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Entries in birth (4)

Thursday
Jul112013

Placenta Justice: A Call To Recognize The Placenta

Today we have a guest post from Kelly Gray, a mother, full spectrum doula, childbirth educator and one of the founders of the Bay Area Doula Project. She grew up as a union organizer for public sector healthcare workers and has a passion for redefining healthcare access, models and justice. When she's not helping women take charge of their reproductive lives, she's guiding her fiery daughter to harness her innate powers or collecting reproductive stories for her audio website  Stories From The Womb.  You can read more about her childbirth education classes or doula work at www.ninemoonsdoula.com or find out how to have your placenta encapsulated at Bay Area Full Circle Placenta Services.

Placenta Justice: A Call To Recognize The Placenta

By Kelly Gray

 

Justice, by definition, allows us to create a system that upholds individual or cultural conduct defined by morals or equitable behavior.

In the reproductive justice movement we examine access to services and deem any obtrusion to choice, access, or service as unjust. We work to create inclusion for all people and all experiences. And rightly so! Currently, 1-3 women die in hospital births every day and this number is primarily made up of poor women and women of color. We see these injustices played out psychologically and physiologically, from forced cesareans and sterilizations, withholding abortions, lack of midwifery care or informed consent, bullying, needless interventions, withholdings based on gender and racial stereotyping, and so on. Thus, we should aim to hold the same lens to all reproductive experiences, including the often ignored birth and after life of a placenta.

The majority of American people have hospital births where interventions are high and compassionate care is low, despite recent studies that confirm that more interventions do not lead to healthier outcomes for fetal, infant or maternal health. Sadly, it seems that the medical industry’s approach to birth is too much “care” in the form of interventions at inappropriate times, and lack of compassionate care when it matters most, such as quality time with a provider, home visits, adequate education about choices, and collaborative decision making. Following hospital birth, the standard model of care is to discard the placenta even though there is potential for the placenta to greatly heal the postpartum body and in turn support the infant.

A placenta printWhat exactly is this placenta and what purpose does it serve prior to birth? Placentas are created in utero alongside the fetus. The placenta lines the uterine walls and partially envelops the baby while blood, oxygen and nutrients flow between mother and child. Fetal waste material is filtered and sent away. Essentially, the placenta acts as liver and lungs for the baby until the time of birth, and then, even after birth for a few minutes if the umbilical cord is left intact. The placenta is born following the infant as the uterus continues to contract and shrink back to its original size. This is true of all mammals. What is also true of all mammals (except camels), despite access to food, shelter or protection, is that they immediately consume their placenta following birth.

As mentioned earlier, our current birth culture spends very little time discussing, studying, or practicing the benefits of proper placenta birth techniques (cord traction, manual removal, etc.), the emotional benefits of keeping the placenta, and the physiological and emotional benefits of consuming the placenta. Despite the longstanding tradition within Traditional Chinese Medicine of placenta consumption, Western medicine has done little research into the effects of eating placenta for new mothers. However, if you talk to mothers, midwives, many OBs, doulas and other birth workers who have consumed placenta, it becomes clear that there is an incentive to do so; a healthy and peaceful mom equals a healthy and peaceful baby equals a healthy and peaceful community and so on.

Placentas contain vital nutrients that replenish a mother’s depleted postpartum body. The placenta, dense with blood, hormones and minerals, completes the birth cycle and restores iron and hormone levels. Mothers report increases in milk production and energy while at the same time a decrease in anemia, fatigue and postpartum depression. 

As individuals and as a society we pay greatly when mothers can’t successfully breastfeed their children; we pay in present time with lactation consultants and gear, and we pay big money to the formula industry. In 2008, taxpayers paid $627 million for WIC, a federal program that distributes half of the formula in the country to low income women. The potential increase in milk production resulting from the consumption of one's placenta could have many positive impacts for low-income mothers who are often targeted aggressively by the formula industry.

The birth and consumption of ones placenta should be given the honor to stand on its own as an individual reproductive experience. It marks the visible connection between the watery in utero world and the world that exists between mother and child. It is the last stage of birth, and one of the first stages of new parenting. When we lack tradition and healthy practices around reproductive experiences then we lack justice. When we lack connection to our own bodies and hand over the keys to industries based on creating financial capital then we lack justice.

Not every person should consume their placenta. There are reasons, such as infection or medications administered during birth, where the consumption of placenta is not advised. It is a choice that every person should make for themselves, based on intuition, desires, culture and health.

Our hospitals' hazardous waste bins are filled with organs that bring love, life and health into the world that new families inhabit, so each and every time someone gives birth the question should be, “Would you like to take home your placenta?” That would be reproductive justice in action. Despite income disadvantages, education disparities, and health outcomes, one thing we know is that after every baby comes a placenta, and this is an opportunity to engage the mother with her own health, vitality, and reproductive experience.

Additional Reading:

Bay Area Full Circle Placenta Services

"Rates of labor induction and primary cesarean delivery do not correlate with rates of adverse neonatal outcome in level I hospitals" (Journal of Maternal-Fetal and Neonatal Medicine)

"Study Finds Adverse Effects of Pitocin in Newborns" (American College of Obstetricians and Gynecologists)

"Masking Maternal Mortality" (Ina May Gaskin)

"Market Failure and the Poverty of New Drugs in Maternal Health" (PLOS Medicine)

"Infant-Formula Companies Milk U.S. Food Program" (Women's eNews)

Tuesday
Jun252013

Notes From The Salon: An Evening With Phyllis Klaus

On June 13th we hosted our monthly Salon Series event in partnership with the Birth Justice Project, an organization that supports pregnant folks who are incarcerated, in addition to providing reproductive health education. This event was an interview with Phyllis Klaus, hosted by Darcy Stanley, co-director of the Birth Justice Project. Phyllis Klaus is the co-founder of DONA International and co-author of When Survivors Give Birth, and this event focused on the impact of trauma on pregnant people and the role of doulas in supporting folks with a history of sexual trauma. This event was of particular relevance to BJP, as significant numbers of incarcerated women and trans folks have experienced sexual assault, and both BADP and BJP hope to create a healing community for the people we serve and our doulas.

Some of the overarching questions from the night were:

  • People who have experienced sexual trauma often live with a lot of shame and silence. How do we build communities to address this?

  • What does the stigma associated with sexual trauma look like in pregnancy and birth?

  • What's the evolution of how our community has viewed sexual trauma? What's the role of new doulas in shaping support around this? 

Phyllis Klaus has been involved in studies on the impact of doula care on people's emotional and obstetric outcomes since the 1970's and has an amazing wealth of knowledge on this topic. Some of her points from the night on the topic of trauma are as follows.

  • Continuous support (such as that from doulas) has huge benefits for laboring folks; however, medicine often attributes those benefits to "active management of labor" instead.

  • Trauma comes from many different places in birth and it's important for us to think about how families can shape and reframe that.

  • There is a huge need for more training around trauma and vicarious trauma, especially when dealing with pregnancy and pregnancy outcomes.

  • One major trauma in childbirth occurs when a laboring person feels inordinate fear and has no control over the environment.

  • Trauma in birth looks like many things and it encompasses more than medical emergencies that are usually classified as "traumatic."

  • Trauma can result in a lack of trust in other people, but also a lack of trust in one's own body.

  • Sexual assault survivors may also fear a loss of control, in addition to shame. Care providers must create an empowering environment. 

How can doulas help support folks with a history of trauma?

  • Doulas can provide comfort measures during any potentially invasive procedures that happen during labor & birth.

  • In your doula role, reaffirm that the survivors you're working with are making the right decisions for themselves.

  • Addressing trauma with someone at your first meeting can be hard, but people may be relieved if you make space for them to talk about it.

  • Reframing may be helpful for addressing trauma (for example, thinking of the baby as assisting in the healing process).

  • There is no judgment; whatever works for the pregnant person is what is best. Give people the space to ask for what they need.

  • It's important to give pregnant survivors, and all pregnant folks, the opportunity to feel heard, regardless of procedural choices (for example, some people may choose C-sections because of prior trauma).

 What about self care for doulas who work with survivors of trauma?

  • It's a good idea to switch self care techniques from time to time.

  • Debriefing, having a doula partner, recognizing that we all experience some trauma that we need to set aside to be present.

  • Stretching, breathing, visualizing healing energy all around you—just some 30 second tips to shift your mental energy as needed. 

Thank you so much to Phyllis Klaus for sharing your important and informative knowledge. Also a special thanks to Darcy Stanley for conducting the interview and leading the group in a closing visualization exercise.  

Hope to see you at the next Salon Series event!

Tuesday
Jul312012

Tuesday Guest Post: "Guatemala: Atención de Mujer a Mujer"

Every Tuesday we feature a guest post related to abortion support, reproductive justice, and other topics relevant to our mission as an organization dedicated to providing nonjudgmental, compassionate and empowering full-spectrum doula services. If you are interested in writing a post for our Tuesday series, email Kelly N.  

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Guatemala: Atención de Mujer a Mujer

By Holly Carpenter

 

As a full spectrum doula and nursing student in the US, I have had ample opportunities to witness the ways in which the culture of hospitals can harm, rather than heal. Hospital caused infections, medication administration errors, and overly managed birth all have negative consequences for patients who enter the hospital environment in search of help and good health. As an intern at a women's health clinic and birth center in Guatemala, I have seen these consequences reach a pervasive and profound extreme I didn't realize was possible, especially for women seeking care during pregnancy and childbirth.

 
I arrived at Asociacion Manos Abiertas (AMA) on a Friday and by Saturday morning I was two hours away in a tiny village setting up a field clinic for cervical cancer screenings with Carmen and Sandra, two of the Guatemalan clinic staff members. We spent the next two days doing over 125 screenings in a makeshift clinic, battling moscas (flies) with electric fans and the faulty health care system with plastic speculums and vinegar. The real challenge, however, was hearing the stories, and not just because my Spanish leaves something to be desired. I’ve worked in many women’s health settings, from a double wide trailer in rural Sonoma county to the inner city San Francisco General Hospital, but nowhere have I heard stories like these. Women who went to the national hospital for their six month prenatal visit and were told that the position of the fetus at that time was enough to warrant a planned c-section. Rampant domestic violence. Women who requested hysterectomies but were never able to find out whether they were actually performed after their c-sections. Babies half delivered and then manually forced back into the uterus because of shoulder dystocia and delivered through the most grotesque and barbaric cesarean incisions one could imagine.  

The theme that really stayed with me though, was the total disempowerment and lack of respect these women faced in the hospital setting. Let me qualify by saying that I haven’t yet been to these hospitals, nor interacted with the health care providers employed there. I don’t know what the pressures were that caused the providers to treat these women so poorly - if I could hazard a guess, I would say it’s probably an extreme lack of resources, minimial funding, low quality education, and a political system that impedes most progressive and idealistic individuals. The doctors I have met are generous, intelligent, and extremely respectful of their patients. But the truth was in these women’s downcast eyes, quiet voices, and complete lack of confidence in their ability to take control of their health. It took nothing more than a sympathetic word to start the stories flowing. The questions about bleeding and birth control. The embarrassment over a grade three prolapsed uterus and the relief from one widow that her husband was dead - setting her free from future pregnancies... she felt 11 was more than enough. These are not typical stories that you hear in the US, with all its health care problems. Occasionally, to be sure. But these stories came from many voices, and echoed the same theme over and over. They had no power.

Fortunately, las mujeres de Guatemala have at least one possible alternative: Asociacion Manos Abiertas. Manos Abiertas is the opposite of the impersonal, disempowering hospital system here. When women walk in the door of our brightly painted clinic, often accompanied by children and partners, they are greeted as peers. They are shown respect, interviewed about their wishes and desires regarding their health and family planning, and provided with a comprehensive set of services including psychology consults, pediatric care for their little ones, and complete gynecological care. Women leave empowered and eager to continue their care with AMA. Best of all, this is not a typical non-profit staffed by gringos with mediocre Spanish (with the exception of me!). The care is largely provided by Sandra and Carmen, women from this community who embody the concept of atencion de mujer a mujer.

If Manos Abiertas didn’t exist, these women would have no alternative to the national hospital. I only wish it could exist in every community here, and indeed, throughout the developing world. It is a simple and beautiful solution to a problem that most international leaders acknowledge as being among the greatest facing our generation - poor maternal and child health care. 

For more information, visit http://asociacionmanosabiertas.org/es/ or
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Holly Carpenter is currently a full-spectrum midwifery student at University of California, San Francisco and volunteer birth/post-partum doula at San Francisco General Hospital. Originally from northern Idaho, she became a California-convert while completing her B.A. at Pitzer College. After volunteering for reproductive justice for years, she decided to depart from politics and policy in search of more tangible, direct work in women's health care. She sought experience in a variety of settings, from patient care in rural teen clinics and Planned Parenthood to several years as an after-abortion counselor with Oakland-based Exhale. As a Pro-Voice Lead Counselor, she heard thousands of abortion stories and facilitated a team of thirty fellow counselors as they provided conscious, compassionate, and non-judgmental support to women and their partners. The missing link between emotional support and clinical services inspired her to work with this group of incredible women to found the Bay Area Doula Project. As a future abortion provider, she appreciates every chance to support women where they are, and ease an experience that can be painful, relieving, complicated and empowering, to name a few.
Wednesday
May302012

Follow-up: Orgasm Out of the Box

After her Salon presentation on "Illuminating the Intersections Between Passion, Sexuality, & Birth," Carrie Flemming wished she'd had time to answer a couple more questions. Fortunately, with this blog, there's no time limit. Here's what she wanted to say:

 

Follow-up: Orgasm Out of the Box

By Carrie Flemming

After we watched the unassisted birth of a Russian midwife featured in the film, Birth Into Being, a woman in the audience asked,

“How come this is the first time I am seeing this kind of birth?”

Tatyana’s birth is calm, gentle and confident as she squats in a clear plexiglass tub surrounded by her partner and children in her home. The births we see in popular media are often traumatic, full of drama and have the overall feeling of a medical emergency. These images live in our cells and minds, shaping the way we perceive and feel about human birth throughout our lives.

But there is another image of birth we rarely see outside of women-centered childbirth education classes. This is the image of a woman listening and moving from her innermost knowing, following her instincts and birthing from the depth of her power. It is inspiring and satisfying to watch.

So, how come this women-centered imagery is rarely seen in mainstream culture?

To find the answer to this question we need to understand the history of midwifery, the creation of the field of obstetrics by a young, male (and largely uninformed) medical community, and the eventual medicalization of birth. We also need to ask ourselves who benefits from this arrangement?

Luckily, there are many wonderful resources available. For those who wish to read more in-depth about the history of birth practices in the United States I recommend:

The American Way of Birth by Jessica Mitford. 

A chronological examination of the history of Western birth from midwives to obstetrics.

Immaculate Deception II by Suzanne Arms    

History, practices and culture of Western birth.

Birth Matters: A Midwife’s Manifesto by Ina May Gaskin

Outlines the history and future of birth from a midwifery perspective.

The Caliban and the Witch by Silvia Federici.

Gives a broader understanding of the state’s control of reproductive rights as it relates to western capitalism and conquest.

The Business of Being Born, 2008 

A documentary created by Abby Epstein & Rikki Lake
Watch the trailer here: http://www.imdb.com/title/tt0995061/ 

Stream it here:
http://www.amazon.com/gp/product/B0054LZ0VO/ref=atv_feed_catalog?tag=imdb-amazonvideo-20 

 

The second question that came up was:  

“Is home birth as safe as hospital birth?”

There are no definitive studies that compare the safety of home vs. hospital birth. The Farm Midwifery Center put forth a study in 1992 based on their birth outcomes over 30 years. Read the study here: The Safety of Home Birth: The Farm Study, A. Mark Durand, MD  http://www.thefarm.org/charities/mid.html.

The prevailing wisdom is that for low-risk pregnancies home birth is as safe as hospital birth. There is no one answer for every woman. Each woman needs to weigh the different factors that will help her feel most safe and confident to birth her baby.

Many practitioners from the women-centered, midwifery perspective believe that the possibility for a safe and satisfying birth increases when a woman:

~Feels secure in her environment and her body

~Is surrounded by people who support her decisions

~Is physically, emotionally and psychically comfortable

~Has minimal lighting and observation by people & machines

~Has the freedom to move & express herself the way she wishes

For some this will be at home with a midwife and for another it will be in a hospital with doctors and nurses. Some women will choose to birth at home unassisted with only their partner and children present. And yet others will opt for a birthing center.

There is no right or wrong choice and there are no guarantees. On a positive note, it is exciting that we have so many possibilities. I do think we have the right (and the responsibility) to be fully informed of our birthing options and their consequences. I believe all women deserve to have access to the information and resources that allow us to make the best decisions for ourselves, our bodies and the new humans we choose to bring into the world. 

Also, continuous labor support from a doula has shown to improve birth outcomes and to be highly beneficial to the mother well into her first few months with her baby. Read more information about continuous labor support here:

The Effect of Doula Support During Labor on Mother-Infant Interaction
http://www.nature.com/pr/journal/v43/n4s/full/pr1998210a.html
Women’s Perceptions of Their Doula Support
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1804309/

The Proven Benefits of Having a Doula

http://mamasfriend.weebly.com/birth-doula-research.html

To learn more about increasing the possibility for a safe and satisfying birth for you and/or your clients, I would recommend:

The Birth Book: Everything You Need to Know to Have a Safe and Satisfying Birth by William Sears, MD and Martha Sears, RN.

Ina May’s Guide to Childbirth by Ina May Gaskin

Orgasmic Birth by Debra Pascali-Bonaro and Elizabeth Davis

The Thinking Woman’s Guide to a Better Birth by Henci Goer