The Birth of the Water Baby

 
 The cover of Midwifery Today magazine from Autum 2015

The cover of Midwifery Today magazine from Autum 2015

 

“In 1977, a state hospital near Paris began quietly changing the way women gave birth.

Obstetrician Dr Michel Odent believed that childbirth had become too medicalised and he wanted a more natural approach.

So he introduced a pool to ease the pain of labour and eventually some babies were even born in the pool.

Witness speaks to Dr Odent about the innovation that has become a revolution using the power of water.”

This intriguing 4 minute BBC Witness video documents the introduction of the birth pool to labor and delivery. Watch it here.

7 Reasons Why Families Choose to Birth at a Birth Center

 
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When a potential client comes to tour the birth center, sometimes they are sure that’s the route they want to go, and sometimes they are exploring their options and trying to find the right fit. Here are 7 reasons that you may want to birth at a birthing center:

1. The ability to relax - Let's face it. The bright lights, beeping machines, and incessant intrusion of strangers in your hospital room is not the best way to promote peace and relaxation. At a birth center, the entire space and experience is designed to be calm and comforting.


2. The comforts of home without being at home - Some families aren't comfortable with the idea of birthing at home, but want to birth somewhere that feels as comfortable as home. The birth center fits that bill, and it has all of the equipment, technology, and experienced care providers needed to keep you safe.


3. Freedom of movement - At the birth center you can move around freely, and even give birth in whatever position feels most comfortable for you. You aren’t restricted to the bed. Additionally, the birth center has birth balls, birth swings, and labor ladders to help you move your body into supported positions that are great for labor.


4. Water! - The birth center has deep birth pools in each room that are a lifesaver for many women. We call water “the midwife’s epidural” because it is so effective at providing pain relief! You even have the option to give birth in the pool if it feels right. Water birth has been shown to be safe for both the birthing person and the baby.


5. Support for a natural birth - You don’t have to fight with your provider about your desires for your birth. Natural birth, delayed cord clamping, immediate bonding with my baby - these and more are all the norm at the birth center, not the exception.


6. Knowing your birth team - Unlike at a hospital, you will know the midwives who will care for you during your birth. In fact, you will likely spend many hours with them over the course of your pregnancy at your relaxed 45-minute prenatal visits.


7. Cost - There's no way around the fact that finances came into play when choosing where to give birth, and the birth center is actually far cheaper than a hospital birth. The birth center is also covered by many major PPO insurance plans. All the amazing benefits, plus cheaper to boot.

It's a marvel everyone isn't having their babies at a birth center!

 

Like A Mother by Angela Garbes to be released next week

Like A Mother

 

Angela Garbes, author of Like A Mother, talks to Terry Gross of NPR's Fresh Air about the experience of becoming and being a mother. The interview touches on her own personal experience, as well as highlighting her new book, which comes out next week, on May 28, 2018.

Here's what one reviewer thought of the book:

"This. Is. Excellent. I say that as a mother, as a maternal-child health MPH, and as a woman. This tells it like it is, with the science and research and sociology to back it up. I laughed, i underlined, I wrote in the margins. I only wish I’d had this when I was pregnant. She writes about that dreaded postpartum poop with a candor that I loved. This should be mandatory reading for pregnant people. And anyone who loves them and cares for them."

Listen to the Fresh Air interview.

Buy the book.

Read more reviews for Like A Mother here.

 

ACOG's Committee Opinion: Mothers Need Postpartum Care

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The American College of Obstetricians and Gynecologists (ACOG), the body of OBGYNs that sets the standards for US maternity care, issued a new committee opinion statement earlier this month on "Optimizing Postpartum Care" for mothers. This is what they decided:

"To optimize the health of women and infants, postpartum care should become an ongoing process, rather than a single encounter, with services and support tailored to each woman’s individual needs."

Currently, women who work only with an obstetrician during their pregnancy have one single postpartum visit after they are discharged from the hospital - at 6 weeks. It appears that ACOG has finally figured out that mothers need to be cared for after the birth too - that one visit at 6 weeks postpartum isn't enough.  It's simultaneously depressing and infuriating that ACOG has released this statement like it's actually news. 

In the 5 week and approximately 5 day interim after a new mother leaves the hospital and before she is seen again at the doctor's office, an abundance of physical changes occur:

  • Vaginal bleeding slows and eventually ceases
  • The uterus returns to its non-pregnant size
  • Breastmilk production begins
  • Breastfeeding is established 
  • Pregnancy hormones drop rapidly and return to non-pregnant levels
  • The muscles and mucosa of the vagina and pelvic floor heal, including any tears or damage caused by the birth
  • The abdominal muscles, which may have separated during the pregnancy, begin to come back together
  • Sexual intercourse may resume

These physical changes are coupled with enormous psychological and emotional shifts. A new baby means the complete disruption of the family's previous way of life. Sleep is greatly reduced. Daily tasks that were simple become difficult and time-consuming. And a mother's (and father's) sense of identity shifts dramatically and irrevocably. All of these changes come with associated risks, where the normal course of things can get off track. The consequences can be devastating if these deviations from normal are not noticed and handled in a timely way:

  • Late postpartum hemorrhage 
  • Uterine or other infection leading to sepsis, causing grave illness or death
  • Anemia
  • Low milk supply
  • Painful breasts and nipples
  • Cessation of breastfeeding due to lack of support
  • Postpartum depression and psychosis
  • Suicide or infanticide
  • Preeclampsia
  • Pelvic floor dysfunction causing urinary incontinence, fecal incontinence, and pain
  • Incomplete or improper healing of the vaginal tissues, causing pain and dysfunction
  • Painful sexual intercourse
  • Diastasis of the abdominal muscles

How many of you have friends who are mothers, or have yourselves, suffered from one of these complications after giving birth? I know many.

And this list is not exhaustive. Giving birth is a complex process, for both the mother and the baby. Why would anyone who knows anything about childbirth believe that a mother doesn't need support from her care provider in the 6 weeks after giving birth to her baby?

That ACOG is only now coming to the conclusion that mothers need ongoing postpartum care, despite decades (centuries, millennia) of evidence, can only lead us to one conclusion: the US maternity care system is yet another way in which our society undermines and silences women. And even more so for women of color.

If you need more evidence that this is true, allow me to point you to a tweet that sent ripples of disbelief across social media a few weeks ago:

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This proud tweet is from a presentation given at the ACOG 2018 Annual Clinical and Scientific Meeting, and suggests that "using condoms to prevent pregnancy [is] ACOG's best advice for reducing the maternal mortality rate that is on the rise in the USA."

Sarita Bennett, Vice President of the Midwives Alliance of North America, summed it up well: "As the only industrialized country to hold the dubious honor of having the most expensive system of maternity care while its outcomes are worsening, the profession who presides over the vast majority of those births [ACOG] seems to think that a cartoon condom holds the answers. Given that these statistics are three times worse for women of color, the sentiment takes on a racist tone to add to the misogynist attitude that is at the heart of the power dynamic identified as a leading contributor to obstetric violence." 

Postpartum care is one of the (many) areas where the midwifery model of care excels beyond the obstetric model. We see our clients five times postpartum, three of those being in the first week after the birth. At every visit, we evaluate and support the wellbeing of both the baby AND the mother. We look at physical recovery and healing, as well as signs that the mother is or isn't coping well emotionally. We support breastfeeding, help with achieving a good latch, evaluate the mother's milk supply, diet and nutrition, and make sure she is getting adequate rest so that her body can heal. That is midwifery care. That is GOOD care for mothers.

It is hard to express how difficult it is to see ACOG and its member physicians slam licensed midwives and home birth on a regular basis and then come out with some asinine statement like this one. It makes me sad for families in the United States because so many do not know, and do not understand, how political and capitalist our maternity care system is. The knowledge gap between consumer and provider is cavernous. Families are caught in the web, thinking they are receiving the best care, and making the best choices for themselves and their babies, when so much of current practice is deeply influenced by money, politics, powerful trade organizations, smear campaigns, and outdated clinical practice.

So yes, ACOG, we should check on the mother more than once after she and her body undergo a deeply transformative physical and psychological process. Thanks for letting us know.

Read the full ACOG Committee Opinion here.

What's the difference between a midwife and a doula?

This is by far the most common question that I get when someone finds out I’m a midwife. So a midwife and a doula are both very important parts of the birth team, but we have very different roles. And there are places that our roles overlap. A doula is an emotional, a physical, and an information support person. A midwife, which is what I am, has a clinical role. In the state of CA I am licensed by the medical board to provide complete care for healthy mothers and babies. That means that during your pregnancy, during your birth, and during your postpartum period, I would be your main care provider.