Reframing Maternal Health

REFRAMING MATERNAL HEALTH: HOW DO WE KNOW WHAT WE THINK WE KNOW?

TUESDAY, MARCH 31ST, 2015 / CHANDLER MARRS, PHD

Washington Alliance for Responsible Midwifery (WARM) had the great pleasure of having Chandler Marrs be our guest speaker on our Educational Teleconference call.  She talked about re-framing the concepts around maternal health and understanding the biases in medical research. She says, "One of the great questions that has been occupying my time lately is understanding how the frameworks for understanding medical concepts emerge. Shorthand: how do we know what we think we know? Read the  annotated and somewhat edited (for publication) version of the talk she gave. Enjoy.

7 SuperFoods for Pregnancy

The following is a guest presenter for the WARM Midwives Blog.

7 SuperFoods for Pregnancy

By Katherine Leonard, MS, NC

www.holistic-nourishment.com

These foods are powerhouses for your body during pregnancy.  Supporting the growth and development of a child is no small feat!  And your body will need to be nourished with high-quality organic foods in order to prepare your body for the new life it supports.    

Eggs and Egg Yolks – Egg whites are a complete protein source and egg yolks are rich in nutrients necessary for the healthy growth and development of a baby.  Yolks are high in choline, which is critical for the development of the brain, neurons, and the synapses where two neurons can communicate. Four yolks and at least one egg white each day will provide about 500mg of choline, a modest recommendation for daily choline intake. Yolks are also rich in cholesterol, a crucial nutrient for the healthy development of a baby’s brain, nervous system, intestinal tract, and hormones.  

Butter – From grass-fed cows, butter is a rich source of cholesterol and vitamins A, E, D, K.  Fat-soluble vitamins and cholesterol are essential for the development of healthy organs, especially a brain.  Butter is also rich in minerals such as selenium, copper, chromium, and zinc which are important in many different metabolic processes.  And perhaps most importantly, butter provides arachidonic acid, fatty acid that is essential for skin, intestinal integrity and brain function.  This fatty acid also supports the nervous system and immune response.  It is essential to fertility and blood clotting.  

Cod Liver Oil – Cod liver oil is rich in several valuable nutrients such as vitamin A that support healthy gene expression, strong bones, healthy skin and lungs, good eyesight, mineral metabolism, hormone production, mental stability, and protection against environmental chemicals and estrogenic substances in pesticides and plastics.

Raw Cheese – From grass-fed cows! Raw dairy products are much more wholesome and easy to digest compared to pasteurized and homogenized dairy. Raw dairy has been shown to build strong bones and teeth, strengthen the immune system, and protect against allergies and asthma.  

Bone Broth – Homemade bone broth is rich in gelatin, amino acids, and fatty acids that will contribute to stronger bones, tendons, connective tissue, and your digestive tract.  High in an amino acid called glycine, bone broth provides nutrients needed for the synthesis of the placenta and it helps you and your baby deal with stressors.  Bone broth is a warming, comforting, and hydrating beverage that you can drink on it’s own with Himalayan sea salt, or use it as a base in butternut or other squash soup.    

Leafy Green Vegetables – Dark green vegetables are a fantastic source of folate and calcium.  They should be cooked and served with butter or coconut oil in order to enhance the absorption of fat-soluble vitamins.  

Fermented Foods – Lacto-fermented foods are rich in enzymes, lactic acid, and good bacteria.  They are a digestive powerhouse that not only helps you digest your food, but boost your immunity, remove toxic compounds from your body, and produce vitamins and short-chain fatty acids that nourish your gut and your brain.  Don’t you want that for your baby too?

Vodoo or Midwifery?

From the beginning of time midwives have been the ones to support a woman in childbirth.  I do not mean to sound like a clanging cymbal, but I have to say,  it was politics and religion that undermined the midwife and planted the seeds of doubt in a midwife's competency and trustworthiness.  The battle has continued to rage. A woman can and is losing her right to choose her birth experience and is being coerced and undermined to the extent that she no longer believes she can bring life forth without medical intervention.  Washington Alliance For Responsible Midwifery in alignment with the Global Midwifery Council wants to educate the populous.  We want to encourage, inspire and educate women.  Remember;  It is YOUR birth ~ YOUR Choice ~ Be Empowered.

Midwives need to be allowed to do what they have been doing since the beginning of time.  Her scope of practice needs to allow her to do what she does best.  Serve woman, legally and safely.

Midwifery Scope of Practice

Time for Sober Reflection 

The Proof Is In The.......

“Midwifery is a vital solution to the challenges of providing high-quality maternal and newborn care for all women and newborn infants, in all countries”

The Above statement was made in "The Lancet"  a well respected medical journal.  

The Executive Summary had the following to say: 

• Midwifery matters more than ever
• The evidence examined in this Series suggests that midwifery is uniquely placed to contribute to the QMNC (quality maternal and newborn care) framework and to offer this combination of skills and relationship-based care, appropriate to the context and situation, and across the continuum.
• There are substantial health and well being benefits for women, mothers and their infants, as well as families, when high-quality midwifery care is delivered by midwives and others with midwifery skills. 
•  Analyses showed that outcomes improved by midwifery care include reduced maternal and newborn mortality, reduced stillbirth, reduced perineal trauma, reduced instrumental birth, reduced intra-partum analgesia or anaesthesia, less severe blood loss, fewer preterm births, fewer newborn infants with a low birth weight, and less hypothermia. The analyses also found increased spontaneous onset of labour, greater numbers of unassisted vaginal births, and increased rates of initiation and duration of breastfeeding. Increased referrals for pregnancy complications, fewer admissions to neonatal intensive care units, and shorter stays in neonatal units are examples of outcomes that indicate both improved care and resource use. Importantly, women reported a higher rate of satisfaction with care in general and with pain relief in labour in particular, and improved mother-baby interaction was also identified.
• To deliver high-quality care in all settings, health professionals and policy-makers need to create an environment where the 72 effective midwifery practices identified in this Series can be implemented in line with the woman-centred values and philosophy outlined in the QMNC framework. This is likely to have important economic effects, potentially reducing health spend, and increasing the sustainability of maternity care systems in the longer term. 
• Midwifery’s contribution to the survival, health, and wellbeing of childbearing women and newborn infants is demonstrated in the analysis of systematic reviews, case studies, and modelling of deaths averted that was done for this Series. Midwifery is a vital solution to the challenges of providing high-quality maternal and newborn care for all women and newborn infants, in all countries. 

Visit our website:   Our mission, philosophy and goals support a woman and her right to choose her birth and be supported by a skilled midwife.

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Ryken Rainier Moyer’s Birth, by Hollie Moyer

Born at home, 13 October 2013, at 7:46 in the morning. 

Weighing 8lbs 4oz., 20 inches long 

My labor with Ryken started mid-morning on Saturday, October 12, 2013. I was noticing more contractions and decided to time them at the breakfast table. They were sporatic but some were pretty close together, 3-15 minutes apart. All day I wondered if they were going to progress to active labor.

We walked to ACE hardware to try out our new jogging stroller and I noticed that they persisted with activity, but when we got home and I sat down they backed off again. I gave the midwives a head’s up just in case and went about my day.

By the afternoon I was feeling frustrated that they had died down. We went to El Porton to celebrate my nephew’s first birthday and I opted for tortilla soup, just in case labor would start that night. I didn’t want a heavy enchilada sitting in my stomach if I would be in active labor soon.

After we got home, Eli helped get Jesh to bed after I had nursed him (though he kept getting up until about 11pm). I did some homework and after a while decided some yoga might ease my frustration about not being in labor. But most of the poses didn’t feel all that great, so I went to bed. I expected to sleep through the night and had even told the midwives that things seemed to slow down and we would probably all sleep through the night.

At about 1:00 in the morning I began to realize that I was breathing through contractions in my sleep as I lay in bed. I got up to go to the bathroom and decided to watch the clock again and time them. They were 5-7 minutes apart and I really and to breath through them. I told Eli, “Ok, I think I may really be in labor now.” So we decided to time a few more. They were consistent and we called the midwife. I stayed in bed for a few more contractions with Eli helping me manage them, but soon said that I couldn’t stand them laying down anymore, so we got up and started to get things prepared.

Eli lit candles all over the house, put the plastic and old sheets on the bed, and brought in the birth tub. I got the birth kit out, and old towels and receiving blankets set up under a heating pad to keep them warm. We listened to a playlist of hymns and worship songs I had prepared for the birthing and had been listening to throughout my pregnancy. It was very peaceful, calm, and refreshingly normal.

I was feeling the contractions mostly in my back and had to brace myself leaning forward on something for most of them. Eli was so sweet and helpful, and my heart was full of thanks and peace. I sipped tea and ate cheese and crackers between contractions. Eli was ever present when he saw a contraction starting, to come and rub my back, sway with me, and speak sweet Truth to me.

Soon Lindsay arrived and my mom came a few minutes after. Every arrival was perfectly timed, a joyous moment. They quietly got the tub ready – though I was still not sure if I wanted to use it and still relatively confident that I didn’t want to birth in it. They slowly filled it with water warmed on the stove and I kept focusing on contractions. I had to bend over or be on hands and knees to manage them as I was having a lot of back labor. I did several contractions kneeling in the living room on hands and knees singing along with the hymns playing in the background. I did several others leaning forward braced in the doorway to the kitchen, and soon singing was not very possible. Almost simultaneously the tub was ready and I decided to give its pain relieving claims a try.

As I stepped in it felt so good, the warmth, the salts… and I remembered all the women I’d seen who said that didn’t want a water birth who ended up not wanting to get out of the tub. But still, I wasn’t keen on a water birth for myself, especially since Eli was planning to catch the baby.

For a while I thought the water might be slowing down my progress, but Lindsay assured me that I was doing fine. I felt the endorphins flowing for a while and was in the zone during contractions, but still able to joke with everyone. At some point the other midwives and the birth photographer arrived and I greeted them in my mid-labor high.

The contractions were soon getting very intense and I found my work harder, focus more intent to manage them. Throughout my labor I found myself speaking out reminders of all the reasons this birthing was better than my experience in Romania with Jesh – I didn’t have to ride in a taxi, I didn’t have an IV, there weren’t strangers surrounding me and yelling in Romanian, I wasn’t being rushed or threatened. As the contractions persisted I delighted in the freedom of this birth.

It was fun to have this baby as a student midwife myself because I understood so fully everything that was happening within and around me. While on my hands and knees in the tub, Lindsay said she could see my “turkey timer” and that my pink line was at the top of my bottom – meaning that I was fully dilated. That information was great, but I wanted to just relax and let the baby come with as little pushing and strain as possible. So I rocked with the contractions, moaned, spoke truths or “Baby, baby, baby,” or reminders to relax and stay soft.

 I was staying soft and relaxed but didn’t notice much of any progress and could feel the baby turning inside. My oldest sister had arrived sometime in here too. My back labor was overwhelming at times and the contractions felt like mountains moving apart. I was beginning to lose my ability to manage the contractions as I was getting tired. Lindsay had me sipping coconut water with molasses and I told her it tasted terrible; but I knew I needed the energy. She suggested position changes and I agreed (though often not willingly).

At one point I realized this baby wasn’t just coming on his own like I had imagined and I told Lindsay that something was wrong. The contractions were close and very intense and she suggested I go to the toilet to pee. I think I told her “No” or “I can’t.” And then another contraction hit me unprepared. After it was over I was helped by Eli to get out of the tub and into the bathroom. My mom draped my bathrobe around me – I was so supported.

On the toilet I was only able to pee a small amount and I did not like being in that position. I started to cry. Eli was kneeling in front of me, holding me, and I said, ‘I don’t want to be in here.” He said, “Okay, let’s go!” But another hard contraction was coming and I said, “But I can’t get up!” We made it through the contraction and headed back to the tub. For a moment I wondered if I should stay out of the tub because for a few moments I had felt like I didn’t want to be in the tub anymore. But the contractions were so powerful that I thought the tub must be helping in some way (in hindsight I wonder if I should have followed that intuition, if it would have helped me cope better).

I got back in the tub with a renewed sense that I had to help this baby out and I was ready to push. My sense that something was wrong was because the baby was taking a long time to get under my pubic bone. In some deep part of me I thought there must be some sort of cord issue or he would be coming faster because I was still staying very relaxed. I began to give some pushes with my contractions and after a few sets I could feel my bag of waters bulging (at one point Lindsay thought my water had broken, but I assured her it hadn’t). Eli later said that he was glad someone told him it was the bag of waters he was seeing and not the head, because with a few more deep pushes it burst.

With that burst I heaved a sigh of relief. It was brilliant to watch and I can still replay it in my mind’s eye – this bursting forth, the first expulsion that would lead to my baby coming. At this point I don’t think my other sister had yet arrived, because her phone had been on silent and so she hadn’t seen the text messages Mom had been sending.

When my water broke, the baby went back up a bit and I had to work hard to bring him down again. Lindsay was suggesting position changes and so I would squat for a few contractions and that really hurt, and I would be crippled to my knees. Eudine was helping a lot by massaging my lower back in long downward strokes. There were times when it felt as if she was really moving the baby down; she was gently, showing him the way (she later told me how she could feel the baby’s head pushing back against her hands).

I was a lot more vocal at this point, my pushing very primal. In between contractions I was lost to the world around me. Fully relaxed. My eyelids felt so heavy and I could only hear the sound of my own breathing and the thoughts in my head. I never heard them coaxing me to take a drink until they would touch me or put the straw in my mouth.

I would be roused almost solely by the contraction and they woke me to my fullest. At the beginning of each contraction I would begin to feel overwhelmed but would then curl around my baby, sink down in the water and give a low guttural grunt as I pushed. I could tell which pushes were effective and which were not, and the low, sinking, curling, grunting ones felt best.

All throughout this stage of labor, I could feel the baby rotating in my pelvis. This was another reason I thought something was holding the baby up. I especially felt these rotations between contractions and would often respond with surprised comments such as, “Whoa, Baby!” or “Whoa, what are you doing in there” or “what was that?!” This stage was also filled with me saying the very same things that have bothered me when I’ve attended other women in labor. Including: “It hurts,” “I can’t do it,” “Why is it taking so long,” and one of the worst, “Get it out!”

Jesh woke up about 45 minutes before the baby finally emerged and was watching during this final stage. He sat with my mom and my sister gave him a granola bar. He was a perfect relief to me during this hard stage as I had another focus between some contractions. Every now and then he would come and hold my hand or peek in the birth tub to see what was going on. He even brought out some of his stuffed animals to witness the blessed event.

Lindsay had been encouraging me for a long time now that I was “almost there.” And I finally told her to stop saying that, but I also was able to reach down and feel my baby’s head about to crown. My other sister arrived at this point and I greeted her as she apologized for not getting there sooner. Lindsay coached Eli to apply a little protective pressure to my perineum while I squatted and pushed and felt the baby coming fast, I said, “I feel the baby coming. It’s coming!” in a frantic voice because the sensation of such a fast descent was overwhelming. In an instant I felt him crowning and bellowed.

Since I was squatting and Eli wouldn’t be able to see to delivery (and the baby was coming fast), Lindsay took over and urged me to go slow and easy. I told her that I couldn’t and immediately my sister was kneeling in front of me (she must have jumped over about five people to get there) encouraging me that I could do it, with the earnestness on her face that only a sister can show. I had mostly been closing my eyes or looking at the table but immediately all I could see was Krystal and I had the image of her own births flash into my mind as I saw myself encouraging her as she birthed her babies. I held back a sentimental tear and was able to pant before my body could no longer slow down and I bellowed again with a great big push and felt the sweet relief of the baby’s head stretching me fully and coming into the water. I took a deep breath (and a sigh of relief) but the shoulders were coming fast and I had to push. I pushed hard and felt the angle at which the baby came and can still remember that glorious feeling of my baby slipping from my body – the feeling of squishy arms and long legs emerging into the world. Praise Jesus!

Since I was squatting, I knew I would have to swing my leg over the cord before I could hold him and I did so instinctively. As I sat back and watched Lindsay lift him from the water, Heather (my oldest sister) called out, “It’s a Boy!” (she later told me she was SO surprised it was a boy that she couldn’t help but call it out). It was 7:46 am.

 As he came up from the water (my little Moses baby) I could see he was very tangled in a short cord and instinctively began supporting him while Lindsay tried to free him. Lorri saw that he was getting turned the wrong way and stepped into help. The cord had gone under an armpit around the neck and under the other armpit --- no wonder he was slow and then fast to come! He cried quickly and I spoke to him and soothed him, and kissed him all over.

He was smothered in vernix and I loved it. Eli and Jesh came beside me and Eli spoke a blessing over the baby. Then I started us all singing the Doxology and the baby quieted down instantly. He cried again when we stopped and so I asked Jesh if he wanted to sing “This is the day” to his new brother. We did and again he quieted down. He was so alert and I could barely believe I was holding him in my arms at last. I kissed Eli and told him I loved him. After he was born, I kept waiting for Lindsay to tell me to get up from the tub, but she gave us an extra bit of time. She finally did though and so I handed the baby to Eli while they supported me to get out. I squatted to help release the placenta, and a few moments later, it was born. Lindsay was concerned about how much blood I was losing and so gave me a shot of Pitocin. I said, “Love the Pitocin!” because I wasn’t really excited about getting it, but knew that Lindsay was keeping me safe. A few minutes, after the placenta had been born, and we were sitting on the kitchen floor leaning against the tub, nursing the baby for the first time, Lorri asked if this baby had a name … Eli and I looked at each other and at once said, “Ryken Rainier Moyer.”
 

"Honest Miss Charlotte" - A Birth Story

There is a line from the movie "Gone With The Wind" where Prissy says, "Honest Miss Charlotte, I don't know nothing about birthing babies!”  As the little gal frantically blurts out this statement, there is a baby about to be born. She was supposed to help, but then the truth comes out.  She knows nothing.  This describes my experience when I first started having children.  I was unaware of my choices regarding birth.  My first child was born nineteen months after I was married.  I was twenty-two and naivety regarding birth was an understatement.  

My doctor was a family friend and physician.  My pre-natal visits were typical:

• weight – check 

• blood pressure – check 

• fundus height - check  

• baby’s heart tones – check 

•  good bye, see you next time - check     

The following were never talked about; nutrition, alternative support, lifestyle.  The only model was a medicalized one.  I was disempowered, uninformed and became a victim of my own ignorance.   My diet was the typical SAD diet and as pounds came on, the blood pressure went up. 

I was put on bed rest and drugs for five weeks for pre-eclampsia. Week six I was hospitalized for toxemia and put on a magnesium sulfate drip to lower the blood pressure.  By this time I was 37 weeks pregnant and an amniocentesis was done to see if the three week premature baby was ready for induction.  It was a go and the pitocin began.  Drip, drip, drip went the liquid. I was a lamb being lead to slaughter and did not even know it.  As the drug pulsed through my veins my body tried to decipher the mixed messages.  It had been suppressed for weeks with drugs and now it was being told to labor with drugs.  I was told the baby was showing signs of distress after twelve hours of labor and emergency cesarean was performed.  

The "saddle block" did not work thoroughly so I felt the surgery.  My cries of agony were meet with, “We have to keep going” and that it was just in my head. My doctor was a “hero”, he "saved" my baby's life, which was born with a 9 apgar score, and I was set up to have my choices limited for future pregnancies and deliveries.

My next baby came 22 months later.  No trial of labor was offered.  Even when my water broke three weeks early and I asked if I could labor, I was told no, it was against hospital policy.  Cesarean number two was performed.  My incision got infected so it had be opened up and cleaned to promote healing. Cesarean number three was executed twenty four and half months later.  No other choice was given except to have my “tubes tied” and I said no.

I wanted more children and began to get very determined about having a vaginal birth after a cesarean – (VBAC).  I read and researched about VBAC and became confident that this was the choice I wanted to make.  I found a doctor that would “give me” a trial of labor.

As I reflect on the word “give”, I now realized how disempowering it was to be “given” something that should have been rightfully mine.  However, I am thankful he was willing.  I had a successful hospital VBAC after three cesareans, which had never been done before in the hospital where I birthed. It was not a perfect experience as I feel like I was violated.  After twelve hours of labor and four hours of pushing, I asked for help.  What I got was not what I meant by help.  The scissors were pulled out and without permission, I was given an episiotomy.  I snuggled my baby as I was stitched up.  Two days later the hospital gave my husband and I a candle lit dinner.  I felt like a bomb at been detonated between my legs, but the steak was good.

I will just let you know in case you are starting to wonder.  I am not Catholic or Mormon.  No offense intended.  It is just that I was asked that a lot when baby number five was in the hopper, so I thought I would  go ahead and answer it. A few more answers for you.  Yes, we knew what was causing it.   Yes, we were aiming for a baseball team.  Yes, they were planned and yes they are all from the same father. 

I have to take a little side trip here.  A few years back the census called. The integration included listing offspring. I named them off; she asked me if they were all from the same father.  I answered her, "Oh no, one was the milk man, then the mail man, UPS man, Fed ex......etc."  The phone was silent. Ok, my humor can be warped, but we had a good laugh and I did tell her the truth, eventually.

Now, back to the birth stories.  By my fifth pregnancy, I was a Birkenstock, wool sock wearing momma and being "el-naturele" was part of my lifestyle. I had been exposed to the idea of a home birth with a midwife.   Obviously, with my history, I was not the ideal candidate, but I was determined.  I read materials to educate myself. I began to feel empowered and believed it my right and my choice to deliver at home with a midwife.  It is a choice I had to fight for.

The doctor who had helped with the VBAC in the hospital, wrote a letter threatening the midwife I had found to assist me with my birth at home. I wrote him a letter to let him know it was my choice and if he had a problem, he should be talking with me.  We never heard from him again.  I had a wonderful home birth after 6 hours of labor.  My friends and children were present and my husband was there to catch our little girl.  The tally was now three boys and two girls.  Would the next one bring it to a tie?

I was laboring at home with baby number six when I started to experience a bulge on my right side above by cesarean scar.  I will not share all the details, but I heard a “pop” in my head and began to bleed heavily.  We loaded up in my car and headed to the hospital.  As I was wheeled in, I said to the nurse, “I think my uterus ruptured”.  

The doctor that was on call was the doctor who had threatened my midwife with baby number five.  I refused to let him touch me and demanded another doctor.  In my heart, I knew he would not honor me and my body and honestly I was afraid of being reprimanded.  A woman doctor was called in.  I begged her to save my uterus as I did not want to deal with the possible long term effects of a hysterectomy.  She asked me to sign for removal of my womb, as she felt it may be the only way to save my life. I was wheeled into surgery and put under general anesthesia.  Before I was finally put under, the pain was so intense, that insanity seemed close.  I remember thinking that if I died it would be a relief from the hell I was experiencing and I was not afraid.

I woke up to be told it was a miracle I was alive and that my baby had lived.  When my abdomen was surgically opened, the bag of waters, which we had decided not to break when I was stalled at 8 cm, was bulging into the peritoneum, acting as divine protection to our little girl.  The doctor told me my uterus was spared, but closing of all the layers was an impossibility. The uterus had shredded so it had to  be “knitted” back together. I was told I could not have any more children. I have theories as to why my uterus rupture, but that is another dissertation.

The next part of this story may seem like the choice a lunatic would make, but it is my story, so withhold judgment and read on.  My husband and I decided we would have another baby.  I went back to the same doctor who performed the emergency cesarean for the ruptured uterus.  When I walked in for my first pre-natal visit with her, she was in shock, but she honored me and my choice.  Her only request was that we schedule a c-section and said, “whatever we do, you cannot go into labor.  Your uterus can not handle it, if we make it that far.”

The c-section was scheduled ten days early, on a Wednesday. The Monday before, my third child died. It was unexpected even though he had many health challenges in his ten short years of life. The surgery had to be postponed until after the memorial service on Friday.  I woke with contractions on Monday at 4:30 A.M., I went to the hospital and my baby was delivered by cesarean,  one week after my son died. 

I have a pretty simple faith.  I believe in God, I am not God.  I trust, surrender and have a profound belief in the synchronicity of circumstances. Somehow, someway, things work out for a higher good. Saying yes to our seventh child was the goodness mingled with tragedy.  She was a healing balm to our grief stricken souls.

I went on to have baby number eight by cesarean with the same doctor about twenty-seven months later. If you have lost track,  that is six cesareans and two vaginal births.  The tally now; five girls/three boys. "If I had another baby, would I have to submit to another surgery?",  began to infiltrate my thought process. 

  

About three years later I was pregnant with baby number nine.  I began to think about the possibility of another VBAC. I had done extensive healing using natural means post rupture.  My two surgeries following the rupture were uneventful.  In fact the doctor mentioned how well I had healed and she could not even believe it was the same body.

My search began for someone who would support me in my choice to have a VBAC.   I contacted many midwives.  For fear of persecution and prosecution, they could not assist me.  I found a doctor who was an OB/GYN.  It was one of those synchronistic events I believe in.  He offered to support me in a trial of labor before I could even ask; note the word, support, not give.  

Support me he did.  He was threatened and belittled, as was I, by hospital staff, but my choice was honored. My baby girl was born when I was forty three years of age, was born vaginally.  I had VBAC after a complete uterine rupture.  I was humbled and thankful, but not surprised.  The body is an amazing healer and determination is a powerful fuel.  Supportive practitioners help a woman to feel empowered when they come along side and not seek to control her birthing process.

Women are coerced with fear and dis-empowered with medical gibberish and are soon convinced that their bodies cannot do what they were designed to do.  Even with all my unusual nuances, I sought to get back to this fact. 

I want to exhort you to be aware, be encouraged, and be empowered.  Be informed of your choices relating to birth. Believe in your ability to bring forth life and that natural physiological birth works for the majority of women. Do not let fear and coercion be the deciding factors. Seek those who will support you.  Birth is trans-formative.

Sharon Hockenbury is the Development Coordinator for W.A.R.M. - Washington Alliance For Responsible Midwifery.  Visit the website today to learn about WARM and see how you can be a part of a grassroots movement that supports a woman's right to choose where she will birth and who will attend her.