Yes, next week my twin girls will be five years old. As I sit wondering where the time has gone, I still can't believe that I have these two amazing little girls. And I still can't believe quite how much their birth transformed me.
April is Cesarean Awareness Month, and there was no time more fitting for my daughters to be born. When I became pregnant with Leila & Sarah, it had been just one year since Joshua's birth by cesarean. After a pretty standard hospital birth with Matthew, I opted for a homebirth with Joshua. Things didn't go as planned and I suddenly found myself recovering from an unexpected cesarean. After discovering I was pregnant again, I knew right away that I would plan another homebirth. What I didn't know was that I was carrying twins.
An ultrasound at 22 weeks confirmed my midwife's suspicions... I was expecting two babies, not just the one big baby I had thought. And suddenly, everything was complicated. Georgia is not a homebirth-friendly state and the midwife that I had hired was not willing to attend a twin birth. My previous cesarean made it even more difficult to find a midwife willing to care for me. Despite the evidence that VBAC (vaginal birth after cesarean) is no riskier with twins than with a singleton, I felt like everyone viewed me as a ticking time bomb. When I hit 38 weeks, my back-up OB scheduled my cesarean. I never showed up for the surgery.
By the grace of God, a series of small miracles led to a knock at my front door when I was in labor. Two amazing midwives came into my bedroom and, a few hours later, helped me give birth to my twin girls. The experience was life-changing. The birth was perfect. I could not believe how incredibly wonderful these midwives were, that they were willing to drive hours to come to my birth, that they trusted in my ability to give birth naturally. My homebirth was one of the most powerful, awesome experiences of my life.
Homebirth is not for everyone... but having a choice is every woman's right.
Nobody should have to drive to another state to have the birth they desire. Nobody should have surgery because they feels it's their only option. Nobody should receive substandard care because of insurance regulations or because of their ability (or inability) to pay for treatment.
In our country today, woman are frequently being denied the right to choose where (and how) they give birth. The cesarean rate is soaring as roughly 1/3 of U.S. women give birth via major abdominal surgery. Women are even being forced into surgery against their will. There is often no informed consent, as women are not accurately told of the risks and benefits to the many procedures performed during a typical hospital birth. Cesarean sections have become the most common major surgical procedure in the U.S., yet many falsely believe that it is a safer way to give birth. Our country's neonatal mortality rates are behind those of 33 other nations, despite the growing cesarean rate. Our maternal mortality rate ranks behind at least 40 other nations, yet we spend more money on maternity care than any other country in the world.
All of this needs to change.
If you have ever read anything about midwifery, you have probably heard of Ina May Gaskin. Ina May has been a midwife for nearly 40 years and is probably the most influential midwife in history. Her midwifery center (The Farm) has been a prime example of what birth can,and should, look like using the midwifery model of care. With low cesarean rates, low rates of postpartum hemorrhage, high success rates for vaginal breech births , and a high VBAC success rate, her midwifery practice illustrates the excellent outcomes that are possible with skilled midwives attending births.
The author of several books, Ina May Gaskin's newest book is called "Birth Matters." I find the title to be very fitting. Although many people will say "all that matters is a healthy baby", this is simply not true. A healthy mother is of the utmost importance as well. When you consider the maternal mortality rate and neonatal mortality rate in the U.S., it is clear that birth does matter. It matters for mothers and it matters for babies.
I recently read "Birth Matters" and had a chance to ask Ina May a few questions about the book. Before I share what she said, I want to point out one thing. "Birth Matters" paints a clear picture of birth in the U.S. today... and it isn't pretty. This book is one that appeals to all women, regardless of whether you're pregnant or not and regardless of whether you support homebirth, hospital birth, or both. This book is about the importance of birth in our society and how modern maternity care is changing, at the expense of mothers and babies.
Discussing "Birth Matters" with Ina May Gaskin
Me: In your book, you discuss the basic, manual skills that many new obstetricians lack. You point out that they are not being taught to palpate the fetus or to turn a breech manually, let alone to deliver a breech vaginally. Yet there are still some older doctors that have held onto this knowledge. I had the honor of witnessing an unmedicated, vaginal breech birth by one such OB and a young resident. After the successful birth, the OB asked the resident whether she would use what she had just learned to deliver breech babies vaginally when she began practicing. Her answer was “No way.” I don’t understand it. What will happen when the newest generation of obstetricians is unable to learn these skills? You wrote about speaking to groups of ob-gyn residents. Is this a good way to bring about change? Can obstetricians stand to learn these skills from experienced midwives?
IMG: To answer your first question, more women will have unnecessary cesareans. To answer your second, talking to ob-gyn residents might not change this trend, but it could keep some from panicking if confronted with an undiagnosed breech that is coming too fast for a cesarean. A nurse told me about such a case in which the baby’s body had been born just as the anesthesiologist walked in the room, whereupon the panicked ob-gyn asked the anesthesiologist to put the woman under general anesthesia. That baby did not survive, and the nurse (who had more experience with vaginal breech birth than the ob-gyn) was sure that the baby could have been born if the doctor hadn’t panicked and asked for anesthesia when it wasn’t necessary.
The answer to your third question is yes, I think that obstetricians can stand to learn these skills from midwives, but we’ll have to get certain barriers out of the way before this can happen.
I just had a conversation with an obstetrician who is nearing retirement about the de-skilling of his profession that has been on-going since the late 1970s. He thinks it likely that if current trends continue, there will be no obstetricians in the future—only surgeons to do the cesareans. This truly is a race to the bottom. One of our problems is that most people don’t understand that it was insurance companies refusing to provide malpractice coverage to teaching hospitals that allowed doctors who were skilled at breech from teaching residents these same time-honored skills that caused this problem. I can’t think of any good reason why insurance companies should be allowed to have power over what doctors and midwives are allowed to know.
There will continue to be women with breech presentations who will insist that midwives provide the services that obstetricians refuse to provide. Increasingly, midwives are recognizing that someone has to keep knowledge and skills about how to deal with breech presentations alive, so leading midwifery educators are accepting this responsibility. It is important to recognize that there are obstetricians and family physicians who are philosophically opposed to the downgrading of their respective professions represented by the loss of traditional obstetrical skills. What has to change is medical education here. European medical and midwifery education has never abandoned the teaching of manual skills, including how to deal with breech presentations, even though these cases comprise less than 5% of the total. Instead of depending upon students being able to witness such births, they rely on teaching the various maneuvers using mannequins and dolls. Such mannequins have to be well-crafted to mimic what happens in real life as a baby is pushed through the pelvis, but I have found at least one great one that was made in Germany.
Me: One of most important things that I took away from reading your book was the need for our country to establish a system of reporting maternal deaths. You discuss this in great detail and you created the Safe Motherhood Quilt Project to work towards this goal. What can we (as mothers, activists, the general public, etc.) do to help bring about this change? What things can we do on an individual basis that can help make a difference?
IMG: Join Amnesty International USA’s Demand Dignity Campaign.www.amnestyusa.org
Dear Human Rights Activist,
The Demand Dignity Campaign was excited to see so many activists from around the nation willing to raise their voice to pressure congressional leaders to protect the right to maternal health at this year's inspirations Youth Summit and Annual General Meeting. As we continue to take action to fight poverty with human rights, we are pressing onward with our agenda to help reduce rates of maternal mortality in the US and around the world. But we cannot do this alone .
With Mother’s Day just around the corner, it is important to let domestic and international decision-makers know that we care about ensuring that the right of every woman to a safe pregnancy and childbirth is fulfilled. This is where you must get involved. In the four weeks surrounding Mother’s Day – April 23 rd to May 22nd – Amnesty International activists from around the country will be holding Mother’s Day card-writing events, visiting their congressional representatives, hosting film screenings, and more. You can join this fight to demand dignity for mothers and get decision-makers to hear our voice by:
1. Writing Mother’s Day cards.
Individuals and groups can register to host a card-writing event at amnestyusa.org/mothersday to receive copies of our cards and case sheets.
2. Lobbying during our spring in-district lobby week.
In March, Rep. John Conyers (D-MI) introduced the Maternal Health Accountability Act of 2011 to protect women’s health in the United States. From April 29th through May 8th, you can lead or join a delegation to lobby your congressional representatives to support this vital piece of legislation. Register at amnestyusa.org/lobby .
3. Using the power of film to raise awareness in your community .
· Host a party to watch the network premier of Christy Turlington Burns’ new documentary on maternal health, No Woman, No Cry (May 7 at 9:30 PM ET/PT on OWN).
· Screen the BBC documentary, Dead Mums Don’t Cry (any time between April 23 and May 22).
Register at amnestyusa.org/mothersday to request a copy of Dead Mums Don’t Cry and film guides for both movies.
You can also check amnestyusa.org/mothersday to find more events to join to support other activists in your community.
Don’t wait. Shine a light on maternal health this Mother’s Day by joining the fight to save the lives of mothers everywhere. Take action now!
The Demand Dignity Campaign Team
"Birth Matters" discusses several other initiatives aimed at changing maternity care today. The Safe Motherhood Quilt Project's goal is the creation of a system for reporting and reviewing maternal deaths. The Coalition for Improving Maternity Services seeks to promote a wellness model of maternity care that will improve birth outcomes and reduce costs. (Can you say "midwives?")
Did you know that in the industrialized countries with the best perinatal outcomes, midwives attend the vast majority of births? Yet in our country, most births are attended by surgeons. OBs are skilled surgeons, yet they are providing most of the care for low-risk women who do not need surgery. Midwives attend only a small fraction of the births in the U.S., despite the evidence that midwifery care is most appropriate for the majority of women. Women in the U.S. today are more like to die in childbirth than their mothers were.
For those who want to learn more about the safety of homebirth, "Birth Matters" exposes the flaws in the recent "Wax study" that claimed that planned home births had higher neonatal mortality rates than planned hospital births. Ina May does an excellent job of explaining the defects of this "study" and shares the data to back it up. Her discussion of the tactics used by those who seek to put an end to midwifery and homebirth is quite eye-opening.
What it boils down to is this: midwifery care and homebirth should be valid options for low-risk women. Maternity care in the U.S. is being controlled by those with special interests-the insurance companies, trade organizations- without regard for what is safest for mothers and babies. Women should have autonomy when it comes to their bodies and their births.
"Birth Matters" is really a must-read for women everywhere. These issues impact us, our children, and the future of our culture. The way that we treat mothers and babies speaks volumes about our society as a whole.
"Birth Matters" is available now in stores. I'm also giving away a copy on my review blog, just in time for Cesarean Awareness Month and my daughters' birthday (and the anniversary of my twin HBAC!)