"Failure" to Progress

I just returned home from attending my best friend's birth. It was 53 hours from start to finish. Yes 53 hours - 33 of it in active labor! My friend hired a midwife and a doula and was at home. Everybody in the house trusted the birth process, never judged the length of her labor, and offered her techniques for moving her labor along. She was tired - VERY tired - but she said she looked at our happy faces and it encouraged her to trust that all was well and as it needed to be (of course the midwife was taking fetal heart tones every 15 minutes and the mom's blood pressure and temperature so we knew both mother and baby were never in any danger). By 8.44am on March 25, with her husband holding her in his arms leaned back on the bed and her best friend (me!), a midwife and labor assistant all smiling at her and lovingly stroking her leg, she gave birth to a healthy baby girl named Asta. Within minutes of delivery Asta was snuggled up to her mother breastfeeding, her mother whispering words of love into Asta's ears. Five minutes later my friend was handed a large glass of juice, and 30 minutes later I cooked her a full breakfast of eggs and toast.

After the birth my friend's husband looked at me and said, "she would have had a c-section in a hospital, right?" Well, who knows, but definitely my friend's labor would have been considered a "failure to progress" situation which would have meant she'd be given pitocin for inducing labor, then an epidural and if she had not dilated to 10 centimeters a c-section would have been encouraged. So, yes, in all likelihood she would have had a c-section. We were all happy this was not her birth story and instead mother was a bundle of energy, excitment and joy.

I wasn't going to write about my friend's birth story on my blog until I got a call this morning about another birth. This mother planned to have her baby naturally in the hospital, was very educated, read MANY books on birth, hired a doula and on Thursday night went into labor. By late Friday afternoon she was not progressing so the hospital encouraged pitocin, then she got an epidural because as any woman who has been given pitocin knows pitocin contractions are often much more painfull than natural contractions. By early Saturday morning, with the baby's heartrate doing well, she had "failed to progress" and the hospital encouraged her to have a c-section. She and her husband resisted. They didn't want one. By 3am, feeling bullied, they agreed. Just before the section the OB said to the mother, "I don't know how many times your baby is going to have to hit against your body for you to get a c-section. I hate when women do this." At 4am her baby was born, taken to be cleaned up and eventually handed to the mother who held her baby for a minute and said to the baby, "I love you, but mommy can't love you now." She then closed her eyes and her husband took the baby to a chair in the room where he sang the baby lullabies while the mother fell asleep in pain from the incision.

Here's what I learned from these two stories:

1. When you give birth you need to be in an environment that trusts birth.
2. Support is critical, but a good doula (which this woman had) can't save you from a medical model of care that does not put the mother at the center.
3. Post partum bonding is optimum for mother and baby.

These two birth stories come after a week where the Takoma Park Birthing Circle in the Washington, DC area (that I founded in 2004) has just announced that two strong birthing options for mothers in Washington DC area are closing in the next few months - the Takoma Midwives and The Maternity Center in Bethesda, Maryland. Two less mother-centered birthing choices for women. How can this be happening? There was a huge turnout Monday night to the Birthing Circle's meeting to address this issue. Unfortunately, this issue is nationwide in the United States and their battle will long and hard (but SO necessary!).

We MUST do better for mothers. Right now. If your community is loosing its mother-centered birthing options anywhere in the world - or has few positive options for mothers - call your legislative representative and tell them your concern. Write letters. Bombard the media. Organize protests. Now is the time.

BOLD's safe motherhood initiative - getting the stories of mothers in developing countries

I've recently been talking to several people who work with mothers in developing countries because at BOLD we believe ALL mothers around the world need to be heard and mothers in developing countries are faced with an alarming crisis in maternity care.

In many countries the primary interest of mothers is SAFETY. By this I mean just having a skilled birth attendant at their birth or supplies available in case of an emergency. I received a disturbing email the other day from a South African maternity care provider who said she has heard terrible stories of women in poor communities in South Africa having their babies outside the government-run hospital in the street because the staff refused to treat them for reasons such as not having had pre-natal care. Also, when these women refuse to push the doctors and nurses will forced the woman's legs open and push down on her stomach. I don't need to tell any of you that this is NOT mother-friendly maternity care. And that we need to hear from mothers in every country about their birth stories so that NO mother is ever subjected to care like this.

An exciting project called Ubumama (a Zulu word meaning "motherhood") has started asking mothers around the world to embroider their birth stories onto garments. We I heard about this I thought: now that's BOLD! Right now 6 groups of mothers in South Africa, Malawi, India, Ethiopia and Tanzania have done garments that Ubumama hopes to display as a traveling exhibit used to educate people about birthing mothers in developing countries. The next group of Ubumama mothers who will embroider their birth stories is in Nigeria, a country where 37,000 mothers die every year due to pregnancy and childbirth. Yes, 37,000 mothers every year! This is not only tragic, but a human rights issue. Why are we not protecting these mothers? What are their stories?

BOLD wants to find out the stories of mothers in developing countries directly from the mothers - hold BOLD Red Tent events - but it's not as easy as organizing a BOLD Red Tent event in the United States or Europe. Developing countries need financial assistance to make it happen. This summer we'd like to raise money to send a student and hire a local camera crew to film the Nigerian mothers as they embroider their birth stories and tell their stories to us in their native language. How can you help? Go to BOLD's homepage and click on DONATION! Send us a donation for this initiative by making your check out to "Birth On Labor Day" and put "safe motherhood initiative" in the memo section of the check. Every small donation counts ($10 or $100!).

All mothers matter. Rich, poor, white, black - BOLD is about uniting all of us so that all mothers can have a safe and mother-friendly birth.

To learn more about Ubumama go to: www.ubumama.org

Marsden Wagner speaks to BOLD Book Club

Two weeks ago 13 BOLD Book Club members packed onto a teleconference line to listen to Marsden Wagner, a well-known childbirth advocate, physician and former Director of WHO's Women's and Children's Health department. His new book - BORN IN THE USA - was our topic of discussion and like most conversations with Dr. Wagner it was lively, passionate and full of ways people can take action to make maternity care mother-friendly.

Here's what one of our Book club members wrote after the discussion:


Was anyone else inspired to do more, write more, learn more, educate more? I was. Being pregnant with my third child has made me feel like I’m in a little bit of a holding pattern in terms of getting more involved in birth advocacy. However, here are the things that I am choosing to do right away:

* write letters to representatives in congress asking for more funding for research into prenatal and birth care (cytotec, the induction and cesarean epidemics, causes and effects of birth interventions, including possible links to the rising autism rates.)


* begin to suggest (or possibly require) that parents in my birthing classes read Marsden Wagner’s “Creating your Birth Plan” I could even just make it part of the materials I hand out at the first class. I also plan to update my “suggested reading list” to include some of the newer titles that have been published in the last year or so, including “Born in the USA”.



I asked Wagner, whose book is an alarming expose on the maternity care system in the US, if he has heard from the US medical establishment (especially the American College of Obstetricians and Gynecologists - ACOG) since his book came out. His answer? No. Not a peep. He calls this "the silence of the Lions," claiming that the typical response from the medical establishment to books like his is either to aggressively attack it or if they cannot find any substantial problems with the research then they ignore it. In his case, his book has been ignored.

I want to know how a book like Wagner's, that clearly makes the case that mothers are not put first in obstetrics today, can be ignored by the medical leaders in the United States? When are we all going to be able to come together to make birth work for mothers? What's at stake for ACOG to say: we can do better?

I encourage all pregnant mothers to think about their birth choices in terms of the medical system that they are entering, and ask hard questions that consider whether your voices will be heard when you're pregnant and giving birth and if not find the birthing option that will keep you safe and your voice heard.