How to get your partner on board with your birth plan

So, you want to change maternity care providers but your husband doesn't understand why you should go through the trouble? You want a natural birth, but your husband says, "why have pain when you don't have to?" You want to write a birth plan, but he thinks it is disrespectful to tell professionals how to do their jobs? You want to hire a doula but your husband doesn't see the benefit? Or maybe you want to give birth at home or in a birth center, but he thinks you should just go to the hospital like "everyone else"?

Here are a few ideas that might help him see why this matters to you:

• Get him to read a book, such as The Thinking Woman's Guide to a Better Birth or maybe a selected article or blog post, such as Dr. Sarah Buckley's Epidurals: risks and concerns for mother and baby or Navelgazing Midwife's Pointless Hospital "Rituals".
  
• If he is the kind of guy who doesn't like to read, have him watch a birth documentary with you. Some possibilities are The Business of Being Born and Pregnant in America.
  
• Set up a meeting for the two of you with the midwife or doula you would like to hire. She may be able to address some of his concerns.
• Get him to take a childbirth class with you. Choose a class that covers the benefits and risks of your various options, rather than one that only teaches what is standard practice at the hospital.
• Sit him down and have a heart-to-heart. Explain how much your baby's birth matters to you and why you want to be involved in the decisions about it.
  

I hope he becomes the supportive partner you want him to be. Or at the very least, he will decide to just leave the choices up to you and go along with it. Good luck!

How Midwifery Care Can Reduce Racial Disparities In Birth Outcomes

At the request of Courtroom Mama posting at The Unnecessarean, I watched the documentary Crisis in the Crib: Saving Our Nations Babies. I think the film does a great job of raising awareness on the issue of racial disparities in birth outcomes and infant mortality in the United States. It really got me thinking about what factors contribute to this disparity. I think it is a very complex problem, and it can be difficult to pinpoint all of the causes. Poor nutrition, lack of exercise, and lack of access to care are all factors, but they don't explain why there is still a disparity for babies of college educated black women. The film suggests higher stress levels and the lack of presence of a supportive partner as possible additional factors that could influence middle class populations. There are also some life-course factors.

As I was considering these factors and trying to decide what to write this blog post about, I remembered this video from last year's The Big Push for Midwives Issue Briefing for members of Congress showing Jennie Joseph, LM, CPM talking about her birth center, The Birth Place, in Orlando, Florida.

It's pretty clear that The Birth Place has drastically fewer racial disparities than her area's average. She attributes the difference to their care being more accessible to the uninsured, but I think that is only part of the story. I believe that the obstetric model of care, which is the norm in the U.S., is failing black women. Here are some components of the midwifery model that I believe may better meet their needs:

• Focus on Preventing Complications with Healthy Lifestyle - While obstetric practices generally focus mostly on screening for pathology, midwifery care includes extensive counseling on nutrition and exercise during pregnancy. This approach integrates prevention of problems.

• Individualized Care - Midwives strive to make their care specific to the needs of individual women instead of providing one-size-fits-all care that may be more suited to one race than another.

• Holistic Treatment - Midwifery care treats the whole woman, not just her body. Prenatal care that is only a medical check up is a missed opportunity to resolve other issues that could contribute to disparities, including social and emotional stresses in the woman's life.

• Longer Prenatal Visits - The average length of a midwife visit is significantly longer than one with a physician. This allows more time to focus on these issues and develop a trusting caregiver/client relationship.
  

• Relaxation Practice - Birth centers do not offer epidurals, so midwives at a birth center would encourage women to prepare for a natural birth. In fact, State of Florida Law requires that birth centers counsel their clients to receive appropriate childbirth education. This preparation usually involves relaxation practice, which can be helpful for dealing with stress.

• Empowering Education - Midwifery supports women in being educated and involved in decisions about their care instead of letting the birth professional make most of the choices for them. This can help them learn to take responsibility for themselves and their babies, both during and after the childbearing cycle.

I believe that the caring, sensitive, woman-centered model of midwifery care may be exactly what is needed to reverse the terrible trends we see in maternity care today and make great bounds in resolving the disparity we see between races in maternity care in the U.S.

Birth Attendant as Lifeguard

Clarification: I use the term "birth attendant" here to describe a maternity care provider such as a physician or midwife, not a doula. I don't often use this term, but I must have subconsciously chosen to use it while writing this post because it is most appropriate for the role I was trying to describe, the midwifery model's idea of a caregiver who "attends births" rather than "delivers babies."

Since writing my last post about lessons from the freebirth movement, I have been thinking more about the roles of birth attendants. A guest post at The Gift of Giving Life (one of my favorite blogs) written by Heatherlady called On Cows and Chickens, got me thinking even more.

I believe that women are created to be able to birth their babies. I have read a lot about how hormones control birth and how negative emotions affect hormones and thus interfere with birth. I think that when a birth attendant interferes with the delicately balanced natural process of birth, they risk doing more harm than good. And interfering can probably happen easier than we sometimes realize.

People who believe strongly in the natural process of birth, including unassisted birthers, often compare birth to other normal activities that have some small level of risk associated with them, such as driving a car, playing a sport, etc. They argue that we don't need immediate access to medical technology while doing these things, so we shouldn't need it for birth.

My husband hates analogies because people sometimes use things that are not similar enough to make a good comparison, and I often agree (for example, unmedicated childbirth is not like getting teeth drilled and has nothing to do with hitting yourself with a hammer). However, occasionally, I find a good anaolgy. One such analogy, which I originally got from the Hypnobabies program, compares the birth attendant to a lifeguard.

Although birthing is instinctual and swimming is a learned behavior for humans, there are still a lot of similarities between the two. Swimming is an everyday activity, and the risk of drowning is quite low. The website for the International Life Saving Foundation(ILS) cites a drowning rate of 1.2 million people per year. Worldwide, swimming is statistically safer than childbirth, as the World Health Organization statistics from 2005 give a stillbirth rate of about 3.3 million, and a neonatal death rate (during the first 28 days of life) of over 4 million (WHO World Health Report). Worldwide maternal mortality for 2005 was 536,000 (WHO maternal mortality)

Most people who know how to swim feel confident and comfortable doing so freely without immediate access to medical technology. We are cautious with our young children, for whom the risk of death is greater ( the ILS website states that children make up more than 50% of drowning victims). But with the proper precautions (such as careful supervision and use of flotation devices), swimming can be safe and enjoyable for young children as well.

Despite the relative safety of swimming, we have people trained to attempt to make it safer. According to the ILS website:

The terms “lifesaver” and “lifeguard” are used around the world to describe individuals with special training who are stationed to prevent accidents and to respond to life-threatening emergencies in the aquatic environment.

My older brother used to work summers as a lifeguard at one of the community pools in the area we lived. His job involved watching swimmers to make sure they were safe and reminding them the rules that would could protect them from danger (things like no running, no diving in the shallow end, and making sure the area below the diving board is clear before diving). He had special training and certifications for the job, and was paid for it. Life guarding is often over-dramatized in movies and television, where they are always jumping in to save people and doing CPR. My brother never had to rescue anyone, he mostly sat on his tower all day and worked on his tan, but he could have saved someone if he needed to.

The ILS website estimates that those trained in their lifesaving skills make over 1 million rescues a year. Considering the drowning rate of 1.2 million per year, that means they cause a significant reduction. Parents who take their children to a pool with a lifeguard might feel some assurance knowing that there is an extra layer of safety there--an extra pair of eyes watching for danger, someone who is trained in rescue swimming and has current CPR certification.

I like to think of a good birth attendant as being like a lifeguard. They are specially trained professionals who have the skills to save lives when things go wrong. Occasionally, they may remind a birthing mom to breathe deeply or help her relax, but mostly they should sit and watch for signs of problems. "Watching" could possibly include a variety of things (checking hearttones, recognizing pathological labors, checking for tears, monitoring blood loss, ect.), but it should not include routine unnecessary medical intervention (e.g. elective induction, IV drips, pitocin augmentation, artificial rupture of membranes, etc), telling the mother how to birth her baby, or making decisions for her. In the event that there are complications, birth attendants can save lives (by helping get shoulders unstuck, giving pitocin for bleeding, resuscitating an oxygen-deprived newborn, ect.) much like a lifeguard, but if lifeguards were to jump in and pull people out of the water who didn't need saving, they would likely interfere with people learning to swim on their own and ruin people's swimming experiences.