Read and Feed (back)

Here's the plan for those who have volunteered to be in the reading group-

1. Around Christmas vacation time, I will send out via email, the confidentiality agreements to sign.
2. When they are returned, I will email 3 consecutive book chapters to each volunteer reader along with the evaluation tool.
3. Readers will have 2-3 weeks to return the evaluations with feedback.

Also in the works:

Yesterday I met with the midwives of Sage Femme- a local birth center. I have been talking with them about possibly doing some births there (as an L&D nurse). Ever since I visited there I can't stop thinking that I'd like to be involved with it in some way. I've been on a birth fast for a year now (since Josiah's birth) and I think I may be ready to go back and do a few births- maybe. I will be on call for this month and the next, try a few births, and see how it goes. I promised myself I would not sit bedside at birth again if it meant hurting women. Of course I expect this to be different, but I'm still nervous. I would love to update and sharpen my L&D skills and it would be the first place I've ever worked where the emphasis is on client care and not monitor-sitting. I need to see with my own eyes what birthcenter birth is like, however my time is so limited. I'll try a couple of births, see what its like, then decide whether or not to take it on as a parttime job. If I don't find that I care to do L&D work, I might switch to marketing and promotions. Either way, I think it will be a grand opportunity.

Practice Makes Perfect

I was watching The Practice last night. I watched it specifically because there were going to be three births on it (okay, I watch it anyway). I was pleasantly surprised. The show actually had 3 unmedicated births (I hesitate to use the word 'natural' since the situations were so surreal- for example, crazed gun-woman birthing in the midst of committing a felony). One was even a waterbirth. None of the 3 births took place in a hospital. It really made me think about the premise of this show- not the relationships among the characters- they're all neurotic- but where the hell is this practice? I don't mean the city, I mean the theoretical framework. Their practice appeared to be set up to do births in their office. I have never heard of such a thing- have any of you? I know their office is not inside a hospital- I don't know if they are supposed to be near a hospital or not, but they have rooms with beds inside their offices. Did I miss some important element of the plot about where they are located, because they seem to do things in their offices they I didn't think docs did in offices. Another thing- I love that their practice is multi-specialty. Wow- is this really happening somewhere? I think its a great idea. Who needs a practice with 13 OBs that all have the same philosophy? They just sort of cross-refer on the spot (although I can see where this can become a problem, even compromise confidentiality). Anyway, enough marveling, back to the births:
One waterbirth with a woman whose husband had recently died (she sorta relives her loss during labor). The pretty but repressed doctor complains that waterbirths are icky, but in the heat of the moment, she jumps into the pool fully dressed to give physical support to the distressed mother ( I was really proud of that character for that). I was also really proud of the birthing mom who was very authoritative and took control of her birth. She was actually directing everything (until she lost it during transition, calling for her dead husband)
One office birth for a woman having baby number 4- she is expecting a long awaited girl but instead gets another boy- and she's not pleased. The male nurse actually catches the baby when she labors very quickly and the doctors duck out of the room to develop secondary plots.
One young woman births while robbing a convenience store- and oh get this- the doc doesn't just happen to walk into the convenience store, he's answering a house call- a house call! Has anyone out there every had a doc do a housecall??? (Actually I have, but its been more than 10 years ago)
This show really had me thinking about how healthcare is delivered. (It also made me think about how friends shouldn't be having sex with one another- but that's another blog entry- in another blog!) I've complained for a long time about the lack of innovation in healthcare delivery, so imagine my surprise at getting inspiration from a somewhat lascivious TV show. Oh well, I'll take my inspiration wherever I can find it.
I actually caught myself daydreaming about turning one of my training rooms in my office into a birth space! (Let's see, shove those manikins to one side, suspend a rope from the ceiling, throw around some beanbags, install surround sound and voila!) I'd call it my 'birth observatory' since I'd employ a hands off approach. Just stop by, hang out, and birth a baby.
Birth can be so much more simplified. I always thought hospital birth was such a HUGE production. Such a simple process taken to an extreme of regimentation and regulation. I'd like to lead a movement to 'declutter' birth. I'll have t-shirts that say BIRTH SLOW : ) or 'Squat and Deliver' and go on cable access shows to demonstrate a step by step process for braiding your own birth rope or write a pamphlet on 101 uses for a placenta. Women everywhere will demand 'Uncluttered Births' that are void of hidden trays and cabinets of medicinals, or hordes of staff that appear at precisely the moment your perineum starts to bulge. In 'Uncluts' (as they will come to be known) there will be no hierarchy and everyone will be called by their first name- the only one who 'delivers' the baby is the mom. The birth plan will be the supreme document, not consent forms. In fact, the caregivers will have to sign the mother's consent form to be present at her birth.
See what one little episode of a TV show has started. I'll be dreaming this stuff all night...

Reader Love

Beloved Readers,
Thank you for your outpouring of support for the upcoming book. I love that so many of you have emailed or left blog messages stating your desire to be a part of the reading group. However- I have decided I will not let anyone who already knows me be in the group. Sorry, I just think I'd get more objective feedback from those who haven't actually met me yet. I might be wrong about this, but I'm going with my gut on this one. However if my local friends could send me names of potential couples for my homebirth workshop in January, I'd be very grateful- I only have one couple so far. Fishing for speaking engagements is going very well- I have applied to several national and regional conferences this week. I'll post them on my website as I get confirmation. My goal is one speaking gig a month. I'd also appreciate any heads up on any conferences any of you might know about that might be appropriate for me. I found a website called Lact Speak that lists lactation speakers for hire. This was such a cool website, and so user friendly. I plan to sign up for it. I looked for a similar website for birth speakers and didn't find one. The Lact Speak site was so simple, I toyed with the idea of starting one myself. Birth Speak anyone? Your warm encouragement and well wishes spur me on- I'm indebted to you all.

Mothering Magazine

I've been meaning to write this post for a while now. While at the LLL conference a couple of weeks ago, I picked up a complementary copy of this month's Mothering Magazine. Folks, this is an EXCELLENT edition. I read it from cover to cover and loved every story. The features included, "Cesarean Birth in a Culture of Fear," "Homebirth in Holland," and "The Legacy of Black Midwives," and also a story on the benefits of extended breastfeeding! I loved reading this issue.

In writing about cesareans, Wendy Ponte, may not know it, but she has the fine makings of a book outline here. Her article was so well written, thorough, and knowledgeable. She quotes all the right folks and draws all the right conclusions and makes a very rational argument for lowering the rate of cesareans, while at the same time showing why they may continue to go up. Pregnant women should be reading articles like this one in the doc's or midwife's waiting room.

Birth in Holland took me back to The Netherlands. This American mama, married to a Dutchman and living in the city of Utrecht, writes about her homebirth there and how vivid the contrast is when birth is truly seen as normal. Part of my enjoyment of this story, is the teller's view of Dutch culture juxtoposed to American. She also writes of Utrecht, a city I walked the streets of when I visited The Netherlands several years ago while attending a Midwifery Today conference. Its ancient cobblestone streets still beckon me back. I loved how she writes that no one ever gave her a pregnancy test. When she presented herself as pregnant- eveyone just believed her! From there the story flows forward with little tidbits of delight all along the way... especially as she makes comparisons with her first birth in America (you know, that place with the best healthcare in the world...)

Black Midwives is about Miss Shafia Monroe, and her organization (The International Center of Traditional Childbearing). I've had the pleasure of meeting her and presenting at her annual conference a couple of years ago. She is a true pioneer and she was in fact, honored at this year's MANA conference. She was not in attendance due to a family emergency, but her husband and several of her staff were there. The article was a nice overview of the organization's and Shafia's accomplishments.

So if you have access, you might want to pick up a copy. When you finish reading it, perhaps you can just happen to leave it in a OB waiting room.

Book Update

Dear Readers,
I'm happy to report good progress on the book and have two requests of you:
1) I'm looking to recruit a focus group to pre-review the finished manuscript and give gut-wrentchingly honest feedback. (I will most likely move ahead with self-publishing- I have an editor, I'm looking for feedback on content.) You do not have to be in my physical vicinity. I will email it out. You have to commit to reading it and giving your feedback. You'll also have to be willing to sign a confidentiality agreement. Just respond to this post if you are interested. The manuscripts will go out after Christmas, and the focus groups (facilitated by someone other than me) will be held (via email/yahoo group) in mid January. I'm looking for about 20-25 folks regionally, nationally, and internationally.
2) I'm looking for homebirth couples due next Spring and Summer to test my workshops on. These folks DO need to be in the Greater Kansas City vicinity or be willing to travel to my locale (I have access to very low cost accommodations). The weekend long workshop will be free and held in January (date tba). I will take 4-6 couples. Using my book as the text, the workshop will prepare them for a homebirth. This test workshop will require extensive feedback as well. I also plan a test workshop for doulas and childbirth educators on homebirth preparation, but I have enough local folks to use for that one.
Thanks everyone for your feedback and responsiveness. I know I've been like a cat hiding her kittens about the book, but I've felt an intense need to write in isolation. I'm just about ready to come out of hiding.

Missouri Update or Show Me the Midwives

I thought I'd send along an update for those who may not have heard what became of the Missouri Bill to legalize midwifery. The short version is this (taken from the Friends of Missouri Midwives newsletter that just landed in my mail.) The bill was shot down before it took affect at the end of August. A bunch of medical organizations (including ACOG) sued to have the addition to the insurance bill ruled as unconstitutional. They won. Now there is an appeal to the Missouri Supreme Court underway to overturn the ruling. Its an exciting saga... stay tuned.

Read the article in its entirety at www.friendsofmomidwives.org

Ready for a controversial question? (Of course you are, why else would you be reading this blog?)

Will making midwives legal really fix what ails us as a state? I just followed the link Dawn sent for a local mother's online forum. The discussion was on the best place in town to give birth, and to hear all the women chime in about their wonderful hospital births gives me pause. Women don't know what a good birth is. Having legal midwives may increase options, but what if those midwives are forced to deliver up the same old, same old that women get now. Lots of folks assume legalization is a good thing, and I suppose in some ways it is. But what drove me from the ranks of aspiring midwife was looking around and seeing midwives who were doing the very things they became midwives not to do. Look, I'm not knocking midwives, I love midwives. I just believe wholeheartedly that we live in a culture that is devoted to making midwives into mini-docs. Our culture does not even begin to appreciate the solutions that midwives have to offer. They want to police and legislate them into servants of the status quo. I want REAL options. I want NEW ideas. I want birth on MY OWN terms. The best conversations I've heard this year have been about unassisted birth. I want a revolution. I want transformation. What will it take to see real change?

Conference Recap

I have been remiss in that I have not written about the three conferences I recently attended, so here is my recap of each:

MANA 2007, Clearwater Beach Florida

I have to say that I did and I didn't attend this conference. Though I was a registered attendant, I did not attend any other sessions. I wanted to, I was just too focused on my own presentation, and technical difficulties kept me from getting beyond my own concerns. I even missed a plenary session that was the buzz of the conference. The topic was racism among midwives and apparently there was some pretty cathartic conversation that went on- but I missed it. My roomates (3 midwife students from the same Florida school) and I had very long and heated discussions into the night on this topic which was in its own way interesting if not productive. My roomates included a Haitian-American (she spoke bitterly of the racism she experienced from African-Americans), an international student from Switzerland (she came to the US for homebirth experience!!!!), and a Caucasian American, and of course me, a Midwestern. middle-aged, black woman. On the topic of racism in midwifery, I can only say that in my corner of the world, I was enthusiastically welcomed and encouraged on my midwifery journey. There were some who expressed disappointment when I changed courses. To this day, there are no midwives of color in my community (or even in my state to my knowledge). Midwives of color remain as rare as hen's teeth.

My session turned out better than I could have hoped. We had a rousing discussion on the ACOG (American College of Obstetrics and Gynecology) statement on homebirth. Oddly, it can no longer be found on their website. I talked about when this statement was published last October, it so enraged me, that I wrote this session and proposed it to MANA. Since the statement is a year old now, we talked about its long term impact to the politics of birth. We also looked at organizational responses to the statement when it came out- that I pre-printed for my audience. We then brainstormed on our own responses to the statement, both as individuals and within our own organizations and communities. This was where things got good. We sited as problems, a lack of scientific evidence that out of hospital birth was unsafe, a lack of scientific evidence that hospital birth was safe, how out of hospital birth collaboration among caregivers was discouraged, how the statement denied an inclusion of all stakeholders, and the socio-economic impact of the statement. We sited as solutions models for clinician collaboration, grass roots action, policy and political change, advocacy models, and pushing for change within the insurance industry. There was also talk of starting an organization or organizations just to address the problems this statement has created or perpetuated. I was so proud of the nurses and midwives in my session. For sure I was preaching to the choir, there were no dissenting voices- but that's why I gave this talk at MANA to fire up the troops. I remain in dialog with a couple of the midwives about starting an organization or two. I see a need for an advocacy organization devoted to out of hospital birth in order to provide resources to women seeking options and create solidarity for out of hospital providers.

KC Doula Conference, Kansas City KS

This conference was a real treat- again I didn't really attend any of it, but my part, but what I did attend was excellent. I participated in a panel the ran the entire morning. The information was so good and of such high quality. The panel included experts speaking on the birth experiences of: deaf women, Latino women, African-American women (that was me), Somali women, and Korean/Chinese women. Each panel speaker gave an intriguing look into the birth customs of her culture (or the culture she served). My favorite was the speaker on deaf culture. I had never thought about birth from the perspective of someone who cannot hear before. The doulas here always put on a good conference and this year's was no exception. The CNMs put on an annual conference as well, but it tends to get more and more medicalized. Perhaps I'll throw my hat into the ring for next year and propose a session on homebirth and scandalize the community!

La Leche League, Missouri Conference- Columbia MO

This was by far the best of the three conferences for me. For one, I didn't present, that helps. I did have a booth pedaling my speaking wares, but I was rarely at it. I mostly perused the workshops and for the most part liked what I heard. I definitely need to submit a proposal for this conference. There was lots of talk around the edges about the impact of birth on breastfeeding, but for me this needs to be a direct hit- successful breastfeeding begins in labor. My biggest treat was hearing Dia Micheals and Diane Wiessinger. These ladies are real pros when it comes to lactation presentations and they did not disappoint. Diane was particularly inspiring on her talk about the importance of mother to mother support groups. Dia was intriguing when she talked about lactation models of other mammals (lactation = childhood, when animals stop nursing its because their young a ready to go out on their own- very interesting). My favorite session was by a local hospital chaplain on the grieving process and supporting families during an infant loss. This session was sooo good and practical. Childbearing loss has long been a clinical interest of mine and I learned lots of new things during this session.

So that's my recap. In the next day or two, I'll have pictures to post. Its been a busy Fall and now I need to get started planning speaking engagements for next year.