,533 for a vaginal birth, according to the most recent state figures. With more than 40 percent of c-sections being performed on Medicaid or charity cases, the trend also has implications for both the state’s Medicaid spending and Sarasota County’s hospital tax, Gilkey said.
She called on Sarasota Memorial to take steps to lower its c-section rate -- in 2008, it was 41.7 percent, ranking 22nd among the 115 Florida hospitals delivering babies, and about 10 points higher than the 2000 rate.
“Our medical model is not as great as everyone thinks it is,” Gilkey said in a later interview.
She summarized her points in a letter published in the Sarasota Herald-Tribune. It caught the eye of Sonia Pressman Fuentes, a longtime women’s rights activist, who said she was amazed at the findings. Pressman Fuentes, a member of the local National Organization for Women chapter, pulled together support for the conference.
The conference’s purpose, Gilkey said, is to provide better education about childbirth risks and about the full spectrum of maternal healthcare.
“If we move toward a collaborative model, doctors and women working together based on risk levels, our VBAC would rise, there would be fewer pre-term babies, NICU admission would decline and our overall health barometer would rise,” she said.
Panelists include Jennifer Highland, executive director of the Healthy Start Coalition of Sarasota; Ina May Gaskin, a national expert on midwifery; Florida Rep. Keith Fitzgerald, who serves on a House health care planning committee; and Dr. Washington Hill, medical director of labor and delivery and director of maternal-fetal medicine at Sarasota Memorial and a nationally-known expert in his field. Vice-Mayor Kelly Kirschner is the moderator.
At the July hospital board meeting, Hill said it was more important to look at the end result. “When I was a medical student in 1965, we all looked at c-section delivery rates,” he said. “I think now what we look at is the quality of that patient and the quality of that outcome.”
“There is no single c-section delivery rate that can be said to be ideal or correct for either the physician or the hospital or the county or the state,” he said.
But the rise of Cesarean section deliveries demonstrates what happens when some of the most powerful trends in medicine interact.
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In 1990, the U.S. Dept. of Health and Human Services set a national goal of reducing c-sections to 15 percent of births. After some initial gains, rates have steadily risen to a national average of about 32 percent. In some Florida hospitals, c-sections account for more than half of all births.
In his talk to the hospital board, Hill pointed to a number of reasons behind the trend.
There are more mothers over age 35, who tend to develop more complications. More mothers of all ages are obese, another complication. More women are concerned about preserving their pelvic floor. Some women elect c-sections for convenience and for a desire to have a “perfect” baby.
And hospitals are trying to respect patients’ decisions. “We’ve made a decision at this hospital that if a patient is well counseled and says she wants a primary elective cesarean delivery or induction, then she can have that done,” Hill said.
One of the most important factors, he said, is fear of a malpractice suit. “The physicians themselves say very clearly that malpractice litigation concerns and the risk of litigation is going to increase their decision to do a cesarean delivery,” Hill told the board.
C-sections are quicker and more predictable, less prone to sudden or unforeseen complications, obstetricians say.
And as more patients and doctors opt for the surgical deliveries, it starts a cycle. If a woman who delivered by c-section is having another baby, her doctor is likely to recommend another c-section. National studies show about 90 percent of women who deliver a baby after a c-section do so by another c-section. ---
Jennifer Petroskey’s four-year-old twins, Alex and Kailin, are happy, healthy kids now. But at birth, one was in breech position, the other transverse, indicating a c-section was the safest course.
Six-month old Jackson presented no such problems, but her obstetrician insisted on a c-section, saying the risk were too great. Petroskey likes and respects her doctor, so she agreed.
“I wasn’t really given a choice. I was told that was what was going to happen,” she said.
The doctor’s advice reflected the evolution of the field’s position on vaginal birth after Cesarean, or VBAC. The long-held dictum was challenged in the 1980s and doctors again began accepting the procedure, with it peaking in the late 1990s.
But the studies reaffirmed the initial position, and doctors again shied away from VBAC. In Sarasota, Dr. Michael Shroder is one of the small handful of obstetricians will perform the deliveries.
He understands his colleagues’ reluctance about the VBAC. "There is a real risk of complications,” said Shroder, who, like Hill, is a member of the First Physicians Group practice.
The potential problems include uterine rupture, hysterectomy, blood clots, infection, maternal mortality. Uterine rupture, tear in the wall of the organ, occurs in about 1 percent of VBACs, but of that 1 percent, few are catastrophic ruptures and can be treated easily.
He cited a Dec. 2004 study in the New England Journal of Medicine, which examined nearly 34,000 cases of mothers carrying a single baby and who had a previous c-section. About half had another c-section, while half had a traditional labor and delivery.
In the labor and delivery group, there were 124 uterine ruptures, about 0.7 percent, and 12 cases of where the infant suffered complications from a lack of oxygen during delivery. There was no difference in maternal death rate. Overall, the researchers found a 1 in 2,000 chance of of an adverse complications for the infant. Echoing the authors, Shroder termed it a "a small but significantly higher risk."
But, he notes, in some cases there are “significant benefits." In addition to avoiding a longer hospital stay, the major advantage is avoiding another scar in the uterus, which could complicate a future pregnancy. Those complications include placenta previa (separating and bleeding), or placenta accreta (intruding into the muscle of the uterus.)
He bases his decisions on the patient’s history -- has the patient had more than one previous c-section, or if the c-section was other than a low transverse incision -- and on the presence of other conditions, like placenta previa, that would indicate a c-section.
And it depends largely on the patient’s plans. A c-section might be indicated for 40-year-old woman planning no future pregnancies. “A 20-year-old who plans two more children has a lot to gain from a VBAC," he said.
“It’s incumbent on me to look at the facts and risks and benefits and help the patient make a informed decision.”
In addition to potential complications and liability, he said, some obstetricians avoid VBAC because of hospital policies. Sarasota Memorial’s policy, which he said is common, requires the obstetrician to be present for entire labor, a major time commitment that can take them away from other patients.
That reluctance of doctors and hospitals may send women to midwives, generally more accepting of the mother’s wishes. But that raises some concerns for doctors.
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“Having a baby at home is a risk. Having a baby at a birthing center is a risk,” Hill said. “If they have a decline of the fetal heart rate, by the time the baby gets here it could be a catastrophe.”
But he also sees the value of midwives in maternal health care, noting the non-profit Genesis Newtown Medical Group’s team approach to reducing fetal death rate, premature births and low birthweight babies. It employs community volunteers, midwives and an obstetrician to provide prenatal care for the low-income community.
Similar programs have a track record of success. In 2002, Florida Hospital Waterman, in Lake County, noted an alarming trend: More and more pregnant women were showing up in its emergency room, some about to deliver, with no prenatal care.
It meant complicated, often premature births, and longer hospital stays for both mother and child. It meant financial losses for the hospital, because most of the mothers were uninsured. Meanwhile, obstetricians were leaving the county, over the rising cost of malpractice insurance -- to some extent because of the more precarious deliveries.
The hospital met with Lake County officials and together they developed a strategy to hire four midwives and two OB/GYNS midwives to provide prenatal care. The midwives also care for the mothers in the early stages of labor.
The result: in 2007-08, the program handled some 700 deliveries and saved the hospital an estimated $1 million.
Lake County saw its Cesarean delivers drop from almost 51 percent in 2006 to 36 percent in 2008, a 14-point drop -- double the reduction of the next-best Florida hospital over that time, and only 11 hospitals reduces Cesarean deliveries by 2 percentage points or more.
County officials attributed the improvements to the work of the midwives. “If you didn’t have a team program that saw the uninsured in the community, what you would have is the patients reporting to the ER with no prenatal care,” said Donna Gregory, a Lake County Health Department administrator, in an interview this spring.
The Sarasota conference planners say they hope to foster similar partnerships and more unified maternal care with the best possible outcomes.
“There are many pieces needed to make this happen -- licensed midwives, hospitals, the community, government. Each piece has some work to do,” Hill said.
“The licensed midwives need to communicate better with the doctors. We need to communicate better with the licensed midwives. We all need to work together. If we don’t communicate with each other, the whole thing breaks down.”
“We should do whatever we can in the community to have a healthy mother and a healthy baby,” he said.
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The conference is free and open to the public, and will be at 3 p.m. Sunday, Nov. 1., at the Hyatt Regency of Sarasota. Call 915-8115 for more information.
This morning's Sarasota Herald-Tribune featured an interview of Ina May Gaskin by Anna Scott, the newspaper's health reporter. Ms. Scott asks Ina May about today's Clinical Conference at the Hospital (Ina May's topic: Balancing the Best of Modern Obstetrics with Respect for Nature and Traditional Midwifery Approaches), her latest book, and The Safe Motherhood Quilt Project. Full text follows:
Midwife to discuss maternal health By Anna Scott Ina May Gaskin, left, shows Tamar Kalta, center, how to feel the position of Cayla Whitehead's baby during a class in midwifery at The Farm in Summertown, Tenn. Gaskin is a midwife who has helped to bring back home birth and lay midwifery.
SARASOTA - Ina May Gaskin, who has been called the mother of modern midwifery, will be in Sarasota this weekend for a panel discussion of maternal health issues. On Sunday she will appear alongside Dr. Washington Hill, the head of obstetrics at Sarasota Memorial Hospital, and Head Start Director Jennifer Highland and State Rep. Keith Fitzgerald, D-Sarasota.
Gaskin grew up in Iowa and lives in rural Tennessee near the birthing center she founded more than 30 years ago. She has written several books on natural motherhood and is leading a movement for better tracking of causes of death in pregnant women. Gaskin is also the first midwife to have an obstetrical maneuver named after her: the “Gaskin Maneuver” dislodges an infant's shoulder during birth without using drugs or surgery.
Q:Your latest book is “Ina May's Guide to Breastfeeding.” What do you think about the recent flare-ups over women breastfeeding in public?
A:In this country too often people are rude to a mom who is giving her baby the best food and medicine she can. And these super bibs people buy to cover it up – who would like to eat with a blanket on their head? It's just bizarre. Babies like to look at their mothers when they're eating. Unless we're going to force women to stay in their homes for the duration of breast-feeding we should look at it as a pretty sight and be glad the baby's not crying.
Q:What is biggest challenge facing the midwifery movement today?
A:Cesarean sections and unnecessary inductions. I think there's a huge fear of malpractice lawsuits. You never hear of someone getting sued because they did an unnecessary cesarian, but there are quite a few lawsuits where they say, you didn't do a c-section fast enough. As for mothers, some of them don't even think a cesarian will hurt. This generation isn't cautious enough about surgery. We're getting too far away from the laws of nature. I grew up around farm people and they believed anything can be born naturally. The body is not a lemon.
Q:What do you plan to say in your lecture today to Sarasota Memorial hospital staff?
A:I think because we don't have a part enough in educating the doctors or their medical students, they don't understand what we do. They only tend to come in when we have a problem so it's easy for them to develop the idea that all the births we do are problems. Those situations are just part of the mix. We midwives know we need doctors. We would never say there should be no such thing as a doctor. In an ideal maternity care system you would also have midwives and we would be part of the backbone of the system.
Q:The Safe Motherhood Quilt Project is your latest project, a traveling quilt made up of individually designed squares, each one devoted to a woman in the U.S. who has died of pregnancy-related causes since 1982.
A:The lowest pregnancy death rate in the U.S. was in 1982 and we can't get it back going down. The CDC said we could be missing as many as two-thirds of the deaths because we don't track them closely enough. That's an intolerable situation. I can't think of any way to end that than to require that every single death be counted, that the CDC be given the power and funding to that, and state laws are amended to be in sync with each other.
Last night, Dr. Washington Hill, MD, FACOG, panelist for Maternal Health Care in the 21st Century: Sarasota and Beyond, was the guest of WWSB ABC 7's Heidi Godman. They discussed the upcoming program and maternity care options in Sarasota. Watch the video:
And this evening at 6:00 pm, please tune into WSLR 96.5 LPFM's program Local Matters, with host Joe Hendricks. The show will feature an interview with the world's leading midwife Ina May Gaskin, as well as studio guests Harmony Miller, LM, CPM, (pictured) of Rosemary Birthing Home, and Maggie Davenport, local mother of two home-birthed babies. Tune in tonight or catch the podcast here, and come meet everyone you've heard on Sunday at the Hyatt Regency Sarasota at 3:00 pm for Maternal Health Care in the 21st Century: Sarasota and Beyond!
Beginning today, three panels of The Safe Motherhood Quilt Project are on display at the Selby Public Library. The Safe Motherhood Quilt Project is a national effort developed to draw public attention to the current maternal death rates in the United States, as well as to the gross underreporting of maternal deaths, and to honor women who have died of pregnancy-related causes. The three panels currently on display in Sarasota represent 58 mothers who have died of pregnancy or childbirth related causes in the US since 1982. I was honored to be a quilter for one of these panels. There are several other panels throughout the country just like them.
Project founder and world's leading midwife Ina May Gaskin will be presenting these panels on Saturday, October 31st, at 11:00 am. Following her presentation she will sign copies of all three of her books (Spiritual Midwifery, Ina May's Guide to Childbirth, and Ina May's Guide to Breastfeeding), in benefit for Florida Friends of Midwives and The Safe Motherhood Quilt Project.
(by Steve Mersinger Jr., about the birth of Caleb, born 09.14.07)
"You can take the Mersingers out of Kentucky but you can't take the Kentucky out of the Mersingers." -ancient redneck wisdom
So most of you are wondering, who are these people again? It's been a while since we've communicated with the outside world, sorry! A lot has been going on and we'll fill you in with more details later on. For now, the best thing for me to do is hop right to the Story of Caleb and "the DGC" (Dodge Grand Caravan). It's a delightful tale in which no exaggerations need occur. I do have the gift of exaggeration but what you're about to hear requires none of my skill, and you'll see why!
Most of you know that nearly 21 months ago we popped Naomi out on a Lazy Boy in Kentucky. Little did we know that it would cause a deep curse to be placed upon our family.
Approximately 4pm on 9/13/2007 Shannon Mersinger started to receive increased contractional activity. So we went to Applebees. Dinner was good and stuff. Around 7pm those contractions got even crazier so I (Steve Mersinger Jr.) drove Naomi to my parents for them to watch her. By the time I returned Shannon's contractions were causing her to spurt profanity and throw stuff (slight exaggeration).
After 24 hours of labor with Naomi, we didn't want to rush off to the birthing center and end up having to turn around if she wasn't dilated enough. However, Shannon's mom, Kitty, with crazy wide eyes said "it's 45 minutes away, we should leave". I'm not one to ignore the advice of someone who has popped out nine kids, but Shannon wanted to wait until she was having minute long contractions (she likes to feel the burn!). The contractions were only lasting 40 seconds so she didn't want to leave quite yet.
However, they were starting to be only 2 minutes apart. So eventually, at midnight, we couldn't outlast Kitty's gaze of foreknowledge saying if you don't leave soon you're going to pop this baby out in the van on the way.
We packed Shannon up, I was already tired from pushing on her back and felt like I needed to rest for the long night ahead of us. So when she asked me to let her mom drive and hop in the back with her, I nobly (cowardly) deferred to her mom and said I needed to drive. We were about five minutes from the house (on a 45 minute trip) when Shannon cries "oh my God, my water broke."
I grinned and thought "of course her water broke, why wouldn't it."
I then beat the crap out of my weak stomach and told myself that placenta stuff smells like roses and continued driving. Kitty had me call the mid-wife and fill her in on what was going on. She remarked how calm I sounded, I replied that freaking out wouldn't help (besides, we had hours left in this thing). The phone call ended and was met by an abrupt cry by Shannon "I feel his head!"
Surely this was intense emotional overreaction.
Shannon's mom checked and I was right again! But Kitty said, you need to drive faster. So I cruised up to 55 in a 45. She said faster and I said I didn't want to get pulled over. Then three words shook my steel like confidence "yes you do!" I suddenly wondered about all of those roadside birth stories and got this grin on my face that I wish someone had recorded. I thought what a cool story it would be to have Caleb in a vehicle, but reality set in that this kind of thing doesn't really happen, or if it does certainly not to people like us (heavy foreshadowing, but you're doubting aren't you?).
I eventually found myself cruising up to 75mph in a 45 and running red lights. While my wife was in intense pain, I was experiencing my dream! I've always wanted to get chased by cops and outrun them in a piece of crap car, now my son was giving me the perfect excuse. 10 minutes down the interstate doing 20 over still hadn't drawn out any coppers. Shannon started saying something about pushing, I checked the vomit from my esophagus, and realized that I had a job to do. Faster and faster we sped, while pieces began to shake on the van threatening to fly off and solidify our roadside appointment with destiny. I saw flashing lights up ahead and decided to take matters into my own hands. As I stopped halfway in the third lane of traffic (in SW FL where everyone is in bed by 7), I jumped out of the van and ran for the state trooper who sat in his vehicle grinning like a hall monitor who's hopped up on impotent power and pop rocks. I said to him "sir, I don't know how important this issue HERE is but my wife is in labor and I was hoping you could give us an escort." I'm not sure that he knew what labor was or if he'd ever seen a woman naked, but he looked panicked and said I"ll call an ambulance. I told him that was unnecessary and we were fine, we were just hoping for an escort. He told me that he could call an ambulance but wasn't allowed to escort us. I think he was scared. I said no problem and ran back for the van. During my sprint I noticed two forms hanging into the passenger window from the outside. Two women from the "accident speeding violation whatever was going on there" were staring at my wife while she screamed and bled and pooped all over the interior of our van. They began screaming like crack addict banshees telling me to get her to the hospital. I'm pretty sure that if I hadn't instantly sped away they would have climbed inside and rode with us screaming the whole way.
We found the trooper about 3 miles from our exit. As we got off I put my game face back on, dreamt of nice, pleasant smells, and determined to tear up Fruitville road. This is a long road filled with lights that like to get in your head and tell you how they own you. I wasn't having it; I came off the interstate and flew through the red light making a statement. Shannon was doing great but I started catching random phrases like "feeling the head" and "need to push" and "he's coming" and I felt a bit unnerved (slight underexaggeration). We were about 10 minutes from the birthing center and I heard a sound come from her that screamed "baby is being shoved out of me as I groan." I'm cutting into turn lanes and around traffic stopped at red lights flashing my brights and honking; varying between 75 and 90 mph depending on how close the next light was.
Kitty tells me that I have to call the midwife again and tell her that Shannon is starting to push. I reach to the passenger seat to find the number again and realize it's gone! I look everywhere and it finally smiles at me obnoxiously from up in the corner near the passenger door. Dodge Grand Caravans are larger than you might realize and the only way for me to get that number was to bust out some crazy Tony Hawk move while I'm flying down this road. So I look around and realize there are no cars which makes swerving an acceptable maneuver, I take the steering wheel in my left hand and get out of my seat, step across, and grab the paper with my right hand. We managed to stay between the three lanes of traffic during this. I get the number dialed in and as the phone is ringing I hear a sound like Jim Carrey coming out of the fake Rhino in Ace Ventura 2. The midwife picks up as I hear my son cry and all I can say is "it's a boy!"
My grin from earlier comes back as I realize that my freakin' awesome wife just popped a kid on the front bench seat of our Dodge Grand Caravan. Kitty, mother of 10, winner of 33 consecutive wife mother of the year awards (not to be confused with the mother/wife award) just delivered our kid while swerving across three lanes of traffic doing 75 mph down Fruitville road. All I can do is shout "Caleb, holy shit you are so freakin cool, you were just born in a van!" I love my family!
I told Harmony, our midwife, that I was still flying there and would get there as quick as possible but Caleb was crying, sounded fine, and Shannon seemed totally fine as well.
We pulled in to the birthing center, got Shannon and Caleb in and cleaned off. Homeboy is 7lbs 4oz and somewhere between 20 and 21 inches (he was squirmy). He was born near the intersection of Fruitville Rd. and Lockwood Ridge Rd. in Sarasota, FL at 12:32am 9/14/2007. He's super chill and looks a good bit like Shannon.
On our way home around 4:15am Shannon said "it's pretty crazy that we keep having our kids on things that our friends and family might have to sit on." Quote of the year!
Also notable: Aunt Jackie was coming for the birth, but missed out. She wouldn't have made it anyways, unless she jumped in our van as we sped down the road, but she stopped at 7-11 for flowers and mentos. Like 35-55 percent of you, she did not believe me when I said we popped Caleb in the van. Unlike 35-55 percent of you, she got to see Caleb and find out that I didn't even need to exaggerate this story (though a little spicing up never hurts). So for those of you that think this is as big of a ploy as last pregnancy's modeling of Rob Raborn in a diaper (can't ever get enough of that, personally I love saucy pics of Rob), you'll have to wait a day or two to call and get Shannon's confirmation, but she has read this and fully approves of the facts, details, and spicy anecdotes that lie within.
This Friday begins a DONA International approved Postpartum Doula Certification workshop at Birthways Family Birth Center. The workshop will be held from October 23-25, and will run from 8:00 am - 6:00 pm with breaks all three days. The instructor is Betsy Schwartz of Tenth Month Doula Services.
Betsy Schwartz has been a doula since 1991. She considers being a doula as her calling and her passion. She established Tenth Month in South Florida in 1994. Betsy holds a master’s degree in management of human services and is a DONA International certified postpartum doula. Betsy is a founding member and former Board member of the Coalition for Improving Maternity Services. She is a member of the Citrus County Breastfeeding Coalition.
What is a postpartum doula?
The postpartum Doula helps a mother tune into her baby’s needs. By taking care of the mother’s needs, the Doula allows the mother to focus on her baby. This, in turn, helps build the new mother’s confidence in her abilities.
What do I need to know?
There are prerequisites for participants of a DONA International Postpartum Doula Training Workshop. Participants are expected to have a working knowledge of the following:
Physical and emotional adjustment in the mother following birth
Newborn characteristics and care
Breastfeeding basics
Common breastfeeding difficulties and possible solutions
To be sure that participants are adequately prepared for their Postpartum Training Workshop, the following are required BEFORE attending the training:
1. Required Reading: From the DONA International required reading list, the participant must have completed reading one selection from each of the categories listed. Some of the books can be purchased on the DONA International website through the Doula Boutique.
2. Breastfeeding Preparation: The participant must have completed at least one of the options listed below before attending the postpartum doula training:
Certificate of attendance of Lactation Consultant / Breastfeeding counseling education
program or peer counseling training through LLL or local nursing mother’s group.
Completion of an on-line breastfeeding study program.
Proof of participation in a breastfeeding workshop (three hour minimum)
Investigative project series with essays. This project would need to be approved by the trainer and DONA International Postpartum Committee.
How can I sign up for the workshop?
Contact Betsy at (352) 527-3550, or pay via pay pal on www.tenthmonth.com. Fill in the dates and city and click the 'buy now' button. The fee is $325.
(by Kitty Lakey, about the birth of David Dominick, born 05.27.07)
I'd been having contractions since my thirty-second week. A fun little stint with pre-term labor had already dilated me to two centimeters. Later in my pregnancy I dilated another two centimeters, bringing me to a grand total of four centimeters. I thought my labor may be a quick one but I didn't want to get my hopes up. I was thinking half the time of my labor with Jonathan, which would've been about six hours, and a pretty typical labor for a second child. Every time I took a trip to the bathroom I focused on the story in Ina May’s book about the flower opening up. My midwife was out of town, having left a week before for a midwifery conference in Costa Rica. She was due back in three days and I was overdue by five days. We even tried to induce via herbs before she left. Well needless to say, it didn't work. Apparently David Dominick just wasn't ready.
The day I went into labor I got very little sleep, which was just unusual. Normally I slept like a lioness during my pregnancy, nine hours at night and a nap every day. I was trying very hard to stay rested at the advice of the midwife, knowing that I could go into labor at any minute and I didn't want to be to tired to make it through. I'm a night owl so I went to bed at around one-ish, feeling fine but very tired. I was awoken an hour later by some serious contractions. No stop watch necessary, these did not need to be timed. Hoping, from lack of sleep, that this was a false start, I tried to go back to bed. No luck, lying down just seemed to intensify the contractions. About two-thirty I woke Dave up and told him to call the midwife and my aunt Vita. Dave dialed and handed me the phone, I paged Sarah and Vita wasn't answering. He began to pack, while I breathed through my contractions. I stopped him every few contractions for a leaning post and moral support. Sarah, the midwife that was filling in for Harmony, called back. I had had a couple visits with her and felt comfortable with her. By this time my bag of waters was leaking, it took me a few minutes to realize I hadn't peed myself. Sarah listened to me and told me to come on in! What a shocker, I thought she'd tell me to go back to bed, that is what had happened exactly one week before. I had really begun to think I was going to be pregnant forever and come to terms with it, I think that is why I finally when into labor.
Dave called his mom since we couldn't get a hold of Vita. Dave didn't tell his mom to come, but thankfully she came anyway! Dave continued to pack everything on the list while stopping occasionally to ask me questions. I remember being able to answer most of the questions. So Dinah (Dave's mom) shows up and we sat in the living room waiting for Dave to finish packing. I don't know how far apart the contractions were at this point I just remember thinking, wow this is really it!
On the ride to the birthing center I breathed through my contractions while Dave repeatedly apologized with each contraction. I told him not to apologize and please watch his driving because I couldn't do it this time. The roads were clear and the weather was cool. A beautiful time for little man to be born. The ride was relaxing and the contractions were steady and getting stronger. The pain had me questioning my ability to do this without pain medication. I tried to put those thoughts out of my mind and focus on my breathing and opening up.
On the walk up to the birth center I had several strong contractions to the point of stopping and leaning on Dave for support. Dave walked me in and went back out to get our bags. The birthing tub was ready. Sarah checked my dilation before I got in. I was six to seven centimeters dilated! At some point I had dilated three more centimeters, what great news! With each contraction I tried to keep in mind that was one step closer to having my baby. I got in the tub which felt pretty good, but I was only in for a few minutes. Sarah had to check his heart rate; normally they can check the heart rate in the water but she couldn't get it, most likely due to his positioning. So I clambered out of the tub. It felt very cold after being in the warm water, and got onto the bed. She got his heart rate right away and it was in the one-forties, perfect. So back in the tub I went. Dave started making jokes about my luxurious hot tub, so I joked back all I needed were the jets. Unbeknownst to me the tub actually had jets. So Sarah turned them on for me. As the contractions got even stronger yet I aimed my back at the jets of water. Dave held my hand, encouraged me and fed me Gatorade and water from the side of the tub. A flurry of activity was going on around me but I was too busy to notice. I was in transition, I only know I was in transition because momentarily I felt like I was going to toss my cookies. The midwives' assistants started bailing water out of the tub so Dave could get in with me.
That's when I began to lose control, yelling in pain. I'd say I could bear the pain ninety percent of the time and then I'd start to lose it. I tried to remember to relax, make low sounds and relax my muscles but the pain was really getting to me. I remember thinking this it, I'm not going anywhere now even if I wanted to. I thought those women who tried to run from this were nuts, I mean really where are you going to go. Sarah asked me why I was yelling. I told her because of the pain, then she asked where it hurt. I told her in the front of my abdomen and at my hips and pelvis. So she asked me to get on my hands and knees and had Dave press my hips together. I was more than willing to try anything that would relieve the pain. She told Dave where to push and said "push as hard as you can, you won't hurt her", he did, and mid-contraction I said "not that hard!" This relieved the pain in the front of my abdomen but also intensified the contractions and the feeling of pressure. I remember Sarah saying "Kitty, that's just your baby trying to get around your sacrum"as she poured water over my back. It was so intense at this point I was yelling out in pain with each contraction. She must have sensed I was feeling a little desperate and came around to the front of the tub and got in my face. To help me focus she got right in front of my face and said "try not to yell so much, it will scare the baby and make him poop." That really got my attention, I didn't want any meconium in my baby's system. So I tried to tone it down, the contractions were so strong at this point I just couldn't stop myself from yelling as hard as I tried, the pain was just too intense. I think at this point I said for the first and only time "I can't do this", but it didn't matter, my body was doing this, whether I liked it or not. So I tried to flow with it.
Shortly after that I began to realize that I was yelling all my energy up and out. I had read about this but didn't really believe it. I realized I needed to use that energy to push that baby out! So with the next contraction that's what I focused all my energy on doing. I don't remember telling Sarah that's what I was going to do, I just did it. Looking back, it is incredible that your body just knows how and when to do this but at the time you don't think about that. Even with the first push I could feel his head. She tried to check for his head but by then his head had retracted. With the next contraction she checked and could feel his head, I thought maybe that feeling of him being that far down was in my head, but no it was real! She asked me if I wanted to feel his head and I reached down and felt it. I just couldn't believe it!
The next contraction I began to feel the infamous ring of fire. It wasn't as bad as I expected it to be. Sarah said "Okay Kitty, now just ease his head out slowly." Some how I controlled it, and did just that, and his head came out. The whole time I was thinking of the girl in our prenatal class that tore, Harmony told me the girl wished she'd waited and push her baby out slowly so she hadn't torn. The birth instructor used the expression spaghetti off a spoon, and that is just what it felt like. The next contraction he was completely out, he just slid out with no effort, like spaghetti off a spoon. Then Sarah guided him in the water underneath me into my arms. Someone handed me a receiving blanket to wrap him in. I wrapped him up and held him in the water with me. The first thing I said was I can't believe I did it, I was in shock. We sat and cuddled and bonded for a few minutes while we waited for the cord to stop pulsing.When the cord stopped pulsing Dave nervously cut it with a little resistance (on his part and the cords). Then I handed the baby to Dave and got out at the midwives urging. As I exited, clots came falling out, it felt like worms, which was pretty gross. Sarah wanted the placenta delivered. She asked me to squat on the bed to deliver it. In my mind that seemed impossible, but I had just accomplished the impossible so I gave it a try, with one push the placenta came out with a thud. I sat down on the bed, which seemed like the most comfortable bed ever and one of the midwife's assistant's brought in some of the snacks we brought with us. Apples, cheese and crackers and a protein smoothie, they encouraged me to eat.
Meanwhile Sarah checked my bleeding and they weighed and measured the baby and checked his reflexes. I couldn't believe it, a nine-pound baby with a fifteen-centimeter head and no tears. He was twenty-one inches of perfection. He had a perfect ten apgar score, I guess you could say he was a perfect ten!
His birth, although painful, was intensely empowering. I chose this mostly for the health of the baby, the idea that it would empower me seemed ridiculous. Now, having experienced it, I know first hand that this is true. I conquered my fears and came out on the other side!
As an OB/GYN physician, I learned long ago the importance for women of all ages to be educated about their bodies and about pregnancy-how it occurs and how to prevent it from occurring. That is the big mission of Planned Parenthood, to combine medical services for women and families with education. An educated patient is better prepared than one who is not, and that includes teens: girls and boys.
Planned Parenthood fulfills its mission of providing medical services, education and advocacy efforts extremely well every day and that is why I believe in speaking up for them whenever I can.
I also believe in choice. I’ve taken care of women who didn’t have a choice of when to become pregnant. Some of them got sick and some died. When I was in medical school, I remember seeing patients sick from septic abortions from unplanned pregnancies. When I was at Temple University, I remember going to the ER and seeing women who had made attempts at self-termination and done it very dangerously. Fortunately, these life threatening medical emergencies are rare now in the United States, but back in those days, were common.
When I worked for Planned Parenthood in Oakland, CA , many years ago, I helped women with family planning, terminations and tubal ligations. A woman should be able to choose these options for herself. It’s her body.
I learned to respect women’s decisions and their right to make their own choices. I feel that is the right thing to do. I believe deeply in Planned Parenthood’s work of education, choice, and prevention and that is why I do everything I can to advocate for them.
Click here to listen to Jane Blanchard's interview with Sonia Pressman Fuentes and me, featuring special musical guests Carmela Pedicini and Tanya Radtke. We discussed Maternal Health Care in the 21st Century: Sarasota and Beyond, and maternal health care issues facing Sarasota today. Thank you so much, Jane, for having us on your program!
Sonia and I will be addressing the following topics:
What is maternal health care?
What are some facts about maternal health that our listeners should know?
What alternatives are there to maternal health care ? What is available in Sarasota?
Insurance and maternal health care. Explain.
Is midwifery safe?
What is the Safe Motherhood Quilt and what does it represent?
Tell us about the upcoming panel discussion Maternal Health Care in the 21st Century: Sarasota and Beyond.
What will be some of the topics discussed and who are the panelists?
Who are the sponsors of this program and how did they become involved?
Women Matters is a discussion talk show exploring matters of interest to women. The goal is to to inform and empower women and expand the women's perspective by providing a feminist point of view. The format may include guest speakers, reviews of articles/book/movies, notices, news, and etc. on topics about or by women. Additionally, each week the show features original music by local female musicians. The program will be recorded and available in the program's audio archives. Thank you for listening, and thank you for supporting your community radio station!
Marie Mongan, M.Ed., M.Hy., of Chichester, New Hampshire, is an award-winning hypnotherapist, who brings to her classroom over thirty years' experience in education and counseling on the college level and in the private sector. She has recently relocated to Florida's east coast, and is coming to Sarasota to participate in the events at the end of this month.
Ms. Mongan is a former college dean who, early in her career, was named one of five outstanding educational leaders in New Hampshire and was awarded a Ford Foundation Fellowship to Harvard University.
Marie (best known as "Mickey") is licensed as a counselor and is certified as a hypnotherapist, hypnoanesthesiologist, and instructor of hypnotherapy. She holds several awards for distinguished service and achievement in the practice of hypnosis and is the 1995 recipient of the National Guild of Hypnotists President's Award. In 2000 she was presented with the coveted NGH Charles Tebbetts Award for her contribution in "shedding the light" and advancing the awareness of hypnosis. In 2005 she became the first woman ever to receive the highest award given by the National Guild: the Rexford L. North Award.
Mickey is the mother of four adult children, all born in the late 50s and early 60s. She experienced all four labors without labor medication, using the theories of Dr. Jonathan Dye, of Buffalo, New York, and Grantly Dick-Read, of the UK, two pioneers in natural childbirth. Two of her birthings were entirely free of anesthesia at a time when it was unheard of, and her husband was by her side in both the labor room and the delivery room. Her book, HypnoBirthing--A Celebration of Life, was written in 1989; her latest book, HypnoBirthing--The Mongan Method is now available in leading book outlets and through the HypnoBirthing Institute.
HypnoBirthing is as much a philosophy as it is a technique. The concept of HypnoBirthing is not new, but rather a rebirth of the philosophy of birthing as it existed thousands of years ago. This philosophy was recaptured in the work of Dr. Grantly Dick-Read, an English obstetrician, who in the 1920s was one of the first to forward the concept of natural birthing. The method teaches that in the absence of fear and tension, or special medical circumstances, severe pain does not have to be an accompaniment of labor.
HypnoBirthing clients gain an understanding of how the birthing muscles work in perfect harmony when their bodies are sufficiently relaxed and they are able to trust birth. HypnoBirthing teaches women how to achieve this kind of relaxation, free of the resistance that fear creates, and how to use natural birthing instincts for a calm, serene and comfortable birth.
Trained HypnoBirthing educators are successfully teaching women and their birthing companions to trust birth and release all fear and limiting thoughts. HypnoBirthing practitioners can be found in 27 countries throughout the world.
Governor Charlie Crist has signed a proclamation observing October 5 through the 9 as Licensed Midwives Week in the State of Florida, upholding midwives for being “dedicated to the care of pregnancy and childbirth and treat[ing] each woman’s pregnancy according to her unique physical and personal needs.” Governor Crist’s proclamation also recognized midwives for their role in the need to “improve birth outcomes in the State of Florida and ensure that women are given proper care and treatment in all phases of childbirth.”
In honor of this week, Florida Friends of Midwives (FFOM), a non-profit grassroots organization dedicated to promoting and supporting the practice of midwifery in Florida, will be hosting various community events throughout the state this month to celebrate the more than 110 Licensed Midwives in the Sunshine State.
Florida Licensed Midwives Week coincides with National Midwifery Week, a time to recognize the contributions of Certified Nurse Midwives (CNMs), Certified Midwives (CMs) and Certified Professional Midwives (CPMs) nationwide. The American College of Nurse Midwives (ACNM) publicly announced the week with an introduction to midwifery. “The heart of midwifery care for women and newborns lies more in the nature of that care than in its specific components. Midwifery practice has a firm foundation in the critical thought process and is focused on the prevention of disease and the promotion of health, taking the best from the disciplines of midwifery, nursing, public health and medicine to provide safe, holistic care.”
Midwives have a long and valued history in Florida. The state first passed legislation to license direct-entry midwives in 1931. In the 77 years since, Florida’s licensed midwives have continued to tirelessly serve the families of Florida and to ensure the continued availability of safe, evidence-based birthing options for Florida’s families. In 1992, Governor Lawton Chiles declared the first-ever Licensed Midwives Week. More women than ever before are seeking out licensed midwives for maternity care. According to the latest data from the Florida Council of Licensed Midwifery, births managed by Licensed Midwives in the state grew by about 5.5% from 2005 to 2006.
“We are honored every day to serve Florida’s mothers, babies, and families,” says Sarasota Licensed Midwife Alina Vogelhut, LM. “It means so much for our profession to be honored by Governor Charlie Crist and the State of Florida.”
Midwifery in Florida In Florida, two types of midwives are allowed to practice: Certified Nurse-Midwives and Licensed Midwives (a Florida state licensure), also known as direct-entry midwives. Throughout the state, about 11.2 percent of births are estimated to be managed by midwives, rather than by OB-GYNs. Many birth centers and midwives have reported a significant increase in business in the past year. This increase is believed to be a result of various factors, primarily a greater number of women seeking alternative birthing choices due to an unhealthy increase in caesarean sections and other unnecessary interventions that frequently occur in hospital settings. In a 2006 report on Florida Licensed Midwives, midwives had a caesarean section rate of 6.3 percent compared to a 36.64 percent statewide average in hospitals the same year.
About Florida Friends of Midwives Florida Friends of Midwives is a non-profit grassroots organization dedicated to promoting the Midwives Model of Care and supporting the practice of midwifery in Florida. Florida Friends of Midwives was formed to support midwives who offer safe, cost-effective, evidence based care to Florida's families. For more information, please visit www.flmidwifery.org.
(by Kate Adams, about the 15 minute birth of Luke Irwin, born 10.01.07)
After several weeks of deliberation you finally decided it really was time to be born! I spent the day having contractions, much like those that I had been having for weeks, waiting all day for them to become more intense. Every few minutes they came, but always the same. After a very anxious day we called our midwife, Harmony, to come visit and help us to understand what was happening. We learned I was making progress, but we thought that because it was so manageable that it might be some time, perhaps days, before true active labor would begin. We agreed that if things changed we'd call, and set our plans for the evening as lots of resting and early to bed. The contractions continued to come throughout the night, but I could sleep in between and it seemed that they were losing strength and coming farther apart. Then at 1:4something I jumped up out of bed from being very asleep. It was as though the volume had been turned WAY UP and labor had definitely changed. My water broke, and I woke up Kenny to tell him. I went to the bathroom, relieved that finally we knew our baby would be here soon.
Kenny went to call Harmony (1:47), and while he was on the phone and running around grabbing things another contraction came and my legs began to tremble. I only made it half way back to our bed, and felt pushed to all fours by the next wave. Kenny was changing the sink over so he could fill the pool when I told him that there wasn't going to be time for the tub, and began asking him what was happening to me. He looked at me with worried eyes and told me that I was doing a great job, and then continued to run around the house trying to get things ready. I told him that I needed the ottoman to lean on (while he was rushing about). With the next wave I felt the baby's head pushing against me and told Kenny to come and look, that he was coming! He did, and suddenly realized why I was making such a commotion (truly I am not dramatic without necessity). He called Harmony back, who rushed out her door also now knowing that this was not going to be a typical birthing.
Kelsea woke up and wobbled to our bedroom door clutching her blanket and dolly. Her eyes were so wide; trying to figure out what Mommy was doing making all that noise in the middle of the night. Kenny called her to him and she came and sat on his lap, the two of them behind me when his head started to crown, slowly going in and out and then emerging completely. Kelsea started to shudder, so Kenny explained that it was just the baby coming and that Mommy was okay. Then she reached out to touch his head and said “BABY!” as loud and proud as could be. She then got very excited for the rest of him to arrive. I felt his warm wet head too, and kept asking Kenny if he looked okay, so worried that being born was hurting him. With the next contraction he was fully born into his father’s hands. It was exactly 2 o’clock in the morning.
And it was how the scriptures say, “A woman, when she is in labor, has sorrow because her hour has come; but as soon as she has given birth to the child, she no longer remembers the anguish, for joy that a human being has been born into the world. John 16:21”. We laughed and kissed and cried all at once at this little miracle that was now in our arms. We did it together, on our bedroom floor of all places, and it seemed like the most natural and wonderful thing in the whole wide world. I guess we were all in a bit of shock trying to decide what to do next when Kenny’s phone started to ring. Harmony was on the other end and heard Luke’s first noises before Kenny could say what had happened. Kenny helped me to the bed and laid Kelsea down beside me and hormones fuzz the rest of the story out. I know it wasn’t long before Harmony arrived and instilled a calm where there had been chaos, setting about checking on us all. There was still work to be done, a placenta to deliver, cord to cut, water to boil (really!). Dad and Minna arrived, greeted our new family member, prepared food and did a number of other noisy but beneficial things in the kitchen. There were stitches for me; they hurt, despite best efforts to make that part of the experience pain free. Little man was measured and weighed, found to be not little, and admired from all around. It was decided that he did not look like a Keegan at all, and would be called Luke instead. There was also Jodi, who fairy godmother like made things clean and said nice things about our naughty cat (he climbed in Harmony’s bag!). Before the sun was up a great many things had been accomplished and everyone hugged and said goodbyes and left us to live happily ever after.
Luke Irwin Adams measured 20 ½ inches long, had a head 13 inches around, and weighed 8 pounds and 4 ounces.
Born in Sarasota is a collective of thoughts, articles, birth stories, events, and evidence in action supporting healthy, normal childbirth in our community. We are dedicated to promoting choices in mother-friendly maternity care practices and providers, informed consent for our pregnant families, and increased support of normal childbirth.
Do you have a birth story or birth photos to share? Please submit them here! Sharing your birth experiences will help empower others!
I believe that the current paradigm of maternity care in the United States must be shifted away from the medically invasive model and back to the embrace of birth as a natural, healthy process, one in which intervention should be used appropriately and with absolutely transparent informed consent. Without such a shift, our mothers and babies will continue to have unnecessarily poor outcomes, and we will lose our primal reverence for birth as a sacred event.
On Sunday, the Sarasota community has an opportunity to improve the health of our pregnant women. "Maternal Health Care in the 21st Century: Sarasota and Beyond" is a free discussion featuring leaders in the fields of obstetrics, midwifery, public health and public policy. This balanced panel will create a forum for much-needed dialogue about the state of maternity care in Sarasota.
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