And Joseph also went up from Galilee, out of the city of Nazareth, into Judaea, unto the city of David, which is called Bethlehem; (because he was of the house and lineage of David:) to be taxed with Mary his espoused wife, being great with child. And so it was, that, while they were there, the days were accomplished that she should be delivered.

And she brought forth her firstborn son, and wrapped him in swaddling clothes, and laid him in a manger; because there was no room for them in the inn.

And there were in the same country shepherds abiding in the field, keeping watch over their flock by night. And, lo, the angel of the Lord came upon them, and the glory of the Lord shone round about them: and they were sore afraid. And the angel said unto them, Fear not: for, behold, I bring you good tidings of great joy, which shall be to all people. For unto you is born this day in the city of David a Saviour, which is Christ the Lord. And this shall be a sign unto you; Ye shall find the babe wrapped in swaddling clothes, lying in a manger.

And suddenly there was with the angel a multitude of the heavenly host praising God, and saying, Glory to God in the highest, and on earth peace, good will toward men. Luke 2:3-14

British OB Nick Fisk is performing slow, gentle, family-centered cesareans. His method is a huge improvement over the typical non-emergency cesarean, though it does not address the urgent need to reduce our appalling national cesarean rate. While Fisk’s method cannot negate all of the risks, for the sake of the mothers and babies who do experience surgical birth, we can hope that it becomes the hot new trend among obstetricians.

This groundbreaking approach to surgical delivery - Fisk calls it a “skin-to-skin caesarean”, or “walking the baby out” - has been pioneered by him partly in response to the rising caesarean rate…

“What I realised was that caesareans were done a certain way because they’ve always been done a certain way, but in fact they can be done differently - and in a way that parents love,” says Fisk. Other doctors are sometimes shocked when they hear what he is doing. “They say, but surely you have to get the baby out fast so she can get oxygen straight away? And I say, when the baby is being born she’s still attached to the umbilical cord and is still getting oxygen from the placenta. Caesarean birth can be gentle, just as vaginal birth can be gentle.

“Obstetricians are too hung up on getting from the point of incision to the birth of the baby as quickly as possible: that’s been the benchmark of a skilled surgeon. But I’m challenging that because, from the baby’s and from the parents’ point of view, it’s not very helpful.”

“Rowan is my third child. His birth was my second home birth. While Rowan’s birth was peaceful and gentle (and that is important to mothers and to babies) I chose to birth at home because I looked at the available information, and from a safety standpoint, home birth makes sense. Rowan was born into my own hands. It was important to me to retain the freedom to birth spontaneously and instinctively. I am grateful for the watchful but unobtrusive presence of my midwife.”

The Sunday photo album is a regular feature of the Safe Birth Blog. If you would like to submit a picture for the album, please email soracolvin@gmail.com.

“Unfortunately, the role of obstetrics has never been to help women give birth. There is a big difference between the medical discipline we call “obstetrics’ and something completely different, the art of midwifery. If we want to find safe alternatives to obstetrics, we must rediscover midwifery. To rediscover midwifery is the same as giving back childbirth to women. And imagine the future if surgical teams were at the service of the midwives and the women instead of controlling them.”

Michel Odent, MD

Missouri’s midwifery advocates have had a long, interesting battle against some of the most restrictive legislation in the country. It’s not over yet.

Last year, a bill that would have provided for state licensure of Certified Professional Midwives was introduced by a supportive Senator, John Loudon. The bill was filibustered. Senator Loudon responded by slipping past opponents, quietly adding a provision legalizing midwifery to a health insurance bill. The Missouri State Medical Association challenged the legality of the provision, a court struck the bill down in August, and the case is being appealed to the Missouri State Supreme Court. In the wake of negative press Senator Loudon was removed from his position as chairman of the Senate Small Business, Insurance and Industrial Relations Committee.

That’s already a fair number of twists and turns on the road to legalized midwifery. Now a new wrinkle has been introduced: Senator Loudon has been restored to his leadership position, on the condition that he work to repeal the new midwifery law.

The story was covered in yesterday’s St. Louis Post-Dispatch. See also this editorial from the Show-Me Institute.

“Today a pregnant woman can not assume that the care offered by obstetrician and in hospitals will be in her and her baby’s best interests. Maternity care is “business,” and women need to be well-informed and careful consumers.”

This article by Susan Hodges (president of Citizens for Midwifery) lays out, clearly and concisely, many of the problems with our current maternity care system and why consumers need to be proactive and well-informed.

I am particularly happy to see the article on the Reproductive Health Reality Check, because it signals an important recognition from a very politically active community that business-as-usual maternity care is not good for women and babies. Safe birth choices cross all political lines. Pro-choice and pro-life groups ought to be able to come together in agreement on the rights of women and families to have choices for safe maternity care: both choice of birth place, and access to midwifery and the Midwives Model of Care, not just out-of-hospital, but in all birth settings.

My name is Laura, and I live in small town with my husband and our daughter, Gabriela. She will be two in January.

Gabriela was born at Greene Memorial Hospital with Molly Dickinson, a Certified Nurse Midwife. Molly’s calm, patient manner was a perfect match for me, and without a doubt I would have returned to Greene for my future children. However, the hospital closed the midwifery center in 2006 and none of the three midwives are delivering babies anymore. My husband and I had planned to have another child in late 2008, and after a lot of thought, I decided that I wanted an out-of-hospital birth with a midwife. We chose someone whom I already knew well and in whom I have supreme confidence and trust.

I know that I want to have another drug-free, natural child birth. In 2005, when I was pregnant with Gabriela, five of my friends were also pregnant. Four of them chose obstetricians for their births; the fifth chose a Greene midwife but was transferred to a doctor for a c-section. Their anecdotes are startling:

1. Two of the five wanted drug-free births, but neither of them was able to accomplish it because they both had c-sections.
2. Four out of five were induced. At her 39 week check up, one was scheduled for an induction at 40 weeks. Another, at her 40 week appointment, was scheduled for an induction without anyone even asking if she wanted it.
3. Three ended up with c-sections. One of them was convinced by her doctor, during labor, that her baby was just too big – he weighed about 7 pounds at birth, and my friend is not petite or small-boned.
4. Another friend said her doctor barely showed up in time – her daughter had already crowned when he walked in the room for the first time.

In contrast, my daughter was born just shy of 42 weeks. During my pregnancy, I was asked if I wanted to be induced, and I said no, as long as there was no medical problem. After 40 weeks, I was monitored twice a week to make sure Gabriela and I were both healthy. Once labor started, Molly arrived at the hospital about 30 minutes after I did, and she checked on me, stayed with me, and talked with me through all eight hours at the hospital.

I feel strongly that my best chance at having a happy, natural, drug-free birth is with a midwife, not a doctor.

Good Samaritan and Miami Valley Hospital are the only hospitals in the Dayton area that have midwives on staff. Good Samaritan is not in my insurance network, so MVH is my only “choice”. However, the MVH midwives are not on call seven days a week, so there is a possibility that a midwife won’t attend my birth. In addition, MVH is a 30 to 40 minute drive from my house. When Gabriela was born, we lived less than five minutes from Greene Memorial Hospital. I want to labor at home as long as possible, and I don’t like the thought of spending so much time trapped in a car, unable to walk around. I’m also concerned about my labor stalling because of the transition from one
location to another.

Ultimately, I want an out-of-hospital birth because even though I was very satisfied with Gabriela’s birth, there are some things I wanted to do differently the next time:

1. It’s important that I choose all the people who are with me during my labor. Molly and my doulas were wonderful, but there was a nurse at Greene Memorial who drove me absolutely crazy with her busy work, like changing empty trash bags in my room and just staring at me while I labored.
2. I want a more relaxing environment. After Gabriela was born, I was exhausted but unable to sleep because it was an unfamiliar setting. The nurses checked on me every hour or two and constantly asked when she last nursed and for how long. They were always concerned that she wasn’t eating enough. Their obsession made me anxious, and I began to doubt myself. I felt vindicated later when a midwife told me that babies generally don’t nurse much in the first 24 hours, because they are still recovering from the birth (just like moms!)

I left the hospital 24 hours after Gabriela’s birth. My hospital stay was marked by anxiety and tension caused by well-meaning nurses. In contrast, I finally was relaxed and truly peaceful once I was home with my family.

For all these reasons, I want my next birth to be an out-of-hospital birth. However, my chosen midwife recently contacted me to say that she has decided to stop attending births due to the current political climate in Ohio. I’m weighing my options to decide whether or not I want to have a child next year after all, and if so, where I will give birth.

I want women in Ohio to truly have a CHOICE about where and how they give birth. Right now I feel like I have no choice, and I don’t want my daughter to grow up and have her children in that kind of environment. I want midwifery to be a legal profession in Ohio, like it is in 24 US states and much of Europe, with home births, birthing centers, and hospitals accepted opportunities for all pregnant women.

Want to share your story? The Safe Birth Blog welcomes submissions to “Family Voices.” Email soracolvin@gmail.com.

This clickable chart from the New Jersey Star-Ledger is great, and I hope it will be imitated in other places. While not as detailed as the data from the Birth Survey will eventually be, it is a valuable tool that lets women quickly and easily compare different hospital’s cesarean rates — and those rates have incredible variation, with some hospitals near or even over 50% surgical births and others closer to 20%. By clicking on a hospital’s name, you get the cesarean and VBAC rates for ten years past; it is rather chilling to see the Cesareans swiftly climbing while the number of VBACs drops.

The Montrose Daily Press in Colorado just ran an article on local birthing options, interviewing families who had chosen home birth with a licensed direct-entry midwife and hospital birth with a Certified Nurse midwife. They also include an assessment of the local hospital — which is a small one, with an enviably low Cesarean rate — from a labor and delivery nurse.

The home birth midwife — Bill Dwelley, one of that very rare species, the male midwife — has a great line: “The worst machine in the hospital is the clock.” And the article gives equal time to each of three birth place / birth attendant choices available to Montrose mothers — it would be great if every community had these options, and if every pregnant mother was aware of them.

Unfortunately, the article places an undue emphasis on the “risks” of home birth — without ever substantiating what those risks might be — and implies, by choice of quotes and by what is left unsaid, that “choice” and “gaining power” are the primary advantages of home birth. This reporter needs to know that home birth with a qualified attendant is just as safe as hospital birth — and that our atrociously high cesarean rate has risks beyond lack of “choice” and “birthing power”.

“This was my fifth home birth and second water birth. My daughter was not at all happy about being born and seemed to be extremely dubious about the situation. I, on the other hand, had been waiting  a long time for this blissful moment and could not have been more delighted.”

The Sunday photo album is a regular feature of the Safe Birth Blog. If you would like to submit a picture for the album, please email soracolvin@gmail.com.