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Birth Talk: Share, Connect, Support

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Thursday, September 10, 2015 7-9pm Kill Devil Hills Library

Birth Talk is a casual gathering for conversation and a place to ask questions, share experiences, support each other’s struggles and triumphs, and connect with others in the community. This circle of trust and support is open to everyone including expecting and new mothers, fathers, doulas, practitioners, childbirth educators, and anyone with a passion for supporting the power of birth. Babes in arms are always welcome. FREE

Bring a snack to share if you are so inspired.

Doors open at 6:45. Meeting starts promptly at 7pm. ***Please follow the sidewalk on the LEFT side of the building around to the ramp/rear door.***

For more info email outerbanksbirth@gmail.com . RSVP on Facebook: https://www.facebook.com/events/1488061488174487/

Please invite your friends. All events are FREE and open to the public.


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Evidence-Based Maternity Care: Pearls of Midwifery

pearls of midwiferyThursday, May 14th 7-9pm –         Kill Devil Hills Library meeting room

Certified Nurse-Midwife Lucille Lamberto will present the proven benefits of normal, physiologic labor and childbirth for mothers and their newborns. Lucille will share her passion for the science and art of the midwifery model of maternity care as well as present the benefits of evidence-based practices in any setting – home, birth center, or hospital. The Pearls of Midwifery represent fine examples of best childbearing care practices.

Partners, husbands, friends, family and babes in arms are always welcome.

RSVP: www.facebook.com/events/631033453707247/

Doors open at 6:45. Meeting starts promptly at 7pm. ***Please follow the sidewalk on the LEFT side of the building around to the ramp/rear door.***

For more info email outerbanksbirth@gmail.com or call 252-207-5601.

Please invite your friends. All events are FREE and open to the public.


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A Clear Connection for Your Pregnancy, Birth, Baby, and Beyond!

dr. brent

Thursday, April 9th 7-9pm.

Thrive Chiropractic in Kitty Hawk. 3712 N. Croatan Hwy. Unit F Kitty Hawk, NC 27949

Join Brent Vuyovich, Doctor of Chiropractic, as we explore:

  • the Brain-Body connection and its role in pregnancy and birth,
  • the intimate tie between structure and function with a focus on how a balanced pelvis influences pregnancy and the birth process, and
  • one of the most overlooked aspects for optimal development of your newborn.

Come and learn how chiropractic care can ease your birth and benefit both you and your baby.

Partners, husbands, friends, family and babes in arms are always welcome.

NOTE: LOCATION CHANGE! 

RSVP on Facebook here: https://www.facebook.com/events/791678227594454/


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Nurses Talk Comfort Measures for Labor and Birth

Thursday, March 12, 2015 7-9pm.

Having your baby at The Outer Banks Hospital? This event will be a great opportunity to meet the staff. If not, join us anyway to add techniques to your labor tool bag.

shutterstock_98943413A team from Labor & Delivery will join us to discuss comfort measures during labor and birth. Whether you’re planning for a medication free birth or not, labor is an intense experience and practicing breathing techniques, relaxation, positioning, and massage can help reduce anxiety and stress in the delivery room. The team will share ways that hospital staff can assist you. They will also discuss techniques that laboring women and their birth partners can use to work together as a team to prepare for the birth journey. Bring your questions!

RSVP on Facebook

Kill Devil Hills Library meeting room  400 Mustian Avenue, Kill Devil Hills, NC 27948, USA


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First Days with Baby

10714017_10205403607429099_8544993444211257023_oNovember 13, 2014 7-9pm Kill Devil Hills Library meeting room

Local pediatrician Dr. Georgia Hennessy will provide an overview of infant “norms” including anatomy, breathing, skin; as well as techniques for infant care. Learn what you can expect from the pediatrician both in and out of the hospital, when to worry, and safe sleep/SIDS prevention. Leave this workshop with renewed confidence in your ability to care for your baby.

Partners, husbands, friends, family and babes in arms are always welcome.

Bring a snack to share if you are so inspired.

Doors open at 6:45. Meeting starts promptly at 7pm. ***Please follow the sidewalk on the LEFT side of the building around to the ramp/rear door.***

For more info email outerbanksbirth@gmail.com or call 252-207-5601.

Please invite your friends. All events are FREE and open to the public. RSVP on Facebook: https://www.facebook.com/events/1487430351534058/


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Gizmo Part 3: The Aftermath

Patient was admitted in active labor and refused all monitoring and nursing monitoring for patient or infant. It should be noted that this infant did need to be transferred to Norfolk for respiratory problems. My comment relates to the nursing care of this patient received even though she was totally uncooperative and abusive. She refused all suggestions and attempts to help and evaluate her labor. She was abusive with me as well. It was extremely difficult taking care of this patient and her labor. Her outcome was still satisfactory even with her not cooperating or allowing us to evaluate her during her labor. The infant was born without evidence of problems but then did develop them afterwards. There was no way this could have been determined prior due to the patient’s behavior. Her care was excellent and needs to be noted as such.

09 nicu day 3Imagine, after a week at a NICU, to read such statements in your medical records. The doctor who assaulted me blamed me for my baby’s respiratory issue and claimed I refused monitoring of my baby during labor.  In those same medical records are several pages of squiggly lines from the monitoring I did indeed have during labor (none of which indicated any problems in a review afterwards by the OB I hired).  The doctor who assaulted me actually called ME abusive.

I was furious, hurt, and violated. For many months I would have nightmares, waking up screaming, panic and cry uncontrollably. I have always had a startle response if someone came up on me with no warning, but now I would have a little panic attack. Everything made me startle and in turn, I would think I needed to run or fight something.

The idea of someone touching me—even if it was my own husband, my best friend, just trying to give me a hug—becameterrifying, something I couldn’t handle. I would think, “What if he doesn’t stop?” I have always loved massages—best thing ever. For my first Mothers Day, my husband gave me a gift certificate to be pampered. I’ve been looking at it for over a year now.

Fear took over. I couldn’t sleep because I was afraid of the nightmares; I was afraid of the startle reaction I had when baby D cried; I was afraid to be in cars or small spaces with only one door. I was afraid to leave the house, my safe place. I realized I didn’t want to live in fear like this. Fear was ruining me, my husband, and my relationship with my baby. But I didn’t know how to make it better.

My doula is a part of Improving Birth and within hours of baby D’s birth she had two people from their board get in touch with me – Dallas Bossola a Postpartum Doula and previous board member and Vice President Cristen Pascucci. There was no handbook or protocol on how to handle these situations, but Cristen Pascucci did her research and sent us a long document outlining what she was able to find at that time.

First I obtained my medical records from that day and I filed a complaint with the hospital.They didn’t do much more than try to soothe me away.  They informed me that the situation/doctor was already under review (“unforeseen outcome of healthy pregnancy/labor”), but that I couldn’t have any say in it.  They were only going on the word of the doctor and on his notes, which were completely false. It was my hired OB who told me to submit my complaint and record of events to the hospital’s president, who would then supposedly bring my side of the story to the peer review.

The president’s response was: “It is unfortunate that you shared you were not entirely satisfied with your stay at our facility… Thank you for taking the time to let us know about your s[t]ay and I apologize that we did not meet your expectations.”  He passed my situation on to their Risk Analyst.

I then persisted in communicating with the hospital’s Risk Analyst, who assisted me through many, many emails and phone calls. After months, they were “unable to substantiate that there was any inappropriate behavior or medical care provided.” Even though the hospital’s Bill of Rights for Patients states: As a patient you have the right to considerate and respectful care, care in a safe setting, be told your rights as soon as possible, talk to someone who wants to protect your rights, freedom from abuse, participate in your plan of care, receive from your physician information necessary to give informed consent prior to the start of any procedure and/or treatment, and refuse treatment.

The hospital could not change my experience, but they implemented several changes. The idea of “patient family centered care” is being acknowledged. The hospital staff was trained on the five fundamentals of patient communication, known as AIDET (Acknowledge, Introduce, Duration, Explanation and Thank you).  They developed a “Low Intervention Order Set” for OB patients (I would love to share the details of this policy, but they won’t share them with me).

I also contacted my medical insurance company, explaining the situation and asked them not to pay for services rendered. After Blue Cross Blue Shield (BCBS) of North Carolina conducted an investigation, they told me they couldn’t file a secondary level grievance for quality of care. We discussed the errors in billing (tip: always request an itemized bill of treatment!) and they encouraged me to continue discussing the matter with the hospital. BCBSNC cited the complaint and paid their portion. Through my persistent communication and refusal to pay for the abuse I incurred, my hired OB and the hospital dropped their bills as a “public relations gesture” by October (6 months after birth).

Two weeks after his birth, I submitted a complaint to the state Medical Board against the delivery doctor. I cited all of the violations of my rights to informed consent and refusal, battery on me by continuing to touch me, forceful penetration against my will, and falsifying medical records. I made clear that the only complications from my labor were the ones that he created.

Two months later, I received a copy of the doctor’s response to the board, and it sent me into a downward spiral of deep depression, crying all of the time and feeling like such a failure for not protecting my child or myself.  I decided I needed help and began therapy.

You see, no matter what I said, they took the doctor’s word over mine.  His response was filled with even more lies and false statements.  For example: “the infant was passed to the pediatrician.”  THERE WAS NO PEDIATRICIAN! Or, “I informed the patient that I was going to use local anesthesia for the repair…”  Not only did he not look at or talk to me, the nurses’ medical records show what really happened: he did not use anesthesia.

I found the best way for me to deal with the lies yet again was to write back to the medical board explaining each false statement. They responded stating that after a careful review “all available information revealed that there was no violation of the Medical Practice Act.”

My complaint is on file and allows the board to monitor problems that may arise. I feel they were wrong not to take action and restrict him in some way, but at least it’s another mark on his record. For all the others out there thinking, “Why should I report it?” I would say: You will be doing a favor for yourself and others in the future. If the board finds a trend in poor conduct, you and all the others who made the effort to make your own reports might save another woman in the future.

I contacted the local District Attorney, but they said they couldn’t help unless I made a complaint with the police. So, I went to the police department and filed a report against the doctor. The sergeant worked with the DA to see about pressing criminal charges.

This was when I learned that, in the view of the state of North Carolina, forcefully penetrating a woman against her will is perfectly legal if it is done in a medical setting:

You are correct in thinking that when a person tells another to stop touching them in certain areas that they must comply with that demand, but in the case of delivering a baby the doctor must invade certain areas to perform his or her duties; this is why when you told Dr. Xxxx to stop and he didn’t it does not constitute a criminal offense.  I realize that this is not what you wanted to hear, but as far as the State of North Carolina is concerned it is the truth.  Once again, please understand I am completely sympathetic to you and wish I could do more. If I can ever be of further assistance please do not hesitate to contact me.

I attempted to hire a lawyer for malpractice, but I could not find anyone to take my case.  I was told over and over again that I couldn’t win. They said since my child has no evidence of long-term damage and I didn’t have any evidence of physical damage, there was no case. North Carolina has lobbyists that protect doctors from “frivolous lawsuits”.

Through all of this, I barely kept it together. In any other setting this would be considered criminal battery. I continued therapy while suffering from postpartum depression and PTSD. The biggest impact, for me, was that even though they repeatedly cited no “wrong-doing,” less than a month after Baby D’s birth, the doctor retired, left his practice, and moved out-of-town. Rumor had it that he was going to retire sometime soon anyway, but I like to think this situation contributed to his departure.  When he left, there seemed to be this collective sigh of relief from the hospital, the company that owns the hospital, my insurance company, the medical board and the police department.  Their responses of “Well, he’s not here anymore,” made me feel like they were saying, “That should do it; you’re all better now.”  And friends would tell me, “It doesn’t matter how your baby came into this world, and it’s just a moment in their life. He’s healthy and fine—you should be happy.”

But I wasn’t better, and it does matter how my baby came into the world.  Hearing these kinds of things just made me feel more isolated and more dismissed. It made me feel that I didn’t matter.

It was written in the delivery room: “Goal: healthy mom, healthy baby,” and they failed at both. What’s worse was that both of those failures were completely avoidable.  Had the nursing staff and doctor treated me with the dignity, respect and compassion I deserved, things would have been perfect. Had the doctor not intentionally torn me apart, rotated my baby’s head into the blood, and taken the time to suction properly, we wouldn’t have had a “surprise bad baby” (hospital’s lingo for such incidents).

Cristen Patucci, with input from me and other women that have stood up for ourselves, has since created an easy-to-follow protocol for filing a medical complaint. You can find that here. Dallas Bossola helped guide and motivate me through this process. I really needed that support.

Dallas also got in touch with Kirsti Kreutzer from Where’s My Midwife?, who came over and interviewed my sister and I on camera about the events that took place during childbirth. (You can see that coming out soon from Improving Birth, leading up to their national Rally to Improve Birth.)

I joined a local chapter of BirthNetwork National for support. Now I am a member of their leadership team helping to educate mothers and mothers to-be about their rights during childbirth and inspire them to be confident in themselves and their choices.

OLYMPUS DIGITAL CAMERAA year later I am still healing.

Thank you for helping me heal and get my life back.

I had great questions on my Part One: The Birth of Gizmo. You can go back and read the response.

There will be a Part Four: What you can do. Please, check back in a few weeks.


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The Birth of Gizmo

Jenn went through a traumatic birthing experience. We are honored to share her story here, written in three segments. This first segment is her story as she feels it. It has all the details, no sugar coating. In future segments, Jenn will share the story that she wants her son to know when he hears how he was born and the different things she has done to deal, move through the trauma, and help mothers in the future.

With reverence and respect we share her story:

The Birth of Gizmo

I live on the Outer Banks of North Carolina, originally from the west coast. I am not a writer but I am a mother. I stay home with our son, teaching him the ways of life, but also work part time in the “real world”. My background is in teaching marine science but I have found that raising a child should come with a degree as well. Thank you for giving me an opportunity to heal.

I was very 01 wk 36 gizmoexcited when my husband and I had made the decision to start a family of the non-furry kind. I had overcome many obstacles in my life with regards to having been adopted. We became pregnant late July and I made the decision to leave my OB-GYN of three years. Not once have I regretted it.

Throughout the pregnancy I never missed an appointment, my doctors always said my pregnancy was perfect and that I made it look easy. My estimated due date was on the 8th of April but I had told everyone I felt like Gizmo (we weren’t finding out the gender) would come on the 14th of April. Sure enough at 40+6, my active labor began around 9pm on Saturday. I don’t like hospitals and was nervous about going. I knew we had a great team and a well thought out birth plan. I was confident that the hospital would work with us because I had both of my doctors look over and approve our written birth plan. I wasn’t asking for any crazy request, just a low medical intervention birth as long as there weren’t any emergencies.

We checked into the hospital around midnight. I declined to wear the hospital gown, which I got some sass for. But I was never bothered for a heplock or to stay in the bed to be monitored. I moved the rocking chair from the other side of the bed to be near the monitors to avoid the bed. I had my initial “check” and was determined to be at 4.5 cm, 70% effaced and baby was at -2 station. Our birth plan was to have intermittent fetal monitoring, so I sat on the exercise ball for the first EFM (Electronic Fetal Monitoring) session, which was uncomfortable. When it was over I went straight to the bath. Wow, they are not kidding when they call it a “midwives epidural”!

I had a total of five EFM sessions. At the 4am session the nurse thought there might be a few early decelerations so she took the readings out to the nurse’s station. When she came back she told us she wasn’t concerned but would like to check me to see where the baby was. When laboring you get to a certain point where the pelvis puts pressure on the baby, which is normal, but she didn’t think we were that far along. Upon checking, I was surprisingly 7cm, 100% effaced. That bath and relaxation breathing had helped my body open 3cm in less than 4 hours. We agreed to do more frequent monitoring but not continuously since there were no signs of fetal distress.

My fourth EFM session I took a nap on the bed, and this was only 35 minutes after the previous session to make sure that everything was fine with baby. There were no dips or spikes with baby so I got back into the bath. Less than an hour later, I began to have the urges to push. I was lying in the bath, in the dark, whispering to my husband, “I’m all done. I can’t do anymore. It hurts too much. I want drugs.” My hubby and doula kept me together and helped to get me through each contraction with low moans and deep breaths. The nurse came in to let us know it would be time for more EFM and realized I was grunting & pushing through the contractions. She asked me to exit the bath for birthing (hospital did not allow for water birthing). It took a while to convince me to leave that tub.

I got onto the bed in a “non-traditional” position. The pains were so intense and much more powerful outside of the water! I was holding my husband’s hands and looking into his eyes searching for strength. After a few good pushes one of the nurses asked me to get into a side lying position because the doctor was not here. Another nurse walked in and said, “I have to check you otherwise the doctor won’t come in”. I had the on-call doctor (he was the doctor whose practice I left) who had gone home. My doula said, “That’s not how you ask a woman if you can put your fingers in her vagina”. Our main nurse leaned in by my side whispered asking permission politely – as if it wasn’t obvious, with my tail in the air, that this baby was on its way earth side. I was 10 cm dilated and baby was at +2 station; baby was coming out! Gizmo’s amniotic sac was still intact so with every push, the little one would slide down and go right back up.

At this time, the nurses were less than helpful. One had the nerve to ask my husband to leave my side to move the rocking chair. My doula moved it for her but the nurse drug it farther out of the way, creating the sound of nails on a chalkboard! My hubs asked the nurses for a tissue (I would not let go of his hands) and they all just stood there staring at him. Again, my doula assisted and retrieved a tissue for him. Another nurse requested that I get on my back into “the physicians preferred position”.

The doctor arrived at 7:10am, walked in, did not introduce himself and said, “Flip over so we can see where we’re at”. I declined, stating that this position was working for me. He repeated himself two more times, clearly showing his irritation. My hubs asked him “to listen to his wife”; he said, “No, you have to”. I didn’t flip over. He stood there watching the next two contractions and his response to my progress was “you’ve got a long way to go” and walked out. My heart sank. I thought Gizmo was never coming and after all of this he would make me have a cesarean. We had a birth plan that was being honored and respected up until now. My doula had the nurses set up the squat bar. After two pushes, I could see in the mirror that baby’s head started coming out and the amniotic sac broke. The doctor came back in and with my legs shaking, he took over me.

I lost the control to my baby’s birth. I was so tired. The doctor told me to roll back onto the bed and I did. I remember my doula looking at me and asking if that was ok and all I could do was look back at her, searching to verbalize “no”. My birth team was in shock and the hospital staff failed to be our advocate.

This doctor failed to acknowledge or listen to his patient or the birth plan. He ignored my rights as a patient and as a human. He put me in a position I verbally said no to in the first place. Demanded I push and hold my breath when he said. Ripped my vagina physically since I didn’t allow for an episiotomy and I asked him to remove his hands twice. He cut baby’s cord immediately while “shushing” three people telling him to stop. He pulled out my placenta instead of waiting for my body to release it with contractions, as my doula, standing right next to him, had reminded him of my birth plan request. Instead he stated, “I’m not pulling. I know what I am doing”. He abused me by causing lacerations when I asked him to stop, not asking me if I want to be repaired, and not providing a local anesthetic. When he completed the stitching he got up and left without a word, no “congratulations” or a “thank you”. He didn’t even fill out baby’s souvenir birth certificate.

As Gizmo had rushed out I saw its body – “it’s a boy!” and I took baby D to my breast. He latched but did not suckle. His breathing sounded wet and rapid. The nurse said to just lay him on my chest for a while but he began to struggle to breathe. After about an hour, our baby was taken from me to get his breathing in order. My hubby stayed by his side talking to him. Things progressively got worse and more care was needed that was not available at this hospital. I sat there watching all of this as I did not have the strength to get up, walk over and stand by my son’s side. I had not eaten for over 12 hours and used all my energy during labor. I had to request breakfast three times before a meal finally came over three hours later and by then I was sick to my stomach not sure if the baby I just birthed was going to make it. The only nurse that checked on me was working with my son. I told her to keep busy with him, so I was not getting checked every 15 minutes for vitals, bleeding and uterus contracting. I was being neglected because the one nurse we had was trying to take care of two people at the same time.

OLYMPUS DIGITAL CAMERAMy baby and husband went to another room with more equipment. I got dressed and followed them. There was so much going on but the doctor checking his respiratory issue introduced himself, made eye contact, and explained what was happening and what the next steps were. While alarms were going off with my baby boy, the delivery doctor walked over, without making eye contact, told the nurse to mute the alarms and walked away.

Arrangements were made to have baby transported to another hospital for respiratory distress. Since I didn’t have any drugs or complications I was discharged from the hospital (4.5 hours after giving birth). We were not permitted to ride in the ambulance to the NICU. We arrived late afternoon, were greeted warmly and assisted with anything we needed. We were informed of Doctor Rounds in the mornings and made sure we were there. Everyone introduced themselves and asked about Daniel. They were confused about how a full term baby with no problems during pregnancy or labor acquired amniotic fluid and maternal blood when waters broke last minute and placenta was intact.

I know that had we had a doctor that was respectful, not abusive or rushed, and wanted to be at our birth, the outcome would have been different. I wouldn’t be recovering from PTSD from the feeling that I was raped and traumatize during birth. I wouldn’t have been rushed to deliver my baby, been torn manually by the doctor and having my newborn aspirate my blood. Another doctor, or midwife, would have taken the time to make sure the baby’s airway was suctioned properly. I went to the hospital thinking that was the safest place to be and instead it was the most unsafe and violated I have ever felt. I never thought that I would be holding my baby searching for strength to ask my baby to forgive me for not protecting him or myself better. That’s not how birth should feel.

06 birth to nicuBaby D spent a week in NICU, two of those days under heavy sedation with a breathing ventilator. I was pumping to make sure I could breastfeed, something that I was determined to do after all of this. When I did get to nurse it was perfect and I just wanted to take him home then. At the silence of our own home all I could hear were beeps from monitors as I held my little guy. I cried and cried for months. I sought therapy and began the complaint process in order to funnel all this anger.

It should not matter who your primary doctor is. At a hospital you should be taken care of as if you have always been their patient. My family and I should never have been treated the way we were at this hospital. Being taken care of at the children’s hospital showed us even more clearly how much we were neglected, violated and grossly mistreated.

I have done everything I could to hold the doctor and the hospital accountable. I am also doing my best to make others aware of their rights and what to do if they feel they were mistreated.

In Part II, I share the birthing story I want my son to know. With my son turning one, a whole new wave of emotions swallowed me.

In Part III of my story, I share how through my complaint process our hospital has made changes to policies to improve the care for birthing women. This has helped me for the future I can tell my son, “yes they did that to us, but I did this for us and all the other mothers to come.”

 

© http://www.outerbanksbirthnetwork.com, 2012-2014. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to http://www.outerbanksbirthnetwork.com with appropriate and specific direction to the original content.


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Having a Baby? Ten Questions to Ask Your Doctor or Midwife

Coalition for Improving Maternity Services

Have you decided how to have your baby? The choice is yours!

 First, you should learn as much as you can about all your choices. There are many different ways of caring for a mother and her baby during labor and birth.

Birthing care that is better and healthier for mothers and babies is called “mother- friendly. “Some birth places or settings are more mother-friendly than others.

A group of experts in birthing care came up with this list of 10 things to look for and ask about. Medical research supports all of these things. These are also the best ways to be mother-friendly.

When you are deciding where to have your baby, you’ll probably be choosing from different places such as:

  • birth center,
  • hospital, or
  • home birth service.

Here’s what you should expect, and ask for, in your birth experience. Be sure to find out how the people you talk with handle these 10 issues about caring for you and your baby. You may want to ask the questions below to help you learn more.

 1. Ask, “Who can be with me during labor and birth?”

Mother-friendly birth centers, hospitals, and home birth services will let a birthing mother decide whom she wants to have with her during the birth. This includes fathers, partners, children, other family members, or friends.

They will also let a birthing mother have with her a person who has special training in helping women cope with labor and birth. This person is called a doula or labor support person. She never leaves the birthing mother alone. She encourages her, comforts her, and helps her understand what’s happening to her.

They will have midwives as part of their staff so that a birthing mother can have a midwife with her if she wants to.

 2. Ask, “What happens during a normal labor and birth in your setting?”

If they give mother-friendly care, they will tell you how they handle every part of the birthing process. For example, how often do they give the mother a drug to speed up the birth? Or do they let labor and birth usually happen on its own timing?

They will also tell you how often they do certain procedures. For example, they will have a record of the percentage of C-sections (Cesarean births) they do every year. If the number is too high, you’ll want to consider having your baby in another place or with another doctor or midwife.

Here are some numbers we recommend you ask about.

  • They should not use oxytocin (a drug) to start labor for more than 1 in 10 women (10%).
  • They should not do an episiotomy (ee-pee-zee-AH-tummy) on more than 1 in 5 women (20%). They should be trying to bring that number down. (An episiotomy is a cut in the opening to the vagina to make it larger for birth. It is not necessary most of the time.)
  • They should not do C-sections on more than 1 in 10 women (10%) if it’s a community hospital. The rate should be 15% or less in hospitals which care for many high-risk mothers and babies.
  • A C-section is a major operation in which a doctor cuts through the mother’s stomach into her womb and removes the baby through the opening. Mothers who have had a C-section can often have future babies normally. Look for a birth place in which 6 out of 10 women (60%) or more of the mothers who have had C-sections go on to have their other babies through the birth canal.

3. Ask, “How do you allow for differences in culture and beliefs?”

Mother-friendly birth centers, hospitals, and home birth services are sensitive to the mother’s culture. They know that mothers and families have differing beliefs, values, and customs.

For example, you may have a custom that only women may be with you during labor and birth. Or perhaps your beliefs include a religious ritual to be done after birth. There are many other examples that may be very important to you. If the place and the people are mother-friendly, they will support you in doing what you want to do. Before labor starts tell your doctor or midwife special things you want.

 4. Ask, “Can I walk and move around during labor? What position do you suggest for birth?”

In mother-friendly settings, you can walk around and move about as you choose during labor. You can choose the positions that are most comfortable and work best for you during labor and birth. (There may be a medical reason for you to be in a certain position.) Mother-friendly settings almost never put a woman flat on her back with her legs up in stirrups for the birth.

 5. Ask, “How do you make sure everything goes smoothly when my nurse, doctor, midwife, or agency need to work with each other?”

Ask, “Can my doctor or midwife come with me if I have to be moved to another place during labor? Can you help me find people or agencies in my community who can help me before and after the baby is born?”

Mother-friendly places and people will have a specific plan for keeping in touch with the other people who are caring for you. They will talk to others who give you birth care. They will help you find people or agencies in your community to help you. For example, they may put you in touch with someone who can help you with breastfeeding.

 6. Ask, “What yhings do you normally do to a woman in labor?”

Experts say some methods of care during labor and birth are better and healthier for mothers and babies. Medical research shows us which methods of care are better and healthier. Mother-friendly settings only use methods that have been proven to be best by scientific evidence.

Sometimes birth centers, hospitals, and home birth services use methods that are not proven to be best for the mother or the baby. For example, research has shown it’s usually not helpful to break the bag of waters.

Here is a list of things we recommend you ask about. They do not help and may hurt healthy mothers and babies. They are not proven to be best for the mother or baby and are not mother-friendly.

  • They should not keep track of the baby’s heart rate all the time with a machine (called an electronic fetal monitor). Instead it is best to have your nurse or midwife listen to the baby’s heart from time to time.
  • They should not break your bag of waters early in labor.
  • They should not use an IV (a needle put into your vein to give you fluids).
  • They should not tell you that you can’t eat or drink during labor.
  • They should not shave you.
  • They should not give you an enema.

A birth center, hospital, or home birth service that does these things for most of the mothers is not mother-friendly. Remember, these should not be used without a special medical reason.

 7. Ask, “How do you help mothers stay as comfortable as they can be? Besides drugs, how do you help mothers relieve the pain of labor?”

The people who care for you should know how to help you cope with labor. They should know about ways of dealing with your pain that don’t use drugs. They should suggest such things as changing your position, relaxing in a warm bath, having a massage and using music. These are called comfort measures.

Comfort measures help you handle your labor more easily and help you feel more in control. The people who care for you will not try to persuade you to use a drug for pain unless you need it to take care of a special medical problem. All drugs affect the baby.

 8. Ask, “What if my baby is born early or has special problems?”

Mother-friendly places and people will encourage mothers and families to touch, hold, breastfeed, and care for their babies as much as they can. They will encourage this even if your baby is born early or has a medical problem at birth. (However, there may be a special medical reason you shouldn’t hold and care for your baby.)

 9. Ask, “Do you circumcise baby boys?”

Medical research does not show a need to circumcise baby boys. It is painful and risky. Mother-friendly birth places discourage circumcision unless it is for religious reasons.

 10. Ask, “How do you help mothers who want to breastfeed?”

The World Health Organization made this list of ways birth services support breastfeeding.

  • They tell all pregnant mothers why and how to breastfeed.
  • They help you start breastfeeding within 1 hour after your baby is born.
  • They show you how to breastfeed. And they show you how to keep your milk coming in even if you have to be away from your baby for work or other reasons.
  • Newborns should have only breast milk. (However, there may be a medical reason they cannot have it right away.)
  • They encourage you and the baby to stay together all day and all night. This is called “rooming-in.”
  • They encourage you to feed your baby whenever he or she wants to nurse, rather than at certain times.
  • They should not give pacifiers (“dummies” or “soothers”) to breastfed babies.
  • They encourage you to join a group of mothers who breastfeed. They tell you how to contact a group near you.
  • They have a written policy on breastfeeding. All the employees know about and use the ideas in the policy.
  • They teach employees the skills they need to carry out these steps.

Would you like to give this information (and more) to your doctor, midwife, or nurse? This information is a part of the Mother-Friendly Childbirth Initiative written for health care providers. Download a copy at MotherFriendly.org.

© 2000 by The Coalition for Improving Maternity Services (CIMS). Permission granted to freely reproduce in whole or in part with complete attribution.


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The Mother-Friendly Childbirth Inititative

Outer Banks Birth Network supports, encourages, and educates women and their families by promoting the awareness and availability of evidence-based, Mother-Friendly maternity care as defined by the Mother-Friendly Childbirth Initiative (MFCI) of the Coalition for Improving Maternity Services.

The First Consensus Initiative of the Coalition for Improving Maternity Services

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© 1996 by The Coalition for Improving Maternity Services (CIMS).

 Mission

The Coalition for Improving Maternity Services (CIMS) is a coalition of individuals and national organizations with concern for the care and wellbeing of mothers, babies, and families. Our mission is to promote a wellness model of maternity care that will improve birth outcomes and substantially reduce costs. This evidence-based mother-, baby-, and family-friendly model focuses on prevention and wellness as the alternatives to high-cost screening, diagnosis, and treatment programs.

Preamble

Whereas:

•   In spite of spending far more money per capita on maternity and newborn care than any other country, the United States falls behind most industrialized countries in perinatal* morbidity* and mortality, and maternal mortality is four times greater for African-American women than for Euro-American women;

•   Midwives attend the vast majority of births in those industrialized countries with the best perinatal outcomes, yet in the United States, midwives are the principal attendants at only a small percentage of births;

•   Current maternity and newborn practices that contribute to high costs and inferior outcomes include the inappropriate application of technology and routine procedures that are not based on scientific evidence;

•   Increased dependence on technology has diminished confidence in women’s innate ability to give birth without intervention;

•   The integrity of the mother-child relationship, which begins in pregnancy, is compromised by the obstetrical treatment of mother and baby as if they were separate units with conflicting needs;

•   Although breastfeeding has been scientifically shown to provide optimum health, nutritional, and developmental benefits to newborns and their mothers, only a fraction of U.S. mothers are fully breastfeeding their babies by the age of six weeks;

•   The current maternity care system in the United States does not provide equal access to health care resources for women from disadvantaged population groups, women without insurance, and women whose insurance dictates caregivers or place of birth;

Therefore,

We, the undersigned members of CIMS, hereby resolve to define and promote mother-friendly maternity services in accordance with the following principles:

Principles

We believe the philosophical cornerstones of mother-friendly care to be as follows:

Normalcy of the Birthing Process

•   Birth is a normal, natural, and healthy process.

•   Women and babies have the inherent wisdom necessary for birth.

•   Babies are aware, sensitive human beings at the time of birth, and should be acknowledged and treated as such.

•   Breastfeeding provides the optimum nourishment for newborns and infants.

•   Birth can safely take place in hospitals, birth centers, and homes.

•   The midwifery model of care, which supports and protects the normal birth process, is the most appropriate for the majority of women during pregnancy and birth.

Empowerment

•   A woman’s confidence and ability to give birth and to care for her baby are enhanced or diminished by every person who gives her care, and by the environment in which she gives birth.

•   A mother and baby are distinct yet interdependent during pregnancy, birth, and infancy. Their interconnected–ness is vital and must be respected.

•   Pregnancy, birth, and the postpartum period are milestone events in the continuum of life. These experiences profoundly affect women, babies, fathers, and families, and have important and long-lasting effects on society.

Autonomy

Every woman should have the opportunity to:

•   Have a healthy and joyous birth experience for herself and her family, regardless of her age or circumstances;

•   Give birth as she wishes in an environment in which she feels nurtured and secure, and her emotional well-being, privacy, and personal preferences are respected;

•   Have access to the full range of options for pregnancy, birth, and nurturing her baby, and to accurate information on all available birthing sites, caregivers, and practices;

•   Receive accurate and up-to-date information about the benefits and risks of all procedures, drugs, and tests suggested for use during pregnancy, birth, and the postpartum period, with the rights to informed consent and informed refusal;

•   Receive support for making informed choices about what is best for her and her baby based on her individual values and beliefs.

Do No Harm

•   Interventions should not be applied routinely during pregnancy, birth, or the postpartum period. Many standard medical tests, procedures, technologies, and drugs carry risks to both mother and baby, and should be avoided in the absence of specific scientific indications for their use.

•   If complications arise during pregnancy, birth, or the postpartum period, medical treatments should be ­evidence-based.

Responsibility

•   Each caregiver is responsible for the quality of care she or he provides.

•   Maternity care practice should be based not on the needs of the caregiver or provider, but solely on the needs of the mother and child.

•   Each hospital and birth center is responsible for the periodic review and evaluation, according to current scientific evidence, of the effectiveness, risks, and rates of use of its medical procedures for mothers and babies.

•   Society, through both its government and the public health establishment, is responsible for ensuring access to maternity services for all women, and for monitoring the quality of those services.

•   Individuals are ultimately responsible for making informed choices about the health care they and their babies receive.

These principles give rise to the following steps, which support, protect, and promote mother-friendly maternity services:

* see glossary below

Ten Steps of the Mother-Friendly Childbirth Initiative

For Mother-Friendly Hospitals, Birth Centers,* and Home Birth Services

To receive CIMS designation as “mother-friendly,” a hospital, birth center, or home birth service must carry out the above philosophical principles by fulfilling the Ten Steps of Mother-Friendly Care:

A mother-friendly hospital, birth center, or home birth service:

1.   Offers all birthing mothers:

•   Unrestricted access to the birth companions of her choice, including fathers, partners, children, ­family members, and friends;

•   Unrestricted access to continuous emotional and physical support from a skilled woman—for ­example, a doula,* or labor-support professional;

•   Access to professional midwifery care.

2.   Provides accurate descriptive and statistical information to the public about its practices and procedures for birth care, including measures of interventions and outcomes.

3.   Provides culturally competent care—that is, care that is sensitive and responsive to the specific beliefs, ­values, and customs of the mother’s ethnicity and ­religion.

4.   Provides the birthing woman with the freedom to walk, move about, and assume the positions of her choice during labor and birth (unless restriction is specifically required to correct a complication), and discourages the use of the lithotomy (flat on back with legs elevated) position.

5.   Has clearly defined policies and procedures for:

•   collaborating and consulting throughout the perinatal period with other maternity services, including communicating with the original caregiver when transfer from one birth site to another is necessary;

•   linking the mother and baby to appropriate community resources, including prenatal and post-­discharge follow-up and breastfeeding support.

6.   Does not routinely employ practices and procedures that are unsupported by scientific evidence, ­including but not limited to the following:

•   shaving;

•   enemas;

•   IVs (intravenous drip);

•   withholding nourishment or water;

•   early rupture of membranes*;

•   electronic fetal monitoring;

other interventions are limited as follows:

•   Has an induction* rate of 10% or less;

•   Has an episiotomy* rate of 20% or less, with a goal of 5% or less;

•   Has a total cesarean rate of 10% or less in community hospitals, and 15% or less in tertiary care (high-risk) hospitals;

•   Has a VBAC (vaginal birth after cesarean) rate of 60% or more with a goal of 75% or more.

7.   Educates staff in non-drug methods of pain relief, and does not promote the use of analgesic or anesthetic drugs not specifically required to correct a complication.

8.   Encourages all mothers and families, including those with sick or premature newborns or infants with congenital problems, to touch, hold, breastfeed, and care for their babies to the extent compatible with their conditions.

9.   Discourages non-religious circumcision of the newborn.

10. Strives to achieve the WHO-UNICEF “Ten Steps of the Baby-Friendly Hospital Initiative” to promote successful breastfeeding:

        1.             Have a written breastfeeding policy that is routinely  communicated to all health care staff;

        2.             Train all health care staff in skills necessary to implement this policy;

        3.             Inform all pregnant women about the benefits and management of breastfeeding;

        4.             Help mothers initiate breastfeeding within a half-hour of birth;

        5.             Show mothers how to breastfeed and how to maintain lactation even if they should be separated from their infants;

        6.             Give newborn infants no food or drink other than breast milk unless medically indicated;

        7.             Practice rooming in: allow mothers and infants to remain together 24 hours a day;

        8.             Encourage breastfeeding on demand;

        9.             Give no artificial teat or pacifiers (also called dummies or soothers) to breastfeeding infants;

        10.           Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from hospitals or clinics.

† This criterion is presently under review.

* Glossary

Augmentation: Speeding up labor.

Birth Center: Free-standing maternity center.

Doula: A woman who gives continuous physical, emotional, and informational sup­port during labor and birth—may also provide postpartum care in the home.

Episiotomy: Surgically cutting to widen the vaginal opening for birth.

Induction: Artificially starting labor.

Morbidity: Disease or injury.

Oxytocin: Synthetic form of oxytocin (a naturally occurring hormone) given intravenously to start or speed up labor.

Perinatal: Around the time of birth.

Rupture of Membranes: Breaking the “bag of waters.”

Bibliography

American College of Obstetricians and Gynecologists. Fetal heart rate patterns: monitoring, interpretation, and management.        Technical Bulletin No. 207, July 1995.

—. Guidelines for vaginal delivery after a previous cesarean birth. ACOG Committee Opinion 1988; No 64.

Canadian Paediatric Soc, Fetus, and Newborn Committee. Neonatal circumcision revisited. Can Med Assoc J 1996;154(6):769-780.

Enkin M, et al. A Guide to Effective Care in Pregnancy and Childbirth 2nd rev ed. Oxford: Oxford University Press, 1995. (Data from this book come from the Cochrane Database of Perinatal Trials.)

Goer H. Obstetric Myths Versus Research Realities: A Guide to the Medical Literature. Westport, CT: Bergin and Garvey, 1995.

Bureau of Maternal and Child Health. Unity through diversity: a report on the Healthy Mothers Healthy Babies Coalition Communities of Color Leadership Roundtable. Healthy Mothers Healthy Babies, 1993. (A copy may obtained by calling (202) 821-8993 ext. 254. Dr. Marsden Wagner also provided maternal mortality statistics from official state health data.)

International Lactation Consultant Association. Position paper on infant feeding. rev 1994. Chicago: ILCA, 1994.

Klaus M, Kennell JH, and Klaus PH. Mothering the Mother. Menlo Park, CA: Addison-Wesley, 1993.

—. Bonding: Building the Foundations of Secure Attachment and Independence. Menlo Park, CA: Addison-Wesley,1995.

Wagner M. Pursuing the Birth Machine: The Search for Appropriate Birth Technology. Australia: ACE Graphics, 1994. (Dr. Wagner’s book has the “General Recommendations” of The WHO Fortaleza, Brazil, April, 1985 and the “Summary Report” of The WHO Consensus Conference on Appropriate Technology Following Birth Trieste, October, 1986.

 

Ratified by these members of the Coalition for Improving Maternity Services (CIMS), July, 1996

 

Organizations (names of organizations’ officers may have changed since ratification):

Academy of Certified Birth Educators (Olathe, KS), Linda M. Herrick, RNC, BSN, CCE, CD; and Sally Riley, BSEd, CCE, CD, & Judie C. Wika, RNC, MSN, CNM, CCE, Co-Directors

American Academy of Husband-Coached Childbirth (The Bradley Method™), (Sherman Oaks, CA), Jay and Marjie Hathaway, Executive Directors

American College of Nurse-Midwives (Washington, DC), Joyce Roberts, CNM, PhD, FACNM, President

American College of Domiciliary Midwives (Palo Alto, CA), Faith Gibson, CPM, Executive Director

Association of Labor Assistants and Childbirth Educators (Cambridge, MA), Jessica L. Porter, President

Association for Pre- & Perinatal Psychology and Health (Geyserville, CA), David B. Chamberlain, PhD, President