The Captain of Her Own Ship

Can you believe that WOMEN want CONTROL over their own birth environment? NO-ooooo... they shouldn't DO that, they should lie back with morphine-type drugs infused into the epidural space of their spines, quiet... not requiring anything from the doctors, nurses or other hospital staff.


Check out THIS load of fecal matter from "Dr" Fart's Phhhlog:

"By all means share your most important preferences with your providers, but think long and hard before you present your provider with a list of refusals and ultimatums. Birth plans have been encouraged by ancillary birth personnel (childbirth educators, doulas) as a thumb in the eye of obstetricians. They accomplish nothing besides gratifying a desire to defy authority."

So... YOUR Birth Plan, which respectfully outlines the important care issues regarding YOUR and your BABY'S birth & postpartum, IS... (per her majesty, "Dr" Fart-from-her-Mouth) a frivolous, self-serving rebellion, causing pain and anguish to the doctor... >cough, gag, vomit<

"...gratifying a desire to defy authority."

REALLY?? ... WHO is the BOSS, "Dr" Fart?
DARE I suggest that the MOTHER (OMG!) is the Captain of her Own Ship? That SHE carries the ULTIMATE responsibility to safeguard her ship and it's precious cargo? That the Birth Attendant is, both, the Navigator & the Engineer assisting the Captain, TOGETHER, through the course of the birth... all the while with the safety of mother and baby as the PRIORITY. What Captain purposefully runs her ship a-ground or into uncharted, dangerous waters?

"...thumb in the eye..."

Hmmmm, isn't that what you are SUPPOSED to do if you are being ATTACKED by a SHARK?

Ah ha! Actually quiet a clever analogy!

But seriously, Friends...

YOUR Birth Plan is a valuable piece of communication between you and your birth provider(s). Both midwives AND doctors value and respect that you have specific desires, wishes, and yes, perhaps some things you don't want, too! Even when planning a home birth, where you'd think that a Birth Plan essentially isn't necessary, it can serve to open the lines of communication with client and midwife.

Write down your specific needs, wishes & desires!
MAKE that LIST, so that you and your provider can discuss these important matters ahead of time. If you have the potential to be cared for by someone you don't know and who doesn't know you or your wishes... the Birth Plan becomes an ESSENTIAL component of your care plan between you and that provider.

No, it isn't the Birth Plan that accomplishes the goal of having a safe and satisfying birth experience. It is the collaboration of ideals of both mother & birth provider, together with the circumstances of the actual birth event, that provides the very best possibility of a good, joyous, and healthy outcome for mother and baby.

And just in case "Dr" Fart-from-her-Mouth is reading... Natural ChildBirth Advocates (among them: Doctors, Midwives, Nurses, Doulas, Childbirth Educators, etc.) very much RESPECT the process of birth and acknowledge that there ARE inherent risks that can affect this very normal, physiologic, bodily function. We KNOW that sometimes mothers and babies need medical interventions, medications, and operative procedures to safely see them through and beyond the birth. We ACKNOWLEDGE that Cesarean Section saves lives and is, indeed, defined as giving BIRTH. We recognize that sometimes NOTHING can be done to prevent a morbidity or mortality.

HOWEVER, we also KNOW that unnecessary interference and practitioner interventions employed out of "routine use" ideology, convenience, ease, time, or other non-evidence-based rationale DO, indeed, INCREASE risk of the birth process diverging from a normal, healthy course.

Your Birth Plan serves to map out your wishes, needs, beliefs and desires for your birth care. A birth attendant who does not respect the importance of this patient/practitioner communication should not be serving birthing women.

The MOTHER is the Captain of Her Own Ship.

Options abound for moms-to-be

CLICK this LINK to read the Chesterfield Observer article featuring ME, Kim Mosny!!

Former Home Birth client, Stephanie Mazzella and
her 9-mon old daughter, Rowan, with Kim Mosny.

If ultrasound destroys sperm, why is it safe for a fetus?

If ultrasound destroys sperm, why is it safe for a fetus?

Facts VS Bias: An Analysis of the Wax Study

** sigh **

I have to completely re-write and re-compile all the information from a "Note" I posted on my HBMS FaceBook page, because FB "decided" that the content of my note "violated [their] Terms of Use." GRRrrrrr...
.

The note itself contained nothing "hateful, threatening, or obscene," nor did it "attack an individual or group, or advertise a product or service."

Thus, I must conclude that the photo, included with the note, of naked new mother holding her newly born baby was the material considered "obscene" by FB or was reported by someone who viewed my note. This is the photo that I attached to my FB Note. Obscene, isn't it?


Well, any whooooo.... on with my "Facts VS Bias: An Analysis of the Wax Study" note...

I was recently asked by a new client about the Wax Study, "Maternal and newborn outcomes in planned home birth vs planned hospital births: a metaanalysis." Am J Obstet Gynecol, 2010; 203(3) DOI: 10.1016/j.ajog.2010.05.028, which concludes that babies born at home have a mortality rate THREE TIMES HIGHER than babies born in hospital.

Their conclusion is controversial because many large and rigorous studies have concluded that homebirth and hospital birth have essentially the same safety for mother and baby. Some recent studies, including one from British Columbia, Canada, reported that planned homebirths actually have better outcomes for the mother compared to planned hospital births.

The study originally intended for print publication in the September 2010 issue of the American Journal of Obstetrics and Gynecology (AJOG), was published online on July 1.  Researchers and critics suspect that the early release was politically motivated to discredit midwives who attend the majority of home births in the U.S. and to discourage legislators from passing increasingly pro-midwife state legislation such as New York State's Midwifery Modernization Act (Bill S5007a/A8117b), which passed on June 28 with overwhelming bipartisan support, providing autonomous practice for all licensed midwives working in all settings.

The Coalition for Improving in Maternity Services ~ CIMS' advisor, Dr. Michael C. Klein, a senior scientist at the Child and Family Research Institute in Vancouver and emeritus professor of family practice and pediatrics at the University of British Columbia believes this is "an unabashed attempt to have poor science cover-unsuccessfully-a political agenda.  I am very surprised that the [Journal] would publish it, let alone call it 'Editors Choice'."

So, how does one know WHAT to believe with regard to research, studies, meta-analysis, etc? How does one wade through the myriad of information available on the web to discover the FACTS and uncover BIAS, and political agendas?

Well, in THIS case, it is little 'ole ME to the rescue to help my clients and others interested in understanding quality research related to the safety of home birth. Thus, we begin with an exploration of much of the discussion surrounding this meta-analysis known as the Wax Study...

• Midwifery Today Responds to Study Questioning Homebirth Safety 
• U.S. analysis on home birth risks seen as deeply flawed
• New AJOG Home Birth Study Political?
• When Research is Flawed: The Safety of Home Birth
• ACNM Expresses Concerns Regarding Recent AJOG Publication on Home Birth
• Hospital: Home births riskier - Some midwives criticize the international study by doctors at Maine Medical Center as biased
• NHS Choices: Safety of home birth questioned
• NACPM press release in response to the Wax et al article
• Home birth should be considered a sage option for pregnant women
• MANA press release in response to the Wax article
• Meta-analysis: the wrong tool (wielded improperly)
• 'Garbage in - garbage out'? Assessment of the quality of primary studies in meta-analyses published in leading journals.
• Planned home birth and neonatal death: Who do we believe?
• Safety of planned home births: Findings of meta-analysis cannot be relied on
• The Birth Activist Blog: Sorry Guys, Home Birth is STILL Safe
• PushNews: OB/GYN Journal Fast Tracks Anti-Home Birth Study in Advance of Pro-Midwife Legislation ~ International Expert Calls Study Deeply Flawed and Politically Motivated
• U.S. home birth risk review 'political'
• Milbank Report: Evidence-Based Maternity Care
• Stand and Deliver Blog: Dutch home birth study
• “Being Safe”: Making the Decision to Have a Planned Home Birth
• Shake it up: Why we need research and activism to change maternity care
• Home Birth Study Reveals Bias, Politics?
• Where's The Birth Plan? 
• Childbirth Connection: Transforming Maternity Care: Blueprint for Action: Steps Toward a High-Quality, High-Value Maternity Care System 
• Medscape: Home Birth Study Findings Raise Controversy
• Bring Birth Home Blog ~ Recent Study by AJOG may be 'Deeply Flawed'
• Mothering Magazine: Faulty Reporting on a Flawed Study on Home Birth
• Birth Sense Blog: Tripled risk of newborn death at home birth?
• RCOG statement on ‘Maternal and newborn outcomes in planned home births vs planned hospital births: a metaanalysis’

OK... So, now let us look at the research, articles, discussion and blogs regarding the Safety of Home Birth:

• Outcomes of planned home births with certified professional midwives:
  large prospective study in North America.
• Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician.
• A qualitative study of women's experiences of home birth in Sweden.
• CDC Report: Trends and Characteristics of Home and Other Out-of-Hospital Births in the United States, 1990–2006
• Midwifery Today: Why Home Birth?
• Birth Wars: Who's really winning the home birth debate? 
• Childbirth Connection: Best Evidence for Choosing a Place of Birth
• Home Birth: The Wave of the Future?
• Meta-analysis of the safety of home birth
• [Outcomes after planned home births]
• Physician Supports Home Birth
• ACNM Position on Home Birth
• Perinatal mortality and morbidity in a nationwide cohort of 529 688 low-risk planned home and hospital births
• Place of birth and satisfaction with childbirth in Belgium and the Netherlands.
• Home Birth: Safely Protecting and Supporting Normal Birth
• Outcomes associated with planned home and planned hospital births in low-risk women attended by midwives in Ontario, Canada, 2003-2006: a retrospective cohort study
• Outcomes of planned home birth: an integrative review.
• MedScape: Staying Home to Give Birth: Why Women in the United States Choose Home Birth
• Outcomes of 11,788 planned home births attended by certified nurse-midwives. A retrospective descriptive study.
• Listening to Mothers II: Report of the Second National U.S. Survey of Women’s Childbearing Experiences
• CIMS: The Mother-Friendly Childbirth Initiative
• Home Birth: good outcomes and few interventions
• Stand and Delivery Blog: What Explains Physicians Beliefs About Home Birth
• Midwifery Today: Home Birth in the UK
• MANA, President's Letter: Doctors Ignore Evidence, AMA Seeks to Deny Women Choices in Childbirth 
• The experience of planned home birth: views of the first 500 women.
• Citizens for Midwifery: Midwifery and the Constitution
• Home Births: RCOG and Royal College of Midwives Joint Statement No.2  & Home Birth

So... I will leave the rants and raves to the scientists, researchers, writers and other Blogsters.
I have compiled quite a bit of reading material here for those interested in learning.

What I KNOW is that home birth is SAFE. Home birth is made SAFER with one-on-one midwifery care and a skilled attendant at the birth. Safer still when a second attendant is present to assist the first.

Home birthing families do not choose home birth because it is "trendy" or "cool" or because some celebrity says they should. Women and their partners choose home birth because its their BEST CHOICE. It speaks to their sensibility, to their hearts, to their intellect, to their joy, to their minds, to their partnership, to their peace, to their spirituality, to their togetherness, to their concerns, to their interests, etc... etc... etc...

Home Birth is SAFE... otherwise I, a home birth midwife of 17 years, WOULD NOT/COULD NOT do this work. It is my calling, my job, my joy, my heart, my hands, my mind, my spirit, my responsibility, my promise, to protect mother's and baby's safe passage. Within that promise is the understanding that I am only the hand-servant through which health and life passes. I am not in control, as much as I might have thought I was in my early career, I have learned life & death's lessons, bitter-sweet and beautiful. I, too, surrender to the power of birth.

Home Birth is NOT for everyone. But for those who choose to give birth with midwives at home, let not your hearts be troubled by the controversy of biased agendas. It has and always will be YOUR RIGHT, YOUR CHOICE where and with whom to give birth.

The effective labour contraction ~ Midwife Thinking's Blog

Such a GREAT post about labor contractions.... I have to share with my Blog Followers!

The effective labour contraction ~ Midwife Thinking's Blog

Midwife means "with women" but wait, there's more....

NOTE: This article is not wholly my original content, but was adapted from an article shared by a student-midwife colleague (thanks Doran!) on a midwifery list serve. No authorship was offered, other than to refer to the author, "from a friend"... otherwise I would give credit where credit is due. Thus, I have "tweaked" and "fine-tuned" the original to fit my own perspective on the "job" of being a midwife. Enjoy.

Most folks would say that I "deliver" babies (though I like to say that I "catch" them) and this is true, but it is a fraction of what I do.... what this calling requires of me. The contrast between the “jobs” within my calling are surprising to me and unknown by many, if not most, who see the signs on my car and think they know who I am.

I am a teacher of an age-old "profession" which carries great responsibility. It is almost a given that a midwife will train others to be midwives, this is how midwifery has survived all of these years. Though I don't feel that I am a great teacher, I love to share what I know… there is much to glean from me and if someone is willing and observant enough, they will learn the art & skills of midwifery as they sit at my side, as they lend me a hand, and as they serve the women with me.

You'll see me at the copy place as I work for hours, making copies, putting together the information that I have been given, and that I have created, that gives the best informed consent I can provide. I want all those who hire me to know who I am and what the responsibilities are when they choose to give birth outside of a hospital. Making copies, creating folders and booklets of information, ordering books and DVDs, staying informed in all the ways available. It can be exhausting, but I know it is a necessary part of being a current midwife, one who teaches others how best to interview a midwife & plan a home birth. I need to continue to learn and to discover, especially what evidenced-based care is - and practice it.

I can find a fetus’ heartbeat and can tell if it is breech, without a doppler or an ultrasound machine. I know of many ways to cope with weeks of nausea and what is safe to take - whether herb or medication and can explain how to time contractions and what to do if your baby is jaundiced. I know many tricks to get a baby to nurse and how to make an herbal bath. I can recommend holistic treatments for a myriad of maladies and complaints for pregnancy from heartburn to urinary tract infection.

I keep my supplies stocked and inventory my bags, car, office & home supplies to ensure I have everything I need for every birth. You will sometimes find me sterilizing instruments at midnight or 1 in the morning because they didn't get done earlier in the day and a baby might decide it's not going to wait until the midwife has time the next day.

I am trained and certified to resuscitate newly born babies, the ones that seem to think that breathing is an option… I don't allow them this lazy notion and go to work, convincing them that it’s not so bad here after all. Nevertheless, the greatest teacher I have ever had was baby Caroline, who taught me that it was not MY decision whether she stayed or left and that I could do everything right and yet I was not in control. She left.

I know how to follow directions and to be more dependable than my mother ever thought I could be. The weather can have little affect on my travel - I go when I am called and it matters not how bad the roads, although I do hate the ice & snow! My partner knows and understands this, a midwife needs one of those, too - an understanding partner. In bad, icy weather, he drives me to a birth or postpartum visit, no matter the time of day or night. 

There is no job "beneath" my title - I wipe away vomit, clean toilets, and feed the family dog. I hope to never feel that I have "earned" anything better. A midwife should always know that she is there to serve, in any way that is needed, and it has nothing to do with what her needs are.

I am an ambassador for all midwives when I enter a doctor's office, clinic, or hospital and I take this responsibility very seriously. I've learned that I gain more trust and respect by saying fewer words and respectfully admitting our need for assistance and collaboration during a consult or transport. I have worked hard, for many years, but respect has been attained and my clients have received better care because of this simple principle of humility. A midwife has to be strong for her clients, they need to know she will not waiver. I have learned to have a “thick skin” when entering a hospital, while being professional and cooperative all at the same time. A midwife needs to learn from those who may not even realize that they are teaching her. There is always something to glean and take with you for another time. A midwife never stops learning. I have changed and matured over time, learning to be mindful and learning to listen to the voice of intuition.

Most of the time I truly love what I do - though my back, neck, arms and legs may ache and I have gone without food and sleep or had to miss a family celebration. I love the associations and sweet friendships I have made and the relationship that last beyond the years and the miles.

Midwifery is a precious calling and it truly can be the easiest thing in the world, but now you know that it comes with much more than just “catching babies”!

Single-Layer C-Section Closure Ups Risk of Uterine Rupture

From Reuters Health Information

NEW YORK (Reuters Health) Jun 21, 2010

Compared with double-layer uterine closure, single-layer closure following caesarean section doubles the risk of uterine rupture during a subsequent trial of labor, Canadian investigators report in the July issue of Obstetrics and Gynecology.

The researchers therefore recommend that "single-layer closure be reserved for women undergoing tubal ligation or those who require very expedient closure of the uterus." There is no consensus on the best way to close the uterus after c-section, the authors note. Single-layer closure has gained popularity because it shortens operative time and needs fewer hemostatic sutures.

Dr. Emmanuel Bujold, from Universite Laval, Quebec, and colleagues conducted a case-control study among women who underwent a trial of labor following a prior single, low-transverse cesarean delivery. Patients were selected from deliveries at nine centers in the Montreal area between 1992 and 2002.

The analysis included 96 cases of uterine rupture matched to 288 controls by time period and hospital. Rates of single-layer closure were 36% and 20% in the two groups, respectively,
"In multivariable analysis, single-layer closure (odds ratio 2.69) and birth weight greater than 3,500 g (OR 2.03) were linked with increased rates of uterine rupture, whereas prior vaginal birth was a protective factor (OR 0.47)," the team reports. All ORs were statistically significant. On the other hand, suture material had nothing to do with outcomes.

Dr. Bujold and associates say it's possible that a single, continuous suture technique does not approximate the tissues precisely together, and they suggest that single-layer closure leaves a thinner or weaker scar more prone to rupture.

Obstet Gynecol 2010;116:43-50.