Happy International Day of the Midwife!

Introducing the UK cover of The Birth House!
(To be published August 7, 2006…but available for preorder now from Blackwell’s and Amazon UK, or your local UK bookseller!)

Today is the International Day of the Midwife

So, I thought I’d post a few links and thoughts in celebration and support of midwifery.

Did you know that recently they celebrated Home Birth Week in Wales?
What a cool thing to happen!

The All Wales Home Birth Group spokesperson for this event, Lorna Tinsley, National Officer for the RCM, said “We are delighted to present the minister with a thank you card for his support for this initiative which enables women to choose a home birth. Women have asked for this choice, the Heads of Midwifery in Wales have supported this choice, and we are on our way to reaching the target of 10% home births by 2007”

Thoughts on the community of birth, birthing choices, and the public perception of birth.

Since the February release of The Birth House in Canada, I’ve had the opportunity to travel across the country, giving readings and interviews, signing books, and connecting with readers. One topic that has come up time and time again is what I have come to call the community of birth – a gathering of family, friends, neighbours, and compassionate, skilled birthing assistants (midwives, doulas, ob/gyns, labour nurses, etc.) around every mother during pregnancy, labour, birthing, and post-partum care. I can’t help but feel that the world might be a different place if every child’s birth was given the attention, time, consideration, compassion and yes, the sense of personal ritual, it deserves and requires.

The other night I gave a reading at a local art gallery and afterwards opened the floor for questions and conversation. Within the crowd of about 40 people was a practicing osteopath, a midwife who is finishing up her osteopathic studies, an OB/GYN who recently had her first child, and three female GP’s. A question came from the back of the room…”You cover many different birthing expereinces in The Birth House, why didn’t you include the emergency c-section?”

For a moment I felt a little dumb struck by the question. I not only wanted to answer the question in an honest, intelligent manner, but I wanted to be able to answer in a way that might allow all of the female health practitioners in the room to feel validated and acknowledged. I went for the historical route, citing that c-sections were rarely if ever performed at that time. I looked at the osteopath, the midwife and the OB/GYN. The OB agreed. But then there was the sticky end note of wondering…”Did more mothers simply die in childbirth because c-sections weren’t practiced?” We didn’t go into it, and part of me wishes we’d had time to do just that.

The truth is, during the WWI era, c-sections had a very high maternal mortality rate.

Caesarean section has a long history. But because of its high maternal mortality rate in the early years, it remained a rarity, even at the turn of the century. –from Giving Birth in Canada by Wendy Mitchinson

As the years went by and obstetrical surgery was standardized, the ease of the c-section became touted as a sure bet…obstetrical sugeons cited that,

“childbirth was considered a branch of surgery” and that “it (the c-section) was an operation just like any other and could be ‘lightly’ selected; there was even a sense that a physician would prefer it, since the operator did not have to wait ‘unduly’ for nature to take its course. – Mitchinson

What of Midwives, C-sections and Britney Spears?

And the fall out continues today…
Are we too quick to cut in today’s society? I think so. Are women fairly consulted (and informed) when it comes to making birthing decisions? Not nearly as often as they should be. I know I felt lost, scared and out of the loop when my first child was born. This happened for many reasons (the portrayal of birth as a danger-laden event in the media, my personal fear of the unknown, the expectations brought to me by doctors during my pregnancy.) And I’m far from alone. Dr. Christiane Northrup’s May newsletter contains an amazing birth story by Shawn Spry.

Shawn Spry’s story illustrates the amazing wisdom that is available to us as women—through our connection with our birth wisdom. Birth is the physical metaphor for how all of creation comes into physical form. And that is one of the reasons why birth always feels like such a miracle. Regardless of how you were born, this birth wisdom lives in you and is available to help you live your life more fully. It is imprinted in our bodies—because they were formed within our mothers.

Shawn beautifully tackles the notion of the ’emergency’ c-section and what it meant to her to be able to have a VBAC (vaginal birth after c-section).

I was made to feel guilty and selfish for caring about how my baby was born. But as the rest of the story will tell, one non-profit consumer advocacy group and two children later, I can say with all confidence: It is not selfish to care how women and babies are treated during pregnancy and birth! Shawn Spry

Read Shawn’s entire essay: The Miracle of Bella

Home Birth Makes the Hit Parade

I know I’ve gone on at length in this post, but I’d be remiss if I didn’t share one last letter with you. This came to me in my email this week. A marvelous essay about home birth, birthing choices, and Britney Spears. 😉

The Thinking Mother’s Answer to Britney Spears’ Cesarean:
Home Birth Makes the Hit Parade

While Britney chooses major abdominal surgery to have her baby and a sculptor creates what should have been – Britney on all fours letting the baby come out naturally on a bearskin rug — there are women who prefer more scientific advice on the best way to have a baby.

Home birth has become the second most popular subject for readers of the British Medical Journal (BMJ), second only to articles on how to treat heart disease. The BMJ recently released its 2005 annual top 10 list of articles receiving the most attention on the web in the first week after publication. “Outcomes of planned home births with certified professional midwives: large prospective study in North America,” was the third most popular article among several hundred published in the BMJ in the year 2005. It was also the third “most sent to friends.” Over 40,000 web users have sought the article since publication. BMJ Article

The research was done by a Canadian research team and many of those downloading the article are Canadian women. Given that only a minority of women in developed countries choose home births, how is it that such an unlikely topic should hold such a prominent position in one of the most prestigious medical journals in the world? The study is, in fact, timely. The Canadian Institute for Health Information has just put out a report demonstrating increased risk of cesareans and other interventions in Canada.

Home birthers are statistically among the more educated in developed countries and this study — the largest prospective home birth study ever published – provides the academic precision to critically juxtapose home and hospital environments and their affect on normal birth.

Hot on the tail of renewed interest in natural birth, studies are presently being formulated to test instead, outcomes when young pop stars and their followers, regardless of risk, ask for cesarean section. Popular promotion of this form of childbirth capitalizes on women’s fear by offering them “a way to get out of birth.”

The only systematic attempt to know what mothers think in North America was done in the U.S. — the Listening to Mothers survey found that not even 1 per cent of mothers who had a first cesarean had requested it. Therefore, while there may be an attempt to render vaginal birth an “extreme sport,” normal birth is still preferred by most women in order to have more control and the satisfaction of engaging in a normal biological function that women have performed for centuries. The outcomes in the BMJ home birth article suggest that women are more likely to achieve this safely if they plan their birth at home.

The BMJ editors one paragraph summary succinctly describes the research:

“Giving birth: home can be better than hospital.”
For women with low risk pregnancies in North America, giving birth at home bears similar risks of intrapartum and neonatal mortality as giving birth in hospital, but planned home births are associated with lower rates of medical interventions. In a prospective cohort study, Johnson and Daviss (p 1416) evaluated the safety of home births involving certified midwives in 5418 women who intended to give birth at home when labour began. The study participants experienced substantially lower rates of epidurals, episiotomies, forceps deliveries, vacuum extractions, and caesarean sections than women with low risk pregnancies who gave birth in hospital.”

Following the lead of Britney and the Spice Girls` infamous “too posh to push” headlines, the National Institutes of Health hosted a conference called, “Cesarean Delivery on Maternal Request” in Washington, D.C. in March. Researchers who attended spoke up widely against such a title, pointing out it was irresponsible and attempting to create a myth. While there is evidence that demonstrates that cesareans and other interventions are on the rise, there is none indicating this trend is being driven by the women themselves. Physicians lack of continuous care, the resulting decreased investment in individual women`s needs, and fear of liability are being offered as more substantial reasons.

With such unsubstantiated claims being made about women wanting cesareans, and the overwhelming response to the home birth article in the BMJ article on how to decrease rather than increase intervention, it appears time to offer “Home Delivery on Maternal Request” instead of cesarean section.

Truth be told, Britney could only give birth on a bearskin rug in front of the fire in a setting outside of hospital.

And if the animal skin seems farfetched, in fact, in the not too distance past, Inuit women in Northern Canada reported reticence in going to the nursing station to deliver because the environment was too foreign — why disturb the nurse’s sterile white sheets when caribou skins are more comfortable and welcoming?
Betty-Anne Daviss, RM MA

Logo courtesy of The Royal College of Midwives

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