Born in Sarasota

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

2012-01-18T12:39:00.002-05:00

Maybe guns aren’t the biggest threat in Newtown.

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

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

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

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

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

For more information, contact info@healthystartsarsota.org.

An Evening for Healthy Start

2012-01-04T13:01:00.000-05:00

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

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

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

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

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

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

2011-12-12T01:17:00.006-05:00

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

“To say I am thrilled for her is the understatement of the century,” says Maternally Yours co-hostess Ryan Stanley. “This win will make real change for mothers and babies in Indonesia and worldwide—mothers and babies will live and thrive because of this award.”

Since 2005, Robin Lim’s clinic Bumi Sehat (translated as Healthy Earth) has treated nearly 113,000 patients and delivered nearly 4,000 babies for free in Bali, where rates of postpartum hemorrhage and maternal and infant mortality are among the highest in the world. “Ibu” (Mother) Robin is a midwife, well-known author and talented poet who has dedicated the last 13 years of her life to this clinic, despite constant financial, cultural and geographic challenges.

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

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

And, for eleven weeks straight, people voted.

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

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

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

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

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

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

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

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

2011-12-07T21:45:00.005-05:00

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

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

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

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

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

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

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

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

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

What is often missed is that excessive cesarean rates have other negative consequences than the loss of midwifery and obstetrical knowledge and skills. Simply put, as rates rise beyond 15-20%, more women die from complications such as pulmonary embolism, infection, hemorrhage, and a sharp increase in placental complications in subsequent pregnancies. None of the countries with

the highest cesarean rates can report on low maternal death rates. This is especially true of the U.S., where women now face at least twice the chance of dying from pregnancy-related causes as their mothers did. In California, between 1996 and 2006, the maternal death rate tripled, with much of the increase being attributed to an excess of cesareans. Don’t expect the U.S. to report these telling facts with any accuracy, though, because the current lack of an infrastructure that requires and produces accurate and consistent reporting, and analysis of maternal deaths, means that the official maternal mortality figures represent possibly only a third to a half of the actual numbers.

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

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

Midwives must have an important say in the formation of maternity care policy. Care should be individualized and founded upon consideration and respect for every woman. When not under

threat of a dominant medical profession, which is itself dominated by a powerful insurance industry or a powerful hospital industry, midwives can provide care that is organized around the principle that women’s and children’s rights are human rights and that access to humane and effective health care is a basic human right. Independent midwives must be able to make a living from their work, which means that insurance companies should not be permitted to charge such high premiums that it becomes impossible for them to make a living.

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

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

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

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

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

Sarasota Leads Statewide Prematurity Awareness Month Campaign

2011-11-16T13:43:00.001-05:00

Would you please pass the cranberry sauce and the facts?

Just as families are preparing to gather together in celebration of the Thanksgiving holiday, theFlorida Association of Healthy Start Coalitions (FAHSC) and March of Dimes Florida Chapter are launching a campaign as part of Prematurity Awareness Month (November). “Healthy Babies are Worth the Wait” is designed to raise awareness about the myths and risks of premature births, as well as educate the public about the importance of staying pregnant at least 39 weeks if a pregnancy is healthy.

According to studies, a growing number of babies are delivered between 37 and 39 weeks. Many of these births occur as a result of planned or scheduled deliveries that are not medically necessary. Nationally, labor induction rates during these weeks have more than doubled from 9.5 percent in 1990 to nearly 23 percent in 2006. In Florida, preterm birth rates increased from 12.8 percent in 2000 to 13.5 percent in 2009. Sarasota is one of seven priority communities leading the statewide community education campaign being launched by FAHSC and Florida March of Dimes in observance of Prematurity Awareness Month. Hospitals in these communities are participating in a statewide quality initiative to reduce elective deliveries.

Non-medically required preterm deliveries pose increased risks to an infant’s life including neonatal hospitalizations, death, respiratory stresses, developmental delays and learning disabilities.

“We are pleased that our coalition and community have been selected to lead statewide education efforts to reduce the risk of babies who are affected by late preterm deliveries and non-medically necessary inductions and c-sections,” said Jennifer Highland, Executive Director, Healthy Start Coalition of Sarasota County, Inc. “There is an alarming misconception among many that a baby is full term and ready for delivery at 36 weeks…so, unfortunately, we see a lot of mothers seeking to schedule C-sections or induced deliveries when there is no medical reason to do so. This campaign will help Sarasota citizens understand that the last weeks of pregnancy actually do count.”

Sarasota is joined by Miami-Dade County, Broward County, Palm Beach, Fort Myers, Tampa and Santa Rosa County as lead participants in the “Healthy Babies are Worth the Wait” statewide campaign, being implemented by the Florida Association of Healthy Start Coalitions with funding from the March of Dimes.

The March of Dimes is a national voluntary health agency whose mission is to improve the health of babies by preventing birth defects, premature birth and infant mortality.

Founded in 1938, the March of Dimes funds programs of research, community services, education and advocacy. For more information, visit marchofdimes.com/florida.

Founded in 1991, the Florida Association of Healthy Start Coalitions is a statewide network of 32 Healthy Start Coalitions that exchange and disseminate resources and information designed to improve maternal and child health. FAHSC was awarded a March of Dimes Florida Chapter Community grant in March to educate Florida women, families, medical professionals and providers about preterm risks.

Vote Robin Lim as 2011 CNN Hero of the Year

2011-10-15T10:53:00.004-04:00

Robin Lim, the midwife featured in the film Guerilla Midwife, shown on the International Day of the Midwife in Sarasota in 2010, has been chosen as a Top 10 CNN Hero of the Year Nominee. If she wins this honor, her non-profit organization Yayasan Bumi Sehat will receive $250,000. People can vote for Robin 10 times per day until December 7th. This money would help Robin save so many mothers and babies; her birthing sanctuaries offer free prenatal care, birthing services and medical aid to anyone who needs it, in areas of the world where postpartum hemorrhage, obstetric fistula, and lack of prenatal care claim far too many lives.

"Naturally I hope that being a CNN Hero will bring attention to the global need for better maternal and infant survival care," says Robin Lim. "Bumi Sehat has a huge responsibility keeping the two community health and childbirth clinics open. There is also the Bumi Youth Education Center, our scholarship program, village recycling and environmental stewardship.

"We do capacity building for Indonesian midwives from many islands and countries. Bumi provides free ambulance and emergency medical service, HIV/AIDs counseling and testing, pediatric care, free weekly special clinics to treat chronic illness. We have elderly and prenatal exercise programs. Bumi Sehat is open 24 hours a day, every day of the year. In the first eight months of 2011 Bumi Sehat has helped 20,500 patients and delivered nearly 400 babies for free!"

Quite close to the epicenter of the 2004 Indian Ocean tsunami disaster, Bumi Sehat operates a clinic which also sponsors capacity building for youth education and environmental protection. "Bumi Sehat needs the CNN #1 award, and will put it to use doing culturally appropriate sustainable care. Imagine a world in which each child is born with an intact capacity to love and trust. This is the world midwives work day and night to build."

Click here to VOTE for Robin Lim. A vote for Robin Lim is a vote for gentle birth, for mother and child survival, for culturally sensitive natural community health care and disaster relief, for midwife-to-mother care that effectively saves lives.

BIRTH STORY: We Become Three

2011-10-15T09:50:00.002-04:00

(written by Kassandra Lowther, about the birth of Aiden Anthony, born 10.10.11)

I awoke at 6am on the dot on 10/10/11, not feeling "right." Anthony sat up at the exact same time that I did and just looked at me; he says now that he just "knew." I was having a lot of intense period-like cramps that would leave me falling to the ground. I went to the bathroom thinking I had to take a poop, which I did; I thought that after that, the pain would go away and I could go back to sleep. Boy was I wrong!

I tried laying back down but I was in too much pain to sit still. Anthony was on and off sleeping at that time, still making sure I was alright every few minutes. I tried going to the bathroom again--nothing. Only a piece of toilet paper's worth of blood. I texted my mom and she responded that she was surprised I was awake so early and asked me to keep her posted. I finally went out into the living room and logged onto facebook to ask if anyone else had ever experienced the kind of pain I was, during labor or just at the end of pregnancy in general; many of my friends said it sounded like labor!

I went onto contractionmaster.com and started timing my contractions, they would come anywhere from 6-7 minutes apart and would last anywhere from 45 seconds to a minute. These were pains I could not talk through, walk through, etc. I knew either something was wrong or I was in labor. I told Anthony he could go to work, that I wasn't exactly sure if I was in labor or not and I didn't want to have him call off if it was only random pains like usual. I timed the contractions for about an hour and realized that I had been having these pains for about 3 hours--time to call the midwife.

I paged the on-call midwife at 8:48am and waited about 2 minutes until I got a call back. Harmony Miller was on the line, I explained to her everything I was feeling--the blood, the contractions; I had multiple contractions that left me breathless while on the phone with her. She said that it definitely sounded like I was going into labor, that I should keep timing the contractions and said that "I will know" when I need to come in and to call her when I need her. Lucky me that was the day she had come back from her maternity leave, her son Cairo would be attending his first birth--mine!! I then called my mother and asked her to come over, that Anthony was at work and I needed someone there with me; she told me after that she could tell by the way I was talking that I was totally in labor.

My mom showed up and she helped me through many contractions; she tried rubbing my back a few times but I just didn't want to be touched. We called Anthony (he had been at work for about a half an hour) and told him that he NEEDED to come home, that I was in labor and we had to get to the birthing home soon. He came through the door about 10 minutes later and asked me if I was sure I was in labor, ohhh yes I was!

He and my mom helped me through more contractions. I was grabbing onto the edge of the couch and on the floor begging for a trash can because I swore I was going to throw up. All I could smell was garlic bread from dinner the night before; it made me gag but I just couldn't throw up. Anthony called Harmony at 10:34 and told her that we were on our way to the birthing home. She said for us to call when we were out the door. I know now why she said that. It took me about 20 minutes just to get off the floor and out of the house.

On the way to the birthing home I wasn't even in the seat of my mom's convertible, I was on the floor in between the front passenger seat and the back seat in sooo much pain; the contractions were definitely a lot more intense. Some a-holes decided to honk at us from behind so I flicked them off, they then pulled in front of us and went about 10mph ON FRUITVILLE just to get me back for giving them the finger. Anthony was so irritated at that and almost jumped out of the car.

We arrived at Rosemary Birthing Home and it took me about 5 minutes just to get out of the car because I was finally and constantly throwing up into a big black trash bag. Anthony helped me waddle my way up the steps and into the birthing home. I looked and saw the sign on the door that said something like "There is a baby being born today!" I couldn't help but smile because I knew that it was put up specifically for me!!

We walked inside and hurried me up the stairs before the contractions came again. The moment we got into the purple birthing room I was already on the floor in pain. My mom got me some water and I was drinking "Frost" Gatorade like there was no tomorrow, although no liquids could quench my thirst. Harmony arrived soon after and I was on the bed on all fours, holding onto Anthony's hand for dear life as yet another intense contraction overcame my body. She asked if she could check me and of course I wanted that more than anything, because if I was only 1-4cm dilated and in that much pain I would've been so mad. I laid on my back and I started having another contraction, she waited patiently and quickly after it subsided stuck her fingers in for a check. The look in her face was pure shock, I don't remember exactly what she said but it was something along the lines of "Oh! You are 6-7cm dilated and STILL stretching as I keep my fingers in!" I was dilating rather fast!

I asked for the birthing tub to be filled because I knew the warm water would put my body and mind at some ease. I kept laboring on the bed with Anthony by my side for what seemed like forever. I kept staring at the birth tub praying in my head for the water to fill up faster; it was taking so long! Anthony's mother and grandma showed up at some point then, I was fully focused on the contractions at this point. I remember saying hello to them and telling Michelle how I loved what she did with her hair! I was given a green bowl to throw up into, it was in front of me on the bed; I had nothing in my system besides Gatorade and water so mostly I was vomitting bile (ew).

Finally the birth tub was "full enough" that I could at least get in and relax. We got into the tub and the heat of the water felt AMAZING, I never thought that water could ever feel so orgasmic. With each contraction came all new sensations: the feeling of wanting to poop, the most intense back pains I've ever felt in my life, the want to get out and give up. I remember looking over and my mom a million times shaking my head, she would just smile and nod; letting me know without saying a word that I can do this. Those looks really got me through it. She kept trying to take my green bowl away from me though, which I kept in the water with me the whole time because I kept feeling like I was going to throw up, which I actually never did; I guess I was just territorial over it!

Grandma Pat kept going downstairs to get ice chips and my mom would feed them to me, and although they didn't seem to help with anything, they still felt amazing to chew on. Anthony was behind me in the birth tub putting pressure on my back with each contraction that passed, most of the time his hands felt to almost make the pain feel worse and I remember smacking his hands away a few dozen times. I then felt inside of me and could feel my bag of water still intact, and behind that I could feel Aiden's skull...it was only about a fingertip away but never seemed to want to budge. I looked around the room many times during labor and kept telling Harmony and the rest of the birth team that I couldn't do it, that it hurt so bad. They kept telling me that I was doing an amazing job and it would be over soon, so I kept trying. Every contraction now sent me into wanting to PUSH, I'd push so hard and feel Aiden coming out but then I would have the feeling to poop so I'd stop pushing. Even though I was in so much pain I really didn't want to poop on my husband who was sitting behind me, it would just feel so awkward to me. The only time I had cussed during labor was about this time, when I yelled "God damnit!" after which I apologized to everyone in the room.

Finally after a few hours of trying not to let my bowels out I turned around and faced Anthony; holding onto his knees, legs, arms, hands, hugging him so tight with every contraction. I finally couldn't hold it anymore and pooped, just little particles came out but at least they came out behind me and not right in front of Anthony. Every contraction after that I kept pooping out little peices; Harmony told me that that meant Aiden was very close, that he was pushing on my anus. It honestly did feel like he was trying to come out of my butt and not my vagina, it was awful! One of the birth assistants (I don't remember her name, sorry!) helped put pressure on my back as I squeezed Anthony's leg through yet another painful contraction. I felt "down there" and I could feel my bag BULGING, I knew he was close. I gave out a really hard push and could feel Aiden's head giving way, coming out into the tub. I leaned back a bit and just let the pain over-take me, this was definitely the most painful part of my labor. All of a sudden everyone was around the tub watching as Aiden's head, then shoulders, then whole rest of his body came out of me. Anthony told me later on that he asked Harmony if he could still breath while inside the sac, she assured him that he was still breathing oxygen and not to worry. Anthony then had him in his hands and pulled him out from the water. There he was, our beautiful baby boy. The moment I saw him all the pain had disappeared, like the labor never happened and my perfect little boy had just come out of the water out of nowhere.

Aiden Anthony Lowther was born on 10/10/11 at exactly 4pm; caught by his daddy Anthony R. Lowther, after a 10 hour all natural labor in the water at Rosemary Birthing Home. He was born still in his sac, which I was told later is very rare, there are several old wives tales about it. Aiden weighed 7lbs 7oz and measured 21in long.

I have never experienced something so amazing in my life, and I definitely plan on having more natural water births in the future. Thank you to everyone who was there, for your support and love; I couldn't have done it without you guys!!!

Introducing Maternally Yours Radio

2011-10-12T06:15:00.001-04:00

I am proud to introduce to you a new radio program I am co-hosting, and am honored and very excited by the opportunity before us. I invite you to tune in and welcome your feedback!

Earlier this month, four Sarasota mothers launched a weekly radio program dedicated to maternal health. “Maternally Yours: Sarasota’s Conversation about Pregnancy, Childbirth and Early Motherhood” airs every Tuesday night at 6:30pm on Sarasota’s community radio station, WSLR 96.5 LPFM. It is the first ever local broadcast dedicated to the subject, and WSLR’s first program hosted by a collective of women.

Maternally Yours is an opportunity for Sarasota to learn about issues affecting pregnant families, infants, and young children from a consumer perspective. The program will be hosted on a rotating basis by four women well-known in the community for their expertise in the areas of pregnancy, childbirth, and the postpartum period. The hostesses will invite local experts in the fields of midwifery, obstetrics, nursing, pediatrics, healthcare administration, breastfeeding, doula work, public health, and consumer advocacy, as well as (and often) parents who might share their experience on a given topic. The show will offer listeners a broad range of perspectives and opinions incorporating all models of maternity care available.

“This is such a balanced, judgment-free, thoughtful, refreshing show,” says Sarasota mother Abby Weingarten. “What a gift to our community!”

The hostesses of Maternally Yours are Cheryl Kindred, Carmela Pedicini, Ryan Stanley and Laura Gilkey. Cheryl is a certified birth doula, birth assistant, childbirth educator, MotherBaby advocate and leads local groups for Babywearing education and postpartum support. Carmela is an Independent Childbirth Educator, Certified Lactation Counselor, Licensed Practical Nurse, and local musician. Ryan is a long-time Sarasotan and young mother whose daughter’s birth shifted her career path toward Postpartum Doula certification. Laura is an advocate for evidence-based maternity care, a board member for Florida Friends of Midwives and the Healthy Start Coalition, author of the blog Born in Sarasota, and marketing director for The Safe Motherhood Quilt Project.

The unifying voice of the programmers is a genuine desire to empower women to take control of their bodies, their pregnancies, their births, and the raising of their children. “We all believe deeply in informed consent and allowing families to make their own choices,” says Laura. “The best way for them to do so is with evidence, information, and support.”

To listen to Maternally Yours, please tune into WSLR 96.5 LPFM every Tuesday evening at 6:30pm. The program is also available via live streaming on wslr.org, and podcast at podomatic.com/profile/maternallyyoursradio. For more information, please contact the hostesses of Maternally Yours at MaternallyYoursRadio@gmail.com, or call (941) 915-8115.

About Maternally Yours: Maternally Yours is Sarasota's Conversation about Pregnancy, Childbirth and Early Motherhood. The Conversation airs on Tuesday nights at 6:30pm on YOUR Community Radio Station, WSLR 96.5 LPFM. The mission of Maternally Yours is to educate and inform our community about the options, support, and evidence-based best practices available to them in maternal-child healthcare.

Guest Column: Safe Childbirth Advocate Honored

2011-10-03T07:43:00.005-04:00

My gratitude to the Sarasota Herald Tribune for printing the following editorial on Monday, October 3rd.

In 2009, American midwife Ina May Gaskin visited Sarasota. She spoke to the physicians at Sarasota Memorial Hospital, displayed her Safe Motherhood Quilt Project at the Selby Public Library, and sat on a panel of experts at the conference on Maternal Healthcare in the 21st Century. She shed some light in our community on the evolution of American maternity care, our current maternal mortality crisis, and the model of care and accountability we must embrace to change it.

These are the kinds of visits Ina May makes on an almost weekly basis, in between delivering babies at The Farm, the "intentional community" in Tennessee she and husband Stephen Gaskin developed in 1970. One book, one airplane flight, one community at a time, she uses her 40-plus years of midwifery experience and research to educate and call to action those of us who are compelled by the fact that, while the United States spends more money on maternity care than any other nation, we remain ranked 50th in maternal mortality and 41st in infant mortality, according to the World Health Organization.

Recently, Ina May received the highest honor of her career thus far: The Right Livelihood Award (rightlivelihood.org), commonly referred to as the "Alternative Nobel." The award, established in 1980, honors "those offering practical and exemplary answers to the most urgent challenges facing us today." Among 2011's four Laureates, Ina May was chosen "for her whole-life's work teaching and advocating safe, woman-centered childbirth methods that best promote the physical and mental health of mother and child."

The Gaskins will travel to Stockholm in December to accept the honor, which will be presented by Sweden's Parliament.

This will be the second time they have done this as husband and wife; in 1980, Stephen became the first Right Livelihood Award Laureate for his establishment of PLENTY International. This is the first time a husband and wife have each been laureates of the award, causing the Right Livelihood Foundation to liken the couple to Marie and Pierre Curie.

Today, Ina May focuses her efforts heavily on The Safe Motherhood Quilt Project (rememberthemothers.org), in which each quilt square honors a woman who has died in childbirth in the United States since 1982. The Project aims at summoning the national will necessary to lower the rising maternal death rate by creating a consistent, mandatory system for reporting, classifying and counting maternal deaths, and reviewing and analyzing their causes.

She is also engaged in a national information campaign, aimed at women and medical professionals, about the potential side effects of using Cytotec, or misoprostol, to induce labor. She continues to teach and speak to physicians and midwives worldwide, and has traveled to Argentina, Canada, Mexico, Brazil, Costa Rica, Sweden, Norway, Denmark, Iceland, Germany, Switzerland, Israel, Italy, Austria, France, the Netherlands, Slovenia, Russia, Hungary, the Czech Republic, Spain, Australia, New Zealand and Japan to do so.

When I was newly pregnant for the first time in 2004, the first book I read was Ina May's "Spiritual Midwifery." Like so many other new mothers, I relied on the birth stories and wisdom so frequently that its pages were dog-eared and tattered by my due date. Since that bestseller, she has penned: "Ina May's Guide to Childbirth," "Ina May's Guide to Breastfeeding" and "Birth Matters: A Midwife's Manifesta," published just this summer. I encourage people to read this most recent work, describing the evolution of our maternity care system, and the path we must take to improve it, not only for the highest good of our mothers and babies, but for nations worldwide that strive to replicate our model of care.

"A society that places a low value on its mothers and the process of birth will suffer an array of negative repercussions for doing so," says Ina May Gaskin. "Good beginnings make a positive difference in the world, so it is worth our while to provide the best possible care for mothers and babies throughout this extraordinarily influential part of life."

We as a nation should celebrate Ina May Gaskin, the U.S. 2011 Right Livelihood Award Laureate, with collective pride and gratitude. Her tireless dedication to her calling has rippled throughout the world, and it is up to us to carry her message. It is a privilege to work with Ina May, and the highest honor to call her my friend.

BIRTH STORIES: Kalina and Jasper

2011-09-27T08:00:00.002-04:00

(written by Erin Ernst, about the births of Kalina Jade, 11.25.07 and Jasper Jolee, 07.05.11)

Labor & Birth of Kalina Jade Ernst

November 25, 2007, 11:31am

8lb 14oz ~ 22” long

Pregnant with our first child, my husband & I were so excited. Early on in my pregnancy, I knew I wanted the intimate & personal care of midwives for my pregnancy and birth. I had taken a Human Sexuality (or something along those lines) class in college and we had a lot of speakers come through. One was a group of midwives from a local birthing center. So much of what they said resonated with me, though I was nowhere near wanting kids yet, that I saved the brochure they’d given us comparing the midwives model of care to the typical hospital care of a birthing woman. Over four years after taking that class, it was time to share my wishes with Joe. I had already done some research and found the sweet little Rosemary Birthing Home. He wasn’t too keen on the idea, but agreed to at least do the tour with me. I also signed us up for a tour of the local hospital.

I was just shy of two months pregnant when we toured the birthing home and met the staff. They were all wonderful. There was another couple there who were back for their 2nd pregnancy. They labored there for their first child but ended up transferring to the hospital where she was given some Pitocin and birthed her baby shortly after. I found it reassuring that she was back again and planning on having her second baby with the midwife there. After we met the very knowledgeable and reassuring midwife Harmony, and asked many questions, Joe & I were both pretty sure we wanted to spend our pregnancy and birth with her. We still did our tour of the hospital the following week. After the loving, homey feel of the birthing home, the hospital felt so cold, impersonal and sterile. I’ve always felt nervous & tense just walking into hospitals, associating them with sickness & death, and this time wasn’t much different. I knew that a normal, easy birth was possible in a hospital as I had watched my mother give birth to my brother in that same one when I was just twelve years old, but I still couldn’t picture myself there after knowing there were other options.

So, we decided we would be giving birth at the birthing home. I had contemplated doing a home birth since it’s basically the same thing, but I figured the birthing home was a good “compromise” between home & hospital, and it seemed it would be easier for our families to understand – since they were already surprised we weren’t planning a hospital birth for our first.

From the beginning of my pregnancy, I was sure we were having a girl, though I wanted to wait until the birth to “officially” know. Joe really wanted to find out though, and since our 20 wk ultrasound was right after Father’s Day, I put in his card that we could find out the sex. He was thrilled. So, when the time came, we peeked up her skirt and let everyone know that we were indeed having a little girl! We were excited to meet our daughter one day soon. In the meantime, I read every pregnancy book I could get a hold of, from mainstream books like the What to Expect ones, to Ina May’s amazing books on pregnancy & birth, and I even read a book on the Bradley Method, and a Hypnobirthing book too.

I enjoyed a symptom-less, wonderfully easy pregnancy. I never felt a bit of nausea and was rarely tired. I was looking forward to my “birth day” and was sure it would be short and easy. Harmony even told us she saw us having a wonderful birth. I continued working and we went out with friends every weekend we could. My due date was Mon., November 19th, and I continued feeling great as it approached. I enjoyed my big belly, doing weekly photos, a belly cast, and then had my sister do henna on my belly when I hit 40 wks. Joe & I were both born 2+ wks past our “due” dates, so I figured I’d probably go late as well. As the date came and went though, all those who we shared that magical date with began asking about the baby, wondering if she was here yet… Even out shopping, people would ask when I was “due” and it went from answering “tomorrow” to “two days ago”, and people would look at me like the baby may fall out right there! Even though I knew that was completely normal, I got tired of telling people I was “late”.

I had Harmony “strip my membranes” when she checked me at my 40wk appointment, since it sometimes helps women go into labor if they are ready. I also found out that I was already 2cm dilated that day. That afternoon I began having period-like cramps for a couple hours. I lay on the couch, wondering if the baby may be coming that day, but they eventually stopped, and I realized labor would begin another time.

Thanksgiving fell on November 22nd that year, 3 days past my due date. We visited both sides of our family that day, and got to share what our baby’s name would be – we scrambled up the letters of the first, middle, & last name and wouldn’t tell them what it was until they got the whole thing right, which they eventually did. Surely, eating two huge meals would push that baby out of my belly! Joe took the next day off of work. We were hopeful that it would be our baby’s birth day. We went out Friday morning and did a little shopping, and stopped at a deli for lunch. I felt a little funny and didn’t have much appetite, so I just ate a little soup and some salad. We continued walking around and ran some errands. I started feeling rhythmic cramping, so I called Harmony to let her know. She told us to continue whatever we were doing and keep her posted. We were excited that things were finally beginning! When we got home early in the afternoon, we made sure all of our things were together that we’d be bringing to the birthing home with us. Then, I laid in bed and began keeping track of my contractions to see how far apart they were. I was too excited & nervous to rest. I called Joe to bed and we tried playing UNO, but the contractions started getting too distracting to pay attention to the game. They continued getting stronger all evening and we finally told Harmony around 11pm that we wanted to come down to the birthing home. We were thinking the baby may be born before the day was done!

We arrived at Rosemary Birthing Home close to midnight. The 30 minute drive down there while having contractions was awful, so I was so glad to get into that cozy house and fall onto the bed. Harmony checked me and found that I was 4 cm dilated. What!?? But I was already 2 cm before I ever had a contraction… She suggested that we could go back and labor some more in the comfort of our own home, but there was no way I was going to make that drive two more times – besides, I was sure the baby would still come soon. I wanted to get in the tub for some pain relief, so we filled it and I got in. It helped a bit, but I was getting tired, so we went back to the bed after a while. I used the heating pad on my back since the heat seemed to help. I was able to doze a bit between contractions, but it certainly didn’t feel like long enough! Harmony slept on the couch in the next room, but came in often to check on me and listen to the baby’s heart rate. “Active” labor seemed to kick in sometime before the sun came up. You mean, it gets even more intense?! Yep. No more sleeping. I labored more… lying/sitting/leaning on the bed, on the birth ball, and in the tub some more. I had Harmony check my dilation, but I wasn’t progressing very quickly and it bummed me out. I was getting tired. Sometime that day, our family’s came down to the birthing home. I had wanted everyone there when the baby arrived, but it was taking a long time, so they waited in the next room. Someone heated up one of the quiches I had made. Funny, being allowed to eat in labor was one of the reasons I wanted to give birth outside the hospital, but when I was offered food, I wanted nothing to do with it! I was feeling nauseous. I took a couple little sips of smoothie, and was able to drink small amounts of water, juice, & Emergen C, but that was about it. I vomited a few times. I’m not one to puke very often (I think I had a stomach bug in middle school the last time I remembered doing so, and I avoid doing it at all costs), but in this case it actually felt kind of nice – a bit of a distraction I suppose.

I had no sense of time throughout all of this, but I know it got dark again. I was checked and was still only 6-7 cm and had been that way for a while, despite regular contractions and all the positions I’d been in. Baby’s heart rate was great though. Joe and Harmony had been doing their best to help me be comfortable as possible. Joe pushed on my back and Harmony massaged my legs and feet. Harmony had also been giving me homeopathic medicines and herbs, to ease my back labor and to help make the contractions more effective. I remember her asking me if I wanted something that would help me rest/sleep or something to help the contractions get stronger. “Neither” and then “Both” was my response. I was a bit delirious and didn’t know what I wanted, except that I wanted to be done and have the baby out already. Around 8pm, I told Harmony she could break my water. We had hopes that it would get things going, as I was becoming quite exhausted. The last real food I had eaten was that soup & salad over 24 hours earlier.

When my water broke, there was a big gush of fluid that came out. It was all clear and the baby’s heart rate was great. My contractions felt much stronger at this point and sometimes felt like they were coming on top of each other. I felt cheated at those times because I didn’t get my “break” I was promised in between! I spent a lot of time in the tub, trying to relax, and moaning through the contractions. I think we thought I may be in transition, as our birth assistant, Jodi showed up. She sat calmly in the corner taking notes and smiling, taking pictures here & there.

When checked again, we found I had gotten to about 8cm, but was still dilating slowly which made me quite discouraged. I got out of the tub and bounced and rocked my hips on the birth ball hoping I could shake the baby down. I also tried squatting while hanging on the end of the bed.

Joe was with me most of the time, but left the room a few times to pee, eat, visit family, and/or nap. I was grateful that he was being so wonderful and supportive when he was with me, but when I knew he wasn’t with me, I was angry that he didn’t have to go through everything I was going through. I was jealous that he was getting a break and I wasn’t. At one point when it was just Harmony and I in the room, she said that maybe I just needed to spend some time alone with my body and figure out what I needed and she left the room. I was alone. I thought she was crazy for telling me that and I was still mad that I had to do this all by myself. I felt that I needed someone there to tell me exactly what I needed to do to make this work.

Sometime in the wee hours of the morning Harmony offered some IV fluids to try and get my energy up. Someone suggested I try walking for a bit, so I donned a hospital type gown (since I had family in the waiting room and until then hadn’t had any clothing on since I arrived). My mom and sister helped me (and my IV pole) walk down the hallway and back a couple of times. I wanted to lie down on the floor every time a contraction came, but they kept me upright. I also tried sitting on the toilet a couple times, but that felt awful! When the IV bag was empty, I was able to get rid of the pole. But then, they wanted me to climb the stairs! Ugh. I was willing to do anything though, knowing that it may help get the baby out. The stairs were as bad as I had imagined. I wanted to quit, but they helped me along. I made it to the top though, and stopped for a couple contractions, and then back down. I remember feeling a bit self-conscious through all this because of everyone who was waiting there for baby and hearing me moaning and whining, and I knew I was probably waking those who were trying to sleep. I was wishing I had stayed home, but I was really too tired at this point to care. (I did finally make peace with those stairs that I once cursed, painting a mural on that wall when my daughter was just a few months old – hoping to make the trip up & down a little nicer for any mamas who would be following in my footsteps!)

Back downstairs, I was able to fall onto the bed again. Harmony checked me and I was hopeful, but I was still just at 8cm. I started feeling like I’d be too tired to push even if I was fully dilated. My water had been broken almost 10 hours now. We started to talk about the possibility of going to the hospital. The plan would be to get some Pitocin to help with the contractions and an epidural to help me relax and finish dilating, and to help me rest before it came time to push. We thought we would be treated a little better and get what we wanted if we didn’t push it by waiting too long after my water broke, so the sooner we could go, the better. Harmony called ahead to find out who the on-call doctor was supposed to be that day, and it was someone she was comfortable with, so we decided to head over to the hospital. I honestly don’t remember much of the conversation or decision-making that lead us there, but I trusted that everyone was looking out for what was best for me. Luckily, it was a short drive, because riding in the car during contractions was no fun at all.

We arrived at Sarasota Memorial Hospital around 6am on Sunday, November 25th. I rode in a wheelchair up to labor & delivery. I felt like everyone was looking at me, pitying me, and talking about me. Honestly though, I’m sure I looked a mess! I had been in & out of the tub a dozen times and I hadn’t seen a mirror in days. Soon, I was placed in a little room. I could only have a few people with me, and Harmony had a call that another mom was in labor, so I told her to go – I would have Joe and some family members be with me when I gave birth.

Being in the hospital was SO much different than where I had just come from. Everyone was in a hurry. Sweet Harmony was able to painlessly slide an IV needle in me on her first try when she needed to. It took the hospital nurses (3 of them) numerous tries at jabbing me before they got it right. Then they finished strapping me up, with a blood pressure cuff and two monitors across my belly – one for me and one for baby. Every time I had a contraction, I needed to sit up to deal with the feeling, but every time I did that, the straps on my belly would move and they would come running and telling me to lay still. It was crazy. I had piles of papers I was supposed to be reading and signing… I got the signing down. They wheeled in a TV so I could watch a video about epidurals. I felt like an inconvenience to them. I can’t imagine going through an entire labor like that. Luckily, baby and I were both doing great. Even though, they started intravenous antibiotics because my water had been broken for a while. Now we just had to wait to see the on call OB.

Pretty soon, a nurse comes in and tells us that the Dr. (who we have not even seen yet) recommends a C-section, so they will begin to prep me for it. WHAT?! It seemed like a joke, and I’m pretty sure I laughed at the preposterousness of it all! When we realized she was serious, we told her we wanted to see the doctor himself, so she left. (By the way, the doctor who was supposed to be on call wasn’t there that day, so this other doctor happened to filling in for him.) Joe talks to Harmony on the phone, who is as shocked as us, and she tells us we can request a second opinion.

Finally, he came in. He told us, “All we ever get is problems” from the birthing home, or something along those lines. That should have been a warning. He seemed to be out for revenge against anyone wishing to give birth outside the hospital. He looked at me like I was someone who had come in off the street having no prenatal care. Though, I’m positive that the care I had received from my midwife was far superior to anything his clients had ever gotten. Anyway, we discuss his decision to do a cesarean. He says that because I hadn’t fully dilated yet, that I would not dilate, period. I disagreed. Then, he asks me why I haven’t followed the “1cm per hour” nonsense. I had read enough to know that most births don’t follow that logic, but since I was still strapped down to a bed laboring without any pain meds, I just responded with “Some people are just slower than others”. To which he replied, “Physically or mentally?” Wow. Honestly, that wasn’t the worst of his condescending remarks, but I’m going to try not to go into just how obnoxious he was. He makes it clear that we either go with a section, or we are "refusing care" and we can leave the hospital. We tell him we'd like a 2nd opinion. He tells us he is the only opinion available. After more arguing, he leaves.

We were shocked. We looked at our nurse, who seemed embarrassed, and only said, “I can’t say anything.” Nice. We contemplated leaving the hospital and going to another, but decided against it, figuring at that point that we’d probably get similar treatment elsewhere. Finally, he comes back in. He says he'd talked to the head of obstetrics as a second opinion and that he’d like to compromise. He says we can do an ultrasound, and if it looks like the baby it "too big" for me to deliver vaginally, we'd do a C-section. If not, we'd get to try the Pitocin. This sounded fair, so we agreed. After all, my petite mother birthed me at 9lb 10oz & Joe was over 9lbs as well. I was prepared for a decent size baby. The ultrasound tech came in and looked at the baby, did some measurements, and left again. Then, the Dr. came back in. He said the baby was 8lbs 14oz. I felt like celebrating! The baby wasn’t BIG after all – she’s even under 9lbs. Unfortunately, the Dr. has a different opinion. He tells us that the baby is definitely too big (something about it being in the 90th percentile for her weight at 41wks. gestation...blah blah blah). He says she is "macrosomic" (which I later find out describes a baby over 8lbs 13oz). I ask again to please just try the Pitocin and see what happens. He says even if I fully dilate and we "blow the baby's head out", there is always the risk of the shoulders getting stuck, and in that case we'd only have 4 mins. to do an emergency C-section, and why would I want to risk my baby's life to make me feel better?!! I wanted to ask him if he hasn’t ever heard of the Gaskin Maneuver for shoulder dystocia, but I was too overwhelmed by what was happening, and figured it wouldn’t help anyway. He was such a bully. I asked him to check me one more time, though I was feeling so stressed at this point that I think my contractions had spaced out a little bit. He checked and said that I was only 6-7cm now, and that my cervix was swollen and the baby would never come out that way. I’m pretty sure he said “Told ya so” to my husband at this point. Deep down I feel he is wrong, but we give in and proceed with the C-section. It was good to know at least, that I’d finally be meeting my baby girl within the hour.

There was no waste of time now. Around 10:30am, they wheeled me in and prepped me for surgery. I couldn’t believe this was really happening. It was so surreal. They gave me a spinal block which felt amazing at that point in labor. I got cold and tingly & then numb all over. It made me want to sleep. Then they put in a catheter. They lay me down and moved me onto the surgery table and put a big sheet in front of my face. I heard the nurses all running around getting things ready, talking to each other, but not to me. One of the nurses asked another what kind of “dressing” this doctor uses. I thought, “Well that’s lovely. They’re ordering the doctor a nice salad. It’s almost lunch time, after all.”, though I felt so unimportant at that point, that I wasn’t in the least surprised. Only later, while reading an online ICAN (International Cesarean Awareness Network) message board, did I realize the “dressing” the nurse was talking about had to with the bandages that the Dr. uses after surgery. Ha! I suppose that knowledge made me feel a little better.

Joe came in and sat by my head. I still hadn't really slept in over 40hrs, so I nodded off a couple times, and Joe would shake me to wake up. I was supposed to be numb from the waist down, but I had a hard time even feeling my arms, and my face was tingly. It seemed like there were a million people in the room walking around doing things. I felt so distanced from the “birth” of my child that was happening that I may as well have been in another room. I could feel my body being jerked back and forth until they said the baby was here. They held her above my head quickly before taking her to weigh, clean & wrap her up like a burrito. Then, they brought her over one more time for me to catch a glimpse before they took her and my husband off to the nursery. I don’t really remember seeing her, but I remember hearing her cry.

Next, they took me to "recovery" for an hour where they monitored me and I waited to feel my legs again. I was in and out of sleep. A nurse sat quietly in there with me, taking my temperature, and asking me to wiggle my fingers and toes. I had a hard time believing that I had just had a baby. My belly was quite bloated from gases and felt bubbly like a baby was still moving in there. It was a strange state to be in.

Eventually, they take me to my room where I'm reunited with Joe and my new daughter! I remember unwrapping her from that silliness and holding her skin-to-skin on my chest. Finally.

They had a lot of drugs in me, so the next couple days were pretty blurry. As soon as I could, I tried nursing that darling girl, and she tried latching on, but I had been pumped so full of IV fluids that I was all puffy and my nipples were flat. She couldn’t get them in her mouth. The nurses, and lactation consultant too (when she finally came to my room hours later) tried mashing the baby’s mouth and my breast together, thinking that would help. It just made me more nervous and made her cry. And cry. And cry. They told me she was hungry and they wanted to give her formula. I refused. Then they wanted to put a drop of formula on my nipple so she would know that was where the food came from. Seriously?! That seemed ridiculous. Again, I refused. So, they told me I needed to pump and bottle-feed her. So, they wheeled in the pumps and I hobbled to the chair squeezing out every drop of colostrum I could to give her. She would drink it up, and then I would try and give her the breast afterward. It was quite an ordeal. Harmony came to see me and it was so nice to see a friendly face. She assured me the nursing was going to get easier at home and I didn’t really need to rent all the pumps to take home like they wanted me to.

The OB came to see us the next day. He was all smiles and cocky, and I think he expected me to thank him for saving me. He told me it was a good thing he did the cesarean because she was so big. It took a lot to not burst into tears. I only replied, “She is long & skinny”.

It seemed like nurses were in the room every 15 minutes needing to do something to me or her. It was impossible to get any rest. If I did fall asleep, I’d have to wake as soon as I’d hear them coming or I’d get yelled at again for falling asleep with the baby on my chest. They’d offer to take her off to the nursery, but there was no way I was letting her go again. Luckily, Joe was able to sleep on the chair next to me the first two nights, but on the third night, L&D was busy and I had a roommate. This meant my husband had to leave, and baby & I were on our own that night. The nurses tried to make cheerful conversation with me while checking my incisions, like, “Now you can schedule your next baby just like a hair appointment!” What?! “I’m not doing this ever again” I tell her, and for the first time, I think about what having a cesarean means to my future baby plans. “Well, I think there is one doctor who does VBACs… “ she replies.

I was so happy when we finally went home the next day. It was a big adjustment for baby though. She cried the entire first night, and it was a rough start. Once we had the peace and quiet of our own bed though, nursing started to become easier, and I felt like I could finally begin bonding with my daughter. I felt guilty for not being with her at the very beginning of her life like I should have. I still couldn’t look at the pictures or the videos of her crying right after birth, or of her in the nursery getting her first bath and first diaper. Now, I could at least spend all day in bed with her, just staring at her and nursing her. Moving (and laughing and coughing) was still pretty painful after surgery, but slowly I was able to get around again.

Unfortunately, we would go to the hospital one more time. A couple days after we were home, my incision began leaking clear fluid and blood. I called the birthing home and was told that I could just tape it up again. I tried that and went to bed, but it opened up again the next day and I bled all over the couch. It was a weekend and we were scared, so we went to the emergency room (at a different, closer hospital). The doctor there didn’t comment much on it, as if it was a fairly normal thing to happen. He just took all the existing tape off and redid it. He said we could go back to our doctor on Monday and have it checked out. So, we did.

I never wanted to see that doctor again, but we went to his office to have the incision checked out. I felt bad for the pregnant women in his waiting room. I wanted to warn them or tell them to run. He saw us pretty quickly and we kept the small talk to a minimum. He basically told me that there was a lot of fluid behind the incision and it needed to drain out. He said it could continue to drain where it had opened up or he could open it up more to drain it. That all sounded awful. I asked him if my body wouldn’t just absorb the excess fluid. He said no, it wouldn’t. We left without having him do anything, and my body did just that.

We continued our post-partum care with our midwife, Harmony. I admit, I was a bit embarrassed going back to the birthing home for our 2 week appointment after I had “failed” at giving birth to my daughter. She was wonderful and supportive though, and never made me feel at all inadequate. She truly cared, and asked how we were doing after our plans didn’t go as we’d hoped. I told her what I though was expected of me, that we were so happy that our daughter was beautiful, happy, and healthy, and that was all that mattered. I remember her looking at me, serious and loving, and telling me that it was fabulous that our daughter was wonderful, but that was not ALL that mattered. My experience mattered too. It was good to hear that. Before that, I felt selfish and wrong for thinking of myself, for feeling sad and cheated, while holding such a perfect child. “A healthy baby is all that matters” was what everyone always says, and that is what people had told me to “comfort” me. And it really was true that our daughter’s health was our utmost concern, and I would totally have done it all over again if I had to.

Harmony referred me to the International Cesarean Awareness Network, where I was able to read online about others with similar experiences. It was comforting to know I wasn’t the only one. When we hear about some celebrities scheduling all their births by cesarean, it’s hard to imagine that someone else may be grieving the loss of their own birth experience due to a cesarean. I explained it to someone to imagine they spent 9 months fantasizing about what it would be like when they lost their virginity, and then when the time came, they were raped by someone else. That’s how I was feeling. I guess it’s all about your expectations.

Luckily, I was surrounded by many loving and supportive people who gave me the time & space to heal, physically and mentally. It took me some time, but I’m glad I had this experience. It left me wanting to help others, and so thankful for the midwives who are there to hold your hand through the ups and downs of it all. It also had me looking forward to my next birth, and having a new experience.

Labor & Birth of Jasper Jolee Ernst

July 5, 2011, 8:48pm

8lb 6oz ~ 21” long

I know that every labor & birth is different from the next, and everyone would remind me of this as I prepared for the birth of my second born. Since I was planning a VBAC (Vaginal Birth After Cesarean) this time, part of me figured people were just being nice & encouraging. I knew that this birth would be different – I was hoping for a shorter labor and a vaginal birth, or course, but my two pregnancies had been so similar so far that I figured my labor would have a lot of similarities too. I imagined I’d go into labor about a week after my due date and thought that I’d probably labor for quite some time before my water broke, if it did break before the baby came. That said, the way this labor began really threw me off.

I prepared for this birth differently than I had my last. I worked hard to let go of the negativity surrounding my last birth experience so that I wouldn’t bring it with me into this pregnancy. The past was just that. I surrounded myself with only positive, supportive people. I didn’t openly tell people of my VBAC/homebirth plans unless directly asked. I wanted to avoid any confrontation & I wanted privacy. My baby did too, so no peeking at the gender prior to birth. And my body needed to be left alone to do what only it knew how to do. I trusted my body this time. This would be my “selfish” birth, and I was looking forward it.

The end of this pregnancy did feel slightly different than my last one. I was more tired, and felt a lot more pressure on my cervix. I assumed it was just a 2nd pregnancy (and having a 3 year old already) thing. I was hopeful though that the pressure on my cervix was working to dilate it in advance, but I didn’t want it to be checked – I knew that would either get my hopes or disappoint me… and knowing that cervical dilation doesn’t mean a whole lot (you can be at 3cm for weeks or go straight to 10cm in an hour!), so I just opted out.

I decided that Mon, July 4th would be my last day working out of the house. I figured the rest of the week I’d spend at home nesting, shopping, and baking. I’d do a belly cast, and maybe I’d even start napping! My husband, daughter, & I went to see the fireworks together that evening. As we sat there waiting for the explosions in the sky and lighting sparklers, I wondered how many more times we’d be out, just the three of us. We talked about our plans to go out for our 11 year anniversary the following Friday – our last time out, we imagined. Little did we know that in 24 hours, we’d be holding our baby!

It had been a long day and a late night for us, and we all went right to bed when we got home. Kalina (our 3 ½ year old daughter) woke up twice that night which was unusual for her… at 2:30 & again at 3:30. She called my name and then went right back to sleep when I went in her room and put my hand on her back. Then, I woke up again at 4am when I felt like I had peed a little. I thought it was strange, but considering I was already getting up to pee like 5 times a night, anything was possible! I realized I was leaking a little more after I peed. I tried to ignore the thoughts that maybe my membranes had ruptured, and tried to go to sleep again. But, the leaking didn’t stop. I grabbed my phone and went to the bathroom to grab a towel and sat on the toilet again. A million thoughts were rushing through my head – mainly that this was the “wrong” way to start labor, since I wasn’t having contractions yet. I was nervous, excited, & scared. I was shaking when I texted my midwife, Harmony, and then I waited. She called me in a few minutes. Her voice was very calming. She congratulated me on my “birth” day, told me to get some rest, and we’d be in touch.

I texted my doula, my friend who would be watching Kalina, and my birth photographer to give them a heads up, even though I had no idea what was happening. I lay back down, but couldn’t relax. I wondered why my membranes had ruptured, but labor hadn’t started – did I not drink enough pregnancy tea? Or maybe I used too much evening primrose oil? I put my Hypnobabies cd on my headphones – it always seemed to put me to sleep in the past! Not this time… I was still worrying. I knew that I was now on “the clock” – which could mean a hospital transfer eventually if contractions didn’t kick in. I felt confused. My 40 wk appointment was supposed to be the following morning. At my last visit, the baby had turned posterior. I had been working to turn baby back, but wasn’t positive that it had happened yet. And now that my water was broken, I was concerned that the baby may not be able to get in the optimal position… I believe head position was one factor that kept our daughter Kalina from descending into the birth canal. I occasionally felt a contraction, but nothing strong or regular, and I wasn’t sure if it was a “real” one or not. I finally woke my husband since I wasn’t sleeping to let him know what was going on. He’d be getting up for work soon anyway, and I wasn’t sure I wanted him an hour away just in case things kicked in fast & hard. He decided to call into work and stay near. Around 6:30am, our daughter woke and climbed into our bed. She snuggled up close to me and I was finally able to go back to sleep! I woke up again around 8:30am (and she slept til 10am! Must have known it was going to be a long day…).

I spoke to Harmony again. Since I was having occasional contractions, she suggested that I could just wait and see if they pick up, or I could go get some acupuncture which generally helps to get things going. I called Deanine and she said she could get me in for acupuncture at 1pm. I had Joe bring me a big breakfast and decided to get some important things taken care of – I washed my hair, shaved my legs, trimmed my nails & painted my toes! Ha! I knew these things wouldn’t be priorities again for a while.

Then, I did some rocking on my hands and knees to get baby in the perfect position, and I sat on my birth ball for a bit, reading my birth affirmations & looking at all the beautiful beads I was given on my birth table that I’d set up in the bathroom. The birth art I did of a labyrinth reminded me of an Indian birth ritual I’d read about in The Labyrinth of Birth, where the women in early labor would draw a labyrinth in saffron on a metal plate, and then rinse it off and drink the water. The idea was that drinking the labyrinth helped the body to know the path and they also believed it would ease labor pains. I figured it couldn’t hurt, so I drew my labyrinth on a plate covered in Emergen-C, rinsed it off & drank it down. The image of a labyrinth is very symbolic to birth and used in many cultures. When you first enter a labyrinth (labor), you seem to be heading straight to the center (the goal, the baby), but the labyrinth twists and turns and takes you away from the center and back a few times before you actually get there. There are no wrong turns or dead ends. You just have to keep going, and know that you are headed in the right direction, one step at a time, even though it sometimes seems you’re going backwards. This was something I wanted to keep in mind for my labor this time, as I thought it would have helped me mentally get through my first labor.

I went downstairs and made a strong batch of red raspberry leaf tea, brought it back to bed with me and decided to rest for a bit. I talked to the baby, prayed, tried to release any fears I had that were holding me back and then dozed for a little bit.

Joe woke me and it was time to head down to Deanine’s. As I was moving around getting ready and going up & down the stairs I realized the contractions I was having were getting a bit stronger. I wondered if maybe I should just stay home and keep moving, but didn’t want to miss my appointment if I ended up needing it later. I grabbed a banana, piece of cheese & a hard-boiled egg as we ran out the door – glad I did as it would be the last thing I ate before meeting my baby! The ride down there wasn’t comfortable. Every time we hit a bump, I’d have a contraction (and yell at Joe!), though I could still talk through them. I spoke to Harmony again and she said she’d meet us down there and check on me when finished with my acupuncture session.

When I finally lay down on Deanine’s table, we realized the contractions were coming about 5 minutes apart. They still weren’t really strong, but I wanted to sit up with each one to feel more comfortable. She decided not to pin me down with needles since I was needing to move, and instead she massaged all my pressure points to make the contractions work more efficiently. It was really great because Joe was there and she was able to show him where on my hand to rub, and how to press on my back to relieve some pressure, along with mixing up some smell-good, relaxing massage oil for us to take home. Her magic was working and contractions were getting intense. I was getting scared of having to drive the 30 mins back home, so we told Harmony to hurry over which she did. She listened to me and to the baby and everything seemed perfect. She told us to head back home and to call her when we needed her. I ran out the back door in a borrowed robe, and a pillow & blanket for the back seat – trying to make it to the truck before another contraction knocked me over.

The ride home was a long one. I stretched out in the back, trying to be as comfortable as possible, moaning through each contraction. With every turn and bump, I tried to picture where we were – hoping we were close! When we got home, I bolted for the door. I ran like a wild woman past Kalina and my friend who were trying to greet me inside the door. I only made it a couple steps up the stairs before I was brought to my knees. As soon as that contraction passed, I hurried upstairs and dove into bed where I cozied up to some big pillows with my hypnobirthing cd again.

Soon, I noticed my doula had arrived. She and Joe rolled in a couple of birth balls and suggested some positions I could try. I made a trip to the bathroom and then tried sitting on a ball. First was too soft, next was too hard…not easy getting comfortable in labor. I finally found a combination of bed/pillows/ball that worked for me. The two of them were great support during labor, rubbing my back and verbally helping me get through.

I decided water would feel nice, so Joe began filling the birth pool. It did feel good. I have no concept of time at this point, but I labored in there for a while. Contractions were strong, but I was able to completely relax, and occasionally drift off to sleep, between them. I thought maybe I had to poop at one point, so got out to sit on the toilet, but couldn’t sit there long enough to do anything – a contraction came on and I was on the floor! Then back into the tub where I got a little relief. At some point I started feeling more pressure, and it felt good to bear down a bit at the end of a contraction.

My midwife Harmony arrived around 5:30pm (or so I’m told!) along with her birth assistant and our photographer. They all slid in silently, and I’d occasionally open my eyes from my dreamy world of labor and catch glimpses of them. Contractions continued washing over me like waves. I really looked forward to the rest time in between. When they came closer together without giving me a break, I felt angry and cheated - I had whole conversations going on inside my head, though I didn’t manage to get many words out! I felt nauseous off & on and would ask for a bowl, but I never did vomit. Joe joined me in the pool so I could lean against him. The contractions were changing – they’d start out feeling like the contractions I’d been having, but then my body would take over and began pushing down on its own. This went on for long time. My sacrum and hips were so sore. I could tell the baby was moving down.

Joe tried pushing on my back, and I hoped it would help, but it didn’t seem to make it better. I continued this crazy pushing… on one side, and then the next. I kept thinking that I wanted to get into a squatting position to make things happen faster, but couldn’t fathom a way to make that comfortable, so I continued with what I was doing.

My doula would occasionally remind, me with her own sounds, to keep my moans low when I would begin to get high-pitched. It was helpful. I tried to remember to keep my face and hands relaxed too. She held my ice water for me and gave me sips with a straw between the hard work of pushing.

Eventually I reached in and felt a fuzzy little baby head. It was just a few inches in, but seemed so far away still – considering that I was pushing and pushing, and it wasn’t out yet! It was encouraging though, even if I didn’t let on to anyone outside my head, so I continued. I was a bit worried that I was pushing “wrong” though, since I felt like I may push the baby out my butt! That’s what my body was doing though, so I kept at it. My support team was so encouraging. I was feeling tired, sad, & whiney. I would look up at them hoping someone would feel sorry for me (and maybe let me quit?!) and they would just smile and tell me how great I was doing, and how my baby would be here so soon. At one point, I looked at all the women in the room – all of whom had children and two of them who were pregnant again. I questioned their desire to ever do this again. They all said they’d do it again without hesitation. I told them they were crazy…

I decided to check on where the head was during a contraction, and was surprised at how close it was – just a fingertip inside. Of course, after the contraction, it would slide right back. After being at quite a few births as a birth assistant, I knew that this was completely normal, and that it was a good thing – letting your body stretch, blah, blah… but it’s so different being on the other side of it! I felt like I was doing the same thing over and over again. Soon, the baby was beginning to spread me open during a contraction. I had Joe reach down to feel his baby’s head. By his surprised reaction, it seemed like he thought I had been making all this fuss over nothing! He was excited to know we were so close though. And then… it would slide back in. This kept up until we could feel more & more head. I was feeling the burn of my perineum & labia stretching for the baby’s head. “Ring of Fire” is right! My body was still pushing on its own, and I’m lucky it was, because I had no desire to continue! I just couldn’t fathom that it could stretch even more – it felt so tight! I kept my hand down there to make sure I wasn’t splitting in half. This whole time, the Hypnobabies “pushing time” script cd was playing in the room, talking about letting my baby gently “slide” down the birth canal… ha! Part of me was laughing at and cursing the words I was hearing and the other part of me was really wishing that I had actually done the Hypnobabies practice – and not just fallen asleep to the cds at night, hoping it would still be effective! It was good to have something positive to focus on though, so I let it be. I wasn’t sure I could handle a quiet room. I thought about putting Pandora on, and then I thought I’d like the ocean waves sounds cd that was in Kalina’s room, but I couldn’t put enough words together to say any of this. I really just wanted to enjoy the time between contractions and not talk. Pretty soon, a contraction ended and the baby’s head didn’t go back in! I was excited, but it stung so! I complained to Joe that maybe if I had done the perineal massage like I was supposed to, that the baby would be out by now. Who knows if that was true!

Kalina & my friend had been peeking into the bathroom off & on for a while. I had been worried that my noises would scare her, and told them I didn’t want her in until the baby’s head was actually on the way out, so at this point they called them in. She was so calm and excited about meeting the baby. She came over and gave us hugs and kisses and greeted everyone in the room. We told her she could touch the baby’s head and she did. Harmony held a flashlight under the water so she could see. It was so cool that she was able to touch her new sibling before we even knew if it would be a brother or a sister!

I was leaning back against Joe, feeling more & more baby head on the outside. In a couple of contractions, the head was out! I could feel the baby moving between my legs under the water - on the outside for the first time – it was thrilling! I knew the shoulders would be born with the next contraction. I waited, a bit worried that pushing the shoulders out would either hurt the baby or hurt me, and was trying to picture which way the shoulders were supposed to turn to come out. When the next contraction came, my body pushed and she slid right out! I reached down to grab her, while Harmony untangled the cord that was wrapped around her body. I picked her up out of the water, amazed, and feeling SO much better! You could hardly see her blue skin under all the thick white vernix that covered her! She was quite alert with her eyes wide open and her arms & legs flexed. I rubbed her back and talked to her, still in amazement. She began to pink up and make a couple little sounds, but no crying. She just took it all in. Someone finally asked about the sex, so I took a little peek. It’s a GIRL! Just as I thought. Kalina’s sister had arrived! I kissed her forehead and my lips got coated with vernix – best chapstick around, I suppose! I offered her my breast and she latched right on like she’d done this before. She had a cone head from molding in the birth canal (thank God she did!) and her right eye looked a bit swollen and squished, but she was the most beautiful thing. I could feel all those love hormones flooding my body. I asked the time she’d been born, and was told 8:48pm – she waited till sunset to make her grand entrance into the world. I had thought that I would probably labor at night while Kalina slept, as many moms tend to do, and then give birth in the morning. But evening turned out to be such a perfect time to have the baby since we’d all get tucked into bed together and get a full nights rest.

Joe got out of the tub and went to phone our families to let them know that she’d been born. As much as we wanted our family to be a part of this, we knew we wanted a much more intimate experience this time, so we kept everything from our estimated due date to the time I went into labor a bit of a mystery. I wanted to fully relax and not feel any pressure if I went past my “due” date, or feel that people were worrying about me if I ended up laboring for a long time again. So, we decided to just let everyone know when the baby had arrived. And that miraculous time had come!

I was starting to feel uncomfortable sitting in the tub, and nursing was causing painful uterine contractions – as it should, helping to release the placenta. I checked to find that the cord was no longer pulsing, so baby had gotten all that she had needed. I wanted Joe to come cut the cord and take the baby so I could work on delivering the placenta. I thought the baby would be upset when unlatched and taken away, but she was quite content, skin to skin with daddy in the rocking chair. I had someone get Kalina’s new baby doll out of the closet. I was hoping she’d adopt this baby and name it “Lucy” so she would stop insisting that we name our new baby that! She liked the new doll, but she was still pretty disappointed that she couldn’t hold the real baby right then.

I tugged the cord a little to see if it would come, and then Harmony tried, but I ended up needing to change positions – I got on my knees and gave it a push to help it come out. I was really not looking forward to pushing anything else, but the placenta was easy like they said. It came out like a blob – yay for no bones! We put the placenta in a bowl and Kalina came in to see it. We had read some books about new babies & home birth, so she knew about the baby’s umbilical cord and what the placenta’s job was in utero. I gave her a little tour of it and showed her the sack that was her sister’s home for 9 months.

I got out of the birth tub and into some clean water in the bath tub to rinse off before I headed to bed. I then got to join my family of 4 in our very own bed to cuddle and bond. Kalina was pretty excited and had to be reminded not to jump around or climb on me. I propped myself up on pillows to nurse the baby. Everyone went downstairs to give us some alone time and to eat some of the yummy food my friend had been busy cooking all day.

When they came back, they brought me a big plate of food. I was so excited – I couldn’t believe how hungry I was! Harmony & Heidi got the things together to do the newborn exam at the end of our bed. Kalina brought her new baby doll over and got to examine her – listened to her with the stethoscope weighed her, etc. I loved how involved Kalina got to be in this experience. It was the same in all my prenatal appointments. She always had a turn to listen to my baby, take my blood pressure, and to have her belly listened to, whenever she came with me. She’s a real pro now!

The lovely Rosemary Birthing Home ladies did baby girl’s exam while Joe & I ate dinner and watched. From the amount of sticky vernix that covered our little girl, her soft ears, and lack of deep lines on her feet, Harmony estimated that she was possibly a younger baby – she could have been a week early, not just a day early like we had thought. Still though, she weighed in at 8lb 6 oz and was 21” long with a 14 1/4 “ head. They looked her over and she was perfect. After having her on the outside, I couldn’t imagine if I had to wait another week to meet her!

Our birth assistant busied herself emptying the birthing pool and doing laundry. When she was done, our bathroom looked better than it had before she came! Harmony accompanied me to the bathroom so I could pee. My peri bottle full of herbs was ready and waiting for me, along with an ice pack and some pads. My friend was downstairs with Kalina, and my mom was on her way over to take over for her so she could head back to her family after a long day. We were given our post-partum instructions and vitals were taken on both the baby & I. Then we were tucked into bed and told to get some rest since this was the longest stretch the baby would sleep for a long time.

Joe passed out before the birth team even left, close to midnight, but I was so in awe of it all, I just laid there and stared at our precious new being for a long time. I did manage to sleep for quite a bit. Every time I woke, I was so grateful to be in my own home, in my own bed this time around. No one coming in disturbing us every hour, or telling us what we should be doing. There were no roommates, and we had our own bathroom and food. It was bliss. It was just our sweet family and our instincts (and our midwife’s instructions) to guide us. This is what made it all worth it. This is what makes me think I could do it again.

September: Infant Mortality Awareness Month

2011-09-21T07:20:00.000-04:00

September is National Infant Mortality Month, but for Orlando midwife Jennie Joseph and her dedicated team, the fight to provide quality prenatal care to all expecting mothers and reduce the high infant mortality rate is a year-round campaign.

“Simply put, our babies are dying!” states Joseph, executive director ofCommonsense Childbirth Inc. and the founder of The JJ Way® Maternity Health Care System, a program that successfully demonstrates reduced levels of infant mortality. “People just don’t realize the impact of infant mortality in our communities.” Joseph’s innovative maternal child health (MCH) program is designed to educate the public, community leaders, and elected officials on te need to reduce infant mortality and the practical steps to achieving that goal.

Joseph, who also operates The Birth Place, a multi-site birthing center , women’s health clinic and midwifery training program in Central Florida, remains committed to eliminating one of this country’s saddest and most preventable medical concerns – the high death rate among African American newborns and babies under the age of one. Statistics show that the infant mortality rate among African-Americans continues to be more than twice the rate among White babies and, according to a new report out just last week, babies in the United States have a higher risk of dying during their first month of life than do babies born in 40 other countries[1].

Medical experts agree that the two most prevalent causes of high infant mortality are premature births before the 37th week of pregnancy, and low birth weight. The Florida infant mortality rate has hovered around 8% for all races and 14% for African American women annually[2]. “These fragile babies are actually a result ,” says Joseph. “The cause is the lack of access to quality maternity healthcare as well as a lack of education and support, particularly for disenfranchised women who face multiple obstacles to finding help.”

A 2007 study[3] conducted at The Birth Place, utilizing The JJ Way® Maternity Health Care System, provided 100 participants with education, support and vital prenatal care. As a result, there were only 4 low birth weight babies born overall and no low birth weight babies to the African American or Hispanic women in the study. While national agencies such as Healthy Start and March of Dimes have led the charge by stressing the need to address this serious issue, Joseph believes that increased community awareness is essential to the campaign to eliminate these disparities. To that end, Commonsense Childbirth and The JJ Way® have developed extensive training and certification programs to increase the number of maternity healthcare providers, doulas, childbirth educators and community agencies willing to tackle this problem.

Additional information including a video can be found at http://commonsensechildbirth.org/jj-way.

Jennie Joseph will be speaking at Bentley’s Cafe (805 Donald Ross Road Juno Beach) at 6:30pm on September 23rd. The event is open to the public. Ms. Joseph will also be holding a Doula Training September 24th and 25th at the Palm Beach Marriott. For more details regarding these events or information about Commonsense Childbirth, The Birth Place or The JJ Way, please contact Kathy Bradley at (321) 213-1112 or emailkathy.ccsmidwifery@gmail.com.

[1] http://www.myhealthnewsdaily.com/newborn-death-rates-1849/

[2] http://www.marchofdimes.com/peristats/pdflib/999/pds_12_all.pdf

[3] Funded by Winter Park Health Foundation, Evaluated by Health Council of East Central Florida

BIRTH STORY: Best Marathon Ever

2011-09-13T09:42:00.002-04:00

(written by Lara Nobles Costa, about the birth of Presley, 04.12.11)

The tale of Presley's birth started on the first day of my 37th week of pregnancy. That morning, I arrived at work at 5AM. Shortly there after, I had a contraction hat stopped me in my tracks. These contractions continued at varying intervals until I went to lunch. And then they ceased. This little game continued for three weeks, contracting all morning and then nothing after lunch.

On April 11th (40 weeks plus 5 days), I went for an appointment with June and Priscilla. I had continued working 50-55 hours a week at a my rather physically demanding job, and I was spent. I was about 2 cm dilated and about 80% effaced, as I had been for about a week. Harmony entered the room towards the end of the appointment and, with all of the wisdom of Solomon, suggested that the stress from my job was keeping my body in a perpetual state of pregnancy. She encouraged me to start my maternity leave immediately. After some serious encouragement from my husband, I acquiesced. As soon as we left, we called our jobs (we both are managers at Publix), explained the situation and told them we would no be returning until well after the baby arrived.

With that burden off of our shoulders, we had lunch with both of our mothers, got haircuts, walked around the mall; all the while I was having contractions every ten minutes. Later that afternoon, we returned home and the contractions stopped…again.

At this point, I was certain I would be the only woman in recorded history to remain pregnant forever. They would write about me in medical journals. Oprah would invite us on her show and give us a free car, possibly a trip to the Bahamas. It wouldn’t be that bad. So we watched a movie and went to bed. Just as I was counting my last proverbial sheep (around 12:20 AM), my water broke. Even though I was still dubious about labor ever starting, I called Harmony to inform her of the goings-on. Knowing that labor could still be hours away, she told me to try to get some sleep. And so I did. For exactly five minutes, and then we were off to the races.

With my contractions moving from every 5 minutes to every 3 minutes seemingly quickly, I walked around our condo for about an hour. Then I remembered something Mlisa had said in one of our childbirth classes. She said the most unbearable thing ever was to be in active labor and have contractions in the car. With this thought piercing my mind, I decided it was time to awaken Mike and call Harmony to tell her we were ready to go to Rosemary. When I called her just before 2AM, I was totally unaware that she was headed to another birth. We arrived at the birth home just after 2:30 at the same time that June did. I found it mildly satisfying that when she saw me, she smiled and said “Oh, you’re definitely in labor!”

When June checked me around 3 o’clock, I was 4 cm dilated and fully effaced. This was the point at which the concept of time became completely lost on me. We walked around for a bit. We got in the tub for a bit and all was well with the world. Then June came in to rain on my parade. By this, I mean she suggested I get out of the tub and try to go to the bathroom and spend two contractions out of he water. So I did, and then hurried my naked self back to the safety of the warm, buoyant water.

Being a long distance runner, I can’t help but relate the experience of childbirth to a marathon. After the first few miles you think “This isn’t so bad. I can do this!” Around mile 13, you realize how fatigued you are becoming, but it’s okay because you’re half way finished. And then, around mile 18, you hit THE WALL (or TRANSITION). For me, this is a place of self-pity and self-doubt. The inevitable “What the hell was I thinking?!?” moment. Luckily, I am all too familiar with this place. I let the fear hold me, but just for a minute, and then I remind myself how strong I am and that I trusted my body. Pain is nothing but misunderstood energy. The final 6.2 miles (pushing) are accomplished through acceptance. That of the task at hand. The race will be finished one way or another, so you might as well embrace the energy and work with it instead of fearing it. With the help of June and Heidi, Mike and I brought Presley into this world at 7:46 AM on April 12th 2011 (6 days “late”). She didn’t cry once.

Sometime after Presley arrived, Harmony called to see how things were progressing. After having just left Mateo’s birth, I’m pretty sure she was ready for a double-header. Since all was well, she went home and (hopefully) got some sleep. Presley was greeted by an environment filled with love and encouragement. Where no one told us how to do what is the most natural and sacred event of all. For this, we are forever grateful.

Seven hours and twenty-six minutes. Best marathon ever.

BIRTH STORY: Surprise!

2011-09-08T07:15:00.002-04:00

(written by Sarah, about the birth of Chandra Rose, born 04.05.11)

I had some mild early labor on April 4, but I also had a high fever, chills, a high pulse, cough, and body aches. Some small contractions, but nothing productive. My midwife, Harmony Miller, and I both suspected it was the flu and she said the fever probably stalled my labor. Later that evening the fever spiked to just under 104. Harmony told me if it got to 105 to head to the ER, but to rest and take cool baths in the meantime to try to bring it down. By bedtime it was back down to 102.

I woke up at 2:15 am with a small twingy cramp. Soon that turned into 35-second long contractions that peaked at 20 seconds. I went to the bathroom, thinking it wasn't going to go much of anywhere because I was still sick. Fever had stalled me once, but with the spike I guess my body decided that it was time to get the baby out where she was safe. The plan was to have her in the tub at Rosemary Birthing Home in Sarasota, but there wasn’t time to get down there. My water broke while I was on the toilet and by 2:45 I was on the bathroom floor, unable to move and unable to keep my voice down because the pain was so intense.

My son J, age 5, had been sleeping in bed with me and my then-fiance Ritesh, as he’d had a cold and wasn’t settling in his own bed. He was screaming right along with me - I woke him up, I guess, and he wasn’t thrilled about that. Our roommate Jess woke up too (heck, I’m surprised half the neighborhood didn’t wake up!) and she came into the bathroom to remind me that I hadn't wanted to have the baby at home. I told her as nicely as I could manage that if she wanted to be born at home, I wasn't about to try to stop her. Ritesh called my mom to get J, then called the midwife and got everything set up, then drew a bath for me.

I got in the tub. Birthing assistant Heidi arrived before Harmony did and she sat with me while Ritesh checked to make sure everything was ready. I remember her asking me how I was doing and thinking that was just about the silliest question I'd ever heard.

Water birth was always the plan, but after Harmony arrived she said the tub in our bathroom wasn’t clean enough. Just as well; the water wasn’t helping me as much as I’d hoped, and it wasn’t really deep enough anyway. Heidi and student midwife Priscilla did sanitize the tub in the hall bathroom, but by the time it was ready she was already close to crowning (I could feel hair when I reached down to check before they had arrived) and if I’d made an attempt to walk to that tub she’d probably have been born in the hallway.

They helped me move to the bed a little after 3:30. I had a big red water bottle that I sipped from between contractions and hugged during them when Ritesh wasn't right there. Scamp, my miniature dachshund, had been banished from the room but his yelping outside the bedroom door was distracting me, so I told them to let him in and just please keep him off the bed. He was surprisingly very good once he was allowed in - he poked his cold little nose up the side of bed to check on me and stayed out of the way from there.

I don’t even know how many pushes it was to get her out - way more than the two pushes it had taken to get J out when he was born. The birth team asked once or twice if I wanted to change from my semi-reclining position, but that was just where I felt most comfortable. I was sick, dizzy and exhausted and I barely had the energy to lean up on my elbows, let alone sit, squat or get on all fours. I felt safest in the position I was in. Her head was out at 3:49, and the rest of her followed at 3:51. She was born covered in vernix, and lots of it, with a full head of long black hair (I had never seen such hair on a newborn!) and big brown eyes. I was surprised to learn that she was born sunny-side up, because I hadn't had even a hint of back labor. All of the contractions had been up front.

Harmony put her on my chest and I hugged and snuggled my sticky, wide-eyed little girl. Someone draped a receiving blanket over her to keep her warm and we just lay there for a bit while the placenta worked its way out. I nursed her and it was probably an hour before Ritesh cut the cord and we got weight and measurements on the baby. She weighed 7 pounds exactly, 21 inches long, with a 13 1/2 inch head. I was honestly surprised that I didn’t tear with her - it felt like I did, but the midwife said there wasn’t even a hint of a tear.

The birth team did clean-up, made sure I ate, and went over some aftercare instructions; they left around 6 or so. We were finally able to get some rest after the excitement of the night. I was woken up around 7 when my sister came to get J's things for school, but after that I went back to sleep. The three of us slept until around noon, a good, long, much-needed rest. Ritesh called into both his jobs once he woke up to announce the baby's arrival and tell them he'd be staying home that day.

My fever and other symptoms didn't go away for two days after her arrival, so Harmony and Carmela told me to head to the ER to get checked out. Turns out I had pneumonia, and a short round of antibiotics got rid of it. A good testament to breastfeeding and the antibodies the baby gets from mom - Chandra didn't even get the slightest hint of illness, despite being quite literally attached to me all the time while I was battling pneumonia.

Author's note: The date on the first photo is wrong; the date resets every time I change the batteries in the camera. Chandra Rose arrived in the wee hours of the morning on April 5, 2011, following a short, very intense labor.

BIRTH STORY: I Will

2011-09-07T08:26:00.000-04:00

(written by Liana Sheintal Bryant, about the birth of Woody, 04.06.11)

While washing my face around 11am, my water broke. I was at home so called Harmony, and with her advice, proceeded with my day and kept her posted of progress. Contractions didn't start for a while, so I practiced yoga, showered, did my hair (wanted it looking good for any labor pics!), did laundry, put on my bikini (one last pregnant belly pic!), and then contractions started around 3:45pm. They became frequent enough by around 7pm to head over to Rosemary Birthing Home. I went with my husband, John, and my mom.

When I got there, I was only 1 cm dilated! The contractions continued to be strong and regular, so we stayed. After some time, we decided to try the tub. It was funny, because at this point, I was still pretty modest and remember asking John whether he thought it was okay to be completely naked while in the tub. Boy, did my modesty soon become a thing of the past! I then ended up spending much time in the bathroom. I felt most comfortable on the toilet and would squat, pressing into my thighs, during contractions (resulting in numb pinkies and ring fingers for a couple weeks later!).

I went back and forth from the bedroom to the bathroom many times. I also would occasionally try going back in the tub. By now, I was completely naked, as I walked from room to room. During the labor, I didn't want to talk, be touched, eat, or drink. I ended up getting an IV for fluids, because I just couldn't drink much. I remember being in pain and thinking it was just too much and saying I needed a break.

Then, oddly, in the midst of active labor, my contractions stopped, so I took a nap. I felt so much better when I woke up. Harmony also showed me the adorable baby that had just been born upstairs by my lovely childbirth classmate. Harmony showed me this sweet boy to remind me what I was working towards! I then got in the tub, but since my contractions still hadn't picked back up yet, Harmony suggested we try things to strengthen my contractions. And, again, I frequented the bathroom often. I remember talking about my options with Harmony. My options were basically to go to the hospital, where I likely would have to get a c-section, or deliver him naturally there. I remember thinking that there was no way I was going through the process of getting dressed, walking out of the birthing home, getting into an ambulance, walking in the hospital, etc... let alone the delivery process! But, I also remember thinking that I didn't think there was any way my baby was coming out of me either!

Harmony suggested I go up the stairs to bring on stronger contractions. She suggested squatting up double stairs. At this point, I was into negotiations, so I suggested squatting up stairs one at a time but in a minute. Deal. So, in a minute, I proceeded to squat up the stairs, completely naked (fortunately we were alone in the birthing home). By the time I got to the top, I had to get to the bathroom. Heidi was still cleaning up the bathroom from the last birth, so I had to wait a second, which felt much longer! I got on the toilet, and very soon, I felt that I didn't have the sensation to go to the bathroom, but rather, that my baby was going to come soon!

Harmony told me that I needed to get on the floor if I thought I was going to deliver, and I knew I was! So, Harmony called John, my mom, and Heidi into the upstairs bathroom. I got on all fours and after two pushes, I believe, he was out! John caught him. It was amazing. I held him. John sang The Beatles song, I Will, to our boy, Woody. My mom watched. I was then pleasantly surprised that moments later, Harmony was able to lightly pull on the cord, and the placenta gently came out. What a relief! A little later, John cut the cord. I showered. We then enjoyed resting on the bed all together.

Author's note: This is the first time I've written out my full birth story. And, I write it now with Woody asleep on my lap, on his 5 month birthday. I love him so much. My 27-hour labor story, relayed above, was the best experience of my life. I am so grateful for the amazing support I had that day.

BIRTH STORY: Certified Organic Baby

2011-07-26T21:09:00.003-04:00

(written by Tanya Hackney, about the birth of Rachel, 05.02.11)

Rachel is two weeks old today, and the most pleasant baby we’ve had. I don’t know how much truth there is to the theory that the kind of birth experience a baby has affects his or her personality for life (it certainly affects the mother's willingness to have more children), but Rachel would support the theory that the more peaceful the birth, the more peaceful the baby. Of course, it doesn’t hurt that we’ve done this four times before, and we’re more relaxed. I am certain that the mother’s feelings during pregnancy and after birth are reflected in the baby’s disposition. All I can say about that is, “Poor Eli.” No wonder our first kid is so keyed-up.

The previous four children were born without drugs and with minimal intervention, under the care of a midwife, but in a hospital setting. There is a time and place for medical attention, for medication, and for “meddling.” Natural, uncomplicated birth is not it. It took me a few babies to realize I do not need to be in a hospital, just relatively near one in case of emergency. I have a history of late babies and long, slow labors. Once I figured out that it takes my body a really long time to prepare itself for the last phase of labor, I just stayed at home until it was time, or, in a couple of cases, allowed the midwife to start an induction using Cervidil (to ripen the cervix), but I never actually needed a Pitocin (IV) induction. I’ve also condoned various interventions to speed things up: stripping membranes, breaking my water, enemas—you name it and we’ve tried it. But I’ve never had an epidural (no needles in my spine, thank you very much) and don’t mind suffering a little to bring a child into the world. In fact, I would say that the suffering is proportionate to the elation one feels afterward.

But this time, I wanted something different. Having a baby in the hospital is like going to McDonald’s at lunch time. A hospital is a place of busy-ness—people running around in scrubs, officiously doing their duties and following protocols. The L&D room is needed for the next customer, so taking 24 hours to have a baby makes one a nuisance. Also, the nurses are used to 90% of women wanting to be drugged immediately, and then they rest comfortably hooked up to a monitor that can be seen remotely at the nurse’s station down the hall. These moms require very little. The mom going natural is always asking for things or refusing things, and some nurses feel rather put out. And when it’s time to actually have the baby, the busy-ness increases: a team of strangers in green swarm into your room and turn on bright lights and start unpacking mysterious packages. The end of the bed breaks away and when that wee thing comes into the world, it is a shock of lights, noise and air conditioning. They are whisked away to a corner of the room to be poked and cleaned and checked. No wonder they scream their little heads off.

As we have gotten more organic and natural in everything we do, it makes sense that this assembly-line approach to birthing babies would become less acceptable to me. When I found Rosemary Birthing Home (www.rosemarybirthing.com) in Sarasota, I knew that aside from having a birth on the boat with an island midwife—we’re not quite there yet—this would be the best option for a peaceful, natural birth for our fifth child. I mean, my midwife’s name is Harmony for heaven’s sake! We were right. There was no rush, no sense that we were a burden, no unnecessary meddling. Instead of McDonald’s at lunch time, it was like going to a friend’s for a home-cooked dinner and staying to open another bottle of wine. The birth was no shorter than normal, but aside from my water having broken (which starts a 24-hour intervention clock ticking) the experience was so much more relaxing. Labor in the courtyard, in the tub, in the shower, in the rocking chair, in the kitchen, in the garden, on the boardwalk along Sarasota Bay—no one was telling me what to do or how to do it. Not that we didn’t try to speed things up a bit—I went to the acupuncturist, tried herbs and homeopathy, even drank a Castor oil smoothie. The difference for Jay was marked, too. He hates hospitals, and was a little wigged out after Sarah's arrival (at 9 1/2 lbs. she was hard to get out). He bowed out of Sam’s arrival, leaving it to a team of girlfriends instead. But he was more comfortable in the homey atmosphere at Rosemary and was on hand when Rachel arrived, just outside the door. Even Sarah, at seven, felt comfortable and was there to see her sister’s birth.

In the end, Harmony gave me the extra time I needed to have the kind of birth I wanted to have (we were close to having to transfer to Sarasota Memorial), and when Rachel finally decided to show up, she came fast. So fast, in fact, that I didn’t even make it to the birthing tub and had her in the shower, where I had been laboring for the pain relief of pressurized hot water. When I picked her up for the first time, she wasn’t crying. She was quiet and alert, looking around and wondering where she was. We spent the first couple of hours of her life just looking at each other, holding her in the warm water of my (undefiled) birthing tub, nursing, and generally basking in the post-childbirth glow. (Man, those hormones are like a really good drug.) We had Rachel the night of May 2nd, and at midnight, we broke out the chocolate cake and candles and celebrated Sarah’s 7th birthday on May 3rd!

I had plenty of time to rest and recover (Harmony herself made my breakfast the next morning after Jay had gone with Sarah to pick up the boys) before heading out to my mother-in-law’s. It was, aside from the part of childbirth I’m already forgetting about, a totally pleasant experience. I will never have another McBaby again (if I have another at all). I never cease to feel amazed at the miracle of new life—thanks be to God for answering all our prayers for a smooth delivery and a healthy baby!

Ina May Gaskin on The Diane Rehm Show

2011-07-26T21:02:00.005-04:00

Ina May Gaskin, America's most prominent midwife and founder of The Safe Motherhood Quilt Project, was a guest on NPR's The Diane Rehm Show this past Monday. When telling the story of how she evolved into her calling, despite the increased medicalization of birth, she told the host:

"I knew that everything could be born on the farm and I thought, there's a lot of species of mammals and only the human doesn't work? I mean, that was just hard for me to accept."

Listen to a complete podcast or read a partial transcript here.

Reposting: BIRTH STORY: The Beginning

2011-06-29T15:54:00.001-04:00

(written by Laura Gilkey, about the birth of Michael Banyan, 06.29.04)

Last journal entry before the birth

Tuesday, June 29, 2004, 3:30 pm

Able to relax on the couch...learning how to breathe and moan through the contractions really well...I just wanted to thank you again for such a beautiful, wonderful, comfortable pregnancy. I will always cherish this time of my life when I was able to hold you inside my soul. Papa is being so wonderful! He's inflated our birth pool and he's making our bed and getting everything ready. He's just as excited as I am!

Soon...Love, Mama

P.S. 4:25 pm: I LOVE THAT IT'S RAINING SO HARD!

First journal entry after the birth

You are the most beauty I have ever seen in all my life. You have changed me forever and I am so thankful to you and for you that it SPILLS out of my heart. Here is the story of your arrival into this world.

As I last wrote on the day of your birth, the rain was coming down in hard, white cascades all around our house, washing over us with each contraction. Papa and I started to watch a movie after he finished getting everything ready...which, by the way, he did a great job of...we joked about it looking like the movie E.T. with all the plastic dropcloths everywhere! We didn't make it through the movie, but it was a nice diversion as we rested between contractions.

I started to need to get up and move around during the contractions, and that seemed to help a lot...it was Papa's idea, and he walked right behind me the whole time, doing laps around the house with his hand rubbing my back. He fed me a raspberry yogurt to keep my energy up and I drank lots of herbal tea and water. When the contractions were very hard for me, I got in the bathtub a couple of times to take the edge off...that was very nice.

It is so surreal to me, thinking back to how I thought it would be and remembering how it actually was. For example, I thought I would certainly want music, and we even turned on a CD (Ray Charles) between contractions once. But once the next contraction came, I didn't want the noise anymore. Through the whole labor the only things that really helped me, my two sole means of strength, were your father's arms and my own voice. His arms kept me steady and I just needed to concentrate on getting my own sound as LOW as I possibly could. My moans sounded like deep tenor "O's" that vibrated deep down in my belly to surround you and squeeze you out into the world.

Papa had been timing my contractions for about an hour or so, and they were between 45 seconds and a minute long, and 2.5-4 minutes apart. We tried once more attempt at conserving our energy by watching this man win his 20th Jeopardy in a row, then we decided to call Anne, who was your midwife on call. I thought that maybe I wasn't brave enough, that it was too soon to call her, that I didn't know the right time and that I was surely only 4 cm dilated. This was all about 8:00 or so...Anne arrived shortly after, about 8:15 or 8:30. First she observed us through some contractions and took my vital signs. She listened to your heartbeat and watched us a bit more, then helped me to our bed to measure my cervix. I couldn't believe my ears...6-8 cm! We were almost in transition! She quickly started to fill the birth pool and ask Papa where all of our supplies were. Papa called Mimi and Aunt Sarah and told them to come on over...you would be born SOON!

I stayed on our bed for a while, and the contractions were coming very closely together. That was when it REALLY helped to feel the vibrations in my own deep voice...I just concentrated on that, and on blowing out my lips like a horse, trying to keep my bottom half loose and open. I was still on the bed when Mimi arrived, and I was so happy to see her! Aunt Gana came soon after that, and I had one or two more contractions before Anne asked me if I wanted to get into the birth pool. I did, and it felt nice. We had lit candles through the house too, including the one we made for Aunt Sarah for your cousin Lotus's birth (but he came so quickly it was never lit!). We also were diffusing some essential oils in the house...clary sage and lavender, mostly...and when I got into the birth pool that was ALL I smelled. It was nice, but a bit too strong, so I remember asking Aunt Sarah to take it out of the room. I'm sorry I'm jumping around so much--Aunt Sarah had arrived right after I got into the pool, and she had an armful of beautiful wildflowers for us! She was SO excited to watch you arrive. The birth pool was in your room, and it felt very good--right--to be in there.

I had a few more contractions before we started to push. I can't really describe what it felt like, but I think I enjoyed that part the most. I knew you would be with us soon, and it felt like you were really helping me to do the work.

Papa might have to tell you this part of the tale from his perspective...he had a better view than I did! Everyone gathered in the room to watch your birth. Heidi would up being Anne's birth assistant, which was wonderful for us, we always wanted both of them there! So in the room at the time of your homecoming were: you, me, Papa, Mimi, Aunt Sarah, Aunt Gana, Heidi and Anne. I was aware of their mixed voices telling me how well we were doing. I pushed HARD and your beautiful little head with all of its thick, long, straight black hair, was born. Then it becomes a bit blurry to me. I had to get out of the pool and into bed...I was incredulous, I couldn't believe I was supposed to lift myself out of the water! The rest of your birth happened very quickly. I felt my body being lifted up...Papa gathered all of the strength he had and ignored his sleeping arms and legs (from my grasping) and carried me from the pool to the bed in your room. Your umbilical cord was wrapped around your little neck, and they wanted me out of the water to make sure they could get your body out quickly. One more big push and you were here! INTO MY WORLD, INTO MY ARMS, MY BEAUTIFUL BANYAN BOY!

So at 10:57 pm on Tuesday, June 29, 2004, you were born to us. They placed you on my belly and I felt so much pride! It was my proudest moment, knowing we had done it, all three of us. You didn't get that first really good cry in right away, and the midwives were worried because your heart rate had dropped from the cord being wrapped around your neck. So they suctioned your mouth and nose and put some oxygen to your face. I asked you to please cry for me...I remember saying "please" a lot. Your eyes fluttered open and from your mouth came the most beautiful sound I'd ever heard. Papa was crying, so thankful and relieved. As the midwives worked to get your heart and lungs acclimated to the world outside, everyone kept saying "he" when they talked about you. So I asked, "is he a boy?" and the midwives lifted up your little legs and said yes, you were a boy...and I hugged you and kissed you and whispered your name, "Oh Banyan, thank you!"

Aunt Gana called Grammy and Grandpa and told them it was time to come over and meet their grandson. They asked your name, and Gana asked if she could tell them...so Papa announced to everyone present that your name, strong and beautiful, shall be MICHAEL BANYAN.

Editor's note: This story was written by hand, in ink, in my pregnancy journal. That medium did not afford editing, and I felt it unjust to edit the story in retelling it here, whether grammar or medical details be slightly askew. The story in my journal continues to describe at length the painful ordeal that was Banyan's transfer, three hours post-birth, to Sarasota Memorial Hospital's neonatal intensive care unit for suspected meconium aspiration. After five of the longest and most excruciating days of our lives, we brought him home. This was the one benefit of the transfer. From my journal:

Bringing you home was easily one of the most perfect moments of my life. The second we walked in the door, your eyes widened and became much more aware--you could sense that the energy here was YOUR energy. I showed you your house and sat down to feed you your first homecoming "meal." That was the happiest moment I'd had since you were born. Papa and I kissed, and I could not stop smiling.
Happy seventh birthday, Banyan. Thank you today and every day for choosing us to guide your path.

BIRTH STORY: Baby Love & Soul Work

2011-06-17T22:07:00.004-04:00

(written by Krystle Sommers, about the birth of Annabelle, born 06.11.11)

Really? I get to keep her forever?

If I knew what day it was I'd say "I cant believe its been x amount of days since Annabelle was born" but life is a little interrupted at the moment and she is worth every bit of it.

Im still recovering, not 100% yet and still unable to wrap my head around what Josh & I just went through.

Delivering our child together after all night Friday and all day Saturday (totaling 19 hours) in hard labor was the most amazing experience of my life. The pain and fear I experienced during childbirth was more than I had ever imagined BUT the feeling of accomplishing what I knew my body could do was priceless. There is a reason less than 2 percent of Americans do homebirths- its REALLY HARD WORK.

But it the type of work that changes your soul.

I have never felt so empowered and strong even though in it I felt weak and scared. I cant tell enough people how proud I am of my husband. For hours I looked him dead in the eyes, bawling, pleading and begging with him to help me and all he kept saying was "You can do this."

I've never had to tap into my inner strength before but when things got so bad I screamed for Jesus, drugs and told everyone I was dying I knew I could either own the situation or let it own me. My midwife, mother and birth assistants also stayed by my side and championed me into delivery.

When in the 18th hour I knew she was close I gave it everything I had and then she was here in our arms as if she had always been here with us. I don't believe everyone should do as I did because we all have different roads to take but I know that I went into labor and parts of me did die and I came out with a strength I didn't know existed.

-New Mumma

HEAVEN.

I give God the credit for it is through Him we find strength.

Sunday's Letter to the Editor

2011-04-25T11:17:00.002-04:00

Thank you to the Sarasota Herald-Tribune for printing my letter on Easter Sunday. I am hopeful that many readers will take action.

Regarding pediatrician Sean Palfrey's column "How patients can help doctors practice better, less costly medicine":

No discipline best illustrates the American medical trend of over-intervention than maternity care.

Despite spending more on maternity care than any other nation (about $98 billion annually), the U.S. ranks an abysmal 50th in maternal mortality, the World Health Organization reports.

Why are two to three American women dying of pregnancy- or childbirth-related causes every day? Because their care falls on one extreme or the other of appropriate. Many women are not receiving prenatal or postpartum care at all. On the spectrum's other end, many are receiving dangerous intervention that exceeds what is medically necessary for a healthy birth outcome.

What can we do? To start, we can adequately count the women who are dying, and discern their causes of death. Florida is one of only 21 states that has a check box on a woman's death certificate to note whether she was pregnant or recently pregnant when she died. The Maternal Health Accountability Act of 2011 aims to change that, making a nationwide data collecting system that establishes maternal death review boards in all states. I strongly urge you to contact your elected officials and convey your support of this bill.

SRQ Daily: Every Child Needs a Mother

2011-04-12T20:25:00.002-04:00

Many thanks to SRQ Magazine for running the following guest column in today's SRQ Daily.

I type from an airplane somewhere between DCA and SRQ, my heartbeat quickening as I anticipate a joyous reunion with my husband and children. Yet for far too many American families, joy is replaced with grief, reunion replaced with loneliness. Saturday’s Healthy Mothers Healthy Birth Summit at Shenandoah University addressed the silent epidemic of maternal mortality in the United States.

Americans spend more on maternity care than any other nation in the world (approximately $98 billion annually), yet World Health Organization data shows 49 countries losing fewer mothers than we do. Some names might not surprise you—Sweden, the Netherlands, Germany, the U.K. But how about Slovenia, Bosnia, Kuwait and Bahrain?

Amnesty International researcher Nan Strauss presented the group’s report "Deadly Delivery: The Maternal Healthcare Crisis in the USA." Amnesty concludes that at least half of American maternal deaths are preventable, resulting from lack of prenatal/postpartum care, or from overuse of intervention such as labor induction or Cesarean section. "We have the research. We have the answers," said Strauss. "We're just waiting for the political will."

Florida midwife Jennie Joseph agrees. Her answer? The Midwives Model of Care, empowering the mother through knowledge and support, minimizing interventions and referring women who require obstetrical attention. The Summit’s experts recommend the midwifery model as the standard for low-risk, normal births.

Renowned midwife Ina May Gaskin then presented her Safe Motherhood Quilt Project (www.rememberthemothers.org). The quilt honors American women who have died of pregnancy or childbirth related causes since 1982.

So what can we do? We can begin by accurately counting and discerning the causes of our maternal deaths. The Maternal Health Accountability Act of 2011 (H.R. 894) would mandate a national data collection system, and establish maternal death review boards in every state. I encourage anyone who is concerned about this crisis to contact your representatives and urge their endorsement of this bill.

Every child needs a mother. I can't wait to get off this plane and show my babies how grateful I am to be theirs.

Nations with Lower Maternal Mortality Rates than the U.S.

2011-04-07T20:37:00.000-04:00

Australia

Austria

Bahrain

Belarus

Belgium

Bosnia and Herzegovina

Brunei Darussalam

Bulgaria

Canada

Croatia

Cyprus

Czech Republic

Denmark

Estonia

Finland

France

Germany

Greece

Grenada

Iceland

Ireland

Israel

Italy

Japan

Kuwait

Latvia

Lithuania

Luxembourg

Malta

Marshall Islands

Montenegro

Netherlands

New Zealand

Niue

Norway

Oman

Poland

Portugal

Puerto Rico

Qatar

Republic of Korea

Serbia

Singapore

Slovakia

Slovenia

Spain

Sweden

Switzerland

The former Yugoslav Republic of Macedonia

Turkey

United Arab Emirates

United Kingdom

(current data from the World Health Organization, http://apps.who.int/ghodata/?vid=250#)

Order Your Safe Motherhood Rally T-Shirts!

2011-03-28T21:53:00.015-04:00

T-Shirts! Get your T-Shirts here! Now taking pre-orders for the T-Shirt that will be worn at the rally on April 10th in Washington D.C. to march the Safe Motherhood Quilt Project up the Capitol steps. The shirts are $25 and are currently being printed in ladies S-M-L-XL; however, please contact me by Wednesday, March 30 if you would like to request a different style or size (i.e. men's, children's, XXL, etc.) and I will get additional pricing for you. Also please note that the above image is not the final proof, but a quick mock-up for pre-sales purposes; final design may vary slightly and will include artist's credits on the front.

100% of the proceeds from the sales of these shirts will be donated to the Safe Motherhood Quilt Project.

THE STORY OF THE SHIRT:

Many of you know that I am attending the Healthy Mothers Healthy Birth Summit in Washington DC on April 9th. I am only able to go because of the generosity of my community, and as a measure of gratitude, I decided to print a shirt with the names of the donors that helped get me there on the back of it. Then things snowballed a bit. The amazingly talented Amy Swagman of The Mandala Journey donated this custom designed painting, entitled "I Will Always Love You," dedicated to American mothers lost in pregnancy or childbirth and intended for the front of the shirt. Since then, many people have contacted me to let me know they'd like a shirt too, and now the rally-goers are lining up to buy theirs as well.

IMPORTANT NOTE TO THOSE ATTENDING THE RALLY:

From what I understand, Washington DC is very strict on permitting--and no t-shirt sales will be allowed at the actual rally. Pre-sales are highly encouraged and your shirt will be delivered to you the day of the event, or if you are attending, at the Healthy Mothers Healthy Birth Summit. Shirts may also be purchased at the Summit.

ALSO, PLEASE INDICATE WHETHER YOU WOULD LIKE YOUR SHIRT SHIPPED OR DELIVERED TO YOU AT THE SUMMIT/RALLY WHEN YOU ORDER. THANK YOU!

Thank you all for your continued support, and please contact me with any questions at laura@kangaroopromotions.net.

March the Quilt: Help Reduce Maternal Mortality

2011-03-18T14:20:00.004-04:00

In 2008, I began creating quilt squares for the Safe Motherhood Quilt Project, created by midwife Ina May Gaskin, to raise awareness about the increasing crisis of American maternal mortality (the U.S. currently ranks 41st in the world in maternal mortality according to the World Health Organization). In November 2009, as Vice President of Florida Friends of Midwives and with the help of the National Organization for Women, I welcomed Ms. Gaskin to Sarasota to speak at an interdisciplinary panel discussion called Maternal Health Care in the 21st Century. Just before her arrival, I finished quilting an entire panel of the Safe Motherhood Quilt, honoring women who have died in pregnancy or childbirth in the US since 1982.

On April 9, Ms. Gaskin will join professionals from all over the world at the groundbreaking, interdisciplinary Healthy Mothers, Healthy Birth Summit in Washington DC, after which she and others will march the Safe Motherhood Quilt from the National Mall to the Capitol steps.

Friends, I would like to attend this summit and bring back to our community the knowledge of the world's experts on how to begin to fix this problem. I would like to march the quilt with Ina May and show the powers that be in Washington DC that this issue is critically important to American mothers. I have shown commitment to improving this community's birth outcomes and will continue to do so in whatever capacity presents itself to be most effective. Due to a hefty investment of time in the non-profit sector, I cannot personally afford the expenses of a trip to Washington at this time.

If you would like to help me on my journey to Washington DC, I will add your name to a custom-designed T-shirt that I will wear during the march, so you will be walking right along with me. I will also report to you my learnings from the Summit upon my return. Finally, you will be showing Amnesty International, American College of Obstetrics & Gynecology, The White Ribbon Alliance, American College of Nurse Midwives, Midwives Alliance of North America, The Tatia Oden French Memorial Foundation, The Safe Motherhood Quilt Project, International Childbirth Education Association, Doulas of North America, The Organization of Labor Assistants for Birth Options & Resources, and MyBestBirth.com that you support their important work and the mission of this Summit to issue a directive to the US Government to reduce maternal mortality in this country.

Healthy Mothers Healthy Birth Summit 2011

2011-03-17T00:27:00.003-04:00

Between two and three women die every day during pregnancy and childbirth in the United States. On April 9th, The Healthy Mothers Healthy Birth Summit 2011 (www.healthymothershealthybirth.com) will bring experts from multiple disciplines, including physicians, researchers, universities, midwives, childbirth professionals, and advocacy groups to examine the rising maternal mortality rate in the US.

Setting aside all cultural, personal, and professional bias, this group of professionals and lay people will tackle an almost silent epidemic in the United States. The results from this working day will be a formal white paper recommendation that will be distributed widely across the country and YouTube documentaries of the day’s events. The all day summit will take place at Shenandoah University’s Dulles campus on April 9th, 2011.

National and international organizations such as Amnesty International, American College of Obstetrics & Gynecology, The White Ribbon Alliance, American College of Nurse Midwives, Midwives Alliance of North America, The Tatia Oden French Memorial Foundation, The Safe Motherhood Quilt Project, International Childbirth Education Association, Doulas of North America, The Organization of Labor Assistants for Birth Options & Resources, and Ricki Lake’s MyBestBirth.com will be represented. Also, numerous universities including Shenandoah, Georgetown, Virginia Commonwealth, George Mason, and George Washington will be present. The summit will hear from midwives Ina May Gaskin and Jennie Joseph as they speak to their experiences combating maternal mortality. Recent research from Perinatologist and Perinatal Epidemiologist Dr. Marsden Wagner will also be presented. Participants are being added daily as the event continues to expand.

On Sunday April 10th, 2011, a rally, open to everyone, is scheduled at the U.S. Capitol to display The Safe Motherhood Quilt (www.rememberthemothers.org) and bring awareness to maternal mortality. Many participants from the HMHB Summit will be present, including midwife Ina May Gaskin. Maddy Oden, the founder of The Tatia Oden French Memorial Foundation (www.tatia.org) will speak about the loss of her daughter and granddaughter during childbirth.

The summit agenda, list of speakers, participants, sponsors, and up-to-date information about the summit can be found at www.healthymothershealthybirth.com. Limited seating and sponsorship opportunities are still available. More information about the Rally at the Capitol on Sunday, April 10th can also be found on the HMHB website. The HMHB summit is organized by the non-profit, grass-roots, consumer advocacy group Birth Matters Virginia, with the assistance and support of Shenandoah University.

Letter to the Authors of Half the Sky

2011-03-14T15:38:00.003-04:00

This morning, I was treated to a wonderful luncheon at the Ritz-Carlton benefiting the Women's Resource Center of Sarasota, at which the keynote speaker was Ms. Sheryl WuDunn, co-author of Half the Sky: Turning Oppression into Opportunity for Women Worldwide. I was grateful to have the chance to hear her speak, as Half the Sky has been on my to-read list since its publishing in 2009. After hearing her, as I have heard her husband and co-author Nicolas Kristof, speak about maternal mortality in developing countries, I used my scant thirty seconds to express my concern about maternal mortality right here at home. The few words I spoke were just not enough, so the second I hit my computer I followed up with this response. Crossing my fingers.

Dear Mr. Kristof,

I was delighted to meet your wife at this afternoon's Renaissance Luncheon benefiting the Women's Resource Center in Sarasota, Florida. Ms. WuDunn signed my copy of Half the Sky and I am very excited to finally read it. I am a huge fan of your work and your thoughtfulness and would like to follow up with you and Ms. WuDunn on a subject I broached with her at today's signing: American maternal mortality.

In 2009, I wrote a letter to the editor of the Sarasota Herald-Tribune, owned by the New York Times, who published your piece entitled "This Mom Didn't Have to Die." I was pleased to see you bringing attention to maternal mortality, and responded with the addendum that although the problem in developing countries is egregious and preventable, the US should lead by example--we are currently 41st in maternal mortality, and as our c-section and induction rates climb, so do our morbidity and morality rates.

One result of the letter I sent to the Herald was the 2009 Sarasota forum "Maternal Health Care in the 21st Century: Sarasota and Beyond," at which I was thrilled to welcome America's foremost midwife and founder of the Safe Motherhood Quilt Project, Ms. Ina May Gaskin.

I encourage you and Ms. WuDunn to read "Deadly Delivery: The Maternal Health Care Crisis in the USA. Why are the numbers here so much higher than they should be? My theory is that we are a nation of extremes. Women either receive zero prenatal care and education, or, at the other end of the spectrum, are given costly interventions whose risks far outweigh their benefits. Cesarean sections should be used only when the risk is there to justify it. Inductions and other medications should only be used when women are fully informed of their implications: Cytotec, for example, is an ulcer drug never approved by the FDA for labor induction--in fact it is contraindicated for that purpose--and yet it is still widely administered in maternity wards throughout the country, even in the face of evidence to its correlation with uterine hyperstimulation and amniotic fluid embolism, which, more often that not, results in death for the mother and/or baby.

Thank you for indulging me. I hope that your busy schedules will allow you to attend the Healthy Mothers Healthy Birth Summit at Shenandoah University in Washington DC April 9th, and stay for the Safe Motherhood Quilt Project demonstration on April 10th. The Healthy Mothers Healthy Birth Summit endeavors to raise awareness and examine the causes of the rising maternal mortality rate in America, to create recommendations to address this terrible phenomenon and finally to publish a statement of the Summit’s collective findings for public viewing.

Present will be renowned midwife, activist, and creator of the Safe Motherhood Quilt Project Ina May Gaskin, activist and midwife Jennie Joseph, speakers from Amnesty International, and a presentation of perinatal epidemiologist (and former WHO director of Women & Children’s Health) Dr. Marsden Wagner’s latest research. Following the Summit, on April 10th, attendees will have the chance to accompany Ina May as she walks the Safe Motherhood Quilt down the National Mall to the Capitol.

Thank you, both of you, for the INCREDIBLE work you are doing. I am in awe of your movement and hope that people are truly listening. I am available at your convenience to help in any way I can. Safe travels home from Cairo!

Gratefully,

Laura Gilkey

Vice President, Florida Friends of Midwives

Board of Directors, Healthy Start Coalition of Sarasota County

Quilter, Safe Motherhood Quilt Project

An Evening with Healthy Start

2011-01-13T21:34:00.004-05:00

On Thursday, January 20th, from 5:30 – 8:00 p.m., Sarasota Architectural Salvage will host its 2nd Annual “An Evening with Healthy Start” Fundraiser to benefit The Healthy Start Coalition of Sarasota County. The event will be emceed by Sarasota Mayor Kelly Kirschner, and will feature live music by local band tropical-pop band, The Equines.

The 2nd Annual “An Evening with Healthy Start” promises to be even better than the first. Hosted by Sarasota Architectural Salvage, a well-known downtown re-sale store for historic and eclectic home furnishings and accents, this distinctive backdrop provides for one of the most unique and fun fundraising events of the season.

Guests will be treated to light fare provided by local restaurants, including Mattison’s City Grill, Nancy’s Bar-b-q, Owen’s Fish Camp, and more. This event will also feature a raffle and silent auction, featuring an exquisite pendant necklace from world-famous Jewelry Designer, Ned Bowman, of Bowman Originals (located at 1400 State Street in Downtown Sarasota).

Tickets are $15 in advance, and $20 at the door, and include two beverage tickets and a coupon for Sarasota Architectural Salvage. Patron sponsorships are available for $50, and include recognition in the Event Program and unlimited beverages. To purchase tickets, call (941) 373-7070, or visit www.SarasotaSalvage.com.

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

2010-12-22T00:47:00.001-05:00

(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

2010-12-14T10:01:00.001-05:00

(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

2010-11-18T20:45:00.004-05:00

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

2010-11-17T14:00:00.004-05:00

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

2010-11-10T21:49:00.003-05:00

(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

2010-10-19T00:51:00.004-04:00

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

2010-10-11T22:02:00.004-04:00

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

2010-10-05T22:58:00.003-04:00

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

Gratitude: The Sarasota City Commission

2010-10-04T22:10:00.002-04:00

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

2010-10-03T08:54:00.005-04:00

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

2010-10-01T08:48:00.009-04:00

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

2010-09-26T21:47:00.003-04:00

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

2010-09-25T08:43:00.000-04:00

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:

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

2010-09-21T23:03:00.005-04:00

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.

Informed Consent and Refusal: Bring Ruth Home

2010-09-17T11:12:00.004-04:00

When I learned, just this morning, the story of Ruth Light--the Illinois baby that was taken from her parents and put into foster care because of alleged neglect (her parents refused a cesarean birth due to breech presentation and opted for a homebirth which resulted in a happy healthy baby girl)--I was heartbroken and very, very angry. I just sent this letter to the Illinois State Attorney. I will be gathering more evidence to support a second letter and encourage anyone reading this to do the same.

Jeff Terronez

Rock Island County

State's Attorney's Office

Fourth Floor - Courthouse

210 - 15th Street

Rock Island IL 61201

Dear Mr. Terronez,

My name is Laura Gilkey. I am a Florida mother of two home-born children. Both of my boys weighed ten pounds at birth, and one was born with shoulder dystocia--all of these would have speculatively pointed me, in a hospital setting, toward a surgical birth. However, with the skilled help of my licensed midwives and the tried-and-true Gaskin maneuver, both of my boys were born safely and easily into my arms, and are as healthy as can be today--just like Ruth Light. The Lights chose to refuse a cesarean birth for their breech baby, which is perfectly within their legal right of informed consent and informed refusal (1).

I am very concerned for the future of our society when a government agency deems it appropriate to remove a healthy baby from the care of her loving parents during the most critical time in her development. During a baby's first moments, days, weeks and months, it is absolutely critical to her physical and emotional development (2)--and to her mother's (3)--to have the benefit of maternal bonding and breastfeeding (4). To remove that benefit from Ruth because someone somewhere didn't agree with her decision isn't neglect on the part of the Lights, but on the part of the state.

Mr. and Mrs. Light are well-researched folks who made an evidence-based decision to birth Ruth at home. Ruth is a healthy baby girl that was not neglected. To return Ruth to the home where she was lovingly born is the right, legal, and just decision.

I look forward to hearing your timely response.

Laura Gilkey

Vice President, Florida Friends of Midwives

Board of Directors-elect, Healthy Start Coaltion of Sarasota County

Informed Consent and Refusal Subcommittee, Coalition for Improving Maternity Services

Editor, www.borninsarasota.com

LTE: Birth Centers' Gentle Options

2010-09-06T20:55:00.003-04:00

I was beyond thrilled to read this letter to the editor from Ryan Stanley in the opinion pages of yesterday's Sarasota Herald-Tribune. I learned from Ryan that her original letter had been edited for length; the following is the letter in its entirety. You may read the edited version here.

Citing a newly released study, Denise Grady (“Majority of Cesareans are Done Before Labor”, August 30, 2010) explains that the increased use of labor inducing drugs, the tendency of doctors to give up on labor too soon and the failure to allow vaginal births after C-Sections are all factors contributing to our nation’s alarming 32 percent Caesarean rate. It is especially clear from this study that if you are a new mom giving birth in a hospital you have a 44 percent chance of receiving labor inducing drugs and thereafter a 50 percent chance of having a C-Section before labor even begins.

As a new mom who chose to give birth in a free standing birth center, I am shocked by these new findings. Based on this new research, I fear that had I chosen to give birth in a hospital, I would not have been afforded the gentle, drug and intervention free birth I so desired.

I feel blessed to live in a community with two free standing birth centers and a number of skilled licensed midwives, doulas and independent childbirth educators. I encourage all women, especially those concerned with the rising Caesarean rate, to seek out their services and to demand that their labors be allowed to progress naturally and without unnecessary interventions.

C-Sections Rise Again, 2020 Vision is Shared

2010-08-25T20:50:00.001-04:00

Yesterday, I learned that the preliminary 2009 data for births in Florida was released. As a state, our c-section rates have increased to 38.9%. Here in Sarasota, this number has risen to a very dangerous 42.3%, up 2.1% from 2008. As I outlined in April in the 20/2020 vision, had this 2.1% increase instead been a decrease, we as a community would be on the path to healthier birth. Sadly, we still are not on that path.

WHY NOT? And what on EARTH are we going to do about it?

As if in answer to my question, I received an invitation tonight to join a webinar from Childbirth Connection, my preferred mecca of comprehensive maternity care research. The subject is the group's recently released action plan entitled Transforming Maternity Care: 2020 Vision for a High Quality, High Value Maternity Care System. This amazing group of researchers, medical professionals, maternity care practitioners, obstetricians, midwives, professors, healthcare administrators, doulas and childbirth educators has created a blueprint for action that will help consumers, care providers and facilities to step on the path toward healthier birth in this country.

At the core of the Transforming Maternity Care project are six aims applied to maternity care:

Woman-centered means that care respects the values, culture, choices, and preferences of the woman, and her family, as relevant, within the context of promoting optimal health outcomes. It means that all childbearing women are treated with kindness, respect, dignity, and cultural sensitivity, throughout their maternity care experiences.

• Pregnancy and birth are unique for each woman. Women and families hold different views about childbearing based on their knowledge, experiences, belief systems, culture, and social and family backgrounds. These differences are understood and respected, and care is adapted and organized to meet the individualized needs of women and families.

• To promote positive maternity care experiences, care teams engage in high-quality relationships with women and their families, based on mutual respect and trust.

• Caregivers and settings have a powerful effect on childbearing women. Attention is given to the power of language, communication, and care practices to create a climate of confidence and enhance outcomes of care, as well as women's childbearing experiences.

Safe means that care is reliable, appropriate, and provided in systems that foster coordination, a culture of safety, and teamwork to produce the best outcomes for women and babies and minimize the risk of harm. Maternity care processes impact outcomes for both mothers and babies; safe care considers and balances the risks and benefits to both recipients, taking into account the health status of each.

Effective means that the care is based on sound evidence applied properly to the circumstances of the individual pregnant woman and her baby to achieve desired outcomes. Effective care minimizes overuse, underuse, and misuse of care practices and services and emphasizes care coordination to prevent duplication, omission, fragmentation, and error.

Timely means that care delivery is structured so that all care is delivered at the time that it is needed. In maternity care, this means that the timing of the onset and course of all stages of labor and the birth of the baby are determined by maternal–fetal physiology whenever possible, and not by time pressures exerted externally without clear medical indication. In the context of informed consent/refusal in maternity care, timely means that whenever possible discussions and information to facilitate women's decision making around the time of birth are available well in advance of the onset of labor and again as relevant during labor. Finally, unnecessary wait times do not compromise safety, system efficiency, cost effectiveness, and satisfaction with maternity care.

Efficient means that the maternity care system delivers the best possible health outcomes and benefits with the most appropriate, conservative use of resources and technology. Overuse and misuse of treatments and medical interventions are avoided because they waste resources and can result in preventable iatrogenic complications. Similarly, efficient maternity care captures the unrealized benefits from effective underutilized measures.

Equitable means that all women and families have access to and receive the same high-quality, high-value care. Any variation in maternity care practice is based solely on the health needs and values of each woman and her fetus/newborn, and not on other extrinsic, nonmedical factors. Furthermore, an equitable maternity care system addresses disparities in the baseline health status of women related to class, race, ethnicity, and language to ensure optimal maternity care outcomes and experiences for every woman and her children.

In addition, Childbirth Connection has outlined very specific goals for each stage of pregnancy and birth. These goals drive the blueprint for action.

Care During Pregnancy: Summary of Goals

1. Each woman is engaged as a partner in her own care and education during pregnancy; she receives affirmation and practical support for her role as the natural leader of her care team to the extent that she so desires, and is encouraged to provide input to shape her own care.

2. Each woman's preferences are known, respected, and matched with individually tailored care that meets her needs and reflects her choices during pregnancy, delivered by a care team whose composition is also customized based on her needs and preferences.

3. Each woman has access to complete, accurate, up-to-date, high-quality information, decision support, and education to help ensure that she feels emotionally and psychologically prepared to make decisions during her pregnancy, and confident about her birth care options and choices well in advance of the onset of labor.

4. Education and care during pregnancy are designed and delivered to be empowering to women, emphasizing a climate of confidence.

5. Education and care during pregnancy include support for breastfeeding; most women make decisions about infant feeding well before they give birth.

6. Each pregnant woman receives personalized coaching and has access to high-quality resources for comprehensive health promotion, disease prevention, and improved nutrition and exercise for optimal wellness during her pregnancy.

7. Care during pregnancy is available when needed and can be accessed in a time and place that is convenient and accessible for each woman, as balanced with concerns for value and efficiency.

8. Care during pregnancy acknowledges the social context in which pregnancy occurs for each woman and includes opportunities for social networking and access to adequate professional and peer support during pregnancy.

Care Around the Time of Birth: Summary of Goals

1. Each woman has a comfortable, confident relationship of trust with her birth care provider(s).

2. Each woman is engaged as a partner in her own care around the time of birth; she receives affirmation and practical support for her role as the natural leader of her care team and approaches birth prepared and confident to express her preferences and make informed choices about key decisions for labor and birth.

3. Each woman can decide where to labor and give birth as appropriate based on her health status and that of her fetus/baby; she is free to make this choice without judgment and can change her mind without sanction, as an array of risk-appropriate birth setting choices is available and supported system wide.

4. Low-risk women planning hospital birth remain at home during early labor with adequate support and appropriate contact with their care team.

5. All maternity caregivers have knowledge and skills necessary to enhance the innate childbearing capacities of women. Each woman is attended in labor and birth in the manner that is most appropriate for her level of need and that of her baby and experiences only interventions that are medically indicated, supported by sound evidence of benefit, with least risk of harm compared with effective alternatives. Women and babies at high risk for complications for whom a higher level of specialized care is appropriate have specialty care available to them that adheres to the same basic values and principles.

6. Each woman is well-supported physically and emotionally throughout labor and birth; continuous labor support is built in to maternity care.

7. Each woman has access to a full-range of evidence-based, nonpharmacologic and pharmacologic strategies for pain management and relief as appropriate to each birth setting and to staff that is trained to implement them effectively.

8. Providers are trained to maintain skills and have system support to offer the fullest range of management options supported by evidence for women with special clinical circumstances.

9. Mothers and babies routinely stay together, skin to skin, receiving evidence-based care, support, and minimal disruption in the minutes and hours after birth to promote early attachment and the initiation of breastfeeding, whenever neither requires specialized care at this time.

Care After Giving Birth: Summary of Goals

1. Each woman, baby, and family receives care that effectively addresses their needs starting in the immediate postpartum period, and extending seamlessly forward across time, settings and disciplines to anticipate and respond to both continuing and new-onset mental, physical, and social needs that may develop throughout the first year of life and beyond.

2. Each woman receives strong support for breastfeeding through an array of community-based resources and the implementation of workplace supports for breastfeeding.

3. Each woman receives strong support for mother–baby attachment that includes educational offerings, experiential learning opportunities, and peer group support available through a web of services and support systems.

4. Each woman has adequate help to cope with the challenges of the period after birth, including physical changes, shifting priorities, changes in primary relationships, family planning, and issues related to sexuality, isolation, mother–baby codependence, and postpartum depression and other mood disorders. Care at this time includes opportunities to connect with people and services through innovative mechanisms and delivery models that emphasize community and social networking, and facilitate the development of longitudinal supportive relationships.

5. Each woman receives practical support at home as needed to cope with increased demands and fatigue in the period after birth and to develop confidence in her competence as a new mother. Each woman has access to social support, health care services and information, and practical advice and assistance in the period after birth. To this end, given consideration for value and efficiency, maternity care extends beyond the direct provision of health care services to routinely include postpartum services that facilitate optimal family development. This helps to ensure that each woman is valued and supported by society in her role as a new mother.

I am looking forward to joining Childbirth Connection in this vision, and hope that you will consider joining them as well.

Letter to Elected Officials in Support of MOMS

2010-07-28T00:48:00.002-04:00

Dear Congressman Buchanan, Senator LeMieux, and Senator Nelson:

Something monumental and potentially life-saving for America's mothers and babies happened last week on the House floor. Congresswoman Lucille Roybal-Allard introduced the Maximizing Optimal Maternity Services (MOMS) for the 21st Century Act (HR 5807), which places a national focus on evidence-based maternity care practices to help achieve the best possible maternity outcomes for mothers and babies. Your Florida colleagues in the House, Congresswoman Debbie Wasserman-Schultz and Congresswoman Kathy Castor, have co-signed this legislation. I am writing to implore you, as a mother, as a taxpayer, as a maternal rights advocate and as your constituent, to sponsor this act.

I have written you before to tell you that the United States currently ranks 41st in maternal mortality, yet we spend significantly more on childbirth than any other industrialized country. Moreover, our nation's 32% c-section rate, high premature birth and labor induction rates, and their subsequent repeat admission rates are all playing a major role in our nation’s escalating health care costs. Hospitalization related to pregnancy and childbirth costs approximately $86 billion each year, the highest hospitalization costs in any area of health care.

The MOMS for the 21st Century Act responds to this crisis by creating a new Health & Human Services focus on the promotion of optimal maternity care, an additional focus area for the Office on Women's Health, and an Interagency Coordinating Committee on the Promotion of Optimal Maternity Outcomes, a widespread consumer education campaign, and a bibliographic database of systematic reviews for care of childbearing women and newborns. Most importantly, it calls for accountability in accurate research and data collection, and the enhancement of an interdisciplinary maternity workforce, including Obstetricians, Certified Nurse-Midwives, and Certified Professional Midwives.

“The MOMS for the 21st Century Act makes overdue reforms to our nation’s maternity care system to better ensure that providers and mothers have the best information available when making serious maternity care decisions,” Congresswoman Lucille Roybal-Allard said last week. “The fact is we have a maternity care system in the United States that has not traditionally adhered to evidenced-based practices. For example, there is widespread over use in our country of maternity practices, such as elective Cesarean sections and scheduled inductions. These procedures are beneficial and needed only in limited situations. When used routinely and indiscriminately and without medical necessity, these and other practices expose women and infants to unnecessary risks at high cost. On the other hand, credible science-based research tells us non-invasive maternity practices...produce considerable improvement in maternity outcomes, such as healthier moms and babies. Yet these cost-effective evidence-based practices, which have no detrimental side effects, are significantly underused in our country.”

As a consumer, I will do everything possible to offer you the utmost support from my community in sponsoring the Maximizing Optimal Maternity Services (MOMS) for the 21st Century Act (HR 5807). I look forward to hearing your response on this issue and will follow up with your legislative aides by telephone. Thank you for your service and your attention.

Hopefully,

Laura Gilkey, mother of two

Sarasota, Florida

The MOMS Act: Maternity Care Reform!

2010-07-24T20:34:00.001-04:00

The very next day after the refreshing revision to ACOG's VBAC guidelines were released, my new favorite Congresswoman Lucille Roybal-Allard (D-California) introduced the MOMS (Maximizing Optimal Maternity Services) for the 21st Century Act on the House floor. Special thanks to Kathy Castor (D-Florida) for co-signing the legislation (Ms. Castor has been vocal in our own state about the correlation between our high c-section rate and premature birth). This has been a very exciting week along the path to healthier American birth! The following is from Congresswoman Roybal-Allard's office, describing her reason for the introduction and what she hopes it will achieve (including accountability for data collection, interdisciplinary maternity care including midwives, pregnancy and labor support including doulas and nutrition education, and more).

The United States spends significantly more on childbirth than any other industrialized country, but ranks far behind almost all developed countries in healthy child birth results for both mothers and babies. To address this national tragedy, Congresswoman Lucille Roybal-Allard introduced the Maximizing Optimal Maternity Services for the 21st Century Act which places a national focus on evidence-based maternity care practices to help achieve the best possible maternity outcomes for mothers and babies.

“Each year, more than 4 million women give birth in the United States. Caring for them and their babies plays a major role in our nation’s escalating health care costs. In fact, hospitalization related to pregnancy and childbirth costs approximately $86 billion each year, the highest hospitalization costs in any area of health care. Tragically, in spite of all the money we spend, the United States continues to rank far behind nearly all developed countries in perinatal outcomes, with childbirth continuing to present significant risks for mothers and babies, particularly in communities of color,” said Congresswoman Lucille Roybal-Allard, who co-founded the Congressional Study Group on Public Health and chairs the Congressional Hispanic Task Force on Health. “The MOMS for the 21st Century Act, which I introduced, addresses these disparities in our nation’s maternity health care system by making key reforms to improve the health and well-being of mothers and their babies in our country while bringing down maternity care costs.”

The Maximizing Optimal Maternity Services for the 21st Century Act (HR 5807) creates a national focus on maternity care by establishing an Interagency Coordinating Committee charged with promoting medical practices proven to provide the healthiest results for mothers and babies. The legislation authorizes a public awareness media campaign to educate the public about the best-proven maternity care practices. The legislation expands federal research on best maternity practices. The bill also authorizes data collection to pinpoint specific geographic areas of the country that lack maternity care providers.

Finally, the measure puts in place a concerted effort to create a more culturally diverse and interdisciplinary maternity care workforce. It establishes loan repayment programs for providers in maternity care shortage areas. It authorizes grant programs for maternity professional organizations to recruit and retain minority providers. It also calls for the development of core curricula across maternity professional disciplines to better ensure that providers are better trained and able to inform patients about all of their maternity care options.

“The MOMS for the 21st Century Act makes overdue reforms to our nation’s maternity care system to better ensure that providers and mothers have the best information available when making serious maternity care decisions,” Congresswoman Lucille Roybal-Allard said. “The fact is we have a maternity care system in the United States that has not traditionally adhered to evidenced-based practices. For example, there is widespread over use in our country of maternity practices, such as elective Cesarean sections and scheduled inductions. These procedures are beneficial and needed only in limited situations. When used routinely and indiscriminately and without medical necessity, these and other practices expose women and infants to unnecessary risks at high cost. On the other hand, credible science-based research tells us non-invasive maternity practices such as prenatal smoking cessation programs and centering of pregnancy group prenatal care, produce considerable improvement in maternity outcomes, such as healthier moms and babies. Yet these cost-effective evidence-based practices, which have no detrimental side effects, are significantly underused in our country.”

A longtime advocate on behalf of mothers, infants and children, the congresswoman has been honored by the March of Dimes and the Association of Maternal and Child Health Programs. Both awards recognize the congresswoman’s authorship of the Newborn Screening Saves Lives Act, which was signed into law in 2008. Enactment of the Newborn Screening Saves Lives Act established national newborn screening guidelines intended to make comprehensive newborn screening widely available throughout the country. The law also provides federal funding to educate parents and health care professionals about the importance of newborn screening, and improves the systems for follow-up care for infants identified with an illness through the newborn screening tests. In addition, the law requires the Centers for Disease Control and Prevention to ensure the quality of laboratories involved in newborn screening, and establishes a system for collecting and analyzing data that will help researchers develop better detection, prevention and treatment strategies.

Amnesty International Executive Director Larry Cox issued the following statement in support of the "MOMS for the 21st Century Act," introduced Wednesday evening in the House of Representatives by Rep. Lucille Roybal-Allard, (D-CA):

"Amnesty International commends Rep. Roybal-Allard for her commitment to improving the outcomes and disparities in maternal health in the United States. Access to good quality maternal health care is a right, not a privilege. It is shameful that as a nation we have neglected this right for so many women for so long. Amnesty International is grateful for Rep. Roybal-Allard's leadership and her recognition of the terrible human cost of this failure. We stand behind this significant legislative effort to ensure that all women have access to the maternal health care they need.

"The "MOMS for the 21st Century Act," if passed, will require the U.S. government to live up to its obligation to address this problem by developing a coordinated approach to maternal care that will improve women's access to quality, evidence-based care and will begin to address maternal health disparities. This is a first step to reducing the needless loss of women's lives that tragically affect so many families in the United States and preventing the complications that have risen steadily for decades.

Normal Birth at a Local Science Museum

2010-07-22T20:04:00.003-04:00

Yesterday I visited Tampa's Museum of Science and Industry (MOSI) with my children and our friends. When we arrived at the "Amazing You" human body exhibit, I was greeted by the statue of a pregnant woman who, albeit notably missing some anatomical details, was portrayed as a loving mother. I was optimistic.

One of the first displays we came to was a video booth with four options: stages of labor, normal birth, cesarean delivery and birth of twins. While time and children did not permit me to watch all four, I wanted to at least view this institution's idea of normal birth. Overall, I was very pleased. Sure, the woman giving birth was in the hospital standard lithotomy position, and I can assume from her demeanor that she was given epidural anesthesia, and there was a lot of manual obstetric manipulation happening during the pushing stage--but the mother and father were alert, present, and afterward, they described their experience as euphoric.

When the baby in the video was born she was placed immediately on her mother's chest. The cord was clamped a bit early, but the care providers encouraged breastfeeding (successfully) right away. I left the video booth pleased that the young women visiting MOSI would view this rather gentle birth experience with a sense of normalcy. There was absolutely no fear embedded into the piece.

But then I saw this daunting tunnel in the kids' play area. The Birth Canal Challenge was dark, angular and menacing--albeit intended in good fun, I couldn't shake their implication that birth was an intrinsically dangerous event.

So while we are coming a long way, there is still an undertone of fear in our society surrounding birth. I have read its evolution and understand its roots, yet I feel it is time to replace it with trust, love, knowledge and information.

ACOG Revises VBAC Guidelines

2010-07-21T17:56:00.005-04:00

Tonight, women with cesarean section scars and their advocates are celebrating no small victory. The American College of Obstetricians and Gynecologists (ACOG) has issued today a revision to their guidelines for Vaginal Birth After Cesarean (VBAC), including the endorsement of trial of labor for most women with one cesarean, some women with two cesareans and some women carrying twins. The revision also states that even if an institution does not offer trial of labor after cesarean (TOLAC), a cesarean cannot be forced nor can care be denied if a woman declines a repeat cesarean during labor. The news is already beginning to trickle into the right places to reach most pregnant women (i.e. WebMD) and I can only hope its recommendations will begin to increase the single digit VBAC percentage, a must in reducing our nation's cesarean epidemic. The press release from ACOG follows in its entirety.

Ob-Gyns Issue Less Restrictive VBAC Guidelines

Washington, DC -- Attempting a vaginal birth after cesarean (VBAC) is a safe and appropriate choice for most women who have had a prior cesarean delivery, including for some women who have had two previous cesareans, according to guidelines released today by The American College of Obstetricians and Gynecologists.

The cesarean delivery rate in the US increased dramatically over the past four decades, from 5% in 1970 to over 31% in 2007. Before 1970, the standard practice was to perform a repeat cesarean after a prior cesarean birth. During the 1970s, as women achieved successful VBACs, it became viewed as a reasonable option for some women. Over time, the VBAC rate increased from just over 5% in 1985 to 28% by 1996, but then began a steady decline. By 2006, the VBAC rate fell to 8.5%, a decrease that reflects the restrictions that some hospitals and insurers placed on trial of labor after cesarean (TOLAC) as well as decisions by patients when presented with the risks and benefits.

"The current cesarean rate is undeniably high and absolutely concerns us as ob-gyns," said Richard N. Waldman, MD, president of The College. "These VBAC guidelines emphasize the need for thorough counseling of benefits and risks, shared patient-doctor decision making, and the importance of patient autonomy. Moving forward, we need to work collaboratively with our patients and our colleagues, hospitals, and insurers to swing the pendulum back to fewer cesareans and a more reasonable VBAC rate."

In keeping with past recommendations, most women with one previous cesarean delivery with a low-transverse incision are candidates for and should be counseled about VBAC and offered a TOLAC. In addition, "The College guidelines now clearly say that women with two previous low-transverse cesarean incisions, women carrying twins, and women with an unknown type of uterine scar are considered appropriate candidates for a TOLAC," said Jeffrey L. Ecker, MD, from Massachusetts General Hospital in Boston and immediate past vice chair of the Committee on Practice Bulletins-Obstetrics who co-wrote the document with William A. Grobman, MD, from Northwestern University in Chicago.

VBAC Counseling on Benefits and Risks

"In making plans for delivery, physicians and patients should consider a woman's chance of a successful VBAC as well as the risk of complications from a trial of labor, all viewed in the context of her future reproductive plans," said Dr. Ecker. Approximately 60-80% of appropriate candidates who attempt VBAC will be successful. A VBAC avoids major abdominal surgery, lowers a woman's risk of hemorrhage and infection, and shortens postpartum recovery. It may also help women avoid the possible future risks of having multiple cesareans such as hysterectomy, bowel and bladder injury, transfusion, infection, and abnormal placenta conditions (placenta previa and placenta accreta).

Both repeat cesarean and a TOLAC carry risks including maternal hemorrhage, infection, operative injury, blood clots, hysterectomy, and death. Most maternal injury that occurs during a TOLAC happens when a repeat cesarean becomes necessary after the TOLAC fails. A successful VBAC has fewer complications than an elective repeat cesarean while a failed TOLAC has more complications than an elective repeat cesarean.

Uterine Rupture

The risk of uterine rupture during a TOLAC is low—between 0.5% and 0.9%—but if it occurs, it is an emergency situation. A uterine rupture can cause serious injury to a mother and her baby. The College maintains that a TOLAC is most safely undertaken where staff can immediately provide an emergency cesarean, but recognizes that such resources may not be universally available.

"Given the onerous medical liability climate for ob-gyns, interpretation of The College's earlier guidelines led many hospitals to refuse allowing VBACs altogether," said Dr. Waldman. "Our primary goal is to promote the safest environment for labor and delivery, not to restrict women's access to VBAC."

Women and their physicians may still make a plan for a TOLAC in situations where there may not be "immediately available" staff to handle emergencies, but it requires a thorough discussion of the local health care system, the available resources, and the potential for incremental risk. "It is absolutely critical that a woman and her physician discuss VBAC early in the prenatal care period so that logistical plans can be made well in advance," said Dr. Grobman. And those hospitals that lack "immediately available" staff should develop a clear process for gathering them quickly and all hospitals should have a plan in place for managing emergency uterine ruptures, however rarely they may occur, Dr. Grobman added.

The College says that restrictive VBAC policies should not be used to force women to undergo a repeat cesarean delivery against their will if, for example, a woman in labor presents for care and declines a repeat cesarean delivery at a center that does not support TOLAC. On the other hand, if, during prenatal care, a physician is uncomfortable with a patient's desire to undergo VBAC, it is appropriate to refer her to another physician or center.

Practice Bulletin #115, "Vaginal Birth after Previous Cesarean Delivery," is published in the August 2010 issue of Obstetrics & Gynecology.

CIMS Responds to Skewed Homebirth Study

2010-07-09T15:16:00.002-04:00

The following is republished with permission of the Coalition for Improving Maternity Services, an organization committed to mother-friendly childbirth and endorsed by over 1,200 organizations and individuals, including myself.

Raleigh, NC (July 9, 2010)-The Coalition for Improving Maternity Services (CIMS) is outraged that the publishers of the American Journal of Obstetrics and Gynecology (AJOG) accepted a poorly designed and methodologically unsound study in which authors concluded there is a 3-fold increase in neonatal mortality in planned home births compared with planned hospital birth.

"In our analysis of multiple studies from countries worldwide," stated CIMS Chair Michelle Kendell, MBA, AAHCC, "CIMS found that the authors of the study included confounding data, such as outdated and low-quality studies, low-risk and high-risk mothers, babies born preterm, babies unintentionally born at home, births attended by unqualified providers, and data from birth certificates that researchers have found to be notoriously inaccurate."

Although the authors acknowledged that most of the articlesreviewed had similar outcomes of low neonatal mortality, they based their conclusion on statistics drawn from questionable and poor quality studies.

Furthermore, the study's lead investigator Joseph R. Wax, MD, and his co-authors inexplicably eliminated the only high-quality study of planned homebirths in the U.S. that showed excellent health outcomes for infants and their mothers when attended by certified professional midwives. (Johnson & Daviss BMJ 2005).

In a press release, the American College of Nurse-Midwives, a CIMS Organizational Member, reported, "the authors' conclusion differs significantly from findings of many recent high-quality studies on home birth outcomes which found no significant differences in perinatal outcomes between planned home and planned hospital births."

Other research conducted by the CIMS Expert Work Group found that planned home births with a qualified care provider resulted in similar, not greater, perinatal mortality rates compared with a similar low-risk population of women having hospital births, despite lower intervention rates, including electronic fetal monitoring, use of IVs, pain medication, instrumental deliveries, and cesarean sections.

Lamaze International, a CIMS Organizational Member, also questioned the study's conclusion. Amy Romano, MSN, CNM, researcher and contributor on Lamaze International's Science & Sensibility blog, wrote, "high quality studies, conducted in low-risk women in integrated maternity care systems, find no excess risk for babies and significant benefits for mothers."

The Centers for Disease Control (CDC) reports that babies born at home are less likely to be born preterm and low birth weight compared to babies born in the hospital.

Mary Lawlor, CPM, president of the National Association of Certified Professional Midwives, a CIMS Organizational Member, stated the study "is far from the high-quality rigorous review that health care providers and the public expect."

Also, commenting on the study, Geradine Simkins, CNM, MSN, president of the Midwives Alliance of North America, a CIMS Organizational Member, stated, "The American public, particularly women in the childbearing years and those who care for them, have a right to high quality research on childbirth. Research literature should not be used to cause undue alarm or limit a woman's choice regarding care providers, including skilled midwives, and place of birth."

The study at the heart of this debate, "Maternal and newborn outcomes in planned home birth vs planned hospital births: a metaanalysis", originally intended for print publication in the September 2010 issue of the American Journal of Obstetrics and Gynecology (AJOG), was published online on July 1. Researchers and critics suspect that the early release was politically motivated to discredit midwives who attend the majority of home births in the U.S. and to discourage legislators from passing increasingly pro-midwife state legislation such as New York State's Midwifery Modernization Act (Bill S5007a/A8117b), which passed on June 28 with overwhelming bipartisan support, providing autonomous practice for all licensed midwives working in all settings.

CIMS' advisor, Dr. Michael C. Klein, a senior scientist at the Child and Family Research Institute in Vancouver and emeritus professor of family practice and pediatrics at the University of British Columbia believes this is "an unabashed attempt to have poor science cover-unsuccessfully-a political agenda. I am very surprised that the [Journal] would publish it, let alone call it 'Editors Choice'."

According to the CDC, the number of women opting to have their babies at home has been increasing since 1990 and rose by 5% in 2005 and remained steady in 2006. This is significant because it marked the first time in 14 years that the percentage of out-of-hospital births increased in the U.S. In 2006 there were 4.2 million births in the U.S., of which approximately 25,000 (.59%) were home births. About 61% of home births were attended by midwives. Among midwife-delivered home births, one-fourth (27%) were delivered by certified nurse-midwives, and nearly three-fourths (73%) were delivered by other professional midwives.

"Women choose to have a home birth for many reasons," states Nicette Jukelevics, chair of the CIMS Coalition Building Committee. "For financial, cultural or religions concerns, lack of transportation in rural areas, or to give birth in a supportive, low-intervention, familiar environment. Other countries like Great Britain, Ireland, Canada, and the Netherlands support women's choice for home birth. The unsubstantiated controversy against planned homebirth with a qualified provider has been with us for many decades. It's time that women in the U.S. have the same right and opportunity to give birth as they choose."

About CIMS: The Coalition for Improving Maternity Services (CIMS) is a coalition of individuals and national organizations with concern for the care and wellbeing of mothers, babies, and families. Our mission is to promote a wellness model of maternity care that will improve birth outcomes and substantially reduce costs. This evidence-based mother-, baby-, and family-friendly model focuses on prevention and wellness as the alternatives to high-cost screening, diagnosis, and treatment programs. Media Inquiries: Denna Suko (919) 863-9482, dsuko@motherfriendly.org.

Responses to AJOG's "Meta-Analysis" Against Homebirth

2010-07-07T22:03:00.003-04:00

In July's American Journal of Obstetrics and Gynecology, a self-proclaimed meta-analysis denounced homebirth, concluding increased neonatal mortality. This conclusion was based on a study that has proven highly misleading, as the following responses from the Midwives Alliance of North America and The Big Push for Midwives Campaign articulate. Born in Sarasota supports both of these organizations and endorses the following statements.

Response from the Midwives Alliance of North America:

A new meta-analysis rushed to on-line publication well before its availability in print, concluded that less medical intervention, which is a characteristic feature of planned home birth, is associated with a tripling of the neonatal mortality rate compared with planned hospital births. In a study published online on July 1, 2010 in the American Journal of Obstetrics and Gynecology (AJOG), researchers at Maine Medical Center in Portland, Maine analyzed the results of multiple studies from around the world. The lead investigator, Joseph R. Wax, MD, Department of Obstetrics and Gynecology, Maine Medical Center, stated, “Our findings raise the question of a link between the increased neonatal mortality among planned home births and the decreased obstetric intervention in this group.”

However, Canadian researchers whose data showing the safety of home birth in a well-organized and regulated system, were used in the meta-analysis, are sharply critical of the study. Dr. Michael C. Klein, a senior scientist at the Child and Family Research Institute in Vancouver and emeritus professor of family practice and pediatrics at the University of British Columbia said the U.S. conclusions did not consider the facts. “A meta-analysis is only as good as the articles entered into the meta-analysis—garbage in, garbage out. Moreover, within the article, Wax et al did their own sub-analysis of the studies in the meta-analysis, after removing out-of-date and low quality studies, and found no difference between home and hospital births for perinatal or neonatal mortality. Yet in the conclusion, they choose to report the results of the flawed total meta-analysis, which showed the increased neonatal mortality rate.” Klein said that this is apparently a “politically motivated study in line with the policy of the American College of Obstetricians and Gynecolgists (ACOG) who is unalterably opposed to homebirth.”

Saraswathi Vedam, a nurse midwife and researcher at the University of British Columbia who is considered to be an expert on assessing the quality of literature related to homebirth, states that the study is deeply flawed for several reasons, particularly, “the authors’ conclusions are not supported by their own statistical analysis.” Vedam states that Dr. Wax et al acknowledges the consistent findings of low perinatal and neonatal mortality in planned home births across the best quality studies they reviewed “but amazingly Wax does not emphasize or even mention this in his sole conclusion.” This begs the question of whether the author’s analysis and reporting of reviewed articles on homebirth do not support his foregone conclusion about the safety of homebirth.

The Midwives Alliance of North America, a professional organization of over 1200 members, believes childbearing women and those involved in maternal and child health policy should be made aware of the flaws and erroneous claims in the Wax et al study. There is a substantial body of evidence-based literature from well-designed studies that establishes the safety of planned homebirth with a skilled birth attendant. The fact that the American College of Obstetricians and Gynecologists maintains its position in opposition to homebirth, despite the evidence of its safety and efficacy, makes one question ACOG’s motive in publishing Wax’s substandard study.

Midwives are the primary care providers in out of hospital settings. Whether their work is studied and scrutinized here in the US or abroad the findings are consistent. Trained midwives are qualified health professionals with the requisite expertise to provide mothers and newborns with outstanding care, using less intervention, resulting in maternal and infant outcomes as good as those in hospital settings under the care of obstetricians.

The American public, particularly women in the childbearing years and those who care for them, have a right to high quality research on childbirth. Research literature should not be used to cause undue alarm or limit a woman’s choice regarding care providers, including skilled midwives, and place of birth.

Response from The Big Push for Midwives Campaign:

As New York and Massachusetts moved to pass pro-midwife bills in the final weeks of their legislative sessions, the American Journal of Obstetrics and Gynecology fast-tracked publicity surrounding the results of an anti-home birth study that is not scheduled for publication until September. Described as unscientific and politically motivated, the study draws conclusions about home birth that stand in direct contradiction to the large body of research establishing the safety of home birth for low-risk women whose babies are delivered by professional midwives.

“Many of the studies from which the author’s conclusions are drawn are poor quality, out-of-date, and based on discredited methodology. Garbage in, garbage out.” said Michael C. Klein, MD, a University of British Columbia emeritus professor and senior scientist at The Child and Family Research Institute. “The conclusion that this study somehow confirms an increased risk for home birth is pure fiction. In fact, the study is so deeply flawed that the only real conclusion to draw is that the motive behind its publication has more to do with politics than with science.”

Advocates working to expand access to out-of-hospital maternity care questioned the timing of AJOG’s public relations efforts on behalf of a study that won’t be published until next fall. “Given the fact that New York just passed a bill providing autonomous practice for all licensed midwives working in all settings, while Massachusetts is poised to do the same, the timing of this study could not be better for the physician groups that have been fighting so hard to defeat pro-midwife bills there and in other states,” said Susan M. Jenkins, Legal Counsel for The Big Push for Midwives Campaign. “Clearly the intent is to fuel fear-based myths about the safety of professional midwifery care in out-of-hospital settings. Their ultimate goal is obviously to defeat legislation that would both increase access to out-of-hospital maternity care for women and their families and increase competition for obstetricians.”

The United States recognizes two categories of midwives: Certified Nurse-Midwives, who are trained to practice in hospital settings and who also provide primary and well-woman care, and Certified Professional Midwives, who undergo specialized clinical training to provide maternity care in out-of-hospital settings. Research consistently shows that midwife outcomes in all settings are equivalent to those of physicians, but with far fewer costly and preventable interventions, including a significant reduction in pre-term and low birth weight births, and as much as a five-fold decrease in cesarean surgeries.

The Big Push for Midwives Campaign represents thousands of grassroots advocates in the United States who support expanding access to Certified Professional Midwives and out-of-hospital maternity care. The mission of The Big Push for Midwives includes educating state and national policymakers about the reduced costs and improved outcomes associated with births managed by CPMs in private homes and freestanding birth centers.

Response to Boston Globe Midwifery Debate

2010-07-05T00:28:00.005-04:00

An editorial debate in last week's Boston Globe caught my attention. The subject: should midwives be autonomous care providers, licensed and regulated by the state's government (as are physicians), or should they practice subordinately to and under the supervision of physicians?

The the initial editorial in The Boston Globe focused on the rise in cesarean section rates, calling for expansion of midwifery access, including licensure of Certified Professional Midwives, as one of three key measures to reversing the trend (the others being stricter induction protocols and increased access to VBAC--I could not agree more). An excerpt:

Enhancing access to midwifery care might well be the most effective approach to safely reducing the overall caesarean rate — and could lead to significant cost savings and improvement in other priority areas such as breastfeeding. It would also address the impending shortage of obstetric providers. The Legislature should pass a bill to expand access to midwifery care in Massachusetts. We must finally make midwives more central in maternity care — as do all other countries whose birth outcomes are superior to ours.

Its rebuttal argued that the CNM's and CM's currently practicing under physician regulation are serving women adequately, and that CPM's do not have adequate training to be state-regulated:

This bill would license certified professional midwives, formerly called “lay midwives,’’ who don’t even have to have a high school diploma to attain certification. This could also potentially cost the state millions of dollars during difficult economic times. Yes, we all care about the caesareans rate and need to develop strategies to improve access to care by qualified providers in safe settings. However, licensing individuals without adequate training is a dangerous proposal and not the answer to challenges in the health care system.

This argument is predicated on several misconceptions. While CNM's certainly do serve women who seek their care adequately, they most frequently practice in hospitals, where the Midwives Model of Care is desperately needed. CPM's specialize in out-of-hospital births, and although lay midwives also practice(d) outside of hospital walls, Certified Professional Midwives and lay midwives are not, nor were they formerly, the same. To clarify (from the Midwives' Alliance of North America):

Certified Professional Midwife (CPM)

A Certified Professional Midwife is a knowledgeable, skilled and professional independent midwifery practitioner who has met the standards for certification set by the North American Registry of Midwives (NARM) and is qualified to provide the midwifery model of care. The CPM is the only international credential that requires knowledge about and experience in out-of-hospital settings.

Lay Midwife

The term "Lay Midwife" has been used to designate an uncertified or unlicensed midwife who was educated through informal routes such as self-study or apprenticeship rather than through a formal program. This term does not necessarily mean a low level of education, just that the midwife either chose not to become certified or licensed, or there was no certification available for her type of education (as was the fact before the Certified Professional Midwife credential was available). Other similar terms to describe uncertified or unlicensed midwives are traditional midwife, traditional birth attendant, granny midwife and independent midwife.

CPMs follow the practice standards of the National Association of Certified Professional Midwives (NACPM), which include the development of collaborative relationships with other healthcare practitioners who can provide care outside the scope of midwifery practice when necessary. The NACPM standards limit the CPM scope of practice to the primary maternity care of healthy women experiencing normal pregnancies.

In Florida, most Licensed Midwives (LM's) also hold the CPM credential, though it is not recognized by the state. The Midwifery Practice Act is upheld by the Council of Licensed Midwifery, a division of the Department of Health. While Florida licensure requirements include and in many cases exceed those of the CPM, the lack of CPM recognition does pose problems in situations like reciprocal practice (when a midwife is licensed elsewhere and wishes to practice in Florida) and Medicaid reimbursement.

Another point argued on both sides of the Boston Globe debate was the cost to taxpayers vs. cost savings of midwifery licensure. While creating a body of regulation in a state, such as Massachusetts, may initially cost taxpayers, the cost savings generated by licensed midwives is astronomical, and has been projected by many to have the potential to save states millions and our nation billions in healthcare costs. In Washington, the Department of Health mandated a study to investigate this very question, and the answer was resounding. Midwives saved taxpayers there $2.7 million annually, reducing intervention and surgery rates without compromising outcomes. Should a similar study be conducted here, it would reveal (by my own number-crunching) that Florida's midwives save almost four times that amount, with our higher population, percentage of births paid for by Medicaid, and current cesarean rates that are second in the nation.

Increased access to midwifery care, including licensure of Certified Professional Midwives that specialize in low-risk, normal pregnancies and out-of-hospital births, is a win-win-win situation. Taxpayers win, through significant healthcare cost savings. Mothers, babies and families win, through safe outcomes and a motherbaby-centered, non-interventive, evidence-based model of care. And, believe it or not, physicians win. Partnering with out-of-hospital midwives in a true collaborative model ensures that women are paired with the care provider that best suits their risk level and preference, increasing transparency and informed consent, thereby reducing litigation against physicians that stems from lack of information or discontinuity of care.

BIRTH STORY: The One I Asked God For

2010-07-03T09:46:00.008-04:00

(written by Becky Saladino, about the birth of Quinn Samuel, born 01.12.10)

Quinn Samuel is the child I spent years begging God for. It was a devastating shock, after conceiving Jonis so unplanned and easily, to suffer unknown secondary infertility. In March of 2009 I sat in my OB's office discussing fertility treatments and seared his words "you'll probably not conceive on your own. I have no idea how you conceived your first child" into my soul. Well sometimes God has other plans and unbeknownst to me I conceived the following month. In May I started to feel nauseous and remember telling my sister that I was sure something terrible was wrong with me. I was going to see my doctor but first to rule it out as a possibility, I randomly decided to take a pregnancy test. The positive test might as well have been a winning power ball ticket.

After the initial shock wore off I set about wondering how in the world I was going to give birth. I knew after a c-section at 36w2d and Jonis in the NICU for 13 days that I did not want that repeat performance. We approached our OB about a VBAC and he agreed. However he informed me that he was out of town for what would be my 39-41 weeks. As the whole VBAC in the hospital is already such a touchy thing this was a big problem. I set about looking into other options and remember hearing about a place called Rosemary Birthing Home. I checked out their website and was horrified and at the same time thrilled at all the pictures of women giving birth. Could it be that simple? that beautiful? I dug deeper. We met with the midwives who agreed to accept us into their care after the standard VBAC consult. The decision to transfer care from our OB to the midwives was agonizing. We must have run a thousand different scenarios in the process. My first pregnancy ended in an early section due to pre-eclampsia and breech. I was afraid that if I transferred into the midwives care and had to transfer back to the OB at the end for either of these issues that a VBAC would no longer be on the table. So because I wanted the best shot at the VBAC we stayed with the OB. The midwives became a source of knowledge and support willing to assist me in any way possible to achieve the VBAC even though I was not technically their patient. They truly are a gift to our community.

So my pregnancy moved along. I beat the pre-eclampsia due in part to nutrition and a carefully controlled weight gain of 20 pounds. If someone would have guaranteed me a VBAC if I stood on my head for a week I would have done it. I so desperately wanted to birth my child. I wanted to do it not to have him removed from my body. Somewhere around the mid thirty weeks we discovered that Quinn was breech. I had been seeing a chiropractor all along for the Webster's technique knowing that I had a breech baby the first time. So I continued almost every other day and added in moxibustion by my mom, Dr. Garcia. I'll also mention that at this point my amniotic fluid had a couple times gotten painfully low. Almost admitted into the hospital low. I was having twice a week NSTs and BPPs at the hospital. So weeks of this chiropractic treatment and acupuncture proved a stubborn baby. We landed at 38 or so weeks and still breech. Due to this my OB convinced me to schedule my section for 39 weeks. He was concerned about me going into labor while he was gone. We hashed it out and I also convinced him to give me version. I figured it was my last ditch effort.

So the morning of the version we went to the hospital not knowing what to expect. Our OB reviewed the list of risks and reminded us if baby and/or placenta did not tolerate the version well that we may end up with an emergency section. We gave him the green light. I received the shot of tributilin and it just felt like drinking a triple shot of espresso. Dr. gelled up his hands, fired up the ultrasound machine, and in 5 minutes proceeded to turn Quinn to vertex! My husband, being generally terrified of obstetrical procedures, left the room midway because he said it was like a scene from Alien. He could see the complete outline of Quinn's body flailing like a baby duckling. The Dr.'s face was utter shock and being a man of few words he gave a slight chuckle. The nurse later told me it was the fastest version she'd ever seen. When it was over Dr. came in and said," Well I didn't think that was going to work which is why I tried to talk you out of it. Since I leave town tomorrow what's the game plan now?" Well for starters we cancelled the c-section that was scheduled for the following day. I told him I understood that he was the only doctor willing to allow me a VBAC trial of labor and that since there was no medical reason to schedule anything that I would just take my chances on going into labor while he was gone. In truth I had no idea what we were going to do. With him gone I knew I would have to come out swinging to have a VBAC trial of labor. I was really scared that after everything we had been through I would not be allowed a trial of labor simply because any other doctor covering for him wouldn't allow it. However I also knew that I would have to consent to a section and I just figured I would refuse to consent. a very weird situation to be in. Then the midwives come back into the story. Knowing my predicament with my VBAC OB gone, the midwives presented themselves as an option. Since they had been following my pre-natal care and had spoken to my OB about it, they offered to attend my birth, at home, should I go into labor while my OB was gone. A huge weight was lifted. So that became the plan.

I relaxed and with a now vertex baby began to prepare for the now possibility of a homebirth. I was terrified of the unknown and fearful of the rupture horror stories everyone seems to want to tell when you mention you're trying to VBAC. The midwife came over for a home visit and walked us through how it would work. I continued the NSTs and BPPs to check for low fluid. I felt like a car going into the garage for "fluid checks" as I affectionately began to call them. The triage nurses and I were on a first name basis. One day, January 12th to be exact, 2 days before my due date I went in for a fluid check. The ultrasound tech shockingly proclaimed," Honey there is no fluid in here. You're not leaving the hospital!" Closer examination revealed that indeed the fluid was dangerously low. What to do now? My OB was gone so I spoke with the on call from the practice who explained that an induction was not desirable as I wasn't in the slightest bit dilated. Plus I knew I needed to avoid an induction at any cost if I wanted to try to VBAC. The short of it was baby need to get out and my body wasn't anywhere near ready to get him out. So after discussing it with the midwife and receiving reassurance that I was making the right choice I consented to my 2nd c-section.

Having Quinn was not part of my plan that day but sometimes God has different plans. At 8 that evening, as I walked into the OR, I felt a strange sense of peace and terror all at once. Peace in knowing that I had done everything possible to achieve my VBAC and that sometimes things are just out of your control. Terror at the thought of the surgery. The nurse that held me during the spinal must have sensed my terror because she so kindly began to reassure me and ask me questions about the mundane. As I laid down on the table, strapped down, the room began to spin and in a few minutes I heard Quinn's cries. 8 pounds 2 ounces perfectly healthy and no need for the NICU.

So in a way I succeeded and failed all at once. Succeeded in maintaining my health during the pregnancy resulting in a full term baby with healthy lungs. Failed in that I didn't have that rite of passage. Quinn passing through me in into life. I'll ALWAYS wonder if I could have done it? Would I have been strong enough? I'd like to one day find out. Yes, this crazy girl is dreaming of a VBA2C. In the meantime I'm thankful. Thankful for my OB that gave me the best shot he could. Thankful for the midwives that were part of my journey so graciously filling in the gaps in our system. Thankful for the support and the many new friends along the way. Thankful for the healthy baby born January 12 who was at my breast within the hour. The one I asked God for. That is what Samuel means. Sometimes God has other plans.