SQUAT Birth Journal

Welcome to SQUAT!

2012-01-20T10:56:00.000-08:00

SQUAT is quarterly publication that supports healthy and empowering birthing practices. We strive to provide a forum where radical, often unheard voices can share their message. It is our goal to promote safe and healthy birth options for all.

Check out our latest issue! SQUAT's Winter 2011 issue features an interview with Whapio Diane Bartlett, Squat's spotlight on education with Ancient Art Midwifery Institute, the photography of Lynsey Stone, the benefits of drumming during labor and pregnancy, a close look at bilirubin, Gail Hart on 'normal' birth, siblings at birth, the artwork of Tess Kashetsky and more!

Submit your work to SQUAT! Check out our submissions page for details and guidelines. Submissions deadline for our Spring issue is February 5th!

Show the world that you love to exercise your rights by getting some SQUAT merchandise! We've got shirts, hoodies, and pants to help you strut your stuff.

Write for our blog! SQUAT's editors would love to have a lively blog, but for now we're dedicating most of our limited time to putting together each print issue. Contact us if you'd like to contribute content to our blog.

2012-01-17T21:42:00.000-08:00

STOP SOPA!

Please help us take a stand against SOPA.
SQUAT relies on the internet to produce, publish and promote our magazine. Like many forms of press that rely on the internet for survival, we will not be free to exist as we do now in a world with internet censorship.

SQUAT stands in solidarity with the global blackout.
http://en.wikipedia.org/wiki/Wikipedia:SOPA_initiative/Learn_more

SQUAT Gear is Finally HERE!

2012-01-07T22:59:00.000-08:00

Check out all out new merch!!

Shirts, hoodies and sweatpants!!!

The Winter 2011 issue is here!

2011-12-21T09:54:00.000-08:00

Just in time for the shortest day of the year!

This issue features an interview with Whapio Diane Bartlett, Squat's spotlight on education with Ancient Art Midwifery Institute, the photography of Lynsey Stone, the benefits of drumming during labor and pregnancy, a close look at bilirubin, Gail Hart on 'normal' birth, siblings at birth, the artwork of Tess Kashetsky and more!

Catching Babies!

2011-11-30T07:10:00.000-08:00

I recently had the great pleasure to attend a screening of a new documentary, Catching Babies, directed by filmmaker Barni Axmed Qaasim. The film follows several clients and student midwives at Maternidad La Luz midwifery school and birth center in El Paso, Texas.
Qaasim, who spoke after the screening, said she decided to do the film after visiting a friend who was in training at Maternidad La Luz (MLL). Qaasim recalled that in watching her fried attend a birth she saw a different side of her, and wanted to more deeply explore the experience and transformation of student midwives. Qaasim describes the journey of the women she filmed:

Texas. Kennasha, Jessica, Diana and Sandra are young modern women embarking on a journey toward the ancient profession of midwifery. They are struggling through one of the most demanding schools of midwifery in the country, Maternidad la Luz, which was designed to be stressful in order to push women to understand their own strength. Sandra's clinical studies go hand in hand with her spiritual studies as she learns the Mexica, indigenous Mexican, traditions around birth and pregnancy. The group bonds as sister-midwives in this transformative space, which gives birth to babies, mothers and midwives. Catching Babies is the personal story of three women as they strive to change the world by changing the way babies are born.

I was ready for a film about midwives and mothers, but Catching Babies surprised me in its utter beauty and thoughtfulness. The camera lingers and meditates on the images that make the work of MLL so special -- strong round bellies, yawning newborn babies, new families sitting together, the smiling and struggling face of a woman in labor.
Catching Babies follows two paths: those of the student midwives and the the mothers that they are serving, teaching, and learning from. The student midwives speak with great candor about their experience at MLL, describing the grueling schedule (a full-time class load as well as 24-hour clinic shifts every 3 days), but also revelling in the thrill of the first “catch” and the way that their midwifery education has taught them more about themselves as women. And while there is a lot of waxing on about “loving women,” the film does touch on less-than-pretty outcomes, particularly when one student says her “insides are shaking” after being part of an emergency response to a mother with a postpartum hemorrhage.
But it's the voices MLLs clients that bring the film to life. Qaasim followed four clients, most of whom live in the bordering Mexican city of Juarez, through the end of their pregnancies, and features them telling their own stories to the background of footage of their incredible, beautiful, cute-as-all-get-out babies and families. These mothers describe the “sisterhood” relationship they feel with their midwives and discuss their past births in hospital environments where “no one cares what the mother feels.”
In watching the film, you feel the wholeness of birth as an experience of an entire family and community. From watching the preparations of an indigenous ceremony to prepare the pregnant woman for her birth, to hearing a father speak about the experience of being the first person to touch his baby boy, the viewer gets a sense of renewing long-held traditions and restoring our faith in the natural process of birth. As one student midwife says (and I didn’t take notes, so this is the best my memory can do), “The more I learn as a midwife, the less proactive I am in a birth, and the more I trust women to do what they do.”
There is, of course, always more a film could cover. In a discussion after the film, Qaasim touched on the inequalities that make MLL work --that the school’s position on the border gives student midwives access to many women seeking affordable maternity care, allowing students to “get their numbers” of births attended. There’s something about that relationship that makes me a little uncomfortable, but the film does demonstrate that each client is treated with great care and thoughtfulness.
This would be a great film to use to introduce people to the midwifery model of care, and to get people talking about midwifery education and the process-both professional, intellectually, and emotionall-of becoming a midwife. It's so fitting that I saw this film while editing SQUAT's next issue, which will begin a series of "spotlights" on midwifery schools and education options.

Qaasim is touring with the film in the Southwest--look at her web site for screenings near you. You can also request a copy to host your own screening, find the film on Facebook. Qaasim is currently working on a Spanish translation of the film so that it can be screened and distributed in Mexico.

-Sarah Tarver-Wahlquist

editor, SQUAT Birth Journal

Asking the schools: SQUAT's Guide to Midwifery Education

2011-11-05T22:22:00.000-07:00

SQUAT has asked the schools all across North America to contribute information to the Midwifery Education Review for the Winter 2011 issue themed around Education and Professionalization. In addition, the Education Review will be incorporated into a future publication entitled SQUAT’s Guide to Becoming a Midwife. If you are reading this via our blog please consider encouraging those in your community to participate.

Some of the questions we'll be asking the schools and programs include:

Accredited or certified, and if so, by which bodies?
Attrition rate
Percentage of graduates actively practicing post program completion
Program Cost
Diversity of student body
Financial Aid available to students (grant/ scholarship/ federal)
Available payment plans or flex pay options if no formal financial aid is available?
Student support or benefits available?
In what type of environment do graduates practice?

Spread the word and encourage the people and schools you know to contribute!

Thanks
SQUAT

Heart to Hart - Listening in Labor

2011-11-01T17:25:00.000-07:00

Heart to Hart is a recurring column in SQUAT, one of of our very favorite features each issue. Lo Kawulok, a midwife in Colorado, poses some questions to seasoned midwife Gail Hart, who answers with evidence and experience. As Lo wrote in SQUAT: "The best part about backing up what we know to be true about birth is that the intuitive and scientific pieces profoundly resonate."

In SQUAT's last issue, Lo asked Gail about monitoring fetal heart tones during later. The whole issue can be purchased here. If you don't already "like" SQUAT on Facebook, please do! We'll be releasing the digital version of this issue for free when we reach 2,000 "likes"!

Listening in Labor

During labor, listening to fetal heart tones can give us an idea as to how baby is reacting to the immense environmental changes that take place throughout the birthing process. Fetal heart tones normally change due to a response to contractions; these changes then may start to form a pattern which can illustrate many things such as a happy, healthy baby, or a baby who needs help.

As birth workers, we are usually educated on the techniques used to listen and record these patterns, as well as how to interpret and resolve possible complications. This, however, can vary widely, depending on with whom and where the birth is taking place such as a hospital, birth center, or home.

In the case of a healthy, low risk mama in active labor, why do these guidelines vary so much? How can one protocol call for constant monitoring (electronic fetal monitoring in the hospital), while another may require intermittent monitoring every five to ten minutes (typical out of hospital standard)? We want to know Gail, hospital and state-specific regulations aside, what is the evidence telling us to be the safest and most comprehensive manner to observe a baby's heartbeat in labor? What does your protocol look like?

Knowledge is Power!
Lo Kawulok

From Gail....

"Protocols" are guidelines and recommendations created by groups, agencies, associations or research institutions. They are written to educate caregivers in the best practices for their profession. But these guidelines and recommendations are not necessarily based upon good evidence; they may be heavily weighted by opinion, or may be influenced by outside professions. (Malpractice attorneys have a prominent voice in many current recommendations.) A midwife must be aware of protocols and be able to evaluate the source and the application to her particular practice or clients. Although "protocols" are intended to be individually-applied recommendations, some licensed midwives are under the authority of licensing agencies which have made these legal requirements. Unfortunately, some licensing agencies are misinformed about correct recommendations and may mandate protocols for fetal assessment in labor which are not appropriate for out of hospital midwives (OOH). This forces the licensed midwife to chose between her licensing rules and different recommendations which are better tailored for OOH clients.

It is essential to be aware of the baby's condition in the womb! Listening to the baby's heartbeat at regular intervals is an effective method to quickly check on how he/she is tolerating the stresses of labor. Make no mistake about this: labor is a stressful condition and some babies can be harmed by diminished blood-flow or poor oxygenation. Uterine contractions slow the placental circulation and the exchange of oxygenated blood to the baby. Some babies may have cords which are pinched or knotted. A healthy baby can compensate for a period of time, but not all babies are healthy. As the length of labor continues, the baby will become less oxygenated and may develop acidosis. His heart rate will change in response to these stresses and we will know he is in trouble; but only if we are listening-- and paying attention to the heart rate!

There is a wide range of texts on electronic fetal monitoring (EFM) and using subtle signs in the heart rate to detect fetal distress in labor. The terminology, definitions, and theories change with new editions as various experts battle about the significance of tiny variations in heart rate pattern. New electronic fetal monitoring gadgets come on the market and are soon replaced by “the next new thing” which is supposed to provide faster and better detection without the high error rate of the previous gadget. The “high error rate” is a huge problem with all of the electronic fetal monitoring devices. The marketing of EFM machinery was more rapid than the science to support it. The science – the evidence – shows that EFM machines do not reduce the rate of birth complications or stillbirth when compared with listening to the baby at regular intervals (intermittent auscultation). Rather, EFM results in a large number of unnecessary emergency cesarean sections to rescue healthy babies which were assumed to be in danger of asphyxia. Listening to the baby at regular intervals is a better option for monitoring low risk women and is the actual recommendation of ACOG, the US Preventive Health Services Taskforce and many other obstetrics organizations. (1)

The human ear – and the mother – are the most accurate detectors of the baby's condition in labor. A healthy baby moves, kicks, and wriggles--even during labor. A baby who is moving gives us reassurance that he is likely handling labor without problems (it is a good idea to include notes about fetal movements on your labor charts). Babies are usually quieter in labor, but they still move and mothers can feel this – and you as the midwife can see this.

But to really know how the baby is doing we must listen to the heart beating – listening frequently but, even more importantly, we need to listen long enough to know the pattern. This means listening for the full length of contractions rather than the quick counts which are commonly done (and commonly taught).

The basic human physiology of a baby in labor is the same now as it was centuries ago and these facts are not affected by ever-changing protocols or electronic gadgetry. All the EFM machines in the world can not improve upon the generation's old understanding of the baby's heartbeat in labor. Every birth worker must know these basic facts of fetal heart patterns.

The average resting fetal heart rate is 120 to 160, and the rate accelerates for a short period in response to fetal movements. The acceleration returns to the basic resting rate within 15 to 30 seconds.
A normal fetal heart rate may slow during a uterine contraction but usually recovers to the normal rate shortly after the contraction.
A slow fetal heart rate in the absence of contractions or which remains slow after the end of the contraction suggests fetal distress; if it does not rise to the normal rate within 30 seconds it strongly suggests fetal distress.
A rapid resting fetal heart rate may be a response to maternal fever, drugs which cause a rapid maternal heart rate, hypertension (high blood pressure), or amnionitis (uterine infection). If the mother's heart rate is normal, a rapid fetal heart rate should be considered a sign of fetal distress

How often should we listen to the baby?

I think the American College of Obstetricians and Gynecologists (ACOG) has a reasonable guideline. ACOG recommends listening to the heart rate “every 30 minutes during active labor, and every fifteen minutes during second stage. The heart should be listened to through the contraction and for at least 30 seconds after the contraction ends”. (2) This schedule nicely balances the need to monitor with the mother's need for privacy. Some licensing agencies require midwives to listen every fifteen minutes in active labor, and every five minutes during second stage! Such frequent interruptions may disturb the mother and interrupt the labor pattern. It is important that we listen to the baby, but we should try to avoid disrupting the mother's concentration. To my mind, a fifteen minute schedule for second stage feels about right.

I modify this schedule to fit the individual mother and baby. I listen more frequently if the membranes are ruptured because the pressure on the baby is greater after he loses the protection of the amniotic fluid. If I am present when the water breaks, I listen continuously for five minutes to make sure there's no problem with the cord. Then I listen again every five minutes for the next fifteen minutes to see how the baby is reacting to the change in pressure. I listen more frequently if the labor is prolonged, or the baby's position is unusual, or if there is meconium in the amniotic fluid.

photo: LA Times

If the mother's active labor is intermittent with a lot of resting periods, I will listen less often. If the mother is not having strong frequent contractions, then her baby is obviously not experiencing stresses from labor. I'm not going to wake a woman from a sound sleep just to listen to her baby! If contractions are mild, the pressure is mild also and the baby has little stress. But if the contractions are strong and long, the pressure is greater and we need to listen more frequently to make sure the baby handles the increased stress.

Protocols and guidelines can give us a rough schedule to follow, but the woman and her baby are individuals. My role of midwife in her birth will have to adapt to her individual requirements. I will listen to the baby with my ears, but with my other senses and intuition also. Almost always labor goes well, and our checking on the baby's heart rate just gives the mother additional reassurance that all is still well.

(1)Macones GA, Hankins GDV, Spong CY, Hauth J, Moore T. The 2008 National Institute of Child Health and Human Development workshop report on electronic fetal monitoring: update on definitions, interpretation, and research guidelines. Obstet Gynecol. 2008;112:661–666.

(2)American College of Obstetricians and Gynecologists, American College of Obstetricians and Gynecologists."ACOG Practice Bulletin Number 106: Intrapartum fetal heart rate monitoring: nomenclature, interpretation, and general management principles" Obstet Gynecol 2009; 114: 192-202.

Huffington Post reports on Undermining Breatsfeeding in US Hospitals

2011-10-26T11:15:00.000-07:00


Above graphic taken from http://keepabreastphils.blogspot.com/2007/11/total-effect-of-infant-formula.html

It is shocking to think that formula companies might actually believe that formula is better than the real thing. Those goody bags they hand out some hospitals- do you think they include a breastfeeding pillow and some supportive literature, no. But they do include free formula samples. There are very justified reasons for a m/others conscious choice to formula feed, however coercion and manipulative advertising have got to go.

The following is excerpted from The Huffington Post article by Lindsey Tanner, you can read the full article HERE.

In solidarity with breasts everywhere- SQUAT

Is Breastfeeding Being Undermined By Hospital Freebies? By Lindsey Tanner

"Jessica Ewald brought more than a new baby boy home when she gave birth earlier this year. Like many new moms, she got a hospital goody bag, with supplies including free infant formula and formula coupons.
"We gave it away the moment we came home because I said I'm not having that in our house," Ewald said.
Ewald, 32, of Oakbrook Terrace, Ill., is the daughter of a breast-feeding activist who fought to get those goody bags out of hospitals. Ewald was taught early on that "breast is best," and even though as a teen she rolled her eyes when her mom asked pregnant women about nursing, Ewald knew she'd choose breast over bottle when her own time came.
Borrowing a line from a blogger, Ewald says hospitals sending newborns home with formula "is like giving somebody divorce papers at their wedding." It can really undermine a woman's determination to breast-feed, she said."

Link to the full article:
http://www.huffingtonpost.com/2011/09/26/breastfeeding-undermined-by-hospitals_n_980840.html

Much Ado About Placenta

2011-10-25T07:06:00.000-07:00

Originally published on Authentic Parenting.

An older expat friend, who had travelled and lived all over the world, once told us that, upon visiting some Asian country - which one it was, I can't quite remember - he was invited to a feast in a small village. All the guests were served a broth-style soup, which was by far the most awful thing he had ever eaten. When inquiring after the ingredients, he was pointed to a young woman, sitting by the side, holding a tiny newborn.
Turns out in this village, when an infant was born, tradition perscribed that the entire village would feast upon a soup which main ingredient is the newborn's placenta (yet there were other probably much more disgusting ingredients added).

Image: lunar caustic on Flickr

Now I must admit, when I gave birth, safe from glancing at it for a moment, the placenta wasn't something I spent much time considering. Yet lately, I have been reading articles about placenta encapsulation, stir-frying, burrying the placenta...

Placenta in the animal kingdom

With just a few exceptions, most mammals eat the placenta immediately after birth, this behavior is called placentophagy.Even herbivores eat the afterbirth (except for the camel). In Marsupials, the placenta is resorbed.
For long it was believed that animals ate the placenta to hide the smell for possible predators. Yet this theory is being refuted because they do not ingest the amniotic fluid released at the birth. Research has shown there are a multitude of reasons why placentaphagy exists in animals.
One of the main reasons the placenta is eaten in the animal world, is because of his high nutritive value.
A second explanation for this behavior is for the effect of the prostaglandin it contains on the uterus, i.e. the retraction of the uterus to its original size (involution). Third, the placenta also contains oxytocin, which soothes stress from the birth and eases milk ejection.
Recent research has shown that the most important reason why the placenta is ingested, might be it's effect on post-partum pain (by enhancement of the body's natural opiates).

Rites and traditions

Eventhough the placenta is mostly discarded in Western society, other cultures have rites and traditions when handling the placenta. Much like previosly mentioned with chimpansees, some cultures leave the placenta attached to the umbilical cord and the child until the cord dries up, which is called Lotus Birth.

In a lot of those rites, the placenta is either burned or buried with some extent of ceremony (Maori, Navajo, Costa Rica, Cambodia,...). Ibo people in Nigeria consider the placenta to be the deceased twin of their child and bury it with full funeral rites.

"In most cultures childbirth is very important and the child is cherished. The placenta is a very important issue that must be disposed of properly or the child will not have a good life." (*)

When the placenta is buried, it is often done close to the child's home. The reason therefor is to prevent children from scattering too far from home and to always have them come back to their maternal home. Often a tree or shrub is planted in the spot the placenta has been buried. If one opts for planting a tree, one must wait up until a year after the placenta burial, because the hormones and nutrients it contains are too strong and most firts be broken down. (If it has been frozen for an amount of time this problem does not occur.)

"After digging an appropriately sized hole, score the sides of the hole so the soil is more amenable to tender roots. Put the placenta in, and cover it with a half to a full inch of soil before placing the plant on top of it. Hold the plant steady while the rest of the hole is filled. Water the plant well after planting. Newly planted trees and shrubs need to be watered on a regular basis the first year until they form a good root system. As the placenta breaks down in the soil, the tree or shrub will reap the benefits of all the nutrients packed in that placenta."(*)

Here in Ivory Coast the placenta is considered as something very potent. Not just anybody can handle it after birth. In small villages, most often the birthing woman's mother (or trusted person) retrieves the placenta after birth and quickly goes off to hide it. It is then buried on a place only the mother and the trusted person know about. This is done so because they believe that the placenta could be used to do harm to the mother or the child.
Even in Western society, some return to some form of ceremony concerning the placenta, which often involves burial. The rites involved are the family's personal choice and can be based on other traditional ceremonies.

Other people use the placenta for art projects (placenta prints or membrane art), in a way to commemorate the birth. These artworks are done either by posing the placenta on a sheet of paper as is, or adding paint or ink. I also came across alternative rituals like naming it or hanging it in a tree.

Placentophagy in humans

While most culture believe the placenta to be of enormous spiritual value, only few cultures eat the placenta. Yet even in the Western there are those that advocate ingestion, here's a list of supposed benefits from placentophagy:

prevent post-partum depression
prevent post partum hemmorage
prevent insomnia and sleep disorders
increase energy level
gives the mother a nutritional boost
recover quickly from childbirth
optimize lactation

Now where would these benefits come from? We briefly viewed some of the placenta's composants from which animals benefit post-partum. Let's take a closer look at those beneficial elements.
Placenta contains:

Oxytocine
Prostaglandine
blood stem cells
Oestrogen
Vitamins and minerals (B6)
rich in iron and protein

Dried placenta is also a very potent medicinal ingredient in traditional Chinese medicine, although there are serious objections to consuming placenta other then your own (risk of diseases transmitted through blood), one of its uses is to increase milk supply (which consists with the occurence of oxytocine, as mentioned above), this use has been scientifically proven.
Another scientifically proven use of human placenta is to reduce menopausal symptoms and fatigue.
If even modern day science can prove these uses of human placenta, than I wonder why it isn't propagated more.

Preparing the placenta for ingestion

If one chooses to take the plunge and consume the placenta, there are many ways in which this can be done.

raw
cooked or steamed
dehydration
encapsulation

"...the fresh placenta should be eaten within the first few days after the birth (refrigeration is a necessity). Any time beyond this, it should be preserved by freezing it, dehydrating it into "placenta jerky" or by making it into a placenta tincture using 100 proof vodka as a preservative..."(*)

Cooking:
A variety of recipes exist for cooking the placenta, from sandwiches to lasagne. You can find some here.

Dehydration:
Dehydrating a placenta can simply be done by drying it in the oven and afterwards grinding it up in a mortar. This is also what's been done previos to encapsulation.

Encapsulation:
Encapsulation can either be done at home with and encapsulating kit, which you can order online at the Placenta Benefits website.
Or you can have it professionally done. On Fruit of the Womb, the process is described as follows:

"This process includes steaming, drying, grinding and encapsulating the placenta. Every placenta varies in size and substance, therefore the average amount of capsules ranges, between 50-200. The capsules are taken 1-3 times per day for the first 1-3 weeks, or until strength has been restored, and as needed thereafter." (**)

Find a specialist in your area. If you want to learn more about encapsulation, you can read my article "Everything You Want To Know About Placenta Encapsulation".

Conclusion
Even though it's use post-partum as preventive treatment for baby blues hasn't been fully researched, the ingestion of human placenta has been proven scientifically to increase milk supply, fight fatigue and decrease menopausal symptoms. In animals it helps the uterus to retract to its original size. Yet it is onknown how cooking or dehydration influences the active substances of the placenta. If the placenta is correctly stored before any cooking, encapsulation or dehydration, there is, however, no risk involved in ingestion. So I'm thinking it might very well be worth the shot.

Additional remarks:

One should always check with ones midwife or caregiver if the placenta is healthy, before proceeding with preparation. With some birth practices (for example Lotus Birth) placentophagia will not be possible due to the treatment of the placenta.
Upon researching this and discussing it with others I found that anything concerning the placenta is pretty much taboo among Westerners, yet Africans have no problem whatsoever discussing it.

What do you think? Tried it? Willing to try it? How would you prepare it? Or have you performed a ritual? Please share!

Read on:

Articles
Many Cultures Revere Placenta, Byproduct Of Childbirth
Placenta Pills as Savior For Mothers To Be
Placenta Recipes article on About.com
Placenta Pizza, some new moms try old rituals on msnbc
Placentophagia, benefits of eating the placenta
The Amazing Placenta on About.com
Placenta: Medicine, Rituals & Art
(*) Birth and Placenta Rituals Vary With Cultures is a very beautiful article on childbirth across different cultures, it offers a ritual for burial and different ways to prepare the placenta for consumption.

Websites on placentophagia
Placenta Benefits
(**)Fruit of the Womb
Placental Remedy

About the author:
Laura Schuerwegen is a Belgian expat wife and mother, currently living in DR Congo. She studied Communication Sciences but opted out of the two-income family, to become a writer and stay at home mother instead. She is expecting a second baby at the end of the year. You can find her daily writing on Authentic Parenting.

Review your school and help SQUAT create the biggest baddest guide to Midwifery Education ever!!!

2011-10-20T14:27:00.000-07:00

SQUAT Birth Journal's winter issue will focus on the issues of Education and Professionalization of Midwifery.

We will be including an Inclusive Guide to Midwifery Education in the winter issue. In addition to our own ratings of each school and/or clinical program we are seeking student contributions for the guide!

Guidelines:
You may review any and all schools that you have attended, past or present.
You are welcome to share any aspects of your experience you feel are relevant, both positive or negative.

Each school review should be 300 words or less
Please include a one sentence nugget of wisdom that you would pass on to someone considering the school you are reviewing.
Your review may be anonymous in print, however we will require your name and contact information for our release forms.
Submissions deadline is Nov 15th 2011 and submissions should be sent to submissionstosquat@gmail.com subject "SCHOOL"

*We welcome all programs including but not limited to: MEAC accredited, non accredited, distance, CNM, DEM, clinical, traditional, international*

The Leboyer Bath

2011-10-17T07:51:00.000-07:00

A Leboyer bath is a gentle way to welcome your newborn into the world. The technique was first described by French obstetrician Frederick Leboyer in his book “Birth Without Violence” and used in order to ease the baby into the world.
Leboyer believed that the crying and dramatic body tension we have come to see as normal, even desired, is not normal or healthy in a newborn and is a sign of severe birth trauma.

A traumatic birth leaves a lasting impression on an infant's mind, setting the tone for future experiences.

- Laura Kaplan Shanley, Unassisted Childbirth

Even a peaceful birth will leave your baby somewhat dazzled - imagine the physical and emotional turmoil they have just gone through! This makes the Leboyer bath a wonderful welcome into the world for any baby.

The Leboyer bath is generally taken about an hour after birth (or any time when it is possible) in order to reintroduce the baby into a watery environment, as a reminder of the womb, but it can take place at any time during the first three days postpartum when the mother feels ready for it. Mother and baby are to be immersed into a warm bath together. Lights need to be dimmed and the room should be comfortably warm.
Mothers will need some assistance, so it is a good idea to have someone around to lay out some towels and clothes, and hand the baby to the mother after she has gotten into the bath.
The bath has an immediate relaxing effect on the baby: the baby may open his eyes or even smile, fall asleep. It has been show to have positive physical effects, pinking up the baby and relaxing any muscle tension. The event will take about 15 to 20 minutes, depending on the baby's reactions. (Giving a Leboyer Bath Successfully)

Bibliography
Unassisted Childbirth, Laura Kaplan Shanley
Birthing From Within, Pam England and Rob Hororwitz (1998)

About the author:
Laura Schuerwegen is a Belgian expat wife and mother, currently living in DR Congo. She studied Communication Sciences but opted out of the two-income family, to become a writer and stay at home mother instead. She is expecting a second baby at the end of the year. You can find her daily writing on Authentic Parenting.

Separating Families for Birth - The Modern Way of Birthing

2011-10-12T01:50:00.000-07:00

As we are planning a homebirth this time around, I got to thinking how I would have done if I were to birth in the hospital. With my daughter being our first child, childcare during labor obviously wasn’t an issue, but now, if I had chosen that route, it would have been.
How would we have managed? Would we have been able to find someone who was ready at any time - day or night - to take care of our daughter?
And it got me thinking about something else... Sibling jealousy and the medical system’s separation of families during childbirth.

Before hospital birth was common, there would always be children around the birthing woman. They might be tactfully guided to the neighbor or a female relative, but not everywhere. Having children around and aware - to some degree - of what was going on, was normal and natural. Yet nowadays, hospital birth and it’s separation of families has become such a normal, integrative part of our culture that we don’t think about this anymore. More so, having children around the birth space is considered odd at the least and detrimental to the child at the worst. Even when discussing homebirth, the question will inevitably be:
- “What will you do with the older child”.
When I went to visit with my midwives, they asked that exact question. At that time, we didn’t have any means of childcare, beside ourselves, so I said that she’d be fine assisting the birth, and she would be free to go or come as she chooses. She’s very much interested in birth and claims to want to catch the baby.
- “But what if she doesn’t want to be there?” was the next question.
Now personally, I don’t have any issue with my daughter coming and going as she chooses and at three and half, she can manage herself in the house, so that was just a non-issue for me. But their policy was to have someone else around for the child at worst, or to drop off the child with a relative at best.
When I uttered that my husband was perfectly capable of taking care of our daughter if need be, and that it didn’t bother me to labor alone - I might actually prefer it - they looked at me cross-eyed.

So here are some of the things I would like to address on this topic:

Image: Oana Hogrefe Photography

I think it is normal and natural and even healthy for children to witness birth. This way they see that birth is just a part of life and might learn to fear it less than those generations who where kept from it (there’s always a certain mystique to the unseen)
I think the modern system of separating families is detrimental to the relationship between siblings. Older siblings get dropped off, because it’s the babies time, only to get picked up again, after long hours, for a short hospital visit, where mommy obviously has fallen in love with this tiny new creature. The older child can’t help but wonder if (s)he is still to be a part of the family, as they went off to have this baby on their own, and mommy and daddy seem to be too distracted to take care of their needs. Of course, this is an extreme, but it is often what happens, and with a hospital birth, the father is often overwhelmed by the responsibilities and running around he has to do, and the mother is stuck at the hospital with the new baby. The older siblings are somewhat left adrift, even in the best of situations.

There is nothing more natural then birth, and having the older siblings around (obviously with the freedom of choice to leave the room if possible, and perhaps a caretaker around to help them out a little if it’s all too overwhelming) is only natural, healthy, and good for family relationships. Birth should not be a time of separation and discontinuity, it should be a celebration of a growing family, where nobody is left out of the marvel and wonder of the event.

About the author:
Laura Schuerwegen is a Belgian expat wife and mother, currently living in DR Congo. She studied Communication Sciences but opted out of the two-income family, to become a writer and stay at home mother instead. She is expecting a second baby at the end of the year. You can find her daily writing on Authentic Parenting.

The Right to Be Fertile

2011-10-10T06:49:00.000-07:00

Here's a great article by Rae Liberto from the very first issue of SQUAT last summer. You can buy the whole issue in its newborn glory here. We've also posted archived SQUAT articles about placenta medicine and chia seeds in pregnancy--check 'em out!

The Right to be Fertile

by Rae Liberto

In my life as a woman, a doula, and a midwife´s apprentice, I have unexpectedly found myself in a struggle to defend fertility. As a woman I am criticized as being irresponsible and naïve for not using invasive or hormonal forms of birth control. As a doula I advocate for young women who choose not to terminate their pregnancies but to give birth and mother their children. As a midwife’s apprentice in rural Guatemala I listened to the stories of women who were sterilized without their consent or whose reproductive organs were removed on false grounds. I have come to see fertility as a human right. It is a right that is denied to certain populations of women and there are not enough of us questioning and resisting this particular form of oppression and violence against women.

As a doula I work for an organization in Seattle that provides free birth doula services to pregnant mothers who would otherwise be birthing alone or with little support. I primarily work with young Latina mothers who are giving birth in major metropolitan hospitals. These women have all received some form of discrimination from either nursing staff or their care provider for having chosen to mother their child. I remember my first prenatal visit with a woman who was 17 and from Mexico. She told me she was seeing a Nurse-Midwife at a nearby hospital. I asked her if her midwife had helped her create a birth plan and she said to me assuredly, “Yeah, she told me all about the IUD and the pill.”

I just recently completed a six-week midwifery apprenticeship of a traditional midwife in Guatemala. During my time living and working with the midwife in her rural, indigenous, agricultural community, I was appalled at the amount of women who were without their reproductive organs. Many women openly shared with me that they had their uteruses removed or had total hysterectomies because the doctor told them they were at risk of uterine cancer from having too many children. Other women had stories of going to the hospital for labor complications, receiving a cesarean section, and finding out later that the doctor also gave them a tubal ligation. In some of these cases of sterilization the consent was given from the husband, but others were done without any consent.

Last winter I was granted medical insurance for the first time in a few years so I decided to go get my lady parts looked at by a Nurse-Midwife for my bi-annual Pap test. Before the deed was done I was asked a slew of lifestyle questions:

Do you take recreational drugs? Not exactly.

Do you smoke? Occasionally.

Do you drink? A little more occasionally.

Are you sexually active with persons of the opposite sex? Yes.

What form of contraception do you use? Fertility Awareness Method and condoms.

She arched her eyebrows and looked at me from above the rim of her glasses.

Have you heard of Plan B, the morning after pill? Yes, I’ve heard of it but I have never used it nor do I plan to. I don’t feel right about taking hormones.

Do you feel ready to be a mother? No.

Then hormonal birth control or abortion is your only option.

The overwhelming message sent to women is that their bodies and cycles of fertility are not to be understood and trusted but controlled by invasive, manipulative, and hormonal forms of contraception. If you are a poor woman, a young woman, and/or a woman of color the message is that you are not capable of giving a child what they “need” and, therefore, you do not have the right to birth, mother, maintain your reproductive organs, or to be fertile. These women face discrimination for their choice to mother and are urged to terminate their pregnancies, put their child up for adoption, and, in some cases, have their organs altered or removed.

So what should we do, and how can we support each other? We can start by educating ourselves, our partners and others in our community about fertility awareness and stewardship. We can gather together to recognize, name and address the oppression of and violence against women and their fertility. We can create women’s health collectives and fertility solidarity groups…the possibilities are endless.

Resources for radical doulas and midwives:

Openarmsps.org

Birthattendants.org

Blackmidwives.org

Sistasontherise.org

Prisonbirthproject.org

MANA.org

Midwivesformidwives.org

Resources for fertility stewardship:

Sisterzeus.com

Gardenoffertility.com

Tcoyf.com

Cyclendar.com

Mum.org (museum of menstruation and devices used to catch menstrual flow)

Get a subscription and save!

2011-10-05T06:11:00.000-07:00

Love SQUAT? The best way to get it in your mailbox every season is to sign up a subscription-- we'll automatically ship you each issue all year, and you'll save on printing and shipping costs.

Today is the last day to get a subscription that will include our latest issue-- so sign up today! Just check out our subscriptions page for more information.

Happy Fall! Check out our latest issue!

2011-09-23T08:49:00.000-07:00

On this first day of fall, we at SQUAT are thrilled to release our next issue!

Buy a digital or print copy on Magcloud, or sign up for a subscription.

This issue includes incredible underwater maternity photography from Kevin Beasley (featured on the cover); perspectives on listening to fetal heart tones during labor from wise midwife Gail Hart, an interview with author and PhD Bruce Lipton; and so so much more! Check it out and let us know what you think.

It's almost that time again...

2011-09-22T06:33:00.000-07:00

We're almost ready to release the Fall issue of SQUAT!!

How incredible is this cover?!

Make sure you sign up for a subscription now, and you'll get this issue when it's published. We'll also be sure to share the link to download the digital version.

Future Midwives Alliance surveying student midwives

2011-08-30T05:37:00.000-07:00

Here's a great opportunity from the Future Midwives Alliance to have your voice heard! Check out the info and survey link below.

The Future Midwives Coalition and the Student Section of Midwives Alliance of North America have joined together to create the Future Midwives Alliance.

We, the Future Midwives Alliance, are working to create a Student Bill of Rights and Apprentice Statement of Rights and Responsibilities. The Student Bill of Rights is intended to represent all midwives across all known lines, including: nurse midwifery, DEM, CPM, licensed/unlicensed, traditional et. al.. The Apprentice Statement of Rights and Responsibilities is intended to codify the ethical relationship between student and preceptor in the apprenticeship model.

Our purpose in this work is to:

bring visibility and voice to the challenges of all students (past, present, and future) in a setting that is safe, anonymous, confidential, and solutions oriented.
outline the rights of students in an inclusive and respectful way to benefit all midwives and the future of midwifery.
begin a movement in midwifery in which all midwives and students, including those in currently marginalized communities, are treated with respect and can succeed in this work of passing on the midwifery model of care in a spirit of support and nurturing.
with room for differences, to create a common language and model for relationships between students and preceptors that can be agreed on and practiced by many.

We see this as an opportunity to improve conditions under which people become midwives, thereby strengthening the midwifery community, leading to the potential for greater unity among future midwives and creating opportunities for future midwives of currently marginalized communities.

The first steps of this process include:

Collect responses from the Student Challenges and Feedback form that may be found here. Please take a minute to fill out the survey, and pass it along!

Seasonal periods, brought to you by Big Pharma

2011-08-15T02:46:00.000-07:00

Following the trend toward inventing diseases and conditions that can be treated by new drugs on the market, the pharmaceutical world has presented women with a new condition that it can conveniently cure: too many periods. I discovered the condition on the back of the May/June issue of “Nurse Practitioner World News” sticking out of my mailbox.

I didn’t know we wanted this before now, but maybe we do? Seasonique, an oral contraceptive offering “fewer periods and, now, more savings” features in its new advertisement a healthy, happy, Patagonia-clad woman enjoying a fresh walk down the beach. She’s probably not having her period!
THIS IS AN INDUSTRY TRADE MAGAZINE ADVERTISEMENT. What’s so disturbing about this new birth control pill is not that it is available, but that the pharmaceutical industry has decided it can — and should — attempt to convince physicians, nurse-practitioners and midwives that it knows what women want. Big pharma understands fifth-wave feminist desires. It can provide us with the means to control and limit our monthly menses to seasonal inconveniences……until Annuelle™ comes on the market.

Personally I’ve used the pill (also called OCPS, or “oral contraceptives”) a few times in my teens and twenties. Back then OCPs seemed like the best fit for me. They weren’t messy, they weren’t scary in the way that IUDs or injections were, or freaky the way implants were. The pill appeared benign enough that one could practically forget they were taking a daily dose of synthetic hormones. Ultimately I became uneasy about the daily dose of hormones I was consuming. I began to recognize that some of the side-effects I was experiencing were the result of the additional hormone load. I remember feeling like some other entity had come in and taken up residence in my body.

While I am not a fan of increasing our exogenous hormone load, I am all for choices in contraception and I accept that the pill is the preferred method for many women. I wish, however, the trade-off for preventing unwanted pregnancies was not an increased risk of certain cancers. In my clinical life, I have had very few clients interested in hormonal birth control methods either because they are nursing mothers, they want to avoid exogenous hormones, or they hope to become pregnant soon. Until now I’ve only been peripherally aware of the new option to have 4 periods per year instead of the regular 13 or so.

Is this really what women want? Seasonal periods? The concept is alluringly pseduo-natural. Maybe this is your body…. in harmony with the four seasons?

There were times when toting along tampons or sponges or whatever was awkward, but I never found myself thinking “How can I get out of having these periods?” And I was one of those women who spent an entire day doubled over with severe cramping every month.(Perhaps my Catholic guilt played a role here). Are women so burdened by their monthly periods that a drug company felt compelled to save us all from our suffering by creating a new brand of birth control pill that “empowers” us to have fewer periods? Perhaps for women already committed to the pill, switching to one that eliminates most of their periods is not a significant stretch.
Suppose this product was created in response to consumer demand, and not the other way around? What price will we pay for “seasonal” periods? In an article about these kinds of OCPs, the Mayo Clinic counsels “you may notice bleeding or spotting between periods (breakthrough bleeding) when you extend the number of days between periods.” Spotting is casually presented as the only noteworthy side effect of these extended cycle OCPs.

In reality, we don’t have any long-term studies (more than a few years) on using OCPs this way. Decades of research on traditional OCPs however is clear about some major risks including heart disease, stroke, and blood clots. And what about cancer? Research has shown that birth control pills slightly decreases the risk of ovarian and uterine cancer, while potentially increasing the risk of breast and liver cancer in some women. In 2006, the Mayo Clinic determined that women who used the pill before their first pregnancies had a 44% higher risk of breast cancer over women who had not used the pill.

The possibility of more breast cancer, even if the research flip-flops on the subject, is a big deal to me. As an American woman I have a 1 in 8 chance of developing breast cancer in my lifetime — much higher odds than having ovarian or uterine cancer. Pills like Seasonique expose women to an additional 13 weeks of exogenous hormones over the regular combined OCPs.
While digging around for information on Seasonique I learned that the pharmaceutical industry in 2004 is estimated to have spent spend $57.5 BILLION dollars on advertising. The industry spent TWICE as much on advertising as it spends researching and developing existing and new medications.

I also learned that maker of Seasonique, Teva Pharmaceuticals, along with 12 other pharmaceutical companies, were sued by the state of Massachusetts in 2003 for Medicaid fraud. These companies allegedly inflated the prices of their medications to their industry’s price reporting services, which in turn caused Medicaid to waste tens of millions of dollars in inflated reimbursements to recipients of the medications made by these companies. Your grandmother has to choose between food and medications while the folks at Teva are raking in obscene profits. All 13 companies in the Mass Medicaid fraud suit settled, returning roughly $23 million dollars back to the state’s Medicaid program.

Drug companies’ influence over physicians’ prescription pads is also obscene. In 2000 the drug companies spent over $20 BILLION dollars on private sales meetings between drug reps and physicians. The industry can afford to spend this amount of money on promotional meetings with physicians because it knows from experience that targeting susceptible physicians will ensure humongous profits. A former drug rep for Eli Lilly describes the nature of the drug rep/physician relationship:

It’s my job to figure out what a physician’s price is. For some it’s dinner at the finest restaurants, for others it’s enough convincing data to let them prescribe confidently and for others it’s my attention and friendship…but at the most basic level, everything is for sale and everything is an exchange.
—Shahram Ahari

What does this mean for the physician-patient relationship in discussing birth control options? I want to believe that providers would place their obligation to provide true informed choice about the risks and benefits of contraception options over cozy relationships with drug reps. But I recall my own experiences and I fear for the women in their teens and twenties going in for their first yearly well-woman exams, and coming home with packs of pills, completely unaware of the money, advertising, and schmoozing efforts involved in getting those pill packs to the providers desk.
Some women might want these pills, and that’s OK. What do I want?

Instead of insurance fraud and a misrepresentation of these medications’ risks, I want transparency. I want the pharmaceutical industry to adopt a shred of decency and stop inventing and selling made-up conditions to women, and start spending more money on making its products safer than on advertising them to us. I want honest discussion about the possible risks. I want more choices and safer choices. What do you want?

This post originally appeared on midwife Erin Ellis's blog, where you can find loads of great information. Check it out!

You Win Some, You Lose Some: Birth Control and The New HHS Guidelines

2011-08-12T16:41:00.000-07:00

My name is Chantal and I love to talk about birth control. In fact, few things excite me more than a convo about condoms, a dialogue about diaphragms, a heart-to-heart about hormones... In my job as a pregnancy options counselor, I even get paid to talk to women about contraception. But that's not why I love it. I love to talk about birth control because it seems to be the great connector of women, a subject we all have something to say about. Almost all U.S. women who have had sex (99%, according to a recent study by the Guttmacher Instituteⁱ) will rely on some form of contraception at some point in their lives. The figures are practically the same for religiousⁱⁱ women. The same study shows that 98% of Catholic women who have had sex have used some form of contraception other than natural family planning, the only method deemed acceptable by the church. (Much to the dismay of my high school theology teacher. Kidding. But really, she'd be so disappointed.) Although women's access to contraception varies based on factors like age, race, gender identity, education level, geographic location, and socioeconomic and immigration status, it is clear that the desire to control our reproductive capacities is something that almost every woman experiences. We may have our differences, but the potential for commonality is great.

I've been talking and thinking about birth control even more lately on the heels of the Institute of Medicine's (IOM) recommendation that birth control and other women's health services be fully covered by health insurance plans with no co-pays, co-insurances, or deductibles. In case you're not familiar with health insurance lingo, these are all fees that the insured person is expected to pay out of pocket before a service will be covered. These fees range from relatively small, like a $10 copay when you go to the doctor, to ginormous, like having to pay as much as $5,000 before your insurance company pays for anything at all. This system is euphemistically referred to as “cost sharing.” Just last week the Department of Health and Human Services approved the IOM's recommendation.

So what does this mean exactly? Well, it means that starting next year, health insurance plans must cover all FDA-approved methods of contraception without any cost to the patient! The guidelines also include services like STI-testing, HPV screening, annual exams, and domestic violence counseling. Are you thinking what I'm thinking? FINALLY. (And also, DUH.) I immediately think of the women I talk to each day for whom cost is the number one barrier to accessing birth control. I can't tell you how many of them are experiencing the same vicious cycle: They choose a birth control method, stick with it for a few months, stop using it when it becomes too expensive, and end up with the “choice” of either continuing an unplanned pregnancy (kids are expensive) or having an abortion (abortions are expensive). I also think of my own contraceptive history. I'm lucky to have decent health insurance through my current job. But in the past, when I was only working part-time, I too had to weigh my contraceptive options based on what I could afford. At the time, I was a broke college student living on microscopic AmeriCorps wages so I couldn't afford much.

I don't doubt for a second that the new preventive care guidelines will make a serious difference in the lives of many women (and men!). However, I just can't shake the feeling that this victory still only pales in comparison to the obstacles women will continue to face when trying to plan out our reproductive lives. Maybe this goes without saying but these new guidelines can only improve the lives of women who already have health insurance. Estimates from 2009 show that there are as many as 50 million people in this country without health insurance and that many of them are working poor.ⁱⁱⁱ As the unemployment rate continues to be high, it is unlikely that the rate of uninsured Americans will go down any time soon. The women who will continue to suffer are those who are already saddled with the greatest inequalities in access to medical care and, consequently, experience some of the worst health outcomes—low-income women of color and women who are undocumented. For these women, cost will continue to be a barrier.

While cost is certainly significant, what is also missing from mainstream discussions of birth control and reproductive health is the topic of safety and acceptability. We don't just need contraceptive options that are low cost or even free. We desperately need contraceptive options that are safe, with fewer side effects and new methods of delivery. We need more studies that prove that the drugs that are on the market now won't do long-term damage to our bodies. We need a system that holds pharmaceutical companies accountable for the products they create while forcing them to create products that meet our needs instead of just lining their pockets.

I had a conversation just the other day with a woman about her choice of birth control. She had been using the method for several months when she missed a dose accidentally and became pregnant. I asked her if the method had worked well for her in the past. She responded matter-of-factly that it had not. The side effects she experienced regularly interfered with her life and made her feel miserable. But she reasoned that it was better than getting pregnant again and, besides, she was uninsured and it was the only method she could afford. Unfortunately, these kinds of conversations are the norm rather than the exception.

I can tell you, anecdotally at least, that most women I talk to at work and in my personal life are dissatisfied with their birth control. Frankly, I think it's about time for the medical field to admit that the side effects associated with hormonal birth control are not always trivial. Sure, not everyone experiences them. But those of us who do, are sick and tired of being silenced. It's amazing to me how willing we've all become to accept the hand we've been dealt. Try this. Find the nearest man and ask him if he'd be willing to take a pill that could cause nausea, hair loss, depression, fatigue, weight gain, and decreased libido, just to name a few—all to prevent an unplanned pregnancy. (I'm not even getting into the potential risk for blood clots, heart attacks, and strokes.) Nah, I didn't think so. So why should we?

As Laura Eldridge points out in her fascinating book, In Our Control: The Complete Guide to Contraceptive Choices for Women, birth control technology hasn't really changed much in the last fifty years. Sure, we've got some new methods of delivery, things like patches and rings, but the basic premise is still the same: using synthetic estrogen and/or progestin to suppress ovulation and generally make the inside of a woman's body a not-so-comfortable place for sperm and egg to meet. It is interesting to note that while new forms of hormonal contraception are out on the market (even if they do use the same or similar hormonal formulas), there has been hardly any innovation in barrier methods. The diaphragm has been around since the 1800's and condoms are virtually prehistoric. (Well, you get the idea.) Eldridge suspects, unsurprisingly, that profit is the bottom line. Pharmaceutical companies stand to make way more money off of pills you buy every month and IUDs that cost hundreds of dollars. A diaphragm will only cost you about $50 and can last for 1-2 years. If pharma is looking to get rich quick, hormonal options are much more likely to get them there.

So what's a girl to do? I've been asking myself this very same question for months. After roughly two years on the pill, I've decided to take a break from hormones. I wish I could say that life is all beer and skittles now. I've spent a lot of time and money and had more than a few panic attacks trying to figure out how to continue to enjoy my sexuality without the constant fear of getting pregnant. At the same time, I feel good and healthy in a way that I didn't before. Gone are the mood changes, which were dramatic with the first pill I tried. Less so with the second, but even then I still couldn't shake the feeling that something was just... off. I look forward to having a monthly cycle again. I want to chart it! I was recently fitted for a diaphragm. I'm telling myself it's retro chic! And I'm reminding myself that I shouldn't have to apologize for my fertility. There are plenty of ways to enjoy sex safely with little to no risk of pregnancy. So, hey, maybe I'll get creative. There are plenty of women out there who have succeeded in finding a birth control method that works for them. That's great! And there are even more women who will now have a chance to experiment with methods that they previously couldn't afford. Ultimately, we all need to be more vocal in demanding some serious changes from the next generation of contraceptives. Now is the time to start thinking critically about what we want and need from our birth control. I can't help but feel that we all deserve better.

iRachel K. Jones and Joerg Dreweke. “Countering Conventional Wisdom: New Evidence on Religion and Contraceptive Use.” Guttmacher Institute. April 2011.

iiIt is important to note that, as far as I can tell, this study only included data about Catholic and Protestant women.

iiiJoan McCarter. “Number of Uninsured Americans Soars to 50 Million.” Daily Kos. January 3, 2011. http://www.dailykos.com/story/2011/01/03/932015/-Number-of-uninsured-Americans-soars-to-50-million

Chantal Tapé is a self-described birth geek, doula, and soon-to-be-midwife. She currently resides in the smallest state, where she can be found drinking beer with other hairy feminists. In her free time, she also enjoys cake-baking, dance parties, and talking about abortion.

Banning C-Sections and Inductions before 39 weeks -- a sign of change, or just a band-aid?

2011-07-29T11:52:00.000-07:00

Banner Hospitals banning elective C-sections, induced labor for pregnant women

While this might appear to be good news, is there a deeper issue here that hospitals are not comprehending? Take a look one reader’s response to the Banner Hospital article:

“I am sure that they will not be banning all elective sections – if a baby is breech, even if the mother wants a normal birth I expect they will be advocating or even insist on an elective caesarean (despite the evidence of harm to the woman over her reproductive life). I bet if she gets to anywhere near 42 weeks pregnant they will advocate or insist on induction to try to reduce the risk of stillbirth (despite the lack of evidence that this actually has this effect). Perhaps they should focus on the many caesareans and inductions women do not need and do not want, rather than try to blame women for choosing these highly dangerous intervention that they have been ’selling’ to

them as safe.”

     The author of the article, Mary Ellen Resendez, states that Banner’s action will “leave mothers with one less choice when it comes to delivering their babies”. Is that what this comes down to? A simple matter of choice, such as deciding whether you want a vanilla or chocolate shake, or if you want fries with your cheeseburger?
     What about the women who want to have a VBAC, or a vaginal breech birth, or who are gestational diabetic and don’t want to be automatically induced at 39 weeks?
Dr. Ken Welch of Banner hospital stated, “We just had to draw that line in the sand and say, because of the data, that we’ve become convinced we know it’s healthier for the baby and we know the mother wants what’s best for the baby.”
     While I agree with Dr. Welch’s statement that the data shows elective inductions and c-sections are not best for baby, I find it interesting that he is not addressing the risk to the mother of these procedures. Higher rates of emergency cesareans, and higher rates of vacuum/forceps deliveries also contribute to maternal injury and death, as well as risk in future pregnancies.
     If Banner and other hospitals really want what’s best for babies (and mothers) why not take a few other bold moves:

Eliminate the central fetal monitor, and move labor nurses into the room of the laboring woman, where they will monitor the fetal heart rate intermittently with a hand-held doppler (continuous electronic fetal monitoring has been shown to be correlated with tripled c-section rates without reducing neonatal mortality)
Provide each woman with a doula, who will support the laboring woman throughout her labor (reduces the incidence of c-section and need for epidural anesthetic)
Hire laborists skilled in the lost art of vaginal breech births and VBAC support. These staff obstetricians would work regularly scheduled shifts at the hospital, and eliminate the argument that women cannot have a VBAC because their physicians cannot be expected to cancel all their patients and remain in the hospital during the entirety of labor
Educate labor nurses in the art of supporting normal labor. Nurses would be skilled in comfort measures, movement, optimal positioning for mom and baby, and support of undisturbed mother-baby bonding after birth.
Treat physiologic birth as the norm, the “gold standard”, rather than something that only happens when the laboring woman doesn’t reach the hospital in time to get her epidural.
Have midwives on staff and available for each laboring woman who wants midwifery care.
Encourage the understanding that many variations of birth are normal. Babies come in different sizes, and gestate for different Title lengths of time. Some come out head first, some come out butt first. Some come quickly, some take their time. All of these variations are NORMAL.

Banning elective c-sections and elective inductions, without promoting normal, physiologic birth, is like closing a c-section wound with band-aids.

This post originally appeared in Birth Sense, a fantastic blog dedicated to spreading common sense about normal birth.

Have something to say? SQUAT Fall 2011 submissions deadline is August 15!

2011-07-18T07:00:00.000-07:00

We are currently collecting submission for our Fall 2011 issue of SQUAT!

Articles can be on a range of birth, midwifery and parenting topics. Please try not to exceed 2500 words. We welcome the submission of birth stories that are 1500 words or less. File formats we accept are .doc , .docx , and .txt.

Photography and artwork submissions are best if (much) larger than 800 X 600 pixels (H X W ratio does not matter). Image files may be .jpeg, .gif or .psd. High resolution and large files are appreciated for good image quality.

Please email submissions by August 15 to SubmissionsToSquat @ gmail.com.

We look forward to hearing from you!

Oxytocin and C-Sections, the breastfeeding baby doll and more-- SQUAT news time!

2011-07-17T10:43:00.000-07:00

http://www.heraldsun.com.au/news/breaking-news/women-should-give-birth-at-home-british-experts-say/story-e6frf7jx-1226094812440A review of 8 studies concluded that the administration of oxytocin in labor does not correlate with a reduced rate of C-Section or use of forceps. While the early use of oxytocin resulted in shorter labors (by about 2 hours), there were no differences in rates of cesarean sections or the use of forceps during vaginal delivery between women who were given oxytocin and those given placebo, or between those who were given oxytocin on an early versus a delayed basis.

Last week’s News Round-Up brought us the story of Afrykayn Moon, a Michigan mother who was harrassed by a SMART bus driver for nursing her son on the bus. This week the driver and dispatcher were suspended for several days and a SMART spokesperson announced that all drivers would be re-educated on a mother’s right to breastfeed her baby on the bus.

This week the Royal College of Obstetricians and Gynaecologists (RCOG) in the UK released a report that called for the UK National Health Service to give greater support to midwife-led birth centers and homebirth options for women. The report cites the stastistic that less than 10% of women in the UK give birth in a birth center or at home as "not acceptable, nor sustainable."

The “Breast Milk Baby” doll, already for sale in Europe, will be making its way to US retailers soon. The doll comes with a “halter top” that is worn by the child; the top has flower nipples on it for the toy doll to suck.

The city of Richmond, Virginia, has put together a commission to form a new proactive breastfeeding initiative in the city. This commission will develop a plan by next summer with the goal to increase breastfeeding to at least 75 percent of infants' mothers, along with plan to secure funding to sustain the initiatives.

Protests in Uganda, dental health and fertility, and more--the SQUAT News Round-Up!

2011-07-09T06:54:00.000-07:00

A Washington, DC, police officer is now taking leave without pay after returning to work after the birth of her daughter because the DC Metropolitan Police refused to give her a desk job that would ensure her ability to have a successful breastfeeding relationship with her new baby. Officer Sashay Brown argues that the bulletproof vest she is required to wear while on street patrol is painful and could cause clugged milk ducts in her breasts, but the department responded that Officer’s Brown’s condition does not warrant her being put on the limited-duty desk job that she requested. Supporters have planned a nurse-in at DC Metro headquarters for Saturday morning.

Couples in the UK will soon be able to gamble at a chance for in-vitro fertilization. A UK-based charity, To Hatch, will sell lotto tickets for $32 (£20) for the possibility of winning about $40,000 (£25,000) in fertility treatments. The founder of To Hatch says the lotto is meant to make up for spoty coverage of IVF by the National Health System, but medical ethicists and others are concerned about the social effects of making a lottery out of a healthcare resource.

According to information gathered in an Australian study about dental health, women with gum disease took an average of 2 months longer to get pregnant than those with better oral health.

A district court in Texas heard arguments this week about a new law in Texas that would require women to undergo a mandatory ultrasound before receiving an abortion. The law would also require doctors to recite risk factors and other facts to patients before an abortion.

Protesters take to the street in Uganda in May

Protestors took to the streets again in Uganda this week to protest the high right of maternal mortality in the country, as well as the delay of lawsuits stemming from two maternal deaths. Approximately 435 out of 100,000 Ugandan women die in childbirth, as opposed to 24 per 100,000 in the US.

Where's Frida? Send us your photos!

2011-07-07T05:51:00.000-07:00

Let’s Play Where’s Frida? !!

If you’ve check out our latest issue of SQUAT, you saw our beautiful logo, Frida Birth, lounging in some summer grass on our back cover. That lovely grass is growing in the backyard of SQUAT Editor Meghan Guthrie, and that great photo inspired us to get photos of Frida all over the place, demonstrating that women and families everywhere are working to exercise their rights!

So we’re launching a new feature on our blog-- Where’s Frida? If you want to play, we’ll send you one of our snazzy business cards featuring the lovely and empowered Frida. You can take her picture wherever you want, and email it back to us. We’ll share your photo on our blog and it might even appear in the birth journal!

Just email as at squattingbirth@gmail.com with the subject line Where’s Frida?. Include your mailing address and we’ll get Frida in the mail to you. We can’t wait to see where she ends up!

Get a picture of Frida with a cute kid!

Or a picture of Frida at your favorite local coffee shop!

Download the updated Summer 2011 issue for FREE!

2011-07-05T08:17:00.000-07:00

Hey SQUAT readers!

Have you had a chance to check out our beautiful Summer issue? If so, we've made a few updates to it, so we're making the download FREE for a couple of days so you can have the most up-to-date version. And if you haven't bought the last copy yet, you're in luck! Check out the free download and you just might find that you need the print version, too!

SQUAT Issue 5: Summer 2011

This beautiful issue features articles about the Catherine Ferguson Academy, evidence-based midwifery, birth choices and queer parenting, gender in the birth network, herbs for pregnancy, book reviews, artwork by Amanda Greavette, and tons more!

Investigating the rise in c-sections, a nurse-in in Michigan, and more -- it's the SQUAT news round-up!

2011-07-02T12:31:00.000-07:00

Breastfeeding in public was in the news again when Afrykayn Moon, a Detroit area mother of two, was asked to cover up while nursing her two week old son on an Oakland County SMART bus. After the driver asked her to cover-up or get off the bus, Moon, who is a member of Black Mother’s Breastfeeding Association, reminded the driver of her right to breastfeed, but says the driver refused to move the bus until Moon was done breastfeeding. SMART has since given clear orders to all drivers to support a mother’s right to breastfeed, but has not issued an apology to Moon. About 50 women and men gathered at a nurse-in at the county bus station Friday.

Women and doctors wanting to plan early births for convenience will have a tougher time in Arizona, after Phoenix-area Banner Health joined a growing number of hospitals in prohibiting induction or scheduled c-section before 39 weeks gestation. noting that the final weeks of gestation are crucial in a baby's development. Women with medical reasons for giving birth early will not be affected.

Researchers at the Yale School of Medicine recently completed a study to investigate why the US c-section rate has increased in recent years. The study, which will be published in the journal of Obstetrics and Gynecology, looked at data from 30,000 births at Yale-New Haven Hospital from 2003-09. Researchers found half of the increase in c-sections was attributable to repeat cesarean delivery in women with a prior c-sections, there was an equal rise in first-time c-sections, due largely to slow progression of labor and concerns around fetal heart rates.

Birth advocates in Arizona have started a petition to ask the Arizona Department of Health to change regulations in Arizona to give licensed midwives the freedom to attend a vaginal birth after ceasarean (VBAC) at home. A Northern-Arizona midwife is currenlty raising legal funds to help defend threats to her license after advising a woman seeking a VBAC.

And if you missed the news last week, the latest issue of SQUAT is waiting for you! Check out a preview of the issue and download it at Magcloud, or get a subscription for yourself or someone you love!

A Love Letter to a Dead Owl -- a SQUAT preview

2011-06-27T12:01:00.000-07:00

A Love Letter to a Dead Owl
by Jane Drichta

About me:

I hate birds. Hate them. Always have. My reaction to a one-legged duck at Disney World, of all places, is legendary in my family. There may have been tears. Nausea. And cursing. Not my finest hour at the Happiest Place on Earth, but I'm not proud. In fact, the very word "bird" cannot even be thought of in my world without adding the inevitable follow-on "mites." Bird mites. I can barely type it. The beady eyes, the seemingly sentient feathers, ruffling without warning … I could go on forever.

Kerry and Jason’s Birth:

This particular bird was some sort of owl. I don't know what kind, and I'm not going to look it up, so don't ask. It was whitish, dusty and very dead. It also happened to be hanging from a hook in my client's living room, wings outstretched as if about to pounce on a mouse or small child, or whatever owls aim for when they swoop down out of the sky. It was 4 a.m., we had been awake for almost two days, and I was alone in the dark with a stuffed raptor.

I'm sure you know the labor. It had all started so well, with rectal pressure two hours in, and lovely contractions that were hard and fast and frequent. These clients lived an hour from me, so I checked in frequently via cell phone on the way out to them because I wasn't sure I would even make it for the placenta.

When I finally arrived, after hitting every red light, I was relieved to see the doula's car, but no ambulance. It would have looked out of place, anyway, in the bucolic setting. Even through the ever present Pacific Northwest sprinkles, the property was gorgeous. Bordered by a river, a corn field and an organic herb garden, I could just imagine this baby tottering on unsteady toddler legs, chasing butterflies or something. It was a good image. I liked it.

When I entered the house, my client Kerry was on her hands and knees, rocking through a contraction, obviously working hard. Her long dark hair was escaping her single braid, but her usual smile was still firmly in place. I had made it with some time to spare, but I didn’t think it would be long.

Sure enough, minutes later, we heard the telltale noise: that first catch of breath at the height of the contraction. I smiled, laying my hand on her sacrum, feeling the subtle lifting sensation as the baby moved further down into the pelvis. Soon she was pushing in earnest, giving it her all. And two hours later, nothing was happening. No perineal bulging, no change in breathing pattern, no mama head thrown back gasping deeply into the night. No sign at all that anything was changing.

I rarely perform vaginal exams. I believe that women do not push until their time. I believe they do not need permission. I believe that cervixes are made to stretch, that babies know how to massage and twist and make their way out in the way that is best for them. I believe it hard. It’s a point of almost pride with me, which obviously means I should look carefully at my motivations. I made a mental note to do so. Right after I did this exam.

Read the rest of this beautiful and introspective narrative by midwife Jane Drichta in the latest issue of SQUAT--available here!

The state of midwifery in the world, Planned Parenthood keeps some funding, birth defects and mountaintop removal, and more... it's the news round up!

2011-06-25T17:40:00.000-07:00

The United Nations Population Fund (UNFPA) released the State of World’s Midwifery Report this week. The report surveyed 58 countries, which together account for just under 60 per cent of all births worldwide, but 91 per cent of all maternal deaths. According to the report, up to 3.6 million deaths could be avoided each year in 58 developing countries if midwifery services are upgraded by 2015.

A 15-month old infant was returned to her mother in Spain this week after an international outcry erupted when she was taken from her mother by Spanish authorities. Advocates for mother “Habiba” and baby “Alma,” as they were called by supporters, claimed that authorities took Alma because her mother was breastfeeding on demand and cosleeping with her daughter. Activists that came together to support Habiba have formed A.L.M.A. (All Loving Mothers Association) to “focus specifically on protecting mothers who are targeted for their instinctual mothering and attachment parenting choices.”

A federal judge in Indiana blocked part of the state's latest anti-abortion law this week, ruling that the state is not allowed to cut off Planned Parenthood's public funding for general health services because the organizations also provides abortions. The state is likely to appeal the ruling.

A study in the journal Environmental Research released this week found "significantly higher" rates of birth defects in areas with mountaintop removal mines than in non-mining regions in central Appalachia. Counties with mountaintop removal were more likely to see more than two dozen types of birth defects, such as malformed hearts and genitalia, circulatory and respiratory ailments, cleft lip, spina bifida, club foot and diaphragmatic hernia, according to the study.

Happy Summer! The next issue of SQUAT is here!

2011-06-23T15:15:00.000-07:00

Well, we just missed the solstice, but we at SQUAT Birth Journal are absolutely thrilled to announce the release of our Summer 2011 issue.

You can buy a digital or print copy here at Magcloud, our on-demand printer. With the incredible art of Amanada Greavette, whose art is featured on the cover, you may want a print copy so the art can adorn your own walls at home.

We are so proud of this issue--it's full of incredible content. We have an interview with midwife Gloria Lemay, an opinion piece about the need for birth support in native communities, a scholarly look at the birth choices of queer couples, a narrative by a midwife her own struggled with a difficult birth, and so, so much more.

Check it out tell us what you think!

Celebrate our male energy this Father's Day

2011-06-19T19:24:00.000-07:00

“They should make a day for people who are fathers, that aren’t fathers…”

Let me back track a moment…

When I first looked at my cervix, the voice inside me screamed, “Oh my goodness, I have a penis inside of me!” A flood of information came over my body; I am male and female together and now I can see it! I searched for ways that others could see this too and found The Beautiful Cervix Project. Started in 2009, The Beautiful Cervix Project has provided an amazing resource to thousands, presenting photos of the cervix through many different stages.

I noticed when reading through the website and countless posts, that healing was a predominant shared experience--people finding a place to heal and learn about their bodies.What I learned and healed from seeing my cervix (and others) may not be that which the majority experiences, yet to me it was the most profound piece of information of could have gained--the paradoxical experience of dichotomy.

Cervix on day 5 of menstrual cycle (Beautiful Cervix Project)

The voice keeps going… “Inside myself I have a cervix and ovaries, and outside of you there are testicles and a penis!” They originate from the same place; they just decided to show themselves in a different way! Much like my eyes decided to be blue and yours brown. Wait, who decided this? Me? My parents? My DNA? Oh, the conversation of our times! Nature vs. Nurture vs. God vs. Atheism….

High school biology was the first place I saw pieces of what I now understand. The differences in genetic make-up that directs our journey into either male or femaleness is so minute, that really I am a huge amount ‘male’ with a bit more female, and so forth. It was a mind-blowing moment! Having grown up very female, it seemed just wrong from one perspective--indoctrined culture--to embrace this knowledge. Yet, when I took a moment, a deeper part of me knew this was true.

Now, being a midwife I have studied genetics for many years, not really because I’ve had to, but because it fascinates me. Each human starting from one united experience, and fractaling out into extremely diverse presentations.

My study of midwifery has also graced me with the knowledge of the polar body: a small pocket of 23 chromosomes, that sits outside of an ovum after its 46 chromosomes divide, with the proven potential to re-fertilize the ovum. This is a far-reaching topic, that which I will not go into detail with now, (but may in the future-look it up!); however, it leads one to speculate on the mechanism that many plants and animals have--self-fertilization. To me, this idea does not perpetuate ‘female’ superiority; it amplifies the idea I am presenting here, the idea that we all hold both energies, that we do not need one sex or the other to procreate. That we are able to transcend the biology we’ve seemingly been constrained within since the recording of human history, realizing the capacity of each individual to be so much greater. Our roles do not need to be dictated by a presenting gender, or by a presenting cultural expectation. Our roles can be lead from the heart, and from compassion.

Even the most up and coming areas of science are now telling us this. The Biology of Belief by Bruce Lipton, PhD states: “genes and DNA do not control our biology; but instead, DNA is controlled by signals from outside the cell, including energetic messages emanating from our positive and negative thoughts.” We do have the ability to mold our gender, either before we are born or after! Because we all hold the male and female principle!

My head spins into all the work I have done over the past decades, work that has taken me through energy, quantum physics, childbirth, and relationships. Work that has introduced me to transcendence.

We all hold the distinct principles that gender embodies, performing ‘each others’ roles, and in this exalting either principles. And we all have the capacity to ‘hold’ both principles at the same time, both male and female, to me this is the transcendence of gender.

Couples, people, communities, have and raise children; who then rise into people, couples, communities. Our bodies are reflections of those that we see as ‘the opposite’ sex. Ebbing and flowing with each move of life. We are both and we are separate…

Let’s transform ourselves; lets transcend our world into that which encompasses both the principles of male and female. And in doing this, we start to embrace every dichotomy into itself, while holding the maturity to entertain our uniqueness. The paradox of biologically being both male and female. The paradox of how some of us are mothers and not mothers, and some of us are fathers yet by the standard definition are not…

Returning to where I started, “They should make a day for people who are fathers, that aren’t fathers…” quoted from my loving partner who embodies fatherhood, yet is not the ‘father’ of my children.

I say yes, there should be a day, and there is! For everyone who is not a father, that is father, for all of those that stand in the place for those who are not, for whatever reason. We are different and we are the same. On this ‘fathers day’ I invite the celebration of all that is the male principle. Exalting everything and everyone we associate with this ‘energy.’ Celebrate those who hold it in your life, and honor it in yourself.

Jaydee Sperry is an Independent Midwife, instructor for The Matrona Midwifery School, founding editor of SQUAT Birth Journal and mother of three.

Circumcision controversy, breastfeeding and SIDS, a midwife in need, and more--it's the SQUAT news round-up!

2011-06-18T12:33:00.000-07:00

A study this week in the journal Pediatrics showed a 73% lower risk of sudden death (SIDS) for babies who were exclusively breastfed for any length of time. Though the link between the two is not conclusive, the studies authors concluded that “Breastfeeding to any extent and of any duration is protective against SIDS.”


Jena Troutman (Urban Christian News)

Citizens of San Francisco will be voting on a referendum this fall that would prohibit circumcisions on minor males. If the referendum is enacted, anybody caught circumcising a boy could face a $1,000 fine or a year in jail. Opponents have called the proposed ban anti-Semitic, and claim that these decisions should be left to parents.

A study by the Child & Family Research Institute and University of British Columbia shows a disturbing trend in pregnant women—many have a dramatic lack of knowledge about birth choices and are increasingly leaving the choices about their care in the hands of their care providers. Of the 1,318 women surveyed, fewer than 30% had attended any prenatal classes; women seeking care from midwives were found to be more informed about their choices than those working with an OB.

credit: Arizona Birth Awareness

Maryn Leister, a Northern-Arizona midwife, is looking for assistance in covering legal fees as she faces a battle to have her license removed. Leister cannot reveal the details of her current situation, but has reported that “the state is investigating my practice because I supported a VBAC mama.” Visit the web page Leister set up to raise legal funds, and check out Arizona Birth Awareness on Facebook.

A Father's Homebirth Story

2011-06-15T06:05:00.000-07:00

With Father's Day coming up this Sunday, I've been thinking about the role that fathers (and all supportive partners) play in pregnancy and birth. After the birth of our daughter Hazel last February, I asked my husband Rob to write her birth story--I wanted to know what it was like for him, and I wanted Hazel to someday have the story of her birth told by both of her parents. And even though I had to hassle him to finish the story when she was five months old, I am so thankful to have it and to see the events unfolding in his eyes, especially as he darted to and from the kitchen to the labor room to ensure I had the groaning cake I had my heart set on. Our son Carter was 2 1/2 when Hazel was born; the other people mentioned in the story are my midwife (Amy), my mom (Nana), and friends. My version of events can be read here.
-Sarah, SQUAT Editor

Two weeks before Sarah’s due date we were getting the house ready for what we assumed was an imminent birth. Her belly was about as large was we could imagine it could get, and Carter was a week early, so it seemed natural and almost inevitable that this baby would come early too. So preparing two weeks ahead of the due date made sense to us. It wasn’t just wishful thinking, though it was in part, since Sarah was tired of hearing about how big her belly was from everyone she saw, and was starting to feel like hiding away in our house like a cat to reemerge later with her offspring in tow. However, the two weeks slipped by. The tentative plans in our normal lives were all realized, even as we marveled that nothing was being interrupted by labor setting in. The due date came and went, and Sarah’s belly grew into proportions we had not expected possible, making the exclamations of “You’re so large” all the more absurd, since of all people she did not need to be informed of the size of her load.

We were forced to continue living life normally, after many days of waiting expectantly for daily life to be changed yet again by the new baby. What was daily life then, interestingly, was but a normalization of the significant changes that had taken place in our daily lives two and half years before. However, we had come to love our current daily routines quite a bit, so having to prepare to stop them, then resume them in the absence of the expected change, was somewhat disconcerting to me. I liked going to work that next week, but it seemed wrong and unnatural somehow, since at no point had I expected to do so, and in fact had expected to be adjusting to all the new new-baby routines at the very moments that I was sweating copper pipes together, painting roof flashings with white paint, and digging ditches for electrical lines.

Hazel politely waited until the work week was over, on Thursday night for me, before she made any attempts to leave her mom’s safe den. Sarah told me when I came home that Amy had stripped her membranes, and that she had had some contractions but they had not picked up or anything. By now I was ready to wait through another week of work, and despite my hope that our baby would come meet us, more or less believed she was willing to wait another week at least. Maybe we were even going to have to coax her out with some treats or something.

Sarah’s contractions were slow and pretty undramatic through the evening. I wasn’t really aware that she was having them at all, except for small pauses in her movements that sometimes meant cramping, or sometimes meant, my back hurts, or sometimes meant contraction! I had to ask every time. By bedtime it seemed she might be able to sleep, though she was having contractions five or ten minutes apart. She just didn’t seem very disturbed by them, so I hoped she could sleep so that she would be rested if they ever turned into more intense labor.
...

I am finishing this as Hazel, five months old, lies sleeping in some sort of coma on Saturday morning. The birth seems so far away, and I am not sure I will now be able to give a very detailed accounting of it.

I remember waking up sometime in the middle of the night, and deciding with Sarah that we should have Nana come get Carter. Contractions were close enough and strong enough that Sarah wasn’t sleeping, and we called Amy also.

For me, everything seemed to go a lot faster. It was only a few hours later that we were starting to question how long it would go on, but it had only been a few hours. Compared to Carter’s birth, I felt like it was all happening so easily. Of course this wasn’t how Sarah felt about it, but I was actually able to think and function having just banked couple hours of sleep. We had moved into the back room, cranked up the heater, and in the early hours of daylight I was baking the bread that Sarah had planned on making. She did not, and still doesn’t, consider this to be in any way easier than the first time, but I kept thinking, wow, this isn’t going to be another 36 hour marathon. It was becoming clear that it was probably going to be over this morning, and that, coupled with not being the one having contractions, made it seem so much easier.

We called Kate early in the morning, and I think I actually napped a little while Kate was with Sarah. The room was kind of like a dark little den for awhile, until the sun rose and it gradually lightened outside, then inside. A couple hours later Colleen and Connie said they were bringing coffee for everyone. Nana and Carter came back too, and reported that Carter had not slept any more at all the rest of the night. I was working on baking the bread and returning to the room for each contraction. I didn’t want to be detached from the time between contractions, but it had seemed like Sarah really liked the idea of baking this “groaning” bread, so I wanted to make it happen. I think she was glad later that it did.

And then we were sitting on the edge of the bed, sitting on a stool, trying to find a good pushing position. I was behind Sarah, with my arms around her, trying to make a kind of a hammock with my arms for her to hang from. I felt the same electricity, the same powerful waves of adrenaline and energy go through her body as she pushed, reminding me of Carter’s birth. I felt the same awe at what she was doing, and pride and gratefulness that she had decided to do this again—pregnancy, birth, and home birth. And there, as the head came out, was another little being that we made together.

Carter was a little scared at first, because of Sarah’s screams mostly, but he announced to everyone that there was a baby coming out of momma’s butt, and that seemed to get everyone past Sarah’s primal screams. Near or during these final moments, Colleen and Connie and Marcus arrived with the coffee. As Sarah pushed the baby out, she thought she saw a penis, and said “Oh, it’s a boy,” which was a little surprising because we had all decided it was going to be a girl. Amy wrapped “him” up and we settled back to rest on the bed. Many minutes later we realized it was not a boy, but a girl. Carter snuggled up with his new baby sister and his mom and dad, and our new family began.

Rob McLane is a great dad and solar-installer in Tucson, AZ.

Birth control for men, pesticide cover-ups, lactivist victory and more--the SQUAT news round-up!

2011-06-11T11:58:00.000-07:00

Oops! We usually get the news round-up up on Fridays, but we're delayed this week. Why? Because I was recovering from a great fundraiser for In Service To Women, an organization set up to help provide legal aid and support to midwives facing prosecution for attending births. I blogged about my midwife being arrested here on the SQUAT blog. Take a minute to check out In Service To Women online and on Facebook. -Sarah @ SQUAT

In a trend of recent anti-abortion legislation around the country, Alabama lawmakers passed a bill outlawing abortion after 20 weeks gestation, with no exception for cases of rape or incest.

A New report by Earth Open Source reveals that studies have demonstrated that Roundup pesticide causes birth defects. Researchers say that industry studies, including those commissioned by Monsanto, showed that Roundup’s glyphosate causes birth defects in laboratory animals and that they have known since the 1980’s of these adverse side effects.

A male form of birth control is getting closer to fruition. The birth control, created by a scientist in India, is an injection that forms a gel in the vas deferens, reducing the number of sperm leaving the penis. Doctors have started the process to begin clinical trials in the US.

Families attend a nure-in in Forest Park, GA.

Nursing mothers scored a victory this week when the city council of Forest Park, Georgia, voted to amend a city ordinance that labeled breastfeeding children over two years as public indecency. The new rule was met by a protest and nurse-in, and the city manager admitted that the public outcry made it clear that the new rule was a bad idea.

A law in Baltimore requiring faith-based pregnancy counseling centers to post signage informing clients that the center does not provide abortion referrals is being challenged in court by pro-life groups, which claim that the law infringes on the freedom of speech of such pregnancy centers.

Advice From a Waterbirthing Mama

2011-06-08T06:26:00.000-07:00

Every pregnant woman imagines her birth. Hospital or home, we each have a fantasy or a fear that we think about. Even though I didn’t know any mamas who had homebirthed, that was my birth fantasy. During my prenatal visits with my midwives, I began to learn about waterbirths and was immediately sold on the idea. I did no research- had no facts about keeping blood pressure low or what not (and there are lots of facts out there for anyone wanting to be convinced or needing to convince another visit www.waterbirth.org). I did hear stories from other home-waterbirthing mamas and my midwives were big advocates of it as a way to ease pain and tension. However, I’m not here to convince anyone to do anything, but if you are considering a waterbirth at home- here’s some things I learned along the way.

First, not all midwives will do a water birth. Fortunately, I was encouraged by all my midwives to do what I felt called to do and they all had experience with assisting in waterbirths. I was surprised to learn that not all midwives are comfortable with the baby being born into water. They may be fine with laboring in water- as is becoming more popular in birth centers and hospitals; however for the actual birth they may want you on dry land. This would be an important point to establish before you are ready to push and they are ready to dry you off.

The birthing tub is probably the biggest decision in waterbirthing. The bathtub is an easy option; however, since bathrooms are notoriously small in the homes I have inhabited I did opt for buying birth tubs. For the first birth we bought a $15 kiddie pool with pictures of fish wearing headphones and dolphins sipping iced tea. It was round, maybe with a diameter of almost five feet and a depth of about 2 feet. We filled it with a hose from our sink after my partner almost hyperventilated blowing it up. In hindsight, while it was a very inexpensive option- having been designed for summertime fun and not birthing it had it’s draw backs (I am really grateful it didn’t spring a leak).

I didn’t realize the drawbacks of the kiddie pool until I experienced an actual birthing tub. For the second birth, I researched birthing tubs. The midwife did have one available for renting; however, I found a birthtub on Craigslist in a neighboring town. I later sold it on Craigslist too. So, when all was said and done I spent about $20 on a tub that retailed for closer to $200. It was considered a “single use” tub; however, it held up well for the several uses I know of. If you are planning to resell a birthing tub make sure it is cleaned with a bleach solution and give it ample time to dry, in sunlight if possible. There are also liners that can be purchased .

A tub designed for birthing has the mama in mind- and the midwife. First, it is deep enough to be fully submerged and holds enough water for you to float. Yes, the warmth of the water is relaxing; equally important is the ability to feel like there is enough water to support you- that feeling that you are suspended in water so your muscles can let the water hold some of the tension, some of the burden.

The higher walls of birthing tubs also allow for a more rigid structure which is good to push against with stretching legs or drape yourself over. Inside the tub were two handles, another good tool for positioning and stability. The walls of the tub also were partially transparent. My older son got a kick out of this because he was able to see through the tub and watch his brother being born. This also lets light into the tub which helps everyone have a better view. To learn more about birthing tubs available to purchase, visit www.waterbirthsolutions.com. They have a handy comparative chart of the many tubs you can purchase through them. They also sell kits with other supplies you might need for a homebirth.

During my first birth I labored in the tub mostly by myself with nervous check-ins from my partner. For the second the midwife and her apprentice was there to tend to me and to the water’s temperature- an important factor in keeping mama relaxed. While each mama will have her own preference having the water stay comfortably warm made a big difference for my own experience.

With my first birth I had to get out of the tub- which took more willpower than I thought I had. The feeling of gravity kicking back in just as a contraction struck was intense and sucked me out of my nice-little-haze, that place where birthing mamas go when awash with various birthing hormones. For my second birth, I didn’t need to get out of the tub to be checked- rather the midwife was able to feel how far I was dilated and encouraged me to do small-grunty pushes. I did need to get out of the water soon after he was born, very soon. As much as I liked being in the warm water- let’s face it- the water was not really that clean anymore. Midwives also need to be able to monitor bleeding which is hard to do in bloody water, so be ready to move shortly after birthing. Planning the “receiving nest” could be a nice job for a caring friend or family member and might be good motivation to get out of the water for the tired mama.

In some ways I am an unexpected waterbirthing advocate. I am not a strong swimmer and have several scary experiences in water. Being pregnant in the desert during summer time found me in the neighborhood pool more often than I would have guessed possible. There I learned the power of floating. I eventually took an aqua-natal class where the midwife encourages lots of floating- claiming that giving our muscles memory of how to relax deeply, deep enough to float in water would serve us well once in labor. I found this to be true. Being in water was a way to feel completely wrapped in a powerful element when I needed that strength most. One of the clearest memories I have of my first birth is resting in the water, my body swaying slightly in the water making small waves and “seeing” an image of a whale swimming in deep blue. I must have watched a video of a mama whale birthing- it was that motion, that rhythm that I saw and imitated while in labor.

Many mamas will share their experience of “riding the waves” of labor. Finding the rhythm of your body’s contractions allows for moments of peace. In between contractions I was in a near-sleep state- completely relaxed and at ease. As the waves of my body’s muscles working to birth my baby built into a higher intensity I could sense that it had a peak and a moment where the pain receded completely. I don’t know if I would have been able to reach that level of relaxation without being in water. Just thinking back on those amazing miracle moments when my boys came out of my water into this earth’s water, into this earth’s air fills me with that same feeling of awe and gratitude. And, not surprising, makes me want to take a nice, warm bath.

Nancylee Bouscher is a mama of two peaceful warrior boys in the Skagit Valley. She works and writes for the local food coop and is currently working with other mamas to create some education options for the community's children. She also writes on her blog at mamaup.blogspot.com about her life and it's lessons- some of which are a bit tough on her, some of which are jaw-droppingly beautiful. And yes, she makes up her own words too when the mood hits.

Pregnant inmates in RI lose their shackles, "laughing gas" for labor, and the continuing saga of the birthing tubs... SQUAT news round-up!

2011-06-03T11:30:00.000-07:00

Police in Nigeria raided a "baby factory" this week, rescuing 32 pregnant girls between the ages of 15 and 17 who were "being made to make babies for the proprietor." Authorities suspect that the babies were sold into trafficking or prostitution, and possibly illegal adoption.

Vanderbilt University Hospital became the 4th hospital in the US to offer nitrous oxide to laboring women. Nitrous oxide, which is used commonly in Canada and Europe, is inhaled and allows a woman to remain moving during labor, unlike an epidural. A full and informative discussion of the use of nirtrous oxide in labor can be read at the Our Bodies, Our Blog.

The Rhode Island State Legislature passed a law this week prohibiting pregnant inmates form being shackled or handcuffed during childbirth, and mandates that only the least restrictive restraints be used during the second and third trimester. The Rebecca Project has been working to push such legislation through other states; according to the organization, 11 states currently have rules on the book that prohibits the handcuffing and shackling of pregnant inmates. Check out Birth Behind Bars to learn how to support birth education and support for pregnant inmates.

The saga of the birthing tubs continues after the FDA seized a shipment in Portland, OR, earlier this month. The FDA released the tubs but warned "we'll be back"; a FDA hearing on the potential status as birthing tubs as medical devices is scheduled for June 7. A sample letter to legislators regarding birth tubs and a woman's right to choose waterbirth is available at Bellies and Babies.

A study in the medical journal Pediatrics found that women with longer maternity leaves tend to breastfeed their babies for longer. An interesting note about the study is that women with longer maternity leaves were more likely (75% compared to 65%) to breastfeed their babies from the get-go.

Dr. George Tiller

This week saw the 2-year anniversary of the assassination of Dr. George Tiller, an abortion provider in Wichita, Kansas, who was shot in the head while serving as an usher at his church. This week in Wisconsin a man was arrested and charged with a plot to kill an abortion provider; the man's gun accidentally went off in his hotel room, leading the police to him. he told authorities he planned to go to a Planned Parenthood clinic the next day, find an abortion Doctor, and "shoot him in the head."

Ongoing Ecstatic Birth Tele-summit

2011-06-02T06:40:00.000-07:00

Here at SQUAT, some of our editors have been attending the Ecstatic Birth Tele-summit: The BODY Series LIVE! The folks at Ecstatic Birth are letting us listen in for free so we can review the experience for our readers.

Familiar with Ecstatic Birth? Here's a a short excerpt from Ecstatic Birth's vision:

Ecstatic Birth is a call to reconfigure our cultural conception of birth. It is a call to put childbirth back on its sacred pedestal and women back into an empowered relationship with their bodies and their experience of birth.

The physiology of birth and sexuality are one and the same. As strange (or even repugnant) of a thought as it may be to some women, the energy that gets the baby in is the energy that gets the baby out. Our current cultural disconnect with our sensuality has only fueled our detachment from birth and our need for interventions to help us do what our bodies are fully and ecstatically capable of doing on their own.

Ecstatic Birth is a movement that shares with women everywhere that birth is a journey we can actually enjoy.

The tele-summit, which is intended for future parents and birth professionals, started in April and still has several events scheduled through June. It carries a high price tag, but features a very interesting and dynamic range of speakers.
Ecstatic Birth will be unrolling a recorded version of this event (and the original Foundation Series) this summer at a much more accessible price point, so if you happen to miss a session (which admittedly with my busy schedule and 5 month old babe is the case for me) you won't entirely miss out, and if you prefer you can pay for the remaining sessions on a per-session basis.

From their website:
The Ecstatic Birth Tele-Summit is facilitated by Sheila Kamara Hay LIVE via teleconference featuring a different teacher each week for ten weeks, including:

Ina May Gaskin, the "Mother of Modern Midwifery";
Sheri Winston, award winning sexual educator and former midwife;
Regena Thomashauer (Mama Gena), pioneer in the field of pleasure;
Nekole Shapiro, Tantric Birth founder;
Elena Tonetti-Vladimirova, visionary and director of Birth As We Know It;
Sheila Kelley, founder of feminine movement revolution S factor;
Saida Désilets, author of The Emergence of the Sensual Woman;
Aviva Romm, MD, midwife, and award winning author;
Akal Kaur, pregnancy kundalini yoga teacher trainer and registered nurse;
Sarah Buckley, family physician and Ecstatic Birth writer and advocate

Visit their web site for more information about Ecstatic Birth and the The Body tele-summit, and sign up for their mailing list to stay in the loop and receive a free copy of their Top Ten Tips for Creating an Ecstatic Birth.

And stay tuned- we will be posting a full review of the tele-summit and other insights into the business of internet-based conferences over the next month!

Jeramie @ SQUAT
--

When Doctor Doesn't Know Best: Birth Choices and True Informed Consent

2011-06-01T11:50:00.000-07:00

Here's a great report from the recent meeting of the American College of Nurse Midwives, originally posted at Birth Sense.

I am just back from an amazing conference. The 56th annual meeting of the American College of Nurse Midwives was held in San Antonio last week, ending yesterday. One speaker, Dr. Andrew Kotaska, was so well-received that the conference added a repeat of his standing-room-only presentation entitled “When Autonomy and Beneficence Collide.” Dr. Kotaska works as an obstetric consultant in Yellowknife, Northwest Territories. 700 miles from the nearest tertiary care center, he is dedicating his services to making sure the women of his district are well-cared for and supported in their childbirth choices. I’d like to highlight here the most important points of Dr. Kotaska’s speech.

It’s important to understand how we are defining the terms “autonomy,” “beneficence,” and “non-maleficance." The University of Colorado San Francisco School of Medicine has an interesting webpage about the ethics of medicine. It defines these terms, and places them in a clinical context: how do we balance the principle of “first do no harm” with the principle of supporting our patient’s autonomy?

For the purposes of this discussion, we’ll say that autonomy means the patient’s right to make her own decisions about her medical care. “Beneficence" is action that is done for the benefit of others. Beneficent actions can be taken to help prevent or remove harms or to simply improve the situation of others. Non-maleficence means to "do no harm." Physicians must refrain from providing ineffective treatments or acting with malice toward patients. This principle, however, offers little useful guidance to physicians since many beneficial therapies also have serious risks. The pertinent ethical issue is whether the benefits outweigh the burdens.” UCSF School of Medicine Ethics Fast Facts.

Dr. Kotaska posed the question, how does a physician or midwife stay with a patient when she declines your recommendations? The “therapeutic alliance,” or the relationship between the provider and the patient, needs to be carefully protected. Yet few physicians understand the importance of guarding the therapeutic alliance, and instead, protect their own interests.

In the May 2011 issue of Obstetrics and Gynecology, a commentary entitled Obstetric ethics: An essential dimension of planned homebirth contains this quote: “Pregnant women also have beneficence-based obligations to the fetal patient, and the child it is expected to become, to take reasonable clinical risks. When a clinical intervention is expected to benefit the fetus and the child it is expected to become, and there are not unreasonable clinical risks to the pregnant woman, she is ethically obligated to accept and authorize such clinical intervention.” That statement chills me to the bone. Ethically obligated to accept and authorize the clinical intervention your doctor recommends? The fact that the authors of the commentary go on to cite the now thoroughly-debunked Wax study as evidence that home birth should not be allowed gives me pause when it comes to embracing the idea that a pregnant woman is obligated to accept whatever clinical intervention her doctor thinks will benefit the fetus.

Dr. Kotaska argues that we need to promote the policies that systems like those Britain and Ontario, Canada have adopted. The Royal College of Midwives policy is: “If a woman rejects your advice, you must continue to give the best care you possibly can, seeking support from other members of the health care team as necessary."¹ Midwives in these areas do not have to remove themselves from their patients’ care (effectively abandoning them), but are expected to continue to support and care for the woman even if she refuses to follow the midwife’s advice.

Dr. Kotaska urges providers to “explicitly state your commitment to her [the woman's] autonomy over your idea of beneficence.” He emphasizes that each provider should embrace these three points:

Your job, as a provider, is to inform your patient
She is free to decline your recommendations
She will not lose your support if she declines your recommendation

What is the result of a provider maintaining this type of attitude with their patient? Dr. Kotaska asserts that women trust these providers because they have not threatened the therapeutic alliance. He also stated that “informed consent” is not truly an informed consent if the woman will not be supported in her choices. For example, giving a woman informed consent about the risks and benefits of a trial of labor after cesarean, while telling her that your hospital does not allow VBACs, is not truly giving her an informed consent because she has only one option.

When asked how a woman should respond when she is refused a trial of labor, Dr. Kotaska replied that a woman should create her own “informed consent” form that she asks the provider to sign. It should state that:

she does not want a repeat cesarean section
she is aware of the potential risks of a repeat c-section, including placenta accreta, hemorrhage, increased risk of stillbirth, infection, increased risk of maternal death, and four-fold increases in neonatal respiratory distress
she is not being offered a choice of how she will give birth
if she experiences any complications as a result of being forced to have a c-section, she will be pursuing legal action against the provider who would not support her in a trial of labor.

With this proposal, Dr. Kotaska received a standing ovation from the midwives attending his presentation. What was clear to me is that midwives and mothers are fed up with the status quo in modern obstetric care today, and if change will only happen through women creating an informed consent form they ask their provider to sign, so be it. It’s time for a birth revolution, and it has to start with midwives, mothers, and a few progressive physicians who are not afraid to challenge the status quo.

1. Royal College of Midwives. Nursing and Midwifery Council (Midwives) Rules & Standards. London: Author, 2004. Accessed
May 29, 2011. Available at: http://www.nmc-uk.org/Documents/Standards/nmcMidwivesRulesandStandards.pdf.

Hide your birthing tubs--it's time for the SQUAT news round-up!

2011-05-27T11:44:00.000-07:00

The Food and Drug Administration seized a shipment of Aquaborn birthing tubs in a Portland, OR, dock, claiming the tubs are unauthorized medical equipment, and have ordered FDA agents to search and destroy the tubs. Barbara Harper, author of Gentle Birth Choices and founder of Waterbirth International, had a conversation with an FDA official in which she was told, “Pregnancy is an illness and birth is a medical event. Therefore, a pool that a woman gives birth in should be classified as medical equipment.” Laurel Ripple-Carpenter, a frequent SQUAT contributor, has a full report on her blog here.


Catherine Ferguson Academy students and supporter

SQUAT has been following the trials of the Catherine Ferguson Academy, a Detroit school for teen mothers and pregnant girls, since the state announced the school would be closed due to budget cuts. Students and school supporters have been voicing their support for the school, and staged a sit-in in May. The Detroit Public Schools announced this week a change to the school consolidation and closure plan, yet the future of the school is still unclear. Stay tuned to SQUAT to learn more about the incredible work of CFA in the upcoming issue of SQUAT, due out in late June. You can contact the superintendent of Detroit schools to show your support for CFA: 14th Floor, Fisher Building, 3011 West Grand Blvd. Detroit, MI 48202. Or call (313) 870-3772.

Over 200 people gathered in Forrest Park, Georgia, to protest a new county law that prohibits breastfeeding toddlers over 2 years old in public. Dozens of women nursed their children in the nurse-in to protest the ordinance, which was enacted to reduce public nudity.


Breastfeeding moms and their supporters gather in Forrest Park, GA.	(FoxNews)

The American College of Nurse-Midwives (ACNM) annual meeting is underway in San Antonia, TX. Up for discussion at the meeting is a proposal to change the ACNM’s name to the American College of Midwives. See our previous blog post to get some context and opinion on this proposal, and download a marketing report (which recommends keeping the current name), at the ACNM web site.

Breastfeeding mothers show different brain activity than those who are formula feeding, according to a study by the National Institute for Mental Health. According to the study, the brains of breast-feeding mothers show a greater response to the sound of their babies' cries than do the brains of mothers who do not breastfeed. The results suggest this brain activity facilitates greater sensitivity from the mother toward her infant as the baby begins to socially interact with the world, the researchers say.

Focus on the grassroots: Choices in Childbirth

2011-05-26T10:52:00.000-07:00

We are proud to introduce a new feature on the SQUAT Birth Blog-- Focus on the Grassroots! We'll be posting profiles about grassroots organizations around the US and the world who are working to help expand birth choices and defend women's rights and autonomy--in other words, groups helping you "Exercise Your Rights!" We start our series with Choices in Childbirth (CIC), a New York City-based organization dedicated to ensuring that women have access to information about making informed birth choices.

(CIC is a finalist for a grant from The Foundation for the Advancement of Midwifery (FAM), and is thereby eligible for the Floradix Fan Favorite award. To see all the FAM finalists and vote for who should received the Floradix Fan Favorite award, go here. SQUAT is a big fan of many of these hard-working groups, and is not endorsing any one for this grant award.)

If you know a great organization that should be featured on our blog, contact us or tell us about them in the comments section!

___________________________________________________________

Choices in Childbirth was founded in 2004 by a handful of doulas, midwifery students and childbirth educators who were tired of seeing their client’s birth options narrow as the medical management of birth increased. Our founders were sickened by the unnecessary overuse of many medical interventions that were potentially harmful to their clients. They were outraged to hear women told over and over again that they couldn’t do it, that their bodies were failing, that birthing their babies was something that was well beyond their capability.

Choices in Childbirth heald its first annual benefit, Concert for Healthy Birth, earlier this month.

In the photo (left to right), are Elan McAllister (Founder and President of CIC),

Christy Turlington Burns (who was being honored by CIC that evening for her work on maternal

mortality), Ricki Lake and Abby Epstein (who working with CIC to produce a classroom edition of the Business of Being Born),

and Funmilayo Brown (CIC's Executive Director)

In response, over the last 7 years, Choices in Childbirth has actively been engaged in efforts around education, outreach and advocacy to help improve the environment in the city for birthing families and to increase access to a full range of birthing options. We advocate for safe, evidence-based care for all women, care that is deeply respectful of families and mindful of the sacredness of birth. We work to provide families with information about their full range of birthing options, help families to connect with care providers who share their philosophy and vision for their birth, and actively support the care providers who uphold the principles of the Mother-Friendly Childbirth Initiative.

Our educational programs include the Guide to a Healthy Birth: a free print publication with articles, resources, and information about women’s rights and options in maternity care (click here to download a copy of our latest edition!), and the new online Mother-Friendly Provider Network: a searchable database of care providers who work with women and families during their childbearing years.

Right now, we are eligible for the Floradix Fan Favorite award that would provide funds to help us expand these programs to serve even more families around the country! Go to www.choicesinchildbirth.org/vote to vote for our project to win the Fan Favorite Award!

Trauma and the Medical Establishment: A Guide to Getting it Right

2011-05-25T10:42:00.000-07:00

Statistics often fail to express the pervasiveness of sexual assault and intimate partner violence in this country. I, for one, have a hard time grasping the enormity of the 1 in 4 young women who will be sexually assaulted by the time they turn 18.[i] The statistics about intimate partner violence, or violence that is perpetrated by a current or former spouse or partner, and which includes coercion and intimidation, economic, physical, verbal, and sexual abuse, are just as alarming. According to the Centers for Disease Control and Prevention, intimate partner violence (IPV) affects approximately 1.5 million women each year, including as many as 324,000 pregnant women.[ii] Again, a statistic that I can’t even begin to wrap my head around. Although certain groups may be at increased risk for IPV and may have fewer resources available when seeking help, ultimately, intimate partner violence and sexual assault affect women of all ages, races, socioeconomic classes, sexual orientations, and so on.

I've been thinking about this issue a lot lately. I was fortunate to be able to attend a workshop last week on IPV and, specifically, on tools that health care providers can use to address the needs of patients who may be experiencing violence at home. The workshop portrayed doctor's offices and hospitals as fertile grounds for opening up lines of communication about violence against women. As a health care provider of sorts (I currently work as a counselor in an abortion clinic and will be starting my nurse-midwifery training next year), I left this workshop feeling optimistic and engaged. Unfortunately, my excitement was soon deflated when a close friend, who has a past history of sexual assault and a subsequent history of post-traumatic stress disorder, recounted to me an extremely violating and triggering experience she had at a medical facility that same week. Her story got me thinking about the medical establishment as a place where sensitivity to past trauma is hardly the norm. If it is true that most women have at least some interaction with the medical system at some point in their lives and that many of these women will also experience sexual assault or IPV at some point in their lives, it stands to reason that understanding post-traumatic responses should be a top priority for the medical community.

Every day countless women have pap smears, pelvic exams, abortions, c-sections, and vaginal deliveries. How many of these women are living with the physical and emotional pain of past trauma? And how many women avoid the stirrups like the plague for fear of being re-traumatized at the hands of a doctor who doesn't mean to do harm but was never taught to ask before they touch? I heard someone say once that although not everyone is a survivor of assault, we are all survivors of the trauma of patriarchy, a system that gives men power and control over women and their bodies. After having a number of empowering and eye-opening conversations with friends, some of whom are currently dealing with the aftermath of sexual assault, I've come up with what I think are some very basic yet very powerful tools for providing women with compassionate and competent medical care that recognizes the wounds of trauma—and doesn't reopen them.

The first and perhaps the most important thing that came out of these conversations is the importance of shifting the power dynamics that are involved in most doctor-patient relationships. Doctors are almost always in positions of power relative to their patients. They wear white coats. They have education, prestige, the power to diagnose, and the almighty prescription pad that may even provide a cure. One of the best doctors I've ever had (and this is huge for me to say because this doctor happened to be a gynecologist and a dude, which is something I never thought I'd be cool with) began our interaction by ceding all power and control to me. Before he began to insert my IUD, before he even put my legs up in the stirrups, he sat down, looked me in the eyes and said, “You're the boss. You are in control. I answer to you. You can tell me to stop at any point and I will.” I was shocked. And then I was shocked about being shocked because it all seemed so simple and so obvious.

For my good friend, we'll call her Rachel, it was the feeling of losing control of her body that triggered a post-traumatic response. Rachel was rushed to the hospital when she began having severe and unusual vaginal bleeding. The bewildered EMTs (all male) couldn't muster the courage to even say the word “vagina” and instead asked her if she had any history of problems with “that region.” She said no but tried to explain to them her history of PTSD and why it would make this experience—lying in an ambulance, strapped to a stretcher in a pool of her own blood, surrounded by strange men, some of them rookie EMTs, who had clearly never dealt with anything like this before—particularly difficult. The EMTs nodded, their faces clearly showing that she had said something important but the conversation went no further. At the hospital, she was met with a revolving door of doctors and nurses, all of whom poked and prodded, casually dropping words like “hemorrhage,” “blood transfusion,” and “miscarriage.” They never stopped to explain what was happening, what might be wrong, or what they were going to do about it. All the while, she fought back tears and tried to keep from dissociating as a way to cope with the memories of past trauma. She attempted to explain to each of them what was happening to her body, why it was that she was shaking and sobbing, that, no, she wasn't in any pain. One doctor even made the egregious error of doing an internal (or transvaginal) ultrasound without explaining that the ultrasound probe would be going inside Rachel's vagina, not on her abdomen as she expected.

The doctor that Rachel felt most comfortable with is the one who took the time to listen, who offered to go at her pace, paid attention to verbal and physical cues, and allowed her to set the tone of the interaction. Rachel went to the hospital that day expecting to be triggered. When I asked her to reflect on the experience as a whole, she told me that she had to weigh her options before even deciding to go. Were her symptoms serious enough? Was it enough of an emergency to risk bringing back feelings she had tried so hard to work through? Would having children someday in a hospital be worth it? It's scary and sobering to imagine how many women in Rachel's position just don't go to the doctor when they need to. Or how many women are experiencing PTSD and don't even know it. The one thing I'm sure of is that doctors and nurses need to do better.

I am pleased to say that another amazing friend of mine is working to help medical students become great doctors. Amy Littlefield works as a gynecological teaching assistant (GTA) at a major medical school here in the Northeast. As a GTA, she helps coach 2nd year med students through the often terrifying process of doing breast and pelvic exams. (I say terrifying because at least one med student has fainted during an exam.) Amy explains everything from what to look for down there to what not to say during those lengthy and often awkward silences.

I asked her to share with me some of the tips that she regularly gives to students. Something that stuck out for me is the emphasis she places on explaining exactly what's going to happen, what tools will be used, and what the patient can expect to feel. She also stresses the importance of eye contact, of validating the patient and using positive language. She might instruct a student to say something like, “I am going to insert two fingers into your vagina. I'll then use my other hand on your lower abdomen to palpate your uterus. You may feel some pressure. Your uterus is healthy and you're doing great.” That's doesn't sound so hard, right? But when compared to the alternative, a rushed exam with little or no explanation that leaves the patient feeling confused, uncomfortable, or violated, a few words and a little extra patience can make all the difference.

Even for a patient who hasn't suffered any type of trauma, a visit to the gyno can provoke serious anxiety. Women are regularly taught to be ashamed of their bodies and thus it's not surprising that having a stranger poke around down there feels unpleasant at best. On the other hand, a routine gynecological exam can be a great educational opportunity, especially for young women who are just learning about their reproductive anatomy. I'll never forget this one particularly rad gynecologist I had in college. As she peered between my legs, she told me I had a beautiful cervix and asked if I wanted to see it. Her enthusiasm might have made me laugh but it also reminded me that my body is not only normal, it's healthy and awesome and beautiful.

So on behalf of women everywhere, especially women like Rachel who carry the scars of trauma as they face the daily realities of a society that rarely respects women, I'm asking doctors to take the extra time to listen to their patients, to respect their bodily integrity and autonomy. There are no blank slates when we put our feet in those stirrups. We've all got some issues to work through.

I want to say a HUGE thank you to all of the amazing women in my life who've shared their stories and wisdom with me. Thank you for being my teachers, my co-conspirators, and my friends. Together we are building a world we can believe in.

[i] “What is Sexual Assault?” Fact Sheet, National Sexual Violence Resource Center. <http://www.nsvrc.org/sites/default/files/Publications_NSVRC_Factsheet_What-is-sexual-violence_1.pdf>

[ii] Intimate Partner Violence During Pregnancy: A Guide for Clinicians. Centers for Disease Control and Prevention. <http://www.cdc.gov/reproductivehealth/violence/IntimatePartnerViolence/>

Placenta Medicine!

2011-05-24T02:12:00.000-07:00

Here is a great article from the SQUAT archives, originally published in our Winter 2010 issue. The step-by-step guide in this article originally appeared in the Spring 2009 issue of CUNTastic Zine. Last week we posted Chia Seeds in Pregnancy and Labor from SQUAT Spring2010.

Placenta Medicine

by Laurel Ripple Carpenter

The placenta is more than just medical waste to be disposed of in a biohazard dumpster. It’s a visceral symbol of the connection between mother and baby--and it’s also a valuable organ packed with hormones and nutrients that your body desperately craves after giving birth.

In Traditional Chinese Medicine, the placenta has been used for thousands of years to treat fatigue, mood disorders, and to increase milk supply. Throughout history, cultures around the world have had traditional practices of consuming the placenta to help women recover from childbirth.

In North America, though, medicalized childbirth culture has viewed the placenta as nothing more than a disposable by-product of the birth process. The past decade has finally seen placenta medicine grow in popularity in North America, restoring the placenta to its rightful place as a revered source of healing for new moms.

The process of preparing a fresh placenta into powder form has become known as 'placenta encapsulation,' and there are also recipes for tinctures, salves, and various other ways to prepare placenta as medicine. To encapsulate a placenta, it is cleaned, dried, powdered and put into pills, and the new mama takes the capsules during the postpartum period. If there are pills left over, they can be stored in a sealed, dark container in the freezer for later use. Many women save them for menopause, PMS, or other hard times, as a method of balancing the hormones.

We are in a cultural moment right now when the placenta is being reclaimed as a tool for the postpartum mom’s health and well being. Placenta medicine practitioners have sprouted up across the US, and have begun to form networks of referrals, training, and information for each other. Birthing mothers who want to use their placenta as medicine finally have access to the information they need to do it.

The following step-by-step guide to placenta encapsulation was gleaned from different recipes given to me by midwives, books, and websites. For further reading, Placenta: The Gift of Life, by Cornelia Enning, is a fantastic resource on placenta medicine, including historical info and recipes.

Always keep in mind that working with the placenta poses the same risks of disease transmission as touching human blood any other time. So, if it’s not your placenta, wear gloves whenever you’re touching it, and use universal precautions. Also remember that you’ll need to sanitize your workspace and all of the equipment you’re using--the steamer, the knife, the food dehydrator, the grinder, and anything else--with bleach.

What You’ll Need:

Placenta
Large Bowl
Gloves
Size 00 Gel Caps
Large, Sharp Knife
Metal Steamer
Fruit Dryer
Coffee Grinder

The Placenta...
should come home from the hospital with you in a sterile plastic tub, wrapped in a bag and labeled with the mama’s name. Open it up and explore! The baby’s side of the placenta has the umbilical cord stemming from it, and the veins running from the cord through the placenta make it look like a tree. The maternal side, which is attached to mom’s uterine wall, will have the remnants of the amniotic sac attached to it, which is like a thin layer of stretchy tissue. This is where your baby lived for nine months. In the tub with the placenta, there will be blood and dark chunks of blood clots.

1. Print the Placenta
You can make prints of your placenta as a keepsake. Before cleaning it at all, remove it from the tub, letting most of the blood drip off of it and into the tub. Too much blood will make your print too wet and blurry. Remove any chunks of blood clots from the placenta and put them back in the tub.
Once most of the blood has dripped off, carefully place the placenta face down on a sheet of 12x12 cardstock paper. If you use the side of the placenta with the umbilical cord, you can create an image looking like a tree with a trunk, limbs, and a treetop. People call these images the Tree of Life, as the placenta is what gives your baby life and nourishment in the womb.
It’ll likely take a few tries to get a good print. Once you have one or a few you like, place them somewhere flat to dry. They can be framed or put in your baby book.

2. Clean the Placenta
To clean the placenta, you need to remove the blood, blood clots, amniotic sac, and calcium deposits.
To remove the blood, hold the placenta under a small stream of cold running water. As you do this, let the bloody water run into a large bowl, so you don’t waste it. Plants love the nutrients in blood, and you can pour the leftover blood-water into your house plants or outside plants when you’re done.
Keep the blood clots separate, in the tub the placenta originally came in. Most of them will wash off the placenta under the running water, but you may have to pick some out of the nooks &a crannies. They look like small, bloody, gelatinous chunks. They look a lot like the blood & tissue that your uterus sheds during menstruation.
The membranes of the amniotic sac are attached to the placenta, and you’ll need to remove them. Just cut the stretchy tissue off.
There may be calcium deposits on the surface of the placenta, which are a sign of aging. They appear as small, hard, whitish spots. These need to be cut out before you process the placenta any further.

3. Remove the Umbilical Cord
When you remove the umbilical cord, you want to pay attention to its length and how carefully you cut it, depending on what you’d like to do with it. Some people bury it, or some may want to dry it along with the placenta and save it for their child to have later in life.
Use the knife to detach the umbilical cord from the placenta. If you’re going to dry the cord, you probably want to make sure to cut it off as close to its base as possible. When it dries in the dehydrator, it will shrink and shorten considerably, and you want to make sure there’s enough of it left.

4. Steam the Placenta
The placenta needs to be steamed on both sides for 15 minutes each. After steaming for 15 minutes on the first side, use metal tongs to flip the placenta over and steam it for 15 more minutes on the other side.
This is potentially the messiest, funkiest part of the process. A lot of people (including me) expect the smell of cooking placenta to be unpleasant. But I actually think it smells a lot like baking bread--kind of a full, earthy smell, not foul at all.
After steaming both sides of the placenta, it will look and feel a lot like a very thick pork chop. There may be additional blood, blood clots or calcium deposits visible at this point. Remove them.

5. Slice the Placenta
The next step is to slice the placenta into thin strips, using a large, sharp knife. The thinner the strips, the faster they’ll dry in the dehydrator. You might find more calcium deposits inside the placenta, which need to be removed.

6. Dry the Placenta
You can dry the sliced placenta in a food dehydrator or in your oven. The drying process can take anywhere from 2 to 10 hours, depending on your equipment. Your placenta is sufficiently dried when the pieces are crispy and break easily when you snap them in half. Be sure not to burn them, though, or they can take on a burned flavor, which you’ll taste in the pills.
The drying process is another time where there’s a distinct smell going on. Not necessarily unpleasant, just different. If you’re using a food dehydrator, some people suggest placing it in a window-sill or even outside while the placenta is drying. Be sure to protect it from curious pets or other animals.
If you’re drying the umbilical cord to preserve it, remember that however you arrange it while it dries is how it will be forever. Be creative - spiral, straight, figure eight, etc.

7. Powder the Placenta
Use a food processor, blender, coffee grinder, mortar & pestle, or something similar to powder the dried placenta pieces. The powder has a similar odor to the steaming and drying placenta, and can tend to get all over everything. Make sure to keep a clean workspace and sanitize the entire space when you’re finished.

8. Put the Powder into Capsules
You can find empty gelatin capsules at most health food stores. You want to use size 00 or larger, to get the ideal dosage. Fill each capsule and close them securely.
It can be tedious work to fill over a hundred capsules with placenta powder. Some stores also sell ‘capsule fillers’ that hold the capsules upright while you fill them in bulk batches.

9. You’re Done!
At this point you’ve produced probably somewhere around 100 placenta pills and a dried umbilical cord! Be proud of your decision to utilize the benefits of your placenta, and your endurance in sticking it out through the entire process!
Dosage recommendations for placenta pills vary, and really it all depends on your personal feelings and needs. You can take anywhere from one pill per day, to two or three with every meal.
The benefits of placenta pills are not only felt during the postpartum period, but at any time of hormonal or emotional transition--menstruation, menopause, or just plain stress. Store your unused pills in a freezer to avoid bacterial contamination, and remember that what’s contained in them is a rare and special resource.

Laurel Ripple Carpenter, CD(DONA), PES, is a mother, an activist, a doula, and an advocate. She’s mama to the fiestiest red-headed toddler ever, and farmstress at the Circle A Farm in Colorado.
She is founder of the Full Spectrum Doula Network, an online community “supporting the full spectrum of pregnancy choices, and the full spectrum of doulas.” She also founded The Doula Partnership, which provides free & low-cost doula services & childbirth education to low-income women in Western Colorado. She publishes the CUNTastic Zine and the CUNTastic Blog, each of which is part personal, part educational, and all political. She operates Two Rivers Birth Services as a Certified Childbirth Doula through DONA International and a certified Placenta Encapsulation Specialist through PBi. Contact her at laurel@cuntastic.org.

Homebirths on the rise, toxic nursing pillows, nurse-ins and more! It's the SQUAT week-in-review!

2011-05-20T07:40:00.000-07:00

Breastfeeding mothers are a lot like exotic dancers, according to a new local law in Forest Park, Georgia. A new city ordinance makes it illegal to breastfeed a child over 2 years old in public, claiming that such an act is publicly indecent. Breastfeedind advocates have responded quickly-- there is now a petition to the Forest Park city council, and a nurse-in scheduled for next Monday in front of Forest Park City Hall.

You might want to think twice about the nursing pillow you're using. A new report this week in Environmental Science and Technology reported that 80 percent of baby products contained toxic or untested flame retardants. Many flame retardants are suspected carcinogens, and toddlers have been found to the three times the level of these chemicals in their bodies compared to adults.

Babies born using increased interventions did not fair any better after birth than those without, according a study of 30,000 births in upstate New York. The study showed no difference in birth outcomes (including whether or nota baby required ventillation, was transferred to an intensive care hospital, or had a low agpar score) between babies born through c-section or induction, suggesting that a routine reliance on such interventions does not help the health of infants. (Yeah, we could have told ya that!)

Maryland-based midwife Karen Carr, who recently plead guilty to two felonies in Virginia to avoid jail time for her role in a breech homebirth, is now under investigation in Maryland, according to the Washington Post. Karr's case has ignited, yet again, the debate about the safety of homebirth and the rights of women and midwives. See one SQUAT Editor's story of her experience with Karen Carr on a previous blog post.

More women are choosing homebirth--A review of birth certificate information found a 20 percent increase in women choosing to birth at home between 2004 and 2008.

And women who use a licensed midwife to give birth at home in Vermont will now be covered by their insurance, thanks to a new bill signed into law this week. The law will require insurance companies to cover home births attended by licensed midwives; 3 percent of births in Vermont happen at home, the highest rate in the country.

"Why won't you bitches help me?!?" The joy of labor in media...or not

2011-05-18T06:23:00.000-07:00

We all know the formula for birth in movies and television-- the water breaks, everyone panics and rushes to the hospital, the woman screams at everyone around her (especially the father, if he's present), and the baby, usually looking like a 4-month old, is born within minutes. Those of us familiar with birth---whether from having children of our own, or supporting and attending to women in labor--know that real birth rarely follows this strict formula. I would love to see what a Hollywood producer would do with the birth of my first child--which took 36 hours from start to finish and didn't involve even one single taxi cab rushing anyone anywhere!

There is plenty of validity in critiques of the depiction of labor in the media. Children, teenagers, and even young adults are forming their ideas about pregnancy and birth based on these scenes in popular culture, scenes that tell girls that labor is nothing short of horrific, and demonstrates to birth partners that the only thing to do is stand there looking dumb or passing out. Women hoping for a natural birth are typically mocked and end up begging for drugs.

This treatment of labor affects us and our culture--it disempowers women and supports the sense that birth is a medical event that must be managed. At SQUAT, we're dedicated to publishing voices from the across the spectrum of birth experiences to demonstrate the pregnancy and birth can be beautiful, transformational, and empowering for women and families.

That said, these scenes are pretty funny. If you let yourself relax a little, they will make you laugh. So let's take a mid-week laugh break and look at some of the "best of" birth depictions compiled by the SQUAT t

Best Breaking Water: Amy Poehler and Tine Fey in Baby Mama. Complete with flood of water, mad-dash to the hospital, and angry screaming!

Angie's Water Breaks

Baby Mama

— MOVIECLIPS.com

Best Vagina Nick-Name: Dr. Bailey giving birth on Grey's Anatomy.

Best Squat: Comedienne Lauren Weedmen on Funnyordie.com, exploring labor positions and birth goo.

Our Bodies Myself: Childbirth - watch more funny videos

Best Music: Quinn has her baby on Glee. This clip's got it all--the rush to the hospital, yelling at the baby daddy, and... dancing! New York Times Magazine put it best, calling this "the most intense show choir/having a baby sequence in recent memory."

Best Pubic Hair: SNL's natural birth class, complete with a super-large VHS tape of a homebirth.

Best. Satire. Ever. : Monty Python. "What should I do?," asks the mother. "Nothing, my dear! You're not qualified!"

No Woman No Cry

2011-05-16T07:27:00.000-07:00

No Woman No Cry

a film review by SQUAT blogger Chantal Tapé

I first learned about the documentary No Woman, No Cry from my mother. She described it as a film about birth (something I might like) and told me she had seen an interview with the filmmaker on Oprah. Self-described birth geek that I am, I made a mental note to look into it. What my mother failed to mention is that the hour-long look at the state of maternal health across the globe was directed by none other than former supermodel Christy Turlington Burns. With this film, Turlington attempts to raise awareness about the plight of mothers around the world, including here in the United States. For many women, birth can be a dangerous and often life-threatening experience. The film provides a baffling statistic: A woman dies every 90 seconds from pregnancy complications. 90% of these deaths are preventable.ⁱ

Christy begins the film with her own birth story. During the birth of her second child, Christy suffered from postpartum hemorrhage, which she would later learn is the leading cause of maternal death worldwide. Thanks to an experienced and supportive birth team, Christy survived and had a healthy baby girl. But what if her circumstances had been different? Would the outcome have been different had she been born in a rural village in Tanzania? Or, better yet, if she had been an uninsured, low-income black or Latina woman living in this country?

Filmmaker Christy Turlington Burns

I must admit that it was not without a degree of skepticism that I sat down to watch this documentary. As a student of anthropology, I'm all too familiar with the many books and films made by well-meaning (but often privileged and often white) folks who set out to open our collective eyes to the atrocities that occur in places like Africa and the Middle East. Many of these authors fail to recognize and understand the tremendous inequalities that people face in these countries and end up recreating the very racist, colonialist, patriarchal discourses that they're trying to change. Furthermore, there is an assumption in many international development circles that the problem is always “over there.” I appreciated this film's consciousness of race and class as two factors that greatly impact a woman's access to reproductive health care. It is no coincidence that African American women, for example, are almost four times more likely to die of pregnancy complications than white women.ⁱⁱ

While most of the film's focus is on the high rate of maternal mortality in the so-called “developing” world, Turlington is wise to remind us that the US itself has a shockingly high maternal mortality rate, making us somewhere around 50^th in a ranking of maternal mortality rates across the world. This means that it is safer to give birth in 49 other countries, none of which spend nearly as much on maternal health as we do! In the film, Turlington visits a midwife who runs a clinic in Central Florida that serves mainly low-income and uninsured women. Many of these women are without access to prenatal care. Statistically, they are at the highest risk for pregnancy complications that may result in death.

The stories Turlington shares in No Woman, No Cry bring to life the extraordinary struggles that pregnant women face in many parts of the world. There is Janet, the young mother living in a village in Tanzania, who walks 5 miles to the nearest clinic, which is staffed by a single midwife, a handful of nurses, and only the occasional doctor. Janet's labor is not progressing, although she complains of worsening pain. When it becomes clear that the small clinic is not equipped to care for her, the midwife recommends that Janet be seen at the nearest hospital. She hasn't eaten in days, has no money, no food, and no transportation to get her there. At the nurses' request, Turlington and her crew intervene. They agree to pay for a van (the equivalent of $30 US dollars, which we are told is more than Janet's family makes in a month) to transport her to the hospital. Although she is dehydrated and malnourished, Janet successfully delivers a healthy baby. It is clear, though, that without the help of Turlington and her crew, mother and baby would have probably died.

On a more hopeful note, perhaps the most inspiring (and my favorite) scenes in this film are of Linda, an OB/GYN in Guatemala. Linda travels around the country training community health workers, many of whom have never received formal medical training. She also provides care to women suffering from complications due to unsafe (illegal) abortions. When speaking about the state of maternal health in her country and around the world, Linda connects women's lack of access to quality reproductive health care to the paternalism of the medical system. Women are not presented with choices, choices are made for them. She also laments the general lack of concern for women's lives in her country. Women are expected to be mothers and therefore, she worries, the general public has become desensitized to maternal mortality. If a woman dies during childbirth, she becomes something of a hero, a martyr who has died fulfilling her duty. Perhaps because she is a physician, Linda is the only person in the film to connect lack of access to contraception and other family planning resources to the poor health outcomes that many women face.

While I enjoyed this film on the whole, I think Turlington could have devoted more time to a discussion of what viewers can do to change the current system, which is obviously failing so many vulnerable women. I was glad to see, however, that a link was made between access to safe abortion and maternal mortality. It reminds me of a statistic I read the other day that was put out by the Guttmacher Institute. Their research shows that 6 out of 10 women who have abortions in the US are already mothers.ⁱⁱⁱ While I believe that all women deserve access to safe and affordable abortion services regardless of whether they already have kids, this statistic seems like a good one to throw back at the anti-choice movement that is so vehemently attacking women's rights these days. Since they care so much about mothers and so-called family values, we ought to remind them that if abortion were to become illegal in this country, it is mostly mothers and families who would suffer. After all, I think we all know by now that making abortion a crime doesn't make it go away. It merely drives it underground, where women in need can no longer demand safety.

This film has given me a lot to think about and probably more questions than answers. I applaud Christy Turlington Burns, who is at the end of the day a mother and a woman of tremendous power and privilege, for recognizing that, for most mothers in this world, pregnancy is yet another obstacle to their survival. I recommend that you watch this film and invite you to comment with your own ideas on what we can do to put maternal health--and women's health--back at the top of the world's agenda. There is so much to be done.

For film trailers and a list of screenings in person and on tv, visit the Every Mother Counts web site.

iEvery Mother Counts. http://www.everymothercounts.org/issue

iiAmnesty International, “Maternal Health in the U.S.” http://www.amnestyusa.org/demand-dignity/maternal-health-is-a-human-right/the-united-states/page.do?id=1351091

iii“Abortion in the United States” Guttmacher Institute. http://www.youtube.com/watch?v=rY-bQ6UzhNI&feature=player_embedded#at=44

Extra! Extra! It's time for the SQUAT News Round-up!

2011-05-13T10:56:00.000-07:00

Midwives and supporters gather outside the Arizona state capital
on theInternational Day of the Midwife
Source: Desert Free Press

Last week people around the world celebrated the International Day of the Midwife, organizing walks and talks to celebrate the role of midwives in serving women and babies, particularly in developing countries. The Virtual International Day of the Midwife hosted a 24-hour online conference, and the proceedings are now available online.

Afghanistan is the worst place to be a mother, according to Save the Children's Annual Global Mother's Index. One of every 11 women die in childbirth in Afghanistan, and only one of every five children in the country will live to age 5. In contrast, Norway was deemed the best place to be a mother, with the US at spot 31.

Ashley, a student at
Catherine Ferguson Academy
Photo by Corinne Vermeulen, NY Time

Teen mothers in Detroit are fighting to keep their school, the Catherine Ferguson Academy, from being shut down. The school serves pregnant and teen moms, and has a 95% graduation rate. Stay tuned for the Summer 2011 issue of SQUAT, where Editor Jaydee Sperry will interview some of the students affected by the potential closure.

The LA Times reported on the flood of anti-abortion bills moving through state legislatures around the US.

This News from April is worth re-reporting: A study of pregnancy-related deaths in California found that the rising rate of C-sections plays a large role in maternal death.

Yet another benefit of breastfeeding was reported by British researchers this week in a study that finds fewer behavioral problems in children who were breastfed for at least 4 months.

And this is certainly news-worthy-- the deadline for submissions to the Summer 2011 issue of SQUAT is almost upon us! Check out our submissions rules and get your writing or art to us by May 15!

Chia Seeds in Pregnancy and Labor

2011-05-11T20:37:00.000-07:00

(From SQUAT: Here is a great article from the SQUAT archives--originally featured in the Fall 2010 Issue of SQUAT, available here. We'll be bringing you "classics" from our archives every now and then to spread the word and give you a taste of the great info found in the magazine. Enjoy!)

Chia Seeds For Pregnancy and Labor
by Katherine Rusch

Chia – Everybody knows those marvelously awful little terra cotta critters, but who knew those guys were the harbingers of health? Well, apparently the people of Mexico have long known what amazing nutritional benefits the Chia seed possesses.

3 tablespoons of Chia seeds delivers 6 grams of protein and a whopping 12 grams of fiber (1). Its calcium content (21% daily value) rivals that of milk (2). It is even more valuable when we consider that it contains boron, an essential mineral for optimally absorbing the calcium. The oils in Chia seeds are 30% omega-3 and 40% omega-6 oils. These oils are especially important to the pregnant woman whose body is hard at work building the tissues of her newborn. Flax is traditionally recommended as a supplement to provide these oils, but Chia has a greater percentage of omegas and does not need to be ground in order to access these oils (3). Chia seeds contain antioxidants that are beneficial to the body and keep the seeds from going rancid, which is a common problem with flax. Also worthy of note is the Chia seed's iron content (12% daily value), magnesium (30% daily value), and potassium (6% daily value).

So obviously, Chia can be an amazing supplement to the pregnant woman's diet. What is also intriguing about these seeds are their potential place as a labor aid. For centuries this tiny little seed was used as a staple food by the indigenous populations of the Southwest and Mexico. Known as the running food, its use as a high energy endurance food has been recorded as far back as the ancient Aztecs. Even today, the Tarahumara Indians, famed long-distance runners of Mexico, attribute their ability to run incredibly long distances nearly effortlessly to the Chia seed. The Chia seed is hydrophilic, meaning it absorbs large amounts of water and forms a gel. The Chia seed can absorb up to 10 times it weight in water! This greatly increases the body's ability to maintain hydration. Also, in the stomach, this gel slows the process by which digestive enzymes break down carbohydrates and convert them into sugar. This results in slowly released energy. Greater energy and hydration? Chia could be the ultimate labor food!

Chia as a Daily Supplement

Chia is most easily incorporated into the diet by simply swallowing a tablespoon of seeds with a full glass of water three times a day.

Chia For Heartburn

Swallow 1 tablespoon of Chia seeds with just enough water to get the seeds down. The seeds will absorb the excess stomach acid. After 5 -10 minutes drink a full glass of water to finish hydrating the seeds.

Labor Endurance Gel

1 tablespoon Chia seeds

1 tablespoon fresh lemon juice

1 tablespoon honey

dash of salt

1 cup water

Stir together and let sit until gel forms, approximately 10 minutes. Take throughout labor for energy and hydration.

Katherine Rusch is a Traditional Midwife-In-Waiting and Mama to five homeborn babies. She resides in beautiful Oregon and looks forward to working with families in under-served areas of the state.

Sources

1-Values given are for Spectrum Essentials Brand Chia Seed. Values may vary slightly with different varieties.
2-Daily values are based upon the contents of 3 tablespoons of Chia seeds.
3-USDA Nutrient Database

So Long, “Nurse” Midwives? Hilary Schlinger CNM, CPM puts ACNM’s proposed name change in 20 years of context

2011-05-10T07:00:00.000-07:00

From the SQUAT Editors: We came across this blog post by midwife Erin Ellis, in which she interviews Hilary Schlinger about a proposed name change at The American College of Nurse-Midwives. We found the post so interesting and relevant that we asked Erin if we could repost the whole thing, and she graciously agreed.

The American College of Nurse-Midwives (ACNM) has a motion on the table to change its name to the American College of Midwives (ACM). There has been talk about this change happening for years, but there may finally be enough support to approve the motion at the upcoming annual meeting in San Antonio. There has been internal discussion in certain midwifery circles about the politics surrounding the name change and how it may affect direct-entry midwifery. I think it is time to move the discussion into a more public arena.

I interviewed homebirth midwife Hilary Schlinger about the proposed name change and her vision for the future of midwifery in the US. Hilary is both a Certified Nurse-Midwife and a Certified Professional Midwife and has a long history in midwifery politics. She has served on the Midwives Alliance of North America board of directors and is the author of Circle of Midwives, a book about the history of the Midwives Alliance of North America and the resurgence of midwifery as a profession in the United States.

Sit tight, this is a long one but there is lots to chew on here. For help with the acronyms, see the MANA glossary of terms here.

Erin: You have spoken out publicly against the proposed name change of the ACNM. Yet you have worked as both a CPM and CNM, and have previously spoken out for unification of the profession. Why would you be opposed to this move?

Hilary: I would only support this name change if the ACNM concurrently commits the organization to working in partnership with MANA, NARM and MEAC to create one unified midwifery profession in the US. Without this commitment, calling CNMs “midwives” will increase their potential for working in opposition to direct-entry midwives who are striving on the political front to have CPMs included in national health reform initiatives, and of their being at odds with legislative efforts in states where the CPM has not yet been recognized. If the ACNM is going to rename itself the American College of Midwives, is it going to wield this moniker for the betterment of ALL midwives, or is the organization going to promote only its own brand of midwifery? As a corollary, is it going to change the title of all its members to CM – Certified Midwife?

Here’s another way of looking at it: Let’s say that the pride of the membership of the ACNM was their position as APNs (Advance Practice Nurses), rather than their attachment to the title of midwife. And let’s say that a motion was put forward to change the name to “American College of Advanced Practice Nurses.” Members would still have to go to an ACME-accredited program and pass the AMCB exam – the educational path and certification exams of other types of Advanced Practice Nurses (FNPs, CNPs, and Nurse-Anesthetists) wouldn’t qualify. Would you expect the excluded nurse-practitioners to think the name change was a positive move? That it wouldn’t confuse the public, or legislators? That it wouldn’t have the potential to undermine the work by other nurse-practitioner groups on political and/or legislative levels?

Erin: But some ACNM members are saying that they need to be more inclusive of their CM members. Why is it important to understand the politics surrounding the creation of the CM credential?

Hilary: For those who joined the ranks of midwifery after the early 1990’s: The history of the CM credential is NOT one that the ACNM can be proud of. To understand why this is so, one must understand the context of the times.

In 1989, the first Carnegie Foundation Seminar on Midwifery Education was held, with joint representation from ACNM and MANA board members to discuss the expansion of direct entry midwifery education. One year later, Carnegie offered funds to establish an inter-organizational task force so discussions between MANA and ACNM could continue. A result of these meetings was the creation of the (original) “Midwifery Certification in the United States” document, jointly endorsed by the boards of both organizations in 1993. The document affirmed ACNM as the appropriate organization to oversee education, certification and advocacy for nurse-midwives, and of MANA to respectively do so for direct-entry midwives.

ACNM acted in direct violation of the agreement when, less than a year later, the idea of the CM credential was “sold” to the membership. Leading the charge for creation of the CM at the ACNM convention was the NY ACNM chapter. In essence, New York was being used as the “testing ground” for an ACNM brand of direct-entry. While other states were concentrating on defining nurse-midwives as advanced practice nurses, the legislative push in NY was to separate midwifery out from nursing. When I say ‘midwifery’ here, I mean ‘nurse-midwifery,’ as their intention was never to include the voice of the existing (but unlicensed) DEMs. The New York CNMs saw themselves being held back by nursing issues, and felt that the creation of a Board of Midwifery was their best route to controlling the parameters of their own practice. Add to this the desire of some influential CNMs to design a European-style direct entry for the US – and NY became the perfect place to test this concept.

So, when the New York midwifery law passed, the CNMs from that state needed the ACNM to move quickly in acknowledging its own route to midwifery separate from nursing. Again, they saw this new law as a triumph, as the opportunity to design midwifery according to their own visions, and this included the opportunity to create direct-entry education. And the last thing they wanted was to muddy their dreams with concerns of those outside their ranks. They didn’t want to talk about place of birth, or about CPM-style education – they wanted to create a brand of direct entry that they perceived would be acceptable to the American public – Master’s Degree educated, prepared for hospital practice, just not entwined with nursing.

In “selling” the idea of the CM, the membership was told that creating the CM was “good for” the existing DEMs because it would create a legitimate route for their practice. This couldn’t have been further from the truth; there was no intention of creating a mechanism for us to achieve certification – it was, and has continued to be, a route in direct competition for legitimization with the CPM.

Although the move to create the CM was a politically motivated effort, with the subtext of undermining MANA, NARM and MEAC by creating a direct-entry pathway that could be touted as more legitimate, it is not one that has been successful. We need only look at how the CM has floundered while the credibility and acceptance of the CPM has grown to observe that this effort has failed. However, if the name change goes through, I am anticipating a re-doubling of ACNM’s legislative efforts to promote the CM as a more legitimate direct entry midwife, and to block inclusion of the CPM.

It is naïve to think of this current proposal as altruistic, or to think that actions of the ACNM won’t affect all midwives. It is always telling to know your own history.

Erin: Voices within ACNM are promoting the name change as a step toward unity within the profession. What do you think?

Hilary: The ACNM is an organization whose charge is to represent its membership, but when that organization has been built on excluding those whose voices don’t fit with its philosophy, how can I trust that the future will be different – that the “new and improved” American College of Midwives is interested in building bridges? With the creation of the CM, they were so willing to burn the bridge they had built with MANA the previous year, because of self-interest. Now, I would like to hope that times have radically changed, that any political currency the organization has gained over the years will be spent on the promotion of midwifery as a whole…but I would not go to the bank with this hope.

Erin: Many would argue that a similar oppressive/hierarchical dynamic is occurring between NARM/CPMs and DEMs who choose to remain uncertified and/or unlicensed.

Hilary: This is not a new dynamic. There has long been a rift between those midwives who perceive certification as limiting to midwifery practice and those who seek out certification, who want to find a way to be included as legitimate providers in the healthcare system.

NARM was born out of a desire for midwives to create their own standards regarding the parameters of midwifery scope of practice and education, rather than waiting for these to be imposed on midwives by the individual states. I happen to believe that staying out of “the system” keeps midwifery care limited to those elite (usually middle class white women) who can afford to pay out-of-pocket for care, as well as making individual midwives vulnerable to charges, whether real or spurious, from any of those in power who feel threatened.

In order for midwifery care to be readily available and for home birth to move beyond the one percent, I believe we need to find a mechanism that allows for our inclusion in the greater health care system. And of course the goal is for this to occur without destroying those qualities which make midwifery unique. I think the NARM/CPM approach holds more potential for achieving both these goals simultaneously than the ACNM one, which I perceive as being willing to dilute midwifery to a greater and greater degree as long as nurse-midwives gain a foothold in “the system.” Theirs is not the model I want to emulate. However, if we step carefully with certification and licensure, being very cognizant not to compromise away our principles in the process, then I think many of those midwives who currently choose to remain uncertified or unlicensed may look differently at the process.

Erin: You started out as a DEM turned CPM, but eventually became a CNM despite your criticisms of ACNMs political tactics and being exiled from New York. Why?

Hilary: I have alluded to my personal involvement in the events that occurred in New York.

When the law changed in 1993, I and twelve other DEMs applied for midwifery licensure. During the prior legislative fight to establish midwifery as an independent profession in the state, we had been assured by the CNMs that we would have at least one seat on the New York board, which was never their intent, and did not happen. Furthermore, we had been led to believe that our educations would be individually considered under a provision in the New York law which allowed licensure for those who could prove educational “equivalency” to CNMs. Instead, the information we provided in our applications was forwarded to the punitive arm of the department, and eight of us received cease-and-desist orders, with felony charges if we failed to comply.

I chose two things: to relocate to a state where I could legally practice, and to continue pressing the New York Department of Education to declare my education as “equivalent.” This fight took over seven years, but finally, after enormous effort, in 2001 my education was deemed “comparative.” I was given clearance to take the ACNM boards, which I did in November of that year, and thus became a CNM without ever attending a CNM program. By doing so I opened a door to licensure that approximately 15 other DEMs have since stepped through. It was a point of pride for me that I not attend an ACNM-created CM program, but instead have the state declare my existing education as equivalent.

Eight years later I chose to attend the only ACNM-accredited school where I could obtain a Masters of Midwifery rather than a Masters in Nursing, not because I needed this degree to practice, but to expand my ability to be involved in the future of midwifery education.

Erin: Is a perceived lack of education the primary reason ACNM fails to support NARM and the CPM credential?

Hilary: I’d like to tie that question to our history. During our discussion, I have been taken back, again and again, to the original convictions that kept me from becoming a CNM during the 1980′s and 90′s. During the time that I was working illegally in NY, I had more education than many of the CNM’s in my community (a bachelor’s from an Ivy League college plus midwifery training at The Maternity Center in El Paso plus licensure as a midwife in New Mexico, at a time when most CNMs were ADN’s who had gone to Newark for 9 months to obtain their midwifery certification), as did the women I worked with (3 of whom were British-trained direct entry midwives). I also had more birth experience than many of the CNM’s around me, and I certainly didn’t see the need to repeat my midwifery education. Yet my education wasn’t acknowledged as such by the CNMs in the state. Was this because the education was inferior, or because it incorporated a philosophy at odds with the CNM educational model?

When the New York legislative push came to the forefront, I spoke publicly about how the New York DEMs needed to be included in the process. And those of us involved weren’t just any DEMs – of the three primary DEMs involved in the legislative effort, two were founding members of NARM, and I was then the North Atlantic representative to the MANA board. In our naïvety, we believed that if we participated in the legislative effort, if we demonstrated the validity of our education and practice, then we would find a place at the table. But this didn’t happen – instead, our voices were forced out, and all three of us ultimately ended up leaving the state. In essence, it became clear that our having more experience with direct-entry (and, for some of us, higher educational degrees) than the CNMs in the state didn’t matter; the point was that our goals didn’t line up with theirs.

So now, when the ACNM has twice raised the educational bar, and can thus wave the flag of “education” as the primary difference between CPMs and CNMs I have to sit back and ponder, “Is thisreally the issue underlying it all?” And my answer is a resounding NO. If the ‘sticking point’ back then had been education, surely those of us with national experience in direct-entry education would have been welcomed at the table during the planning of CM programs, not barred from participation.

What it boils down to for me is that the roots (and subsequent actions) of the ACNM are in the gaining of power and legitimacy by being presentable to the powers-that-be. Even though the ACNM was born from out-of-hospital midwifery (be it in Santa Fe, Hyden or NYC), the emphasis from the start has been on incorporating midwifery into the existing medical and educational systems. And if this meant that those midwives had to wear a nurse’s cap, so be it. And if it later meant that they had to obtain a higher degree (regardless of their own research showing that ADN/certificate midwives had superior performance on the job), then so be it. And if it meant that they had to present a more medicalized version of midwifery in order to gain entrance to hospitals, then so be it.

Thus the question isn’t about “educated” versus not, but about the acceptance of midwifery knowledge that is both applicable to and acquired outside of, versus inside of, institutions.

This comes back to your question of how CPMs are viewed by the CNM community. One of the largest misperceptions about CPMs is that they have no didactic education, because for many it has occurred outside of the walls of standardized institutions. CPMs are all educated; however, a substantial percentage have not opted for “traditional” institutionalized education, often for the same philosophical/political reasons that lead them to avoid birthwork in medical institutions.

For those who don’t know, the NARM credential was created in conjunction with the National Assessment Institute to be in line with accepted psychometric standards. To quote Ida Darragh of NARM, “NARM does have a required curriculum – over 800 topics – which must be mastered both in theory and in practice. There is no requirement that it happen in a classroom, but it must happen and must be verified by a qualified preceptor through over 50 pages of documentation. All candidates then must pass the exam. It is NARM’s job to evaluate the educational pathway. There IS education, and it IS evaluated.”

We are seeing a veritable revolution in “non-traditional” education within many fields. Programs such as Empire College within the State University of NY system grants credit for demonstrated life experience, and Harvard admits homeschoolers. Both ACNM and NARM recognize didactic education online (ACME via Philadelphia University, Frontier, and SUNY Downstate; MEAC via National College of Midwifery, Midwives College of Utah, to name a few). So if both CNMs and CPMs now mutually acknowledge that nursing is not a prerequisite to midwifery, and as a society we are increasingly acknowledging multiple routes of education, then why are CNMs reluctant to acknowledge NARM certification as valid?Is the issue really about education, or is it about the underlying philosophy?

To turn the scrutiny the other way, we need to look at CNM education, as well. Most CNM education is lacking in continuity of care, in large-volume birth experience, in non-technological birth, in hands-on labor care, in newborn care, and the majority of ACME-accredited programs are educating CNMs only for employment in hospital settings, not for out-of-hospital (or even for true full-scope midwifery) practice. As a dually-educated midwife, I see the practice and the educational scope of each branch as overlapping circles – neither has it all, but merged together they would encompass the full scope of midwifery.

Erin: You’ve mentioned a merging of nurse-midwifery with direct-entry midwifery. How would one midwifery credential better serve childbearing women? Wouldn’t it mean less choice for them?

Hilary: It would only mean less choice if we allow the current model of nurse-midwifery to subsume direct entry.

A true merger takes the best of both worlds, and in the process gives the participants a greater societal voice. As long as we continue to put our focus on creating hierarchies within the midwifery community, rather than really listening to each other and learning how to work together, we will not be successful in building midwifery as an independent and powerful profession. If we choose instead to have one unified profession, where all midwives are educated to work in all settings, where the goal is to increase the profession until all women throughout the US can have access to a midwife, then we are creating more, not less, choice.

I believe that there is great potential for merging the two branches of midwifery via education, specifically via educational opportunities that have evolved due to the internet, as well as by weaving innovative midwifery programs into state colleges. Imagine a system where each midwife is educated (and permitted) to practice in all settings, incorporating the best of both NARM and ACME educational elements. Imagine a system where women who want to be midwives do not, on the one hand, have to spend years studying nursing when their true goal is midwifery; or, on the other, spend years studying midwifery, yet have no college credits to show for it. Imagine that midwifery education is available in every state college system, thus increasing the diversity of the midwifery population while decreasing the educational costs. There are waiting lists for state nursing programs; but I would bet that a fair number of those standing in line would jump at the chance to become midwives instead (and I’d bet that, for some, this was already in their plans). Imagine that we build birth centers in rural communities which serve the dual purpose of providing needed care while providing training sites for midwifery students.

And, if you can, imagine that we channel all the energy we have been wasting on fighting each other, and instead make a concerted effort to grow the profession. Imagine that the word “midwife” is known to every pregnant woman, and we read “more women demand midwives” in our local papers. We could stop celebrating when the number of midwifery-attended births in a particular state have reached the double digits, and instead look forward to them becoming the majority.

I am privileged to work in the state with the highest percentage of midwife-attended births in the US. Not surprisingly, we also have the lowest percentage of cesareans in the nation. I have full prescriptive privileges, the ability to provide primary care, am an independent provider, can write my own practice guidelines, and am reimbursed by all health insurance plans, including Medicare, Medicaid and private insurance. I am not saying that everything is ideal here; for example, hospitals are not required to grant admitting privileges to midwives, there is still a rift between the majority of CNMs and CPMs, and I only know of one midwife in the state who attends both home and hospital births. Still, I have gotten a glimpse of the vast potential for midwifery by working in New Mexico over the past 15 years. I believe that expanding the scope of practice for CPMs to include more well-woman and primary care, while simultaneously expanding the education and practice of CNMs to include more of the “midwifery model” qualities that CPMs hold dear, would serve to broaden choices for all women. It is only our misperceptions and petty squabbles that keep us from achieving unity. We will never know what opportunities for midwifery expansion are available as long as we continue our in-fighting. The current system limits choices; joined together we would have a much stronger voice, and the potential to reach all American women.

Erin Ellis is a mother, midwife, and wanna be artist in Montana. She has been attending births in homes, birth centers and hospitals in the western US and abroad for about thirteen years. She is a Licensed (LM) and Certified Professional Midwife (CPM). Erin's web site is www.erinmidwife.com.

Hilary Schlinger, CNM, CPM, MS, RN, is a Certified Nurse-Midwife (ACNM), a Registered Nurse and a Certified Professional Midwife (NARM). She holds midwifery and nursing licenses in both New York and New Mexico. She first became a Licensed Midwife in NM in 1982. Hilary has attended approximately 1000 births, with a focus on home birth practice, and has provided well woman care for hundreds of women. Hilary holds a Bachelor of Science degree from Cornell University, an Associate of Science in Nursing from Regents College, an Associate in Midwifery from the National College of Midwifery, and a Masters in Midwifery from Philadelphia University. She held a seat on the Board of Directors of the Midwives Alliance of North America for four years. Hilary is the author of the book Circle of Midwives, editor of four midwifery texts, and has been a guest lecturer and workshop presenter in settings from medical schools to midwifery conferences. She has served as preceptor for numerous midwifery students, and is currently a faculty preceptor for the National College of Midwifery as well as adjunct professor for the Department of Continuing and Professional Education at Philadelphia University, where she teaches the on-line course “Homebirth Practice Essentials.” She lives and works in Albuquerque.

HAPPY MOTHER'S DAY!!!

2011-05-08T09:06:00.000-07:00

Happy Mother's Day everyone! However you are choosing to build your family, this is a day to honor the women in our loves and honor the care they give to us each day. And all you mamas out there--give yourself a pat on the back, because you're doing great. If you haven't already, make sure to download our Spring issue FREE, it's the least we can do for you on Mother's Day.

Here at SQUAT, we're busy putting together the next issue--we're still accepting submissions through May 15! We've also been working hard to wake up the blog and keep it packed with information you'll find interesting and relevant--maybe you've noticed?

But for today, let's just all take a deep breath and say a thank you to mothers everywhere, and the dedicated birth workers who support them through their journey. And how better to stop and take that breath than to meditate on some beautiful art?

Here's a beautiful work of art by Kate Hansen, the featured artist of our very first issue of SQUAT. Use the comments section to link to some of your favorite mother art!

Happy Mother's Day!

Stephanie and Kofti
by Kate Hansen

My midwife is not a criminal

2011-05-06T09:15:00.000-07:00

Yesterday, which just happened to be the International Day of the Midwife, midwife Karen Carr plead guilty to community endangerment and practicing medicine without a license, avoiding jailtime and a charge of involuntary manslaughter for attending a birth in Virginia. More than 50 supporters stood behind her in the courtroom on Wednesday, many of them wearing the babies that Karen caught in her trusted and experienced hands.

Those hands also caught one of my babies. My son Carter was born in 2007 in my little house in Washington, DC, as the morning sun shone into the window. Karen had been with me all night, and as dawn broke she was frantically calling other clients to rearrange appointments—I’d wave my arms and she’d put the phone down and come to my side, then return to the phone when my contraction ended. I was a first-time mom, shocked and terrified at the intensity of labor, and she guided me through the journey with grace and kindness.

Me and my baby boy September 12, 2007.
Karen Carr was my midwife when I was left out in the cold by DC licensing rules.

So this is personal for me. Washington, DC, licenses only Certified Nurse Midwives (CNMs) to attend births at home. Due to a series of events during my pregnancy, my original midwife was not able to attend my birth, and I was left at 6 months pregnant without a birth attendant. I’d heard about Karen through the grapevine and drove up to Baltimore to meet her. I’ll be honest—I’ve always been one to follow rules, and I was nervous about Karen, who is a CPM, attending my birth illegally in DC. But I knew a homebirth was a smart and educated decision for me, and I knew Karen had the experience to help me along my path.

She didn’t flinch at the idea of being unlicensed in DC. She’d attended hundreds of births in DC, Maryland, Virginia, and Pennsylvania, often serving women who were risked out of natural birth options in birth centers and hospitals (such as twins, VBACs, and breech births). Quite simply, she went where families needed her.

Very tragically, one of those families lost a baby. And the state of Virginia charged Karen with involuntary manslaughter and child endangerment, with a possible prison term of 30 years. Yesterday she plead the charges down, and will not serve any jail time. She still faces proceedings for a Cease and Desist order in DC, but the nightmare in Virginia is over. She will not practice again in Virginia.

This is all very complicated. It’s sparked a renewed debate about the safety of homebirth, the education and licensing of midwives, and how women should approach childbirth. I’ve struggled at finding ways to talk about this case to friends and family who are not active in the natural birth world; “Why didn’t she just get licensed?” they ask, or “If the baby was breech, why didn’t the mother just go to the hospital?”

Part of me just wants to scream and shake my fists, while the rest of me knows that if I want to spread a message that women have the right to make their own healthcare decisions, and that certifying midwives may not be the answer we seek, I have to take a breath and have these conversations, as difficult as they can be.

At Karen’s hearing, the prosecutor implied that the mother in this case—whose baby was breech—did not have the right to birth at home, given her status as high-risk. This kind of language certainly raises alarm bells, and tells us that we need to keep paying attention to these issues, because they are not going away.

Andrea Kimball (whose baby is pictured above) writes of Karen: "Each day as I cared for the four beautiful children she helped into this world, she was constantly in my thoughts. Her care for me, her compassion, her wisdom, her sacrifices ... so that I could have the choice to birth in the way I knew to be best, in the place I knew to best, and with the people I knew to be best. I would trust Karen with my life and the life of my children."
Photo by Emily Sopha

For more information about Karen’s case, visit In Service to Women. Founded by some of Karen’s supporters, In Service to Women set up a legal defense fund for Karen and other midwives facing prosecution. You can donate to this important organization and follow them on Facebook.

And Karen, if you read this as the dust settles—Thank you. Your care and support has empowered me as a person, a woman, and a mother. For the gifts you gave to me, and hundreds of others, thank you.

-Sarah, SQUAT Editor

International Day of the Midwife!

2011-05-05T06:34:00.000-07:00

Today, May 5th, is the International Day of the Midwife. Originated, by the International Conference of Midwives, it's a day to bring special attention to the integral role of midwives and all birthworkers in maternal and child health around the world.

According to the ICM, over 340,000 women die each year, with millions more suffering infection and disability, as a result of preventable maternal causes. 80% of maternal deaths are due to 5 direct causes: haemorrhage, sepsis, unsafe abortion, obstructed labor and hypertensive disease of pregnancy. And 60% of these deaths occur in just six countries (India, Nigeria, Pakistan, Afghanistan, Ethiopia and Democratic Republic of Congo).

According to the ICM, up to 90% of maternal deaths could be prevented by universal access to adequate reproductive health services, equipment, supplies and skilled healthcare workers.

These are sobering statistics indeed. We could go on and on here about the forces at work--economic, political, cultural--that have made pregnancy and birth so dangerous for so many women, and we invite your thoughts on those issues. No doubt these shocking rates of maternal death and injury in developing countries contribute to a myth in American culture that birth is inherently dangerous and should be treated as a medical disease. The dissolution of that myth is just one of the many reasons we need to be working together to promote reproductive rights, including access to skilled midwives and birth attendant, for women around the globe.

Today, around the world, people are walking together through their communities to raise awareness of the importance of midwives in helping reduce maternal and infant mortality. You can find a list of local events on the Internal Day of the Midwife web site. If you can't attend a local action in your area, check out the Virtual Day of the International Midwife -- they've got streaming events and speakers all day long, and will be posting recordings of the sessions next week.

And thank a midwife today!

Have something to say? SQUAT Summer 2011 submissions deadline is May 15!

2011-05-02T15:18:00.000-07:00

We are currently collecting submission for our Summer 2011 issue of SQUAT!

Articles can be on a range of birth, midwifery and parenting topics. Please try not to exceed 2500 words. We welcome the submission of birth stories that are 1500 words or less. File formats we accept are .doc , .docx , and .txt.

Photography and artwork submissions are best if (much) larger than 800 X 600 pixels (H X W ratio does not matter). Image files may be .jpeg, .gif or .psd. High resolution and large files are appreciated for good image quality.

Please email submissions by May 15 to SubmissionsToSquat @ gmail.com.

We look forward to hearing from you!