If you’re not outraged, you’re not paying attention. . .

Right now, all over the state of North Carolina, families are in pain.  They have been excitedly awaiting the arrival of a new family member, maybe expecting their first baby.  All of the joy that they have been feeling surrounding their upcoming birth has now turned to fear, for the women they have come to know and trust as care providers are no longer able to practice.  Maybe they interviewed several providers before choosing the Certified Nurse Midwife (CNM) they felt most comfortable with; maybe they have had the pleasure of having her attend a previous birth and were thrilled at the thought of having her present at the birth of their next child.  That’s what makes this situation so painfully sad – the kind of care midwives provide goes above and beyond what most folks expect from a health care practitioner.  To have experienced such personal, attentive care and then be asked to accept anything less at such an important time is unthinkable.  But due to the actions of the North Carolina Board of Medicine, many families will now have to find someone else to assist them at their birth.  Many will now have to give up the option of having their baby at home, because there are so few CNMs left practicing out of hospital.

How is it that our state is so out of touch with what the families who live here want?  The North Carolina Friends of Midwives (NCFOM) have been working tirelessly for the last several years to get legislation passed that would allow Certified Professional Midwives (CPMs) to obtain licenses to attend home birth.  With HB522 poised to be heard in the House Health Committee, they are closer than they have ever been to seeing that come to fruition.  It is no coincidence that the Board of Medicine rescinded Dr. Dorn’s ability to back CNMs who want to practice at home at this time.  The physicians in this state have made it clear how they feel about home birth.  Not only have they vocally opposed NCFOM’s legislative efforts at every turn, now they are closing the home birth practices of CNMs as well.  If you are a family who has chosen to give birth outside of a hospital – at home or in a birth center – or if you simply want to see others have that option, you must stand up and let your voice be heard.

Go to NCFOM.org and find out who your local legislators are, and give them a call.  Let them know that the families of our state deserve to give birth at home with the care provider that they choose.  Ask your friends and families to take a few minutes out of their day to do the same.  There has never been a more important time to act.

Anna is Pregnant! – Episode 1, Where’s my midwife?

The question “Where’s my midwife?” has suddenly become very personal for me. I am pregnant! My estimated due date is 12/12/12, wouldn’t that be an awesome birthday!?! We will be a family of five! So now that I have somewhat adjusted to all that excitement and caught my breath, I need to find a midwife! My last baby was born at home in North Carolina with the most wonderful CPM. Now I am living in Salt Lake City, Utah. The two states could not be more different as far as midwifery options go.

The state of North Carolina does not license CPMs, even though it is perfectly legal to have your baby at home, it is not legal for your midwife to be there supporting you.  And CNMs are required to have a physician’s signature to obtain a license, so only a handful of them practice home birth in the entire state!  These restrictions limit the number of midwives who will work in NC.  In Wilmington, where I lived, there were three CNMs practicing in hospital and one CPM practicing home birth.  We really wanted a home birth, as our first child was born at home in Boston.  But choosing the CPM meant that, throughout my entire pregnancy, I had to live with the very real possibility that my midwife may get arrested or be forced to quit working.  It was her loving support that turned me into a birth activist!  How could health care that was so personal, so wonderful NOT be an option? 

Now in Utah I can have a midwife that is licensed and doesn’t have to break any laws to help me out! I don’t have to press my ear to the underground to find someone. Oooo maybe I can even have one that is covered by my insurance and not pay for my entire birth out-of-pocket, wouldn’t that be neat!

So I went was my insurance company website. First I searched for “home birth midwife”, but alas that was not a recognized term. When I did I search for “Salt Lake City” and “midwife” I got 68 matches! Wow, surely some of these ladies will do a home birth, right? After further internet exploration I found that there is only one midwife, Rebecca Williams, a CNM, who is considered to be “in network” by my insurance. When I went to her website I saw that she is already booked through January! Yikes, I guess I am not on the ball enough to have the option of maximum insurance coverage. Oh well, going out of network opens things way up. I am not sure how many home birth midwives there in my area, my guess is more than ten.

My next step was to get recommendations from folks I knew in the birth community. From their advice and a little more help from Google I set up three consultations and interviewed five midwives. I love that I have options here, I get to choose! All five midwives were wonderful to meet with and highly skilled. I would trust them all with the details of pregnancy and birth. That makes choosing actually rather tricky. They all answered my questions perfectly, no red flags, five fabulous midwives.

My first consultation was with a pair of CPMs, Melissa Mayo and Heidi Sylvester.  One is licensed, and one is unlicensed. In Utah an unlicensed midwife is not illegal, so not everyone chooses to license. The benefits of licensure include being able to carry certain medications, such as things that would slow a postpartum hemorrhage. Some of the draw backs to licensure are being banned from attending breech and twin births. So midwives choose what works best for them.  If the licensed and unlicensed work together theoretically you have the best of both worlds.

The second pair I met with run a birth center and also attend births at home. The duo consists of Becky McInnis, a CNM, and Adrienne Trahnstrom, a CPM. They use the centering model for their prenatal appointments, all of that peaked my interest. With the birth center they also have the capacity to do ultrasounds and other clinical tasks at their offices and a CNM can prescribe medications. They had a lot of resources.

My last appointment was with Cathy Larson, the midwife I ended up choosing. She is licensed CPM with a solo practice. We met at her home office, but all of my other appointments will be at my home. I love not driving! In the end my decision was based on geography and temperament. Simply put, I thought her style would best serve my needs. I feel so fortunate now to have access to so many high quality midwives. I didn’t even meet with half of the midwives in my community! What are the birth options like where you are?  I would love to hear from you!

Safety in Numbers

Working to bring awareness to our broken maternity care system can feel quite lonely.  When we produced the play “Birth” by Karen Brody back in 2007, we had a strong group of doulas helping, and a close-knit home birth community to fill the seats.  Ultimately, aside from the professionals who agreed to participate in the talk back panel discussion after the play, it felt a bit like preaching to the choir.  But we plugged along, undeterred because we so passionately believed that nothing would improve if we weren’t talking about it.  So, we held a screening of “Business of Being Born,” we hosted Jennifer Block to discuss her book Pushed, we hosted a screening of “Pregnant in America”and we created Women In Labor Daze, a week long celebration of motherhood which culminated in another weekend of the play “Birth.”  But all along, we wondered if our message was being received by the folks who most needed to hear it – the providers and the women who were afraid of birth.

When a large midwifery practice in our community was abruptly shut down we organized a daily protest at the hospital.  After we had been protesting outside the hospital for a couple of weeks, I arrived first one day and pulled my poster board sign out of the van and stood on the sidewalk waiting for others to show up.  A guy in a red pick-up truck drove by and shouted, “GET A JOB, BITCH!!!” out his window.  Wow.  At the time, I thought, “It’s true, I don’t have a job.  I just stay home with my kids.  I’m just a mom. . .but I want this to be my job!”  How was anything going to change unless women made it our job to change the current culture around childbirth?  So we decided that we would!  We recognized that after most women have their first baby, they are so overwhelmed with the transition to motherhood, they don’t necessarily have time to reflect on their birth experience much less set out to try to change the system.  But we knew there were others like us out there – there were communities all over the world producing the play, “Birth,” the film “Business of Being Born” was being screened everywhere.  What if we could somehow coordinate our efforts?  Form a national campaign to raise awareness?  Start networking with other activists and find out about where other folks have affected change in their communities so that we can replicate those things in our own communities.

And that’s where you come in, birth activist!  We need you.  We want to know what you have been up to.  If you are available June 22 – 24, join us at the Farm for our Birth Activist Retreat.  If you have already been accepted to the retreat, look for an invitation this week to join our private facebook group where we will begin brainstorming ways to actively engage the public about pregnancy and birth.  And if you cannot make it in June, but want to be a part of the discussion, sign up to be on our mailing list and we will invite you to join the discussion on facebook.

It may feel lonely being the one lady holding up a sign, talking about transforming maternity care.  But you are not alone – there’s safety in numbers.  Join us.

Bad Behavior, Part 2

Last year, I wrote a post called, “Time Out for Bad Behavior” which was supposed to be the first in a series.  And then it didn’t really pan out that way.  I’ll be honest here – I have a hard time writing about these issues.  I was raised in a household that used the dreaded phrase ‘be a good girl’  which has taken quite some time to get over.  If I got angry or upset, I was told, “quit yer cryin’.”  Also, it was made quite clear that no one wanted to see a woman get angry because then everyone would think you were (God forbid) a bitch.  But now I have daughters, and if I don’t talk about the problems I see with our maternity care system, they will have to get pregnant and give birth under the same messed up conditions that I did.  So, I have to talk about it!  I have met folks in the birth-y world who very strongly believe that we ought to just keep it positive and plug along, don’t talk about the problems, don’t be negative.  And that’s exactly why nothing is changing. That’s more of the same ‘be a good girl’ thinking that keeps us stuck.  How can anything improve if we don’t talk honestly about what is not working?  Being almost 40, I have been given the gift of time and wisdom, and I’ve come to realize that it really doesn’t matter what other people think of me, what matters is what I think of me.  And I have also realized that not talking about it makes me feel miserable, makes me feel like I am part of the problem.  So, let’s talk about providers in the hospital setting. . .

I recently had a conversation with a physician (we’ll call him Dr. X) who had quit obstetrics and opened a birth center.  Yay!  He also said that while he was practicing obstetrics, his c-section rate was only 5% – again, Yay!  But, he then shared the fact that he had colleagues who had c-section rates close to 50% – boo.  And Dr. X claimed he understood why – huh?  Dr. X said he was recently named in a lawsuit from a birth that happened years ago because the child was diagnosed with ADHD and the family was claiming birth trauma was to blame.  He said that if it wasn’t for such a ‘litigious society,’ physicians would not feel so much pressure to perform cesareans.  WHA?!  I get it – doctors who get sued have to deal with really high insurance rates, and might even get sued personally.  That really sucks.  But the key word here is MIGHT.  They might NOT get sued.  And if it is perfectly acceptable for a physician to perform defensive medicine in order to protect his own livelihood, why don’t we talk about the countless women whose livelihoods MIGHT be impacted by an unnecessary cesarean?  Why is this physician’s livelihood/lifestyle more important than the women he serves?  What of all of the women who end up with physical issues stemming from surgery that last a lifetime?  Is a physician’s life more important because we value doctors more than we value women?

And another thing – why aren’t the providers taking some responsibility for the ‘litigious society’ that they helped create?  If you are going to claim that the hospital is the safest place to have a baby, to claim that you have all of these fancy machines designed to prevent anything from going wrong, then you better have a good explanation when things inevitably do go wrong.  Essentially, women are being told, “Trust me.  Just lie back and let us take care of everything for you.”  If you ask a woman to give up her power to you, she is participating in your version of birth where the woman is just a vessel and your only goal is to take a live baby out of her.  But somewhere along the line, she is going to realize that what happens to her in birth is going to stay with her forever.  And you lied to her – you told her to trust you and that everything would be okay if she does exactly what she is told.  If she is a ‘good girl.’  So of course she is going to be upset when she does what she is told and something horrible happens.  In her mind, you were doing everything TO her, so it is your responsibility, not hers.  Of course you’re going to get sued!  You promised she wouldn’t have to participate in her own birth, that you would do all the work.

But there are no guarantees in birth.  No matter how many fancy machines you have, injury and death are always a possible outcome.  And no matter how much you might want to control birth to prevent a bad outcome, it is never really the care provider’s work to have control over.  It’s that woman’s labor, and the work needs to be HER work.  It took us a long time to forget this important fact, and it’s going to take a lot of work to help women and the people who care for them to remember and act accordingly.  So, let’s start talking about it.

Rally in Hawai’i – by Summer-Lee Faria

Guest blogger, Summer-Lee Faria, has agreed to keep us posted on what’s going on with the midwives in her home state of Hawai’i.  Here is her first report:

For the Midwives at the North Hawai`i Community Hospital Rally

A friend of mine and I hear about this rally on Hawai`i island to protest the proposal to cut staff from 3 full time CNMs, 1 per diem CNM, and 3 OBs down to
1 CNM and 2 Ob’s. Last year the hospital had 680 births, and they want to cut it down to 300. According to news sources, they claim the Medicaid reimbursements slow processing is partly to blame and that the hospital lost about 1 million dollars last year.

We fly from O`ahu to Hawai`i the morning of the rally, the desire to save any midwives threatened to be let go from any hospital in the state gets us going. The North Hawai`i Community Hospital has been the gem of the island since integrating midwifery care into their system, with parents/pregnant women driving sometimes hundreds of miles just to get the ‘women-centered’ care they desire that can be covered by their insurance.

There were about 2 dozen women, men and children gathered on the lawn, the
sun was shining and the wind was blowing the chilly air; typical Waimea weather. When we arrive, the signs saying, “Where’s My Midwife” and “More Midwives Not Less” are greeted with tons of honks, waves and “shakas” from passersby.  A few motorists stopped in the parking lot to ask what was going on and 2 media crews came and did interviews. There were laughs and talks about each others families going on the hour or so we were there waving our signs of support.

After our visit with our sisters there, we got inspired to start a rally on O`ahu at the State Capitol this Thursday, to show support for the midwives at NHCH, raise awareness that the Midwives Model of Care is essential to women’s well being and should only be increased and never decreased.

Stay tuned for an update from our sisters in Hawai’i!

Is this thing on???

Hello, birth workers.  I’m talking to you – midwives, doulas, activists, advocates, physicians, nurses, bloggers, hospital administrators – anyone and everyone who can see what a mess our maternity care system is in.  I want to congratulate all of you for working to make birth better for mommies and babies, and to ask if you are ready to ‘kick it up a notch’?  For over a year now, I have been using the word ‘revolution,’ and calling on all of us to unite and begin actively engaging those who hold positions of power to effect change where it is needed (Let’s get it started in here, Time out for Bad Behavior, and Who Ya Gonna Call?).

Over the Christmas break, I read a post over at the Unnecessarean about ‘pit to distress.’  I had heard of this practice, but did not realize how pervasive it is.  As the post points out, pit to distress (giving a mother high amounts of pitocin in order to send a baby into distress) was occurring in our country at such high rates, the act found its way into nursing text books.  I was so angry after reading this post, I couldn’t sleep for weeks.  I wanted to blog about it, but every time I sat down to write, I became afraid of my anger.  How could this be happening in our country?  How could people who had taken an oath to ‘do no harm’ be putting women and babies in danger for their own convenience?  And what of the people who were carrying out the orders, knowing what the implications were for their patients?  The post was written three years ago – is this practice still going on?  And when will it stop?  As a wise physician once said to me, “We [the physicians] are comfortable with the way things are. Nothing is going to change until the women ask for something different.”

We at WMM? have been emboldened by our successes. Twice now, when mommies and midwives have stood together and demanded change, the folks who have the power to affect change have listened. We believe the time for action is now. Let’s stop talking about how bad things are and do something. Let’s come together, gather our allies, learn from the people who have improved maternity care in their communities and lay the groundwork for a full-scale birth revolution! Join the national grassroots movement to change maternity care.

WMM? invites you to spend a weekend at the Farm in Tennessee, collaborating and brainstorming, coming up with activities that can be carried out in any community at any time for little to no money. These activities will raise public awareness about our broken maternity care system, and draw attention to the methods that are producing better results for mothers and babies. We need to put public pressure on the people, organizations and businesses in positions of power and hold them accountable for improving outcomes.

If you are ready to take the next step, join us June 22nd through the 24th at our first annual Birth Activists Retreat. For more information, e-mail us at info@wheresmymidwife.org.

And remember, “Well-behaved women seldom make history.” – Laurel Thatcher Ulrich

Put Your Big Girl Panties On

Do you all remember my t-shirt slogans from months and months past… or is it years?  I’ve come up with another slogan: “Put your Big Girl Panties On.” Let me back track. A year ago, I started writing a series for the Where’s My Midwife? blog. My series was about potential slogans for t-shirts. I came up with “Don’t Hate Me Because I Had a Beautiful Birth” (one of our most popular blog entries ever—thanks readers!) When I wrote that blog, I was feeling positive and upbeat. Then personal tragedy hit.

My sister, Elena, had been diagnosed with a highly metastatic form of cancer only a month after our midwives were fired from a local practice. If my sister could (and was!) battling, and seemed to be kicking cancer’s ass, well, I would battle right along with her. While I would continue to fight against the injustices that I witnessed daily in my community, not only about access to midwives, but also to woman-centered care locally and nationwide, I would try to spend as much time with my sister as possible.

About a year after Elena’s diagnosis, she lost her battle, and she suddenly passed away.  I was with her as she took those last difficult breaths. There were moments that I thought as I slept next to her on the hard cot in her hospital room, and as I kept certain forces at bay (unwelcomed visitors, etc.) that this was actually the culmination of my work as a doula. I will always hold those moments with my sister close, as difficult and painful as they were.

This was the second year that we experienced the holidays without my sister. It was harder this year for me than last year. Last week I sat across from my friend and midwife, Suzanne, one of the two midwives who was dismissed from our local practice. As I wept, wailed, and screamed (unfortunately my grief has recently manifested as anger towards people who I dearly love), Suzanne gently suggested that I contact a therapist. She chose her words carefully, “Sylvia, I want you to consider if you might benefit from medication, therapy, or both.” It is one of the things that I appreciate about the way that midwives practice. They are at their core “with woman,” and they are trained to care for the total person. I appreciate that Suzanne recommended that I seek help not only as my friend, but also as a health care practitioner.

The last two years were for me the intersection of a personal fight (dealing with my sister’s illness and death) and of a more public battle (increasing access to midwives.) It’s been a tough couple of years. For me “put your big girl panties on” has meant that I got up every day and not only take care of myself and of my children, but it has also meant that I continued to work to make change in my community and beyond. As we become “big girls,”(i.e. women) we face major life changes and tragedies. “Putting my girl panties on” means that I need to prepare myself mentally and physically for this next stage in my life. I am facing life without my big sister, and I am also squarely in the middle of middle age. (Did you know, by the way, that midwives provide continuity of care throughout women’s lives?) I have made an appointment with a therapist to help me navigate these unchartered waters. Thank you, Suzanne, midwife and friend, for reminding me that it’s necessary to take care of this aspect of my health.

So, I leave you with this. When I say, “put your big girl panties on” I mean that we all have our personal and public battles to fight. For me it’s one of the mantras that have helped me through the past couple of years. Join me in putting ‘em on and in fighting your own fight: whatever this may be.