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

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.

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 2^nd 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 3^rd 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 Future, Dawn Thompson and  Cristen Pascucci from Improving Birth, Karen Brody from BOLD, Gina Crosley-Corcoran from The Feminist Breeder, January Harshe from Birth Without Fear,  Kate Donahue, David 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.

The Sweeping Nets of Legislation

Do you remember the uproar that created the dolphin-safe tuna movement?  People discovered that fishermen, with nets trawling the ocean searching for tuna, captured and killed whole pods of dolphins.  Nets, as big as two kilometers long and two hundred feet deep, were used to encircle schools of tuna.  Once the tuna were surrounded in the net, the bottom was pulled tight, and the catch was hauled onto the boat.  The practice is still continued today, with about 60% of tuna being caught by this method.  It turns out many different species of marine life are caught in those giant nets.  It is called “bycatch.”  It is the unintended consequence of the business of industrial tuna fishing, and it kills hundreds of thousands of non-targeted sea animals, including endangered sea turtles, sharks, barracuda, and a number of other species.

Every time I read about the anti-abortion legislation being passed in states around our country I think about the dolphins and other majestic creatures that die in those giant nets as bycatch.  I think about them because to me they represent the collateral damage of a sweeping, indiscriminate practice that is wasteful and damaging, and that is how I see this legislation.

If the reproductive rights movement was viewed on a spectrum, one end would be those fighting for access to birth control and abortion, and at the other end would be those of us who are demanding access to optimal maternity care for women so they can have their babies in a safe and healthy way.  As an advocate for healthy birth, I am at the forefront of a movement that involves reproductive rights, and I fight for women who have made the decision to follow through with their pregnancies.

I have experienced the unintended consequences of anti-abortion legislation, including limited access to healthcare and polarized community.  The birth-related organization I work for decided to remove the tagline, “It’s your birth.  Know your options,”   that we used for marketing because I and several other chapter leaders reported being confronted at events on several occasions by angry people who thought the word “options” referred to abortion.  How many women did not approach our booths to get information about healthy birth and breastfeeding because they mistook our mission?  A woman I know who desperately wanted another child had to wait to miscarry a pregnancy that was not viable (no heartbeat was detected) because she was in a place that did not allow “abortions” and they would not do a D&C.

The whole idea of “personhood” seems to put the needs of fetus before the needs of the already living, breathing mother.  Both anti-abortion and personhood legislation seem to make it acceptable to view the mother as simply a vessel for growing life; an incubator that has no need for healthcare, human rights, personal autonomy, or bodily integrity.  Every woman who is denied a VBAC (vaginal birth after cesarean) because the risks to the baby may be slightly greater than a repeat cesarean, regardless of the fact that cesarean surgery exposes the mother to serious risk, is affected by this attitude.  Women who live in places where women are denied homebirth with a qualified birth attendant are victims of the same philosophy.  A friend of mine who moved to North Carolina had to go through the “underground railroad,” sending carefully coded emails and having furtive phone conversations to find a homebirth midwife who would attend her.  She felt a homebirth was a safer choice for her than a hospital birth because of all the unnecessary interventions to which she would be subjected in the name of ensuring a “healthy baby,” even at the sacrifice of her own health.  And heaven help the women who attempt a home birth but need to transfer to a hospital and are seen as criminals and undergo investigations by child protective services or are arrested for child endangerment.

Women have been carried out of their homes in shackles while in labor and forced to undergo cesarean surgeries.  This video by the National Advocates for Pregnant Women describes incidents where pregnant women, some of whom are anti-abortion, were denied their rights in order to protect the rights of the fetuses they were carrying.  While this video focuses on personhood legislation, what we are seeing with much of the current anti-abortion legislation which is closing down clinics is that women will have less access to all kinds of healthcare, including well woman exams, cancer screenings, and STD and HIV screening.

The other type of anti-abortion legislation that has unintended consequences for women who want to be pregnant involves mandatory ultrasound.  I have already heard stories of women who have found out that their babies suffered from genetic defects that are incompatible with life or who died in utero who had to endure mandatory vaginal ultrasounds before undergoing medically necessary abortions.  How much more pain and grief must these women suffer?

These laws being enacted are just like those giant fishing nets, catching their target but also capturing women who are pregnant and have very different needs than those of the women the laws seek to thwart.  Yet, women’s reproductive health runs along the full spectrum, and all women need individualized care.  Each woman has a different story, different needs, different circumstances, and different health concerns.  Women need to make these healthcare decisions with their doctors and have access to the full package of reproductive healthcare in order to remain healthy.  Legislation is too broad and general to adequately answer women’s healthcare needs when it comes to pregnancy.  It is wasteful and damaging, and produces too much bycatch in the form of personal pain and suffering for individual women and societal damage because so many women are unintentionally caught up in the sweeping net.

Give the Gift of Knowledge

One step that pregnant women can take towards making sure their care provider is familiar with the latest evidence-based maternity practices is to give their doctor or midwife a copy of the book “Optimal Care in Childbirth,” by Henci Goer and Amy Romano.  Every maternity care provider should read this book, and keep it handy as a reference.  Women might want to keep a copy for themselves too.  Giving this book to your doctor or midwife sends a strong message that you value and expect to receive evidence-based maternity care and that you are savvy enough and motivated enough to seek out the evidence basis of their practice.

This book is not an easy read, nor is it intended as a reference for expectant women.  Instead of “what to expect…” this book is full of detailed scientific evidence about the care birthing women should be given and uses the physiologic, or normal natural physical process, of birth as the basis of care.  Authored by a medical writer and acknowledged expert in evidence-based maternity care and a research expert/midwife, “Optimal Care in Childbirth” gives thorough analyses of current medical maternity practices and the evidence that supports or refutes their use.  It also provides strategies for optimal care and mini-reviews of the evidence, and leaves no stone unturned with respect to the scientific basis for cesarean surgery, induction of labor, augmentation of labor, positioning for labor and birth, care after birth, newborn practices, and more.

I have heard doctors and midwives complain that it is hard to keep up with the research because they are so busy delivering babies.  I have also seen that “silos” exist, where doctors only read journals in their specialty, and miss out on the research that is conducted in related fields, such as midwifery, nursing, and childbirth education.  This book captures research from many sources and packages it in a manner that is portable and easy to share with others.  The mini-reviews provide quick reference points for decision-making in non-emergency situations.

The book costs $50, and by giving it as a gift to your doctor or midwife the message it sends is priceless:  receiving evidence-based maternity care matters to you and you are willing to invest your time and your money in order to get it.

Do they already have a copy?  Suggest they re-gift it to another doctor or midwife in the practice, or to the nurse’s station on the labor and delivery floor of the hospital, or to a nurse, or a hospital administrator, or…

 

Goer, H. and Romano, A. (2012). Opimal Care In Childbirth:  The Case For a Physiologic Approach. Seattle, WA: Classic Day Publishing.

Available on Amazon.com

This is an unsolicited review and I receive no compensation for posting it.

2013 Childbirth Education Blog Carnival

This is a post that I wrote that was published on Childbirth Today from Birthsource.com

http://www.childbirthtoday.blogspot.com/

Welcome to Day #5 of the Blog Carnival honoring 

the International Week for Respecting Childbirth.  

We are focusing this Blog Carnival on the importance of childbirth education!

Lights!  Camera!  Childbirth Education!

By Michal Klau-Stevens

Contrary to popular belief, watching reality birth TV shows like “A Baby Story” does not constitute childbirth education.  Women should understand that while you feel like you are watching a birth from inside the delivery room, what you are really watching is a highly edited soap opera.  The woman giving birth has often had her labor artificially started, sped up by drugs, optimized for filming schedules, and managed to conform to hospital schedules and regulations (and carefully overseen to avoid lawsuits because everything happening is captured on video).  The boring parts end up on the cutting room floor, and the exciting, scary, or emotional parts have been hyped up with tension-inducing music and quick-cut editing.  A process that has really taken up to 24 hours to transpire has been whittled down to a half-hour snippet of tantalizing mom-to-be “birth porn” meant to excite women who have no other way of viewing birth from a more realistic perspective.

Quality childbirth education is the next-best thing to actually observing another woman giving birth.  You learn how your body naturally works to birth a baby, techniques to prepare you for the physical and mental work of labor, and common interventions that might become necessary and why you might or might not need or benefit from them.  You gain an understanding of the issues surrounding giving birth in an environment that is more accustomed to processing you through a system than providing you with individualized care, and you learn methods to give you the best chance of getting quality care suited to your specific needs.

You also build your community by sharing a common experience with other pregnant couples.  That social support is priceless during pregnancy; a time that can be challenging, nerve wracking, and exciting.  As important as it is for you, it can be even more important for your man, who may not have anyone else to connect with about his concerns and needs for the birth of his child.

Seeing more realistic images and videos of real births, having a teacher who can answer your questions, making friends, and learning good information and skills are hallmarks of a good childbirth education experience.  The real thing is NOT like what you usually see on TV!  Birth is a situation where the less drama you have, the better.  Childbirth education helps you be a NO DRAMA MAMA!

Michal Klau-Stevens is the President of BirthNetwork National, an expert on consumer maternity care issues, a Lamaze Certified Childbirth Educator, and mother of three active boys.