Re-Post: BIRTH STORY: Solstice, Bluegrass and Moonlight

(Reposting on Benjamin' s Third Birthday by Laura Gilkey, about the birth of Benjamin Wilson, born 12.22.07)

(December 22, 2007) It is 3:30 am, and I believe this solstice day may be your birthday! What a time for rebirth!

I was in Banyan’s room singing him to sleep when I felt a lot of wetness between my legs. I went to the bathroom and found I had lost my mucous plug, and since then I’ve had more show and some trickling water. I nested for a moment, emptying the dishwasher and folding laundry, then laid down with Papa and tried to rest. I’m awake now timing your squeezes…not quite time to let Harmony know yet. I’ll go back to bed and try to get as much sleep as possible. Who will you be? My eyes will know you!

It’s 9:30 am and my contractions have slowed to about once every 20 minutes, but super intense and short at each interval. Sweet Harmony is at a birth right now and will come and check things out on her way home. Banyan just woke up and gave me a big hug and whispered “happy birthday” to my belly. I LOVE YOU!

(December 26, 27 & 28, 2007) While it is still fresh in my madly-in-love mind, let me tell you the rest of the story of your birthday.

After speaking to Harmony Saturday morning, I decided to go ahead and make the kimbly, or ‘groaning cake,’ that I had read about in midwifery books. The story is that if a woman bakes this cake during labor, her pains will be short, and prosperity will come to the family. The scent of the cake baking throughout the home brings strength to the mother. The cake was beautiful and smelled of winter spices.

I stayed in a creating sort of space, brewing tea and preparing food for the day. We relaxed and played together throughout the morning. I wasn’t sure whether I was really in the thick of labor or not, because the contractions had slowed so much; so Papa and Banyan watched a mid-day movie and I took a glorious nap, waking only every half-hour or so for a contraction.

I was just waking up and planning to go in the kitchen and bake a blackberry crisp when Harmony arrived at our house, around 2:30 pm. We chatted, she told us about the birth she attended that morning, it was all very relaxed and casual. She decided to give me an impromptu prenatal checkup to see how we should proceed, expecting to go home and have us call her when things really progressed. I don’t think I’ll ever forget the look on her face when she said, “I want to be sure what I’m feeling here before I say anything….um, Laura? YOU ARE 8cm DILATED!” I felt elated, giddy, silly, and proud. I felt like Wonder Woman and like a little kid at the same time. We decided we’d better call Aunt Sarah and Mimi, and hope they made it in time, and Harmony decided she’d better not go anywhere! I told Harmony I didn’t know what to do with myself! She said, “if you were going to bake a blackberry crisp, go bake a blackberry crisp!” So I did, and the laughing and the baking and the happy day continued, right into the evening.

Aunt Gana arrived, Aunt Sarah arrived, and then Mimi arrived, and right on cue, my contractions started getting closer together. I stuck the chicken I had brined in the oven so my labor team would have something to eat for dinner. I was in a place of ecstasy, so happy I couldn’t stop smiling. Everyone was! At one point we all were sitting on the floor in Banyan’s room taking turns reading him stories. I was sitting on the birthing ball through those contractions, just happy to be in the room with everyone and not feeling reclusive at all, the way I remember feeling in labor with Banyan. I’d just have a contraction, open up, and it would be over, and I don’t think I ever stopped smiling! Banyan looked so beautiful to me as I was preparing to bring you into the world. He was absorbing the happiness of everyone around him.

As the evening progressed and my contractions became stronger and closer together, we put on some bluegrass music and started to move.With each contraction I would lean against Papa and have him press his strong hands into my back. Mimi made a salad and Harmony colored a mandala at the dining room table.We were still laughing, telling stories, and just busily creating our birthing space. Harmony called Jodi, our birth assistant, who arrived around 7:00. She was just lovely. She felt right at home in our space and said so, making me feel proud of my cozy nest. She was the last piece in the perfect group of attendants, waiting for you.

We continued dancing right on through the contractions. Everyone ate dinner while Papa and I danced our labor dance. Things began to intensify yet again, and at around 8:30 we decided to take a moonlight walk. What a great idea that was. All of us went, even Banyan, the lightkeeper, who thought it was terrific fun. It was the most gorgeous winter solstice night, two away from a full moon, cool and crisp and clear. I looked at that moon and those bright stars and felt surrounded by the energy and wisdom of the universe. I felt like a miracle.When our walk was over, things changed in my body. My amazing birth team sensed that and even as I walked in the house, the bluegrass had been turned off, the lights turned down, and the mood much calmer. I needed all of those things to have happened and I didn’t even know it, much less voice it. I was only in the house a few minutes and a few contractions before I decided it was time to get into the birth pool. Harmony and Jodi filled the pool; Banyan helped, then went with Aunt Sarah to his room to read stories. I was a bit saddened by this. I really wanted him to see your birth, but I knew he was exhausted and would fall into the rhythm that was right for him. And of course, everything happens for a reason. I just missed him a little.

When the pool was full I took off my clothes and got in. The water felt amazing. The birth altar which had been set up since my Blessingway was alive with candlelight, and I chose an angle to labor that would allow me to look right at all of those symbols of support. Papa knelt right beside me, giving me that same strength that he had given me through Banyan’s birth, the strength that was the most important element of my birthing ability. I enjoyed very much the time we had alone together in that small space, while the rest of the birth team waited to come and watch your arrival. Kissing him felt so good, I didn’t want to stop doing it. I was still riding a wave of ecstasy I couldn’t believe.

I had several contractions in the pool before my water broke. I kept feeling an urge to push, and kept feeling to see if your head was within reach, even though I knew it wasn’t time yet. Now I know that feeling was because of the bag of waters bulging in front of you. Suddenly, with one strong contraction it was like a cannon shot out of my body, making everyone in the room jump. It burst forth in huge white ripples through the water. Harmony said in her sweet voice, “the next contraction is going to feel a little different.” I braced myself. I was given one contraction to prepare, one final moment of ecstasy.

Then came the next contraction, and I felt my body being tunneled down by a freight train, ripping through me faster than I felt ready for. I remember asking my body out loud to “slow down.” You crowned immediately and stayed that way for four or five minutes. I felt your sweet head and heard everyone say they could see your nose, your ear. With one more contraction your head was out. Papa was behind me and I knew he wanted to catch you, but he stayed by my side, because Harmony needed to work her magic. She spoke those unbelievable words I had never expected to hear again: “Laura, you need to get out of the tub now.”

I gathered the strength to stand up and held onto Papa with everything I had. That is when I felt a bit of fear. I knew it would be over soon and you would be in my arms; it was this singular thought that gave me comfort. This cannot possibly last more than a few moments. Breathe. Breathe. Breathe. But I know on the outside I was screaming. What I didn’t know then was that you had shoulder dystocia, where your little shoulder was stuck behind my pelvic bone. It had caused the cord to be wrapped around your body like a harness, and Harmony couldn’t free your shoulder or the cord with me in the tub. So I stood, clinging to Papa, trying with all my might not to bite him as I pushed your body out with Harmony’s hands inside me, tumbling you over so the cord would free you. And there you were, my little bird, on the floor beneath me, with Harmony above you giving you oxygen. I felt helpless at that point because I couldn’t hold you, I couldn’t turn my body around without pulling on our cord and Harmony needed to be with you. She abandoned the oxygen mask and knelt down to you, giving you a breath of her life and speaking sweet welcoming words into your heart. I saw that you were a boy and announced it joyously, then said to you as closely as our still-joined bodies would allow, “we’re not going anywhere. This is our home.” And we didn’t. You breathed, you cried, we cried, and just like that, our family became a foursome.Harmony suggested we move into bed. I found it a difficult task, but you were in my arms at last and my liquid insides didn’t seem to matter much. Because of the crazy push through the birth canal and the extra oxygen you needed, Harmony really wanted you nursing well right away. It took you a while to get the hang of it. It finally happened after I delivered your placenta, which we left you attached to as long as possible; then Papa cut the cord and you were free, your own little bird. Everyone was at the foot of the bed checking out the placenta and making prints of it (that turned out beautifully) when you latched on perfectly and never looked back.

While I was pregnant with you, I was unsure of your gender. But when I was in labor, especially as you were traveling through me, I was picturing you: a boy, clear as day. And the second I saw your face, I knew your name. Benjamin. Once you were free of the placenta, Harmony measured and weighed you, and you took after your big brother and tipped the scale at ten pounds even, 22 and a half inches long. I wanted to get into a nice herbal bath (even though I didn’t tear, my bottom half was rather sore!) so Papa proudly carried you into the living room to announce your name, your weight and your length to Grammy and Papu under the twinkling lights of the Christmas tree.

After getting dressed we snuggled down together in bed, nursing, smiling, and drifting into a blissful sleep. While everyone was still sleeping, Banyan woke up at about 5 am. He sleepily crawled into bed with us and said hello to you for the first time. It was beautiful to watch him look at your face for the first time, kiss your sweet blond hair, clutch your tiny fingers.

Welcome, little bird. Thank you for choosing me to give you the grand tour!*edited to add: Re-reading this story makes it even more clear to me why I have chosen to advocate for choices in childbirth so passionately. Because of the midwives' model of care, I was able to have the most supportive labor team and most comfortable setting imaginable. Thank you Michael, Harmony, Jodi, Mama, Sarah, Gana, Kathy and Mic for your unbelievable support.

BIRTH STORY: Patience Makes Perfect

(written by Ryan Stanley, about the birth of Jude Ali Shaqiri, born 04.28.10)

Dear Jude,

The calendar said you were due to arrive on Saturday, April 17th. Ten days after that date I woke up asking myself the same question I’d asked for the previous nine mornings - Do I feel any differently today? No, the answer came.

I went on with my day nervous and a little scared. Since I was past my due date I had already gone to the hospital for one round of fetal monitoring. If you didn’t come by tomorrow afternoon I would have to go in for another. If you didn’t come by Friday it was likely that I would have to be induced.

Around 11 a.m. I noticed that I’d soaked through the panty liner I was wearing. I mentioned it to your dad when he came home for lunch and he suggested I call our midwives.

We arrived at Rosemary around 1 p.m. and Alina checked the fluid with a test strip. Sure enough, I was leaking a small amount of amniotic fluid. Since it wasn’t gushing, Alina guessed there was a leak in the side of your sack. This was confirmed when she checked my cervix, which was about 2 centimeters dilated, and still felt the bottom of the bag intact. Because of the risk of infection, I would have to start IV antibiotics within 6 hours. If I wasn’t in hard labor within 24 hours I would have to go to the hospital. Your dad and I were worried but Alina put us at ease saying, “you’re going to meet your baby today!”

From that point on we were on a mission to get labor started. Alina gave me some herbs to take every 15 minutes. Your dad dutifully set reminders on his iPhone. After returning home to eat and take a short nap your dad and I walked the Ringling Bridge and swung on the swings at Arlington Park. We even drove up and down Orange Avenue flying over the speed bumps. We were trying everything we could think of to shake you loose!

While Cheryl was on her way over to do some acupuncture, I made the decision to take castor oil to further hasten your arrival. I blended the castor oil into my favorite smoothie – hemp powder, almond milk, almond butter, banana and flax oil – and chugged it down. Within minutes I was upstairs in the bathroom pooping my brains out. By the time Cheryl arrived, around midnight, I was feeling a slight but regular tightening in my belly. Your dad had them timed, again with his trusty iPhone, at about five to ten minutes apart.

As the contractions got stronger I started feeling nauseous. When I was sick enough to throw up I remembered Carmela saying that throwing up was a sign of labor progression. By this time it was about 3 a.m. and I was moaning through contractions that were now a solid five minutes apart. Your dad called Alina who said she would meet us at the birthing home. We were finally in active labor!

Walking through the dimly lit courtyard felt like a dream. The birthing home shone like a giant amethyst. The small pond gurgled exceptionally loudly. Alina had prepared the birthing room. Candles were lit and soft music was playing. Everything was sharp and sparkly but blurry and concave at the same time. I knew the lyrics to the song that was playing yet I’d never heard the tune before. I suddenly remembered the joke I had made in birthing class about how Carmela’s explanation of labor could be confused for a bad acid trip. Not so much of a joke now that I was in it. And although I didn’t consider it bad it certainly was a trip.

In addition to the visual and auditory intensity, time seemed to slow down and speed up all at once. At one point I looked at the clock as I felt a contraction coming on – 4:04 a.m. I could hear the “click, click, click” of the second hand for what seemed like hours as I dove head first into a wave of contraction. As the wave crashed and then faded I looked at the clock again – 4:05. How was that possible?

I wanted desperately to curl up on the bed and sleep but my body wouldn’t let me. The discomfort while lying down was almost unbearable. Instead of sleeping, I went inside myself and played with all the ideas I had about childbirth. I paced, rocked in a glider, hung from the bed posts, leaned over the bed as your dad and Cheryl rubbed my back. Mostly I howled. I was like a she-wolf – bending and baying at the full moon.

I didn’t realize it at the time but was told later that at some point during labor you turned face up. Since it isn’t ideal to deliver a baby in that position, Alina had me flip flop on the bed while she attempted to manually turn you. This was painful and exhausting. Then I labored on the toilet for about an hour. In between pushing contractions, which spaced to nearly 10 minutes apart, I rested. Then, after pushing in bed and in the tub, I climbed up and down the stairs for an hour or so before returning to the tub.

Your head was emerging ever so slowly – one centimeter out, two centimeters back. Cheryl got a mirror to show me the progress and even fashioned a birthing stool from two chairs so I could squat and get you lower. Even though I was determined to see you it felt like I had no control over my pushing. The contractions would force me to the ground, my knees on the hard wood of the stairs, and I would bare down aimlessly. But you knew what you were doing. You worked so hard to carefully stretch my perineum. Thank you.

By this time Harmony, Julia and Heidi had all arrived and were helping me stay focused and hydrated. It felt so good to have one of them put cool washcloths on my face and body. And your dad never left my side. He was my shadow. He rubbed my back and stroked my head. He waddled behind me up and down the stairs. He even held me up while I sat on his knees in a squat and worked through contractions.

Then, back in the tub, I pushed for another hour. As soon as I hit the water I entered a new state of awareness. I was exhausted and I knew it. I wanted you in my arms so badly. This whole thing was taking forever! My contractions slowed, there was an eternity between them, and my body would just curl around itself and flex downward as if on auto pilot. Your head would slide forward with each contraction only to retreat back inside.

After nearly five hours of pushing, the burning on my perineum was intense. I was given oxygen. I started crying. I was desperate and scared. In my head I was screaming at my mom, “why didn’t you tell me it would be this hard!?! Why aren’t you here to help me!?! I need you!!!” I pleaded with my midwives to help me, to do something, but there wasn’t anything they could do. Perhaps an episiotomy would have brought you out more quickly but they knew I didn’t want one.

I wish I had words to describe what I was feeling in that moment. This was, by far, the most difficult part of the entire process. It wasn’t physical pain that blocked my progress, it was emotional pain.

But then something happened. I was asked to stand up. Blood had darkened the tub water. Alina needed to check the bleeding and get your heartbeat. I guess this was a big deal but Harmony and Alina were so calm I didn’t think anything of it and just stood up (with your head hanging half way out of my vagina, by the way, like it was no big deal). Your heartbeat was strong and there wasn’t any major bleeding so I sank back into the tub. I could feel that the change in position had forced you lower and perhaps the distraction helped clear some of my fear. I only knew one thing – that I wanted you in my arms. So I closed my eyes and waited silently for the next contraction.

I don’t remember the pain of your head finally delivering. All I remember is hearing someone scream (presumably me) and then hearing someone (Harmony, I think) say, “Ryan, look down at your baby”. I looked down and as your head slowly turned you looked right at me with two huge black eyes. Your hair was dancing in the water. I had such an intense longing to have you in my arms but when I reached down to pull you up I saw your dad eagerly fixed on your arrival. I let go, leaned back and let him catch you.

As the rest of your body emerged I felt so many things. Every inch of you – neck, shoulders, chest, stomach, waist, butt, legs, feet – was examined by my insides like I was feeling sensation for the first time. Simultaneously it was as if I had left my body and was watching from above. I could see inside myself. But I also clearly remember this strange X-ray image that I was seeing from above was also being projected on the wall in front of me. My bones flexed and bended around your tiny body as its skeleton stretched and compressed and came forth into the world. It was the most transcendental thing I have ever experienced.

In that moment the exhaustion and pain and fear evaporated and they were replaced with pure love. I barely paused long enough to see if you were a girl or a boy! You were wide eyed and alert and nursed beautifully within the first 20 minutes. And as your dad and I chatted and giggled and snuggled you close it was as if we had known you forever.

Love,

Your mother

BIRTH STORY (and Call to Action): Sam I Am

We've never had a baby as a guest blogger before; but Sam is a special exception. Reposted courtesy of Birthways Family Birth Center. Sometimes it really does take a village. Let's do what we can.

My name is Samuel John Lee, my fans know me as "baby Sam" or "Sam I Am." My Mom, Cheryl, is an EMT, she was 26 weeks pregnant when she went into labor after a long shift helping others. She and I were really strong together and I stayed for just a few more days, but then I was born on 7-27-2010, weighing 2 lbs 5 oz, a full 3 1/2 months early. My due date was in the beginning of November.

It was very scary for my Mom, my Dad John, and my big sister Shelby. I was one of the lucky babies who has done better than the doctors expected, but I still need lots of help. I've been in the Neonatal Intensive Care Unit since I was born and I was so sick that Sarasota Memorial had to send me to All Children's Hospital in St. Petersburg.

It's been very hard on my family. They tell me that we live in a place called Port Charlotte. I haven't been there yet, so I'm not really sure where it is, but I know it's really far away from where I am and my mom has a hard time getting to be with me all the time. She tried to go back to her job as an EMT in Fort Myers, which I guess is even further away, but it was just too much for me, with the 12 hour shifts and all the travel...it kept her away from me way too much!... I really need her to be with me, and my sister Shelby really needs her too; so my mom and dad made the brave decision to forgo the second income because they say I'm worth "more than all the money in the world" and they just want me to get better so I can come home! That's Mom's Christmas wish... that I'll be home for Christmas! (that's what I want too)

I have heard about the amazing community of families around here who help each other out when there is a need, so I thought I'd let all of you know how much my parents, sister, and I need your help. My mom doesn't like to ask for help, so my friends at Birthways said they'd help me get the word out. I can tell my Mom's real worried and I don't want her to worry. She has helped so many other people as an EMT, I figure, others will help her too. My Dad's working real hard, but since Mom can't work right now, there is not enough money to keep the bills paid.

My mom is working hard to provide me with enough pumped breastmilk, some from her and some from a milk bank. She says that is the best thing for me, and I think so too. I am not strong or well enough to nurse on my own always. I can't wait to be able to nurse full time!

I'm so proud of my family. They have been so brave and strong for me. And when my mom's with me, I do even better! So, if you could help my family pay some of the bills that are piling up, my mom can continue being with me and maybe I'll get big and strong enough to go home before Christmas!

I don't know how to use a computer yet, but the ladies at Birthways have been very helpful. I have my own Paypal account...whatever you can see to contribute would be a big help! You can also follow my progress on facebook.

Dr. Hill's Editorial on Preterm Birth

The following column can be found in today's Sarasota Herald-Tribune here. Born in Sarasota will post follow-up commentary shortly.

The burdens of pre-term births are significant -- in terms of the individual's lifetime health, the medical care required and the economic costs expended. Simply put, reducing the rate of pre-term births is in everyone's interest and must become a priority.

The most recent national statistics show a 3 percent drop in the pre-term birth rate, to 12.3 percent in 2008 from 12.7 percent in 2007. Prior to this decline, the rate of pre-term birth had steadily increased for more than 20 years.

The modest decrease was encouraging, but pre-term birth remains a serious health problem -- an epidemic -- with more than 540,000 pre-term births annually.

In Florida, the pre-term birth rate in 2008 was 13.8 percent and has not declined in recent years; in other words, one of every seven babies is born too soon.

Nearly 240,000 babies are born annually in Florida -- more than 32,000 of them prematurely.

Even worse, each year 1,700 babies in Florida do not live to their first birthday.

Prematurity is the leading cause of newborn death and has increased more than 30 percent since the 1980s -- in both Florida and Sarasota County. Many of the county's newborns suffer serious health problems or die because of their early births. Preventing pre-term birth (birth before 37 weeks of pregnancy) is critical to give more babies a healthy start.

These statistics are startling. Yet even more surprising is a growing trend of women electing to deliver their babies early.

Just because grandma is in town or daddy is off work is no reason to have a baby early.

A healthy full-term pregnancy is 39 to 40 weeks, yet we are seeing a rise in scheduled deliveries at 37 and 38 weeks -- a practice once thought to be safe.

But research is revealing the serious consequences of scheduling births even a few weeks too early. While not officially labeled "premature," babies born between 37 and 39 weeks are at significantly greater risk of complications compared with full-term babies.

More bothersome is a 2009 study that found many women do not clearly understand the definition of a full-term pregnancy.

Nearly a quarter of moms surveyed considered a baby of 34- to 37-weeks' gestation to be full term. Half defined full term as 37 to 38 weeks and 92 percent of women reported that giving birth before 39 weeks was safe. Some women mistakenly said that, since pregnancy is nine months, 36 weeks is safe as well. Clearly, this information shows we have a lot of work to do to educate mothers, their families and the community about the definition of a full-term pregnancy, which is 40 weeks.

Scheduled cesarean sections and elective inductions have become frequent and are viewed as an accepted way to avoid potential complications and problems during labor and delivery.

Unfortunately, those good intentions often result in health problems for newborns who may have to spend time in a hospital's neonatal intensive care unit, need a ventilator to help them breathe or have trouble feeding because of their early birth and may miss an opportunity for the benefits of breastfeeding.

The March of Dimes has invested millions of dollars in the fight to prevent pre-term births. Today the March of Dimes marks the eighth annual Prematurity Awareness Day by issuing its 2010 prematurity birth report card. Sadly, Florida will receive an "F" for the third consecutive year.

Florida can do better to help its pregnant women and their families lower the pre-term birth rate to a national goal -- 7.6 percent.

Hospitals and health care professionals can help by following guidelines to decrease elective deliveries before 39 weeks and recognize the warning signs of pre-term labor.

The March of Dimes has joined with other health organizations in an effort to eliminate early, elective scheduled inductions and cesarean sections -- those done without medical cause. The partners are launching an aggressive educational campaign for women and physicians.

With aid from the March of Dimes, a new tool has been developed in the fight to ensure all babies get to a full 40 weeks. In Florida, several hospitals -- including Sarasota Memorial Hospital and Manatee Memorial Hospital -- are taking a leadership role to address elective deliveries before 39 weeks and to teach the early recognition of symptoms and signs of pre-term labor.

These hospitals are using a new tool kit, which supports health-care providers, patients and hospital staff in changing delivery practices and making decisions to eliminate elective deliveries. Health care providers in Sarasota have always been concerned about reducing the risk and the number of pre-term births. We now expand our concern to ensuring babies have a full 40 weeks of pregnancy.

We want people in our community to know how they can lower the risk of an early birth by encouraging smoking cessation, preconception care and early prenatal care; promoting awareness of treatments for women with a history of pre-term births; avoiding multiple gestation from fertility treatments and unnecessary cesarean sections and inductions before 39 weeks of pregnancy.

Together pregnant women, their families and friends, policy leaders, the general public, health care professionals and hospitals can make a difference in the health of babies born in Florida and all across our county.

Washington Clark Hill, M.D., is a Maternal and Fetal Medicine Specialist at Sarasota Memorial Hospital and a member of the Board of Healthy Start Coalition of Sarasota County Inc.

Re-Post: BIRTH STORY: A Tale of Two Midwives

(In honor of Sage Marie's third birthday, we happily repost one of our favorite reader's birth stories. Written by Elizabeth Sniegocki, about the birth of Sage Marie, 11.10.07.)

One knelt next to me beside the birthing tub, modeling ever so gently how to release my breath with each contraction. Her presence in the room was ethereal – she was there, but invisible, offering guidance and support like an angel whispering in my ear.

The other crouched at my feet, her easy smile and grounded presence giving me confidence and encouragement. Her mindful touches and soft-spoken words offering empowerment; “Let your body guide you,” she whispered calmly. It was in this powerful, supported space that I gave birth to my daughter, Sage Marie.

I was blessed with the gift of two midwives at the home birth of my second child. One was Harmony Miller, LM, CPM, my midwife and maternity care provider. Over the course of my pregnancy, and during labor and delivery, Harmony provided thoughtful, thorough and professional mother-centered care. The other midwife in attendance was my dear friend, and midwife to my first child, Heidi Dahlborg, LM, who this time served as my birth assistant. Together, these women guided me through the most magical experience of my life.

I labored in the warm embrace of the water that filled a small inflatable pool near my bed, strategically placed to face my birth altar. Like my first home birth experience, the labor was short, escalating rapidly and lasting only about three hours. When it was time to push, my husband and my mother each held one of my hands. My 3-year-old daughter Selby danced near my feet with a wide smile on her face, clapping her hands and cheering me on. “You’re so strong mommy,” she said. I smiled through the pain and knew I was, in fact, very strong.

When the head crowned, Harmony told me I could reach down and feel my baby’s head. It was soft and fuzzy. She was almost here! Within minutes, my baby girl was born in the water, into the hands of her daddy, and in the comfort of her own home.

After the placenta was delivered, the umbilical cord cut and the baby weighed, measured, nursed and snuggled, my midwives focused their attention on me. They had prepared an herbal steam bath for my sore perineum, and as I sat over it, they chanted softly: “Woman am I, spirit am I, I am the infinite within my soul, I have no beginning and I have no end, all this I am.” Next, I was given a healing compress made with fresh aloe from my yard. Finally, they settled me into my family bed, where I was anointed with sweet-smelling rose water and fed warm, nourishing food and drink.

Like modern day wise women, my two midwives attended to me with love and support and skill. It is in the gifted hands of midwives such as these that the energy and traditions of ancient womanhood shall live on.

FFOM Supports Access to Birth Centers

Born in Sarasota fully endorses the following position statement from Florida Friends of Midwives against the Agency for Health Care Administration proposed rule change 59-A, restricting YOUR access to birth in a Florida licensed birth center. I encourage you to contact your elected officials as well as Mr. William McCort at AHCA and voice your stance on this issue.

Florida Friends of Midwives believes that a woman has a right to choose her birth attendant and her place of birth. It has come to our attention that the Agency for Health Care Administration (AHCA) is currently seeking to amend the rules that govern the operation of birth centers in Florida. The proposed rule changes, should they be adopted, will restrict a woman's access to out-of-hospital birth for conditions that are widely accepted by the CDC and other regulatory bodies to be safe and normal factors not worthy of high risk status.

This past March, AHCA held an administrative hearing to review proposed birth center rule changes. Prior to that hearing our understanding was that any changes would serve the purpose of bringing birth center rules into greater symmetry with the rule that govern the practice of licensed midwifery. It was also our understanding that interested parties including state midwifery professional organizations and consumer advocacy groups would be kept apprised of further meetings and decision-making regarding this issue. Unfortunately it is now clear that there have been several meetings held in the last several months and additional language was been incorporated into the proposed rule changes based in large part from internal suggestions by the Board of Nursing. These proposed changes include: eradicating the option for vaginal birth after cesarean (VBAC) in birth centers; increasing mandatory prenatal testing without recourse; limiting access for any woman who has ever tested positive for Group Beta Streptococcus bacteria; removing the ability for licensed midwives in birth center settings to administer lidocaine; eliminating informed consent for multiparous women; and finally, restricting care providers including licensed midwives, certified nurse midwives, family practitioners or obstetricians, from practicing as they would in a hospital or out of hospital setting, including conducting physicals, evaluating risk score criteria or other limitations that bind them beyond their own practice regulations.

These changes were proposed in a way that does not follow the accepted and appropriate method for amending rules as per Florida's Sunshine law. It also effectively keeps the licensed midwives, certified nurse-midwives and obstetricians who own birth centers out of the process, as well as the women and families who utilize their services.

Please visit our website at www.flmidwifery.org for additional information including a copy of the most recent proposed rule changes and a template letter for contacting AHCA staff. Right now it is essential that consumers make our voices heard. Should this rule change be accepted, as many as one half of the women who currently choose to give birth in Florida's birth centers will be unable to do so legally.

Guest Post: Fed With Love

by Abby Weingarten

Today, I watched my husband feed our miraculous, 16-month-old daughter a bottle, as he has done since she was a tiny infant.

And for the millionth time, I thought to myself, “What could be more precious than this picture?”

As you’re reading this, you might have questions. Maybe you’re confused about why a father instead of a mother is feeding a daughter, why our baby is not breastfeeding, or why I am somehow making excuses for that fact.

It’s OK. I know exactly how you feel.

Before our little girl was born, I had a plan. I had so many plans. I had decided how and where she would be delivered, and how and what she would eat. I assumed it was my responsibility, and my husband’s, to cement these items before her birth. I guess I never considered our daughter’s opinion on the matter.

As it turned out, my birth and breastfeeding plans, despite all my protestations, did not unfold the way I’d envisioned. As much as I tried to avoid an emergency C-section, it happened, and our nursing attempts were equally traumatic and ultimately failed.

For months afterward, I couldn’t evade the inner voices. “You should’ve tried harder!” and “Don’t you care about your daughter?” echoed tirelessly in my brain.

Yet, all the while, my serenity—the moments that pulled me out of those remorse spells—were the times I peeked in on my husband, our baby, and their magical bottle.

Those feeding times, as he rocked her in her nursery chair, meant everything to him. He would stay up all night with her while I recovered, and he’d happily tend to her every whimper. I know how incredibly important it made him feel.

Many of the most profound, beautiful and nurturing moments in our daughter’s life have been with her dad and their bonding bottle. To this day, the idea of weaning her off of it is too emotional a step for him, and neither of them is quite ready.

They often say that, if food is made with love, you can taste it and feel it. I know our daughter can and always has.

I sometimes wonder what it would have been like if things had gone according to “the plan” and it was only me that ever experienced that invaluable closeness with our girl.

For us, there was another way. For you, maybe it wouldn’t have been the right one.

But I’ll never erase that image in my mind of dad and daughter and the food that has inseparably linked them.

Whether it comes from a breast or a bottle, love is love. And our daughter, I know in my heart, is full.

Editor's note: This is a story that needed to be told. Much like the evidence supporting natural childbirth, the evidence supporting breastfeeding can be overwhelming to a fault: those that can truly not sustain the relationship, for whatever reason, must fight feelings of inadequacy that can even lead to postpartum depression in some cases. This story is another case-and-point: we should all be striving toward healthy practices for birth and postpartum care as a society. And we really should support each other. Period.

Video: Midwives Week Proclamation

Click here to watch yesterday's Proclamation of Licensed Midwives Week from the City of Sarasota (3:38:11).

Gratitude: The Sarasota City Commission

Dear Mayor Kirschner and the City Commissioners, City Auditor, and Administrative Assistant for the City of Sarasota:

Thank you so much for your proclamation tonight honoring Licensed Midwives Week. I know that I speak on behalf of hundreds of Sarasota families when I tell you that such a recognition is much more than a piece of paper, much more than a pat on the back for our midwives. It shows our young families that our elected officials care about healthy maternity care practices. It gives pregnant women a vote of confidence that their local government supports their evidence-based decision to choose the safe and loving care of midwives for their prenatal, labor and delivery, and postpartum care.

In the words of our nation's most groundbreaking and well-respected midwife, Ms. Ina May Gaskin: "You all are creating a little oasis of sanity there in Sarasota. Keep building: this is such important work! Please give my greetings to Kelly Kirschner. I hope that we will soon see other cities and towns making similar proclamations." With our city, state and nation's cesarean section rates on a dangerous incline, and our nation's maternal mortality rate an abysmal 41st in the world, moments like the one you facilitated tonight offer beacons of hope to so many who work so hard for improved outcomes in maternal and infant health.

Many, many thanks to each of you.

LTE: Midwives Nurture Our Health

My thanks to the Sarasota Herald-Tribune for printing my letter to the editor in this morning's paper, encouraging readers to bring their families to City Hall for tomorrow's proclamation.

At the Sarasota City Commission meeting on Monday at 6 p.m., Mayor Kelly Kirschner will proclaim Oct. 4-8 as Sarasota Licensed Midwives Week. The recognition will pay tribute to the skilled, individualized care that licensed midwives offer women and their families throughout the childbearing cycle, making a strong contribution to the health of our community through appropriate care in all phases of childbirth.

The week has also been proclaimed Florida Licensed Midwives Week by the office of Gov. Charlie Crist, coinciding with National Midwifery Week, a time to recognize the contributions of certified nurse midwives, certified midwives and certified professional midwives nationwide.

Throughout the state, about 12 percent of births are managed by midwives, rather than by an obstetrician gynecologist. Many birth centers and midwives have reported a significant increase in business in the past year. This is believed to result from various factors, primarily a desire for an alternative to hospital birth because of an unhealthy increase in caesarean sections and other unnecessary interventions that frequently occur in hospital settings. The Midwives Model of Care is based on the fact that pregnancy and birth are normal life events.

I am proud to live in a city that recognizes the safe, cost-effective, nurturing model of care midwives provide and the positive effect their service has on our community's birth outcomes. Please bring your families to City Hall on Monday evening and show your support for this proclamation.

Laura Gilkey, Sarasota

The writer is vice president, Florida Friends of Midwives, and serves on the executive board of directors, Healthy Start Coalition of Sarasota County.

Petition to Congress: Report Maternal Deaths

Amnesty International has brought media attention to the maternal mortality rate with the installation of the International Maternal Death Clock in New York's Times Square on September 20th. Yes, this is an international crisis that deserves immediate action. But every time I see an article or hear a news report about how many mothers die elsewhere, I feel compelled to bring even more attention to the current estimated mortality rate of the United States.

Data from death certificates compiled by the CDC’s National Center for Health Statistics indicated the annual maternal mortality rate to remain approximately 7.5 deaths per 100,000 births from 1982-1996. Between the years of 1996 and 2003 the approximate maternal mortality rate increased from 8.5/100,000 to 12.1/100,000. In the year of 2006 a total of 569 women were reported to have died from maternal causes and the maternal mortality rate for this year rose to about 13.3 deaths per 100,000 births. Since 1982 the United States has been largely ineffective at lowering the current mortality rate and in recent years the number has been rising.

As a nation we moved further away from our Healthy People 2010 goal of reducing the maternal mortality rate and, rather than addressing this issue, we pushed it back as a goal for Healthy People 2020. Despite the $86 billion dollars we spend on pregnancy and childbirth, more than every other nation in the world, we offer our mothers substandard care that is focused on high rates of intervention (and thus high rates of cesarean section) and outcomes that rank us 41st in terms of maternal mortality according to The World Health Organization.

What is most disturbing is that this number is a very rough estimate as only 6 of our great nation’s states require mandatory reporting of a maternal death and only 21 states have maternal mortality review boards for their state. How can we properly assess our present situation and implement corrective action when our country does not even have an accurate and standardized reporting system of such information?

This nation needs to implement a standardized system that evaluates periodically how many women die yearly as a result of complications of pregnancy, during childbirth, and as a result of childbirth (with particular attention paid to women who are readmitted to the hospital after complications of cesarean delivery).

It's shocking that with as much money as our country spends on health care and on maternity care in particular that we don't simply keep track of the mothers that are dying and why. Please sign this petition to Congress to simply make maternal death reporting mandatory. It's the only way we can begin to be a safer place to give birth.

Sarasota Licensed Midwives Week: Oct. 4-8

At the next Sarasota City Commission meeting, Monday, October 4th at 6:00 pm, Mayor Kelly Kirschner will proclaim October 4-8 Sarasota Licensed Midwives Week. The first full week in October is annually proclaimed Florida Licensed Midwives Week by the office of the Governor, coinciding with National Midwifery Week, which recognizes certified nurse-midwives.

This proclamation will pay tribute to the skilled, individualized care that licensed midwives offer women and their families throughout the childbearing cycle. It will signify the strong contribution licensed midwives make to the health and well-being of our community's mothers and babies through appropriate care and treatment in all phases of childbirth.

The Midwives Model of Care™ is based on the fact that pregnancy and birth are normal life events. The application of this model has been proven to reduce to incidence of birth injury, trauma, and cesarean section. The Midwives Model of Care includes:

• monitoring the physical, psychological and social well-being of the mother throughout the childbearing cycle;
• providing the mother with individualized education, counseling, and prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support;
• minimizing technological interventions; and
• identifying and referring women who require obstetrical attention.

I am so proud to live in a city that recognizes the value and service our midwives provide. I know that many people reading this blog share this sentiment, and I encourage you to bring your families to City Hall next Monday evening and show your support for this proclamation. Contact your local media, your elected officials, and most importantly your midwives, and communicate how important their service is to you. Spread the word about the overwhelming body of evidence supporting the safe, cost-effective, nurturing model of care these practitioners offer our families.

Healthy Start Coalition Annual Meeting

On Thursday, September 23, the Healthy Start Coalition of Sarasota County held their annual meeting. In attendance were many of our community's midwives, obstetricians, hospital staff, health department officials, leaders of health care organizations, families, educators, legislators and more.

Healthy Start Board of Directors co-chair Shara Abrams began the meeting by reminding guests of the uncertainty of the past year, with the Florida legislature coming dangerously close to eliminating all Healthy Start Coalitions. She also announced new Fetal and Infant Mortality Review (FIMR) Coordinator Beth Rubin. Jennifer Highland, Healthy Start Executive Director, then took the podium and gave an overview of Healthy Start (now in its twelfth year) and its services. She too spoke about the near-elimination in the legislature, as well as the downward shift in incoming young families to our community. Jennifer talked about some of the improvements made over the last year, despite the reduction in budget, including the addition of a Spanish speaking Certified Lactation Consultant to the care coordination team.

Jennifer went on to describe the Service Delivery Plan (SDP) 2010-2015, issued by Healthy Start this summer. I had the privilege of joining the Planning and Evaluation Committee of Healthy Start just in time to watch this incredibly thorough document's creation. The SDP identifies key risk factors and trends affecting pregnant woman and infants, and uses those to set forth an activity plan for the next five years. The statistics and research compiled to create these initiatives came from a variety of measures and sources, all referenced and double-checked, resulting in a comprehensive and thoughtful outline of steps. The SDP identified the following as the most affective negative trends in Sarasota County:

• smoking;
• substance abuse;
• obesity;
• maternal infections;
• unplanned pregnancies;
• high cesarean section delivery rate leading to unnecessary pre-term births;
• sub-optimal breastfeeding rates;
• and significant maternal and infant health disparities among African-Americans.

The SDP's plan of action outlines nine initiatives to execute during the next five years:

1. Implement "Right from the Start" and "text4baby" campaigns, both of which target pre/interconception, pregnancy, and infant health.
2. Promote uniform counseling messages and the "5 A's Approah" for women at risk of continuing tobacco use during pregnancy or between pregnancies.
3. Improve screening for drug abuse among pregnant women, and advocate for routine drug screening and treatment.
4. Provide education to the community and enhance Healthy Start services to reduce the hazards of obesity during pregnancy.
5. Improve public awareness of the risks of maternal infections during pregnancy and the importance of prevention and adherence to treatment protocols.
6. Offer updated family planning education to Healthy Start, MomCare and Healthy Families clients.
7. Improve public awareness of the dangers of elective C-sections prior to 39 weeks of gestation.
8. Improve breastfeeding rates among Healthy Start and Healthy Families clients by working along the continuum from pregnancy through the postpartum phase.
9. Increase and sustain education and support for preconception, interconception and pregnancy health for high risk African-American pregnant women.

After introducing two women who have been positively impacted by Healthy Start--one through taking advantage of its services, and one by recognizing high need and taking the path toward the field of obstetrics--Jennifer passed the microphone to Sarasota Mayor Kelly Kirschner, one of two keynote speakers for the morning.

Mayor Kirschner framed his message by sharing his personal journey with maternal and infant health--his oldest child, Bodhi, was born at 27 weeks gestation and spent three and a half months in intensive care. Kirschner's wife, Tracy, is a Certified Nurse Midwife who suffered a grand mal seizure as a result of sudden eclampsia during her pregnancy. After Bodhi's birth by emergency c-section, the couple watched by his side as Bodhi literally struggled for survival, using machines to help him breathe. Mayor Kirschner's message was clear: this was a necessary c-section, and the bill for Bodhi's care exceeds half a million dollars. His treatment, albeit appropriate and one for which the Kirschners are grateful, comes with repercussions today. The cesareans and resultant NICU admissions that are NOT necessary must be eliminated if we are to improve outcomes and healthcare costs.

Kirschner cited the recent Health News Florida article that connected high c-section rates and populations with high Hispanic percentages. Kirschner challenged some of these correlations, saying Florida has been home to Puerto Ricans, Brazilians, Chileans and others for decades, and that their presence here can't explain the sharp c-section increase. He focused instead on a hospital in Guadalajara, Mexico, that requires a second opinion, a documentation of reason, and monitoring and follow-up with the obstetrician when a c-section is suggested. Kirschner also reminded the Healthy Start members that while convenience, lack of VBAC access, fear of litigation, obesity and more are often called out as reasons for the high c-section rates, the highest increase is currently in women 25 and under--indicating that a lack of informed consent is perhaps the true culprit.

Mayor Kirschner summarized his message, inspired by Dr. Albert Bandura, by saying that a belief in self-efficacy is the foundation for change. We--mothers, fathers, families, policy makers, maternity care providers, hospitals, legislators, insurors--have to understand that to improve the practice of childbirth today, through a return to normalcy and appropriate care, is to reduce a high-cost impact tomorrow, both fiscally and physically.

Florida Representative Keith Fitzgerald was the second keynote speaker of the morning, and he continued Mayor Kirschner's sentiments with a plea to those present to get involved in their state government. He very honestly described the near-elimination of Healthy Start from a legislative perspective, which was enlightening to say the least: he said that the Coalitions were never intended to be eliminated, but rather cut in funding; however, proposing elimination allowed the Coalitions to rally, and allowed the State to then "save" the slice of the pie (albeit a smaller piece), making all parties look heroic. As these sorts of games continue to be played, it is more important year after year that consumers and advocates make their voices heard. Representative Fitzgerald adjourned with a strong message: It's up to YOU.

Jennifer Highland returned to the podium to present annual awards from Healthy Start for Volunteer of the Year (Liz Murphy), Business Partner of the Year (Sarasota Architectural Salvage), Community Partner of the Year (United Way 211), Family of the Year, the Mission Award (Shelley Rence), and the Lawton Chiles Award (Barbara White, Cyesis founder).

Jennifer then thanked outgoing Board of Directors members for their service, including six-year co-chair Jenna Norwood, who passed the "silver rattle" to incoming chair Shara Abrams. I am very honored to have been nominated and elected to the 2010-2011 Board of Directors for Healthy Start, along with many people whom I have respected in this community for years, and several new faces as well. Joining the board as honorary members are Representative Fitzgerald, Representative Ron Reagan, Ed Chiles, and outgoing director of Maternal Fetal Medicine at Sarasota Memorial Hospital, Dr. Washington Hill.

The mission of Healthy Start is to improve the health and well-being of pregnant women, infants and young children. I am privileged to join this group in this capacity, for I truly believe there is no organization in our community better poised to improve birth outcomes.

Florida C-Sections Driven by Culture?

I had the pleasure of a phone interview with Sarasota Health News editor David Gulliver, working on a story for Health News Florida examining possible contributing factors to Florida's "stubborn" cesarean section rates. The story, originally posted here, follows in its entirety:

A report from California last week found a statistically significant link between high rates for cesarean-section births and the for-profit status of hospitals. Health News Florida ran a similar analysis and found no such association.

Our analysis of the 116 Florida hospitals that delivered babies in 2009, both in overall rates and in rates of c-sections where there were no medical complications, found similar results in non-profits and for-profits. See complete list.

The overall rate statewide of around 39 percent, about seven percentage points above the national average, shows differences tend to be geographic. That didn't come as news to Tampa OB-GYN Robert Yelverton, a member of the Florida Perinatal Collaborative.

"We know it's higher in hospitals below (Interstate) 4, in general," he said. "We’re attempting to find funding to study that."

That suggests a demographic difference linked to the culture of the community. Ten of the 12 Florida hospitals with the highest rates of cesarean section delivery are in Miami-Dade County, where 62 percent of residents claim Hispanic ancestry.

“It’s sort of a cultural phenomenon,” said Dr. Rafael Perez, an obstetrician on the South Miami Hospital executive committee, where 61 percent of births are c-section.

Florida's highest c-section rate is at Kendall Regional Medical Center, where almost two-thirds of babies are delivered via that way. All Miami-area hospitals except two that are part of the public system deliver about half of babies by c-section.

The findings echo a 2006 state report that found women of Hispanic ethnicity had a higher c-section rate than women of other backgrounds.

While culture may explain why Florida's rate is far above the national average, it doesn't explain the inexorable increase, from 26.2 percent in 2000 to to 41.2 percent in 2009.

The Florida Department of Health, working with physicians and other groups in the Florida Perinatal Collaborative, has been working for more than two years on a report on the reasons for preterm delivery, in which c-section is often implicated. That report may be ready by the end of the year, said DOH epidemiologist William Sappenfield, MD.

In the meantime, physicians, parents and healthcare advocates point at a variety of causes, and sometimes at each other.

“It’s becoming an epidemic, and it’s being swept under the rug,” said Laura Gilkey, a Sarasota mother and advocate for natural childbirth.

Se habla espanol?

Florida experts have noted the link between Hispanic ethnicity and c-section rates before. A 2006 study by the Agency for Health Care Administration found that Hispanic women were the most likely to deliver by section.

That tendency surfaces in examinations of other countries. A Centers for Disease Control study found c-section rates of 45 percent in Puerto Rico in 2002, nearly double the mainland United States’ rate at the time. And some Central and South American countries have even higher c-section rates -- like Brazil’s 70 percent.

South Miami’s Dr. Perez said about two-thirds of his patients are Hispanic, and they have a different approach to childbirth. They are eager to attempt natural birth, said, but also quick to abandon it if they sense problems. “They have a fear of complications,” he said.

But mothers in general have changed, he said. He is seeing more older mothers, often using fertility treatments. “The people coming to see us now are not the same as the ones in the ‘50s and ‘60s,” Perez said. “They are delivering one baby, later in life, and they want it to be perfect,” he said.

About a quarter of his patients have c-sections, he said. Of them, about half attempt labor first. But his other patients’ choices illustrate some of the controversy surrounding cesarean sections.

No more VBACs

About half of Perez’s c-sections were likely from the outset, because of complications or because the mother had a prior c-section. Obstetricians have become reluctant to allow mothers to deliver vaginally after c-sections, a procedure known as VBAC. Studies show that in slightly less than 1 percent of cases, it can cause the mother’s uterus to rupture.

The American College of Obstetrics and Gynecology in July said the sharp decline in VBACs was a major cause of rising c-section rates. It issued new guidelines on when the procedure is safe, to persuade more doctors to perform it.

Doctors may still have doubts. VBACs are successful only about 70 percent of the time, so many end up with a c-section anyway, Perez said. In the rare uterine rupture, a medical team must anesthetize the mother and deliver the baby in a 10-minute window before lack of oxygen causes brain damage.

That illustrates another incentive for c-sections: Physicians’ fears of malpractice lawsuits.

“The first thing the lawyer is going to tell you, when you have a baby with a neurological impairment, is ‘Why did you do a VBAC?’” Perez said. “These kinds of lawsuits go into the millions of dollars, and that weighs heavily,” he said.

A handful of his patients will choose a cesarean delivery from the start, he said. Physicians, researchers and childbirth advocates have targeted those elective c-sections as the most dangerous.

ACOG guidelines tell members to avoid performing elective c-sections before 39 weeks of gestation, but difficulties in estimating fetal growth can result in babies born weeks before they reach full-term. This is the focus of the ongoing Perinatal Collaborative study.

“You absolutely cannot predict with certainty the gestational age of the fetus,” said Jennifer Highland, a registered nurse and director of the Sarasota County Healthy Start Coalition.

Incorrect age estimates result in elective c-sections performed too early, leading to health problems for infants. “It is the number one reason why our prematurity rates are going up,” Highland said.

Babies born in planned c-sections ended up in neo-natal intensive care units almost twice as often as those delivered vaginally, and had twice the risk of pulmonary problems, according to a 2006 study published in the American Journal of Obstetrics and Gynecology.

“We’re electing to put those risks on the baby, for no good reason,” Highland said.

Convenience a factor?

Doctors say some parents press for early deliveries for convenience or to avoid pain. Healthy childbirth advocates say some doctors also do so out of convenience. Perez said he educates his mothers about the risks.

“Babies should be born at 39 weeks,” he said. “Delivering at 38, 37 weeks -- that is not a good medical decision.”

Reducing those early c-sections -- the goal of initiatives by March of Dimes, hospital accrediting group the Joint Commission, and others -- may improve outcomes, but will not significantly change c-section rates, he said.

Despite those concerns, Perez sees cesarean deliveries as an advance in obstetrics and a safe choice for most women

“You have to ask a philosophical question: Are c-sections that bad?” he said. “Nowadays, a c-section is one of the safest procedures, because we do so many of them.”

That’s where physicians and advocates differ. C-sections carry significantly higher risks of infection and surgical injuries, and slightly higher risks of death or blood clots leading to stroke. “You don’t want to have surgery unless you have to have surgery,” Highland said.

Gilkey, the Sarasota mother, has two children. Both were 10 pounds at birth, both delivered at a birthing center with a midwife. In one birth, the midwife resolved a case of shoulder dystocia, allowing the natural delivery to proceed. “That never would have happened in a hospital,” she said.

While she believes hospital deliveries are best in some cases, the experience turned her into an advocate for natural childbirth. “Where birth is concerned, we live in a culture of fear,” she said.