I was so pleased to read today that the State of Washington is taking away any financial incentive for medical providers who do Cesarean surgeries covered by Medicaid. Almost half the births in Washington are covered by Medicaid and paid for by taxpayers dollars. Now, doctors and hospitals will receive the same payment for an uncomplicated Cesarean surgery as they would for a complicated vaginal birth.

To read a wonderful analysis of the new legislation, check out Carolyn McConnell’s article in CrossCut: Take away the incentives for too many c-sections doctor-money

Maybe the State of Washington can lead the way in reducing the rate of Cesarean sections, saving more than 10,000 women a year from undergoing unnecessary surgical births and supporting the availibility of VBACs in our hospitals, and dare I say, even our birth centers too! While we are at it, let’s make midwifery care available to all low risk women, and send our high risk mamas to the OBs! But hey, that’s a post for another day! A girl can dream, can’t she???

I was reading one of the many birth blogs I follow, and came across this wonderful HBAC (Home Birth After Cesarean) birth story about a strong woman who worked very hard to have the birth she wanted second time around! I encourage you to head over to Women in Charge and read about this great birth! But the part that struck me most of all, that I will immediately add to my toolbox when I work with any birthing woman is the following:

My mantra was that I be yoga’s corpse pose in between contractions. It worked. I slept. I had prepared by meditating on a chart given by my hypnotherapist of a typical hour of active labor – a 1.5 minute contraction divided into three equal parts is, 30-seconds rise, 30-seconds peak, 30-seconds fall. Being 3 minutes apart, as contractions usually are in this stage, means that in one hour, there is 15 minutes of contractions, only 5 of which are peak, leaving 45 minutes of absolute nothing – REST.

When you do the math, it really works out to 7 minutes/hour of peak contractions, but hey, the birthing woman was in laborland! CtxPieChart I just love this image! ONLY SEVEN MINUTES OF PEAK CONTRACTION SENSATIONS IN AN HOUR! We can do that. right? Seven minutes of hard peaky contractions in an hour! You bet, with support, and trust and patience, a birthing woman can do this for an hour, and another and even another, if need be!

I can’t wait to share this mental image at my next prenatal meeting with clients! Maybe I even bring some colored pencils and paper to our prenatal, and we draw a wonderful pie chart or other representation of the seven peak minutes of contractions that occur in an hour of labor!

I will let you know how it is received. And I would love to hear your favorite visualization tip that works well for your clients. Share with me and let me learn!

Birth Matters Virginia announces the winners of their recent video contest, and first place goes to “Prevent Cesarean Surgery,” chosen from more than 40 outstanding video submissions! Ragan Cohen from California submitted this stunning production that is at times hard to watch, but contains a very important message! birthmatters-virginia1With the United States approaching a 32% cesarean rate, highest C/S rate ever, and some hospitals (in Florida) with stats that indicate 70% of their babies are born by cesarean, women need to stand up, educate themselves, and be an educated consumer of their maternity care! Enough is enough! Women take back your births! Thank you Ragan for this great effort at turning the tide! And thanks to all the people who submitted videos for the contest, I have enjoyed watching most of them! What a resource for all of us!

All of the submissions are worth watching, particularly those that took top honors! Watch, learn and share with those who are finding their way in our rocky maternity system! Do what you can to help more women achieve their birth right and birth their babies free from routine interventions and unnecessary surgeries. Support our midwives who are doing what they can to support normal birth! We can make a difference, one birth at a time.

I read a great blog post today by a Certified Nurse Midwife about the usefulness (or actually, the possible emotional harm!) of vaginal exams prior to the beginning of labor. I think this is a great read and good information to take to heart, and have at times said exactly the same words to both clients and class participants. I already posted this over at the ICAN Seattle blog, ( I am the co-leader of the Seattle Chapter) but felt it was so good, I needed to get it up on my own blog too!

The question I always ask is this…. ‘Will the information gained from THIS vaginal exam change what we are going to do today?’ In your present situation, unless you are considering being induced a vaginal exam is irrelevant. What do I mean irrelevant…it does not change what we are going to do TODAY and things can literally change overnight. Because of this, I encourage you to avoid all vaginal exams until you think you are in labor and are having a labor check or you are preparing for an induction. I encourage you to let go of your current cervical change expectations and focus on getting your mind ready for labor and motherhood. You can go from closed to delivered overnight. It will happen. Don’t start to doubt and don’t start to worry. Your body and your baby know the perfect time to move to birth.

Recently I had a student in a class come to me during a break and ask me if spotting, crampiness and some contractions were normal at 33 weeks. I told her that those symptoms might be a reason to check in with her Health Care Provider, as they might want to rule out pre-term labor. She went on to tell me that she had had an appointment the day before, where a vaginal exam was done, that was fairly painful. 1013-gyno-exams_vg
Ever since then, she had been feeling some contractions and cramps. When asked why the exam was done, she could not tell me, other than her HCP suggested it. I honestly did not know what to say, and wondered to myself if this woman was going to be birthing a 33 weeker because some things got stirred up when they should have left things alone. I did encourage her to check in with the provider, and am pleased to report that after another day, things settled down and she has not yet gone into labor!

Skip over to read this entire blog post by It’s Your Birth Right; Skip This Routine and think about keeping YOUR pants on if you are not in labor!

Dear Clients,

I am writing this letter to you, my clients, to thank you! Thank you for showing me strength, grace, power and absolute fortitude during the labor and birth of your beautiful daughter. I was honored to witness this fundamental power during your recent birth! It has changed me forever.

I remember when we met to discuss working together at the birth of your baby. You shared your fears, your concerns and your doubts. Tears were shed. As I got to know you, I listened as you expressed your thoughts and self doubts about your own strength. So many things to worry about, so many unknowns.

As you neared the end of your pregnancy, so many deadlines and obstacles arose that required you to prove that you and your baby were doing well. As your due date came and went, you wondered why you were still pregnant, yet you knew that your baby would choose the date of her birth. Balancing doubt and belief became a daily struggle, and you still forged on, waking up each morning, surprised that you were still pregnant. Acceptance and peace settled slowly, and you found your rhythm to wait for your daughter. thank-you

And then, labor started. Contractions regular and intense, starting as midnight drew near, needing to breathe through them and pay attention….this continued, throughout the night, with little sleep, during the day and onwards through a second night. Exhaustion was huge and the question about why things were not progressing? and still you soldiered on! Another day and evening, and then a spontaneous release of water after 48 hours, and things kicked into high gear. Active labor started and you never looked back! Strong contractions dilated your cervix and you found your groove. You got down to the hard work of birthing your baby, without complaint, without question, so calm, so intent and so intentional! The questioning, uncertain woman who expressed doubts during pregnancy was nowhere to be found. In her place, a strong, powerful woman, loose, fluid and laboring. Internal and composed. Accepting and strong.

And when things were at their most intense, you looked inside and found strength to advocate for yourself and your daughter. During the most vulnerable, most intense, final hours, you were composed and grounded! I listened and watched as you found your voice, in a way that few women do, ever in their life, never mind at 9 cm in labor! I was and continue to be in awe of your actions and thoughts and your conversations with your health care providers, speaking your mind and your intent. You are woman who can do anything! I hope that as you reflect back on this experience, you recognize how powerful and capable you are! Your daughter should grow up knowing what a strong, capable woman her mother is, and how lucky she is to have you as her mom.

Thank you for letting me support you and watch you in all your glory, as you brought forth your daughter! I am in awe of your power! Thank you!


I am so excited about the news that The Transparency in Maternity Care Project: The Birth Survey results are now available to everyone! You can search this dynamic database for information on all the providers (OB, CNM, LM, Family Practice) and birth locations specific for your area! You can read how women who have given birth in the past three years at these locations and with these providers rate their satisfaction in many categories! And you too, can rate your provider or birth location as well, sharing the information on your own personal experience. This is just so powerful, that I am giddy with excitement! Consumer information and ratings on maternity care by provider and location is a long time coming. Now, women and their families expecting a baby can make provider and facility selections based on knowledge and information that is current and reported by other consumers with recent experience with those providers and facilities! resultssurveyreport1

Information available includes:

The consumer reviews just launched include:

– Overall ratings and recommendations for birth facilities and care providers
– A seven-item set of questions on providers’ interpersonal and communication skills
– Facility intervention rates
– Information on finding good care.
– A national average of ratings is also displayed to provide comparison with individual ratings.

If you looking for a provider or birth location go here, and click on connect to check out the survey results.

And if you have given birth in the past three years, take a few minutes to share your experience here, by clicking on the share link, so that others may benefit from your recent birth experience. link_pages_survey

I think this is really big, and maybe the beginning of change, women sharing information so that others can make informed choice! A huge thanks have to go out to The Coalition for Improving Maternity Services (CIMS) for making this possible. Check out their fantastic website just jam packed with important information for expectant families!

Being a birth doula involves waiting. Waiting for babies! Babies who come in their own sweet time! Babies who have their own secret, internal clock that we mere mortals can only hope to understand! Here I sit. On call! I am usually on call. I am on call for most of the year, probably 48 out of 52 weeks. What that means is that at any time of day, or night, I can expect a phone call from a client telling me she needs me. Or telling me she doesn’t need me, but just wants to update me. Come now. Come later. What that means is that my phone is always on and always close. What that means is that I need to always be sure to get enough sleep, go to bed at a decent time, so that I can be ready for a 1 AM phone call. I am waiting now. A woman will be asking me to join her soon! This I know, as she is now admitted to a local hospital for an induction after spontaneous rupture of membranes in the pre-dawn hours of yesterday! And no labor, as of yet, so a push to get things rolling. Hopefully, a gentle push. hourglass1

Since the news of yesterday’s events, I have been on “high alert.” High alert, I suppose is more alert than normal, of which I already am always on alert. Is that possible? With every action, with every errand, with every event of my day, I calculate, “What do I need to do, in case I get the call NOW!” Sometimes, this can be exhausting. Very exhausting. Emotionally draining. For the doula and also for her family. Thankfully, I have been doing this for more than 6 years, and my family rolls with the punches well. But, the waiting doesn’t get easier. Not for me, not for the pregnant mama and her family, and not for my own family. Yet, the thrill of the call, the rush to join a laboring woman, the chance to help and witness women trust in their bodies and their babies, to participate in that age old labor dance, that brings a new baby earthside! There is nothing like it! Nothing! And I suppose, that is why many birth professionals do it. Over and Over!

And still I wait. Restless, unable to complete anything, drifting from task to task, unable to really focus, while I wait. So many things still undone, yet I can accomplish almost nothing. Should I go for a walk on this lovely day? Make a yummy casserole for my family to eat this evening, as surely I will be gone? Will I??? Will I be gone? Rest? Nap, in case tonight is a night of no sleep?? Sometimes denial is a good state of mind. Be ready, really ready and then forget about it! Just forget about it! That works for a while, but now as I sit, and wait, I reassure myself that this baby will come like all the others, in its own sweet time! I remind myself of this a million times! And so, it goes. Wait with me, and help me by sharing your own stories of waiting, for babies, for something else? What was your experience like?

As for me, I will go and put together a new, tasty mac and cheese casserole from the Splendid Table’s newest cookbook! And leave it in the fridge, as I suspect my family will be enjoying it this evening without me. Or will they?

Share your stories of waiting for babies with us! Post a comment!