Skip to main content

Stepping Down & Stepping into a New Adventure

Posted by Midwives Alliance on April 29th, 2014

Topics  

Embracing my lifelong career in midwifery began not as a conscious intention, but rather, as Destiny. In 1976, I was a twenty-something back-to-the-land hippie in rural northern Michigan when I caught my first baby for a first-time mother. I was also pregnant with my own first child. I wasn't doing it for the money. I was doing it for "the movement" to take birth back. I figured I'd be catching babies long enough to help my girlfriends have their births the way they wanted them, and for me to have mine. After that, I'd move on to my "real job."

Thirty-eight years later, it turns out catching babies was not only my real job, but moving midwifery forward in the United States was my real calling in life. For nearly four decades I have answered my calling fully and wholeheartedly. My midwifery journey has taken me to assorted destinations from community-based homebirth, to clinic-based healthcare for underserved populations, to co-founding a freestanding birth center with a team of DEMs and CNMs. I have caught babies at home, in birth centers and in hospitals. Even in sailboats and under apple trees. I have been educated through multiple pathways including self-taught lay midwifery, competency-based direct-entry midwifery (DEM), and university-based nurse-midwifery (CNM) with an accompanying Master's degree. Each pathway contributed to my expertise in a unique and valuable way. But my early homebirth roots—when our nurslings and toddlers accompanied us and stood wide-eyed and open-mouthed as they witnessed everyday miracles in the birth bed—laid the unflappable foundation for it all.

In the 1970s in my local neighborhood, I blazed a trail for a liberated and personalized way to give birth. In my state in the 1980s, I joined with likeminded peers to organize and co-found a vibrant professional midwifery organization that thrives to this day. In the mid-1990s, after specializing in normal physiological home birth for almost two decades, I went back to school and became a nurse-midwife so I could serve a broader range of women and their families.

It has been a gift and a pleasure to work for two populations different from my own. First I served Hispanic migrant farmworkers who traveled from Texas, Mexico and Central America to harvest fruits and vegetables in Northern Michigan, and then, numerous Tribal communities in the Upper Midwest. It has been a privilege to learn about traditions, health practices, languages, and beliefs unlike mine. For it is only through being immersed in a culture distinctly different from one's own that we learn to think outside of our narrow lens on the world. It is then that the doors of true compassion and understanding can open wider. When I moved into the realm of national midwifery leadership, advocacy to affect U.S. maternity care policies, and international midwifery initiatives, I was able to bring the numerous lessons I'd learned from people, cultures and politics. I became fiercely dedicated to issues of access, equity and respect for women's self-determination and for their right to make decisions about their health and that of their unborn and newborn infants.

In the late 1990s I made a transition from MANA member-at-large to a member of the MANA leadership team. For more than 15 years I have been deeply embedded in that team, first in three different roles on the Board of Directors, including President for two terms, and more recently as MANA's first Executive Director. Throughout those years, it has been my pleasure and privilege to work with many talented, passionate, and dedicated people, very few of whom are paid, and most of whom volunteer their precious time and energy to MANA and the midwifery movement. Gratitude, gratitude to each of you.

As I stand on the cusp of this transition, it is stunning how swiftly all of the years have flown by. During those times when I patiently waited for a breech baby to be born or feverishly worked to get a stuck baby out, the moments were inordinately slow. In fact, at those moments, time stood still. But earlier this month, as I worked amongst colleagues at the historic national meeting of the US MERA Work Group, it was odd to hear these words coming out of my mouth..."I am retiring."  A voice inside me whispered, "Already, really?"

But indeed, I am retiring. I heard my calling. I answered it with a lifetime of service. And now, I am entering into a period of rest and renewal.

As many of you know, after more than 20 years of living as a single, self-employed midwife and mother of three kids, seven months ago I married Fred, my old friend and lover. And as many of you also know—life is short! I intend to jump deeply and fully into this new adventure. Fred has a sailboat, and who knows what destination you might be hearing from me next.

A new and intriguing era for MANA has begun...and I wish you many blessings. May you be confident that MANA is in good hands with the next generation of leaders that are taking the helm and with the generation of Founding Mothers standing side-by-side to guide them. May you be generous in supporting the vision for the future articulated by your new and inspiring President, Marinah Farrell. May you be patient with the leadership team as MANA makes its next evolutionary leap into unchartered territory. And may you find a comfortable and welcoming home in MANA and a satisfying place just right for you to contribute your unique talents to the U.S. midwifery movement.

I leave you all with my spirit-arms wrapped steadfastly around you in camaraderie. Thank you for the honor of serving you all these years, for the many extraordinary and memorable adventures, and for the love you have shown me.

In gratitude,

Win MANA Swag! How Has A Midwife Impacted Your Life?

Posted by MANA Community Manager on April 25th, 2014

May 5th marks the International Day of the Midwife. We're taking this opportunity to honor and celebrate the many ways midwives provide life-long support to families.

To celebrate, we're hosting a story contest! Share with MANA the story of how your midwife supported your family. Midwives provide care, counseling, and support throughout a family's life, from birth to miscarriage and pregnancy loss, fertility, lactation, newborn care, and health advocacy as well as routine and preventive gynecological care. We welcome your stories not just about birth, but about any of the ways a midwife has impacted you.

The winning story will earn a one year membership to MANA for your midwife and a Celebrate t-shirt for you! 

Here's the way the contest will work:

Please send your story to MANA either via e-mail at info@mana.org, or message us privately on the MANA Facebook page. (Please do not post your story on the MANA page directly! We'll do that in the next step . . . ) Please send us your stories by noon eastern on May 2nd. (The fine print: By sending us your story, you are granting permission for your story to be shared on MANA's Facebook page and other social media.)

From all of the entries, MANA will select five stories to share on the MANA Facebook page May 3rd - May 5th.

Come vote! The story that gets the most likes and comments from the MANA community wins!

We'll announce the winner - based on the community voting - on International Day of the Midwife - May 5th - at 5 pm eastern time. We'll also share the winning story with the MANA membership via e-mail.

New Best Practice Guidelines For Transfer From Planned Home Birth To Hospital

Posted by Midwives Alliance on April 24th, 2014

As midwives, we all know that the way a woman is received at the hospital during a transfer from a home birth can impact both her physical and emotional safety. Midwives, hospitals, and policy makers have a new tool designed to help create an optimal transfer environment.

The model blueprint, known as the Best Practice Guidelines: Transfer From Planned Home Birth To Hospital was designed as an open source tool that anyone can use in creating policies and procedures for optimal transfer.

The new guidelines are a landmark achievement by the Home Birth Consensus Summit (HBCS) Collaboration Task Force. Chaired by past MANA President Diane Holzer and including past president and current MANA Communications Chair Jill Breen, this is a multi-stakeholder collaboration among physicians, midwives, nurses and consumers who have worked together to support the safety and well-being of families who choose home birth by creating this tool that bridges practitioners and sites of birth.

You can read about the guidelines in Science and Sensibility and at the HBCS website. MANA is a proud endorser of the guidelines. The HBCS delegates are seeking additional endorsements, from both organizations and individuals. You can learn more and sign on here.

An Open Letter to ACOG

Posted by MANA Community Manager on April 10th, 2014

The American Congress of Obstetricians and Gynecologists recently released a joint statement with the Society of Maternal-Fetal Medicine on ways to reduce primary cesareans. As a part of our Cesarean Awareness Month efforts, we wanted to share with the MANA community our open letter to ACOG. We welcome your comments.

Dr. Jeanne Conry, President
Dr. Hal Lawrence, Executive Director
American Congress of Obstetricians and Gynecologists

Dear Drs. Conry and Lawrence,

On behalf of the Midwives Alliance, I am writing to congratulate you for the strong commitment to high quality maternity care that ACOG has demonstrated by developing and disseminating the Joint Statement by the American Congress of Obstetricians and Gynecologists and the Society of Maternal-Fetal Medicine, Safe Prevention of the Primary Cesarean Delivery.

In recent studies and commentaries regarding causes for the escalating rate among low-risk patients, experts suggested the increase in cesarean sections was due to maternal health issues, such as gestational diabetes and obesity, fetal issues, such as malpresentation and multiple gestation, as well as malpractice concerns affecting hospital policies and practitioners. However, this new position statement by the nation's maternal and fetal health experts suggests that modification of certain maternity care practices could in fact reduce primary surgical deliveries. The World Health Organization called for the elimination of unnecessary cesarean sections as early as 1996, yet until recently there were few resources to assist maternity care providers in achieving this goal. This new joint statement provides a critical, evidence-based and actionable guideline for both health care providers and consumers. The emphasis placed on accounting for patient preference when making these complex decisions is reflective of the value that ACOG places on patient oriented outcomes.

As you may be aware, in May 2012, MANA, ACNM, and NACPM issued a joint statement entitled Supporting Healthy Normal Physiologic Birth That statement provides a complementary evidence-based guideline for practitioners who seek to facilitate normal physiologic birth and limit obstetric interventions to those that are necessary and evidence-based. We look forward to future opportunities to collaborate across disciplines to endorse evidence-based best practices in maternity care.

I wanted you to know that MANA publicly endorses the Joint Statement on the Safe Prevention of the Primary Cesarean. We are committed to working together—physicians, nurses, midwives, hospital personnel—to strive for an integrated maternal and child health system that provides high quality care for all women and infants in the U.S.

Thank you again for your leadership and vision.

Marinah V. Farrell, President
Midwives Alliance

Marinah V. Farrell is the president of the Midwives Alliance of North America. Politics and traditional medicine is what led Marinah to midwifery, and she has a firm commitment to both political activism and birth work. Marinah has been the president of various non-profit boards, has worked in waterbirth centers and medical facilities for international NGOs, free-standing birth centers in the U.S, and has been the owner of a long standing homebirth practice. Marinah also works with various local grassroots organizations in Arizona such as the Phoenix Allies for Community Health, a free clinic in downtown Phoenix, and assists in collective endeavors with other grassroots groups. Marinah is focused on the issue of lack of access to midwives and the profession of midwifery in communities where health disparities are overwhelming, as well as training in cultural safety.

Thoughts? Comments? Please add them here.

What We Know - And What We Can Change - About Cesarean Birth in the U.S.

Posted by Midwives Alliance on April 9th, 2014

Topics  

When three women in early labor walk into a hospital in the United States, we know that one of them will have her baby by cesarean section. Why is the surgical birth rate so high, and what can we do about it? We know that full term vaginal birth with mother and baby enjoying skin to skin during the first hour, with baby at the breast, and an environment filled with love and familiar voices is what both science and instinct tell us is best for mother, baby, and family. How do we make this a reality for more women in the U.S.? Identifying the issues can help us develop the best solutions through education and implementation of what we learn.

What are some of the challenges women face in achieving normal physiologic birth?

1. Hospital birth procedures. Time limits on stages of labor, interventive or interruptive hospital routines, and lack of support for women with challenging labors and longer labors may all contribute to high c-section rates. Experience shows us that:

  • Each woman's labor has its own rhythm that works well for her and her baby.
  • Even minor interventions,  procedures, and interruptions can distract, slow down or even stop labor and can impact the progress.
  • Fetal heart monitors can restrict a woman's ability to move during labor and distract her and her team from the work at hand.
  • Continuity of care, even having one person such as a doula or midwife stay with a woman throughout her labor and birth can help her cope, decreasing the need for pain medication and increasing her confidence and ability to birth without intervention.

2. Inductions. The increasing rates of inductions may be a contributing factor in the high c-section rate.

  • Inductions with an unripe cervix or undescended fetal presenting part (the baby's head in a vertex presentation if well-flexed and low in the pelvis will work with the contractions to promote efficient labor and dilation of the cervix) may result in cesarean section.
  • The use of pitocin increases the need for pain medication, both of which may not be well tolerated by the baby and may lead to cesarean due to fetal distress - a classic snowball effect of one intervention leading to another. A new study also suggests that term newborns exposed to pitocin in labor have a higher rate of admission to Intensive Care than those who are not.

3. "Normal" pregnancy. Many "variations of normal" that used to be considered reasonable for vaginal delivery, such as breech and twins, are now candidates for routine cesarean section. Physicians may not have the training or skills to adequately assist due to inexperience in these types of vaginal births.

4. Restricted access to Vaginal Birth After Cesarean. Although we no longer believe "once a cesarean, always a cesarean," it has become harder and harder for women to find care providers to help them achieve a vaginal birth after cesarean. Although ACOG has modified its position on limiting VBACs to advanced care centers with 24 hour in-house operating room staff, liability insurance providers have been much slower to reinstate coverage to smaller hospitals who may have had excellent VBAC success rates 10 years ago but were forced to discontinue offering VBACs because of policy. Even large hospitals who have numerous providers in their on-call list may find it unrealistic to offer VBACs when all their providers are not on the same page. A woman may have to travel hours to find a provider and a hospital who will support her goal of normal physiologic birth after a previous C-section.

5. Birth culture. A cultural attitude that does not value normal labor and birth, does not believe in women's abilities to birth, and does not believe in pain as a positive force, does not foster a woman's confidence in herself, her body or her connection to her baby during labor and birth. Just recently, we saw a very public example of the devaluation of physiologic birth when a national sports commentator criticized a major league baseball player for missing the season's opening game in order to be at the birth of his child, and suggested the player and his wife should've opted for a scheduled a C-section.

Paving the Way for Change

We know that cesarean section, now considered "routine" surgery, has risks for both mother and baby, including infection, adhesions, anesthesia complications, unintended damage to mother's organs, unintended damage to baby, and respiratory compromise for baby. Repeated cesarean sections with subsequent pregnancies carry greater risks for mom with each surgical delivery. Also, delayed bonding and breastfeeding are often consequences of operating room and recovery room routines and incapacitation of mom.

Education and the implementation of our learnings are key to decreasing cesarean sections and making the benefits of normal physiologic birth available to more women and babies. Thankfully, more and more resources are available for women to get the information they need for the birth they want, including consumer organizations such as ICAN, Homebirth Cesarean International, and websites like MothersNaturally.org. For mothers who do have a cesarean delivery, they can minimize separation and delayed bonding by requesting support for skin-to-skin with baby in the operating room, breastfeeding with the help of a Certified Lactation Counselor (CLC) or International Board Certified Lactation Consultant (IBCLC) in the recovery room, and having a "mommy" surrogate (partner, family member, or friend) stay with baby for all necessary procedures and when mother is unavailable.

There are many ways we can work to make hospitals and surgical experiences more mommy, baby, and family friendly. Midwifery care in all settings, including birth centers and homebirth, is linked to lower C-section rates. Hospitals that achieve Baby Friendly certification focus on natural birth and breastfeeding. In May 2012, MANA, ACNM, and NACPM released a Joint Statement entitled Supporting Healthy Normal Physiologic Birth to provide guidance for the birth community in how we can change the culture of birth in the U.S. We are now encouraged by the recent Joint Statement for the Safe Prevention of the Primary Cesarean Delivery released last month by the American Congress of Obstetricians and Gynecologists and the Society of Maternal-Fetal Medicine as another impetus for finding solutions to the cesarean epidemic. 

This month is Cesarean Awareness Month. We have been - and will continue to - highlight stories, images, and research about cesarean birth, prevention, and VBAC all month long on Facebook and Twitter. We hope you will join the conversation with us there, and add your comments here on the blog.

Author Jill Breen, CPM, CLC, has been serving women, babies and families for 36 years as a homebirth midwife and natural family health consultant in central Maine. She has 6 children and 8 grandchildren, all born into the hands of midwives including her own. She is working on Best Practices Guidelines with several state and national task forces. She served on the MANA Board, most recently as President, and is currently Communications Chair.