Category: Midwifery Model of Care

Portland Ranked Best City to Have a Baby

February 2, 2010 | Filed under: In the News, Midwife in Portland, Midwifery Model of Care | Tagged | Comments (0)

Fit Pregnancy Magazine ranked Portland, Oregon as the best city to have a baby! Go Portland.

What made Portland so awesomly birth friendly? Portland has tons of health food options, walkability, many many many birth options and exceptional breasfeeding rates! The survey was based on 47 different critera, and here’s a look at some Portland stats:

• Relative to population, Portland has more specialty retailers of healthy/organic foods and vitamins than most places.


• Portland has 150 miles of stroller-friendly trails and public pathways, according to a survey of parks departments. In a per capita comparison, that’s 163 percent more than the average city surveyed (3rd highest overall relative to population).


• 14.9 percent of births statewide are attended by midwives. That’s 98 percent more than average. Midwifery is more widely available in Portland than anywhere else surveyed, with 189 percent more midwives than average. Relative to the number of live births per year, Portland has 64 percent more doulas than average–that figure is the 5th highest in the survey.


• 25 percent of babies in Oregon are born via Cesarean section. That rate is 8 percent less than average, and among the lowest in the survey.


• 26.6 percent of Portland mothers breastfeed their babies exclusively (meaning no solids, formula, or other liquids) for six months or longer (as recommended by the American Academy of Pediatrics.) That’s among the top 2 percent of cities in the survey. Eighty-nine percent of Portland mothers attempt breastfeeding. That’s the highest percentage of any city in the report. Portland moms are 20 percent more likely than average to at least try breastfeeding. Compared to the number of babies born, Portland has 81 percent more lactation consultants than average. That’s the 2nd highest ratio Fit Pregnancy found. And, once Portland mothers begin breastfeeding, they are 19 percent more likely than average to continue through 6 months. That’s the 3rd highest level of follow-through of any city studied. Finally, By six months of age, 42 percent of Portland babies are still being breastfed. That’s the highest percentage of any city in the report.


• According to data from the CDC, maternal mortality in Oregon is especially low. (My own comment: you can thank midwives and childbirth education for this one.)


• Portland babies are 22 percent less likely than average to be born prematurely.


• Oregon allows greater dependent-related tax breaks than most.


• Portland babies are 25 percent less likely than average to be born with low birth weight.




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Pain is Acceptable

December 22, 2009 | Filed under: Medical Model of Birth, Midwifery Model of Care, Pain Management | Tagged | Comments (0)

Why are we not allowed to accept pain in our lives? Hurt from another person, a headache, the pain of childbirth – if you want to accept grief from a broken relationship, try natural cures to your headache and especially if you want to work through labor pains on your own, you’re often considered by some to be a bit odd.

We need other words for pain. Pain is used to describe a hang nail and a broken neck, yet those are two totally different types of pain. Where are our 50 words for pain? There is certainly enough of it to warrant a richer language.

In a previous post about the differences between the midwifery model of care and the medical model: (http://fullmoonsdaughter.com/blog/2009/03/the-differences-between-technocratic-and-holistic-models-of-care) Robbie Davis-Floyd mentioned that in midwifery care pain is acceptable. Pain is not acceptable in the medical model.

It’s okay to be in pain. We learn a lot from our darkest hours. And birth is a time when a woman becomes a mother and learns that she could do anything. She learns to get out of her own way, speak her truth, open up and surrender to her own power. She feels her strength and is in awe of her will.

Labor is hard work and most women interpret the sensations of labor as pain. It is a joining force between women around the world to connect together and hold the power of creation and the Universe in their bodies.

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Thinking Woman’s Guide to a Better Birth

June 10, 2009 | Filed under: Childbirth and Labor, Labor Doula in Portland, Medical Model of Birth, Midwifery Model of Care | Tagged , , | Comments (0)

Henci Goer is a medical author and activist who is able to deliver clear birth statistics and information that anyone can understand. Admittadely biased towards natural birth, this book provides mothers with information they could use to better understand the hospital systems they are working through during pregnancy and labor. Though the stats are a bit outdated, the philosophies behind them still hold truth.

Here are some great points that Henci makes:

~ Obstetric belief tends to become a self-fulfilling prophecy. It has been said that a healthy person is someone who hasn’t undergone enough testing by specialists.

~ Cesarean is the most common major surgical procedure performed in the United States.

~ Baby’s head fits neatly against the cervix like an egg in an egg cup. This prevents the umbilical cord coming down ahead of the baby and getting pinched between baby and mom’s pelvis.

~ Inducing for exceeding your due date is a textbook case of how mainstream obstetric care keeps narrowing the definition of normal until practically no one fits, which tends to create the “need” for intervention.

~ The conventual 40-week pregnancy length is completely is completely arbitrary. It was established by a German obstetrician in the early 1800’s. He simply declared that a pregnancy should last 10 moon months, this is, 10 months of 4 weeks each.

~ The uterus is most sensitive to Oxytocin at night, which is why labor usually starts at night.

~ Electronic Fetal Monitoring (EFM) is said to lower the risk of cerebral palsy or mental retardation because of oxygen deprivation during labor, but this is less than 10% of cases. Continuos EFM has become nearly universal since the 80’s and it it worked it should have affected the cerebral palsy rate by now, but it remains unchanged.

~ During cervical exams, moms should find out about state of cervix, how far baby is down, and baby’s position. Mom may be making important progress even though she isn’t dilating. As a labor doula this is information I always find out for mom.

~ Natural labor offers an unparalleled opportunity to discover inner resources, capacities, and strengths you never knew you possessed. And there is great value in such an experience.

~ Labor will hurt, probably a lot, but whether this is a negative experience is another matter.

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Induction – Not so Hot

June 5, 2009 | Filed under: Induction, Midwifery Model of Care | Tagged , , | Comments (0)


I’m excited by this article! I’ve placed it in my Resource Notebook and plan to give to Doula clients whose doctors are talking induction. Gail Hart is one of my favorite midwife authors and I love reading anything by her. This article really gave me more foundation for what I have already been telling moms about induction. In addition, she provides ways women can help themselves prevent pre-term labor by cultivating a healthy vaginal floriculture. I think everyone should read this article:

 

http://www.midwiferytoday.com/articles/timely.asp

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Stages of Labor Mirror Pregnancy and Motherhood

June 2, 2009 | Filed under: Midwifery Model of Care | Tagged | Comments (0)

 

Verena Schmid, an Italian Midwife,  believes that pregnancy patterns have the same rhythm as stages of labor. That doesn’t mean if a mother’s first trimester was difficult, then the first stage of labor will be the same way. Instead, Verena speaks about the instinctual rhythms of women, pregnancy and birth.

A woman’s first trimester and first stage of labor are very similar because at both times mom is learning to create inner space for her baby. Second trimester and second stage are both about learning to open up; opening in pregnancy as the baby is growing inside or opening during birth as baby moves to open the cervix. The third trimester and third stage of labor are about learning to let baby go and let her be born. 

Verena continues with this theory, stating that once a baby is born the stages begin again. The baby adapts to mom and to life outside the womb, while mom adapts to baby and motherhood.  Months 3 – 6 are often a time for mom and baby to live peacefully together with very little stresses. Finally, 6 – 9 months after baby is born, she starts to be more explorative and mom learns to let go.

I never looked at birth from this perspective and find it quite fascinating. Reading this short interview has definitely changed the way I look at birth and mothering.

The actual interview that Midwifery Today publisded in 2002 with forward-thinking Verena Schmid can be found here if you are interested in reading more than the summary above:

 

http://www.midwiferytoday.com/articles/verena.asp

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The Active Management of Labor

June 1, 2009 | Filed under: Medical Model of Birth, Midwifery Model of Care | Tagged | Comments (0)

http://www.birthinternational.com/articles/wagner01.html

 

 

The above link takes you to an excellent article written by Marsden Wagner. He started out as a neonatologist and is now a consultant for WHO. He fully supports natural birth, midwives and midwifery and you may have seen him in birth movies – he’s the over-educated elfin guy who is fun to listen to.

 

I’ve jotted some highlights from the article and added my own thoughts on it.

 

From my own personal experience, I agree that most health care providers no longer know what a non-medicalized birth is. Their training rarely covers natural hospital births and almost never brings the medical student into a free-standing birth center or home to observe birth.

As a result of lack of exposure to natural birth, hospital staff often believe that labor is something that happens to women rather than something women do that can be empowering and a rite of passage. Because labor is involuntary and unpredictable, many doctors and nurses interpret that as birth being out of control.

It’s sad to read the example of a hospital considering birth normal even if it includes an amniotomy, induction, augmentation, epidural or episiotomy. I feel that the list can go on to include continuous fetal monitoring, IV, withholding of food, drink and privacy, numerous cervical checks and disregard to birth preferences. What is even sadder is that most women today have accepted those same standards and also believe that birth with serious intervention is normal.

I found it interesting to read how the clock has quickened. Marsden states that the definition of the normal upper limit to labor has been reduced from 36 hours in the 1950s to 24 hours in the 60s and now holds steady at 12 hours since 1972, when active management was introduced. He also mentions that these random times were based on clinical concerns and not scientific evidence. With this scenario on hand, women adjust to the hospital and not the other way around.

My head was shaking when Marsden compared active management to inventing cars that can be driven too fast and then when the speed causes accidents, rather than change the cars, we invent speed bumps and as a result of the speed bumps people hit their heads on the car ceiling and we give them pain medication.

I think a better comparison would be the creation of entire task forces whose job is to monitor speeders and catch them in the act so they can then ticket them and make money from their speeding. That feels similar to hospitals making money from highly medicalized births.

Marsden concludes that hospital staff can never tell a woman that a certain procedure is safe because that person is not taking chances. A safety determination can only be made by the one accepting the procedure and that is the woman taking the chance.

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The Differences Between Technocratic and Holistic Models of Care

March 26, 2009 | Filed under: Medical Model of Birth, Midwifery Model of Care | Tagged , , | Comments (0)

Robbie Davis-Floyd is a medical and cultural anthropologist who has written extensively on the differences between the hospital (technocratic) model vs. the holistic (midwifery) model of care for childbearing women.

Below is a table Robbie put together, that Anne Frye published in Volume 1 of Holistic Midwifery, that I’d like to share with you. It simply lays out the differences, as she sees them, between the technocratic (T) and holistic (H) models for women seeking care during their childbearing year.
I’m taking the time to post this because I have yet to find such an extensive, starkly honest and accurate listing. When I first read this I was both shocked and relieved to see it all on paper in one place. Of course, this list doesn’t fit every doctor or midwife, but it feels fairly accurate to me. I hope you enjoy.
T: Male-centered
H: Female-centered
T: Women = objects
H: Women = subjects
T: Male body = norm
H: Female body = norm
T: Female = defective male
H: Female is normal on her own terms
T: Classifying, separating approach
H: Holistic, integrating approach
T: Mind is above & separate form body
H: Mind & body are one
T: Body = machine
H: Body = organism
T: Female body = defective machine
H: Female body = healthy organism
T: Female reproductive process dysfunctional
H: Female reproductive process healthy
T: Pregnancy & birth inherently pathological
H: Pregnancy & birth inherently healthy
T: Doctor = technician
H: Midwife = nurturer
T: Hospital = factory
H: Home = nurturing environment
T: Baby = product
H: Mother/baby inseparable unit
T: Baby grows itself through mechanical process
H: Connection between growth of baby and state of mother
T: Fetus is separate from mother
H: Baby & mother are one
T: Safety of fetus pitted against emotional needs of mother
H: Safety of baby and emotional needs of mother are the same
T: Best interested of mother and fetus antagonistic
H: Good for mother = good for baby
T: Supremacy of technology
H: Sufficiency of nature
T: Importance of science, things
H: Importance of people
T: Institution = significant social unit
H: Family = essential social unit
T: Action based on facts, measurements
H: Action based on body knowledge, intuition
T: Only technical knowledge is valid
H: Experiential & emotional knowledge valued as highly as or more than technical knowledge
T: Best prenatal care is objective, scientific
H: Best prenatal care stress subjective empathy, caring
T: Health of baby during pregnancy ensured through drugs, tests, techniques
H: Health of baby ensured through physical & emotional health of mother & her attunement to the baby
T: Labor = a mechanical process
H: Labor = a flow of experience
T: Time is important, adherence to time charts during labor is essential for safety
H: Time is irrelevant, the flow of the woman’s experience is important
T: Birth must occur within 24 hours
H: Labors can be short or take several days
T: Once labor begins it should progress steadily; if it doesn’t pitocin necessary
H: Labor can stop and start, following it’s own rhythms
T: Some intervention is necessary in all births
H: Facilitation (proper food, effective positioning, support) is appropriate, interventions are usually inappropriate
T: Pain is unacceptable
H: Pain is acceptable
T: Analgesia & anesthesia for pain during labor
H: Mind/body integration, labor support for pain
T: Environment is not relevant
H: Environment is the key to safe birth
T: Uterus = involuntary muscle
H: Uterus = responsive part of whole woman
T: Woman is hooked up to machine with frequent exams by staff
H: Woman does what she feels is appropriate
T: Once a surgical birth always a surgical birth for most woman
H: VBAC is normal
T: VBAC = high risk
H: VBAC = low risk
T: Cesarean for breech presentation or twins
H: Squatting or hands and knees for breech, twins often born via the birth canal
T: Birth = a service medicine owns and supplies to society
H: Birth = an activity a woman does that brings new life
T: Obstetrician = supervisor, manager, skilled technician
H: Midwife = skillful guide
T: Doctor is in control
H: The midwife supports, assists
T: Responsibility belongs to the doctor and the system
H: Responsibility is the mother’s 

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Midwifery Today Conference

March 13, 2009 | Filed under: Michel Odent, Midwifery, Midwifery Model of Care | Tagged , | Comments (4)

Just got back from my only day at the Midwifery Conference in Eugene, Oregon today. There were very bright and precious gems of insight I gained from being there, but I am left wondering where are the critical thinkers? Where are the midwives who are looking at what we are all doing and questioning the directions we are headed and the right steps?

I understand that midwives need to support each other and that, as a community, midwifery needs to insulate itself from the medical model of childbirth. I understand that some of us can be arrested in their state if they have to transport a mother to a hospital. And I understand that we need to celebrate what we do and how we do it. Cheerleading is great – at times.
But I left the conference only hearing one person, Michel Odent (who I am totally in love with), ask such questions. He proposed that men all together, male doctors, husbands and fathers should be banned from the birth room. This stems from the fact that Midwifery is woman’s work and men are under pressure in this situation and their stress hormones are contagious to the birthing mom (among other factors).
Interesting point he brings up. I would love to ask him if he could re frame that to try to educate men to understand the birth process and recreate a supportive environment for the mom? But I want to talk more about this later.
What I’m really feeling is this very uncomfortable notion that we, as a midwifery community, are living in a bit of a vacuum and only asking questions that are politically correct. Which is partially hilarious when you think about it considering Midwifery has been pushed to the fringes of all that is acceptable.
Michel Odent is holding a conference next year in the Canary Islands (I think) that is bringing people who normally wouldn’t interact with each other (you know, the guy who invented this really great way of doing a C-section and Ina May) to really question each other and talk about the things that no one seems to be talking about. That’s my kind of conference. 
At any rate, I’m sure I’ll have more insights after I’m able to process it a bit more. What I do know is that being there today got me fired up to begin my studies and interview for apprenticeships. It also left me feeling very confident and comfortable about the path I’m choosing to pursue Midwifery…I know now, with out a doubt, that a traditional academic classroom is not for me. I need to be able to more freely challenge what I’m learning and have many different avenues of exploration.
Today also showed me that I have never been as passionate about anything in my life as I am about childbirth and for that I am so grateful.
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