I met Robin Lim at the CIMS forum a couple of weeks ago. This woman is amazing! She is so full of love and doing a great service from her heart. She is a midwife with 3 birthing centers in Bali, Aceh and Haiti. Her website (http://www.bumisehatbali.org/) has field notes from Haiti and a list of supplies that each birthing center is in need of.
One of her daughters also attended the conference and showed a screening of her new movie dedicated to the work her mother has done. This documentary is amazing!
It is women like these that give me the inspiration to follow my heart and make a positive impact on our world. They are a great testimony to the power of love!
I copied this important article from San Diego Birth Resource Network’s blog. I will now also ask all of my client’s about any history of cervical operations or procedures. Coincidently, I just read about cervical scar tissue in Elizabeth Davis’s Heart & Hands: A Midwife’s Guide to Pregnancy & Childbirth. It is nice to know that there is a pretty simple fix for this scenario, too. Heart & Hands recommends massaging the cervix (the mom can do this herself) with evening primrose oil twice daily for several minutes (this is contraindicated for any woman with a history of premature labor until she is at least 37 weeks). This can also be done in early labor, in case it is prolonged. The evening primrose massage will soften tissues and break up adhesions, preparing the cervix for dilation. Here is yet another way to treat our bodies gently!
Cervical Scar Tissue – A Big Issue That No One Is Talking About.
by Doula
In my first year of being a birth doula, I had this client. She desperately wanted a VBAC (vaginal birth after c-section). She told me how in her first birth that she was in labor for hours. Waters broken, Pitocin, epidural, tubes and wires coming from every direction. During her extremely long ordeal the only change to her cervix was the effacement (the thinning of the cervix). Her cervix never opened at all. I assumed at the time that this was because her baby was just not ready to come out. This time could and would be different. She would wait for labor to start. We would stay at home and labor where she was comfortable. When the day came, that is exactly what she did. Her labor seemed to be moving right along. When we got to the hospital I expected they would tell her that she was 4-5 cms. Instead what we got was, 100% effaced but only a finger tip dilated. I think I may have even gasped out loud. I immediately started beating myself up in my head. How could I have read her labor so wrong? 6 more hours would pass with her, her husband and I working hard. Moving from the birth ball to the shower and I swear every inch of that hospital room in between. After 6 hours, still a finger tip dilated. Obviously there is something wrong with her cervix, but what. No one seemed to know. Not the two different nurses that we had the pleasure of getting to know or the doctor who we saw just once when he was coming to explain that she would be having yet another c-section. This is one of those moments in my career that I really wish I knew then what I know now.
I have never stopped thinking of her. There has always been this part of me that wanted to call her and say “I know what it is now, can you have another baby so we can fix it?” I just know this would not make her feel any better. Instead, I keep her close to me whenever I ask the question now during each and every prenatal visit, “Have you ever had any procedures done to your cervix?” Every single birth professional that is assisting clients should be asking this question.
Look, I’m not a scientist, researcher, doctor and anything else that would know how to study this stuff. What I am is a doula that has had the pleasure of attending over 100 births. I know that the client I mentioned above was not the only one who had a c-section because of scar tissue during my earlier days. I can look back and think of all the clients that seemed to be in transition (7-10 cms) but when checked were still only 4cm. Stuck there for hours and hours. Then wondering for days after their c-section if there was something I could have done differently to help.
A New Day!
The day that changed my life as a doula forever, my very own sister was having a baby. She was having her second baby. I told her how great it would be and it would be so much faster than her first. When she started having surges just a few days before her due date, we were excited. I went to her home (3 hrs away) and stayed the whole weekend. She had surges off and on all weekend but nothing really steady. I went home after three days and decided that maybe my being there was freaking her out. For the next week, she had surges every day. I kept telling her it was going to be great. All this work would get her cervix open slowly and gently. Then she visited her midwife. She was just a finger tip dilated. I chalk this up to my sister being a big drama queen. All the surges have been Braxton Hicks! The next weekend comes and I find myself making the drive because this time her water broke. Now we know this baby is coming. She has mild labor, 7 minutes apart for 16 hours. Nothing is changing. I suggest we head in. Something is just not right. We get to the hospital and a different midwife she has never met comes to check her. 100% effaced but only a finger tip dilated. What?! Are you kidding me?! Then the words that changed my life. “Have you even had any procedures done to your cervix?” My sister says “yes, I had cryo surgery done a couple of years ago to remove pre cancer cells”. Midwife “ok well that makes sense, you have scar tissue on your cervix, and I can feel it.” Huh? Scar tissue on the cervix? Why had I never heard of this? My client from before comes rushing back to my head. Of course! The midwife proceeds to explain to my sister that she is going to try and massage the cervix and break the scar up. With some discomfort for my sister, she went from a finger tip dilated to 3 cms in a matter of minutes. An hour later she was 4 cms and an hour after that my nephew was born. Once the scar tissue had completely released, she flew to 10 cms.
As you can imagine, I asked that Midwife a ton of questions. I wanted to know all I could about this scar tissue stuff. Besides “massaging”, what can you do before hand? She shared her knowledge with me. Told me that HPV is so very common and more and more women are having these standard procedures done, but are never informed that it most likely will leave scar tissue. Although less common, this includes women who have ever had a D & C after a miscarriage or abortion.
Once I was armed with the knowledge, my successful VBAC rate shot up as did my vaginal birth rate in general. I would ask the question and if the answer was yes, I would tell them what I knew. I would suggest that they mention it to their doctor so that if anything came up during labor, would he or she be willing to massage the cervix. Also I learned from that Midwife that evening primrose oil taken orally and vaginally would help break up the scar tissue before labor. (Orally taken the entire pregnancy and vaginally each night only after 36 weeks).
Since this very important day 3 1/2 years ago, I know I have prevented c-sections. Several times in the hospital I have asked the doctor to please, when he is checking mama to feel for scar tissue. Almost every time the doctor has said “oh yeah, I feel some sort of knot here” or some other variation of that statement. This then leads to a question of; can you try and rub it out?
Why Doctors aren’t talking about this is beyond me. I honestly think they don’t know that it is an issue. I don’t believe it is something they are being taught in medical school. We all need to start talking about it because unless women are being asked the question, they just don’t know.
The current US Health Care System is failing babies and families before, during and after birth. At this critical moment when the US government is re-envisioning our health care system, we are seizing the opportunity to make a 10-12 minute video not only to point out the flaws in the way we care for babies and families, but also to identify the keys to improved care. Our infant mortality ranking is 42nd on the world stage which means 41 countries have better statistics. This places us right in the middle of the following countries: Guam, Cuba, Croatia and Belarus, with over double the infant deaths compared to the top 10 countries of the world. (CIA World Factbook).
Our astronomically high African American infant mortality rate at 16 deaths per 1,000 is similar to countries such as Malaysia and the West Bank. Not only are babies dying needlessly, but the ones who survive this failing system are also often adversely affected by unnecessary procedures and separation from mother and family. Our intent with this video is to encourage policy makers to consider a health care system that holds prevention of these calamities as a high priority. The midwifery model of care for healthy low-risk women is a simple solution which addresses many of these issues simultaneously.
We are advocating for a health care system in which it will be standard procedure for mothers and babies to thrive and not merely survive through birth and early life. The midwifery model of care will save our health care system millions of dollars each year.
Photo Credits:
Creative Commons Photos
Palestinian woman from the Gaza Strip is giving birth to quadruplets in a cesarean surgery in an Israel Hospital Edi Isreal
Cesarean team Bob J Galindo
Cesarean Eduardo Marquetti
Epidural Rave Dave
Fetus Lunar Caustic
DSCN 6000 Vesna Roganovic
First bottle feeding Jason Morrison
Esto Somos Nosotros Quique
Takahata HS 10 F a r e w e l l
Photo by Alejandra Sarmiento from the book Beautiful! Images of Health, Joy and Vitality in Pregnancy and Birth by Jennie Joseph (2007) reprinted with kind permission of Jennie Joseph.
Premature babies Photos by Raylene Phillips MD
Film footage:
What Babies Want
Vintage Film footage:
Labor and Childbirth 1950 Prelinger Archives Produced by Medical Arts Productions Public Domain
Reducing Infant Mortality has a creative commons copyright for sharing and attribution
The Experts in the film:
Marti Glenn, PhD, Founder and President, Santa Barbara Graduate Institute.
Geeta Maker-Clark, MD, Family Physician, Maternal Child Health, Prenatal Yoga Instructor, Magnolia Family Medical Clinic, Ventura County Medical Center.
Bruce Smith, MD, MPH, Medical Officer, County of San Bernadino Department of Public Health, Maternal, Child and Adolescent Health Section.
Sarah Buckley, MD, Dip Obst, Author: Gentle Birth, Gentle Mothering: A Doctors Guide to Natural Childbirth and Gentle Early Parenting Choices.
Chauntelle Williams-Parker, Mother, Lactation Specialist, WIC Program (Federally Funded, Women, Infants and Children Program).
Jennie Joseph, LM, CPM, Executive Director: Commonsense Childbirth, Inc., Founder of "The JJ Way' Maternal Child Healthcare System.
Monica Matos, Founder Ten Moons Rising Holistic Family Education, Birth Educator and Activist, Doula: Author: articles include, Reclaiming the Wisdom and Power of Birth, Women Disregarded in Maternity Care, The Amazing Motherbaby Connection, The Power of Healing Early Trauma.
Phyllis Klaus, MFT, LMSW, Author: books include, The Doula Book, Bonding, Your Amazing Newborn, a video, The Amazing Talents of the Newborn,and When Survivors Give Birth: Understanding and Healing the Effects of Child Sexual Abuse on Childbearing Women.
Marsden Wagner, MD, Perinatologist, 15 years Director, Women's and Children's Health, World Health Organization (responsible for Women's and Children's Health in 45 industrialized countries),131 scientific papers, 20 book chapters, 14 scientific books published in English, German, French, Spanish, Russian, Italian, Japanese, Chinese, Swedish, Hebrew and Danish.
Paula Ingalls, BA, Lecturer, Author: In Search of My Mind and Soul: Birth Traumas and Beyond.
Bryan Oshiro, MD, Medical Director, Perinatal Institute, Loma Linda University Children’s Hospital.
Stuart Fischbein, MD, FACOG, Internship and Residency at Cedars-Sinai Medical Center in Los Angeles, Certified by the American Board of Obstetrics and Gynecology. Expertise includes high-risk OB, ultrasound and infertility. Advisory Board: The Baby Center. Co-Author: Fearless Pregnancy, Wisdom & Reassurance from a Doctor, a Midwife and a Mom.
Raylene Phillips, MD, MA, IBCLC, Preterm Infant Developmental Specialist and Neonatology Fellow. Loma Linda University Children's Hospital.
Due to the length and pointed focus of this short film not everyone interviewed could make it into the final version. Our gratitude to all the distinguished experts who lent their wisdom, suggestions and words to our understanding of the issues of Infant Mortality and creating Healthy Babies.
Michel Odent, MD, Obstetrician and researcher. Medical studies at Paris University. Author of more than 50 scientific papers. Author of 12 books published in 22 languages including: The Farmer and the Obstetrician,The Cesarean, The Scientification of Love, The Functions of the Orgasms: The Highways to Transcendence.
Thomas Verny, MD, Psychiatrist, internationally recognized author who has written 7 books and published 44 scientific papers on topics relating to prenatal and early postnatal environment on personality development. His book, The Secret Life ofthe Unborn Child, has become an international bestseller published in 27 countries. Founder, the Association of Pre and Peri-natal Psychology and Health.
Marshall Klaus, MD, Neonatologist , Professor Emeritus of Pediatrics, University of California, San Francisco, Author: books include, Care of the High-Risk Neonate, The Doula Book, Bonding, Your Amazing Newborn,and co–editor for 10 years ofThe Neonatal/Perinatal Yearbook.
David Chamberlain, PhD, Author: The Mind of Your Newborn Baby.
Karen Strange, Midwife and Clinical Director, Maternidad La Luz Midwifery School on the US/Mexico border in Texas, Neonatal Resuscitation Instructor: newbornbreath.
Robbie Davis-Floyd, PhD, Senior Researcher Fellow, Dept of Anthropology, U of Texas, Austin, Author- books include: Birth in Four Cultures, Birth an American Rite of Passage, mainstreaming Midwives, From Doctor to Healer – The Transformative Journey.
Yeshi Neumann, CNM, MA, MPH,practiced midwifery in diverse settings, from high-risk obstetrics in an urban hospital to working with traditional midwives in Nicaragua, Guatemala, Mexico and Tibet. She created Homestyle Midwifery at St. Luke’s Hospital in San Francisco, CA in 2000.
Arisika Razak, BSW, RN, MPH (Masters in Public Health), CNM, Director of the Women’s Spirituality M.A. and PhD. Programs in Philosophy and Religion at the California Institute of Integral Studies. She was worked for over thirty years in women’s health, spiritual dance and nurse-midwifery.
Paul Fleiss, MD, Masters in Public Health. Pediatrician in private practice, Hollywood, California.
Maria Iorillo, LM, CPM, Wisewoman Childbirth Traditions, Vice President, Midwives Alliance of North America (MANA), Board of Directors California Association of Midwives (CAM).
Rupert Linder,MD, President of JSPPM, OB-GYN, Psychotherapist.
Wendy Anne McCarty, PhD, RN, Founding Chair & Faculty, Prenatal & Perinatal Psychology Program, Santa Barbara Graduate Institute. Author, Welcoming Consciousness: Supporting Babies' Wholeness from the Beginning of Life–An Integrated Model of Early Development (2009). Co-founder, BEBA, a non-profit clinic for babies and families to early trauma. International presenter, educator, consultant and practitioner specializing in optimizing human potential from the beginning of life. Guest editor, Journal of Prenatal and Perinatal Psychology and Health.
Tara Blasco, PhD, RCST, Therapist BEBA Family Clinic.
Micheline Charpie, MD, PhD, MA, MT, LCAT, Newborn Intensive Care, Roosevelt Hospital, New York City.
Brent Babcock,DC, Author: My Twin Vanished: Did Yours?
Barbara Findeisen, MFT, PhD, President of the Association of Pre and Peri-natal Psychology and Health.
Charlotte Peterson, PhD, Director Oregon Network of Infant Mental Health, Infant Mortality Task Force of Lane County Oregon.
Corey Colwel-Lipson, MA, LMFT, ATR-BC.
William Emerson, PhD, Author: Healing Birth Trauma in Children.
Debra Bonaro-Pascali, LCCE, CD (DONA), Director-Producer of the film: Orgasmic Birth.
Carrie Contey, PhD, Co-Author: CALMS, A Guide to Soothing Your Baby.
Julie Gerland, Chief Administrative Officer UN Representative for OMAEP, (The World Association for Prenatal Education Associations) an NGO in Special Consultative Status with the Economic and Social Council of the United Nations.
Simon House, MA, Parish Priest, Author: The Unborn ChildandGenerating Healthy Brains.
Mia Kalef, DC, Director of Emerging Families Clinic, Author: The Secret Life of Babies.
Guiditta Tornetta, Doula, Founder: Joy in Birthing.
Dave Paxton, RCST, MBA, Clinical Social Worker.
Dorothy Mandall, MA, PhD, Consultant for autistic and developmentally delayed children.
Wendy McCord, PhD, Psychotherapist.
Myrna Martin, MN, RCC, RCST, President of Kutenai Institute of Integral Therapies, Director of Nelson and Area Mental Health Services. Author: Birth and Attachment: how to totally support your baby from here on.
Michael Trout, MA, Licensed Clinical Professional Counselor specializing in Infant and Maternal Health.
Laura Uplinger
Giselle Whitwell, BA, MA, Board Certified Music Therapist, MT-BC.
Marilyn Milos, RN, Executive Director National Organization of Circumcision Information.
Judith Prager, PhD, Consultant, Verbal First Aid, Author: THE WORST IS OVER: What to Say When Every Moment Counts and Journey to Alternity, Transformational Healing through Stories and Metaphors.
This is an excellent video of a couple and their journey on deciding to have a home birth.
I wanted to post this video mainly to enforce that having a home birth is a safe option. Many women do not even know that they have a CHOICE on where they want to give birth. I also think a certain stigma surrounds home births and videos like these are steps toward more women having empowered and beautiful births.
Who is this beautiful lady? This is my new mentor! Her name is Debra Day and she is wonderful! We met in a hospital bathroom while we were both giving labor support to clients practically next door to each other. I had her and her daughter (who lives right down the street from me) over for tea last week to talk more about becoming a midwife and all of the cards fell into place.
I am now working with her two days per week. She works independently and with another midwife in town, Mary Barnett. Debra provides labor support, prenatal and postpartum care and attends home births.
I am still in awe that I am studying to become a Certified Professional Midwife to assist women in their home births!
Check out their websites and look forward to many more adventures on my new journey.
Childbirth Connection is a wonderful organization that is dedicated to improving maternity care. Here is what they have to say about informed consent & refusal:
Who is responsible for making informed maternity decisions?
When pregnant, giving birth, and after birth, women are responsible for making informed
decisions for themselves and on behalf of their babies. They have the legal right to give
"informed consent" or "informed refusal." Most women report a high degree of interest in
knowing what a proposed maternity intervention would involve, alternatives (including no
action), and potential benefits and harms of the different choices. Maternity professionals are responsible for providing scientifically supported care and for carrying out established legal processes for informed consent. Legally, "patient viewpoint standards" are in effect in many or most states. This means that clinicians must tell those in their care about the possible benefits and harms that a reasonable person in that situation would want to know to make an informed decision. Much time and effort are required to meet these legal and ethical standards for informed consent. Women need full and accurate information about labor and birth decision points and interventions well before labor to be able to pursue the care of their choice and make informed decisions around the time of birth.
Why is women's involvement in maternity care decisions important?
The decisions women make and the maternity care they receive can have lasting effects on
the health and well-being of their baby, themselves, and their family. It is always important to understand whether there is a clear, well-supported rationale for any procedure, drug, test or treatment that is being considered. In many care settings, some practices are used freely and even routinely, whether or not the mother or baby have shown a clear need. Although these practices may be of value to women or babies in certain situations, they may be unnecessary for most. They may be disruptive, be uncomfortable, cause more serious side effects, and lead to the use of other interventions. For these reasons, interventions should not be used routinely or unnecessarily.
What are important factors for informed maternity decision making?
For a woman, making informed decisions means learning and thinking about the best
information available on maternity care, and then deciding what's right for herself and her
baby. Key questions include:
• What are the possible choices?
• What does the best available research tell us about beneficial and harmful effects of each of these choices?
• What are her own needs and preferences and those of her partner (if she has one)?
• What choices are available and supported in her care setting and through her caregivers?
• If she wants an option that will not or may not be available, would she consider switching to a care setting or caregiver that does offer the preferred care? It is not possible to know ahead of time exactly what a woman's labor experience will be like. Being as informed as possible in advance can help women deal wisely with any new decisions that may arise at the time. It is important for a woman to learn about options, get answers to her questions and think about her preferences well before labor begins. It is also important that her partner or other support people are aware of her wishes and prepared to speak on her behalf if the need arises.
What does it mean to give "informed consent?"
Informed consent is not a form or a signature. It is a process between a woman and her
caregivers to help her decide what will and will not be done to her and her body. In the case of maternity care, informed consent also gives a woman the authority to decide about care that affects her baby. The purpose of informed consent is to respect her right to self-determination. It empowers her with the authority to decide what options are in her best interest and the best interest of her baby. Her rights to autonomy, to the truth (as best as it can be known at the time), and to keep her and her children safe and free of harm are very basic human rights.
What are women's legal rights to "Informed Consent" and "Informed Refusal?"
Whenever a medical procedure, drug, test, or other treatment is offered to a woman, she has the legal right to "informed consent." This means that her doctor, midwife or nurse is
responsible for explaining:
• why this type of care is being offered
• what it would involve
• the harms and benefits that are associated with this type of care
• alternatives to this care, and their respective harms and benefits, including the possibility of doing nothing and simply waiting longer.
A woman has a right to clear and full explanations about her care and answers to any and all
questions about her care. She also has the right to request and receive a copy of her medical
records and to get a second opinion. Then, by law, she has the right to decide whether to accept the care that is offered. If she disagrees with her caregiver and decides not to accept care that is offered, she has a right to this "informed refusal." And, even if she signed a form agreeing to a particular type of care, she has the right to change her mind. Although these are well-established legal rights, they have been challenged in a few recent cases. It can be difficult to carry out the informed consent process in busy health care settings. Yet, a woman and her caregiver should set aside the time to discuss these issues in advance whenever possible, and again when it is time to make a decision. It is crucial that women do not learn about procedures and options for the first time while in labor and facing important decisions. At that time, it may be too late to get all questions answered, weigh options, and pursue specific preferences.
What are some tips to help women explore these issues with their doctor or midwife?
Women can make a list of questions before each visit, and jot down the answers. They may
wish to bring their partner or someone else who is close along to listen to what is said. This is not the time to be shy; nothing is off limits.
While talking with caregivers, women can say:
• I don't understand.
• Please explain this to me.
• What could happen to me or my baby if I do that? Or if I don't?
• What are my other options?
• Please show me the research to support what you're recommending.
• Where can I get more information?
• I have some information I'd like to share with you.
• I'm uncomfortable with what you are recommending.
• I'm not ready to make a decision yet.
• I'm thinking about getting a second opinion.
Any question that a woman has is worth asking. When answers are not clear, women should
ask again until they understand.
What happens if a woman and her caregiver disagree?
Caregivers have rights, too. They have the right to agree or disagree to provide care that a
woman may request. For example, if a woman requests a cesarean and has no medical need
for this procedure, her caregiver has the right to refuse to do the surgery. Increasingly, fear of lawsuits is leading caregivers and hospitals to refuse to provide some types of care that would be a good and reasonable choice for many women, such as vaginal birth after cesarean (VBAC). Forcing healthy pregnant women with a previous cesarean to have major surgery against their wishes seriously compromises the quality of maternity care. Major liability system reforms are needed to improve this situation.
These issues speak to how important it is to have a good collaborative relationship that
includes open communication, mutual respect, and shared points of view. A woman who takes care to find a doctor or midwife who respects her needs, values and goals can help avoid conflict down the road.
My good friend and doula partner, Kate, has been watching The Princess Bride a lot with her kids lately. Being the birth junkie she is, Kate found a great line in this phenomenal movie that relates to birth...
“Rush a miracle man and you get rotten miracles.”
She was even able to amend my favorite line of the movie...
“I’m not a witch, I’m a midwife!”
Enjoy the clip, then rent the entire movie, and be ready for The Princess Bride to become your family’s favorite!
