I saw this blog entry today (it was posted a month ago) and thought that I must share it with you:
Skin to Skin Minutes After C/S in the OR… Speaking Up and Making it Happen
Go over there and read this and then take a look at her blog. This is a nurse who really understands how to make things happen and to get past all the objections and problems that we hear of that get in the way of women and their babies bonding and having a healthy start.
Check out the video on the blog - a great video on "Breast is Best" from Norway. WOW. I can't even imagine that happening here - breastfeeding during a c-section? Baby skin-to-skin on way back to a room? If a mother's not available, the father does skin-to-skin until the mother can be with the baby? Just listen to all the benefits of skin-to-skin. We in the US have a mighty backward system compared to Norway.
I'll be adding this blog to our blogroll.
Saturday, July 31, 2010
Quote of the Day
People will forget what you said. People will forget what you did. But people will never forget how you make them feel. -Bonnie Wasmund
Monday, July 26, 2010
Surrender
Women have long fought for their rights: to vote, to own property, to education, equal pay, rights to hold certain jobs, marital rights, legal rights and others. More recently, the fight is around abortion. The latter controversy is still in lively discussion, as anyone reading the news can attest to. Elections are won and lost on that issue alone, and emotions run high. Few are without a passionate opinion on the matter, and the battles are still being fought.
Yet - where is the outcry from women and men - and from both the vocal pro-choice and pro-life movements - about what happens after a woman becomes pregnant? Both sides agree that a woman can get pregnant and keep her baby, but then neither seems to care what happens next.
What often happens is that the pregnant woman is thrust into a world where she has high stakes (the health and very life of her and her baby) and lots of conflicting information. Her mother, aunties, friends, work buddies and internet support groups weigh in with experiences and stories which either support her, pressure her or scare her, her partner suddenly urges her to be careful and will "protect" her, the natural birth crowd says how wonderful it is to have unmedicated labor or how important it is to do things the natural way implying all else will cause harm, and her doctor is usually friendly, caring and offers medical opinions based on experience, research, policy and litigation concerns.
Many women lean toward what their doctor says, which might make sense until they realize that it may or may not be something that is supported by the medical literature, might be based more on facility policy, insurance underwriters, or lawsuit exposure than on that particular woman's health or even on whether that doctor personally supports that option. Many practices today say they are low-intervention and don't do "unnecessary procedures," but how do you know whether that scheduled c-section for a "big baby" is unnecessary or necessary?
So how does a new family sort this all out? Underneath all of this is the underlying message: do what you're told or anything that does go wrong will be your fault. In the end, many women surrender and simply follow along - and deal with the consequences later. It's ironic that this happens right before she becomes fully responsible for her new baby. "Give up and follow along, we know best." How exactly does that help create an empowered, confident, strong parent?
Think about the dizzying array of options that a birthing woman is unable to make. Perhaps the choice is simply denied due to policy (such as VBAC/vaginal birth after cesarean, water birth in a hospital or even something like eating or drinking during labor). Maybe there is strong pressure against it (such as homebirth, which requires strong commitment just to choose it and put up with all of the nay-saying - look at this homebirth post for some of the hot controversy.) Or, maybe a doctor doesn't allow the choice and once she finds out, she'd have to switch doctors to get what she wants, making it costly, inconvenient or downright impossible.
It starts right after that pregnancy test turns positive. Insurance companies get involved and decide what is and isn't covered. Maybe a woman finds insurance or Medicaid will cover an obstetrician at a particular hospital but not another one, or a midwife in the local university hospital but not a midwife in a birthing center - so that decision is made for her. Even the decision whether to receive prenatal care can be made based on things such as finances. The further a woman progresses in her pregnancy, more and more choices begin to disappear: Can I go into labor naturally? Can I avoid an IV? What do I do if my breech baby doesn't turn? How about electronic fetal monitoring? How about mobility during labor, or something as simple as the ability to eat or drink? How am I allowed to push this baby out? What am I allowed to do postpartum?
Different caregivers enable women to have more choice, or less choice, according to their own philosophy, experience, and policies. Yet when it's averaged out, over a third of normal, healthy women and babies in this country require major abdominal surgery to have their babies! There is something deeply wrong here.
The other day, the New York Times ran an article that has been making it around the birth circles: New Guidelines Seek to Reduce Repeat Caesareans. C-sections are a hot topic for sure. How is it that the medical literature says that vaginal birth after cesarean is safe in many circumstances (even with twins!), medical guidelines permit it and still a woman's right to choose it is in many cases outright denied?
It is followed by things such as this:
and this:
When it's liability - the legal system, not the medical system - that starts deciding what can happen to you and your baby over your objections (and if you don't believe it, read this about coerced and forced c-sections), then there's something vastly wrong. Women aren't stupid. Women make choices for good reasons, and they and their babies, not the doctors or lawyers, live with the consequences. I have to believe (want to believe) that the care providers don't like this either. It even isn't good from a cost-saving perspective - many of the unnecessary procedures add thousands to medical bills. If decisions are made to protect from lawsuits or for the financial benefit of hospitals and not for health reasons, then I really can't see this situation is tolerable for anyone but malpractice attorneys.
Women deserve the right to have a safe birth, free to respond to their bodies without interference, free from humiliation, shame and punishment, and to make informed choices for themselves and their babies.
I hope that more and more people see that reproductive rights are broader than simply contraception and abortion. Women must insist on being fully informed and then take responsibility for their decisions (and not then sue a doctor for not having forbidden the option) before anything is going to change. It is also going to require a change in the culture of fear around birth.
Personally, I am hoping that this is the generation of women that will take this on. What do you all think?
Yet - where is the outcry from women and men - and from both the vocal pro-choice and pro-life movements - about what happens after a woman becomes pregnant? Both sides agree that a woman can get pregnant and keep her baby, but then neither seems to care what happens next.
What often happens is that the pregnant woman is thrust into a world where she has high stakes (the health and very life of her and her baby) and lots of conflicting information. Her mother, aunties, friends, work buddies and internet support groups weigh in with experiences and stories which either support her, pressure her or scare her, her partner suddenly urges her to be careful and will "protect" her, the natural birth crowd says how wonderful it is to have unmedicated labor or how important it is to do things the natural way implying all else will cause harm, and her doctor is usually friendly, caring and offers medical opinions based on experience, research, policy and litigation concerns.
Many women lean toward what their doctor says, which might make sense until they realize that it may or may not be something that is supported by the medical literature, might be based more on facility policy, insurance underwriters, or lawsuit exposure than on that particular woman's health or even on whether that doctor personally supports that option. Many practices today say they are low-intervention and don't do "unnecessary procedures," but how do you know whether that scheduled c-section for a "big baby" is unnecessary or necessary?
So how does a new family sort this all out? Underneath all of this is the underlying message: do what you're told or anything that does go wrong will be your fault. In the end, many women surrender and simply follow along - and deal with the consequences later. It's ironic that this happens right before she becomes fully responsible for her new baby. "Give up and follow along, we know best." How exactly does that help create an empowered, confident, strong parent?
Think about the dizzying array of options that a birthing woman is unable to make. Perhaps the choice is simply denied due to policy (such as VBAC/vaginal birth after cesarean, water birth in a hospital or even something like eating or drinking during labor). Maybe there is strong pressure against it (such as homebirth, which requires strong commitment just to choose it and put up with all of the nay-saying - look at this homebirth post for some of the hot controversy.) Or, maybe a doctor doesn't allow the choice and once she finds out, she'd have to switch doctors to get what she wants, making it costly, inconvenient or downright impossible.
It starts right after that pregnancy test turns positive. Insurance companies get involved and decide what is and isn't covered. Maybe a woman finds insurance or Medicaid will cover an obstetrician at a particular hospital but not another one, or a midwife in the local university hospital but not a midwife in a birthing center - so that decision is made for her. Even the decision whether to receive prenatal care can be made based on things such as finances. The further a woman progresses in her pregnancy, more and more choices begin to disappear: Can I go into labor naturally? Can I avoid an IV? What do I do if my breech baby doesn't turn? How about electronic fetal monitoring? How about mobility during labor, or something as simple as the ability to eat or drink? How am I allowed to push this baby out? What am I allowed to do postpartum?
Different caregivers enable women to have more choice, or less choice, according to their own philosophy, experience, and policies. Yet when it's averaged out, over a third of normal, healthy women and babies in this country require major abdominal surgery to have their babies! There is something deeply wrong here.
The other day, the New York Times ran an article that has been making it around the birth circles: New Guidelines Seek to Reduce Repeat Caesareans. C-sections are a hot topic for sure. How is it that the medical literature says that vaginal birth after cesarean is safe in many circumstances (even with twins!), medical guidelines permit it and still a woman's right to choose it is in many cases outright denied?
The panel reaffirmed that vaginal birth was safe for many women with past Caesareans, and urged the obstetricians’ group to reassess its guidelines.
It is followed by things such as this:
Dr. Sandra B. Reed, an obstetrician at Archbold Memorial Hospital in Thomasville, Ga., which does not offer trials of labor after Caesarean, said, “I do not think this bulletin is strong enough to change the current policy in our facility.”
and this:
Dr. Waldman said he still hoped the new guidelines would encourage more hospitals to allow trials of labor after Caesarean, but, he added, “the big issue is liability.”
When it's liability - the legal system, not the medical system - that starts deciding what can happen to you and your baby over your objections (and if you don't believe it, read this about coerced and forced c-sections), then there's something vastly wrong. Women aren't stupid. Women make choices for good reasons, and they and their babies, not the doctors or lawyers, live with the consequences. I have to believe (want to believe) that the care providers don't like this either. It even isn't good from a cost-saving perspective - many of the unnecessary procedures add thousands to medical bills. If decisions are made to protect from lawsuits or for the financial benefit of hospitals and not for health reasons, then I really can't see this situation is tolerable for anyone but malpractice attorneys.
Women deserve the right to have a safe birth, free to respond to their bodies without interference, free from humiliation, shame and punishment, and to make informed choices for themselves and their babies.
I hope that more and more people see that reproductive rights are broader than simply contraception and abortion. Women must insist on being fully informed and then take responsibility for their decisions (and not then sue a doctor for not having forbidden the option) before anything is going to change. It is also going to require a change in the culture of fear around birth.
Personally, I am hoping that this is the generation of women that will take this on. What do you all think?
Monday, July 12, 2010
Visit to Washington, DC
Open Arms Executive Director Sheila Capestany traveled to Washington DC in June to participate in a meeting of Administration for Children and Families (ACF), for their Early Learning Communities Initiative. She was joined by John Bancroft from the Puget Sound Educational Service District and together represented the work currently underway in our Thrive by Five project community, White Center. Sheila spoke as a community partner in the White Center Early Learning Initiative (WCELI) on a panel discussion to pull out best practices across the country.
Just for a little background, ACF is developing a place-based framework drawn from successful community models of comprehensive and continuous early childhood services. The development of this framework is part of a project called The Early Learning Communities Initiative, which is designed to encourage dialogue between and within communities, and to spur local action. The outcome goals include healthy pregnancies and births, toddlers who are thriving, and young children who are prepared for success in school and well-being of families. Open Arms and WCELI fit perfectly into this and have a model which is working for many families here in the Puget Sound area.
Much of the initial discussion on the panel centered around Geoffrey Canada's place-based initiative in Harlem through the Harlem Children's Zone. This is a very interesting initiative for those of you who might not be familiar with it, and it's been very successful and held as a model. Check them out.
However, one of the most interesting things about the discussion was that the topic of doulas came up early - and continued to be the topic of conversation on the panel for quite a while. Why? Because it is becoming clear to many - and this is a new, radical idea in early learning circles - that birth work is foundational to early learning. Very, very few early learning initiatives in the country include services for families during pregnancy and through birth and most (if not all) of those that do, address only first-time parents. Open Arms' work in the White Center Early Learning Initiative was of great interest to many of the participating groups because we do serve our clients during the perinatal time and do not restrict our services to first-time parents. In fact, we do not place any limit at all on the number of children a woman might have had before receiving our services.
Birth is the foundational building block for a child. It is also a potentially transformative time in the lives of women and families - and we at Open Arms have found that it's true not only of a first birth in a family, but with subsequent births as well. Many participants were interested in this because the commonly held belief is that families are not open to services after a first birth. We have not found it to be limited in that way. Each birth is an opportunity for a family to connect, change, grow and achieve greater health and contribute to an enriched learning environment for all of the children in the family. Families must be healthy and empowered in order to take advantage of other policies and services later on. Otherwise, much of the effort put into these services is lost because families are not in a position to take full advantage of them.
Birth is the only time in a person's life when a person is admitted to the hospital healthy. There's nothing wrong with a woman during labor - she's just pregnant, and everything is normal. Yet our medical model of birth does not mirror that. Certainly medical events can occur during birth and hospitals and medical interventions are sometimes necessary, but some of the countries with lowest c-section and maternal - infant mortality rates are those with large numbers of women birthing out of the hospital in either birth centers or at home, and served by midwives rather than obstetricians. (Note it is also true that societies without birth support whatsoever have some of the highest maternal and infant mortality rates, so this obviously is a statement about planning and good support, not the absence of health care.) Many of the families we serve are from cultures where this medical model of birth is not familiar. When doulas are able to be cultural bridges between clients and the American way of birth, bias and misunderstanding can be minimized.
Open Arms is looking forward to more national discussion on issues around the importance of perinatal support to early learning, and we're proud to have a program which is being looked at as a model for others across the country.
Just for a little background, ACF is developing a place-based framework drawn from successful community models of comprehensive and continuous early childhood services. The development of this framework is part of a project called The Early Learning Communities Initiative, which is designed to encourage dialogue between and within communities, and to spur local action. The outcome goals include healthy pregnancies and births, toddlers who are thriving, and young children who are prepared for success in school and well-being of families. Open Arms and WCELI fit perfectly into this and have a model which is working for many families here in the Puget Sound area.
Much of the initial discussion on the panel centered around Geoffrey Canada's place-based initiative in Harlem through the Harlem Children's Zone. This is a very interesting initiative for those of you who might not be familiar with it, and it's been very successful and held as a model. Check them out.
However, one of the most interesting things about the discussion was that the topic of doulas came up early - and continued to be the topic of conversation on the panel for quite a while. Why? Because it is becoming clear to many - and this is a new, radical idea in early learning circles - that birth work is foundational to early learning. Very, very few early learning initiatives in the country include services for families during pregnancy and through birth and most (if not all) of those that do, address only first-time parents. Open Arms' work in the White Center Early Learning Initiative was of great interest to many of the participating groups because we do serve our clients during the perinatal time and do not restrict our services to first-time parents. In fact, we do not place any limit at all on the number of children a woman might have had before receiving our services.
Birth is the foundational building block for a child. It is also a potentially transformative time in the lives of women and families - and we at Open Arms have found that it's true not only of a first birth in a family, but with subsequent births as well. Many participants were interested in this because the commonly held belief is that families are not open to services after a first birth. We have not found it to be limited in that way. Each birth is an opportunity for a family to connect, change, grow and achieve greater health and contribute to an enriched learning environment for all of the children in the family. Families must be healthy and empowered in order to take advantage of other policies and services later on. Otherwise, much of the effort put into these services is lost because families are not in a position to take full advantage of them.
Birth is the only time in a person's life when a person is admitted to the hospital healthy. There's nothing wrong with a woman during labor - she's just pregnant, and everything is normal. Yet our medical model of birth does not mirror that. Certainly medical events can occur during birth and hospitals and medical interventions are sometimes necessary, but some of the countries with lowest c-section and maternal - infant mortality rates are those with large numbers of women birthing out of the hospital in either birth centers or at home, and served by midwives rather than obstetricians. (Note it is also true that societies without birth support whatsoever have some of the highest maternal and infant mortality rates, so this obviously is a statement about planning and good support, not the absence of health care.) Many of the families we serve are from cultures where this medical model of birth is not familiar. When doulas are able to be cultural bridges between clients and the American way of birth, bias and misunderstanding can be minimized.
Open Arms is looking forward to more national discussion on issues around the importance of perinatal support to early learning, and we're proud to have a program which is being looked at as a model for others across the country.
Thursday, July 1, 2010
KUOW Morning Edition: Story of Natural Birth
Thanks to board member Lisa Chin for pointing out this great piece by KUOW this morning:
There Will Always Be Three Now: A Story Of Natural Birth
You can listen online at their website.
The program is about choices in childbirth - in particular this is about the 1% who choose a "natural childbirth". I chuckled a bit because many in the birth field know "natural childbirth" can mean different things to different people and as such, is a very confusing, and sometimes loaded, term.
To some, natural childbirth simply means having a vaginal birth, regardless of the interventions - just not a cesarean birth. To others, natural childbirth means birth without pain medications, and sometimes without any interventions at all. This program, however, seems to refer to natural childbirth as out-of-hospital birth, including home birth and birth center birth, which is why they say only 1% of families choose it. A listener commented on the show about obstetric or nurse-midwife practices in-hospital, which have a high percentage (50% or more) of birthing moms who deliver without intervention or medication, but still in the hospital setting.
One of the people interviewed in this piece is Penny Simkin, a doula and childbirth educator here in Seattle and one of the founding board members of Open Arms. Penny provides some fabulous information about doulas in this program as well as reiterating some of the statistics about c-sections - the shocking rising rate of c-sections, for example - up 50% since 1996! She says this is due to the inflated sense of dangers of vaginal birth and unrealistic appraisal on the part of parents of dangers of cesarean. She also talks about the variation in the "cesarean epidemic" across the country, where different states and areas are apt to have widely differing c-section rates. For example, you're far more likely to get c-section in New Jersey than Utah. One of the reasons? Malpractice fear. Another reason for the rise was breech birth. Penny explains there was one very widely study finding bad outcomes in breech births that since has been completely discredited, but now 7-8 years later, medical schools are no longer teaching new physicians how to vaginally deliver a breech baby. So, with no training, few doctors can do them now.
All in all, this was a lovely program. For those of you doulas listening in, it's so nice to hear a peaceful birth on a radio show - you'll appreciate it. My husband rolls his eyes every time there's a birth on television. All that drama and huffing and puffing - he knows I'll make some sort of comment about that initial contraction and boom! she's in labor and boom! out pops the baby with screaming and hollering. It's nice to hear a birth happen in calm and peace.
On another note, this program has a caller that talked about the hard fight women had to gain their birthing choices - in her case, admitting the father to the birthing room. That work isn't done. Have you all seen the recent controversy about the Ohio medical practice that bans doulas? It's pretty interesting - read the comments on that blog. Those of us in Seattle are used to having quite a few more birth choices than in other areas of the country, or even other areas of the state. The fight for birth choices isn't over.
There Will Always Be Three Now: A Story Of Natural Birth
You can listen online at their website.
When it comes to giving birth in America, there are choices. What doctor? What hospital? What medication? What kind of birth do you want? Less than 1 percent of couples choose a natural birth, a birth with no drugs and little to no intervention. Producer Katy Sewall brings an intimate look at one couple's decision to go that way. What is your birth story? How did you make the decisions you did? Are you satisfied with the choices that you made, or that were made for you? Call 1.800.289.KUOW (5869).
Special thanks to the midwives at the Puget Sound Birth Center and at Group Health Seattle.
The program is about choices in childbirth - in particular this is about the 1% who choose a "natural childbirth". I chuckled a bit because many in the birth field know "natural childbirth" can mean different things to different people and as such, is a very confusing, and sometimes loaded, term.
To some, natural childbirth simply means having a vaginal birth, regardless of the interventions - just not a cesarean birth. To others, natural childbirth means birth without pain medications, and sometimes without any interventions at all. This program, however, seems to refer to natural childbirth as out-of-hospital birth, including home birth and birth center birth, which is why they say only 1% of families choose it. A listener commented on the show about obstetric or nurse-midwife practices in-hospital, which have a high percentage (50% or more) of birthing moms who deliver without intervention or medication, but still in the hospital setting.
One of the people interviewed in this piece is Penny Simkin, a doula and childbirth educator here in Seattle and one of the founding board members of Open Arms. Penny provides some fabulous information about doulas in this program as well as reiterating some of the statistics about c-sections - the shocking rising rate of c-sections, for example - up 50% since 1996! She says this is due to the inflated sense of dangers of vaginal birth and unrealistic appraisal on the part of parents of dangers of cesarean. She also talks about the variation in the "cesarean epidemic" across the country, where different states and areas are apt to have widely differing c-section rates. For example, you're far more likely to get c-section in New Jersey than Utah. One of the reasons? Malpractice fear. Another reason for the rise was breech birth. Penny explains there was one very widely study finding bad outcomes in breech births that since has been completely discredited, but now 7-8 years later, medical schools are no longer teaching new physicians how to vaginally deliver a breech baby. So, with no training, few doctors can do them now.
All in all, this was a lovely program. For those of you doulas listening in, it's so nice to hear a peaceful birth on a radio show - you'll appreciate it. My husband rolls his eyes every time there's a birth on television. All that drama and huffing and puffing - he knows I'll make some sort of comment about that initial contraction and boom! she's in labor and boom! out pops the baby with screaming and hollering. It's nice to hear a birth happen in calm and peace.
On another note, this program has a caller that talked about the hard fight women had to gain their birthing choices - in her case, admitting the father to the birthing room. That work isn't done. Have you all seen the recent controversy about the Ohio medical practice that bans doulas? It's pretty interesting - read the comments on that blog. Those of us in Seattle are used to having quite a few more birth choices than in other areas of the country, or even other areas of the state. The fight for birth choices isn't over.
Wednesday, June 30, 2010
Building a Community-Based Doula Program in Your Area
Occasionally, people visit our blog who have read about the effectiveness of community-based doula models and are researching how to create a program in their area.
If this describes you, please contact us for information or just to talk about what you're considering. Open Arms has had a community-based doula program for years now and have learned a few things along the way, especially as we've built our Outreach Doula program with the White Center Early Learning Initiative, and we are happy to share that expertise with you to help your program get off the ground.
The Open Arms program is based on the Chicago HealthConnect One community-based doula model. To follow that model, there are several key steps that a program must adhere to:
Contact us by email or phone at 206-723-6868 and we'd be happy to talk with you.
If this describes you, please contact us for information or just to talk about what you're considering. Open Arms has had a community-based doula program for years now and have learned a few things along the way, especially as we've built our Outreach Doula program with the White Center Early Learning Initiative, and we are happy to share that expertise with you to help your program get off the ground.
The Open Arms program is based on the Chicago HealthConnect One community-based doula model. To follow that model, there are several key steps that a program must adhere to:
- Employ women who are trusted members of the target community
- Extend and intensify the role of doula with families from early pregnancy through the first months postpartum.
- Collaborate with community stakeholders/institutions and use a diverse team approach
- Facilitate experiential learning using popular education techniques and the HealthConnect One training curriculum
- Value the doulas' work with salary, supervision and support
Contact us by email or phone at 206-723-6868 and we'd be happy to talk with you.
Wednesday, June 23, 2010
Open Arms featured today on KONG TV's Learning for Life series
Today's Learning for Life show on KONG featured an interview with Open Arms Executive Director Sheila Capestany, speaking about our Outreach Doula program.
Here's the description from the website:
Here's the description from the website:
Giving birth and raising children should be among the most natural things in life.
But for women going through the process without the support of family and friends, the experience can be intimidating and lonely. This is especially true for women who come from a different country and culture and speak a different language.
The Outreach Doula program, started by Open Arms Perinatal Services last year as part of the larger White Center Early Learning Initiative, supports both immigrant Latina women and Somali refugees in their own languages by women of and from their own communities.
Outreach Doulas work with families from early pregnancy through a child's second birthday.
Sheila Capestany, executive director of Open Arms, talks about the Outreach Doula program and the difference it's making in the community
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