Sweethearts guide to preparing for pregnancy

Happy Valentine’s Day!
If you are thinking of taking your relationship to the next level by getting pregnant and growing your family, here are a few tips to help you have a healthy start!

One Day, Last Tuesday: A Day in the Life of a Birth Advocate

Publishing and publicity seminar photo

The pressure was on now.  She rose to speak, in a roomful of 50 strangers.  This was just the practice; the true test would come tomorrow when she actually would meet with ten professionals in the publishing field.  She would have three minutes to convince them that her book would be worth a second, more in-depth look to see if they could sell it to a publisher and the public.

The lives of women and children depend on her being able spread to a wide audience the words of her mission:  to change the maternity care system to one that supports the needs of mothers and babies.

Her hand shook as she took the microphone and she tried to modulate her voice to sound confident, yet relaxed and friendly.  She took a deep breath and began,

“Hello, my name is Michal Klau-Stevens.  I am the President Emeritus of BirthNetwork National, a nonprofit with fifty chapters around the country, and I am an expert on citizen maternity care issues.  The book I am writing is a business book geared towards anyone in business or government working on healthcare reform and corporate financing of healthcare.  It is called “Million Dollar Babies: Controlling the Billion Dollar Business Costs of Maternity to Save Money and Lives.

Businesses pay for almost half the births in this country for a system that is costly and leads to some of the worst outcomes in the industrialized world.  Obamacare is forcing coverage of maternity now, healthcare is bankrupting our country, and everyone is looking for solutions.  The midwifery model of care is the billion dollar answer, and nobody is talking about it.

The reason I think this book will sell is because I am a leader in the movement to promote evidence-based maternity care and with my position, public speaking skills, and connections to national midwifery and birth related organizations I can reach at least half a million people in the birth community with my message, and I’m actively reaching out to the business community now too.

How does this sound to you?”

She looked up to the stage, where her guru, the seminar leader, was standing illuminated in the spotlight.  “Very good,” he said.  People in the room were applauding.  Relief flooded into her body.  At least now she knew she was on the playing field, not outside the ballpark.  So much was riding on this day.

The next day she rose early, unable to sleep from the nervous excitement about the experience which lay ahead.  She dressed in her best businesslike clothes, so different from the jeans and crocs that are her usual uniform as a work-from-home pregnancy coach and birth advocate.  As she walked into the room full of people all jostling for the attention of the eight agents, one editor, and one hybrid publisher, she released her intention out to the universe.  “Just do your best,” she whispered to herself.

In speed-dating form, she met with agent after agent.  She had one minute to give her pitch, then two minutes to answer questions, give clarification, ask for and receive advice from experts in their field.  Her first pitch, with her number one pick to publish her book, was less than thrilled with what she had to offer.  “Maybe if you had a person in business or government writing with you it might work, but it’s not really our kind of book now.”  A disappointment, to be sure, but she picked up her head and moved on.

Meeting after meeting she offered her pitch to the agents.  Some of them felt that the market isn’t big enough, or her platform isn’t big enough, or they didn’t understand why she is writing a business book on a subject that only affects pregnant women.  Sometimes her pitch was right on the mark, and other times, when she varied it to appeal to something the agent had said earlier in the day, it lost its punch or she wandered away from key points.  Every interaction was a chance to learn something new about how to improve, to gain experience to be able to do this well.

Some of the agents understood right away what she was talking about, and saw potential in the market for a book with a new take on serious problem that our whole country is grappling with right now.  Those meetings buzzed with energy.

In the end, she finished the day with three agents interested in reading her full book proposal to learn more about her work.  It doesn’t mean the book will be published, but it is another step along the road in the right direction.

By evening, she felt the day had been a success.  She hadn’t caught the big fish she dreamed about, but she wasn’t walking away empty-handed either.  She had connected with people and was moving forward towards her goal of publishing a book in service to her mission.  Over the course of the seminar, seven people had approached her to say they felt she is doing important work and she should continue to try to get her book published.

She realized that this is the work of an activist; serving her mission by taking action, stretching her boundaries, and taking personal risks.  Speaking her truth, believing it will resonate with some, and accepting it will not resonate with all.  Hoping that others who hear her message will want to share it.  She showed up and did her best.

Will you help me promote my dream book?

proposal pic on laptop

It has been my dream for the past four years to write a book that will activate American corporations to support evidence-based maternity care for healthy pregnancy, birth and breastfeeding.  Next month I am pitching my book proposal to a number of literary agents to see if any are interested in working with me to get my dream book published.  A big factor in whether they will see the proposal as a viable project is my “platform;” my ability to promote my book through existing relationships that I have with organizations and people in order to sell copies of the book.  I’m reaching out now to see what my platform actually looks like.

I often picture myself as a lone mother/activist working out of my kitchen in my sweaty workout clothes after a morning walk or run, no make-up on and munching on rice cakes while writing blog posts, answering emails, and participating in conference calls for BirthNetwork National and other organizations.  I write and talk about my ideas for maternity care and citizen involvement in transforming birth practices and I send them out into the ether of cyberspace.  Occasionally, I put on my fancy clothes and connect with other birth advocates at conferences, such as the CIMS Annual Forum and the Birth Activist Retreats, but those are oases in deserts of time spent working alone.  When I speak with other activists about the nature of our work, I often counsel, “Carry water, chop wood.  Do the daily work that needs to be done, and eventually the village will be built.”  Well, for the past eight years I have been carrying water and chopping wood, daily performing the tasks to speak out about the need for a maternity care system that supports the needs of mothers and babies to have healthy safe births.  Today I am picking my head up, and looking around to see how my village is coming along.

Inspired by Childbirth Connection’s “Blueprint for Action,” I want to address American corporations as stakeholders in maternity care who have the financial resources and clout to transform maternity care in this age of medical reform.  The book I am proposing is primarily geared towards Human Resources and Benefits managers and corporate financial executives, healthcare and medical industry managers, and government workers focused on healthcare.  It will also be of interest to birth professionals who promote evidence-based care.  It will outline the billions of dollars of costs savings and the positive impact on employee productivity and wellness of promoting evidence-based maternity care practices and family-friendly programs in their businesses and in their communities.  To make the business case for promoting evidence-based care the book will utilize the abundant evidence that has been investigated, compiled, and published by organizations such as Childbirth Connection, CIMS, and Lamaze, as well as the individual authors, filmmakers, and bloggers who are part of our birth community.  It will shine a light on corporate programs that work and the resources that are already available in some communities such as birth centers, midwives, and birth networks and include many nonprofit organizations such as BirthNetwork National, ImprovingBirth, ICAN, Holistic Moms Network, La Leche League, Breastfeeding USA, and others.  It will also tell the stories of working mothers and fathers and how they are affected by corporate approaches to family needs.  The idea is to activate corporate awareness and spending to promote practices that achieve better outcomes because American businesses can save billions of dollars by doing so.

You can help me achieve my dream of writing this book and seeing it published by being a part of my platform.  Are you part of an organization that would invite me to speak about these ideas or my book at an event?  Does your organization have a publication, blog, newsletter or other outlet that would publish a book review, article by me, or post on the topic?  Would you post on your social media pages about the book when it is released?  Would you consider bulk purchasing copies of the book to distribute as gifts or incentives to your members or event attendees?  Are you a blogger who would publish a guest post by me or would write a book review or post?  Would you promote the book to your list? If you and I are friends on Facebook or LinkedIn would you share a post with your friends?

Let me know!  While your response would not be considered a formal contract or binding in any way, it would give me and the agents I will be speaking with an idea of the reach that I have going into the project.  Please leave a comment here on the blog or send me an email at Michal@thebirthlady.info and tell me what you or your organization might be willing to do to help me as I promote the book.  Tell me a little bit about your interest in the project, your organization, and your work.  Please include the size of the organization or the size of your readership, followers, or list, as that will be a key piece of information for the agents to know.

I’m excited and nervous to see what my village looks like and who visits it!  Your responses will let me know if my platform is a small life raft or the deck of ship that will sail me towards my dream of writing my book and seeing it published.  Either way, I will be blessed by connecting with others in service of my life mission.  Thank you for all of your support!


How much engagement should we expect from corporations when it comes to improving maternity care?

When businesses offer healthcare packages as benefits to their employees, they take on the responsibility of having a direct impact on the health and well-being of their employees through the programs they offer.  There will be lots of changes to our healthcare system in the coming years as more aspects of the Affordable Care Act come online, yet as long as corporations continue to offer employee healthcare as a benefit, they have an influence on the quality of care and how it is delivered.  As stakeholders in the healthcare system, businesses have a responsibility and a financial imperative to ensure that the healthcare access they offer through their insurance programs is going to lead to high-quality care with the healthiest outcomes at the lowest cost.  To do this, they may have to use their best business tools and skills to engage unlikely corporate partners in the healthcare field.

My husband’s company offers us several healthcare plans to choose from as part of his corporate benefits package.  We choose the plan that best suits our needs, but even that statement is somewhat laughable based on the choices that are made available to us.  In the decade that he has worked for this company, our costs of participating in this benefits package have more than doubled, while our coverage has diminished.  We went from paying $400 out of pocket for our first birth to over $1400 for our third, and they were six years apart.  (The first birth was with an epidural, and the second two were totally unmedicated, yet cost more than twice as much – crazy, right?)  Costs of childbirth education and a doula were not covered, yet both services have been shown to improve outcomes and reduce costs.  I had low-intervention births because I prepared in advance and demanded it from hospital staff, not because that type of care was freely offered.  The nearest birth center is an hour and a half away, and homebirth is not covered by our insurance.  Of course, to go outside of this system and pay for maternity care without insurance is even worse.  A relative who did that got slapped with a $10,000 hospital bill that will take years for her to pay off.  We are forced into expensive, poor quality care partially because that is what our employers provide to us as our choice.

The insurance company that manages these benefits is making record profits, but my husband’s company is certainly not getting a great deal from this arrangement, as it is paying more for the service, giving less to its employees, and paying for the poor outcomes both in healthcare bills and lower employee productivity.  The hospitals that provide care in the community where my husband’s corporation is located deliver non-evidence-based services that have a direct impact on the corporation’s bottom line.  Participation in this system contributes to infant and maternal mortality rates that are some of the worst in the industrialized world, and are putting a huge financial strain on our country’s economy.  At what point does it become fair to say that corporations, as major stakeholders in healthcare, have a responsibility to force change within the insurance, hospital, pharmaceutical, and medical industries because they have the resources and the clout to do it in a way that nonprofits and individuals can’t?  I think the time is now.

This means that, for an example, my husband’s employer would have to invest time and money into learning about optimal maternity care.  A good place to start is with Childbirth Connection’s report “2020 Vision for a High-Quality, High-Value Maternity Care System.” Next, they would work with insurance companies to develop benefits packages which offer high-quality, high-value care.  I’m sure there is an insurance company out there that would be happy to work with a Fortune 50 company to develop an innovative maternity care package that provides high-quality, evidence-based care at reasonable costs, with good profit margins because it utilizes lower-cost practitioners.  His company could go to the hospitals that serve its employees and work with them to institute midwifery programs, redesign labor rooms to be more conducive to low-intervention birth, and provide training for nurses, midwives, and doctors on collaborative, evidence-based care practices.  It could send its lobbyists to advocate for change in payment for healthcare and tort reform, as well as laws that limit the powers of the hospital, pharmaceutical, and medical industries to influence research and the practice of non-allopathic care while increasing access to midwives and birth centers through legislation.  Also, his employer could support community-based resources such as birth networks, independent birth centers, and nonprofits that provide information and services to expectant and new families, and steer employees towards healthier options through education and improved access.

Through the tools and skills of negotiation, leveraging business relationships, utilization of resources, and government and community engagement, corporations can play a major part in quickly changing the quality of our maternity care system.  It is in their best interest to do so, and it is their responsibility to do so.  As long as corporations continue to take on the role of healthcare payers, it is reasonable for society to expect a high level of corporate engagement in ensuring the system they are paying for produces good outcomes at reasonable cost.

Creative Solutions to Vexing Maternity Care Problems

We know our maternity care system is broken, and there are many steps that will need to be taken to fix it.  Our regulatory, legal, and compensation systems will need reform.  We need to change our education system so that we have enough midwives and doctors coming through the learning pipeline to manage all the births that take place every year in our country.  We need to ensure that the information these students are learning about birth is accurate, evidence-based, and clinically appropriate.  Research must be unbiased and include qualitative evidence so that the psychological and emotional aspects of birth are understood as well as the physical aspects.  Women must have physical and financial access to normal, physiologic birth in hospitals, birth centers, and at home, which means that midwives and birth centers must be legal and accessible in every state.  In order for these changes to happen, the infrastructure our current system will have to undergo drastic changes that will reduce the number of hospital beds and displace obstetricians, who are surgical specialists.  It is not enough for advocates of maternity care reform to demand change; we must also work together with the existing systems to find creative, workable solutions which focus on having healthy women and babies as the primary result.

Evidence shows that midwifery care outside of the hospital setting provides comparable outcomes for babies and improved outcomes for mothers at much lower cost than hospital birth.  That is causing competition to grow with doctors, Certified Nurse Midwives, and hospitals, many of which are educational institutions, on one side and Certified Professional Midwives and independent birth centers on the other.  From a fiscal point of view, this is a David vs. Goliath fight.  Billions of dollars flow through the hospitals systems, while birth centers are small, independent businesses.  According to Salary.com, Obstetricians are paid a median income of $251,374, while Certified Nurse Midwives are paid $92,115, and SimplyHired.com puts the annual salary for Certified Professional Midwives at $50,000.  “Big Birth” is trying to eliminate its smaller competitors to maintain market share, even while the evidence and financials support the benefits of utilizing less costly practitioners.

Viewed through a lens of improving outcomes though, opportunities exist that might satisfy both sides.  Reducing malpractice cost is a primary concern, because that is what is driving the maternity care system currently.  Obstetricians can pay between $85,000 and $200,000 for malpractice insurance.  Rising payouts for non-economic damages and punitive damages drive the malpractice rates to dizzying levels.  The problem is that sick babies are expensive to care for, and even when doctors and hospitals are not at fault for poor outcomes, they have the deep pockets to cover the costs of ongoing care.  Many years ago, Suzanne Arms, an advocate for maternity care reform, suggested creating a superfund that would be used to support children born with birth defects, genetic illnesses, and other poor outcomes that are not due to negligence but are financially overwhelming to parents.  Having an option to care for sick children that is not tied to the legal system would go far in reducing the pressure on doctors and hospitals to provide perfect results in an imperfect world.  Implementing such a plan today would break the stranglehold that risk management has over giving appropriate care to pregnant women.

Furthermore, a common practice now is for hospitals to build new wings to accommodate more labor and delivery beds that accommodate patients who have Cesareans.  This creates the revolving problem of having more beds, so they need to be filled to pay for them.  Why not purchase or rent nearby existing buildings that could be converted into freestanding birth centers to accommodate the low-risk birthing women?  This would free the in-hospital beds for the small percentage of women who truly need to have surgical births, while offering the more appropriate level and style of care that most birthing women need.  These “flex spaces” would allow for changes in the needs of the community in terms of numbers of beds as populations ebb and flow.  More out-of-hospital births that are still connected with learning institutions would provide more opportunities for medical and midwifery students to learn about and research normal, physiologic birth in a way that they are not able to do now in hospitals.  Also, they would provide more access to safe, appropriate, cost-effective care to birthing women.  These freestanding birth centers that employ a mix of obstetricians, CNMs and CPMs would be models for collaborative care.

We know that money is major factor that drives decision-making, but outcomes must also be at the top of our list of priorities.  Right now, our outcomes are terrible – in fact, they are some of the worst in the industrialized world.  It is time that all the elements in the system work cooperatively to take steps to change this broken system.  There will be mid-points where compromise will be necessary on all sides, and the groups with less money and fewer, less influential voices must be allowed an equal seat at the table.  There are many bright, motivated people working to improve care for birthing women and babies, and there are many opportunities to employ creative solutions to the vexing problems within our maternity care system.

Look How We Are Changing The World!

I returned yesterday from the Where’s My Midwife?’s 2nd Annual Birth Activist Retreat, which took place at the beautiful Snowbird Resort outside of Salt Lake City, Utah.  Of course, the beautiful surroundings took a back seat to the high-level strategizing and learning that was taking place in the conference center as around 40 birth activists gathered to advance the citizens’ movement to improve maternity care in the United States.

The group included leaders and members of organizations, such as BirthNetwork National, ImprovingBirth.Org, Where’s My Midwife?, BOLD, MEAC, Empowering Birth Awareness Week, Uzazi Village, Birthing the Future, and more.  Bloggers from the sites The Feminist Breeder, Plus-Size Mommy Memoirs, Portland MamaBaby, Human Rights in Childbirth, and Evidence Based Birth were in attendance.  Others in the group were birth workers and independent activists who want to participate in collective action.

The speakers were top-notch, hitting on a number of important topics. Major themes that ran through the speeches and through conversations included:

  • The violence and trauma that we experience as part of our maternity care system today, and how it is now being viewed as a violation of human rights
  • Finding areas of unity within our diverse network of organizations, missions, and beliefs
  • The need to increase the racial and cultural diversity of the movement for greater understanding within our network, and greater impact on our cause
  • Learning tools and frameworks to work efficiently and maximize our impact
  • Monetizing the movement, and birth work in general, to “step into our worth,” and recognize the value of the work we do so that others will recognize it too

Every person in the room had stories of abuse that they had either personally experienced or had witnessed in maternity care settings.  They ran from blatant failure to provide informed consent, to disregarding the wishes of laboring women, to physical assaults such as cutting episiotomies without consent, using a vacuum extractor on a baby without consent, and performing cesarean surgery without consent.

What does that look like?  Picture in your mind, a doctor saying that his on-call time is almost over so it’s time to get this birth done and over with, while a woman is being wheeled into an operating room, screaming that she can push the baby out and she does not consent to surgery.  While the doctor is in the hallway trying to convince the husband to consent to the surgery, the woman pushes the baby out onto the bed while she is in the operating room with the anesthesiologist.  The woman is traumatized and suffers PTSD, the husband is traumatized by being powerless to protect his wife and by missing the birth of his child, the doula is traumatized by witnessing the abuse and being powerless to stop it, and the doctors, nurses, and hospital staff are affected by working in a system that fosters this type of behavior.

This is a true story.  It is not the first time any of us had heard a story like it.  In fact, each of us in the room had participated in stories like it, and had helped our fellow birth workers process through similar events.  We know that every woman giving birth can fall prey to this type of abuse while engaging with the current maternity care system because it happens daily in hospitals and caregiver’s offices around the country.  Almost every speaker at the Retreat started her or his speech with a story about violence in childbirth and the need to protect the empowering nature of birth as being the catalyst for our work.  For many of us in the room, the fire of our activism was ignited because of these experiences.  These abuses simply cannot continue, and we feel compelled to do everything in our power to stop them.

To change our maternity care system, activists are developing programs and events to raise awareness and empower action.  Uzazi Village serves low-income women in the urban core in Kansas City by teaching and providing services to support healthy birth, breastfeeding, and parenting and will act as a model for such villages in cities across the country.  Rallies to Improve Birth will happen on Labor Day in over 150 cities along with movie screening and performances of the play “Birth.” Empowering Birth Awareness Week offers activists the opportunity to focus and unite during one week in September to amplify their messages.  Activists can utilize BOLD classes to enhance skills to affect change.  Women and birth workers can download printouts about the evidence basis of common birth interventions at Evidence Based Birth.  Lawyers who have a passion for issues surrounding birth can get active through Human Rights In Childbirth.  BirthNetwork National focuses on community organizing through growing chapters where all the stakeholders involved can come together to problem-solve, and the activities of many of these other activists in the network of the greater birth movement can be done through those local community groups.

Being an activist is challenging, isolating work.  We all felt renewed by coming together and “refilling our activist cups.”  That renewal allows us to move forward with our important work.

Learn about these organizations and activities and participate!

The organizers of this amazing event put their personal finances on the line to make it happen, and it did not break even.  Please consider making a donation to help defray the costs so they can make sure there will be a 3rd Annual Birth Activist Retreat next year!

Join Me At the Birth Activist Retreat!

This Friday I will be traveling to participate in The Second Annual Birth Activist Retreat, Friday, July 26- Sunday, July 28, 2013 at Snowbird Resort near Salt Lake City, Utah.


I will be speaking on Sunday about “Adopting a Network Mind-Set to Become a Force for Good,” utilizing concepts from the book Forces for Good: Six Practices of High-Impact Nonprofits by Leslie R. Crutchfield and Heather McLeod Grant to show how the individuals and organizations involved in the birth community can use proven methods to work together to grow a movement to improve birth in America.  We are implementing many of these concepts in our leadership of BirthNetwork National as we work to harness the power of our network, and we are working outside of our network to increase impact throughout the whole birth community.  These concepts are powerful tools for your activist toolkit that can transform the way you go about working with others to change maternity care.


Joining me as speakers are Suzanne Arms from Birthing the FutureDawn Thompson and  Cristen Pascucci from Improving BirthKaren Brody from BOLD, Gina Crosley-Corcoran from The Feminist BreederJanuary Harshe from Birth Without Fear,  Kate DonahueDavid Paxon and Kirsti Kreutzer and Anna Van Wagoner form Where’s My Midwife?, alongside birth activists from all over North America!


Where’s My Midwife? says, “The retreat is a time for activists to come together, inspire one another and get to work on affecting change in their own communities and the nation at large. We will plan nationally coordinated actions and build skills that every birth activist needs. We will share success stories and you will have opportunities to receive feedback on your own unique local birth issues as you network with other activists.”

I hope you will join us, either in person or via live-streaming, at this event geared for birth activists.  Being an activist can be frustrating, isolating hard work.  There is very little that is more exciting and fulfilling than coming together with like-minded people who “fill your cup” and inspire you to keep moving forward to achieve your goals.

For more information or to register for the retreat go to www.wheresmymidwife.org.