Wednesday, December 31, 2008

A Quick Note

As the new year starts, I find myself quite unexpectedly expecting! That's right, baby #3 has made him or herself known. I am going to be tracking the beginning of my pregnancy journey on my other blog (my hyperemesis blog), as that may (or hopefully, may not be) more applicable. As things progress, I'm not sure what to do - whether to split my pregnancy entries between these two blogs or keep my journey on one blog only. The latter is probably more sensible, but I don't know which blog to choose! Ah well, a decision for another day. Wish me luck!

New Article by Jennifer Block

A Yahoo! group to which I belong just posted this article by Jennifer Block. It is really great! Jennifer knows her stuff. Check it out!

Midwives Deliver

If you haven't read Jennifer's book, "Pushed: The Painful Truth About Childbirth and Modern Maternity Care," you're missing out! Go get a copy today. It's an eye-opener if there ever was one.

Thursday, December 25, 2008

Merry Christmas

A very merry Christmas to each and every one of you! As we celebrate the birth of the Savior (the homebirth of all homebirths!!... or perhaps the home-away-from-home or cave-away-from-home birth), I wish everyone a fun and safe day of celebration and a wonderful start to the coming year.

This blog looks like it will have to stay dormant for at least a couple more weeks, as our house is still not move-in-able (not to mention that I've been too busy to pack), so house things will continue to engross my time for at least the next month. Rest assured, this blog is not dead! It will be up and running in no time (I hope!).

Merry Christmas!

Thursday, November 20, 2008

Notes on Life

This is a cross-post from my other blog, "The Whining Puker"....

Just a quick note!

We got our house last week, and my parents have come out to AZ to help us get it livable - so my blogging time is apt to be very little over the next month or so - not to mention the fact that we're probably going back to dial-up after our move, so it may be reduced permanently! I don't know - we'll see. But I wanted to write a quick note to explain that this blog is not dead - it's just going to be on a bit of a sabbatical.

I'm learning a lot working on the house. Growing up, I groused so much about helping with home-improvement projects (which I do not enjoy) that my parents let me off the hook - with the result that until now, I have done nothing more home-improvement-wise than hang a picture! Seriously! This week I have been ridiculously proud of myself for learning to remove doorknobs!! LOL Hopefully a preview of more to come, for I am absurdly ignorant.

Our house is lovely, but it does have some serious issues due to severe neglect. Its previous owners didn't beat it to a pulp, like some other houses we saw, but they neglected it so badly that they might as well have. There are literally masses of cobwebs hanging from the ceiling!! And there are things like water damage from neglected leaks, corrosion from mineral build-up gone mad and not taken care of, appliances that have to be trashed because they weren't cleaned in so long that they're no longer redeemable, etc. But I'm learning a lot! And DS is having a blast having a larger space to roam and a bit yard to play in.

So that's about all! I'll try to check back in periodically. Love to all!!

Thursday, November 13, 2008

Book Review: "Infertility for Dummies"

"Infertility for Dummies"
Sharon Perkins, RN, and Jackie Meyers-Thompson
2007, 362 pages

Before reading this, I should warn you that it is written from my strongly pro-life position. Okay, you've been warned.

I decided to pick up a basic book on infertility simply because so many of my friends are dealing with this. In fact, out of the six young married couples in our church with whom we hang out, four have dealt or are dealing with infertility. I didn't want to leave such a widespread issue out of my reading, so I picked up this book. I'm definitely going to read more books on the subject to develop my understanding further.

I wasn't that crazy about this book, both informationally and ethically. I'll deal with those issues in a minute. First, what I liked:

Like all the dummies books, this book is clear, concise, humorous, well-organized and easily accessible. The language and the explanations were clear, and I learned a lot (though the hormonal interchanges of the fertility cycle are still largely beyond me!). I think that this would be a good reference book (it's really easy to find specific information that you might need at a time) and as a basic primer.

The two things I didn't like: information problems and ethics.

Starting with the book's information:

I can't speak to the later chapters, because I was reading much of this information for the first time. However, though I am not overly conversant with reproductive technologies and the ins and outs of infertility, I am fairly knowledgeable about basic female fertility and especially natural family planning. When I was reading these sections, I kept finding errors - lots of them, some tiny, some not so tiny. But that made me wonder just how accurate the following chapters were. Now, don't get me wrong. Most of these errors were really tiny and wouldn't make a big difference to the reader. But they are errors that wouldn't be written by a truly knowledgeable author and which shouldn't have made it to print. Here are a few examples:

Text: "The cervix... keeps the baby from falling out of the uterus when you're pregnant because it's a tight, muscle-like tissue." (p. 23)
Correction: The cervix is not muscle-like, it IS a muscle (being part of the uterus, which is a muscle).

Text: ""But the most consistent thing about your menstrual cycle should be that ovulation occurs 14 days before your period begins. So if your cycles are 28 days, you ovulate on day 14. But if your cycles are short, say 25 days, you're actually ovulating on day 11..." (p. 29)
Correction: This was a big one. In fact, I can't believe they included this simplistic of an explanation of female fertility, because it is vastly misleading. While the average fertile luteal phase is assumed to be 14, it can range anywhere from 10 to 16 days (some docs say 12 is the lower limit, but many babies have been carried to term with mums who have 10/11 day luteal phases). Thus, timing sex to be just before [average period length - 14 days] is extremely inaccurate and misleading. The authors do acknowledge different luteal phase lengths, but in their directions on "how to get pregnant," they just tell you to subtract 14 from your average cycle length to get your ovulation date.

Text: In reference to charting: "Look for a subtle drop in temperature, followed by a sustained rise in temperature.... at least 0.5 degrees" (p. 70)
Correction: #1 - It's 0.4 degrees, not 0.5 degrees; #2 - They completely ignore the fact that many women "stair-step" with their temperatures - you may see your temperature rise gradually to the high temperature level rather than just one big jump. #3 - They also fail to tell anything of the official natural family planning rules, such as "3 over 6," etc. It's not so much that it's wrong as that it's incomplete. #4 - Not every woman gets the "pre-ovulation dip;" in fact, most don't. Thus to depend on the dip as a predictor of ovulation is not a reliable method.

Enough on that.... I will just say that these little errors made me slightly distrustful of the book's reliability.

Onto ethics...

This is a hard subject, because it really depends on your beliefs. I am dissatisfied with the book's ethics because of my pro-life and Christian beliefs, but you, gentle reader, may not be. So read on, and make of it what you will.

Basically, my position: I believe that a new life begins at the moment of conception. In other words, Sperm + Egg = Baby. This is regardless of whether the embryo is one cell or ten or a hundred or a hundred million - I believe that it is a unique individual, created by God. Thus, to "discard embryos" is, to me, the same thing as an abortion. This is not a popular view, but it is my honest belief.

IVF (in-vitro fertilization), thus, is rife with ethical dilemmas for those of us who believe this way, because "extra embryos" are generally part of the process. Many couples try to transfer all of their embryos, but usually this is impossible, as the number of embryos is usually far greater than the average woman's ability to bear children. Some couples purposely try to ensure that a small number of embryos is created so that they will have the ability to transfer all of them. A very small number put their extra embryos up for adoption (or, in a less formal process them, "donate" them - since the state regards embryos as property rather than persons, the legal adoption process is optional and therefore generally used only by parents who want to respect the personhood of their babies). However, most extra embryos are eventually discarded. As I believe that embryos are babies, and not "genetic material for making babies," the practice of embryo disposal is ethically unacceptable.

There is also the issue of pre-implantation genetic diagnosis, in which embryos are tested for gender and genetic conditions - those with characteristics the parents want are kept, those with unfavorable or unwanted characteristics (wrong gender, genetic conditions) are discarded. Ethically, this is the same thing as an aborting a baby with health defects. (Not to mention that embryos are often injured in the process of testing them, with some data showing that these babies have a higher incidence of birth defects, possibly resulting from the testing itself.)

Thus, for me, there are many deep, deep problems with the reproductive technologies industry. However, this book is completely dismissive of these issues. Besides stating that "there are ethical issues under debate with such-and-such procedure" or "some people have problems with this," they are somewhat contemptuously dismissive of all ethical considerations. The book is filled with statements such as the following: "Many people with frozen embryos would like to see something positive done with embryos that they donate for research, and would rather have them used for stem cell development than just be destroyed." (p. 324) Furthermore, in referring to embryos, the authors refuse to call them more than "potential life," which is an easy way to dismiss the personhood of embryos.

Lastly, here is one corker that made me really angry, and also made me wonder if the authors have the emotional maturity to be even writing a book, let alone one on infertility. In the chapter on adoption, there is one teensy-weensy section on adopting special-needs kiddos, and the main jist of the section is to discourage adoptive parents from doing so. Let's hear this choice morsel from the authors:

"Sometimes, people are tempted to adopt special-needs children because they're more easily available. Other couples are drawn by a picture of a child... Sharon (one of the authors) remembers thinking seriously about adopting a child with handicaps while her family was waiting for their referral... every one of the pictures appealed to her. However, she realized that her family wasn't really emotionally prepared to handle a child with serious problems. Although it's easy to be caught up emotionally in the idea of raising a special-needs child, look realistically at your lifestyle and personalities before making a decision." (pp. 312-313)

In other words, "Stop and get ahold of yourself before you do something stupd."


Do I recommend this book? It gets a "whatever" kind of rating. The information is okay, the ethics are (in my opinion) absolutely deplorable. Next time, I'm going to look for a book with a conscience.

Wednesday, November 12, 2008

Book Review: "The Natural Pregnancy Book" by Aviva Jill Romm

"The Natural Pregnancy Book"
Aviva Jill Romm
2003, 318 pages

This is going to be another short book review, because I loved this book and have nothing to criticize! This book easily goes down as one of my all-time favorites and merits a place on my "buy soon" list.

I have read several other Romm books and loved them all, so I was expecting great things from this book - and I was right! This is truly an excellent book.

Part II of the book, "Common Concerns during Pregnancy," is an alphabetical compendium of the various complications and concerns that occur during pregnancy (morning sickness, heartburn, etc.), with Romm's recommendations and comments on each. This section is excellent. She gives general/dietary recommendations and also herbal recommendations (complete with dosage instructions and lots of herbal formulas), and they look absolutely fabulous in terms of usefulness and thoroughness. I wouldn't want to go through another pregnancy without this book.

Part I of the book covers many of the usual pregnancy topics (prenatal care, nutrition, baby's development, exercise, physical changes, preparing for birth, etc.), but with a twist - not only is Romm in favor of natural birth and midwifery care, but she also has incredible respect for women's bodies, women's birthing rights, women's spirituality, the sacredness of birth, and women's wisdom. Rather than saying, "Do whatever the doctor says," (as oh-so-many pregnancy books do), Romm says, "Educate yourself. Listen to your body. Listen to your baby. Your body knows how to do this, so trust yourself." In today's fear-mongering birth world, where pregnant mothers are treated like time bombs waiting to go off, this book is extremely refreshing. Romm works consistently to bolster and build a mother's confidence in herself and her abilities, and that is a great asset of this book.

Romm also has a great understanding of the understanding of the birth experience as a pivotal event in a woman's life - the fact that birth is truly a rite of passage for a woman. Most pregnancy books, and Western culture in general, dismiss the importance of the birth experience to women. Most view birth as "something really unpleasant that you endure in order to get a baby." After the birth, culture will dote on the baby but give little to no attention to the woman who has experienced a unique and earth-shattering transformation in her rite of passage to motherhood, and who also deserves honor and attention. (Although I believe that motherhood begins with conception, there is something especially transformative about birth in terms of the "becoming" process.)

I experienced this above-mentioned phenomenon very much with my birth experience. After my birth I wanted to shout from the rooftops how proud I was of myself and my abilities, and how I had experienced this amazing transformation, and I could have told my birth story to every passerby who came within ear's reach. However, I found that in general, all eyes were on the baby. (In fact, one of the times I was asked about my birth, I had to go into the back room to nurse the baby and came out just in time to hear my husband finishing up telling my birth story! What a bummer!!!)

Romm really focuses on the importance of the birth experience and gives great examples of how to honor your experience - and for others, how to honor the mother and make her birth the acknowledged rite of passage that it should be.

I love how Romm describes communicating with unborn children as something that can and should be done, and as something that is possible. As a Westerner, I tended to think of my baby as someone who was unreachable, on another planet, etc. - i.e. "I know you're there, and we'll talk when you get here." She emphasizes the importance of prenatal communication and giving love to pre-birth babies, and I really love that.

I also love how life-affirming Romm is. Something that can absolutely drive me up a wall is a pregnancy book that refers to the baby as a "fetus." While "fetus" does literally mean "unborn child," it is used (consciously or unconsciously) to dehumanize the infant, to make it seem less than human (this is especially true when talking of abortion, when the baby is dehumanized further into "fetal tissue" or "products of conception"). Romm consistently refers to the unborn child as a "baby," something that I try to do as well, and I love that. Here's a quote from her:

"From the onset, this was my child, not an embryo or a fetus with potential defects or a pregnancy with potential complications, but my child. I truly believe that it is partially this attitude that has nurtured health in each child. But had one of my babies not been perfectly healthy, that baby would still have felt loved and accepted from the beginning.

"Later in this book you will find a discussion of the various prenatal diagnostic tests that are commonly offered to pregnant women. There are times when these tests are medically warranted; however, routine use of such testing can prevent a woman from developing and trusting her connection with her baby. The real connection between a mother and her baby exists before the connection that is fostered by seeing the baby on a screen, knowing whether the baby is a boy or a girl, or hearing the baby's hearbeat by electronic amplification."

(Romm, 2003:20)

I love that.

This book has a great emphasis on natural health, herbal treatments and non-invasive methods for handling pregnancy concerns. It is a great compendium of wisdom and knowledge.

I highly recommend this book to all new mothers. If I get pregnant before I manage to get my hands on a copy, my fingers will be marching straight to Amazon to order it! Highly, highly recommended.

Tuesday, November 11, 2008

Book Review: "Our Bodies, Ourselves: Pregnancy and Birth"

"Our Bodies, Ourselves: Pregnancy and Birth"
Boston Women's Health Book Collective
2008, 370 pages

I'm on a roll! That stack of to-be-reviewed pregnancy/birth books on my dresser WILL decrease, if I have to review one book a day!!!

Having gotten the notice from my library that I can't renew my loan of "Our Bodies, Ourselves" for the fifth time (I don't know why!!!), this book has now moved to the forefront, as it has to be back at the library today.

I have found, rather surprisingly, that the best books get the shortest reviews from me. Why? Well, what's there to say? "I loved it - I loved it - I loved it!" Bad books get longer reviews because of all the anger I need to vent after reading them (See "From Here to Maternity" book review, for example).

With that in mind, I don't have an overwhelming amount to say about this book other than - I LOVED IT!!! It gets the highest review from me. It is a book of almost unequaled excellence, absolutely thorough in its coverage of pregnancy/birth issues, and utterly and completely evidence-based. Basically, if you are pregnant or interested in pregnancy/birth, this book is a must-have. It's definitely going on my "want" list.

Looking through the book, I remember again why I loved this book - it's just SO thorough! Anything and everything to do with pregnancy, birth, baby and postpartum is covered.

The book is supportive of natural birth while remaining balanced - it is not fanatically anti-hospital or anti-homebirth. I'd say that it would be a good book for anyone, regardless of whether one is planning a hospital or home birth.

I have two complaints about this book:

#1 - This book is supportive of all women's choices, which in my opinion is great as far as birthing options go. But as a Christian and thus someone who affirms the sanctity of human life, I am NOT okay with a mother's decision to have her in-utero baby killed because it is not perfectly healthy. This book is supportive of that decision, and I found the chapter covering that to be heart-rending. Basically, the book's attitude is "Decide to keep your non-perfect baby? Great! Decide to kill your non-perfect baby? Great!" I believe that this is irresponsible and unethical. After skipping ahead to read that chapter (which I usually do with all books, to catch the moral and ethical tone of the book), I was so sickened and saddened by the book's support for the killing of non-perfect babies that I almost didn't finish the book. I'm glad I did, because the book on the whole is excellent. But the authors need to seriously rethink their ethics on the issue of abortion. What does it say about a society which gladly sanctions the killing of all less-than-healthy babies?

#2 - After addressing the issue of the multiple social issues facing pregnant and postpartum mothers (the birth situation, single parent epidemic, etc.), the authors present their idea of what should be done to remedy the situation. I found myself disagreeing sharply with most of this chapter. Their ideas, which are mostly political in nature, involve massive governmental programs and welfare assistance, and seem to be somewhat socialist in nature. I think that we could do women a big favor not by focusing on increased governmental control and involvement in family life, but by focusing on moral reform. Having a society in which men marry women before making babies and stay married to them for life will do a lot more for women and children than funneling governmental funding into social programs to try to fix the irreparable harm done to mothers, children and families by fatherless homes or dysfunctional families.

I don't mean to get off too much on politics, but the final chapter was fairly irritating. I'll stop now, though, before I turn this into a political blog.

Barring the above two issues, I loved this book and recommend it strongly to all.

Monday, November 10, 2008

Book Review: "Wise Woman Herbal for the Childbearing Year"

"Wise Woman Herbal for the Childbearing Year"
Susan S. Weed
1985, 196 pages

I have been reading madly lately, trying to get through all of my books that I've injudiciously over-borrowed, while at the same time procrastinating on writing book reviews, with the end result that many of the books I've borrowed have been returned long-since, while the reviews have remained unwritten. I am going to try, over the next few weeks, to catch up with book reviews so that I can move on to more books and other writings. I want to focus on Arizona birth resources for Arizona mothers soon, and I can't get to any of that until I get these reviews done!

"Wise Woman Herbal for the Childbearing Year" is one book which had to be returned to the library almost a month ago, but it is still sitting in front of me. Why? Because it was one of those books which are so excellent that possession of them becomes an immediate and obsessive need! So when hubby said, "Hon, I need a book to put on this Amazon order to get to the free shipping amount," I knew which book to order!

This book is a keeper. It is so much of a keeper that I can't even tell you how much I liked it! Suffice it to say that I will recommend it unreservedly to all and sundry I meet. It is truly excellent.

I have been getting into amateur herbalism lately, and finding reliable information about herbs in pregnancy literature can be downright frustrating. For example, a pregnancy book (even a naturally-minded one!) might say, "For morning sickness, take dandelion." Well, great. Do you mean fresh herb, dried herb, tea, infusion, decoction, fresh herb tincture, dried herb tincture, oil, salve, or compress? How often should I take it? What strength? How should I take it? How much at a time? This book is one of the few books that explicitly gives dosage directions. For example, "Ten to twenty drops of Witch Hazel tincture under the tongue can be used repeatedly to control bleeding until the placenta is delivered." (p. 71) It's terrific!!

The book is arranged in chapters by time period (pre-conception, pregnancy, labor/birth, postpartum, baby), with a great chapter on making your own herbal products and several helpful appendices. Within the chapter, various complaints and conditions (hemorrhage, cramps, etc.) are listed alphabetically for easy access.

Another thing I love about this book is that for each condition, there is a section on "prevention" as well as a section on "what to do if you have this condition." That is just terrific! I love to be proactive. For example, with my delivery I had horrendous after-pains, something which is supposed to be negligible or non-existent for primips. Since they generally increase in intensity with each pregnancy, I know that I can expect them with any future pregnancies, and now I have the preventative advice of this book to help me prevent afterpains with pre-birth herbs. Hurray!!

There is one chapter in this book which I found very disappointing, but I won't elaborate further. On the whole, this book receives my complete applause and approval.

When I told my midwife that I was reading this book, she told me that she keeps multiple copies both at her home and at her office because it is so vital to her practice.

This book is indispensable, and I love it! Highly recommended.

Friday, October 24, 2008

"A Brief History of Midwifery in America," or, "Why on Earth Are There So Many Kinds of Midwives?"

I've been wanting to write an article on this subject for a long time, but didn't have time to do the research - and then I found a book which had done that research for me! Thus, most of the information for this article is taken from "Mainstreaming Midwives: The Politics of Change," edited by Robbie Davis-Floyd and Christine Barbara Johnson. I will be reviewing this book (in glowing terms!) very soon as well, but I wanted to write this article as soon as I could, as I need to return the book to my midwife on Sunday. So here goes!

Midwives are still, for the most part, America's best-kept secret in terms of health-care practitioners. When I was in Border's last year buying a copy of Elizabeth Davis' "Heart and Hands," the clerk said, "Do midwives even still exist? You're kidding!" Yes, Virginia, there really are midwives! Alive and thriving (and growing!) but unfortunately still attending only about 1% of all births.

However, for those of us who do know about midwives, the sheer number of midwife "titles" can be overwhelming and confusing - certified nurse midwife, certified midwife, certified professional midwife, lay midwife, licensed midwife - and more!

The purpose of this article will be to briefly (and incompletely, I'm afraid) examine the history of American midwifery and throw some light onto the differentiations between types of American midwives.

The history of American midwifery is a long and conflicted story which has unfortunately not always been a positive one. The story of midwives in the early part of the 20th century was marked by persecution and witch-hunts (still going on, unfortunately), and in the latter part of the century was marked with internal strife and divisions which led to midwives oftentimes fighting amongst themselves over ideological differences rather than uniting as a common front.

To begin....

In 1900, only 1% of births took place in hospitals. By 2000, those numbers had reversed, with only 1% of births taking place at home. How and why did this change occur? It occurred because a decision was made by the medical profession that birth was profitable and midwives, therefore, needed to go. A massive propaganda campaign was launched against midwives, with midwives portrayed as dirty, ignorant, old-fashioned, archaic, disease-carrying crones who were unsafe care-givers and who were practicing medicine illegally. This campaign was especially effective with immigrant mothers, who wanted to forsake everything having to do with the Old World and become as "American" as possible - and being "American" soon came to mean having a male obstetrician delivering one's babies in a hospital (and giving formula, etc.).

Unlike European midwives, who were well-organized in trade unions and professional organizations and were able to protect themselves and their profession, American midwives were not well-organized, or even organized at all. They were isolated, working within their own ethnic groups, with little to no communication with other midwives, and had no professional organizations. To put it vulgarly, they were sitting ducks who went down with one shot - they were not able to resist the combined efforts of the government and the medical establishment who were bent on eradicating them.

Of course, lay homebirth midwives never completely disappeared - but their numbers were greatly reduced and they were forced to practice underground.

Midwives who wished to continue practicing legally made a monumental decision, one that affects American midwifery to this day - they decided to unite with the respected position of nursing. Thus, in 1925 Mary Breckenridge formed the first organization uniting nursing and midwifery, the Frontier Nursing Service, bringing midwifery care to the Appalachian poor, and the profession of nurse-midwifery (eventually producing the certified nurse-midwife) was born.

In 1930 a second nurse-midwifery institution was opened - the Lobenstine Clinic in New York City, later home of the nation's first nurse-midwifery program. This clinic met the needs of poor, inner-city women and was staffed by nurse-midwives.

Initial efforts of nurse-midwives met with success. There was a notable lack of opposition from obstetricians because of the clientele that the midwives were serving - most obstetricians did not want the "down and dirty" jobs of providing care to the poorest-of-the-poor or to mothers in extreme rural districts. Midwifery survived by meeting needs no one else wanted to meet, and by finding a niche for itself there. Nurse-midwives also survived by proving their worth with excellent statistical results and by finding small numbers of physicians sympathetic to their cause who would support them and work with them.

Thus, nurse-midwifery gained a foot-hold in American maternity care, but growth for the profession was extremely slow. Additionally, many of America's nurse-midwives were lost to the system in that they decided to pursue careers overseas in missions work or left the nurse-midwifery profession altogether and worked in health-related fields.

Also, at this time nurse-midwifery was not synonymous with hospital birth, as it often is today - many nurse-midwives attended home births or worked in maternity centers. Thus hospital births were attended primarily by obstetricians.

In 1929, six nurse-midwives from the Frontier Nursing Service formed the American Association of Nurse-Midwives. This was not a professional organization, but an attempt to focus on providing better maternity care for women and babies.

However, the lack of a true professional organization for the nurse-midwives was soon felt. Unable to find a good niche for themselves in other health-care professional organizations, nurse midwives in 1955 formed the American College of Nurse Midwives (ACNM), still extant today. Their initial goals were to develop educational standards, sponsor research and participate in the International Confederation of Midwives. The formative purpose of the ACNM was to promote and protect the profession of nurse-midwifery, and in doing so it was an enormous step forward for midwifery.

At the same time, the baby boom was occurring, and city hospitals were overwhelmed with the sheer number of birthing mothers. To reduce costs and meet staffing needs, hospitals began to hire large numbers of nurse-midwives, and thus the transition of nurse-midwifery into a hospital-based instition began - and has really never reversed. Nurse-midwives now overwhelmingly work in hospitals and attend hospital births.

There were several positives to this shift into hospital-based work. Nurse-midwives were now able to serve more women, able to increase their knowledge-base by serving cases with complications (which in homebirths would have been risked out to hospital care, as they are today), able to better serve the needs of the poor, and also able to more firmly establish themselves in the maternity system. Because of the shift into hospital-based work, more nurse-midwifery schools opened and there was steady employment for larger numbers of nurse-midwives.

However, there was also a negative side to the shift into hospitals. Primarily this was seen in nurse-midwives' loss of autonomy and increasing subordination to doctors. Rather than always being independent practitioners in charge of women's health-care, nurse-midwives were now subordinate to the doctor in charge, and in many cases became nothing more than glorified obstetrical nurses (something that holds true today).

In-hospital conflicts for nurse-midwives have never disappeared. Although nurse-midwives are still entrenched in the hospital system, they are still often treated as nurses and are under the authority of physicians. Additionally, because of intervention-heavy hospital protocols, they are often forced to practice against the midwifery model of care, resulting in births that are midwife-atended but still heavy on unnecessary and dehumanizing interventions. Also, the training and hospital work of nurse-midwives can unfortunately produce midwives who are more obstetrically-minded than midwifery minded (called "med-wives") who are no longer practicing according to midwifery standards but have conformed in both thought and behavior to the model of mainstream birth as a medical event. Thus, although nurse-midwives are able to provide hospital midwifery birth services to women who want hospital births (which is the majority of modern American women), their practice and sometimes their beliefs can be negatively altered by their chosen place of practice.

For nurse midwives, the shift to hospital-based work was so complete that in 1973 the ACNM published a statement against homebirth, saying that the hospital was:

"the preferred site for childbirth because of the distinct advantageto the physical wefare of mother and infant" (ACNM 1973, quoted in Rooks 1997:67, quoted in Davis-Floyd 2006:36)

(This statement was retracted in 1980.)

During the 1960's and 1970's the profession of nurse-midwifery made great strides. Although in 1963 there were only forty nurse-midwives practicing in the United States, the ACNM was making great strides in terms of developing the profession of nurse-midwifery. In 1965 the ACNM developed their accreditation process, and by 1970 it was administering national certification and accreditation for all nurse-midwifery programs. In 1978 the ACNM defined the core competencies for nurse midwifery (core competencies are "the fundamental knowledge, skills, and behaviors that are the expected outcomes of..... education", p. 38) and by 1980 there were nineteen nurse-midwifery education programs, with nurse-midwifery legal and protected in 41 states. Nurse-midwives attended approximately 1% of all American births.


And now we examine the other side of the coin: We will examine the story of the lay midwife, also called the direct-entry midwife (DEM) who is not a trained nurse and who often learned her trade by apprenticeship.

In the 1960's and 1970's there was a reactionist movement (mixed together with the countercultural and feminist movements) against the extreme medicalization and often brutalization of birth in American hospitals. At the time women were isolated from family during birth, physically restrained, and forcibly anaesthetized during the birth process. Both mothers and babies suffered from the drugs used on them, breastfeeding was discouraged, and babies were isolated in newborn nurseries.

"From the 1930's to the 1970's scopolamine was heavily employed. A psychedelic amnesiac that was supposed to take away memory, this drug often did not render women unconscious during birth, but rather made them wild. They were strapped down with lamb's wool bands (which did not leave marks on thier arms) and often left alone to scream until the baby finally came; many women were subsequently haunted by spotty nightmarish memories. Technological interventions such as forceps and episiotomies became increasingly common as humanistic care for birthing women became increasingly rare." (p. 38)

Some mothers, helped by certified nurse-midwives, tried to change and improve hospital birth for the better. Benefits gained during this time included getting fathers into the delivery room, permitting mothers to labor without being restrained and the promotion of conscious birth and breastfeeding. However, change was limited and slow.

Frustrated with slow change, women within this movement began to give birth at home. Since there were oftentimes no midwives to attend them, these women became each other's midwives - attending births of friends and families and slowly building their knowledge-base by experience and self-teaching. They became the first generation of the resurgence of the lay midwife. As time went by lay midwifery grew in numbers and knowledge, formed relationships and began producing literature, such as Ina May Gaskin's "Spiritual Midwifery."

Lay midwifery was not well-received by nurse-midwifery. To put it succinctly, "They're destroying everything we've worked for!" Nurse midwives stood for credibility, professionalism, standards of care, medical orientation, protocols, etc. Lay midwifery stood for women's rights and natural birth and was often hippie-ish and spiritual in nature (especially in the early days), making nurse-midwives fear for the credibility of midwifery professionalism. Thus began a conflict between schools of thought in American midwifery which has never been completely healed, and which has often caused deep and bitter resentment and divide between the two camps. (In fact, the divide and the conflict has often been so deep and problematic that American midwifery has been used by other nations, Canada in particular, as a model of how not to do midwifery.)

In 1981, Sister Angela Murdaugh, then-president of the ACNM, met with a group of lay midwives and, in a controversial move, urged them to organize and create principles of practice by which lay midwifery could be organized and made more professionals. Sister Angela received a great deal of opposition from within her own ranks in the ACNM - many nurse-midwives felt that lay midwives should either be discouraged from practicing altogether or encouraged to become nurse-midwives and join the ACNM. However, Sister Angela's courageous move gave impetus to the lay midwifery movement and started wheels turning for the organization of lay midwifery. However, the two professions remained separate and did not in any way unite. Although the ACNM had in 1980 made a counter-statement now supporting homebirth, the ACNM did not open to lay midwifery until 1994 - by which time lay midwifery was already well organized on its own and did not need the ACNM's help.

And so the stage was set for one of the biggest accomplishments for lay midwifery in America - the formation of the Midwives Alliance of North America (MANA), a coalition formed by lay midwives and some sympathetic nurse-midwives. There was no nursing requirement for membership, as nursing was seen by nurse-midwives to be detrimental to the practice of true midwifery, the two having completely different philosophies and knowledge-bases.

"As these original lay midwives became more sophisticated in their understanding of the details of medical training an dpractice, they saw quite clearly that what they were seeing at homebirths often did not reflect what they were reading about and seeing in hospital birth. Understanding that they were developing a different knowledge system, over time they sought to develop educational methods and programs that would perpetuate that systyem, and to avoid incorporation into the more medicalized nurse-midwifery approach." (Anne Fry, quoted on p. 43)

MANA and lay midwifery thrived despite ill-wishes of the medical and nurse-midwifery community and despite active persecution law enforcement. Occasionally supportive CNM's joined MANA as well (MANA valued inclusivity and welcomed nurse-midwives).

However, MANA was not then an official professional organization because, at the time, it had no ability to enforce its core competencies as educational requirements, and thus was open to the accusation of illegitimacy as an professional organization.

In the late eighties and early nineties, meetings called the Carnegie Meetings were held between MANA and the ACNM to try to create much-needed unity. While each deemed that their core competencies were equivalent, the philosophical divide between the two was too great to achieve unity.

One of the most deeply divisive issues at hand was that of apprenticeship. ACNM holds that apprenticeship is an invalid and incomplete method of training, and that only a university degree can validly qualify a midwife. MANA holds that apprenticeship is a valid route to midwifery training, and furthermore, that it is an essential method that preserves the midwifery model of care, and additionally, that university training in a traditional setting can be destructive to the formation of holistically-minded midwives.

(Speaking as a woman who was cared for by apprenticeship-trained midwives, I wholeheartedly agree with MANA's position and view apprenticeship as vital and essential to midwifery education. I now would not want to be under the care of a midwife trained any other way. - Author)

In 1991 MANA created the Midwifery Education Accreditation Counsel (MEAC) which was recognized by the US Department of Education in 2001, comparable to the ACNM's Department of Accreditation (DOA) which was recognized by the Department of Education in 1982. Thus MANA was well on its way to becoming more "professional." MANA recognized the need for a mechanism to prove the competency of its midwives. Most lay midwives had already dropped the term "lay midwife" for the term "direct-entry midwife" (DEM), by which they meant apprenticeship-trained or non-university-trained midwives. Thus, by 1994, MANA's daughter organization the North American Registry of Midwives (NARM) had developed into a testing and certifying agency and had developed the Certified Professional Midwife (CPM) credential, a credential that recognized formal training, self-training, apprenticeship training and portfolio work for credentialing as well as designing the NARM written and practical exam for licensing.

"CPM certification is competency based; where a midwife gains her knowledge, skills, and experience is not th eissue - the fact that she has them is what counts." (p. 53)

At the same time, certified nurse-midwives were reexamining their self-identity. Many wished to break with nursing, for some of the following reasons: (1) they were tired of being treated as glorified nurses, (2) they desired autonomy from doctors and state nursing boards, (3) Physicians Assistants had started attending births, and (4) the realization that only some nursing knowledge is needed for midwifery. Nurse-midwives thus created the Certified Midwife (CM) credential, a certification that maintains the tradition and philosophy of nurse-midwifery without the nursing requirement. Nurse-midwives refer to the CM as their direct-entry midwife, creating some confusion as to what a DEM really is.

In summary, America has two basic types of midwives:

Type #1: Nurse Midwife
Includes: Certified Nurse-Midwife, Certified Midwife
Professional Organization: ACNM (American College of Nurse Midwives)
Accreditation Organization: DOA (Department of Accreditation)
Location of Practice: Mostly hospital, occasionally birth centers and home

Type #2: Lay or Direct-Entry Midwife (DEM)
Includes: Lay Midwife, Licensed/Unlicensed Midwife, Certified Professional Midwife
Professional Organization: MANA (Midwives Alliance of North America)
Accreditation Organization: MEAC (Midwifery Education Accreditation Counsel)
Location of Practice: Home (may not practice in-hospital in America)

A few other notes:

The legality of homebirth DEM's differs greatly from state to state. In about ten states (poor pitiable places) lay midwives' work is 100% illegal, and midwives must work underground. In other states it is "a-legal" - neither legal nor illegal, but midwives maintain a tenuous position of being open to prosecution in cases of poor neonatal or maternal outcomes. In other states (such as Arizona, hurray!) midwives are legal and may practice openly, though they still deal with backward attitudes in hospitals and from doctors.

Midwives' legal scope of practice varies widely by state as well. For example, homebirth midwives may deliver twins in California, but not in Arizona; they may deliver VBAC babies in Utah, but not in Arizona.

Additionally, some states allow midwives to practice while unlicensed, such as Utah and Oregon (Arizona doesn't).

I'd like to look at a few other terms:

"granny midwife" - a term for an elderly female midwife, usually black, who served her ethnic community, generally in the deep south. These women were effectively put out of business by the health departments.

"plain midwife" - a midwife, usually unlicensed and unregistered, who works (often unpaid) among her religious or ethnic community. Examples are Amish & Mennonite midwives, and midwives who serve Mormon communities and Christian Scientist communities

"renegade midwife" - there are a couple of different types here:

(!) a midwife who practices without sufficient training and is dangerous to the community - few and far between, but it does happen. These are not licensed midwives, but unlicensed lay midwives who branch out on their own when they should still be studying or learning under apprenticeship

(2) a midwife who practices outside the legal scope of practice for her region but is generally considered responsible by the midwifery community. For example, a midwife might attend VBAC homebirths, which are considered safe by midwives (VBAC's are generally only risky when labor-augmenting drugs are used) but are often illegal by state licensure laws

(3) a midwife who attends women at home in risky situations, such as triplets, etc. These women can be risk-takers but are often valued by the community as midwives who keep options open for birthing women. (I, for example, support a woman's right to birth how she wishes, even if a hospital birth is medically indicated. But midwives who don't want to endanger their licensing or ability to practice are often reluctant to take on such mothers, even though they support mothers' rights. This type of renegade midwife ensures that mothers retain their rights even when other homebirth midwives have to turn them away. - Author) However, they can give the midwifery community a bad name.

Midwifery in America is a constantly growing, changing, evolving profession, and one which I am glad that I now know of! I love midwives and am so happy to have several among my close acquaintance.


That's about it! If you see any omissions or errors, please contact me, as I want the above to be as accurate as possible.


Postscript on January 5th, 2009:

The Mommy Blawger sent in the following comments, which I wanted to add below, as they're both very pertinent points which I should have included in the article:

"I will make just one or two additions. First, since the rise of the CPM credential, the term "lay midwife" has taken on an almost pejorative meaning, and is almost exclusively used (at least by midwives) to refer to women without any formal midwifery training or credential.

"Second, many (including myself) believe that there is no such thing as an "alegal" state. Either a state recognizes/permits/regulates direct-entry midwifery, or it doesn't. In a state where midwifery is not "authorized", even if there is no statute specifically prohibiting DEMs, a midwife runs the risk of being charged with practicing medicine or nurse-midwifery without a license, or a number of related offenses. You can see that in states such as Pennsylvania, which was formerly described as "alegal", it took only one bad outcome for the powers-that-be to start actively prosecuting midwives.

"Your readers may be interested in this resource for more on the legal status of midwifery:

Wednesday, October 22, 2008

Mainstream Birth: It's Not Just the Docs

Today I was sitting in a public place (researching midwifery, oddly enough) and happened to overhear a somewhat saddening conversation between two women, one of whom was pregnant. I'm going to try to piece it together here for you, with details obscured... I'm not guaranteeing accuracy, as this is from memory, but you'll get the gist.

Woman (not pg): So, when's your due date?
Pregnant Mother: {mentions date}
Woman: Well, my last couple of babies were cesareans. We had my last one two weeks early so his birthday wouldn't be too close to Christmas.
Pregnant Mother: Oh, that's cool!
Woman: Yeah, I mean, when their birthdays are on Christmas, they don't get the special treatment that everyone else gets. My {mentions relative} has two kids who were born just before Thanksgiving and just after Christmas, and they never get real birthday parties. And I'm thinking, "Gee, couldn't you have planned better than that?" Those poor kids!
Pregnant Mother: That's a good idea. I'll keep it in mind.

My goodness! Scheduled prematurity so your child can have "real birthday parties"???? Is this what we're coming to? What ever happened to letting a baby come when he is ready?

As much as we vilify ACOG (and they definitely deserve some vilification), we must, as women, take responsibility for the birth situation as well. Unethical birth practices only exist because we submit to them and sometimes actively encourage them by willing participation and willing ignorance. If we refused to participate, hospitals and doctors would follow suit.

Food for thought!

Tuesday, October 21, 2008

Childbirth in Vintage Movies: "Blue Skies"

I had an interesting experience the other day - getting to watch a vintage childbirth scene from a 1946 film, "Blue Skies" with Bing Crosby and Fred Astair.

First of all, as an aside, I should say that I now understand why a movie with two such phenomenal actors is not well-known - talk about overdone!! This was supposed to be Fred's last movie (it wasn't), so they pulled out all the stops for it - they had a song and/or dance number about every five minutes. Literally. It was extremely tiresome! Combined with a weak plot, it made for a movie that we probably won't be watching again.

Anyhow, there was an unexpected childbirth scene in the movie that I found very interesting. Here's what you see: Bing Crosby pacing with his friend in a lobby in front of a newborn nursery. The nurse comes out with a baby and shows it to him, then takes it away. The doctor comes out and Bing immediately says, "Can I see her, doctor?" The doctor says, "Well, I don't know - she's still kind of sleepy." He rushes in anyway, in time for a conversation with a half-unconscious wife. The next scene is of them giving a bottle to the baby.

Okay, let's unpack this for just a minute. Here's the reality of what would have happened:

During labor, the wife (Joan) would have been isolated from her family and then doped out of her mind with various drugs, including scopolamine. She would have been strapped down to a delivery table in the lithotomy position (flat on her back, head lower than her legs, legs tied into stirrups). For the actual delivery she would have been (either willingly or forcibly) drugged into complete unconsciousness. The doctor would have cut one heck of an episiotomy, dragged a near-unconscious infant out with forceps, and spanked it vigorously to it breathing (a drugged mother is a drugged baby) and then toted it off to the newborn nursery. Not only would the mother not have been conscious for the birth, but she probably wouldn't have seen her baby for some time (and would be too drugged out to care). She would have been discouraged from breastfeeding and told to give the always-superior formula.

The arrogance of humanity astounds me. God has given us a perfect process in human childbirth which is self-contained and needs (in most cases) only loving support and encouragement. But in every age since we've been able to do so (including the present time) man has with the utmost conceit assumed that a perfect process needs improvement by humanity, and thus has created such atrocities as scopolamine-drugged births in the 1950's and a now 32% cesarean rate in the 2000's. Sad.

This just makes me mad because I know how important a woman's birth experiences are to her. Rather than go on a rant, I'll just refer you to my entry below this one.

A couple of years ago, I would have seen this scene and thought it merely sweet. After all, they abound throughout film - "I Love Lucy," etc. And modern childbirth scenes in the media are really no better. There's always the emergency situation, the "rescue" by the godlike doctor, the unnecessary interventions accepted by unknowing mothers as good and needed. Gee whiz, you'd think we could improve out of this mess!

Enough grousing! Back to what I should be doing!

Tuesday, October 14, 2008

Why Natural Childbirth?

I wanted to share a few thoughts on this topic - in other words, why would any sane woman in the 21st century choose natural childbirth when there are so many chemical methods for pain relief?

(This is separate from an upcoming entry, "Why Homebirth?" which is related but separate. One can have natural birth at home or in hospital (although it's much tougher in hospital), but the benefits of homebirth aren't transferable to a hospital - so I'll write on those later.)

What is natural birth? Most obviously it is birth that is untainted by artificial chemicals, either in the form of induction/augmentation agents (pitocin, misoprostol, etc.), or chemical pain relief (epidural, spinal, narcotics, etc.). Actually, I should correct myself... There are different definitions, depending on who you ask. In the mainstream birth world, "natural birth" generally just means birth without chemical pain relief, regardless of whether or not the mother was artificially induced or had an artificially augmented labor. "Pure birth," which I experienced and which I highly recommend, is the technical term for birth which is completely free from any chemical interference (and generally other externals such as an IV or continuous fetal monitoring).

There are deeper facets to natural childbirth, which would include things like natural birth positions (squatting, standing, etc.), immediate skin-to-skin contact with baby, delayed cord clamping, continuous labor support, no directed pushing, etc.). However, for the purpose of this entry I am going to focus on the "chemical" parts - I will define natural birth as birth in which the mother receives no pain medication, and ideally no labor induction or labor augmentation drugs. (With a national cesarean rate of about 32% and a national induction rate of around 40%, you can bet that any of the above is pretty stinking rare.)

First, let's get the obvious out of the way. Natural birth is way better for baby and mother. This is not hard to understand or to prove. Fewer cesareans (a first-time mother with an epidural is roughly four times as likely to end up with a cesarean as is an unmedicated mother), fewer long-term health effects on mom and baby, better bonding, you name it. The health benefits of natural birth for mother and baby are endless. This point isn't even up for debate, it's been so well-proven. Period. End of story.

But there's a bigger story.

Let me tell you my own experience, briefly.

I hated childbirth. Every minute of it. It started out uncomfortable, and worked up to excruciating - and stayed there. I basically screamed for the last six hours of it. It was hell on earth. In fact, as soon as it was over, I turned to my husband and told him that childbirth should be a Christian missionary's best friend, because there is no closer analogy to hell on earth. I didn't even experience the classical "birth ecstasy" of the unmedicated mother - the "my baby, my baby!" moment. I just wanted to crawl in a hole and die. I felt awful, birthing the placenta was also excruciating, and I immediately had afterpains so badly that I couldn't stand to nurse (and they hung around for over six weeks, dang it!!). If you look at my birth pictures, I am not even smiling because I was exhausted and in pain.

I'm not saying this to be discouraging - I just want the reader to know that I DO know how bad childbirth hurts. It hurts big-time. For me it was eighteen hours of torture. If I had been in the hospital I would have requested an epidural about ten hours before our son was born (another reason I'm glad I wasn't in the hospital!). Many women say that they experience childbirth as spiritual, that that they find "their rhythm," etc. I didn't. It was horrible start-to-finish.

Then, the intelligent reader asks, why are you now a proponent of natural childbirth/homebirth with a blog devoted exclusively to the subject? Are you stark, raving mad?

Let me continue with my story.

It is hard to explain this, but in the days after my birth I experienced the most amazing spiritual transformation. Next to Christian salvation, it has been the most amazing life-change - one that I could not have anticipated, and one that I cannot even fully describe. I will say this, though - Who I was before natural childbirth was not who I was after experiencing natural childbirth. It was a complete transformation, one which still awes and amazes me and which is completely beyond my understanding.

For one thing, I am now much more self-confident. I know that I am competent and able to do whatever I need, because I have done the most difficult thing that any human being can do. My body is amazing, and frankly, so am I! I withstood that tremendous pain and got through it - and I can do ANYTHING now. I have lost all amazement for athletic feats. Someone climbed Mt. Everest? Ran a 3-minute mile? GIVE ME A BREAK!!! I came through natural childbirth!!!!!

For another thing, natural childbirth also greatly healed my self-image. I, like the other 99.99% of American women who have been brainwashed into only seeing beauty in quasi-anorexia, definitely had issues with seeing my body as anything but flawed. But natural childbirth showed me the brilliant complexity and functionality of my body in ways that I could never have imagined. My body is "wonderfully and marvelously made," and I gained immense respect for it and for myself. Now, post-pregnancy, my body has way more issues than it did before - stretch marks galore, ten extra pounds and proportions so radically different I probably wouldn't recognize myself from before. But my self-image is much more positive and affirming, and I have learned to be grateful for the amazing things that my body can do - regardless of whether or not I look like a supermodel.

For another thing, I feel that in many ways that natural childbirth was truly my "coming of age." This was truly that transformation point for me. It wasn't puberty, high school graduation, sweet 16 (or 18 or 21), first date, first kiss, marriage, sex, pregnancy - no way. Not even close. It was natural childbirth. It was truly the coming of age for me. I can't say how or why, and I certainly didn't expect it. It just was. Some part of me just matured and ripened over that 24-hour period and emerged as a woman. I believe that there is some part of woman's soul that is tied to the experience of childbirth. If you ask almost any woman who has experienced natural birth, she will generally agree with this without even thinking about it (and will often go into detail about it!).

I need to add something here: It's hard writing the above, because there are some women who can't give birth, due to singleness or infertility. One of my close friends is dealing with longterm infertility right now, and it is a heart-wrenching process (another proof that birth is important to women!). I believe that that things are different spiritually for women who cannot physically give birth - that God provides other methods of maturation and self-discovery and spiritual growth. God is a God of individuals - no one is left out of spiritual growth opportunities in the economy of God. But speaking for myself, I know that there was a depth to my soul that could only be reached with unmedicated birth. And that's something I never would have guessed before my birth experience.

Some might say, "All of the above was just from childbirth - not natural childbirth." Nope, not at all. The pain of labor and birth was inextricably wrapped up in transformative effects of both. For me, childbirth was a "baptism of pain." It taught me to reach out to other women, my midwives and doula, and to see how much true love and friendship there can be among female friends, and how comforting women can be to one another during birth. It taught me compassion for other birthing women and for people who must endure pain. It taught me the great kinship that I experience with women throughout the ages of history who have endured the same thing to bring the human race into existence. It taught me to value my baby greatly, because he was birthed through my pain - and is unutterably precious.

From a Christian perspective, experiencing natural childbirth gave me a deeper understanding into the meaning of the Bible passage, "But women will be saved through childbearing" (I Tim 2:15) This is not referring to salvation from eternal death, but to something quite different. There are many different interpretations and lines of thought on this passage. But to me it has become clear that God has used the "curse" of the Fall (for man, hard and unproductive labor in their lifework, for women, pain in childbirth) to also be our greatest blessings. Who would deny that men find some of their greatest blessings and self-identity through hard work and discovery/industry/building/etc.? And I know now that women can find some of their deepest grounding, meaning, and self-identity in the pain of childbirth. Our curse has become our blessing.

But frankly, there is just so much to this transformation that I just can't describe it. If anyone would like to write a comment and give me a hint as to what I ought to be writing, I would appreciate it and will add it in! I can only say that natural, drug-free childbirth was an earth-shattering, life-changing transformation that will be with me for the rest of my life. I am even eager to go through it again, just because of that. And I have the deepest sorrow for all the women who do not get to experience this transformation because they have been cut open or drugged. I want every woman to experience this tremendous blessing and transformation - and that's one of the main reasons this blog is here.

Having a baby is more than a messy, unpleasant process that one must endure to get a baby. When people hear a horrible birth story and say, "Well, at least you have a healthy baby! That's what matters!" they completely miss the point. A woman's birth stories are part of her identity and will affect her profoundly for the rest of her life. Many women spend years and subsequent births trying to heal from cruel and demeaning treatment during previous births, or births that were in one way or another traumatic. Yes, the baby is the most important thing, but a mother's birth experience is a close second. There is nothing like it in the world, and I hope to spend the rest of my life promoting natural birth for this reason.

Email me with comments and questions!

Thursday, October 9, 2008

A Brief Interlude

As I wrote on my other blog, I'm afraid that both of my blogs have been terribly neglected lately. We're in the busiest time of the year for our family and church (Bible studies, holiday prep, play groups, etc.), and we're also in the middle of a home purchase (it has only taken us 15 months of searching and 11 bids to find one!!). If all goes as planned, we should be moved in before Christmas. Of course, getting our life in order will take much longer. It generally takes me about 3 months to get settled into an apartment (and I've never done it with a toddler before!!), and with unpacking plus yard work (something new!) and home repairs/upkeep (also something new!) I wouldn't be surprised if it took us till June or longer to get really settled down.

Of course, I won't neglect this blog till June! But it may be a bit slow between now and the holidays.

I'm having a bit of confusion as to how I ought to formulate this blog - there is a conflict between the purely "official" - i.e. information, book reviews, statistics, etc., and the personal - my personal journey into the homebirth community. I would like to have a good mix, but I don't know if the two can mix. It'll be interesting to find out.

In terms of my personal journey, I have just been spending a lot of time reading, interacting with the Arizona Birth Network Yahoo! Group (this is a great source of information - try it!!!) and attending birth circle meetings. I haven't yet received the great epiphany into what I am destined to do in the homebirth/childbirth community. I may get the opportunity to participate in a doula training in February, though, and that should be a wonderful source of information and inspiration.

And now I'm off to retrieve some now-incinerated sweet potatoes from the oven! More later!

Sunday, September 21, 2008

Book Review: "From Here to Maternity"

"From Here to Maternity"
Connie Marshall, RN
1994, rev. 2002, 291 pages

I found this book randomly at Goodwill a couple of months ago (along with four other pregnancy books - someone was cleaning house, hurray!) and picked it up to read.

This is a nice little book. Really, I found myself with mixed feelings over it. It's great on the one hand and not so great on the other. The good part is that it is (except for various biases and inaccuracies) a great source of material. The bad part is that it is not a book that leans toward either natural pregnancy or natural birth. If you are already educated about natural birth, then it is probably a great book to read for information. If you're just starting out, make sure that you include a good selection of naturally-minded books along with this one.

I found a surprising number of inaccuracies in this book, along with some obvious bias for the medical (as opposed to holistic/midwifery) model of care. Let's look at some of these areas to start:

Let's start with the worst of the worst. This statement BLEW ME AWAY in its blatant falsehood:

"An epidural does not increase your chances of having a cesarean." (p. 86)

What???? People have the right to be in favor of epidurals (I sure was when I was in labor!), but they do not have the right to lie about them. Here is the truth of the issue: A laboring woman who has an epidural is roughly four times more likely to have a c-section than a woman laboring without one. Don't believe it? Here's the study:

Association of epidural analgesia with cesarean delivery in nulliparas

Why is this so? Many reasons. Hormone disruption, laboring on one's back, cascade of interventions (including pitocin augmentation to replace the uterine activity usually lost with an epidural, leading to fetal distress, etc.) - there are a number of reasons why things start to go wrong once a mother accepts an epidural. This is especially true of mothers who get epidurals early in labor - the earlier you get an epidural, the higher your chance of a c-section (see section in "Hey! Who's Having This Baby, Anyway?" by Breck Hawk for more information on this subject).

So anyway, that statement made me upset. It is blatant disinformation and should not be present in a well-researched pregnancy book.

Here's the second mind-blowing statement in this book (talk about unsubstantiated bias!):

"The decision for a home birth transcends economic and safety considerations because of a deep emotional commitment to a home birth experience." (p. 83)

Basically, "If you are having a home birth, you're a mindless fanatic who doesn't care about your safety or your baby's safety because of your illogical devotion to a cause." This is in spite of the fact that numerous reputable studies have repeatedly shown homebirth to be as safe or safer than hospital birth, with overwhelmingly more positive birth experiences for the mother and more gentle treatment for both mother and baby. Hmmm. Interesting.

However, following that degrading statement, Marshall does give some good guidelines on choosing a homebirth midwife. Kind of weird, but at least it's there!

Here are a couple more...

"If you and your doctor opt for inducing labor, skip to the induction section - your prayers have been answered." (p. 122)

Considering the myriad of problems for both mom and baby that are started by unnecessary labor induction (and with our induction rate at about 40%, you can bet that most of them are unnecessary), a good pregnancy book should never encourage or make light of this subject.

The following is another mind-blower - it is filled with so much falsehood that it was hard to read:

"Before electronic fetal monitoring, the labor nurse listened to the baby's heartbeat once an hour for 15 seconds; it didn't provide a wealth of information. As a result, some cesareans were done for fetal distress that wasn't there. Some babies who were distressed were missed because a stethoscope couldn't pick up subtle clues the electronic monitor can. More than a few cesareans have been avoided because the heart rate pattern was reassuring. Overall, the fetal monitor has had little impact on the cesarean birthrate... In many cases, fetal monitoring heads off disaster by detecting early signs of fetal distress." (p. 146)

Now, for the actual truth of the matter:

- Intermittent monitoring with a fetoscope, stethoscope or handheld Doppler has been proven to be as effective in monitoring fetal well-being as is continuous electronic monitoring.

Why Are We Using Electronic Fetal Monitoring?

- Continuous electronic monitoring has had absolutely no positive effect on the fetal mortality rate or on rates of birth-related damages to babies. On the contrary, it has been linked to an astronomical increase in the rate of cesarean births.

Association of electronic fetal monitoring during labor with cesarean section rate and with neonatal morbidity and mortality.

- Continuous electronic monitoring is infamous for both false positive readings (looks like something's wrong when it's not) and false negatives (everything looks fine when it's not)
- Continuous electronic monitoring is also a tool used by many unscrupulous caregivers to influence reluctant mothers into unnecessary cesareans

Moving on....

On episiotomy:

"It all boils down to being flexible and trusting your doctor to make the appropriate decision at the time. Most women who have a regular midline episiotomy agree that it's no big deal. The incision heals rapidly and the discomfort is minimal - you don't need pillows to sit." (p. 174)

Point #1 - I think there might possibly be some women out there who would disagree with that. Just possibly.

Point #2 - If I make it clear to my care provider that I do not want an episiotomy, then I expect my wishes to be honored. If an episiotomy is really necessary, then he/she can ask for and receive my permission. But I'm certainly not going to sit there and say, "Do whatever! I don't need to know, just feel free to cut without consulting me!"

Regarding internal fetal monitoring, in which an electrode is screwed into the baby's scalp:

"The procedure is probably no more uncomfortable for the baby than the contractions." (p. 177)

Hmmm. Hmmm. Hmmm.

No one is going to deny that internal fetal monitoring is sometimes necessary and beneficial. But to write off the baby's pain from the procedure (which is a highly unnatural pain) by comparing it to pain from contractions (which may or may not exist for the baby!) really seems like a cop-out.

Those are just a few of the inaccuracies I found.... But I won't go on.

Despite having started with the negative, I really did like this book. The author has a clear, concise writing style, a well-organized text, and a great sense of humor. Here's a great one:

"The herpes virus is the Greta Garbo of sexually transmitted diseases - elusive and mysterious." (p. 108)

This book is thorough (not too detailed, but still thorough) and covers all the usual topics very well.

One thing I love about this book is the diagrams, illustrations and charts - they are super-informative and very helpful.

This book also covers a surprising amount of alternative health care options - therapeutic touch, herbs, reflexology, pressure points, and more. I learned quite a bit that I didn't know!

I really liked this book. The only thing that keeps me from giving it unqualified recommendation is the fact that it is definitely within the medical model (rather than holistic), and is hostile to homebirth, midwifery care models and anything that swerves from mainstream pregnancy care. Thus, although I can't recommend it completely, I do recommend it - just make sure that you are reading other good-quality natural childbirth books at the same time.

Monday, September 15, 2008

Book Review: "Managing Morning Sickness" by Miriam Erick

The following is a cross-post from my other blog, "The Whining Puker":

"Managing Morning Sickness"
Miriam Erick
2004, 412 pages

After reading this book, I felt.... confused. Yes, definitely confused. And also irritated.

I liked the book better upon rereading it. It definitely has good information. So I guess that my review is mixed!

I want to start off with three big complaints.

First - This is not a book about hyperemesis. This is a book about morning sickness - ALL morning sickness - from the slightest queasiness to the severest case of HG. I am not sure that the choice to lump all forms of MS/HG together was a wise choice. What works for one will not work for the other, and what applies to one will not apply to the other. I found it confusing to wade through oodles of advice, only some of which applied to me.

Of course, I realize the quandary. Hyperemesis is not a well-defined condition, just because morning sickness is a spectrum/continuum condition. It progresses from mild to life-threatening, and the exact dividing point between garden-variety MS and HG is not well-defined - or rather, it is an artificial division that doesn't really exist! So it would be hard to separate the conditions for separate books! Still, it was confusing.

Which brings me to my second complaint - Miriam's definition of HG. First of all, she gives several different definitions of HG:

"The technical name for moderate-to-severe nausea and vomiting during pregnancy is hyperemesis gravidarum (HG)." p. 5

Although she admits that "Currently, there is no set of criteria that can delinate this spectrum," (p. 5) she later states that "On occasion a hospital stay to correct dehydration is necessary. If this happens, morning sickness becomes known as hyperemesis gravidarum." (p. 245)

She seems to stick with this definition, for the most part - she repeats it several times throughout the book. So, if you end up in the hospital, you had hyperemesis; if you don't, you didn't.

Speaking from a somewhat scientifically-trained background, this is the WORST possible way to define a condition - to define it based on the clinical action taken. Frankly, I don't know how she could even contemplate this methodology! Let's take some analogous situations to see how ludicrous this appears:

- "You only have pneumonia if you go to see a doctor. Otherwise it's just a bad cold."
- "You only have cancer once the doctors decide to do chemotherapy. Otherwise it's just your imagination."
- "You only have a broken bone if the doctor gives you a cast. Otherwise it's a strain."
- "You only have a bad cut if you get stitches. Otherwise it's just a scratch."

Conditions need to be defined symptomatically; not by end-results.

My own case is a good example. I know, by personal experience and symptom-matching, that I had a (mild) case of HG. If I had known then what I knew now, I would have gone to the hospital (and thus I would have "had HG"). However, we did not have insurance and I believed (falsely) that there was no medication to give to pregnant mamas for fear of harming the baby. Thus, we stayed home even though I was dehydrated and wanting to die. But if we had gone in, like we should have, then I would (by Miriam's estimate) have had HG! Since I didn't, I obviously didn't!!

A couple more examples....

- What about the woman in a third world country who doesn't have access to medical care? Well, obviously she doesn't have HG because she wasn't hospitalized!
- What about women who check themselves into a hospital unnecessarily? I once heard a doula describe an unbalanced, hysterical-type client of hers who constantly checked herself into the hospital for imaginary or minor complaints (including nausea and vomiting, which didn't exist). Well, obviously she had HG - because she was hospitalized!
- What about the woman who isn't hospitalized because her doctor is ignorant or insensitive and refuses to hospitalize her even though she needs it? Well, obviously she didn't have HG!

Forgive the sarcasm - but her definition did make me angry. You simply cannot classify a disease condition by what the medical community decides to do about it. It must be symptom-based.

My third complaint:

I realized about two-thirds of the way through the book that this book didn't have the same "feel" as other HG books I have read. It took me a minute to realize what it was, and then I realized that this book (as far as I could tell) was not written from personal experience. Miriam has not been through HG herself. How do I conclude that? #1 - She has no "my story" part of the book, something that will never be missing from an HG-mama's writings. #2 - She has a statement in the beginning of the book that pretty much clinches it (more on that later).

Hyperemesis is what I can only describe as a "path of darkness." It is an experience with the deepest physical agony and mental suffering - an encounter with deep, deep darkness. A friend of mine described it as "sliding into the Pit," and I highly concur. Writings of HG women (such as McCall and Schmitt) deeply reflect this experience with darkness. This book had no such reflection - it was mostly bright and cheerful. I found myself thinking, "Gosh, I was making a fuss over nothing! This is just a normal condition that can be treated sensibly like anything else."

This statement made me laugh, and it made me a bit mad at the same time. Here it is:

"Believe me I know exactly what you are going through - because I take care of women just like you every day of the year." (p. xxiv, italics in original)

Oh, my goodness! Miriam, don't write things like that! If you have not been through HG, you do NOT know what HG-mothers are going through. You may know about the condition, how to treat it, have empathy with HG-mamas - but until you've been there you will not know anything about "what you are going through" - and it is presumptuous to say that you do. If you have had HG, you need to state it. If you have not had HG, then I suggest the following rewording: "Believe me, I have a lot of experience working with severe morning sickness - because I take care of women just like you every day of the year."

Let's take an example: Imagine a male obstetrician leaning over a woman in transition (the hardest part of labor) and saying, "Believe me I know exactly what you are going through - because I take care of women just like you every day of the year." What would we do? We'd laugh him out to the parking lot!!!

For major life changes, disease conditions, suffering and crises, not one of us can say that "I know just what you're going through" until he/she has been there. I cannot truly know the hurt of infertility, the hurt of deepest grief, the hurt of losing a child (much as I may sympathize) because I have not been down those paths in my own life.

There's no reason why people shouldn't study or write about conditions that they haven't experienced. Counselors and pastors counsel people all the time who are going through disasters that the counselors themselves haven't experienced. Men can make great obstetricians. And I'm sure Miriam is a great dietition helping out HG mothers. But she should not say that she "knows exactly what we're going through."

Enough complaints (for the moment).... Let's move on to a survey of this book.

The first chapter deals with the question "what is morning sickness?" There are so many facets to this condition that it is actually a pretty hard question! Miriam lists some of the different facets of morning sickness:

- Nausea, vomiting, retching
- Aversion to odors
- Aversion to bright lights
- Aversion to noises
- Aversion to tight-fitting clothes
- Low-level claustrophobia
- Sensitivity to visual motion from computer screens/televisions

I personally experienced the first two, and I have no idea about the rest - I was too sick to notice!!

She then goes on to give some of the differences between MS and HG (which, again, is hard to do). She mentions some of the other facets of morning sickness - that it's not generally "morning" sickness, that it doesn't always (or even usually) dissipate by the end of the first trimester, and that it is a condition unfortunately prone to relapse.

Miriam then writes a chapter about how morning sickness affects women's careers and families/relationships. Very important! I know that with my experience, social relationships suffered greatly (from neglect). If I had had a career, it would have been over, and if I had had a less than perfectly-patient DH, my marital relationship would have suffered as well. I got off easy - but many women don't, especially when they have careers or small children.

Chapter three is really interesting - it presents the different theories as to WHY women get morning sickness. Oddly enough, no one really knows for sure!! Here are some of the theories:

- Lowered blood sodium
- Adjustment of the brain's chemical sensors
- Metabolism of pregnancy hormones
- Slower emptying of the stomach
- Rising hormone levels
- Left vs. right ovary theory (women, for some reason, have more MS when the egg is released from the right ovary)
- Protection from sexual activity (which might conceivably harm the baby)
- Placental enzymes and low blood sugar
- Protection from food toxins
- Heightened stress
- Your diet 1 year before pregnancy (diets higher in saturated fats result in more morning sickness)
- Baby girls (has been pretty much disproven)
- Altered ratio of t-helper cells
- Lowered levels of B vitamins

When it all comes down to it, no one really knows! But it's a great education to read about it.

Chapter 4 is a study of "morning sickness through history" - it describes, in some detail, the remedies for morning sickness used throughout history and in other cultures. When I first read this chapter, I was really annoyed - because this is a chapter that is utterly useless to me as an HG mother. However, upon rereading I realized that this book is a book about morning sickness - and thus, any information known about morning sickness should be included in order to form an exhaustive text. Anyone doing research on morning sickness from an academic perspective will find this chapter very interesting - it's just not useful to here-and-now morning sickness sufferers.

After a chapter on odors (where they are, how to avoid them, etc.), Miriam writes about the technique of dealing with morning sickness "triggers." In other words, for MS/HG women, various things (noises, sights, odors, tastes) set off vomiting. Miriam writes that one should practice extreme vigilance to notice what triggers nausea and strictly avoid that. She also writes that one should think deeply about what one wants at a given moment (ice cream? soup?) and pursue that. She gives a chart which women can use daily to chart their nausea level, food preferences, climate (which can cause shifts in nausea levels) and various environmental stimuli so that they are able to track patterns and make shifts accordingly.

This all sounds great in theory. In practice? Well, she claims it works. But when I think back to my own experience, it doesn't sound very practical. I was too sick to be charting anything, all food sounded repulsive, and the least bit of solid food would cause uncontrollable vomiting. There is no way on earth I would have been able to sit there and say, "Okay, it's ten o'clock and I'm craving pickles. I see by the weather that the storm front caused an increase in nausea, so I'll wait to take my prenatal." No way!!

But I'm willing to give it a try. Hey, I'd stand on my head for an hour a day if it would work! So I'm definitely willing to give this a try.

And I should say that this book got great reviews on Amazon, with five HG mothers saying that Erick's techniques helped them greatly. So despite my skepticism, I'm not writing off this advice - it just sounds impossible from the outside.

Miriam's next chapter is on morning sickness and emotions. This covers a myriad of topics, most of which are helpful. However, there was one section in here which was so funny (unintentionally, I'm afraid) that I have to mention it. It is called "boredom and morning sickness" - a list of things to do when one is kept at home by morning sickness - things such as "make beaded barrettes or belts with a kit," "writing a child's storybook for the baby's third or fourth birthday, complete with pictures," "Knitting or embroidering," "Organizing a photo album," etc. What on earth??? If, like I was, you are in bed with morning sickness, you are in NO condition to even think about activities! That is just about as practical as giving a list of "things to do when you're home with severe food poisoning." When I was at home in bed, I was either throwing up or sleeping. Period. Origami never crossed my mind. If you're feeling well enough to do these things, I don't think you need to be in bed!! Of course, every case could be different. Who knows? I only have my experience from which to judge.

The next part is the part I find the most puzzling. As a nutritionist (registered dietitian), Erick's main focus is on "helping morning sickness with food." She (as mentioned above) asks mothers to think, for example, "Would something salty reduce or aggravate the queasy feelings at this very minute? What food or drink comes to mind at this very moment?" (p. 171) and "What food or beverage would ease your nausea? Something salty, sour, bitter, tart, sweet, crunchy/lumpy, soft/smooth, mushy, hard, fruity, wet, dry, bland, spicy, aromatic, earthy, hot, cold, thin or thick?" She then gives lists of foods for each category and asks mothers to focus on finding what they really want to eat or drink and to pursue that thing.

I can't but be puzzled by this. Erick claims to have helped cure hundreds of women with hyperemesis with this method... But even with my own mild HG, I can't imagine this helping! When all food sounds horrible beyond belief and you're retching at the first bite of solid food (and some of my severe-HG friends have been unable to even tolerate liquids), I can't really think that satisfying cravings (which I didn't have) would be the least bit helpful.

She then gives "sick day meal plans" according to the various flavors mentioned above (crunchy, salty, etc.). Again, I am puzzled. Let's look at this one, from p. 204

Sick-day meal plan (bland)
7 am - 4 unsalted oyster crackers
8 am - 1/2 egg matzo cracker
9 am - 1/2 cup instant cream of wheat
10 am - 1/2 ripe banana blended with 1/2 cup milk to make a milkshake

How does that help when you're throwing up so hard you can't even leave the bathroom? How does that help when you're so sick you can't even handle food? I remember being annoyed with my poor mother when she suggested making milkshakes, because getting out to the kitchen and getting out food and equipment to make a milkshake was simply impossible due to exhaustion and food aversions. In a later chapter, Erick gives recipes as well. They look great, but again, how is a woman with HG (whose hubbie is generally at work) going to get out to the kitchen to start cooking? I couldn't even manage to make the cheesecake for my friend's baby shower, let alone get out into the kitchen to cook for myself!!! The average hubbie is not going to be spending his entire evening cooking up various from-scratch recipes (not to mention that even if he did, that wouldn't help day-time cravings). Especially since HG-hubbies generally have a TON to do in the evenings with childcare, basic meal prep, shopping and housework - they don't have time to be whipping up various recipes.

Erick then gives a very helpful chapter on hospitalization, with all the procedures and policies to expect. This is not as indepth as McCall's treatment, but still very good.

She writes sections also on pharmaceuticals for HG, and also a bit about alternative treatments - her main focus is on acupuncture, with a wee bit on herbs and homeopathy. Her sections on herbs/homeopathy need a bit of formatting help for clarity, as she just incorporates the remedies into the text rather than putting them in bold or bullet-format - they're very hard to locate.

She closes with a chapter on the rarer complications of HG, and then gives a list of resources for HG women. Very, very helpful.

Side note: I do not like Erick's treatment of the subject of abortion. She is remarkably complacent and blase about the fact that many HG pregnancies end in abortion. It was kind of like, "So-and-so couldn't handle the nausea, so she aborted. Okay! Moving on to our next subject..." There is sympathy, but that's it.

Abortion is an inextricable part of HG. It's kind of inevitable in a country where abortion is available on demand. When you're in the midst of unbearable suffering and relief is either nine months away (basically an eternity) or one short doctor's appointment away, many women choose abortion. While I don't condemn these women, as I know what they went through, I am still 100% pro-life and believe that any abortion is a tragedy and a deep violation of human rights on the part of the unborn baby who was denied life. Any book on HG needs to contain in-depth material on abortion - at the very least, encouragement for abortion-minded women, telling them strongly that HG WILL PASS and that their beautiful baby will be in their arms. When HG is over, it is over. But when an abortion is over - the HG is gone, but the baby is dead. And most post-abortive HG women feel compelled to try again for a baby - meaning that their journey through HG will be considerably longer than if they didn't abort in the first place.

Ashli McCall's book "Beyond Morning Sickness" covers this in depth. McCall suffered severe HG four times, the first time ending in a second-trimester abortion which left her deeply scarred and grieving for life. She devotes a large part of her book to dealing with abortion and encouraging HG mothers to stick it out. There is no such encouragement in this book, and it is a big hole that needs to be filled.

On the whole? Well, I recommend this book for the information. There's a lot of information here. Even if the nutritional stuff doesn't help, there's a lot of helpful information. For myself, as a post-HG mother contemplating another pregnancy, I want to know everything about morning sickness and HG before going into another pregnancy. In the middle of HG is NOT the time to be flipping through reference books! I want to know all facets of morning sickness, drugs, alternative therapies, hospital procedures, coping strategies, nutrition, complications - knowledge is power, and I want as much of it as possible before facing another pregnancy.

In terms of the nutritional coping strategies Erick outlines, I do not possibly see how they could be helpful (although for any morning sickness short of HG, I am sure they would be GREAT - don't get me wrong). However, this woman has years and years of experience with treating HG mothers, so I'm not going to write her off. I'll give her methods a try. And I'll let you know if any of it works!

So.... Buy this book. Read it, and let me know what you think of it. If you use or have used any of her techniques in the past, let me know about it and I'll post it here. I'm quite willing to eat crow if they work!

Signing off,