MANA Conference 2009 and Taking the NARM Exam

I'm trying to figure out where to start with writing about my trip to California. I could start with talking about my flight, or I could start with talking about checking in at the Conference, or I could start with how I even ended up going to California in the first place. There are so many places to start. I thought I could start with acknowledging how the first birth I ever went to started me on the journey to California, and then realized that it wasn't the first birth that started me on the path, but that it has been something that was within me at a very young age, perhaps something that has always been there, even before I used to pretend that all of my Barbies were pregnant and giving birth all the time...

So, then, I decided to skip all of the philosophical mushy stuff about why and how I ended up in California, in favor of just getting down to it.

Got to the airport REALLY early on Wednesday, October 21st. My friend Teri joined me on this trip to lend me moral support and to take a very well-deserved vacation from the Northern Virginia rat-race. Desiree Cripps, my friend and sister student midwife, was also testing at MANA, and she coincidentally booked herself on the same flight Teri and I were on. It was nice to spend that time with Desiree, and I think we helped each other stay sane by supporting each other and being there to get through the pre-test jitters and post-test crying.

Once we arrived in San Francisco, we got our rental car and decided to stop off for Chinese food on the way to Asilomar. Awesome Chinese food, by the way. It was nothing like the usual greasy, salty, buried in sauce Chinese food we have here in Virginia. They had dim sum, which I had never tried before. None of us knew what dim sum was, so we ended up ordering a couple of entrees off of the menu to share, but then when we saw the carts of dim sum going around the dining room, I think we all were wondering if we should have taken a chance and had the dim sum. Maybe next time!

After our lovely lunch, we began our almost 2 hour ride to Monterey. Northern California is so amazingly beautiful, so we didn’t mind the trip at all. In between oohing and ahhhing over the beautiful redwoods, Desiree and I did midwifery pop-quizzes for each other – name the components of the biophysical profile, explain physiological jaundice, review gestational diabetes testing steps, etc.

The Asilomar State Park in Pacific Grove is where the MANA conference was held this year. This beautiful park was such a relaxing back drop for such a high stress test as the NARM exam. The rooms were, well, not great, but they were OK once we bought a fan, some Lysol, and a scented candle. Just a little too musty and stuffy for our comfort. Once we got the air moving and worked on getting the mildew smell out of our room, it wasn’t half bad. The food was marginal, but hey, we didn’t have to cook, so it was AWESOME! Walking outside between sessions and mealtimes was one of my favorite memories of Asilomar. Always present in the background was the roaring sound of the ocean waves. It was just absolutely idyllic at Asilomar.

I only made it all the way to the beach once. One other time, I got close to the beach to watch the sunset, and there were a few other times when I saw the ocean at a distance. Teri spent quite a bit of time reading and people watching at the beach. I think she probably misses her time there, despite the dead seals.

After a good night’s sleep, I got ready for my big test day. I had wanted to have a watch to wear to help me keep time during the test, but I had forgotten to bring one. Then, when I got dressed, I found my watch was in my pants’ pocket! I had left it in there and had washed my pants with my watch still in the pocket. Fortunately, my watch is waterproof, so it was no worse for the wear! I saw finding the watch to be a good sign that the day would go well.

Another good sign was being seated at the breakfast table with Anne Frye (author of Holistic Midwifery Volumes I & II, Understanding Diagnostic Tests, and Healing Passage, amongst other things). I had referred to her books countless times in preparation for the test and in doing the modules for my school. Not only was Anne Frye at my table, but everywhere I looked I saw a famous midwife having breakfast in the dining hall with us. Being surrounded by so many wise women helped me to feel supported, and reminded me that all of us new midwives were there standing on the shoulders of the midwives who had gone before us. My realization was that this day was truly a rite of passage for us new midwives.

Desiree, Teri, and I walked to the testing room, and Teri snapped a few last pictures of us before we walked in to take our test. I arrived at the testing room and found my instructor, Shannon Anton (one of the co-founders of my school, National Midwifery Institute, and contributor to Heart and Hands), was helping Ida with administering the test that day. I gave her a hug and introduced myself. She said something like, “your work has been excellent,” which really boosted my confidence and helped me start the test from a good mental place.

Ida and Shannon handed out the tests and went over the test-taking rules. I sat there with my little pencil box, eraser, bottle of water, and Rescue Remedy in front of me, deciding to take a dose of Rescue Remedy as soon as I saw the test booklet! Someone, I think it was the president of MANA or NARM, came in and said a blessing for those of us taking the test, which was really beautiful.

Over all, the test wasn’t too bad. Most of the questions were scenarios, which was good and bad. On the one hand, as midwives, all that really matters is the decisions we make when faced with a particular situation. On the other hand, midwives aspire to provide holistic care to our clients, a two sentence passage to describe a scenario can’t adequately describe the entire situation, and individualized care means that a midwife might make one decision for one client and a different decision for another. The questions that fit into that category were the ones that made me the most crazy. For the most part, I felt I had prepared adequately for the exam. There were maybe 5 questions total where I really had no idea what the answer was, and another 40-45 questions where I had narrowed my choices down to two and had to decide between the two good answers.

As far as test preparation goes, I feel that doing the NMI program really helped me. The program guided me in my studies, encouraging me to explore my reference materials and really dig deep into the material. A lot of the questions in the Study Group Modules were scenario-based, so that in itself was good preparation. I also think using the NARM Written Test Specifications (found in the NARM CIB) as a study guide helped me focus my attention during the last weeks before the test. A lot of what I needed to know was qualitative rather than quantitative. Almost all of the questions were something like this, “Your client who is __ weeks pregnant calls you and says ____. What is the first thing you do?”

The test was long. We were given about 8 hours to complete it, with a 1 hour break for lunch between the two 4-hour testing sessions. My strategy for the test was to work through each question, keeping track on scratch paper which questions I wasn’t sure about. Then, after I made it through the entire test booklet, I went back to those questions and looked at them again. Each test session took me about 3 hours. I thought about going back through the entire test and re-checking my answers, but decided not to do it. My reasoning was that the first answer is usually your best answer, and that there was no way I could go back through all 175 questions in one hour.

Teri (thank GOD for Teri), had Fat Tire beer and Mike’s Hard Cider chilling for Desiree and me for after the test. Desiree and I had a little to drink, went through our emotional decompressing together, and moved on to enjoying the evening.

Off we went to dinner. Elizabeth Davis (my hero!) was there, so I introduced myself and gave her a hug. She was warm and kind, just as I thought she would be. She thanked me for my hard work at school and told me I was a great student (I was so thrilled to hear her say that!). Ina May Gaskin, Carol Leonard, Robbie Davis-Floyd, Anne Frye, so many famous people from the world of birth were there!

After dinner, we had a gathering where California midwives told stories of their work and of their struggle to practice. The stories were fascinating, but I was freezing cold, and couldn’t make it past about 11pm. Off to bed I went.

The next day, Friday, I listened to the keynote speakers. There was a wonderful midwife from Burkina, Faso, Sobonfu Some, who gave an outstanding address. She spoke of her people’s reverence for mothers and for their view of pregnant women as being beautiful. Next, I heard addresses from Jennie Joseph about midwifery’s ability to improve the rate of preterm birth. Her presentation has inspired me to think of ways to bring midwifery care to at-risk populations in my community. Still not sure how I would do that, but it is something on my list of things I want to do. Her presentation, combined with another one from a midwife serving aboriginal people in Australia really fueled a fire in me to serve people for whom midwifery care would ordinarily be out of reach.

I visited the exhibit hall next, where I met Suzanne Arms. Suzanne’s work has always inspired me. I also got to meet some of the suppliers we use in Peggy’s practice, as well as see other things that were available.

After lunch, I went to a session on the ethics of how we teach pelvic exams. I was stunned to find out that medical students frequently learn how to do pelvic exams by practicing on anesthetized, unconscious patients. The presenter has put together a movie that is in its final stages of production. She hopes to release it in 2010. It is called “At Your Cervix,” and it looks really interesting. Go to her website and watch the trailers. Very interesting and disturbing.

Next, I went to a session on Centering Pregnancy to learn how this concept of group prenatal care and community building could be used in a homebirth practice. I had been wanting to learn more about Centering Pregnancy, so it was good to discuss it in a group and hear feedback from other midwives, as well as hear how homebirth midwives have used it successfully in their practices. I think it is a great concept.

After dinner, I attended a movie night. I saw Birth of a Family, which was wonderful. I think I’m going to have to get a copy of that one. I also saw Le Primer Cri, a French film about birth in different cultures. It was interesting to see how birth is done in other cultures, but it was truly disturbing to see the “care” some women receive around the world. The film isn’t available in the United States yet, so I can’t say “watch it yourself and see what you think.”

Saturday, I got to see a great presentation by Eugene DeClercq about statistics surrounding birth in general, as well as midwifery and homebirth in particular. He is a great speaker, injecting humor into what would otherwise be a very dry and boring topic. The whole audience was captivated and he got a roaring standing ovation when he finished.

We decided to do some sightseeing for the rest of the day until we had to go to the airport. I was sad to leave the conference, but I felt like I really needed to seize the opportunity to explore Northern California. I was so torn! I felt like Asilomar was this safe little enclave of people who shared my beliefs about birth, where I could be free to say whatever I wanted to about birthing and not be judged or have people say to themselves, “oh, that Kim, she’s so radical.” Far from it! Compared to the community of midwives there, I was pretty mainstream! But, I couldn’t stay in this mini haven for midwifery forever, so off we went to explore California for the rest of the day.

We drove south along the coast on Highway 1 to Big Sur. WOW! The coastline, with its cliffs and rocks and crashing waves was just breathtaking. On the other side of the road were steep hills with colorful plants, farmland, and “happy California cows.” We saw the occasional hippie van along the way. The redwoods at Big Sur were impressive indeed. It seemed like the terrain changed every few miles. Mountains, then ocean, then redwoods, then more ocean, then farmland… there was so much variety.

Once we got to Big Sur, we turned around and headed back up the coast. We stopped off for some yummy Mexican food at a little hole in the wall cafe for lunch. Man, I wish we could get Mexican food that good here in Virginia!

Next, we headed to San Francisco. We went over the Golden Gate Bridge and stopped at Vista Point to take pictures of the bridge and the bay. We headed back over the bridge and went downtown to see the cable cars. Driving in San Francisco is INSANE by the way! I wasn’t sure what I was doing, so that made it ten times worse, but hey, we survived! After the cable cars, we made our way to Haight-Ashbury to see where all of the hippies were during the 60’s. Along the way, we saw a lot of interesting people we’ll never forget.

After all of our big adventures that day, we finally headed to the airport to wait for our flight home. Note to self; never fly overnight if you have trouble sleeping on an airplane. Total torture being in a seat made for a much taller person and trying not to touch the person next to you as you drift off. Anyway, we got home around 6am, got our bags, and headed home to our little town. My bed never felt so good!

The trip to California was an amazing experience for me. I stepped over the threshold from student to midwife while I was there, although I know I’ll always be a student as I continue to stay open to learn from the experiences I encounter as a midwife. I also felt the sisterhood of midwives from around the world coming together to support and learn from each other. I got to meet some midwifery superheroes and had some unforgettable experiences while I was there. I hope I can take some of what I learned and bring it back to the women I serve here in Virginia.

Perinatal Birth Symposium

What an amazing day! Today, at George Mason University, I was able to attend the Perinatal Birth Symposium. I was amazed at how many big names in birth were in attendance. I got to meet Robbie Davis-Floyd, Henci Goer, Shafia Monroe, Debra Pascali-Bonaro, and many other wonderful, passionate, brilliant women. I also got to see so many local midwives, doulas, and midwifery students. It felt like a family renuion!

My first stop, after checking in, was to catch the last half hour (I was running late) of the talk about Unassisted Childbirth, featuring Lynn Griesemer. I think midwives can learn a lot from listening to women who choose unassisted birth. There are reasons women choose to birth unassisted, and while it isn't a choice I would make, I think midwives, by listening to UC moms can improve our care. Just as midwifery clients choose midwifery over OB care so that they can feel empowered and respected, UC moms choose to UC because they feel they won't get that empowerment and respect from midwifery care. I disagree with some of the things that were said in the session, but overall thought it was good.

Second stop was to watch an audience-led performance of Birth: A Play, by Karen Brody. I had been wanting to see this play for a long time now, so it was great to be able to see it today. The cast included Robbie Davis-Floyd, Debra Pascali Bonaro, Vicki Elson, and several others. It was so great to see this play, and I could see how it would be such a powerful experience for teens and college students to learn about women's experiences of birth. So glad I got to see it.

Next, I went back to the Harris Theater to see Robbie Davis-Floyd speak about Birth Models that Work. I got to hear about how other countries, whose outcomes are much better than the US model, go about doing births. I am so used to seeing the American model that it was really helpful for me to think out of the box a bit to consider how we might go about integrating these other countries' models into our own. We have a lot to learn from how other countries manage normal labor and birth.

After this, I got to see Shafia Monroe speak about Birth as a Social Justice Issue. Shafia is so eloquent, and she helped me learn more about how race and racism affects birth outcomes. I also got a small taste of the heritage of midwifery amongst black women. Black midwives have a very different heritage than white midwives. For example, black midwives were not victims of the burning times (witch hunts). Black midwives practiced in Africa and in the US South as respected healers in their communities. I also got to learn about ICTC's Sistah Care Program, where girls age 13-17 learn basic midwifery skills and learn how to care for each other and for their community. I was so inspired that I feel like maybe I will pursue starting a Sistah Care Program here in Northern Virginia.

Next, I learned more about the legal aspects of birth and about informed choice. The discussion was facilitated by Tabare Depaep (Co-Chair of CIMS, doula, and lawyer) and Lisa Pratt (a law student at the University of D.C. who is active in supporting reproductive justice and VBAC rights). I came away from that one with a great idea for a project. I am going to put together a VBAC birth plan document with some very specific language to help VBAC moms get the birth they want. Tabare suggested having the doctors and nurses sign that they had read your birth plan. So, I plan to include the signature part, but also include a statement that the doctor will provide intrapartal care for the client at a hospital that will accomodate her wishes and respect her informed choice to have a VBAC.

After this discussion, I got to see Henci Goer's moving presentation about abuse of women in the hospital environment. Being a survivor of abuse myself, it helped me understand how I need to do some inner work to better serve women when we transfer to the hospital. Because of my own history of abuse, I find myself feeling very intimidated by the powerful male presence at a hospital birth, as well as feeling intimidated by the male-oriented medical model of care. Normally, I am very assertive, but I find myself losing my voice when I deal with doctors and feeling very much like I did when I was abused as a child. I fight it, but it is an ongoing challenge for me.

The last event I attended was a rountable discussion about birth practices and reproductive rights. The panel included Juliana Fehr, Robbie Davis-Floyd, Lisa Pratt, Debra Pascali Bonaro, Barbara Stratton (VBACtivist), Marjorie Brahms Signer (President of Virginia NOW), Shel Lyons (Birth Survey, CIMS, Mother's Rights Network), and Shafia Monroe, and was moderated by Jessica Clements. A lot of great ideas were discussed, but an empassioned plea from a woman in the audience got the panel to pull together a plan to move forward to begin work on legislation to protect the rights of childbearing women. A strategic planning committee was formed, and several members of the audience (myself included) volunteered to be a part of this strategic planning committee.

What an INSPIRING day I had! I feel so moved to do work to support mothers' choices. I wish everyone in the birthing community could have been there today.

And they think I'm a rebel! The fruit doesn't fall far from the tree!

I just read my baby book. Yep, I know, when was the last time you did that? I was organizing my photo albums and noticed the remnants of my own baby book. My mom had given it to me a few years ago when she was in an organizing phase. Organizing her house means packing her car full of stuff she doesn't want anymore and unloading it at my house -- but I digress...

So, this baby book was quite a treasure trove. There was, of course, a lot of really great stuff in there about my growth and development as a toddler, which was a lot of fun to read. It was great to see my mom as a young mother, noting the same things I noted about my own kids' babyhoods. I can just see her in her psychedelic 1960's outfits, with her Sophia Loren eye makeup and bouffant hairdo, chasing little me around trying to get me to eat my pureed peas.

I was born in 1966, back at a time when most moms were knocked out for birth. The natural childbirth movement was just starting to gather momentum back then. Dr. Bradley had just published Husband Coached Childbirth the year before, but I don't think my mom had read it before my birth. She did, however, read Grantley Dick-Read's Childbirth Without Fear.

I was born at an Air Force hospital in Topeka, Kansas. My dad wasn't allowed in the room with my mom. My mother, having read Childbirth Without Fear, decided she wanted a natural childbirth. I, like many first babies, was late. According to my mom's calculations, I was 3 weeks late. She ended up being induced. Despite the induction, mom insisted on having no pain medication. She says she remembers the pain was like waves, and she would just visualize ocean waves during the contractions to get through it. She remembers a very nice nurse who was very comforting and maternal towards her during her labor. When mom started to push, the doctor had the nurse strap a face mask to her leg. It had trilene gas, a popular anesthetic at the time. The nurse said it would be there for her if she needed it, and she could just grab it and inhale if the pain became too much to bear. At the moment of crowning, when mom felt "the ring of fire," she grabbed the mask and inhaled, not knowing it wasn't going to get any worse than it was at that moment, and she was knocked out. When she came to, she remembers hearing me cry, and she thought I was a cat meowing.

When mom tells the story of my birth, she gets really angry, and rightly so. She made it all the way to the end and then took the drugs because she didn't know she was at the end. She never had any more children, so she missed her one chance to experience the moment of the birth of her child. As a woman who has experienced that moment for all 5 of my children, I really feel like my mom got ripped off.

I always thought that story was so sad, but I was so proud of my mom for trying hard for a natural birth back in those days. She was the only woman in the maternity ward who chose to breastfeed too. My mom was such a rebel. At the young age of 19, she knew already just how important natural birth and breastfeeding are. I am forever thankful for her choices and so proud of her for taking that path.

So, I was reading my baby book today and thinking about all that my mother went through when I was born, all of the challenges she faced. The baby book she had for me was part baby book/album and part baby care guide. It was really interesting to read what they had to say about birth, breastfeeding, and baby care. Here are some snippets I found particularly telling about the mindset surrounding birthing back in 1966:

"If you believe you are going into labor, do not eat any food until you speak with your doctor. Anesthetics are best tolerated on an empty stomach."

"After the doctor has examined you, he usually orders the nurse to give you an enema."

" 'Natural Childbirth' is a term that has been accepted by those mothers wishing to experience the birth of their babies without the aid of analgesia and anesthesia. Even those mothers, however, are frequently given a local anesthesia."

"When you recover from your anesthesia and delivery, you will, of course, be tired and so you may fall off into a natural sleep for three to four hours. Following this rest ... your first interest will be your baby and the nurse will bring him into your room as soon as you ask to see him."

"Most hospitals thoughtfully give the mother a bottle containing enough formula for 24 hours on her day of discharge from the hospital. This takes the pressure off the first day at home and makes the preparation of the first formula a pleasure rather than a hasty chore. You will be given a copy of the formula the baby has been receiving, and with the demonstration of formula preparation which you observed the day prior to discharge fresh in your mind, you will find that formula making is much easier than you may have anticipated."

"(Rooming in) requires special nursing routines and special regulations concerning visitors that most hospitals do not customarily allow."

"All normal newborns receive a 2 1/2% sugar water solution twelve hours after birth and at intervals during the following twelve hours. 24 hours after birth, the baby is put to the mother's breast for three to five minutes every four hours for one day. Feeding time is then gradually increased to the normal period of 20 minutes."

Regarding Infant Identification:
"Some hospitals expose the infant to enough ultra -violet light to sunburn his name on his skin. Others place a large piece of adhesive on the infant's back upon which his mother's name is recorded."

WOW. I knew it was bad then, but wow. My mom traversed some pretty high obstacles just to even breastfeed back then. I saw in my baby book that she remained in the hospital until June 1st, which was 6 days after I was born. I can't imagine not seeing my baby until 4 hours after the birth, nor can I imagine only being "allowed" to breastfeed my baby 24 hours after the birth, and then for only 3-5 minutes every 4 hours. Can you believe the stuff about the sugar water and not nursing for the first 24 hours??? The sunburn thing is absolutely barbaric!

My baby book was a real eye-opener in so many ways. It gave me a whole new respect for my mother's courage and determination in the face of a very well-established system of obstetrical care. I find it absolutely amazing that she was able to do as much as she did. In fact, I find it pretty amazing that anyone breastfed or had natural births back then. It is pretty mind-boggling to think of what a radical shift in philosophy the natural childbirth movement was back then. It makes my current efforts seem tame by comparison. Now, when people call me a radical or a rebel, I'll wear that label with pride and a little smile because I know I'm not nearly the rebel my mom's generation was. I aspire to be the rebel she was.

Birth As It Should Be

I just got home from a lovely birth. It was as close to a "perfect" birth as it gets. It was the kind of birth where it would have been a shame for it to have happened in a hospital, where the medical machine just screws up a thing like this.

The woman I served today came to care early in her pregnancy. I had the pleasure of going to 8 of her 10 prenatal visits, and 7 of those 8 were in her home. I got to know her, her kids, her husband, her friends, and her home long before I showed up at her birth this afternoon. I became friends with her on Facebook, and we each learned even more about each other's lives. Her placenta is in my fridge right now awaiting encapsulation (a whole other blog post!).

This woman had a picture perfect pregnancy. She exercised and ate well throughout. She had a history of fast labors, so one of her greatest hopes for this birth was to be able to experience labor, to be more present and aware of what was happening during the birth. So, she hired a photographer to document her birth experience.

Since she had this history of fast labors, I knew I needed to act quickly once I heard she might be in labor. I got the call this morning from Peggy that the woman was showing some signs of early labor, so I asked my husband to stay home from work in case I needed to leave in a hurry. I followed her updates on Facebook, made sure I got everything done I needed to get done before leaving home, and waited for the call to leave for the birth. Finally about 8 hours after the first call from Peggy, I got the call from her that our lady's water had broken. Yay!!! Time to go! I practically didn't let Peggy finish her sentences as we wrapped up the call.

I arrived at the house to find our mama just hanging out and making Lego creations with her kids. She said the contractions were about every 5 minutes but were still light. I checked the position of the baby, running my hands along her tummy, feeling her baby's body with my hands instead of looking at it on an ultrasound machine. I listened to her baby's heartbeat with my Doppler through a contraction and afterwards, and was assured that all was well with her baby. Since her membranes had ruptured, I didn't want to do a vaginal exam unless the mom asked for it. No sense in risking infection. In fact, we never did a single vaginal exam during the labor at all. I checked mom's blood pressure, pulse, and temperature. Picture perfect.

Peggy and I worked on getting the supplies ready for the birth. The mom had taken great care to be sure that she had gathered the supplies we requested. I set up the heating pad with blankets and an outfit to keep warm for the baby. I put some water in the crockpot to heat in case we had time to do warm compresses. We got a tray ready with supplies we might need in a hurry. Meanwhile, the mom spent time with her family, chatting, eating, drinking labor aide, and contracting every few minutes. The photographer, friend, and grandmother arrived. Peggy and I charted and spent time talking on the couch, checking on our mama from time to time.

After a short while, the contractions had built in intensity enough that the mom wanted to retreat to her "birth nest." We knew birth was imminent and didn't leave her side. Once she got up to her bedroom, she knelt by the side of her bed, and we knew we were moments away from meeting this new life face to face. After a few gentle pushes, the mom reached down to feel her baby's head emerge, and in another push, the shoulders and rest of the baby slid out of her body and into our waiting hands. The baby, a beautiful vernix covered boy, opened his eyes and looked at his mother right away. He made quiet sounds to let the world know he was breathing, and he pinked up right away.

The baby's cord stayed intact until it was done pulsing, giving him a nice bolus of cord blood. He stayed in his mama's arms for a long time. He stayed there nuzzled up to his mom's breast and soon started nursing. He transitioned into the world, surrounded by the love of family and the caring hands of his midwives and his mother.

The photographer captured the beauty of these first moments of this baby's life. I heard the camera in the background as she caught special moments that can never be replayed -- crowning of the baby's head as it was born, mom receiving her baby into her arms, baby meeting his older brothers, dad cutting the cord, midwives weighing him for the first time...

It was a birth as it should be. It was beautiful and sacred. It the type of birth that could only happen at home.

I feel honored to have served this family today. I had an opportunity to see something today that only rarely happens in America. I saw a beautiful, natural birth, free of unnecessary interventions, allowed to unfold in its own time and space. I can never thank this woman enough for including me at this special moment in her life. It is the type of birth that fills me with hope and reminds me of why I chose this unpredictable life I live.

Making the choice -- Are you a good candidate for a hospital birth?

I was just reading Gloria Lemay's blog post "Are You A Good Candidate For A Hospital Birth?" and it really got me thinking about how to reach more people and help them understand what their choices really are. I think if first-time moms really understood what the hospital birth experience is all about, they would think twice. At least, that's the idealistic part of me who thinks that. Some moms are content to not think, and some moms know both perspectives and choose the path more well-traveled by their peers. There is such social pressure to conform, especially when your family says things like "choosing homebirth is a selfish choice" (yes, I just heard that from someone!).

Here's Gloria Lemay's list of questions for her blog post "Are You A Good Candidate For A Hospital Birth?":

• Must not be scared of needles.
• Must not be claustrophobic or uncomfortable in confined spaces.
• Must be able to go for long periods of time without eating or drinking.
• Must be happy to share a bathroom with others.
• Must enjoy sleeping on a mattress covered with plastic.
• Must not have a rebellious or questioning nature.
• Must accept the possibility of contracting antibiotic-resistant infections.
• Must be confident with caregivers who are overtired and overworked.
• Must realize that a limited amount of time can be spent in a hospital room before it is needed for the next patient.
• Must like and trust electronic equipment.
• Must be comfortable with cesarean rate of 30%.
• Must accept that the mood of the nurse on duty will be a large determinant of the birth outcome.
• Must realize that someone you have never met before will likely receive your baby.
• Must realize that the written birth plan will be ignored.
• Must be willing to have fluorescent lights turned on at all hours.
• Must be capable of birthing without making loud noises.
• Must look good in a flimsy blue gown that is open up the back.
• Must be willing to be a teaching subject for student doctors who are learning to do pelvic exams, surgeries, and suturing.

Do women know that this is what they are choosing when they choose hospital birth? Are they so afraid of the process of birth that they're willing to give their safety and their birth experience up to a system that promises the worst outcome for them and their babies than every other industrialized nation? What motivates women to make this choice?

I ask these questions of myself as well. Why did I choose hospital birth for my first three babies? Maybe that's a good place for me to start as I look for answers.

With my first baby, I wanted the best possible care, which to me meant the most expensive care -- an obstetrician. I thought midwives were somehow "less than," and that homebirth was dangerous. The Internet didn't exist for me in 1989, so the ability to make a truly informed choice was very limited. I'd have to say my pre-conceived notions about midwives and my uninfomed opinions about homebirth and about obstetricians drove me to seek a hospital birth with an OBGYN.

With my second baby, I just did as I had done with the first. I thought I had been pretty happy with my first birth experience (since I didn't know any better), so I went back for more of the same. My second birth was a tough Pitocin augmented persistent posterior birth. Being restricted to lying on my back or my side made labor excruciating. I left that birth not ever wanting to go through that kind of pain again.

So, now fearful of birth, I chose a birth I felt I could better control -- scheduled induction at 39 weeks with an epidural at 1cm. Not much pain, but instead of feeling in control, I felt totally out of control. I had no sensation, which meant no feedback on how my labor was progressing. I felt disconnected from the experience. I was totally at the mercy of what the doc felt my progress was. It was horrible.

The turning point for me, the biggest impact on my decision to choose a homebirth with my 4th baby, was my involvement with La Leche League. It was through listening to the experiences of other mothers that I learned doctors don't know everything. Finally hearing that this was the experience of so many other mothers, caused me to question whether my choice to give birth with an OB in the hospital was the best choice for me. They helped me to see that it was not my body that had failed me. The clincher for me was when I told my OB that I was interested in taking Bradley Method childbirth classes. She grabbed me by the shoulders and said, "Kim, tell me you are NOT having a natural birth." I nearly ran away screaming!

I'm an intelligent, educated woman. Heck, my great-grandmother was a midwife! I don't consider myself to be one to bury my head in the sand when it comes to making important decisions. What could have helped me to know the truth sooner? Maybe if I had seen Gloria Lemay's blog back in 1989, or maybe if I had seen the Business of Being Born back then, maybe those things could have helped me to know the truth about giving birth in the hospital.

I think the best thing we midwives and birth activists can do is to just keep spreading the truth, whether it is in a big way or just one woman at a time. Reading Gloria Lemay's blog post has re-energized my determination to keep fighting the good fight. Speaking of which, I sent a copy of The Business of Being Born to my sister-in-law. She's newly pregnant and needs to know the truth. I think I'll send her a link to Gloria Lemay's blog post too.

Homebirth Video for Peggy Franklin's Client

Check out this great video from Aimee Fairman's blog. This movie is made about a client of Peggy's, and I think it was really well done. It is such a great representation of what we do and how we do it.

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Virginia HB 2163 and HB 2167 Seeking to Limit Scope of Practice for Licensed Midwives Serving Women Seeking VBAC

Delegate Matt Lohr of Harrisonburg, Virginia recently introduced two bills (HB 2163 and HB 2167)seeking to limit the rights of Virginia women seeking homebirth with a licensed midwife after a prior cesarean section. I recently wrote to Delegate Lohr to ask him to pull both bills. Here is a copy of the letters we have exchanged. They're shown below with the newest one first. My original email to Delegate Lohr is at the end. I hope others will be moved to write to Delegate Lohr at DelMLohr@house.virginia.gov and let them know what they think of these bills.

1/19/ 2009 My letter in response to Delegate Lohr's letter to me

Dear Delegate Lohr:

Thank you so much for taking the time to answer my letter. And, thank you for supporting midwives and homebirth. I would like to take a few moments to respond to some of the points in your letter, as it appears more clarification might be helpful.

Midwives DO practice safely, regardless of any legislation in place (or not in place) to regulate their practice. Time after time, studies have continued to prove both the safety of homebirth and the improved outcomes associated with midwifery care. Midwives were practicing safely in Virginia before the CPM credential was recognized, and they continue to provide evidence-based care and have excellent outcomes now after the passage of the law that allowed for the licensing of Certified Professional Midwives here in Virginia.

VBAC is NOT a procedure. It is a physiologic outcome to a normal pregnancy. This is an important point. Repeat cesarean section IS a procedure, one which carries greater risks to both mother and baby than a normal vaginal birth. I contend that it is repeat cesarean section that should be looked at more closely, and not vaginal birth (with or without prior cesarean section). When serving a woman seeking a vaginal birth after cesarean section, midwives in Virginia disclose the risks associated with both vaginal birth and cesarean birth after prior cesarean section. Consumers use this information, in addition to their own research, when making their informed choice to have a normal vaginal birth at home rather than being forced into having a repeat cesarean section at their local hospitals.

I urge you to consider the options women face with their pregnancy after a prior cesarean section. The two choices are either a vaginal birth or a repeat cesarean birth. That’s it. The bottom line is that cesarean is more dangerous for mothers than vaginal birth, regardless of whether the mother has had a previous cesarean birth. Many hospitals in Virginia have NO-VBAC policies, forcing mothers seeking hospital birth to either have a more dangerous repeat cesarean section or seek a safe vaginal homebirth. If licensed midwives will be unable to legally provide care to women seeking vaginal birth after cesarean section, many will choose to birth unassisted, with friends, or with an unlicensed midwife.

Limiting Medicaid funding to not cover VBAC for Virginia women is discriminatory towards low-income women, who are already at greater risk just by being low income. These women especially would benefit from the extensive nutritional counseling and one-on-one support of a licensed midwife. Outcomes for poor women are greatly improved through midwifery care. So, by denying their right to receive the same care options as other U.S. residents (mandated by Federal Medicaid Law, I believe), Virginia would be unfairly discriminating against an at-risk population by denying them the care they need and rightly deserve.

I agree that there are some procedures that are very risky and that those procedures are best left in the hands of obstetricians, who are trained in the pathology of pregnancy and in the management of high-risk obstetrical care. Cesarean sections, for example, are best left in their hands. However, for women seeking normal vaginal birth, the evidence shows that homebirth with a qualified midwife is as safe or safer than hospital birth with an obstetrician.

Thank you for your help in protecting the interests of Virginia mothers and babies.

Sincerely,
Kim Pekin
Student Midwife
Purcellville, VA
www.gentlehomebirth.com

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1/19/2009 Delegate Lohr's response to my email on 1/16/2009

Dear Kim,

Thanks for contacting my office regarding the proposed midwife legislation.

Throughout the year, legislators meet with hundreds of constituents about issues of importance. Some of those concerns warrant possible legislation. The medical community met with me this year about incidents involving midwives and the safety of mothers and children. I have always supported midwives and greatly appreciate the work they do. I do not support shutting their practices down. This is not a bill to bash midwives. It is a bill to make sure that their practices are done safely.

The first bill I introduced was just a requirement that midwives have full disclosure with patients about their practices and associated risks. This is not directly stated in the code, which is why I introduced the bill. After visiting with the midwife lobby last week…who by the way were great folks…I actually decided to strike this bill because this process already takes place. I found out that part of their licensure process requires that they do this. That bill will be stricken from the docket. I was glad to see that this important step was already being done.

The second bill will be amended. The new amendment will narrow down the scope of the bill. To deter midwives from taking on very high risk deliveries, the original bill said they would be denied funding if they chose to do this. Some procedures are very risky and in my opinion they should be done in hospitals with medical doctors. I met with the midwives lobby last week at length and had very positive discussions. The new bill will only apply to the VBAC procedure (Vaginal birth after C-section). This procedure is deemed unsafe and risky by the medical association. Now, a midwife would only be denied funding if they conduct a VBAC delivery. All other high risk deliveries will remain in place. I am all for choice, but in my opinion certain choices deemed “very risky like a VBAC” should not be taking place in homes with a midwife.

Midwives provide a great service to our society, but I do have concerns over them attempting very delicate and complex procedures that place mother and baby in dangerous situations. I appreciate your opinions on this matter.

Sincerely,

Delegate Matt Lohr
26th House District of Virginia
Room 526
Richmond, VA 23219
(804) 698-1026


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1/16/2009 My initial email to Delegate Lohr about these bills

Dear Delegate Lohr:

As a citizen of the Commonwealth of Virginia, a midwifery student, and mother of 7 children (2 born at home with a Certified Professional Midwife), I urge you to pull HB 2163 and HB 2167 from the docket and to work to help INCREASE access to midwives rather than restrict it. Homebirth with CPMs is as safe or safer than hospital birth. With the outrageously high c-section rates in Virginia hospitals, more than 1 in 3 mothers are having surgical births now, and each of those mothers who have had c-sections are finding it nearly impossible to find a health care provider to support their informed choice to have a vaginal birth (VBAC) for their future births. These women, being very well-informed as to the safety of VBAC, are increasingly finding support for their informed choice through the support of CPMs and are choosing to have their babies safely born at home.

Further, these bills seek to restrict access to CPM care for low-income people. A homebirth with a CPM costs around $3000, and that includes all of the prenatal care, the birth, and care for mother and baby through 6 weeks postpartum. An uncomplicated vaginal birth in the hospital easily costs at least 3 times as much money, and a c-section costs much more. Legislators committed to reforming health care, cutting costs, and improving outcomes support CPM care as a way to meet those important goals.

Midwives and the clients they serve care very deeply about preserving the rights of women to continue to receive evidence-based care and to receive support for their informed choice of homebirth. Please do all that you can to help us increase access to CPM care.

Sincerely,

Kim Pekin
Student Midwife
Purcellville, VA
www.gentlehomebirth.com