The gentlebirth.org website is provided courtesy of
Ronnie Falcao, LM MS, a homebirth midwife in Mountain View, CA


For Parents - How to Get the Best Care

Easy Steps to a Safer Pregnancy - View e-book or Download PDF - FREE!
An interactive resource for moms on easy steps they can take to reduce exposure to chemical toxins during pregnancy.

Other excellent resources about avoiding toxins during pregnancy

These are easy to read and understand and are beautifully presented.

See also:

Subsections on this page:

The Language of Birth

Remember that in a normal birth, mothers give birth and babies work to get themselves born by pushing off with their feet against the top of the uterus and by maneuvering their head to fit optimally through the pelvis.  In a physiological birth, the birth attendant simply "attends" the birth, ideally supporting the mother-led birth process and intervening only when it is truly necessary.

Doctors truly deliver babies only by cesarean, forceps extraction, vacuum extraction or a variety of other invasive and often harmful interventions.

In the way that we're all trying to work towards giving babies their birth right of a physiological birth, I think it would be helpful to use the language of physiological birth.

Another Improvement - A Rating System for Doctors
DrScore - Give your doctor feedback. Doctors can't get better if they don't know how they're doing.
RateMDs.com is changing the way the world looks at medicine by providing patients with the unique opportunity to rate and read about their doctors.

Request A Copy of Your Medical Records after the Birth!
An Idea Whose Time Has Come

This idea came from a researcher in the field of prenatal and perinatal psychology who observed that the people who have control of the information have control of the research.  If you want to be able to participate in long-term research studies about your child's health as a side effect of the procedures performed during pregnancy, labor and birth, and in the newborn nursery, then you will need to have a copy of your records.

"As a prenatal/perinatal therapist, such records can be invaluable in explaining a problem or validating a hunch about what happened to a baby/child presenting symptoms of birth trauma. . . .[I]f it becomes routine for mothers to request their medical records, it's possible that hospitals will become a bit less defensive about releasing them (fearing they'll be used to support litigation) and that the idea that this information is rightfully that of the parents (and the baby, really) might become more accepted.  This would serve to support more and more research I see taking place down the pike as my fellow students in our field explore different aspects of pregnancy and birth and empower families to learn more about how birth relates to how their children think, feel and act in life. . . . So . . . let's think in terms of working towards having medical records of births easily and frequently released to mothers who request them, and having mothers empowered to believe they are entitled to this data and that it can ultimately benefit their understanding of their birth, and their child's well-being."

The researcher suggests asking for the full medical records (including nurses' notes) of their birth (and/or child's nursery stay).

WARNING!!!  If you have Aetna health insurance, you may want to change at the next opportunity, when your employer has their annual "open enrollment".  Aetna doesn't cover homebirth, citing a single study based in rural Australia which shows that high-risk births far away from a hospital are high risk.  They further cite the policies of the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists, both business competitors to homebirth providers. Their policy statement ignores a mountain of evidence that homebirth is as safe as or safer than hospital birth for normal, healthy pregnancies..  If their policymakers have any integrity, this logic will soon lead to cessation of coverage for planned VBAC's . . . there's no dearth of studies and AAP and ACOG policies proclaiming the danger of VBAC's . . . and then they'll stop coverage for any woman who declines standard ACOG/AAP recommendations regarding routine ultrasound, routine induction, routine IV's, routine use of continuous electronic fetal monitoring, routine administration of antibiotics for all GBS positive women (up to 40% of birthing women), and prompt cesareans for any woman who fails to progress in a timely fashion during labor and pushing.  They may also stop coverage for children who are not vaccinated according to the full schedule of vaccinations recommended by the AAP, even though many intelligent parents decline the newborn hepatitis B vaccine and practice selective vaccination according to their child's own needs.

If this is troubling to you, as it should be, let them know.  You can easily send e-mail to Aetna's National Media Relations Contacts and simply tell them that they should not be in the business of denying coverage for reasonable healthcare choices, such as homebirth, waterbirth and VBAC.  They will especially want to know if you are choosing another healthcare provider because of this unreasonable policy.  You might also suggest that they expand their research beyond ACOG and AAP recommendations.  They could start at:  http:

Boycott Nestle

OK . . . if I can boycott Nestle, so can you.  It happens that I love chocolate, and it further happens that the chocolate I love best is made by Nestle.  My favorite candy bars are Nestle's Crunch, $100,000 Bar and KitKat.  I LOVE their hot chocolate mix, and, of course, Nestle's Tollhouse Morsels.  Oh, did I mention those great new Treasures morsels with coconut?!?  Unfortunately, Nestle is actively killing thousands of babies around the world through their unethical business practices in pushing formula to families that cannot afford to use it properly.  I can no longer come home from births where we struggle to help babies breastfeed because it's so good for them, and then eat a Nestle's Crunch to keep myself awake on the drive home and then make a nice cup of hot chocolate while I do birth laundry.

If I can boycott Nestle, so can you!

If you need more motivation to boycott Nestle, then read breastfeeding.com's Stuff That Will Make You Mad

"Mr Ian Smith of York, gave his account of the company's ethics: "As one the members of Synod from York, where we have a significant Nestlé presence, I was invited, before the last debate on this subject in 1994, to meet some of their directors to discuss the issue. At that time they freely admitted that they were the market leaders of a trade that was being mishandled in some parts of the world. I observed that this resulted in many thousands of infant deaths. The response was that if they didn't sell the product someone else would. We've heard that line with regard to landmines recently: In other words, it's better that they're killed by our products rather than someone else's. Nestlé admitted that the business has its unethical side, but they still push it hard. They say they will stop - if others do too."

You Tube Videos

See also: Podcasts

You Tube Videos can be the easiest way to bring yourself up to date with some important birthing issues.  This list is courtesy of Kelly Harrison.

EPISIOTOMY - If you want to see an episiotomy (or want to show someone), you'll find it in this video about 1min45sec into the clip. Then watch the MD pushing the baby's head.

EPIDURAL - The MD explains the steps he's performing. Note that the video is edited so that the time for the entire procedure is shortened.

C-SECTION (w/ "Mobius Extractor") - I find the pleasing music an odd contrast to the up-close cutting, prodding, tearing, etc. This leaves no details left to the imagination. The "extractor" is a new device. This video is supposed to illustrate the ease and benefit of using it. Shows stapling of incision. I can't help but feel sorry for the women behind the curtain.

C-SECTION (Hartford Hospital) - This is an hour-long "documentary" showing off the hospital facilities, but it also gives us a c-section up close, uncut, so you can get an idea of the time involved. The intro says there are over one million cesareans each year making it the "most common procedure." I love this doctor quote from the start, saying c-sec is "one of the most rewarding [procedures] for the obstetrician to perform." The baby is breech and the MD says delivery by c-sec is "safer" for the baby than vaginal birth. Also note lots of lavage and O2 for baby who is very floppy.

HOMEBIRTH - 6-min homebirth with use of dopler and amniohook to break bag of waters. Older sibling at birth.

HOMEBIRTH in the UK - delivered on all fours on Christmas morning. Only "technology" was dopler.


   Animation of the normal process of dilation and delivery.

   Animation explaining "stations" relative to pelvic bone.

   Animation of shoulder dystocia

HUMOR - This is the Monty Python Birth Skit, which is BRILLIANT. I love the part about the totally irrational depression the mother will experience, so "it's happy pills for you!"

Bill Cosby's old birth skit, in two parts, Part A and Part B.


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Lamaze offers a new personalized weekly e-mail newsletter for expectant parents, Lamaze... Building Confidence Week by Week. Free weekly e-mails from Lamaze feature trustworthy information, practical tips and inspirational stories to help guide women and families through pregnancy, birth and beyond.

If you want to see a glaring example of how obstetricians don't GET the normal physiology of birth, you can go read their statement on Lay Midwives.  Their first problem is that they don't understand the difference between a lay midwife and a Licensed Midwife or a Certified Professional Midwife.  Here's a primer for them and for you!

A lay midwife has no formal midwifery education or training, so typically wouldn't carry anti-hemorrhagic drugs or resuscitation equipment.

A Licensed Midwife is a midwife who has satisfied the educational and experience requirements of her state to earn a license.  Here's information about a California Licensed Midwife (LM), which is considered the most rigorous set of requirements.  Here are photos of some of the equipment she might bring to a birth.

A Certified Professional Midwife (CPM) is a midwife who has satisfied the educational and experience requirements of the North American Registry of Midwives (NARM).  CPMs typically train and practice in an out-of-hospital environment.

A Certified Nurse-Midwife is a midwife who has satisfied the educational and experience requirements of the American College of Nurse-Midwives (ACNM).

(Notice that the last three are not mutually exclusive.  In fact, a single person could be an LM, CPM, CNM, CM, MD, RN, PhD if she wanted.  In fact, there is a great deal of overlap among the formal certifications, but here's an easy way to think of it: The C is for "Certified", and this means that someone received a Certificate from a Certifying body.  A license is from the state, and it gives someone the legal right to practice.)

One of the really funny things about ACOG's statement is that they seem to think it's very important for midwives to be trained as nurses first in order to attend births, but not for physicians.  Have you ever heard of a nurse-OB?  No, I didn't think so.  In most countries, such as the UK, midwives are independent practitioners working in collaboration with physicians, and they specialize in midwifery directly, without detouring through nursing school.  ACOG's repeated opposition to efforts by all kinds of midwives to reinstate their relationship as collaborative rather than supervisory emphasizes their desire to control women, birth and midwives.  It is no wonder that they oppose midwives who train outside the hierarchical environment of the hospital, where the physicians are the ultimate authorities.

You can read more about the Different Types of Midwives.

Their second problem is their emphasis on hospital training, which is typical for nurse-midwives.  Homebirth midwives are specialists in normal birth, with specialized training for handling birth emergencies in an out-of-hospital environment with the portable equipment and supplies typically used in a home environment.  So it's obvious that they should be trained in the environment in which they expect to practice.

You can read the Bridge Club's Letter to ACOG re: Improper Term "Lay Midwife" [March, 2006].  (The Bridge Club is a committee composed of midwives from the two main midwifery organizations in the United States.)

Guide to a Healthy Birth - excellent resource from Choices in Childbirth.
Available online or for $1.50 by mail.

Listen to Mothers: Surveying the Experience of Birth from Childbirth Connection [8/28/13] - Childbirth Connection's ongoing Listening to MothersSM Initiative is devoted to understanding experiences and perspectives of childbearing women and using this knowledge to improve maternity policy, practice, education, and research. Listening to Mothers surveys enable us to compare actual experiences of childbearing women and newborns with mothers' preferences, as well as with evidence-based care, optimal outcomes, and protections granted by law. Identified gaps present opportunities to improve conditions for this large and important population during this crucial period.

The Other Side of the Glass - Youtube video.  Empowering fathers to protect their babies and partners.

Easy self education about childbirth - audio file BIRTH - A one-hour public radio and audio documentary about the practices and perceptions of birth in America.

The companion piece, BORN: An hour-long audio journey exploring the postpartum experience in contemporary American life.

Wow!  Now this is an idea whose time has come!

Lilah Monger is a co-ordinator for the AAMI Reading Rooms:

The childbirth reading room is designed to educate women about natural birth.  Books are chosen for their promotion of birth truth and birth trust.

The unassisted childbirth reading room is similar in format to the childbirth reading room but features books that are recommended reading for women who are considering unassisted homebirth.  Books are chosen for their promotion of gentle, unhindered childbirth.

The midwifery reading room is also similar in format but intended for birth professionals and students.

Why Your Baby's Birth Matters by Diane Wiessinger - A fabulous summary of the most important aspects of birth from your baby's perspective!

Childbirth: What to Reject When You're Expecting - [4/13/16] - from Consumer Reports - 10 procedures to think twice about during your pregnancy

What Natural Childbirth Means to Your Baby - Wow!  This isn't about haranguing moms to force them to have unmedicated births. It's about transforming birth in this country so moms have the best possible birth that is also the best possible birth for their baby.

These articles are written by Ronnie Falcao, LM MS, the editor of the Midwife Archives and owner of gentlebirth.org

Homebirth Benefits - Why Homebirth Is Most Appropriate for Normal Birth

Dangers of Hospital Birth - Why Birthing in a Hospital Causes More Problems Than It Solves for Normal Birth

What's the Best Way to Spend 80 minutes of your pregnancy?  Listen to Your Body, Your Birth - Secrets for a Satisfying and Successful Birth - a great audio book from Lynn Griesemer.  "80 minutes of warmth, common sense, humor, integrity and love that inspires, encourages and reveals secrets for a most rewarding birth experience - one you will cherish the rest of your life."

"This is the best audio resource about childbirth I've encountered.  It's got lots of wonderful tips and really does capture the secrets in a way that's easy for women to understand.  I highly recommend it!"  - [Ronnie Falcao, editor, The Midwife Archives]

Indie Birth - an online homebirth magazine.  Here's the purpose of Indie Birth:

To fire up the minds of modern-day mamas, so that they are inspired, educated and aware of all the choices surrounding them concerning their pregnancies and births.

To cater to those that are already independent, free-thinking and maybe a little bit radical... and to transform those mamas not yet in touch with their instinctive abilities to birth and nurture naturally.

Midwife Blogs


Seeds of Compassion - from a conference Apr. 11-15, 2008, with the participation of the Dalai Lama. When we look across secular and religious wisdom traditions, and across human history and cultures, compassion may well be the virtue that is valued most highly and most broadly. The resources below seek to expand our conversation about what compassion looks like in action and how best to nurture it in future generations.

Check to see if the hospital you're considering is on the list of Baby-Friendly Hospitals and Birth Centers.  A Sept., 2005 study showed that these hospitals had higher rates of breastfeeding, regardless of demographic factors that are traditionally linked with low breastfeeding rates.

The Mommy Uprising By Tina Cassidy - They're fed up with the unwanted C-sections, the endless tests, the dubious interventions, and the scary advice from overworked, malpractice-spooked doctors. And Boston women are shunning the area's world-class hospitals to go to surprising lengths--and sometimes take big risks--to give birth on their own terms.

For expectant women, it's not too much to ask by Tina Cassidy.  This great article will help you to understand why "less is more" when it comes to midwifery or medical support for a physiological process such as birth.  (Tina Cassidy is also the author of Birth: The Surprising History of How We Are Born.)

Tina Cassidy's article is based on the Listening to Mothers surveys.

Why do women go along with this stuff? [Full text of Part 2]
Klein MC, Sakala C, Simkin P, Davis-Floyd R, Rooks JP, Pincus J.
Birth. 2006 Sep;33(3):245-50.

PREFACE: Normal childbirth has become jeopardized by inexorably rising interventions around the world. In many countries and settings, cesarean surgery, labor induction, and epidural analgesia continue to increase beyond all precedent, and without convincing evidence that these actions result in improved outcomes (1,2). Use of electronic fetal monitoring is endemic, despite evidence of its ineffectiveness and consequences for most parturients (1,3); ultrasound examinations are too often done unnecessarily, redundantly, or for frivolous rather than indicated reasons (4); episiotomies are still routine in many settings despite clear evidence that this surgery results in more harm than good (5); and medical procedures, unphysiological positions, pubic shaving and enemas, intravenous lines, enforced fasting, drugs, and early mother-infant separation are used unnecessarily (1). Clinicians write and talk about the ideal of evidence-based obstetrics, but do not practice it consistently, if at all. Why do women go along with this stuff? In this Roundtable Discussion, Part 2, we asked some maternity care professionals and advocates to discuss this question.

One of the simplest and best things you can do for your baby is to work with your birth attendant to prevent premature cutting of the umbilical cord.  Take a copy of Clamp the Umbilical Cord Early and Risk Injuring Your Child's Brain by G. M. Morley, MB, ChB (Ed.), FACOG, and discuss the issue with them.  [More info about premature cord clamping/cutting.]  While you're at it, you can talk to your birth attendant about using a cord clamping system that is breastfeeding friendly.

Study Shows Homebirth Superior to Hospital Birth - A summary of the 2005 BMJ Homebirth Safety Study.

Early skin-to-skin contact for mothers and their healthy newborn infants (Cochrane Review) - The Cochrane Collaboration is a committee of MDs who review all known research in their fields to produce summaries.  This is a landmark abstract from The Cochrane Library, Issue 3, 2003 by Anderson GC, Moore E, Hepworth J, Bergman N

Make sure your birth attendant and hospital staff are familiar with this study!

"Background: Early skin-to-skin contact involves placing the naked baby prone on the mother's bare chest at birth or soon afterwards (< 24 hour). This could represent a 'sensitive period' for priming mothers and infants to develop a synchronous, reciprocal, interaction pattern, provided they are together and in intimate contact. Routine separation shortly after hospital birth is a uniquely Western cultural phenomenon that may be associated with harmful effects including discouragement of successful breastfeeding."

Briefcase Full of Diapers - The Working Woman’s Resource for Having and Nurturing Healthy Children by Julie Fagan

From Birthing the Future - they offer information, ideas, conferences and inspiring books & videos.  970-884-4090

Birth in a Sanctuary - Imagine .  . . a place where everyone:
Honors the work you & your baby are doing
Values natural, normal birth!
Treats you as the amazing woman you are
Understands your baby is fully conscious and sensitive to everything.
Respects that both of you need only positive words & images
Don't settle for a typical birth, create an extraordinary one!

The National Childbirth Trust - From the UK, this site offers support in pregnancy, childbirth and early parenthood.  They have a separate portal for professionals.

You can also educate yourself week-by-week in your pregnancy with theLamaze Weekly Pregnancy Newsletter for Parents

Birth Blogs - Giving Birth With Confidence - The authors of the Official Lamaze Guide muse about birth, babies, and a whole lot more…

Empowering Birth Blog - A homebirth after cesarean healed my scars and renewed my trust in birth. Trying to spread the message that birth should be EMPOWERING.

Reclaim Your Right To Birth Right by Christiane Northrup, MD [10/16/09]

The Birth Ecology Project advocates for midwifery, doula care, natural birth, conscious parenting, and sustainable living. The Birth Ecology Journal publishes articles and essays of quality on topics of interest to parents, birth professionals, and birth advocates on the website. Workshops for parents and professionals are also in the works.

Homebirth at the Hospital By Doula Giuditta Tornetta

Home Birth Talk provides information about the home birth option and midwives, the facilitators of home births. Download or subscribe to free podcast episodes fromMidwiferyWorld Podcast By Kris Bagiu, CPM, LM

My first baby was born at home. The second (for lack of caregiver) was born in the hospital (within an hour of our arrival) into my husband’s hands while I squatted on the floor. The doctor who was called in by the nurse was too shocked to do much more than watch and the only words we heard from him were “oh my God!”.  My husband reassured the OB (later featured in the local newspaper for having 4,000 births to his credit) with the words…”it’s okay we’ve done this before.” LOL

We left a few hours later.  As “homelike” as that experience was there is no question that I was not in my home and that the offers of “help” (are you sure you don’t need a shot of oxytocin, wouldn’t you like to move to the bed for the birthing of the placenta, do you think it is wise for your 2 ½ year old to be in the bed with you, wouldn’t you like us to bathe your baby before leaving) wouldn’t have been uttered by the midwife who attended my first birth.

Some aspects weren’t even negotiable; I was required to leave in a wheelchair rather than walk to the front door and my baby needed a name before leaving if we wished to avoid extra administrative costs.

Although I had the complete support of my pediatrician (after interviewing a mere half dozen) even he made a mistake and suggested we test the baby for metabolic disorders before leaving.  This of course proved to be too soon and the results came back with a diagnosis of cretinism!

Flowered sheets or not…they weren’t my sheets and didn’t smell like my laundry, the view out the window wasn’t my garden,

the people who knocked on my door weren’t my family members or guests, and the attitude of those talking about us outside the door weren’t the sounds of my household.

Was it a triumphant experience?  You betcha!  Did I use it to motivate the dozens of couples taking my childbirth classes to create their ideal (albeit hospital births)---but of course!!  Would I ever tell them it would be the same as having a  homebirth?  NO.

National Advocates for Pregnant Women (NAPW) - NAPW has a vision of a world where women enjoy full personhood and where neither pregnancy nor drug use serve as an excuse to dehumanize and punish select groups of people

Dr Pregnancy is an educational resource from the UK that seeks to celebrate the wonderful world of pregnancy and childbirth.
There are hundreds of Articles from "Preconception Advice" and "Pregnancy Fitness" to "Breastfeeding in Public".
We have an online Discussion Forum with a community of mothers (and fathers) with expert advice. Come and join in and share your thoughts on the wonderful world of pregnancy!  You might check out their page on Advantages of Natural Childbirth.

The Biology of Belief reveals the leading edge science of how parenting programs a child's genes and behavior.  If you have a child, are planning to have a child, or have ever been a child, this book is for you.

Normal Care for Normal Birth by 2020 ~ Rehabilitating our National Maternity Care policy by the year 2020 by Faith Gibson, LM CPM

Challenging Chokepoint Medicine - For those of you who are most interested in maternity care, midwifery and PHB, i think this material will help you understand that the real root of these problems -- the prejudice against physiological management and midwives, the political issue of obstetrical supervision, the escalating medicalization of normal birth through induction and elective Cesarean -- comes from the same place and is a symptom of basic problems with health care writ large.

Let your monkey do it! by Skylar Browning - a fun article written by a dad about how the primal part of the brain controls birth.

Ten Moons Rising - Holistic Family Education & Resource Center.  "It is painfully obvious that our society is in need of change, and it is parents who will play a critical role in realizing that change.  For not only do we bring new life into the world but, through the consciousness we bring to our children's earliest experiences, we have the power to shift our current path from one of fear and violence to one of transformation and healing."  They have an excellent links list.

The Landscape of Caring for Women: A Narrative Study of Midwifery Practice [Medscape registration is free.]

"Midwifery care has been demonstrated over and over to be excellent and associated with positive maternal-infant outcomes. . . . The midwives in this study were negotiators, not dictators. They believed that power rested with the women and not necessarily in themselves. This does not mean to imply that they were weak or compliant; in fact, they were often the opposite. . . . In addition, emphasis on presence and relationship, rather than routine use of technology, may be misaligned with an institutional and consumer fascination with machines as the solution to achieve optimal birth outcomes. In this study, the midwife represented the "instrument" of care. It was the midwife's ability to communicate, engaged presence, and clinical judgment that presided, not the technology that was used."

Home birth: A woman's right to choose? By Mary Murry, R.N., C.N.M.
This article from the Mayo Clinic advocates for women to have the right to choose where to give birth.

Mayo Clinic approves homebirth

Birth center: An option for pregnancy care By Mayo Clinic staff - The Mayo Clinic's article about birth centers applies exactly to homebirth, except that the midwife brings the birth center to your home.  A midwife at home can do anything that a midwife at the birth center can do.  In fact, a midwife at home can do almost anything that a hospital midwife can do, with the exception of order pitocin, an epidural or an amnioinfusion because these are dangerous procedures that need to be close to an operating room.
Pregnancy is a normal part of life. Typically, healthy mothers and babies don't require special medical attention. Choosing a facility that doesn't provide emergency services carries a small risk, however, since serious or life-threatening problems are possible during pregnancy or labor and delivery. In those cases, the need to transfer a mother and baby from a birth center to a hospital can delay care."
This article does an excellent job of capturing the essence of birth center and homebirth care. Their only glaring omission is that they forget to mention the increased safety at home and in birth centers that comes from being away from dangerous hospital germs, which can kill vulnerable newborns. They also forget to mention that out-of-hospital birth is safer than hospital birth because of avoiding the dangers of pitocin, epidurals and artificial time restrictions.  Keeping the baby with the mother and facilitating bonding and breastfeeding also improve the baby's health and prevent future health problems for the mother and baby.

In an age when women are choosing cesarean under the mistaken impression that abdominal surgery is less painful and causes less damage, it's important to remember that alternative birth positions can prevent most perineal birth trauma; instead of choosing cesarean to prevent perineal trauma, it seems important to remember that there are other important choices one can make, such as your choice of birth attendant.  In this study, 73% of women attended by midwives birthed babies over intact perineums.

Web-only resources written for parents

fish can't see water - Why medicalised birth is bad for you.  This is a fabulous collection of information, including Marsden Wagner's writings.

Aletha Solter's new book, Raising Drug-Free Kids: 100 Tips for Parents, begins at conception and includes a discussion of how the drugs used in labor and birth predispose children towards drug abuse.

The "Trust Birth Initiative" is an old/new concept in the birth field.
Women talking to women about birth.
Not another expert, not another class.
We facilitate discussion/support groups.
Meetings are usually in leader’s home, but may be in a library or church nursery or community center.
The meetings are usually held one night a month.

The Circumfort Kit contains sufficient quantities of materials to effectively manage up to five potentially painful procedures that are routine in the hospital.  This is a kit for parents to take with them to the hospital to make sure that their baby receives adequate pain relief.

Home Birth from the American Pregnancy Association

A Field Guide to Birthing: A Conversation With Michael Witte, M.D., and Heidi Bednar, R.N. - A great discussion of birth options from Medical Self Care, edited by Tom Ferguson, M.D., 1978.

The goal of Prenatal Parenting is a psychologically and physically prepared mother who will birth a happy and healthy baby with full support from loved ones. A family that follows the techniques described in Prenatal Parenting: The Complete Psychological and Spiritual Guide to Loving Your Unborn Child will birth a happy and peaceful newborn infant and help reduce the unacceptably high infant mortality rate in the United States.

Bonding With Baby Before Birth (from WebMD) - Making a connection with your unborn child can strengthen the bond you share, make you feel closer, and enrich you and your baby's lives.  Talk to the baby. Say goodnight before you go to bed, good morning when you wake up, and talk to it throughout the day. . . .

See also: Bonding and Prenatal Communication

Must Read - The Annual New Baby Issue 2004 of Attachment Parenting

This booklet is terrific - it is truly a treasure! : The Annual New Baby Issue 2004 of Attachment Parenting: The Journal of Attachment Parenting

It includes some wonderful articles:

Bonding with Your Newborn by William Sears, MD - This is the best, most accessible summary of attachment and bonding that I've seen.

The Benefits of Co-Sleeping

The Chemistry of Attachment by Linda F. Palmer, DC (reprint)

A New Look at the Safety of Breastfeeding During Pregnancy by Hilary Dervin Flower, MA

What is Attachment Parenting

Since the 1930s there was a steady reduction in the maternal death rate each year until 1982. The Safe Motherhood Quilt Project is a national effort developed to honor those women who have died of pregnancy-related causes during the past twenty years and to draw public attention to the unchanging maternal death rate.

Quilt honors mothers who died giving birth - BY HOLLY TKACZYK - about The Safe Motherhood Quilt Project

For a fun introduction to midwifery and natural childbirth, read BABY CATCHER: Chronicles of a Modern Midwife  by Peggy Vincent.  This is a really fun, engaging book and will help you to get a sense of your own strengths when it comes to birthing.  It presents both home births and hospital births in a way meant to avoid alienating those on either side of what too often degenerates into a heated argument about place of birth.

Think baby's first hours or even days don't make a difference?  Read The first hour following birth - 4th September 2002 - In this article, first published in Midwifery Today, Vol 61, 2002, Michel Odent catalogues 12 perspectives on the first hour following birth.

Bursting the bubble on mobile myths By Peter Cochrane [8/13/04] - Beyond the critical issues of the importance of birth choices and baby's first hour, there's the key issue of not being able to use cell phones in hospitals.  This article points out that the cordless phones used in hospitals are more likely to cause interference than cell phones, yet hospital staff seem to use them freely.

Women of Spirit - Ancient Women's Knowledge in a Modern Context - lots of wonderful articles by Sarah J. Buckley, MD

Maternity Wise helps women learn about options and make informed decisions.

MidwifeInfo.com - Resources for Midwives and their Clients

Ecstatic Birth is a call for a revolution, a revolution in the way we think about birth, and, as a result, the way we give birth.

CHILD MIRTH: A conscious, empowering, lovingly supported pregnancy, labor, birth, and postnatal experience that's respectful of the mother's needs as well as the baby's; an ecstatic or orgasmic birth; mindful parenting.

Planning a low-intervention birth?  Wondering what your chances are of achieving this?  Read The First National Survey of Women's Childbearing Experiences:  In short, all but a tiny percentage had highly interventive births although about half felt that a non-interventive, natural birth was best. The ones with non-interventive births were the home birthers. One-quarter had c/secs, and about 40% were induced. Almost all felt they had enough information and participated in decisions to the extent they desired, although most didn't know there were drawbacks to epidurals or that they were entitled to full info on interventions or that they could refuse them. Many had experienced pp problems of various kinds, especially the c/sec moms. One-third had clinical depression.

ROUNDTABLE DISCUSSION: PART 1 - Why Do Women Go Along with This Stuff?
Sheila Kitzinger, MLitt1* Josephine M. Green, BA(Hons), PhD, AFBPsS, CPsychol2* Beverley Chalmers, DSc(Med), PhD3* Marc J.N.C. Keirse, MD, DPhil4* Kathleen Lindstrom5* , Elina Hemminki, MD, DrPH6*

PREFACE: Normal childbirth has become jeopardized by inexorably rising interventions around the world. In many countries and settings, cesarean surgery, labor induction, and epidural analgesia continue to increase beyond all precedent, and without convincing evidence that these actions result in improved outcomes (1,2). Use of electronic fetal monitoring is endemic, despite evidence of its ineffectiveness and consequences for most parturients (1,3); ultrasound examinations are too often done unnecessarily, redundantly, or for frivolous rather than indicated reasons (4); episiotomies are still routine in many settings despite clear evidence that this surgery results in more harm than good (5); and medical procedures, unphysiological positions, pubic shaving and enemas, intravenous lines, enforced fasting, drugs, and early motherinfant separation are used unnecessarily (1). Clinicians write and talk about the ideal of evidencebased obstetrics, but do not practice it consistently, if at all.

Why do women go along with this stuff? In this Roundtable Discussion, Part 1, we asked some maternity care professionals and advocates to discuss this question. (BIRTH 33:2 June 2006)

Doctors are not scientists  [BMJ  2004;328 (19 June)]

Lack of Evidence-Based Medicine in Obstetrics

This booklet is written for care providers but is a very easy read for non-professionals.

Care in Normal Birth: A Practical Guide Report (from the World Health Organization) - now online!

Maternal and Newborn Health also now online!

The following book was recommended for evidence-based care of uncomplicated labor and birth. Supporting your practice with evidence-based care is helpful when seeking reimbursement from HMOs and when challenged by supporters of increased use of technology. This is an inexpensive paperback and is available from WHO Publications Center USA, 49 Sheridan Ave., Albany, NY 12210.  tel. 518-436-9686 or fax 518-436-7433  The cost is $10 with $5 for shipping. ($1 shipping for each additional copy.)


Excerpt of Summary of Research on Place of Birth (or the full section)

1997, iv + 54 pages
WHO/FRH/MSM/96.24; order no. 1930104
Sw.fr. 10.-/US $9.00; in developing countries: Sw.fr. 7.-

Establishes universal guidelines for the routine care of women during uncomplicated labour and childbirth. Reflecting the consensus reached by an international group of experts, the report responds  to the recent proliferation of practices designed to start, augment, accelerate, regulate or monitor the physiological process of labour in industrialized and developing countries alike. Recommendations for routine care are based on a critical review of what considerable research has to say about the effectiveness and safety of 59 common procedures and practices.

The report has six sections. The first establishes a definition of normal birth, and then considers the reasons why, in the interest of improving care, so many maternity services have uncritically introduced interventions that have been shown, in well-designed studies, to be useless, inappropriate, excessively costly, and frequently dangerous for mothers and babies. The differences between normal birth in hospitals and in homes, in industrialized and in developing countries are also considered together with the personnel, training, and skills needed to attend a normal delivery.

The four sections which constitute the core of the report systematically review the available evidence for and against the use of specific procedures in general labour care and during each of the three stages of labour. Details of this evaluation range from the advisability of withholding food and drink during labour, through a review of evidence demonstrating that routine use of episiotomy is harmful, to a description of several non-invasive, non-pharmacological methods of proven efficacy in pain relief.

In a key achievement, the final section classifies each of the 59 practices  considered into one of four categories: clearly useful, clearly harmful or ineffective, inadequately supported by research findings  and thus to be used with caution, and frequently used inappropriately.

"... contains several important messages, messages that are perhaps more crucial for the developed world than for the non-industrialised countries, although they, too, will find much that is useful here..."
- Midwifery Digest

To order, send e-mail to QCORP@compuserve.com

This book is written for care providers but is also a valuable reference for parents

Probably the single best source of research summaries regarding childbirth is the book, Guide to Effective Care in Pregnancy and Childbirth by Enkin et al.  [Now ONLINE !!!]

For those that don't know, this book is a guide to a huge two-volume book in which the studies done on most everything done in obstetrics have been evaluated and conclusions drawn. This work is also the basis for The Oxford Database of Perinatal Trials.

The smaller, very readable paperback Guide is available for $28.95.  Amazon.com has a review, including the table of contents.

The most valuable part is the section in the back:

What's the evidence about Home versus hospital birth (Cochrane Review)?

The Midwives Model of Care is based on the fact that pregnancy and birth are normal life events.

P e a c e f u l   B e g i n n i n g s -  a collection of several of the more popular and useful articles and information sheets that I written or put together during the 1970’s and 80’s for use in childbirth education classes, for the expectant and/or new parent clientele of health care providers, and for educating the general public.

If you want to have a little fun while learning about pregnancy and childbirth, check out the new game - "Who's Having This Baby Anyway?"

If you read only one article about childbirth, read this one!!

OUT OF THE WOMB, INTO THE FIRE - The Myth of the Safety of Hospital Childbirth

Even if you're planning a medicated hospital birth, this is the closest thing to informed consent you'll get, and you owe it to yourself and your baby to learn some of the realities that the hospital glosses over when they pretend "the drugs don't get to the baby".

Technology in Birth: First Do No Harm by Marsden Wagner. M.D. - a great discussion of the concept of appopriate technology and the folly of using technology as if it carries no risks.

Cesareans: Are they really a safe option? by Henci Goer - If you watched the recent segment on Good Morning America [June, 2000] addressing the safety of cesareans and the issue of a woman's right to choose this surgical procedure, you probably ended up feeling quite confused.

BirthChoiceUK - This non-commercial website helps women in the UK choose where to give birth using information about maternity care, maternity statistics and research-based information about childbirth.

Has the medicalisation of childbirth gone too far?
Richard Johanson, Mary Newburn, and Alison Macfarlane
BMJ 2002; 324: 892-895.

Getting What You Want from Your Birth Experience an article by Doris Haire

4 minute speech to convince you to have natural childbirth

Kim's Collection of Woman's Wisdom - great site for inspiration and self-education.

Mother's Intention: How Belief Shapes Birth by Kim Wildner

Reports on Birth Preference Options - This page contains reports, free for personal use, that explain the origins of the interventions often found on birth plans, their rationale & medical indications for use, and the scientific evidence either supporting, or not supporting, their routine use.  From Women's Wisdom,

What is Fearless Birthing™? - It is a program of self-discovery. It is nothing short of a map to the place where mother's intuition awaits. It is a way to access the 'instruction manual' that does come with each child!

My Words of Wisdom - a collection of articles, poems and opinions from Patti Blomme, author of the site Heads Up!  All About Breech Babies - Feed the Mother, Rest during Labor, Birth's Most Dangerous Enemy, The Missing Link, A Rant on Choice, The Chemical Symphony of Birth, She Could Have Died, Innocent Ignorance, Can you Homebirth in a Hospital, I Can Do It, A Father's Affirmation, Ode to An Epidural, Ode To A Home Birth, Little Wonder

Birthing the Easy Way -Learning the Hard Way - a book about birthing by Sheila Stubbs

Tips for Labor - A Midwife's Suggestions after Birthing Her First Baby by Joanna Baldwin, LM

A Father's Anger and Birth Love by Bill McCracken - "the time is coming where fathers will unite to stand up for their rights as the loving protectors of childbirth."  And Bill DID go on to have the birth he envisioned.

Online Birth Center

Evaluated Childbirth - a terrific site for women looking for support for natural childbirth

There’s no Place Like Home - The advantages – and joys – of giving birth where you live By Pam England, author of Birthing From Within

This is a fabulous article from Mothering Magazine:

Revealing the Real Risks: Obstetrical Interventions and Maternal Mortality
Issue 118, May/June 2003
By Marsden Wagner

I must applaud all of the women who try to find caregivers before they become pregnant.  They are more likely to find someone who "clicks" with them, than when those pregnancy hormones are flying and they just want to make a decision so they can feel that everything's calm.  At least, until they're eight months pregnant and push comes to shove about testing or induction.  Ask the hard questions early in care.

Visualization/Affirmation Poster

One of the best ways to help yourself have an easier labor and birth is to encourage the baby into the optimal position and to surround yourself with positive affirmations.  This is especially true if you have a care provider who ignores everything about your baby's position other than where the head is, or if your care provider is full of doom and gloom, always focusing on the negative possibilities.  This Visualization Poster is truly inspired and inspirational - it can be ordered from a U.S. distributor, Birth With Love, either plain paper or laminated.

Become Educated Parents so you can make Conscious Choices for your children

Laurie's Online Bookstore has a very nice list of books that will support you in your decision to make conscious choices about your children's care.  If you don't know what your choices are, you don't really have a choice.

You can ask questions from The Midwife Pro (Midge Jolly, LM, CPM) (formerly at Moms Online - oxygen.com)

The Compleat Mother - The Magazine of Pregnancy, Childbirth and Breastfeeding - This quarterly magazine is a wonderful source of affirming information and support for following a path that is in your family's best interests, even if it's different from the mainstream path.  They also offer some absolutely wonderful publications, "Birth Pleasure", "Birth Joy", and "Breastfeeding Anyway".Two of these are described on the web pages, or you can order them in bulk (10 for $20 + $3 shipping) from jody@minot.com

At BabyCenter.com they take weekly polls. Out of 5,717 respondents to the question: "Will you use drugs during childbirth?" 66% said yes, and 33% said no.

In a separate question, 15% of 2,888 women who planned an unmedicated birth actually had one.

If you're serious about wanting an unmedicated birth, make sure you're setting yourself up for success - hire a supportive practitioner and a doula and choose a birthplace where you know your choices will be honored.  Personally, I think homebirth is the easiest such situation to arrange, but some women can make hospital birth work for them, too.

As you're making your birth choices, keep in mind both your own experience and your baby's experience.  Here's a terrific picture of a baby that is halfway born looking absolutely ecstatic.  Here's more information about the baby's experience of birth.

Your baby really does care about his or her birth experience!

TLC's A Baby Story sometimes has homebirth or birth center birth stories that can give prospective parents an idea of how they contrast with the standard high-intervention hospital birth.

Baby McGlynn - Twenty-five years after getting married and raising four children, Jack and Karen McGlynn are expecting again. At 43, Karen's desire for a natural home birth makes for a tricky delivery, but they know they can make it as long as they're together.

Baby Armstrong - Barry and Brenda prepare their two sons, Brendan and Brian, for the birth a third boy by painting a welcome home sign and attending a baby shower. The baby gets yet another B-name, as Blake is born in a water tub at a birthing center.

Baby Johnston - Both previously married, Julia and Ross are expecting their fifth child. This close-knit family home-schools and will all participate in the home birth with a midwife in attendance.

Baby Panec - Keri and Elliot commissioned an artist to create a unique nursery for their first child in their brand-new home. For the water birth, Elliot climbs in the tub with Keri to offer support during the labor and to watch with joy as their son, Eric, is born.

Baby Rachwal - Steve, an art director, and Karen, a professional storyteller, have arranged their careers for the tag-team parenting of their daughter Hyla and their new baby. They are planning a home delivery, complete with birthing tub, midwife and labor assistant.

Baby Herren - When Kathleen met Bill, they were stunned to discover they shared the same last name; but they also shared a commitment to traditional family values and their faith. This match made in heaven will give birth to their second child at home.

Baby Andrews - After deciding on a natural home childbirth, Robin and Ryan attend breastfeeding class and Robin checks out cloth versus plastic at Dydee Diaper Service. With 15 family members present for the painful natural birth, Ivy Rae is born at home.

Baby Bagnell - Chiropractors and parents Larry and Karen Bagnell believe in living life naturally with minimal medical intervention. They will apply those beliefs to the birthing process with a drug-free labor and delivery at home.

Baby Morgan - This unconventional couple prepares for their first child by hiring a body-cast sculptor to commemorate the birth. Then, they visit their pastor to plan the non-denominational christening before Sierra Rose is born by natural water birth.

Schedules for A Baby Story for the next month

What Does Safe Motherhood Mean? - Safe Motherhood in the USA means that no woman should die or be harmed by pregnancy or birth.  from Safe Motherhood Initiatives-USA

Lists, lists and more lists - a great list of lots of different support lists.

Why Have Natural Childbirth? - an essay written by a mom who found her birth experience wonderfully transforming.

Drugs in Labor - Why aren't We Screaming? - How do drugs in labor affect your child's intelligence, motor development and socialization?

Natural childbirth options - even CNN is jumping on the midwifery bandwagon

Five Good Reasons to Delay Clamping the Cord - Hospital personnel have their agenda based on schedules and check-off lists, and it's unlikely to be in synch with your agenda to take advantage of those special birth hormones that give your baby a once-in-a-lifetime chance to bootstrap the way nature intended.  Delaying clamping of the cord is your biggest ally in keeping the baby with mom ?smile>.  I don't know if nature anticipated obstetricians, but the umbilical cord was certainly a clever way of giving them a hint that the baby is meant to stay with the mom after the birth.  Too bad they've not gotten it quite yet.

Don't Cut The Cord! - a great summary article with tips for parents planning to give birth in the hospital.

Risks of Premature Cutting of the Umbilical Cord, with some tips on encouraging the hospital staff to provide the best care for your baby.

Birthing from Within - 

This Book is Absolutely Terrific and All the Rage!

There is a great new book available called BIRTHING FROM WITHIN by Pam England and Rob Horowitz that addresses birth as an emotional and spiritual process.  Pam was my childbirth educator and one of my midwifery mentors. I can attest to her wisdom and to the transformative nature of her childbirth prep classes.  [They have a Web site with information about courses for educators and parents.]

Independent Midwifery in the UK

Bornfree!  The Unassisted Childbirth Page - When I first heard about the unassisted childbirth movement, I was dumbfounded.  It sounded so terrifying, so risky, almost irresponsible even to consider it!  Then I read the book.  Wow!  What a gift Laura Kaplan Shanley has given us.  [More about Unassisted Childbirth]

If you want to buy a video that you'll want to watch over and over again to see how calm and relaxed this mom is, check out the DVD, Psalm & Zoya - The Unassisted Homebirth of Our Twins.

Although this family arranged to have a midwife attend their birth, the babies came before the midwife could get there.  Both parents (and the older sibling) are amazingly calm, even with the footling breech.  If pregnant women watched this video every day of their pregnancy, they'd have a very different view of labor and birth!

I also think it's really important for all midwives to see footage of at least one unassisted birth, and this particular video has it all!  Here's a blurb from the web page, but I'll add "Breastfeeding an older sibling during labor".

· A vertex birth
· A footling breech birth
· Use of a “birth ball” during labor
· Mother performing her own vaginal exams
· Mother catching her own babies
· A child present at birth
· A calm birth environment
· Birth sounds
· Smiles and laughter during labor
· Breastfeeding of twins

What an eye-opener.  Well worth the purchase price!

Delivery Room Tragedy - Dangers of Vacuum Extractors

ABC's 20/20 did a piece on the dangers of vacuum extraction, which is preferable for many reasons to a cesarean in the case of a difficult birth.  However, this piece and mainstream medicine completely ignore the superior alternatives:

"BIRTH CONTROL - When did the movement to empower pregnant women to make informed choices turn into a guilt-laden cult?" by Nina Shapiro.  This controversial article about epidurals and other drugs for labor generated a number of responses that may help you to figure out what you really want your labor to be about.  This copy of the article is hosted at a very interesting French site (with articles in English) called Sorceresses Reborn.

OUT OF THE WOMB, INTO THE FIRE - The Myth of the Safety of Hospital Childbirth
(A Response to Nina Shapiro’s article "Birth Control" in The Seattle Weekly, November 26, 1998) by Jock Doubleday

If you read only one article about childbirth, read this one!!

Even if you're planning a medicated hospital birth, this is the closest thing to informed consent you'll get, and you owe it to yourself and your baby to learn some of the realities that the hospital glosses over when they pretend "the drugs don't get to the baby".

Choosing An Obstetrician or Midwife: What is the difference? by Suzanne S. Powell, ICCE

Association of Texas Midwives' Daily Gestational Age and EDD Calculator - This is easier to read than "the wheel" for some people.

Giving Birth: Challenges and Choices (1998, 35 min, color, stereo) A model for normal childbirth, addressing popular misconceptions and hospital routines, focussing on issues of pain, fear, midwifery, doulas, babies; featuring Dr. Christine Northrup, OB.   By Suzanne Arms

Yvonne L. Crynn's site The Midwife and Home Birth, including Midwifery/Homebirth Articles and information about the video, Home Sweet Homebirth- This site is intended to help you educate yourself and others about the choice of midwifery and homebirth. Families need to be aware of birthing options.  Midwifery is a model of care which includes good nutrition, skillful midwifery, natural childbirth, homebirth and breastfeeding. Also available in Spanish - LA PARTERA Y PARTO DOMICILIARIO

Mother of Six Writes Passionately About Birth - Read This if You Want To Learn the Truth About Birthing

[Ed: birthlove.com is not available at this time.]

BirthLove - The Revolutionary Passion of Mothering - For a really eye-opening account of birth, read this mother's thoughts on birth.  She's got lots of great short articles and wonderful links.  For wonderful support during pregnancy, subscribe to her BirthLove newsletter!  [As of spring, 2002, the BirthLove site is by subscription only - it's well worth the $10 membership fee; you can get a "sampler" by reading BirthLove's Top Twenty- For Free!.]
The passion of mothering is not a New Age idea; it's a Stone Age absolute.

Deep within us is a fantastic pulse of ferocious love: it binds us to our babies, and makes us vigilant in their lifelong care. This pulse has been eroded by the institutionalization of many basic life events; most significantly, childbirth and learning.

Instead of ancient mothers selfishly guarding the individual loves and virtues of our children, we become modern custodians for the state - breeders and caregivers of an easily manipulated populace. Women must once again claim birth as a powerful, liberating life event- instead of a painfully medicalized one; and families must allow themselves to learn and stay together in the short time they have- and shun the bizarre lessons in life given by often hostile institutions whose main focus seem to be that of severing families and crushing true intelligence.

It is revolutionary to reject what society so stringently dictates, and revel in being Mother: not as a producer of marketable goods, but as the conduit of life itself.

Leilah's web site includes a fun, humorous article, What I Can Expect When I'm Expecting (which is always) - written while pregnant with her eighth child - just one of the many excellent articles from her Birth Love Columns in the Online Birth Center News.  She also has a new book available - "Resexualizing Childbirth" - A collection of essays by Leilah McCracken

One of Leilah's most recent pieces, Being Born Blessed (born in the rain), is well worth the small membership fee.  Or . . . thanks to her generosity, it is also available at gentlebirth.org

Citizens for Midwifery

Midwifery in Canada

Welcome to the Labor of Love An Internet Community Built by Parents for Parents 

Options for Childbirth - Hospital, Birth Center, Home
A woman gives birth the easiest where she feels the most comfortable.

Gentle Birth Alternatives - Links to Great Web Sites

The Midwifery Link, a resource guide for finding midwifery, doula, parenting, vaccination and related issue information on the Internet.

Alternative Birth Resources - at Robin Elise Weiss' pages at The Mining Co. 

Home Birth Resources -  at Robin Elise Weiss' pages at The Mining Co. 

Water Birth Resources -  at Robin Elise Weiss' pages at The Mining Co.

The Birthing Options Page

Father's World Web Ring

The advantages and disadvantages of homebirths, birth centers, and hospitals

Is Homebirth For You? 6 Myths About Childbirth Exposed
Online version of a pamphlet created by the now-defunct Friends of Homebirth in Texas.

Mother Friendly Childbirth Initiative

Baby Friendly Hospital Initiative

A Nurse Speaks Out About Hospital Care - she shares her frustrations with assembly-line birth and the crazy economic pressures that result in suboptimal maternity/newborn care.

What price for a perfect delivery?  - The importance of continuity of care is highlighted in this article from the UK.  I'm amazed that it considers a three-midwife group to offer "continuity of care" though!

Our culture tends to be very undereducated about the importance of sensible postpartum recovery.  Women bounce back much more quickly and easily when they are pampered for the first few weeks.  And new babies are less likely to have colic.

Here's a good book to read BEFORE baby comes, because you'll be too busy afterwards:

The Keys to Postnatal Rejuvenation

How to Avoid Colic, Avoid Postpartum Depression, Experience Deep & Profound Rejuvenation
"Many cultural traditions use the same principles after childbirth, the ones which statistically don't have problems. The language is the same - mothering the mothers with TLC, warmth, oiliness (internal and external), massage, simplicity, moisture, favoring sweet, sour and salty tastes, specific foods, freshly cooked (not raw) soupy foods, herbs, and of course rest - these are keywords to favor. The details even of these considerations are significantly more under guidance (and communication with/advice of your primary care provider is essential with pre-existing medical conditions)."

The Trials of the Midwife
by Katie Granju - From Minnesota Parent, October 1997
A must-read article for anyone trying to understand why the healthcare system in the U.S. continues to snub the midwifery model, despite reduced Cesareans, proven safety, and lower costs. 

The State of California Access for Infants and Mothers (AIM) Program is a new program. It provides low cost health insurance to pregnant women and their infants who are not eligible for no-cost Medi-Cal or health insurance. The pregnant woman will choose a health plan that serves the area she lives in. The AIM Program is part of California's efforts to increase health care for mothers and their infants.

Access for Infants and Mothers Program (AIM)
c/o Healthcare Alternatives
P.O. Box 15248
Los Angeles, 90015
The AIM program provides health care to pregnant women with no
health insurance for their pregnancy and who are not receiving health
insurance through Medi-Cal.

The State of California, Managed Risk Medical Insurance Board (MRMIB) office performs outreach for the Access for Infants and Mothers (AIM) Program - low cost health insurance for middle  income pregnant women.

Medical Patient Modesty, a non-profit organization to promote stronger medical patient modesty.  They have a directory of all-female OB/GYN practices.

Evidence-Based Medicine

See also: Online and Offline sources of information

Viva La Evidence - great YouTube video by James McCormack - a song all about evidence based healthcare
You won't be sorry you took the 4 min. to watch this video!

New for 2008 / 2009! a new report, Evidence-Based Maternity Care: What It Is and What It Can Achieve.

The report takes stock of the U.S. maternity care system, identifies many opportunities for improving the quality, outcomes, and value of maternity care, and presents policy recommendations.

Understanding Evidence-based Healthcare - This web course has been created by the United States Cochrane Center as part of a project undertaken by Consumers United for Evidence- based Healthcare (CUE), and is designed to help consumer advocates understand the fundamentals of evidence-based healthcare concepts and skills. Registration is open and free of charge.

The FP Revolution - The Family Practice Newsletter - The new web-based source of contemporary information on primary health care for professionals and consumers. Sponsors of the novel health care e-zine,  - Dr. Colin Kopes-Kerr continues "to scan, review, analyze, and promulgate those sources of clinical information that I believe to be most practical, most cost-effective . . . "

The Death of Evidence-Based Medicine? - June 12, 2002 - "The New England Journal of Medicine will announce Thursday that it has given up finding truly independent doctors to write and review articles and editorials for it, as a result of the financial ties physicians have with so many drug companies in the United States. The Journal says the drug companies' reach is just too deep."

Evidence-Based Medicine Simplifies Practice [Medscape registration is free.]
Evidence-Based Medicine: Here to Stay or Gone Tomorrow?  [01/04/2005 - Medscape registration is free.]

There seems to be a new movement towards educating parents about the practice of "evidence-based medicine"; this means that practitioners make recommendations based on medical research, rather than on concerns about liability or "the way they've always done things".

There seem to be more and more books that focus on evidence-based medicine instead of simply telling you what your practitioner is likely to recommend.  I think this trend is very beneficial for the well-being of mothers and babies and for consumer rights and advocacy.

Here are some good books about Evidence-Based Medicine:

Obstetric Myths Versus Research Realities: A Guide to the Medical Literature - This is the book that seems to have started this whole movement.  It's very technical and perhaps best suited to healthcare practitioners or childbirth professionals.  [Based on this work, we can no longer say that a great deal of American obstetric practice goes forth without adequate research. It is now more accurate to say that many interventions are used routinely or frequently in spite of research that has clearly shown that the procedure is being used inappropriately in this country." - Judith P. Rooks, CNM, MPH - Midwifery & Childbirth in America (1997)]

The Thinking Woman’s Guide to a Better Birth by Henci Goer - Practical recommendations for better births based on recent obstetric research.  This book is a joy to read, and it provides lots of good, solid, valuable information.   ***** FIVE STARS *****  You can also read Henci's articles about When Research is Flawed: Critiques of Influential Research Studies by Henci Goer

Pregnancy, Birth and the Early Months by Richard I. Feinbloom M.D. - This is a very common-sense book that manages to avoid a lot of the emotion about different birthing philosophies.

Care Practices That Promote Normal  Birth from the Lamaze Institute for Normal Birth

DRUGS NOT FDA APPROVED FOR OBSTETRICS - There have been no adequate and well-controlled studies to determine the delayed, long-term effects of the drugs listed below on pregnant women or on the neurologic, as well as general, development of children exposed to the drugs in utero or during lactation. Such use is defined by the FDA as "off-label" use.  This list includes fentanyl, morphine, terbutaline, Cytotec (misoprostol), Duramorph, Narcan (naloxone), Prostin E2 (dinoprostone), Vistaril and Xylocaine (lidocaine hcl).

Munchausen Obstetrics - The American Way of Birth: Trauma and Brain Damage (excerpt from a letter to a legislator) by Rich Winkel

Health Care Consumerism

What You Should Know About Filing Your Health Benefits Claim - If you are an employee or family member of an employee who receives health benefits from a health plan provided through employment in the private sector, a Federal law, the Employee Retirement Income Security Act (ERISA), protects you. Among the protections, ERISA sets standards for administering these plans. Those standards require plans to give you important information about the plan and to have a fair process for handling benefit claims.

How Using Our Power as Consumers Could Change Maternity Care Forever by Sarah Clark [1/15/16]

Weighing Your Health Plan Choices - Consumer Reports, Sept., 2005 - the Overview is available for all to read. [You must pay to subscribe to Consumer Reports Online.]  This article has a later section - How to appeal denials of care

The Secrets of Medical Decision Making: How to Avoid Becoming a Victim of the Health Care Machine by Oleg I. Reznik
This book will help you understand all the forces at work behind the recommendations you get from your healthcare providers.  A must read!

Health Choices from Consumer Reports - Use our Health Plan Report Card and Recognized Physician Search Tool to ensure that you and your family are receiving the highest-quality health care available in your area.

A Consumer Guide to Handling Disputes with Your Private or Employer Health Plan - Kaiser and Consumers Union have a great set of web pages about Consumer Rights and Health Insurance.

Consumer Reports Medical Guide - Compare disease and drug treatment options

12 Phrases Said to Birthing Women that Steal Our Power and How To Change the Conversation

RealAge.com - Information about avoiding disease, the effects of aging, and medical errors.

WebMD.com - Recommended by Consumer Reports for health-related tools.

The Pricing of U.S. Hospital Services: Chaos Behind A Veil of Secrecy [Medscape 01/12/2006

How Childbirth Went Industrial:  A Deconstruction by Henci Goer

Among the many good reasons for seeking an out-of-hospital birth, one reason is to avoid infection. It turns out that hospital infections are a growing, but hidden problem. In fact, in most states you cannot even find out how your local hospital stands regarding infections.

The organization Consumer Union is working to do something about this problem.  You can read about their Stop Hospital Infections campaign at:

She Births: A Modern Women's Guidebook to an Ancient Rite of Passage


The Cato Institute's Policy Analysis #246: "The Medical Monopoly: Protecting Consumers or Limiting Competition?" by Sue A. Blevins. 


Raising your child in a toxin-free world - Four Steps To Organic Motherhood - . . . Katie and Mic LeBel knew they wanted to raise their children in an environment as free of toxins as possible.

Selecting an Insurance Plan

I had Kaiser in the SF Bay area. I have heard it varies depending on where you are, but I sure wouldn't recommend them around here.

I have Kaiser in southern California and while I was only pregnant for 13 weeks before my miscarriage, I have no complaints about my prenatal care whatsoever.  I also felt that except for the one OB who tried vehemently to persuade me to miscarry naturally (instead of having a D?C), the midwives, OB's and OB Nurses were all wonderful.

This has been my experience as a labor coach.  If you're high risk and need to be in a hospital, Redwood City Kaiser is my all-time favorite, now that they've got "almost" full-time midwife coverage again.

Statistically, the safest births are those with the least intervention, so they're also going to be the cheapest.  This puts the HMO and the consumer/client/patient on the same side in terms of wanting to avoid interventions.  This is so different from the non-HMO hospitals, where they make more money by doing more procedures and by extending the hospital stay.

I've labor coached three births at Kaiser-RC and had great experiences all three times.  In fact, two of those births are the all-time best hospital births I've witnessed.  The staff was very respectful of the parents' wishes for a calm, quiet, gentle birth, and they came through beautifully.

They were even supportive of the parents' desire to delay the newborn screen (aka PKU/heelstick) until the sixth day, when it's more accurate.

When you're shopping around, make sure to ask lots of questions about the things that are important to you.  If you're looking at Kaiser, ask your local Kaiser hospital how many midwives they have on staff, and whether there are gaps in the coverage.  If you're considering other insurance plans, ask whether they cover doulas or other professional labor support.  If you want to make sure you have as many options as possible, also make sure they cover homebirth.

And, be sure to get it in writing.  ?smile>

From: C-upi@clari.net (UPI)

Subject: Consumers' report makes hospitals improve

Organization: Copyright 1997 by United Press International

Date: Tue, 18 Nov 1997 8:35:06 PST
UPI Science News

WASHINGTON, Nov. 18 (UPI) -- Getting hospitals to wake up and improve their services may be as simple as publishing a consumers' report.

Missouri researchers released a study today showing that overall, hospitals offered more options with better outcomes just a year after the release of a comparison of care for pregnant women.

Daniel Longo (``LONG-goh'') told a meeting sponsored by the American Medical Association today that a shoppers' guide put out by the state health department lowered the rates of cesarean sections. Longo and colleagues found that within a year C-sections had dropped 6 percent in places the consumers' guide noted as high-rate hospitals.

Longo, from the School of Medicine at University of Missouri in Columbia, says many of the more limited hospitals beefed up services to match the competition. Half of the places the report identified as lacking follow-up programs filled that gap within a year. A third of the more limited hospitals added a nurse educator to coach breast feeding. And 43 percent of the hospitals without car seat programs offered one by the time Longo surveyed.

The researchers also found that zestier competition cut health costs. Longo found that improvements in ultrasound use and C-section births, first-time and repeats, saved some $2 million in just one year.

A 1992 Missouri law required the health department to start publishing these hospital consumer reports. Longo points out that a new consumers' report, on emergency rooms, is scheduled for release Friday and that the researchers plan to track its effects.

However, the obstetrical analysis, published in the Journal of the American Medical Association, has already made Longo a believer in the reports' power. He says, ``My advice to people in other states is, if you don't have one, talk to your politicians.''

Bizarre Hospital Attitudes Towards Consumers

I think that the attitude toward women in the hospital is totally bizarre considering what you would reasonably think you would get in an enlightened democracy like America. You would think, being in a country where we are all consumers and you can "have it your way at Burger King" and where everyone believe their rights are important and we all talk about not being racist and not being unkind....how is it that women can go to a hospital where they ought to be honored and well cared for, and they get etc.

Not to say this always happens, but the trend is, you go to have your baby, it's supposed to be a painful but happy occasion, but once you get in the hospital you quickly learn that You personally have no rights. The reality, at least the way I heard it from the doctor at the meeting I went to, is that the hospital staff and doctors can do to you whatever they feel like doing, and say it was medically justified, and they don't feel they have to answer to anyone. And then you go home and get the bill for this baloney.

Resort-style Maternity Care

I seem to be reading more and more about how hospitals are trying to attract more birthing women by offering deluxe accommodations and food.  I actually find this a disturbing piece of evidence that birthing is big business and susceptible to all the weird forces associated with money and power.

Henci Goer's Letter to the San Jose Mercury News, 6/24/05

To the Editor:

Choosing where to have a baby based on whether it offers afternoon tea (Moms Feted Like Royalty, Mercury News, June 21, 2005) is like choosing a car because you like the cup holders instead of on crashworthiness. The savvy woman has more substantive issues. She wants to know:

What is the cesarean section rate? A cesarean is major surgery with all that implies in terms of pain, recovery time, and hazard, especially hazards for future pregnancies. Research shows that cesarean rates should be less than 15%.

How often is labor induced? Research does not support the principle rationales for inducing labor. Among other risks, induction doubles the likelihood of cesarean surgery in first-time mothers.

What percentage of women have epidurals; what comfort measures are available? Where most women have epidurals, other options tend to disappear. A host of potential complications follow in the wake of having an epidural and the other interventions that an epidural makes necessary. The same is not true of comfort measures such as tubs, showers, birth balls, and rocking chairs.

What are the usual practices for laboring women? Research shows that continuous electronic fetal monitoring, routine I.V.s, denying oral intake, breaking the bag of waters, confinement to bed, pushing and giving birth while lying on the back, and episiotomy—cutting the vagina to enlarge it  for birth— offer no benefits but have harms. The episiotomy rate should be 10% or less.

How do you promote successful breastfeeding? Among other measures, hospitals supportive of breastfeeding keep mothers and babies together day and night, do not give babies water or formula, do not give babies pacifiers, and do not give out formula samples.

How do you ensure my right to informed consent and informed refusal? Any advocate for normal birth who works with pregnant or laboring women can recount story after story where women were given inadequate information, no information, or misinformation or were pressured into consent. Denying vaginal birth after cesarean, which forces women to agree to cesarean surgery in order to obtain medical care, is the most salient example of this, but it is only
the tip of the iceberg.

Henci Goer

Henci Goer's latest book is The Thinking Woman's Guide to a Better Birth. You can find out more about her and her book at http: Previously appearing on ParentsPlace.com as the "Birth Guru," she is now a resident expert on Lamaze International's website, the Lamaze Institute for Normal Birth, at http:

Support Groups

MotheringDotCommune Forums at Mothering Magazine

EmpoweredChildbirth · Birthing in Love and Wisdom (A Yahoo Group)

20ishAPPregnancy  - Pregnancy list for young mothers interested in practicing attachment parenting. Topics of discussion may include gentle and low internvention methods of birthing, including midwife assisted and homebirthing, breastfeeding, herbal and homeopathic medical treatments, non-circ'ing, non-vacc'ing, vegetarian and vegan living, and other alternative, natural life styles

Yahoo! Groups homebirth list

Homebirth Email List at kjsl.com - This forum is for anyone who is interested in supporting and learning about homebirth.

Yahoo! Groups Birthdates - groups of women due or babies born in certain time periods.

A Little Humor

A Comment on Natural Childbirth, including mention of the "Steiger curve" of penile performance.

A Thanksgiving Dinner to Remember -  some more humor about a medicalized family event

Labor As a Car Ride

Mother Care, Whelping Information & Beautiful Canine Birth Pictures! from Mari-May Kennels.  This is a great description of how to provide hands-off labor support for dogs, and it's amazing how much of it applies to humans, too!

How to Support Midwifery

See also:  General Midwifery Advocacy

This brief essay, "Midwife Leaves Illinois After Legal Harassment" helps illustrate what may happen to the good midwives in your state, province or country if the birthing families and caring citizens don't support them.

You can donate money to Citizens for Midwifery by just spending a few minutes on-line.  Check out:  www.iGive.com - CfM is listed with organization and receives money everytime one of us visits the site.  Just by signing up and designating CfM as your charity of choice, CfM receives $2.00.  Then CfM gets 10 cents everytime you visit and make ten quick clicks after that.  You don't have to spend anything to make a donation to our cause.

Join a Midwifery Organization

The Midwives Alliance of North America (MANA)  is an organization of North American midwives and their advocates. MANA's central mission is to promote midwifery as a quality health care option for North American families. Print our their membership form to join.

Citizens for Midwifery - print out the membership form at the bottom of their online brochure to join.

Coalition for Improving Maternity Services (CIMS) - help circulate the The Mother-Friendly Childbirth Initiative or volunteer to serve as a liaison for getting a local birth service designated as mother-friendly.  [Mother-Friendly Childbirth - Highlights of the Evidence]

Contact your local midwifery organization and ask how you can help.

Recommend Books to your Local Library

Recommend your five favorite birth and midwifery books to your local library.  If you have the resources to purchase and donate them yourself, so much the better.

Lobby with Your Employer for Better Midwifery/Homebirth Coverage

If you have health care insurance provided by your employer, talk with people in your human resources or personnel department to ensure that your insurance covers midwifery and homebirth care.  If not, provide the necessary information to help educate them that midwifery/homebirth care offers better outcomes and significant cost savings.

You might also point out to them that homebirth saves the insurance company (and ultimately your employer) lots of money, so they should consider covering it at in-network rates even for out-of-network providers, or actively lobbying homebirth midwives to join their network.

I *always* talk about my positive birth experiences, make sure women know their opinions, answer any questions Im asked (normally after I've asked them leading questions ;-)  !!!) and stayed involved in my local hb assoc so other women continue to have info / access to the same services I did.   Other little things I did were put home birth stickers on my car bumper, added a "I was born at home" badge to my nappy bag and also I've made up a carry bag that has my HB assoc logo and "Home Birth Naturally" on it which I use for shopping etc.-  this gets *lots* of looks in the street and I can see them reading and then looking at normal me!   This has gone down so well that my HB assoc has decided to take on the idea and we are next month making 100 of these for free gifts to homebirthing mums in our area!

Midwifery Stamps - U.S. Postage - This doesn't really support midwifery financially, but it helps to recognize the work of two women who have left their mark on midwifery:

Mary Breckenridge adapted the British combination of nursing and midwifery to serve the rural poor of Appalachia through the Frontier Nursing Service, which she founded in 1925.  These 77-cent stamps are postage for 3-ounce pieces, which is exactly what my intro. packets weigh.  What better way to send them than with Mary Breckenridge?

Virginia Apgar, a doctor, developed the Apgar system for assessing a baby's condition at birth.  The scoring system is somewhat outdated, but she was one of the first, possibly the first, whose name was used to coin a birth-related term.  It's such an irony that so many of these birth-related terms have mens' names attached to them, totally ignoring the thousands of midwives who preceded them.

Include Midwifery Support Quotes or Statistics in Your .sig File

Most mailer software allows users to customize their .sig file, the little bit of text which is automatically appended to every outcoing piece of e-mail.  It's generally acceptable to include some short form of personal expression in this text.

Some Possible Examples:

The risk of neonatal mortality (an infant death occurring in the first 28 days of life) was 33 percent lower for midwife-attended births compared to physician-attended births with comparable risk factors.  (Midwifery care, social and medical risk factors, and birth outcomes in the USA, J Epi ? Community Health, MacDorman M, Singh G, 1998;52:310-317)

It is much more difficult for obstetricians to defend high-technology, high-intervention obstetrics when midwives and a few doctors are meanwhile showing that a much less expensive type of maternity care is equally safe. -- Marsden Wagner (World Health Organisation maternity specialist.) Editorial in The Lancet.

The World Health Organization (WHO) states that the preferred location for most births is outside the hospital, either at home or in a birthing center, and that out-of-hospital birth should be implemented and maintained as the basic standard for all midwifery education and training programs.

From the CDC bulletin: National Infection Control Week is October 18-24 (1998).  Each year, approximately 2 million patients develop a hospital-associated infection, and an estimated 88,000 patients die as a direct or indirect result of such infections.

Dr. DeLee, who introduced forceps and episiotomy around the turn of the century, stated just before he died that if he had his whole life to live over he would do home births and nothing else, realizing that the majority of his work was probably going to do bad instead of good.
        -Mayer Eisenstein, MD in Safe Alternatives in Childbirth

More facts available from the Citizens for Midwifery Fact Sheets

Send more suggestions for this list.

Routine Hospital Procedures

A listing of routine hospital procedures with links to pages that analyze each procedure.

Association of Nurse Advocates for Childbirth Solutions  - WWW.ANACS.Org - "We foresee a time... when all childbirth professionals will support women in their childbirth choices and nurses will all practice evidence-based maternity nursing and actively facilitate childbearing women to have the most optimal birth with as few interventions as possible."  Parents can join this organization and further their own goals by supporting and participating.

Tips for Labor from an OB Nurse

"Birth as an American Rite of Passage" is a book by writer and medical anthropologist, Robbie Davis-Floyd. Dr. Davis-Floyd is renowned for her research in the field of birth.  This website decodes the messages conveyed by hospital birth rituals otherwise known as "standard procedures for normal birth". These ritual procedures, common in many American hospitals, make birth appear to conform to the technocratic model and babies appear to have been produced by society. Each procedure is explained in detail in the body of the chapter.

Gracious Births by Judy Edmunds - a midwife contrasts her experience of home labor, hospital birth and homebirth.

I have delivered two babies in the past two years and both naturally (no drugs or interventions). I see you are getting advice about having a "birth plan" so I thought I would share with you that one of the best things we ever did was NOT have a "birth plan" but rather a "Birth Preferences" sheet. Honestly I know it sounds stupid but my doula suggested it and even my OB commented on how that language is so much less off putting to hospital staff.

One more step in the non-offending birth plan / preferences is to not show the staff what you've written down.  We simply discussed what we wanted with our OB during regular visits, and my husband and I were clear with each other on what we wanted.  I wrote down a sheet of my preferences (see Ina May's Guide to Childbirth... it helped me immensely), and made sure my husband had a copy.  It was for him to be able to stick up for us, not to give the staff (which could potentially annoy them).

Other things I'd echo from what others have said: make sure someone sticks to your child like glue from the moment they're born.  We asked for our child's hands to not be washed, but my husband noticed that the nurses kept trying to distract him or get him to leave while they gave dd her bath.  And be very clear about all the ointments and shots... they will try to persuade you.  Regularly and often.  It gets really annoying.

Just remember that when you go into a hospital, the staff has habits and routines which work for most of the people who come through.  So if you want something different, you really need to go in knowing that you're challenging a system, even if it doesn't seem like that big of a deal to you.  Every time there's a shift change, there will be  someone new who will notice that you haven't done X, and they'll ask you about it.  It's all a part of their hospital routine.  You just need a plan for how you're going to remind them that you're different.

There's a list for women who have suffered birth trauma, i.e. birth experiences so traumatic that it continues to affect them very seriously - BirthTraumaSupport@egroups.com.  This exchange may help women to appreciate the importance of the choices they make:

I am a childbirth educator and work very hard to get people to plan their births and have dialogue with their care providers. I encounter families that just walk in and lie down, and let the doctors do what they will. Such a setup for misery. What can I tell people that will help them to see that birth matters, that the choices that are made affect the outcome, that technology has risks?

My opinion is to tell them that the #1 thing Dr's do when you just, as you say, "come in and lie down", is they automatically give you the birth THEY want. By that I mean they put your labor and delivery on THEIR schedule. They will induce you so they don't miss their kid's birth day party, they will break your water and strip your membranes, give you pitocin, etc.... until your healthy and normal labor becomes something very rushed, medical, unnatural and extremely controlled. There becomes NOTHING beautiful and natural about it. And, if they are busy and impatient, (which they always are), then instead of letting you pass your placenta naturally, they will push on you, yank on your cord, and rip it out as if you could never do it for yourself because somehow they render you helpless and insufficiently equipped to do what women have been doing without all this "help" since the beginning of time. That's what I would tell them. Knowing what you want is only half the battle. Having someone to ENFORCE your wishes in the midst of all the medical intimidation is the other half. So in two words I will tell you what the key is..... TRUSTED DOULA

I disagree.  To ask a doula to take on the responsibility of fighting your battles for you is unfair.

If you don't want to be induced, hire a midwife or doctor who doesn't induce labor. If you don't want electronic monitoring, don't go to a place where that is standard while you're in labor. If you don't want the placenta "delivered," hire someone who doesn't do that.

It's highly unlikely that you can, while giving birth, also manage to convince some L & D nurse that everything she has been taught to do is wrong. Much easier to just hire someone who agrees with you in the first place. The likelihood of negotiating a homebirth in a hospital is pretty slim.

Shame of it is many do hire people they think will respect their wishes, but when push comes to shove they say, "It must be done for safety sake."



Ten Questions To Ask Your Neonatologist

Patients' Rights

See also:  Legal Issues - Informed Consent

Midwives Code of Professional Ethics from Artemis House

Language as an illegitimate tool to control reproductive biology in healthy CB women
[6/19/14] by faithgibson - You’re Not Allowed to ‘Not Allow’ Me

ICEA Statement on Informed Consent

Getting a stubborn patient to say Yes - an article written by and for OBs about how to coerce laboring women to agree to routine treatment.

The Issue of Informed Consent:By Katherine A. Dettwyler, Ph.D., Associate Professor of Anthropology, Texas A?M University, Specialist in Infant Nutrition 

The New Zealand College of Midwives statement on Informed Consent.

The Code of Health and Disability Services Consumers' Rights from New Zealand.

If your paycheck has SDI taken out every time, then you are eligible for state disability insurance AND paid family leave.  You can read about California disability.  Along the left side are links for benefits, eligibility, etc. etc.  In short, you can start 4 weeks before your due date, then they pay disability for 6 (vaginal) or 8 (C section) weeks after your delivery date.  As someone said, if your baby is early, you lose the extra time.  But if your baby is late, you get extra time.  When your disability time is up, you are then eligible for 6 weeks of paid family leave (PFL).  They will automatically send you the forms near the end of your disability period.  Both pay only 55% of your salary up to a maximum of $987 per week.  And the first week of disability is unpaid, but you can use your sick leave or vacation from work to cover it if you have enough.  There is no separate 7 day period for the paid family leave, it kicks in right away.


What are the Benefits?
What are the Risks?
What are the Alternatives?
What does your Intuition tell you?
What if we do Nothing?

12 Phrases Said to Birthing Women that Steal Our Power and How To Change the Conversation

Key Questions Card

Penny Simkin, wonderful woman and a major figure in ICEA and DONA, developed a business card size list for anyone who ever has a need to connect with any healers (THIS MEANS ALL OF US (G), but most specifically with the medical model. This card is: "Key Questions About Your Care" and can be ordered in packets of 10 for about $ .15 each from ICEA, PO Box 20048, Minneapolis, Minnesota 55420. I give them to all potential client contacts at our first meeting (not to mention family and friends)(G).

Being able to pull this card from your wallet when confronted with urgent or major treatment/test decision manages your mind and keeps the questions consistent throughout test/treatment discussions. A very upset or shy person could just hand the practitioner the card and ask that all discussion occur within that format. As a practitioner myself, I use it to organize my thoughts and keep my discussions complete, informed and consistent.

Key Questions About Your Care

Answers to the following questions will help you participate in your care responsibly and help you know what to expect.

When a Test is Suggested:

When a Treatment or Intervention is Suggested:
  1. What is the problem? Why is it a problem? How serious is it? How urgent is it that we begin treatment?
  2. Describe the treatment: How is it done? How likely is it to detect or solve the problem?
  3. If is does not succeed, what are the next steps?
  4. Are there risks of side effects to the treatment?
  5. Are there any alternatives (including waiting or doing nothing)?
  6. Ask questions 2,3,4 about any alternatives.
In an emergency it may be impossible to fully explore these questions. Your caregiver should tell you how serious and urgent the situation is.

Please order and disseminate the card freely....this is just another way to make for educated, informed people who may then choose midwifery care.

A Note to Providers from a Birthing Couple

Simply substituting your will for that of a client is wrong no matter how much harm you think you are preventing or benefit you are providing. Simply doing whatever a client wants you to do in the face of your convictions and knowledge is equally unacceptable. The solution is to educate your clients as best you can and then let them choose. They have to live with their choice --you don't unless you choose to implement it.

Clients cannot be expected to know what no one is teaching them.

Patient's Rights - Pregnant Patient's Bill of Rights

"The Pregnant Patient has the right after appropriate medical consultation to choose a position for labor and for birth which is least stressful to her baby and to herself" available from The Committee on Patient's Rights Box 1900 New York, NY 10001 or recent Maternal-Infant Nursing Text Book.

I couldn't resist forwarding this post on to these lists as I am appalled by its contents. I guess it is something many of us suspected, but to have it stated at an ACOG meeting is terrible. Please read on as this may affect the way some of us talk about birth plans and assertiveness and doctor/patient relationships!

I have been a silent observer on the list for about a month. I haven't written because I am just an aspiring midwife/ student and I will be unsubscribing voluntarily next week. I respect that many midwives feel a need for a private space without us "wannabes," but I just couldn't resist responding on this topic before I go.

As far as parents' right to refuse eye drops for their babies- I have been doing my senior thesis on the legality issues of midwifery, (I must say I am not a law student though, I am studying women's health and development/ population) and my research in the law libraries led to the issue of mothers refusing medical treatment for their unborn babies. I would like to remind everyone that there has been a terrifying precedent set in many state courts which allows doctors to perform a variety of interventions on the pregnant woman and her fetus against her will. Examples include experimental operations in utero to prevent deformity- not even to save the life of the fetus! Of course, there have been many court-ordered C-secs, court-ordered hospital births (the pregnant woman in AL who had wanted to birth with a midwife was arrested and court ordered to have the baby in the hospital). The law has been very severe to "protect" babies inside mom, and it seems even worse with babies outside mom. Even the religious exemption has been overruled lately... very scary from my perspective.

I attended an ACOG course on obstetric emergencies, and one section, "how to deal with the difficult patient who presents a birth plan" sparked the comment from one of the teachers, "Tell her whatever she wants to hear and when she is in labor you can do anything you- the dr.- want because the courts have accepted the argument that the pain of labor is so intense she is not in her right mind and can not make decisions that hold legal weight...(a paraphrase from my memory) Of course, the official ACOG book says to cooperate with the woman if possible first because courts have been "very reluctant" to force women to have procedures...the courts are becoming less and less "reluctant".

I have an article called "Abuse and Neglect of the Unborn" which has a section on precedents set in parents refusing care for their children (unborn and born), and a (pretty extensive) collection of articles from legal journals on (lay) midwives' court cases around the US, and the debate over regulation and enforcement. If anyone needs a place to start in creating a legal defense or wants copies of any info for file just in case, please email me at tammy.nakanishi@sit.edu Thanks for letting me listen, I learned a lot.

Winkler, Rosenthal. Sexist practice in medical school- vaginal examinations on women without consent. Needle 1988 June:10-11.

Phillips A. When what you don't know can hurt you. Guardian 1991 Jan 22:34.

Bewley S. The Law, medical students and assault. BMJ 1992:1551-53.

Robinson J. Are we teaching students that patients don't matter? J. Med Ethics 1985; 11:15-21.

State Takes Baby Away from Parents

It seems that a nursery nurse turned them into CPS (Child Protective Services). This was after the dad asked her if someone else could try to place an IV on the baby. She had been trying for 45 min. and when the dad asked her to stop and let the baby rest while they got someone else she claimed he was interfering with a needed medical procedure. The police came 20 min. later.

My experience here was with child protective being brought in against a family for trying to take their newborn out of the hospital AMA.  The family was accused of depriving the child of 'standard of care' treatment, which was interpreted as child abuse.  The crazy part was that this was for prophylaxis -- not treatment of any diagnosed condition. Once the court order was presented, this family buckled under the pressure and left the kid for treatment, rather than risk having him taken.  Crazy that educated parents really have no choice sometimes!

I had a similar experience with transport.White,middle class married couple,early twenties.Transport after 2 and 1/2 hours of pushing with no descent,mom pretty tired,dad scared and frazzled etc.Vacuum extraction,apgars 8?9.OB announces that she saw pus on the baby's head,and that the baby is grunting and retracting.She calls in Peds and they have mom sign a form for treatment except that mom refuses to have a Lumbar Puncture done unless bloodwork indicates a problem.They are then threatened with losing custody of the child unless they cooperate.They agree,baby and mom were kept for three days,baby in isolation,tests were all negative.The OB requested 3 months of followup for this "at risk" couple from social services!

How to Find Childbirth Educators

Find A 
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Voice of Experience: There is a lot of anxiety among pregnant women these days - our country is at war, and the political environment is very adversarial.  This isn't a supportive environment for birthing women.  My personal recommendation would be for women birthing for the first time to take two different birth classes - one Bradley class to help educate you about the physical aspects of childbirth, and another class that focuses more on the mental/emotional aspect of birthing: Hypnobirthing or Birthing from Within.  It's possible that  BirthWorks classes would satisfy both needs.

Do They Deliver? - Comparing the Claims and Philosophies of Natural Birth Methods Can Be Challenging, Learns a Mother-to-Be by Lindsay Moran [8/22/06]

Sacred Birth Workshops: Childbirth Preparation for the Heart, Mind and Spirit with Stephanie Dawn - The Sacred Birth Workshop was designed to explore conscious conception and fertility, and to empower your pregnancy, childbirth and your postpartum life as parents…

Using spiritual tools, as well as practical steps and insights, Stephanie Dawn shows you the way to the pregnancy, birth and life of your dreams!

Breck Hawk, RN, midwife, doula and author of Hey! Who's Having This Baby Anyway?  has created Childbirth Awareness classes for newly pregnant women / couples. - These classes are called iCARE (Improving Childbirth Awareness for a Richer Experience) and are not designed to take the place of classes that already exist out there.  They are an added bonus to the education that pregnant women need to have the safest and richest experience in their baby's birth.  The classes are designed to be taught before a woman chooses which direction she wants to go with her labor.

Adele Szilardi's The Bay Area Childbirth Education Locator

Western Canada Birth Professionals Directory

Bradley and BirthWorks

What's the difference between BirthWorks and Bradley?  How can I get  more information about both?

Sorry for the newbie question - we just decided to have a home birth  (YAY) - and I would like to find a method that works.  We used Lamaze  with our first child and it didn't work very well.  It might have  also been the surroundings, the quick labor and the busy hospital  room but...I'd like to explore my options.

Birth Works is a childbirth education program that teaches women that there is no one right way to give birth.  Instead of focusing on breathing patterns, Birth Works helps women to look at (and deal with) the beliefs and attitudes that they have about birth, as well as dealing with grieving and healing, using breathing and visualizations, affirmations, etc.  It really is a wonderful program, that I think could have saved me from an unnecessary cesarean.  But then again, if I hadn't had that cesarean, I wouldn't be training to teach Birth Works!

The Bradley Method®

888-TO-BIRTH (862-4784)

"BirthWorks is:
 A childbirth education and teacher certification program with an  innovative and experiential design. Birth Works® embodies a philosophy  that develops a woman’s self confidence and trust in her innate ability  to give birth. The classes are experiential and provide both a physical  and emotional preparation for birth. Birth Works® classes are taken by  new parents, and parents with prior cesarean or vaginal births. Our  comprehensive program meets the needs of parents planning hospital,  birthing center or home births.

It is based on the belief that the knowledge about how to give birth already exists within every woman."


(800) 4-A-BIRTH

Bradley Childbirth class goals are for:

"you and your baby to have the best, safest, and most rewarding birth  experience possible. For that reason we endorse and teach the following ideals in classes:
1. Natural Childbirth
2. Active participation of the husband as coach.
3. Excellent nutrition, the foundation of a healthy pregnancy.
4. Avoidance of drugs during pregnancy, birth, and breastfeeding unless  absolutely necessary.
5. Training: "Early-birth" classes followed by weekly classes starting in
the 6th month, continuing until birth.
6. Relaxation and NATURAL breathing.
7. "Tuning-in" to your own body.
8. Immediate and continuous contact with your new baby.
9. Breastfeeding, beginning at birth.
10. Consumerism and positive communications.
11. Parents taking responsibility for the safety of the birth place,
procedures, attendants, and emergency back-up.
12. Parents prepared for unexpected situations such as emergency childbirth, and cesarean section."

Call the organizations above, and see what instructors are in the area. Both methods are great!

Birth Works® childbirth education

Utilizing Energy Psychology Techniques During Pregnancy:  Empowering Parents to Decrease Stress, Heal, and Optimize - Seminars, Workshops, and Events by Wendy Anne McCarty, Ph.D., R.N.

The Prenatal Parenting Program consists of 8 modules filled with exercises to manage fears, reduce stress, change unwanted behaviors, and to prepare spiritually and psychologically for the most important gift parents give their child - a healthy and peaceful birth.  The best way to find the closest Prenatal Parenting Program to you is to email them with your address including the zip code or call 610-727-4145.

Mindfulness-Based Childbirth & Parenting Education Program is modeled on the pioneering work of the Mindfulness-Based Stress Reduction Program at the University of Massachusetts Medical Center founded by Jon Kabat-Zinn, Ph.D. Through meditation, yoga, awareness of breathing and group dialogue we learn a precious life skill that can hold us as we engage in one of the most important, joyful and stressful jobs on the planet, that of giving birth to and parenting the next generation.

Lamaze International - Lamaze works great for some people.

Although this isn't a form of childbirth education, per se, their Pink Kit "provides you with the knowledge you need to understand your unique body structure and how it works. Using this information, you will gain a new understanding of pregnancy, labour and birth."  The

The Pink Kit is a comprehensive, multi-media (book, video-tape and audio tape) childbirth preparation kit for homestudy.  Quite well done.  The video is the most informative, covering breathing, relaxation, "mapping your pelvis", effective positions and exercises for pregnancy and labor, as well as, core concepts relating to "know your body" and issues of self-empowerment.  The Side 1 of audio tape includes detailed instructions for prenatal perineal massage (self or with your partner's assistance).  Side 2 of audio tape is the sounds of a mother "breathing" her baby out during a birth that takes place at home.  I own three copies that I loan to parents.  Especially those that are not overwhelmed by the inundation of information and are self-motivated to learn on their own.

Magical Beginnings, Enchanted Lives - This program offers an intuitive natural access to the child bearing year.  Since our society is fear based in its approach to childbirth the program offers a new method of discovering what childbirth as a whole family experience means.  The Magical Beginnings, Enchanted Lives program offers the mother, father, and child a pactical tool based on the consciousness model recognizing that we are an integration of body, mind, and spirit.  Having the whole family practice this model within the program helps our approach to childbirth dramatically change.

Joyous Birth League International - JBLI intends to boldly reclaim the term “natural childbirth,” to henceforth exclusively describe the physiological (characteristic of or appropriate to an organism's healthy or normal functioning) process of birth as it occurs when completely free from outside influences and interventions or mental, emotional, and spiritual hindrance from the woman herself. [1/05 - these pages weren't accessible, but maybe they'll re-appear!]

Is There a "Method" for Achieving Naturally Painless Birth? (Updated September 2003)

The McMoyler Method is not very well thought of by the birth professionals I know.

Regional Programs

There are some specialty childbirth preparation programs available in some regions:

The Mind Body Center: Leclaire Hypnobirthing Method in Pacific Palisades, CA

What is Fearless Birthing™? - It is a program of self-discovery. It is nothing short of a map to the place where mother's intuition awaits. It is a way to access the 'instruction manual' that does come with each child!

How to Find Doulas - Professional Labor Coaches

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Find A Doula - findadoula.com

Night Doula Care - a website that lists *just women that work at night* as a night doula or baby nurse

I just found out that the ACOG recommendations are to have one nurse for at most four laboring women.  Yikes!  No wonder the nurses can't provide individual care and are pressing the women to get epidurals and be on constant monitoring.  They can't possibly be running from room to room and providing intermittent auscultation for four women at a time.  You can read more about the Benefits of Doulas.

California Birth Services Directory at Birth Alliance.com

Adele Szilardi's The Bay Area Doula Locator

Frequently Asked Questions About Doulas/Childbirth Assistants

Massachusetts Friends of Midwives Directory of Birthing Resources

Western Canada Birth Professionals Directory

Look in the Yellow Pages under Labor Coaches, Doulas and Midwives. Many midwives are also available for labor coaching in your home for early labor and then accompany you to the hospital as an advocate.

Midwifery Today's Directory of E-mail Addresses

DONA - Doulas of North America

ALACE - The Association of Labor Assistants and Childbirth Educators

doulabirthconnection Yahoo! group is to connect newly trained birth doulas with pregnant women seeking free or low cost doula services.

Look in the online FREE YELLOW PAGES! yellow-page.net

How to Find Midwives

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Finding a Midwife from Citizens for Midwifery:

Midwife Referral Directory from the Midwives' Alliance of North America maintains

You can also search for midwives in your area using the online FREE YELLOW PAGES! yellow-page.net

California Licensed Midwives

South Peninsula Midwives for the San Francisco area's South Bay

To find a Naturopathic Midwife in New Hampshire, Oregon, Pennsylvania, and Washington

Dr. Mercola writes about homebirth - Dr. Mercola's article about homebirth has some suggestions for finding a midwife.

Shonda Parker maintains a referral list, featuring Christian midwives.

From Giving Birth - A Journey into the World of Mothers and Midwives by Catherine Taylor:

  • Did you know? Midwife-attended births in the United States have doubled in the past ten years.
  • Midwives have a 19% lower rate of infant deaths and a 33% lower rate of neonatal mortality (infant death in the first month) than doctors attending comparable births.
  • Midwives who attend hospital births have a cesarean rate that is half the national average.

  • The dutch have the lowest percentage of babies and mothers who die or are injured during childbirth.  they also have the lowest rate of medical intervention at birth.  70% of their births are with midwives and 1 in 3 births take place at home.

    The Midwifery and Medical Models of Childbirth Care from midwifeanddoula.com

    There are many different types of midwives, and each state may create its own midwife designation.  In a number of states, their state licensing program uses the same standards as the NARM CPM . . . in those states, a Licensed Midwife is functionally equivalent to a CPM.

    The Midwifery Model, Care Provided by Midwives, Types of Midwives and How to Choose a Midwife from . . .

    Check the web pages of your state midwifery organization to see if they have a referral service.

    Ideas from Midwifery Today:
    Sometimes you have to be a private detective to find a midwife.  Since the choice of a birth practitioner is one of the most important decisions you'll ever make, a careful search is worth the extra effort.

    California Birth Services Directory at Birth Alliance.com

    Massachusetts Friends of Midwives Birthing Resources Directory

    Western Canada Birth Professionals Directory

    Nurtured.Com Birth Team Directory

    Midwifery Today's Directory of E-mail Addresses

    Find a Nurse-Midwife

    Look in the Yellow Pages. Ask the local La Leche League folks.

    Look in the online FREE YELLOW PAGES! yellow-page.net

    The Doctor Makes House Calls!

    For people living near Libertyville, Illinois, they can hire a physician to attend their homebirth - George B. Elvove, M.D., P.C.,  (847) 362-1367
    Here's his Home Birth FAQ

    There's also a physician group called the Homefirst Health Services  - Physicians who do home births in and around Chicago.

    Can't deal with the American birth system?  Can't find a homebirth midwife in your area?  Having trouble finding birth attendants for VBAC?

    On a quiet, beautiful and secure country estate, overlooking the central valley of Costa Rica, Central America, Birth-my-baby offers two modern homes for expectant mothers to have their babies in peace and gentleness.

    How to Find Lactation Consultants

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    This feature works for United States and Canada only.

    The International Lactation Consultant Association (ILCA) - Find an LC by zip code.

    US National Registry of International Board Certified Lactation Consultants, Registered Lactation Consultants

    How to Find Healthcare Providers for your Children

    Holistic Pediatric Association - The HPA is committed to supporting parents who seek a healing model of health care, helping parents reduce the use of ineffective and harmful drug treatments, and empowering parents to build healthy bodies and spirits in their children.  Find a practitioner in your area by searching our Health Professional Directory.

    Pediatric Holistic Health Education and Research - The International Chiropractic Pediatric Association is a non-profit organization dedicated to advancing awareness of the family wellness lifestyle.  They offer a referral directory.

    Family practice doctors are a great option for the entire family, and they're less likely to recommend hospitalization and extreme testing for typical childhood conditions.

    Shonishin & Kids - Shonishin (children's needle therapy) is a unique and specialized pediatric style of acupuncture that developed over 250 years ago in Japan. It recognizes the fact that children do not like needles and has instead developed specialized treatment techniques, many of which are non-invasive and thus not frightening to the child. In ancient China, when acupuncture was first being described, nine kinds of needles were described, several of which had rounded ends, being rubbed or pressed on the skin instead of inserted into the body.

    Family Physicians can be an excellent choice for the whole family!

    Attachment Parenting International (API) is starting a Listing of Medical Associates

    How to Find Naturopaths

    Association of Perinatal Naturopathic Doctors (APND) - Members of the APND share a vision of universal "care". Care at the beginning of life begets care for all life. A natural birth allows powerful bonds to form with the newborn and mother - bonds, which inevitably expand outward to include the family, the community and ultimately, society.

    American Association of Naturopathic Physicians

    The California Naturopathic Doctors Association (CNDA) is a professional association of naturopathic doctors (NDs) who live and work in California.  Their web page has a referral page for Naturopathic Doctors.

    How to Find Chiropractors

    See also: Chiropractic Care, Prenatal Breech Issues, and  Chiropractic Care for Babies and Children

    The International Chiropractic Pediatric Association has a particular interest in birth-related matters and maintains a Referral Directory.

    In some states, chiropractors are licensed to attend births.

    Practitioner Directory: How to find a Chiropractor from holistic.com

    Find a chiropractor in your area

    International Chiropractic Pediatric Association and referral directory.

    SORSI - The Home of Sacro Occipital Technique with a web page to help you locate a doctor.

    How to Find Other Healthcare Providers

    There are many paths to good health.  Here are some other locator services:

    How to Find a Homeopath

    How to Find an Acupuncturist

    Mercury Free, Holistic, Biological Dentists

    Registered Craniosacral Therapy Practitioner

    Questions to Ask Birth Attendants

    Possible Questions to Ask a Caregiver Who May Attend Your Home Birth 

    List of 47 Questions to Ask a Midwife During an Interview (with printable) by Shannon Brown

    Here's a list of questions from my page about Local Resources in the San Jose/Peninsula area.

    About Peer Review

    A midwife peer review group is a group of midwives who meet on a regular basis to review unusual or difficult cases, to discuss and establish community standards of midwifery care, and to share knowledge about the practical and legal aspects of midwifery.

    Even midwives who live in rural areas can participate in online peer review groups or in peer review sessions at state and national midwifery conferences.

    Midwives who do not regularly attend peer review may be what are called "renegade midwives" who do not believe in community standards of midwifery care and who simply practice according to their own way of thinking.  It's possible that such a midwife might be perfect for you, but you should know that she may practice very differently from other midwives in your community, and you may be surprised at some of her opinions and recommendations.  Please use good judgment in choosing your midwife, as you would with any healthcare provider.

    Having a Baby? Ten Questions to Ask - How to identify mother-friendly birth attendants - a handout from The Coalition for Improving Maternity Services (CIMS)

    Check to see if the hospital you're considering is on the list of Baby-Friendly Hospitals and Birth Centers.  A Sept., 2005 study showed that these hospitals had higher rates of breastfeeding, regardless of demographic factors that are traditionally linked with low breastfeeding rates.

    CIMS also offers numerous resources for individuals and organizations who support mother-friendly care. These include fact sheets (Breastfeeding Is Priceless, The Risks of Cesarean Delivery to Mother and Baby, Problems and Hazards of Induction in Labor), questionnaires (Are Your Birth Classes Mother-Friendly?, Is Your Doula Practice Mother-Friendly?).

    IMPORTANT - Recent discussions postulate that routine use of the Ritgen maneuver to force premature delivery of the baby's head increases the likelihood of shoulder dystocia.  Ask your practitioner whether they routinely use the Ritgen maneuver and at what percentage of births they have used the Ritgen maneuver.  [The Ritgen maneuver is performed by applying moderate pressure from beneath the baby's head to the baby's chin to force premature extension and delivery of the baby's head.  Co-incidentally, it was traditionally used with an episiotomy; when the Ritgen maneuver is done to a mother with an intact perineum, it inevitably tears the perineal tissues because the unnatural extension of the baby's head widens the diameters significantly.]

    Hiring Your Birth Attendant: Questions to Ask When Choosing a Hospital, Doctor, Birth Center or Midwife

    A simple, effective list of questions for a birth attendant

    Consultation Questions for Prospective Midwives

    Questions for Clients to Ask Midwives

    More Questions for Clients to Ask Doctors and Midwives

    Regardless of the exact letters after your birth attendants name, it's important to ascertain that they are trained to attend birth in the place where you're planning to give birth.  If your birth attendant was trained in a hospital where the neonatal team always handles the babies, they may never have learned how to provide standard newborn care or to handle newborn emergencies; you need to ask where she got her training and experience in handling newborn emergencies, assessing the newborn, assisting with breastfeeding, etc..  If your birth attendant was trained in a birth center, they may not have the expertise in managing epidurals or interfacing with the NICU that you might need in a hospital birth.

    Questions for Clients to Ask Doctors

    Questions for Clients to Ask Obstetricians

    When interviewing my first midwife,  I failed to ask *very* specific questions about 'protocols' when things step outside of 'normal'.  I failed to ask her to define diabetes -- something she risks people out for.  My definition of diabetes and her definition of diabetes turned out to be 2 different things.  Unfortunately, we discovered this when I was 30 weeks pregnant.  She risked me out for failing a GCT (her protocol) -- I had to look for another midwife who viewed gestational diabetes in the same manner as I do.  That is, if my blood sugar levels are controlled through diet/exercise, the "GD" is not 'active' (for lack of a better word) -- therefore, should not prevent me from birthing at home.  In my mind, having the label GD and at the same time having normal blood sugar levels controlled through diet and exercise, being in the hospital would have been a very foolish move on my part considering all of the interventions my baby and I would have been subjected to in order to satisfy protocols for GD moms and babies of GD moms set forth by doctors, hospitals, etc.

    With that said, I think you also have to ask yourself what kind of midwife you want.  Knowing the answer to this question will help you to formulate specific questions which address your personal needs.  Do you want a midwife who has protocols for every little thing so you do not have to make decisions when something comes up (my first midwife did not want me to make any decisions about GD under her care)?  Or do you want a midwife who will help you find a solution to problems (if a problem comes up) which fits your individual needs?  If you choose the latter (btw -- there is nothing wrong with choosing the former if that is what you feel comfortable with), do you want a midwife who will *support* informed choices you make even though those choices aren't ones she would personally make?

    Special Questions for Women Planning VBACs

    I would advise anyone seeking a VBAC in a hospital to ask for a written copy of the hospital policy regarding VBACs. If you've had more than one previous cesarean, ask specifically for their policy about vaginal birth after multiple cesareans. There's a national backlash against VBAC, and it is really, really ugly to be threatened with a court order to have surgery. It is possible for the hospital to seek a court order to force you to have a Cesarean, even if you have the full support of the obstetrician for a VBAC. 

    I intend to ask about the GD stuff, and the handling of breech births, and their opinion and experiences dealing with VBACs, and also the waterbirth aspect. What am I missing?

    Aside from the obvious questions about training, etc., it sounds as if you may want to ask questions about how they handle conflicts, how many births they consider a full load, how many births they've missed, etc.

    Some midwives have a checklist covering all aspects of care. This lists all the things they'll be covering with you and might be interesting to read..

    Also, you may want to ask what their rates of tearing and suturing are. Be sure to ask how many first, second, and worse degree tears, and what percentage require suturing. This will give you some idea, but it's also important to know that deciding whether a tear is a first or second degree tear may be somewhat subjective. A midwife who doesn't see much tearing at all may be more likely to call a minor tear a second degree because she sees so few.

    So, after you ask for the numbers, ask what she finds works best to prevent tearing.

    Ask what she recommends to avoid posterior and breech presentations.

    Ask about the rates of hospital-acquired infection and antibiotic-resistant infection in your hospital?

    You might also ask how she keeps current. A midwife who wants the best for her clients is always looking for better ways to serve them.

    Oh, also, ask thorough questions about her thoughts on going postdates. This may not be such a big issue there, but it's a biggie here.

    And, of course, ask how she feels about clients making decisions different from her recommendations.

    Also, ask how long your appointments are and how much education she incorporates into these appointments.

    And ask for several references and see if their experiences bear out what the midwife told you.

    I'm still working on my list of questions for a doctor, but right after "What is your c-sec rate?" is "What is your epis rate?" and I expect to get a number. Anything as vague as not "without the mom's permission" would make me wonder why the doctor wasn't as eager to brag about her epis rate as she was about her c-sec rate. Maybe my husband's right, maybe I am paranoid.:-)
    You should be paranoid. Unfortunately, it's a mistake to assume that any caregiver shares your values and priorities.

    I work both as a homebirth midwife and as a labor coach for women birthing in the hospital. I have occasionally worked with women who had found wonderful OBs, who promised not to cut an episiotomy. Unfortunately, they also didn't seem to know enough about avoiding tearing, and suturing was required.

    Specifically, ask any caregiver what they do to avoid tears and the need for suturing. Ideally, waterbirth would be universally available. At the minimum, you should hear something about a slow, gentle birth rather than Olympic-style pushing, especially once the baby is crowning. There's a great deal of debate about the value of warm compresses and perineal massage, so answers may be all over the place on this question, but the caregiver should have considered them and have good reasons for what they do in this regard. Most also flex the head as they support the perineum, which should continue to be supported as the shoulders and body are born. Ask how they manage this. It's best if they have four hands or an assistant.

    Many midwives have tear rates under 20%, and not all of these need suturing. If your caregiver can't tell you their suturing rate, it's obviously not very important to them. If it's important to you, it's probably worth discussing further.

    Asking for Statistics

    [ about how to tell whether your caregiver is trustworthy ]

    First, ask them for their statistics in writing. If they're telling the truth, they shouldn't mind putting it in writing.

    Ask about rates for all the things that matter to you, but the rates they should have handy are:

    Ask them some philosophy questions. Ask them what percentage of women and babies they think would be fine if they had an unassisted childbirth at home? Anything under 90% indicates a gross lack of education and trust in the process.

    Ask them what they think of homebirth? The answer to that question can tell you a lot about whether they truly consider birth a normal physiological process. It will also tell you a lot about their view of having the family in control of the circumstances of birth. Again, prejudice against homebirth is prejudice against empowering the family.

    And if they tell you that homebirth is just unsafe, ask them for references supporting their assertion. Any caregiver who is still parading this tired old prejudice doesn't place much value on presenting you with accurate information.

    Ask them what kind of birth gives them the greatest feeling of satisfaction - an uncomplicated birth where they're basically just keeping an eye on things, prepared to intervene if necessary, or a birth where they have to use their skills to "save the mom or baby". People do the things that feel the best to them. (And again, this is generally a big difference between MDs and midwives (homebirth or hospital); midwives believe they have done their job when the mother gives birth, reaches down to bring her own baby to her belly, and is left to follow her instincts about interacting with the baby, without need to suture or inject anything; MDs believe they have done their job when they've used their most sophisticated skills to save lives.)

    Think about the implicit promises that were made by your providers . . . we'll help you do what's best for yourself and your baby. How many people here believe that their providers followed through on that promise?
    Not me. But that is what they say, and I pinned them in that meeting June 30. They admitted there that they practice as they wish because of the legal climate. Then I told them, "But no-one says this when I come in for prenatals. I was never told that you practiced that way. I was told you would take care of me and my baby and that everything was for my baby's good." Silence and some snorts were my response. What COULD they say?
    Statistics don't give the whole picture, but they help to remove some of the deceit in those empty promises.
    Yes, if you could get them. My CNMs spent so much more time with me than any OB I'd ever seen, were friendly, funny, kind, involved, remembered my name, and never seemed to be in a hurry. THAT alone sold me. What a sad, sad commentary on our health care system. That emotionally I was willing to give up (Oh well, it'll be all right anyway. WRONG!) my right to the statistics, the details of their usual procedure, because I mistakenly thought A) they liked me B) they knew what they were doing and C) they were honest.
    I think all midwives (and all other birth providers) should spell out exactly what kind of care they provide. I think they should make their protocols accessible to their clients, and I think the rates of infections at their hospital should also be available. Without this information, how can you make any kind of informed choice?
    Are you kidding? Remember how many times I had to ask to get the c/s rate which when finally given was FALSE!!!!!!

    And I'm sure I've mentioned the list of questions I went with (how many of your clients labor in different positions? with IV? with monitor? etc.) that I never even asked because I got the message that I didn't need to worry about that because I wasn't going to have problems anyway...after all I was low risk perfect health and taking excellent care of myself.

    I didn't know that then. I was naive and misinformed despite being a Bradley student. I thought these people sincerely cared about me and my birth. They appeared to. They most certainly did appear to. But they did not REALLY care.

    This may seem odd, but I was surprised that my midwife didn't wear gloves at my birth.  In some ways, it seemed much nicer that my baby wasn't being touched by nasty latex or vinyl, but then I realized that my baby was basically being exposed to the germs of every other family this midwife had ever served.  That wasn't such a happy feeling.  It's worth asking whether your midwife wears gloves at all times at the birth?

    I would love to see these promises made more explicit. This is why I keep urging people to ask for statistics. No, of course no doctor is going to admit that they routinely perform unnecessary procedures, so they say they only cut episiotomies "when they're necessary". But if you can get the statistic from them in writing, and it says that they are necessary 95% of the time, that tells you something. If you can get your midwife to provide, in writing, the average amount of time she was at a birth with her previous five clients, this will give you a good guess of the amount of time she will spend with you.

    Statistics don't give the whole picture, but they help to remove some of the deceit in those empty promises.

    I think all midwives (and all other birth providers) should spell out exactly what kind of care they provide. I think they should make their protocols accessible to their clients, and I think the rates of infections at their hospital should also be available. Without this information, how can you make any kind of informed choice?

    When it comes to protocols, though, my feeling is that "my protocols" will be parameters within which I'm comfortable working. Then I'll present clients with a long list of choices they can make within those parameters. I'm happy to make recommendations, of course, but the choice must rest with the client. They're free to choose to follow all my recommendations, as many probably would, but this approach should solidify in their minds that they can change any of this at any time.

    Theoretically, this is how it works now even with all medical providers. Ha, ha.

    In reality, most people are never told that they have the right to decline any offered care. (Assuming their provider doesn't get a court order to force care on them and/or call in Child Protective Services. Sigh.)

    Typically, providers simply state the recommended care as if it's incontrovertible, i.e. "We test for GBS at 36 weeks", "All first-time moms need episiotomies", or "The state requires that we vaccinate newborns with HepB." There's no recognition that every person is supposed to be choosing components of their care. Instead, they choose "a caregiver" and then figure they just have to suffer the consequences of that choice.

    I have been hearing some very disturbing indications that even the illusion of choice will be disappearing. I've heard that HMOs require that women submit to certain types of procedures in order to continue prenatal care with them. And I've heard that other insurance companies are denying coverage to unvaccinated children. Very disturbing.

    What are their episiotomy and suture rates?
    What do they find most successful in preventing tears?

    Ask for the details of their protocols in writing for:

    Ask them whether they think women are happy with the care they offer? Then ask them how they know? Do they do postpartum surveys or some kind of "quality assessment"?

    Also, you might try stopping in at the office just to chat with the women who are carrying newborns and/or strike up conversations with women who look very near birth and ask if you can call them afterwards.

    You might also try asking the childbirth instructors, labor coaches and midwives what they think of the caregiver?

    Things a Midwife May Forget to Mention/Midwife Complaints

    In our case, the midwife failed to prepare us for many of the procedures that could occur in case of transport to hospital. This would be an issue that I think should be discussed with homebirth parents, even though most homebirth parents don't want to face that reality. But the real issue as I see it does not revolve around what we discussed in prenatal care, rather it is how the midwife was not there for us in labour, did not give us the dignity of informed choice with regards to vaginal exams, AROM, etc.. Not having given birth before, we did not know what to expect or ask, even though I was well read. I had a classic posterior labour, and wish the midwife had told me positions to adopt so as to help baby rotate, which could have avoided AROM and subsequent transport.

    I guess it really is this midwife's personality, and not an issue that she failed to bring up with us. She did everything "technically" right, according to the backup midwife, but she wasn't there for us emotionally at all. Birth is magical, and far from being a purely physical event, hence the emotional upheaval in women where this process is violated.

    How to Enjoy Your Pregnancy and Birth

    For me, when I found ICAN in March I learned about and wrote up a birth plan patterned after our local chapter president's plan. This was my first step in putting childbirthing in perspective. Over time I became more and more educated about interventions in childbirth and realized I didn't want any unnecessary intervention at all! No routine IV, no time limit for second stage, no routine ultrasounds or electronic fetal monitoring, no restrictions to bed, no special treatment once amniotic sac breaks or leaks. I shared my plans with the best VBAC obstetricians in my city, St. Louis, MO, USA and each one had a favorite intervention that would become their sticking point. I finally realized I was not going to get the natural birth I was looking for in a hospital, and delved enthusiastically into homebirth plans!

    So for me my written birth plan helped me to know what I really wanted in my birth. It never seemed to be viewed by obstetricians as a guide to follow to the T.

    I learned that almost every pregnancy and childbirth are healthy events and medical attention is not necessary in the least. I couldn't believe how wonderful an experience pregnancy and childbirth were for me once I adopted this attitude! What glorious fun!!! I wish it could be this way for all women that are normally healthy. You do not need to be super human despite what so many try to tell you. Home is a very healthy environment to have and keep one's baby.

    I also said "No" to all internal exams and ultrasounds this pregnancy, and once I was on the homebirth route I never felt I had battles anymore about these decisions. I trusted my vagina and pelvis and didn't feel I needed someone looking at it, much less take the risk of having some infection introduced. Ultrasound of any amount has never really been proven safe. Besides, for me there is nothing I could find out on an ultrasound that would make me carry or birth my baby differently. I enthusiastically allowed the fetoscope (like a stethoscope) to monitor baby's heartbeat in prenatals and labor.

    Money and Insurance Issues

    See also:  Money and Paperwork/Health Insurance Plans - Getting Payment

    Which are the best plans to cover homebirth?

    Parents often contact me to ask which are the best plans to cover midwives and homebirth-related care.  There's no one answer to this, as it depends very much on the plans that are being aggressively marketed in your area.

    I'm in Mountain View, CA, and the main plans seems to be CIGNA PPO, United HealthCare PPO and Aetna PPO.  (Actually Aetna uses a variety of strange plan names that really don't tell you much about what they really offer, so you have to dig.)  Far and away, my favorite plan is CIGNA PPO.  Even if you just switch to CIGNA for the year your baby is born, you will probably end up saving money, and you will certainly save on a lot of heartache and time wasted on the phone with insurance companies.  And sleep-deprived parents caring for a newborn are not in a good position to be making phone calls to insurance companies all the time.

    So . . . a word to the wise . . . you get what you pay for, and skimping on insurance will affect the quality of services you get.

    In general, CIGNA, UHC and Aetna are decent about paying for a midwife's professional services associated with homebirth.  Aetna doesn't "cover homebirth", but there is no such procedure as homebirth.  In fact, since every birth is technically defined as an emergency situation (i.e. one requiring immediate healthcare attention), they are required to cover for the services of whoever is present to assist you with the emergency / emergence.  :-)  But why not just get a plan that's going to be easy for you and your midwife to deal with?  You want your energy and your midwife's energy to be focused on providing the best care for you and your newborn.

    With CIGNA PPO, it's very simple.  I file claims, and they pay them.  Sometimes they are reasonable about asking for additional information about the birthing tub rental fee or something like that.  United HealthCare and Aetna are generally as reasonable.

    Blue Cross of CA and Blue Shield of CA are both difficult to deal with in their own way.  First, they won't send reimbursement directly to an out-of-network provider, and it's not possible for homebirth midwives to become in-network providers.  Secondly, they drag their feet, inappropriately say that claims have the wrong codes, pay for only one half hour (or unit) of care when many such half hours of care were provided.  The list goes on and on.  Blue Shield can't seem to get its head around the fact that midwives provide care for newborns, in addition to the mothers.  And they both seem to think that a homebirth midwife just waltzes in to catch the baby and then leave twenty minutes later, the way they do in the hospital.

    Anyway, I get very annoyed with Blue Cross of CA and Blue Shield of CA, and they are not accepted or preferred plans for my practice.  I will still file claims for my service, but my clients have to pay for prenatal care as we go along, and then pre-pay for expected services at the birth.  This can be a burden on the parents.

    So if you can possibly get a good CIGNA PPO plan, that's the best way to get good coverage for homebirth.

    Insurance Coverage for In-Home Postpartum Care

    In California, state law requires insurance companies who cover maternity care to cover care for a minimum of 48 hours after a vaginal birth and 96 hours after a cesarean birth.  (California Codes, Insurance Code, Section 10123.87)  You may arrange with your in-hospital care provider for this postpartum care to be provided in the home by midwives.

    healthinsuranceinfo.net - Consumer Guides for Getting and Keeping Health Insurance

    Helpful Hints for Dealing with Your Health Insurance Company

    As a former hospital employee, I can say that professional fees are always billed separately and don't include hospital fees. If you call the registration dept they will give you your specific breakdown based on insurance as well as cash pay amount if you decide to go that route ( which they provide discounts of up to 75% of cost). Just make sure you ask for a financial counselor.

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    I've heard the following ranges of prices for homebirth midwives providing typical full-service prenatal care, birth services, postpartum care and lactation consulting and newborn care.  (Cost of "average" home, where stated, in parentheses for perspective)
        Alexandria, Virginia - $3500-$4000 ($150,000)
        Houston - $4500 ($150,000)
        Los Angeles - $4200 ($450,000)
        Dallas/Ft. Worth - $2000-$2500 for direct pymt, more if billed through insurance ($?)
        New York City - $3800 ($?)
        Long Island - $5000 ($?)
        Quebec - $3000-$5000 ($?)
        South Dakota - $3000 ($?)
        Tennessee.  $2800 ($?)
        Maryland, rural - $1500-$1800 ($?)
        Las Vegas, NV - $1400 ($?)
        Washington, DC - $1500-$3400 (birth center)
        Northern Florida - $2500
        Southern Florida - $3200

    What You Get For Your Money

    "There’s nothing to compare with the birth of your child ­ not your wedding day, a trip to Hawaii, or a new car.  Be willing to give birth the same consideration of financial investment as those other special times." from Santa Cruz midwife, Laura Maxson LM.

    I used to think that charging $3000 for a birth was an awfully lot of money for someone to make for essentially a week's work.  And I've heard people say that midwives must make a lot of money because they multiply the midwife's fee by 52 weeks, assuming she does one birth every week of the year., but as I got to know my midwife more, I started to get a sense of the costs of running a business:

    First of all, she probably isn't attending 52 births each year.  She may have to turn down births some months if she's already got 4 clients signed on that month, and there may be other months where she doesn't have a full schedule.  I know my midwife doesn't use that extra time to go to the beach - she reads journals and books to keep up with her profession, she re-works her practice protocols and handouts, etc.

    Also, I guess even midwives deserve a vacation now and then.  Well, I guess I'd really have to say that *especially* midwives deserve a vacation now and then.  Some of the women in my women's group talk about labors that went on for days and days, which must be really draining on the midwives, and that doesn't even take into account the additional stresses of transporting into the hospital.

    In addition to the 40 hours or so of her personal time that goes into direct contact with the client, she also spends probably a couple of hours on the phone with each client, and she must spend additional time maintaining charts and reviewing lab results, etc.

    She also has to maintain a business - I figure the cost of maintaining a home office is probably about 1/5 the cost of renting a house in your neighborhood.  My midwife seems to have more ways to communicate than a Vulcan - she's got her business line, her personal "hot line", her pager and her cell phone.  Mine happens also to have Internet access so she can show me lots of research online when I've got questions.  I figure her "communications" costs alone must be over a hundred dollars each month.

    Then she's got her professional fees.  In our state, renewing a license costs $200 every other year, but in order to get her license renewed, she must get about a week's worth of continuing education credits.  For a midwife who's always on call, the best way to do this is often to do it all in one shot by going to a big midwife conference.  Between the conference fees and the travel expenses, this must cost about a thousand dollars.  And I know those professional journal subscriptions can be pretty expensive.  A midwife's business is basically a consulting business, and the rule of thumb is that the cost of running the business (paying for their own health insurance, paying self-employment taxes and social security, providing office space and the basic operation of the business, having some vacation and sick time) is basically half the consulting fee.  So, if a midwife charges $3000, she probably only gets to use about half of that as income, and that's still before taxes.  Plus, being a consultant myself, I know that 15% of her income off the top goes to self-employment taxes.

    Then, when I think about her expenses for each birth, well, obviously, there's transportation expenses.  Whether you live in New York City and she takes a cab to your birth or you're out in a nice, rural spot, I suspect midwives must incur expenses between $50-$100 for transportation for the four home visits for each birth.

    Then there's the equipment and equipment maintenance and sterilization.  I used to think midwives just went home from births and went straight to bed for twelve hours.  It turns out that one of the first things they have to do when they get back home, however exhausted, is to sterilize their instruments and repack their bags, because you never know who's going to call next or when.  That whole process seems to take about three hours, from what my midwife says.

    I've also noticed that a lot of the equipment she uses is disposable, obviously, for health reasons.  This is stuff in addition to the birth kit we ordered.  For example, the special suction device she used even for the light meconium costs about $15 in the Cascade catalog, and the ambu-bag that she had to open "just in case", even though it wasn't used, costs more like $30.  My midwife also uses lots of incidental herbs and homeopathics that she doesn't charge for.  It turns out that the vitamin K is also kind of expensive, and I don't  know about the eye ointment she used.

    My midwife doesn't carry liability insurance, but I suspect that's a big ticket item if yours does.

    Oh, I forgot, the biggest expense for the birth itself is the fee paid to the second midwife.  I don't know how much you'd charge to be on call to come out in the middle of the night to offer your highly skilled services and possibly provide life-saving procedures, but I assume it's several thousand dollars.  In actuality, I think they charge each other a ridiculously low fee, sort of as a reciprocal professional courtesy.

    Oh, duh, another thing I forgot is that when you compare a homebirth midwife's fee to the fee of a hospital birth attendant, you're comparing apples and oranges.  When you have a hospital birth, the bulk of the care is provided by hospital staff, which all shows up in the hospital bill, rather than in the obstetrician's fee.  I started to think about the numerous hospital staff I saw during my time there, and I know their salaries must come out of the  money my insurance company pays the hospital.  First, there were the administrative people who handled the insurance.  Then there were the nurses, who provided about 18 hours of care before the OB showed up.  Then there was the cast of thousands that showed up for the birth itself.  I know some of those people were there in case my baby needed resuscitation, and I guess this is what the second midwife usually does?  So it's not fair to count those people twice.  But then there were the postpartum nurses, plus the nurses in the maternity unit, plus the lactation consultants, plus the nursery staff.  Oh, and, of course, there was the janitorial crew that came in to clean up the birth room as I was being wheeled out.  Most midwives seem to wears lots of hats - they handle the administration stuff, labor management, the birth itself, take care of both the mom and baby immediately after the birth and then continue to provide check ups and are available for care during the next six weeks.

    Anyway, by the time I got done thinking about all this, I figured my midwife really doesn't charge much for offering the incredible services she provides, all the while having to fight "the establishment" that is trying to take away her license or put her in jail.

    In Florida, HMO's must cover midwives, whether hospital or homebirth; it's written into the law in 641.31.  If I remember right it is about paragraph 18, but it reads: "Health maintenance contracts which provide coverage, benefits, or services for maternity care shall provide, as an option to the subscriber, the services of nurse-midwives and midwives licensed pursuant to chapter 467, and the services of birth centers licensed pursuant to ss 383.30-383.335."

    For care providers who aren't covered by health insurance plans, some will accept alternative forms of financing, occasionally including barter or payment plans that extend beyond the birth date.  Do ask about these.

    I just don't know how we're going to pay a midwife at a time when I'm going to stop working, and we're going to have the extra expenses of a new baby!

    Have you thought about trying to borrow money from your parents or from your 401K plan?

    I was shocked when the midwife I called said she charges $3000.  One of our local childbirth educators is also a midwife and charges very local prices, and I'm thinking that may be all we can afford.

    I am very curious what price you were hoping for.  Be  very cautious of anyone asking for much less.  As you could imagine that person would not have the training or skill.  This is nothing to play  around with.  In addition to prenatal appointments at her office, a midwife would have many hours, energy, and responsibility left with the remaining part of your pregnancy.  Just one example is she would be coming to your house for 4 home visits.  A home visit before the birth, the birth, and 2 postpartum visits. Prenatals are every week now and each one lasts an hour.  There are also 2 other postpartum visits done in the midwife's home.  Can you imagine what this would all cost if it was an MD?  I know that some midwives are willing to take delayed payments or barter.  I also know that it is an unexpected expense.  You can have the birth that you want.  It is time to really think about what you want and why, and go with that.

    Isn't it funny the way people will spend thousands and thousands of dollars on a fancy wedding but don't want to pay a couple of thousand dollars for a great birth experience for themselves and their baby? Maybe if they thought of the birth as a baby welcoming party, they'd be more comfortable paying for it.  Heh, maybe midwives should start advertising themselves as entertainment for the baby welcoming party!  It might solve some of their legal problems, and I've heard midwives say some pretty funny things when they've been up several nights in a row with a first-time mom!  [VBG!]

    My husband is pretty careful with money, but he agreed wholeheartedly to paying our midwife out of pocket.  He said that even thousands of dollars would be less than what we paid for counseling after my first birth, not to mention the formula we had to buy when the breastfeeding relationship didn't work.

    It sounds like he's careful with money in that he's happy to spend it on the important things, which is the best kind of money management.

    Yes, people really need to think about what they want, etc., and figure out how important a good birth experience is to them and to their baby.

    People are so funny sometimes.  They want a midwife with lots of training and experience, but they somehow imagine that because birth is so sacred, she should work for free.  I'm sure many of them would like to be able to do that, but I suspect they have bills to pay, too.  (And I have to say, you couldn't pay me enough to be on call 24 hours/day almost every day of the year and to have to work a shift that simply doesn't end until the baby is born and the mom and baby are safe.  What a hard way to make a living.  I can't imagine anyone would be doing this kind of work for the money.  I assume they do it for the love of mothers and babies and earn what they can to support themselves.  Most of the midwives I know are not living in lavish style, even in our very affluent area.)

    I sat down once and figured out the amount of time a midwife has to put into each birth: if you figure you start seeing the midwife in your fourth month, say around 16 weeks, then again at 20, 24, 28, 30, 32, 36, 36, 37, 38, 39, 40, 41, plus 4 postpartum visits, assuming an average of an hour apiece, that's already 17 hours of direct contact, not including preparation or post-appointment charting.  Then add in travel time for one prenatal home visit, the birth and three postpartum visits, assuming an hour each - that's another 5 hours.  Then you're already up to 22 hours, not counting the birth.  If you're lucky and have a relatively fast active labor and birth, she may only be there for 6 hours before the birth, and then she'll be there 3 or 4 hours after the birth.  So time spent directly providing care for you is probably an average of about 32 hours.  And that's not counting all the extra time for first-time moms, or the phone calls.  And it certainly doesn't take into account the time she has to put in maintaining a business and keeping up with her profession, such as online groups and conferences, which most professionals get paid for.

    Anyway, I know midwives often say that one birth/week is about the right work load in terms of being able to provide good care to each client.  So I figure her work time averages out to about 40 hours per client.  That's a whole work week.

    So, I figure people should be willing to pay their midwife at least the amount that they earn in a week, plus her supplies, equipment and travel expenses, plus the cost of a second midwife or any other help that is included in the fee.  Suddenly $2500 isn't looking like that much.  And if you put some effort into it, you should be able to get insurance to cover most of it.

    And, as those credit card ads say, "Midwife fee, $2500.  Postpartum doula, $200.  Birth kit, $50.  The adoring gaze of your newborn resting peacefully in your arms after a gentle birth in your own bed . . . Priceless."

    I think some of this attitude comes from the feeling that our health care should be paid for by health insurance, and we tend to be very stubborn about not wanting to pay anything that we think should be covered by health insurance.  Yes, in fact, midwives, doulas and home health care should be covered by health insurance.  But if we're not, are we really "getting back" at the health insurance by going along with their rules about what they think we should be doing about our birth?

    I've read some of the information about the link between a baby's birth and bonding experience, and things later in life like violence and teenage drug use, and I'm thinking that a couple of thousand dollars is looking cheap to protect myself and my baby from a bad experience.  Also, I've read the stories on the ICAN page about marriages that were severely harmed by an unnecessary cesarean - the women felt betrayed that their husbands didn't support them better.  Those aren't the sorts of things that show up as "risk factors" for the standard birth experience, but they're awfully important to me!

    For those of you wondering why I chose to have my second child with an OB in the hospital after my first baby was born at home, I know that must have sounded odd! I hated the fact that I had to have a hospital birth, but at that time direct-entry midwifery was illegal and my insurance would not cover a birth center birth. I could not afford to pay for the birth myself so I had no choice! I was heart broken! My hospital birth turned out to be the nightmare that I had feared, but it was a learning experience! I will never have a baby in the hospital again unless medically necessary!!!!!

    My insurance wouldn't pay a dime for my homebirth.  I kept telling them that they were crazy, that I was saving them thousands of dollars, but they wouldn't pay due to the legal status of midwives in my state.

    Even if insurance won't cover the birth attendance part, I think it's worth pursuing reimbursement for the other services that midwives provide.

    For example, you could ask your midwife to write up an invoice for labor support services, lactation consultant services and postpartum doula services, all of which are customarily included as part of homebirth midwifery care.

    Especially if your midwife includes a letter explaining that her labor support allowed you to avoid expensive procedures such as IV, epidurals and operative delivery, and that her excellent postpartum doula care allowed you to reduce your time in the hospital by 48 hours, which is the amount of time that insurance companies are mandated to cover here in California.

    As the consumers, homebirth parents need to be consumer activists, lobbying so that their state laws support midwifery and so that their insurance companies provide reasonable reimbursement.

    Otherwise, homebirth midwifery is an endangered occupation.


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