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Rights For Homebirth - May 2013 Update

Posted on May 17, 2013 at 8:56 AM Comments comments (98)

The final Midwifery Scope of Practice Meeting was held on Wednesday, May 15, 2013.  It is now time for the families of Arizona, and anyone else who believes that compassionate care is a human right’s issue for the mother and the baby to take a stand.

You can click on the links below to read a copy of the current draft rules and to see Wednesday’s proceedings:
Most Recent Draft: http://1.usa.gov/YZw4Xt
Most Recent Meeting: http://bit.ly/104ZtKT

Here is my statement on the Arizona Department of Health Services Website:
In addition to agreeing wholeheartedly with Allyson Fernstrom's statement below, I want to direct the committee to THIS brief article with references if they want to dig deeper:
As the article and study succinctly show, "FTP" and "CPD" in the 21st century are mostly iatrogenic.  "Watchful waiting" IS the midwifery model of care in the hospital, in the birth center and in the home setting.  Many midwives have less than a 15% cesarean rate (defined as an "acceptable" rate by the WHO) in their practices because they do not intervene until necessary.  This does not mean emergency; read: most of these are non-emergent and appropriate.
At this point in our history, 99% of births are still occurring in the hospital setting (read more HERE), and a vast majority of those women are still under the OB model of care: the "do something to help this along" model.  A 32.8% cesarean rate calls into question the common practices that are being forced on women.  It should not surprise us that some of these women are demanding a different model of care with subsequent pregnancies.
It is unreasonable to essentially punish women who are seeking compassionate care after feeling abused in the traditional care system by doctors who subscribe to a different philosophy about birth.  By including FTP and CPD in the final version of the rules and regulations, you are essentially providing a VBAC option on paper without providing a VBAC option that will be a choice for the majority of the consumers who are now faced with choosing unassisted births instead of facing the trauma they faced in a previous birth.
Before a final draft is approved, I implore Dir. Humble to attend a home birth.  See what it is we are talking about.  Really understand why we are so passionate about this cause, and why we believe that birth is a fundamental human right and a woman's rights issue.  We are not asking for the sun, the moon and the stars.  We simply want you to understand the power of birth, and why we want our care providers to have all the tools they need at their disposal if we choose a home birth setting. 
Midwives have the ability, the training, and the knowledge to bring babies safely into the world without compromising the health of the mother.  They believe that mothers care about the life they carry within them, and will do their research when it comes time to choose or decline procedures.  Midwives also know how to recognize non-reassuring patterns and when it is time to safely transfer to a different birth setting in the rare cases that complications do arise.
I advocate for midwives to be free to choose the clients that they feel they have the training to care for, be that VBAC, breech, or mothers of multiples.  As an informed consumer, I ask for the state to certify that the women who offer this care are educated in the care and management of those labors.  Along with this, I trust that midwives will have the opportunity to continue their education so that they can assist at VBAC, breech and multiples births once they have completed training in those areas.  I am glad to see that there is a review process to keep midwives accountable for their decisions, none of which will be made lightly because at midwives care deeply about the women and the children that they serve. 
Dir. Humble, you have the opportunity to lead here and set a new standard for the great state of Arizona.  Please take it.
Krystyna Robles-Bowman
Mother of 4
Chandler, AZ
Statement from Allyson Fernstrom:
"I am extremely grateful to see that VBAC is still included in the drafts. I believe this is a huge step in the right direction. It shows that the department is listening to the concerns of the consumers. I appreciate that more options are being opened up to the growing number of women who desire to achieve a VBAC. However, I have GREAT concern with some of the conditions suggested. It currently reads that a midwife can not attend a VBAC if their was a diagnosis of "failure to dilate" or cephalopelvic insufficiency". I heard in the last meeting that it is supposed to read "failure to progress". That does not make the problem better. Failure to progress, failure to dilate and cephalopelvic insufficiency/disproportion are ALL unacceptable. There is NO literature to support this rule. Listen to the members of the committee, including those from the medical community, who have mentioned may times that FTP is over diagnosed. FTP only tells you that a mother did not progress. It did not tell you WHY she did not progress. What if there was failed induction? What if it is an emotional issue that stalled labor? What if the baby was in a poor positioning? Maybe the care provider followed the Friedman's Curve, which does NOT allow the typical mother enough time to labor to full dilation? There are too many variables in play. A woman should not be excluded from attempting a VBAC because she had a failed induction, an emotional block, a baby in a poor position, an impatient care provider, etc. Because the diagnosis of FTP does NOT explain WHY the woman had a cesarean section, it should NOT be used to determine whether or not she is capable of vaginal delivery. CPD is also highly disputed in the literature. It is difficult to ever give a TRUE diagnosis of CPD. The testing is unreliable. FTP and CPD are subjective, over diagnosed and would be completely inappropriate in the rules. Director Humble mentioned that if he allows VBAC, he does not want to make it so restrictive that no one can do it. Leaving in FTP and CPD would essentially make it impossible for most VBAC clients to qualify for a homebirth VBAC. Consumers and members of the committee have been asking from the beginning that this be removed from the rules. Listen to these important stakeholders!"

Do you want to get involved?  Please do!!

There is a peaceful Rights For Birth rally being planned for today and Monday in the Phoenix area – click HERE for all the details.

Do you want to submit your own comment?
Click HERE for to make a direct public comment.

Let me be clear that I do not believe that OB's are bad people.  I simply disagree with the birth paradigm under which many of them practice.  I am forever grateful for their skill set as surgeons when it is an appropriate and needed use of their considerable skill in the operating theater.

Do you believe birth is a human right and/or a woman's rights issue?  Why or why not?
Please leave us a comment - it will be moderated and posted. 
*I think* that the amount of traffic you so generously generate has led to a lot of spam posting.  In an effort to keep the spam to a minimum, I am taking the time to moderate comments now.
Bradley Method® natural childbirth classes offered in Arizona: Chandler, Tempe, Ahwatukee, Gilbert, Mesa, Scottsdale, Payson The material included on this site is for informational purposes only.
It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult her or his healthcare provider to determine the appropriateness of the information for their own situation.
Krystyna and Bruss Bowman and Bowman House, LLC accept no liability for the content of this site, or for the consequences of any actions taken on the basis of the information provided. This blog contains information about our classes available in Chandler, AZ and Payson, AZ and is not the official website of The Bradley Method®. The views contained on this blog do not necessarily reflect those of The Bradley Method® or the American Academy of Husband-Coached Childbirth®.


Failing to Progress or Naturally Aligning

Posted on June 1, 2012 at 4:52 PM Comments comments (7)
Bradley Method® natural childbirth classes offered in Arizona: Chandler, Tempe, Ahwatukee, Gilbert, Mesa, Scottsdale, Payson  We have had a couple of students have had textbook “NAPS” in the last two classes…and since we still have several couples waiting for their babies, I thought this might be a reminder and an inspiration to them for their labors.  NAP – no, they didn’t take epic naps in labor (although I am a big advocate for sleeping in labor)…what it means is that they were very patient in their labors.   

One of the cornerstones of The Bradley Method® is a Healthy Mom, Healthy Baby outcome.  All of the discussion below only applies if Mom and Baby are not showing any signs of distress through labor.  Mom is maintaining a healthy temperature, heart rate and blood pressure, and Baby is also showing that it is doing well as per the monitoring that is being done.  If Mom or Baby are starting to demonstrate that their health is compromised, then parents are encouraged to make the best choices for their particular situation.   

The words “Failure To Progress” are the sound of doom to some of us (I say "us" because I heard this three times!).  They very often mean that interventions are going to start being suggested.  How a couple acts upon those suggestions is very individual.  Marjie Hathaway coined the phrase “Natural Alignment Plateau”, or “NAP” as an answer to the dreaded “diagnosis”: “FTP”, or “Failure To Progress”.    

Failure To Progress is based on the Friedman’s Curve*.  It looks like this: 
 As human beings, it is in our nature to see this neat, explainable graph and say, “It’s a rule!” This can have dire implications whilst in labor if you really want a natural birth.  There are no averages in the midst of a labor – each labor on is unique and individual.  

Mathematically, it’s unfair for all labors to be expected to fit the average.  That brings in another concept we teach in The Bradley Method® classes: consumerism and informed consent.  If there is time: ask questions, ask for time, and then communicate and evaluate what you have heard with your partner before you decide on a course of action.   

  • It is important to remember that the graph is AN AVERAGE representation of labor.  It indicates that a mom should dilate 1 cm per hour, and push an average of 3 hours – for an average length of labor that is between 12-14 hours long.    
  • Math class reminder:  The average number is the number you get when you add all of the data in a set of information, and then divide that total number by the number of units that provided the data.  Applied to laboring mothers: That means that there will be some people that have labors much shorter than 14 hours, and other people that have labors much longer than 14 hours, more will be around that number…and then a few will be right on with the average.  

When a mom does not progress in dilation from one vaginal exam to the next, or between several vaginal exams, she may be diagnosed with “Failure To Progress”, and along come the string of possible interventions.  They can include any or all of the following, along with other interventions: an Amniotomy (intentional rupture of the bag of waters), augmentation of labor with Pitocin, an Epidural to take of the edge of Pitocin-induced contractions, a Cesarean.  

A cesarean may also be suggested if the care team suspects that the baby may not fit through mom's pelvis.  Diagnosed as "CPD", this is the subject for another post altogether.  For now, check the link I listed below* for more information.

Instead of accepting the words, “Failure To Progress”, Marjie decided to suggest a new phrase to her students: “Natural Alignment Plateau”.  NAP instead of FTP.  Natural Alignment Plateau is a different way of approaching that point in labor when dilation does not change.  What we teach in class and hope that our students will remember when they face this crossroads is, "Labor is much more than dilation."   

Labor can be slow to start, dilation can stop and/or contractions can slow down for many reasons.  Here are some to consider: 

  •  Did you change locations where Mom is laboring? 
  •  Is Baby posterior? (Click here for ideas to move baby)
  •  Is Baby trying to figure out how to line up in the birth canal? 
  •  Is there an emotional component that hasn’t been dealt with? 
  •  Is Mom tired and does she need a nap? 
  •  Is Mom making more hormones for labor? 
  •  Is Mom's pelvis still stretching (and using the extra hormones) for baby to fit?
  •  Is the Baby's head still molding for the passage through the birth canal?
  •  Is Mom making more colostrum for baby? 
  •  Has Mom surrendered to the birth? 
  •  Has Baby accepted the birth process?  

If your labor has been slow to start after a spontaneous rupture of membranes, or if you are seemingly “stuck” at a measurement of dilation, it might be time to evaluate what could be going on and change tactics: 

  •  Try a new labor position. 
  •  Go for a walk to clear your heads. 
  •  Take a nap to conserve your energy (It’s hard for a care provider to argue with a dad or doula who is protective of a sleeping mom.)  
  •  "Talk" to your baby and encourage them that you are ready to meet him/her. 

If Mom and Baby are doing well, you can ask for time.  There is not a medical reason for an intervention if Mom and Baby are doing well in labor and your care team confirms that Mom and Baby are okay.  Here are two examples for you to consider and think about if you face a point in labor when there is no measurable progress.   

We had a mom from our Winter class go from 6 cm dilated (usually considered Active First Stage – not yet in Late First Stage) to holding her baby in 21 minutes.  Yes – you read that correctly.  She went from what most care professionals would consider mid-range in labor to holding her baby in 21 minutes…that meant she pushed within that time, too, folks.  Hers was an emotional component.  She was waiting for her mom to arrive.  Once her mom arrived at the hospital and stepped into the room where she and her husband were laboring, her baby and her body got busy.  They dilated a total of 4 cm from 6 cm to “complete” at 10 cm, then pushed, and they were holding their baby in 21 minutes.   

Our other story is from our Spring Class.  Mom had a slow start to labor.  She had started seeing some clear fluid on Sunday, noticed some more on Monday, and went to the hospital on Tuesday.  They tested her fluid and it was amniotic fluid.  Although they were in triage and barely 1 cm dilated, the couple was strongly encouraged to be admitted.  Now they are into the hospital and the expectations of “Friedman’s Curve.”  

This couple did a great job of asking, “Is Mom okay? Is Baby Okay?” After getting their “Yes” answers, then they followed up with, “That’s great!  Then let’s wait a couple more hours and see where we are.”  And sure enough, the next time the staff and their care provider checked in, they were a little further along in labor.  Once things got going, this mom went from being 4 cm dilated to 8 cm dilated in one hour!  Within two hours of that point, they were holding their baby.   

The great news about hitting the NAP is that once the Mom’s body and Baby “get organized”, labor seems to progress very quickly.  Again, remember what I said at the beginning – things go well when a Healthy Mom and a Healthy Baby are given the time they need.  If Mom or Baby start to indicate that “healthy” is losing out, then a family needs to make the best choice for their situation.   

What has been your experience – have you had a NAP in your labor?  What choices did you make?   

For a full explanation of Friedman’s Curve click here or enter this URL into your browser: http://allaboutbirth.net/pdfs/Failure-to-progress.pdf    

 The material included on this site is for informational purposes only.
It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult her or his healthcare provider to determine the appropriateness of the information for their own situation.  Krystyna and Bruss Bowman and Bowman House, LLC accept no liability for the content of this site, or for the consequences of any actions taken on the basis of the information provided.  This blog contains information about our classes available in Chandler, AZ and Payson, AZ and is not the official website of The Bradley Method®. The views contained on this blog do not necessarily reflect those of The Bradley Method® or the American Academy of Husband-Coached Childbirth®. 

Let's talk about Cesareans

Posted on April 17, 2012 at 8:33 AM Comments comments (260)

In honor of Cesarean Awareness Month, I am going to devote the next two Tuesday posts with some information on cesareans.  I am not going to write a lot on how to avoid one in the first place or the specifics of a Vaginal Birth After Cesarean (“VBAC”) since there is already a wealth of information at the International Cesarean Awareness Network (“ICAN”) and Childbirth Connection websites. Instead I will offer an introduction to the topic for people who are not aware that cesareans are performed at an alarming high rate, and offer a quick look at causes and precautions.  At the end of the post you will find several links for more detailed information.
Here is a brief introduction:
In this country, the cesarean rate in 2009 was 32.9%.  It means that over 1.4 million women and families welcomed their children into the world via a surgical procedure.  It marked the 13 consecutive year of a rise in cesarean rates in the United States.  For a look at cesarean rates by the numbers, click here.
The good news is that for the first time in 14 years, the preliminary data in the statistical year 2010 shows that the cesarean rate went down by 0.1% (from 32.9% to 32.8% - still means over 1.3 million cesareans).  It doesn’t sound like very much, yet by the numbers, that means approximately 405,700 more women had vaginal births instead of a surgical procedure to birth their babies.  There are lots of different factors that contributed to the decline; my Pollyanna is hopeful that all the good work of ICAN, and other educators, is providing information to help mothers avoid what is termed the “unnecesarean”.  For those moms in whom a true emergency situation warrants a cesarean birth, I continue to be grateful for the medical knowledge that allows for a Healthy Mom, Healthy Baby outcome.
The World Health Organization recommends that the cesarean rate should be around 15% (See Reference 1 below).  This is what it estimates to be the more accurate percentage of instances when performing an operation instead of allowing for a vaginal birth saves a mother and/or child’s life.
So are all the cesareans performed in the United States life saving?  Here is a look at how we rank internationally: the "World Health Statistics 2010 identified 33 countries with lower maternity mortality ratios than the United States, while 37 countries had lower neonatal mortality rates, 40 had lower infant mortality rates...” (2)
So working strictly off the numbers, our predominantly medically managed and intervention based hospital model (which includes a high incidence of cesareans) does not equate to a better outcome for mothers and babies.  It is quite shocking to realize that some third-world countries have much better outcomes with their approach to labor and birth in comparison to ours.
Dr. Berman, who sits on the board of the American Academy of Husband-Coached Childbirth®, taught me a healthy respect for what a cesarean really is as opposed to how it is perceived in today’s society.  We had the privilege of hearing him speak at our Bradley Method® training in Anaheim.  According to him, if you were to sustain the injuries and the trauma associated with a cesarean surgery outside of the operating room, you would have a fatal injury that very few people could survive.  Cesareans are a surgical procedure and carry all the risks associated with surgery (see link list below).
Causes and Precautions:
Here are six leading causes of cesareans identified by The Academy of Husband-Coached Childbirth®,
  • Inability to relax
  • CPD: Cephalo-Pelvic-Disproportion ~ the baby’s head is too big to fit through the mother’s pelvis
  • FTP: Failure To Progress ~ the mother’s dilation doesn’t match the care provider and/or hospitals expectations, protocol or practice
  • Fetal distress
  • Prolonged labor
  • Pain
How do you prepare yourself and avoid facing these in your labor?

Inability to relax: attend a childbirth preparation class, like The Bradley Method® series, that teaches you about the process of labor so that you are educated.  Knowledge eases fear and has the potential to break the Fear-Tension-Pain cycle that stops relaxation.  The Bradley Method® also prepares couples with twelve different relaxation techniques – if a couple attends classes and does their homework, they will have several tools to use until they find the one that best relaxes the mother and allows her body to work with her labor.
CPD:  True CPD is a real medical complication.  It is usually found when a woman has experienced severe malnutrition.  However, it cannot be accurately diagnosed until a mother has had a trial of labor, which has a very ambiguous definition (3).  Know how long your care provider will let you labor before coming to this conclusion. 
In addition, we need to remember and trust that our pelvis is a comprised of moving parts, and that there are hormones made by our bodies that relax the tendons so that those parts can stretch and mold with our babies, and then return back to the proper alignment and shape after we give birth.  We also need to remember that labor works best with gravity.  If a mother has been lying on her back and fighting gravity, she will be more tired and her body will be less likely to function as it was designed to do.
If you hear this term in relation to your labor, ask for the time (as long as mom and baby are not at risk) to try different positions and see what your body is capable of.   Chances are good of a vaginal birth if you get a mother off of her back and into positions that open the pelvis and work with gravity, i.e. walking, upright and squatting positions.  With these, her pelvis will be more likely to open and expand to welcome her child vaginally.
I recently learned that a possible indicator for CPD might also be a swollen cervix.  You can read a conversation between midwives here .  I thank my lucky stars that I am not a medical professional when I read their dialogue.  I am always open to sharing information – so please take the time to read this so you can consider possible options you want to ask for if you face CPD in your labor.
FTP: This is a clear instance where knowing what your care provider and birthplace consider “normal” is of utmost importance.  If one or both of them expect all moms to deliver by a certain timeline, find another care provider or birthplace.  All bodies are unique and all babies are unique.  Each labor will be exactly as long as it needs to be – and if you are expected to fit into a particular timeframe or else face the knife, trust your instinct that is telling you that this is an unrealistic expectation.
Fetal Distress:  This is another situation that could be a real medical complication.  Fetal monitors were designed to be used intermittently, and specifically in instances when distress was suspected.  Instead, monitors are used as a continuous procedure unless you make a specific request in your birth plan to have it otherwise.
The word “labor” applies to both the mother and the baby – and as we all know, hard work causes stress.  Most babies will handle the stress of labor beautifully when the mom has stayed low-risk and eaten a well-balanced diet throughout her pregnancy. It is important to read and educate yourself on what true fetal distress is and what the causes are so you can make an informed decision if you start to hear that term during your labor.
If fetal distress is indicated solely due to the tape the machine is spitting out, the first thing to do is ask if you have time.  If the clear and urgent answer is no, then you decide what you want to do for a Healthy Mom, Healthy Baby outcome.  If there is time, then you can ask for a second opinion, and/or ask for them to listen to the baby by other means, such as a fetoscope or a Doppler.  The monitors can give false readings by the simple fact that they are just a machine interpreting the signs from the baby instead of a trained set of hands and a human ear that feels and listens to the baby.
Prolonged Labor: This is a situation when knowing what your care provider or birthplace considers “prolonged”, and also when having a supportive coach and a support team makes a huge difference.  The mother and coaches attitude about having a prolonged labor will affect how a choice for or against a cesarean.  The questions to consider here are: Is the mother okay? Is the baby okay? Do we believe that our labor is what our baby needs?  Are we willing to give baby the time he or she needs to be born? What else could we do/try before we agree to a cesarean?
Every couple will make their own choice under these circumstances.  Their list of things to do or try before they accept a cesarean will depend on their training and the experience of coach or any assistant coaches the couple has with them.  If the mom and baby are not in distress after a prolonged labor, there is no right or wrong answer in this case – it is entirely up to the parents to decide which path they want to choose.  If either the mom or baby is showing signs of distress, the path forward is clearer when you are central goals are a Healthy Mom, Healthy Baby outcome.
Pain: I would be lying to you if I told you that childbirth is painless.  However, the pain is bearable and welcomed when you focus on the result of the work you are doing and when you are surrounded by the love and care of your coach and any assistant coaches.  There are times when the pain changes, and an excruciating pain that doesn’t break and/or that is accompanied by bright red blood and/or large blood clots is a true complication. It could be a life-threatening complication like placental abruption or a uterine rupture.  These clearly indicate a cesarean to attempt to save the life of the mother and the child.
If the pain increases in intensity, but it continues to ebb and flow with the strength of the contractions, then the team needs to evaluate if maybe the baby is malpositioned and needs to be encouraged to move again.  The other cause of intense yet manageable pain could indicate an emotional component of labor that the mom needs to address before labor can resume its normal course.
The bottom line is that you, as a consumer of medical services, need to educate yourself, ask questions of your care provider, and advocate for the choices you want.  If your requests are reasonable, chances are high that you will be able to find a care provider who supports your choices and only uses cesarean surgery in the emergency situations for which it was intended.
ANNOUNCEMENT FROM ICAN: ICAN of Phoenix will be offering a Cesarean Prevention Class on Saturday May 19th from 2-4pm. Location is TBA but will be in the East Valley this time. Cost will be $25 per couple, your other half is strongly encouraged to attend (your doula may attend too, no cost for bringing her). There will be a sign up form on the website as soon as the location is set, but you may rsvp if you already know you will attend. If you need more details please email Stephanie Stanley at [email protected] 
Link List
Things you can do to avoid an unnecessary cesarean:
Risks associated with cesarean:
More information on cesareans and related topics:
ICAN Facebook page:
ICAN Phoenix Facebook page
(1)  World Health Organization. Appropriate technology for birth. Lancet 1985; 2: 436-7.
I used the provisional 2010 number and multiplied it by 0.01%
For the number geeks:
Number of births in the US
Preliminary Data (11/17/11) 2010 was 4,000,279

Feb 2012 update: 4,057,000 for the 12-month period ending June 2010  4,057,000 - 32.8% = 1,330,696 cesareans

Final 2009 Data (11/03/11): Number of births: 4,130,665
4,130,665 – 32.9% = 1,358,989 cesareans
Comparing 2010 to 2009 
2010 Birth rate: 2% lower
2010 Cesarean rate: 0.1% lower
The material included on this site is for informational purposes only.
It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult her or his healthcare provider to determine the appropriateness of the information for their own situation.  Krystyna and Bruss Bowman and Bowman House, LLC accept no liability for the content of this site, or for the consequences of any actions taken on the basis of the information provided.  This blog contains information about our classes available in Chandler, AZ and Payson, AZ and is not the official website of The Bradley Method®. The views contained on this blog do not necessarily reflect those of The Bradley Method® or the American Academy of Husband-Coached Childbirth®.
Bradley Method® natural childbirth classes offered in Arizona: Chandler, Tempe, Ahwatukee, Gilbert, Mesa, Scottsdale