Yukoners for Funded Midwifery

Globe and Mail ~ June 19, 2009

noreply@blogger.com (Asheya) — Fri, 19 Jun 2009 17:03:00 +0000

C-section not best option for breech birth

The Society of Obstetricians and Gynecologists of Canada will launch program to teach physicians breech vaginal delivery

Carla Wintersgill

Friday, Jun. 19, 2009

Physicians should no longer automatically opt to perform a cesarean section in the case of a breech birth, according to new guidelines by the Society of Obstetricians and Gynecologists of Canada.

Released yesterday, the guidelines are a response to new evidence that shows many women are safely able to vaginally deliver babies who enter the birth canal with the buttocks or feet first. Normally, the infant descends head first.

“Our primary purpose is to offer choice to women,” said André Lalonde, executive vice-president of the SOGC.

“More women are feeling disappointed when there is no one who is trained to assist in breech vaginal delivery,” he adds.

Since 2000, C-sections have been the preferred method of delivery in breech births. Studies suggested that breached births were associated with an increased rate of complication when performed vaginally.

As a result, many medical schools have stopped training their physicians in breech vaginal delivery.

The problem now, according to Dr. Lalonde, is that there is a serious shortage of doctors to teach and perform these deliveries.

With the release of the new guidelines, the SOGC will launch a nationwide training program to ensure that doctors will be adequately prepared to offer vaginal breech births .

The new approach was prompted by a reassessment of earlier trials. It now appears that there is no difference in complication rates between vaginal and cesarean section deliveries in the case of breech births.

News of the change is a boon for the Ottawa-based Coalition for Breech Birth.

“We're really, really pleased,” said Robin Guy, co-founder of the coalition.

Ms. Guy started the group after the birth of her second child in the fall of 2006. Although she had given birth to her first child at home with a midwife, Ms. Guy delivered her daughter in the hospital because of the baby's breech position.

“I was cornered into an unneeded and unwanted C-section because the obstetrician that I had didn't have the experience to catch her,” said Ms. Guy.

The aim of the coalition is to ensure that women know what their options are when it comes to breech birth. Ms. Guy believes that many women don't realize that vaginal breech births are even possible.

“Educating women is our primary goal because it takes more than just a guideline change,” she said.

The SOGC stresses that because of complications that may arise, many breech deliveries will still require a cesarean section.

Breech presentations occur in 3-4 per cent of pregnant women who reach term. That translates to approximately 11,000 to 14,500 breech deliveries a year in Canada.

The new decision to offer vaginal breech birth aligns with the SOGC promotion of normal childbirth – spontaneous labour, followed by a delivery that is not assisted by forceps, vacuum or cesarean section. In December of 2008, the society release a policy statement that included its recommendation for a development of national practice guidelines on normal childbirth.

“The safest way to deliver has always been the natural way,” said Dr. Lalonde.

“Vaginal birth is the preferred method of having a baby because a C-section in itself has complications.”

Cesarean sections, in which incisions are made through a mother's abdomen and uterus to deliver the baby, can lead to increased chance of bleeding and infections and can cause further complications for pregnancies later on.

“There's the idea out there in the public sometimes that having a C-section today with modern anesthesia and modern hospitals is as safe as having a normal childbirth, but we don't think so,” said Dr. Lalonde.

“It is the general principle in medicine to not make having a cesarean section trivial.”

The SOGC believes that if a woman is well-prepared during pregnancy, she has the innate ability to deliver vaginally.

The national average for babies delivered via cesarean section in Canada is 25 per cent.

Film Night ~ A Must See for Every Parent to Be

noreply@blogger.com (Asheya) — Wed, 15 Oct 2008 20:49:00 +0000

Yukoners for Funded Midwifery
invites you to a special showing of
Ricki Lake's film

The Business of Being Born
Saturday, October 18, 2008
7 pm @ Alpine Bakery
(Admission by Donation)

A must see for every parent to be.
You will never look at giving birth the same way.

Hosted by Yukoners for Funded Midwifery
Sponsored by Alpine Bakery, Due North Delivery, and Copy Copy

Los Angeles Times ~ July 9, 2008

noreply@blogger.com (Asheya) — Mon, 15 Sep 2008 02:05:00 +0000

Big Medicine's blowback on home births

Why do U.S. doctors strong-arm women into our standard maternity care system?

By Jennifer Block
July 9, 2008

You'd think the healthcare establishment would have bigger fish to fry than Ricki Lake. (The 47 million uninsured, maybe?) But Lake's recent documentary, "The Business of Being Born," which includes footage of her own delivery of her second child at home, was on the agenda at the American Medical Assn.'s annual meeting in mid-June. Lake was personally name-checked in a "Resolution on Home Deliveries" introduced by the American College of Obstetricians and Gynecologists: "Whereas, there has been much attention in the media by celebrities having home deliveries, with recent 'Today Show' headings such as 'Ricki Lake takes on baby birthing industry.' " The AMA ultimately passed the resolution without the Lake citation, but not before the Hollywood media got wind of it and, overnight, home birth was thrust into the mainstream light.

It's about time.

Last year I flew to Britain to be with a good friend for the birth of her first child. She's American but married into Britain's National Health Service, lucky duck. The differences in the prenatal care she got there were striking. First and foremost, she never saw a doctor. As a healthy woman with a normal pregnancy, she saw midwives. And one of their first questions to her was, "So, would you like to give birth in the hospital maternity ward or at home?"

Planning a home birth with a midwife may sound old-fashioned -- maybe you think it sounds crazy -- but a solid body of research shows that for healthy women who seek a normal, nonsurgical birth, there are several benefits. At home, a woman can get one-on-one care and monitoring from a midwife trained to support the normal labor process. The mother-to-be is free to move about, eat and drink, sit in a birth tub -- Britain's national health guidelines call water the safest, most effective form of pain relief. A woman will be helped to give birth in positions that are effective and protective: sitting, squatting, on hands and knees, even standing.

The physiological birth process is automatic: hormones fire, the cervix gradually opens, the uterus contracts, the baby descends, muscles engage. An optimal birth, one in which mother and child emerge as healthy as can be, is one that begins spontaneously, progresses on its own and concludes with the least amount of intervention necessary.

But hospital maternity care in the U.S. is typically not supportive of this process. More than half of women are induced into labor, or it is sped up with artificial hormones; the vast majority of women labor and push in the desultory flat-on-the-back or leaning-back position; and (perhaps not surprisingly) nearly one-third of women end up giving birth through major surgery, the caesarean section.

This has led to an epidemic of pre-term births in the United States. A 2006 survey showed that the majority of babies are now born before the spontaneous onset of labor, which leaves them more prone to breathing and feeding difficulties. Caesareans are also contributing to a rising maternal death rate, announced by the Centers for Disease Control and Prevention last year.

Which is why some women, such as those in the film Lake produced, choose to give birth somewhere other than a hospital. Their choice is backed by sound science. Studies of "low-risk" women in North America planning out-of-hospital births with midwives have found that 95% give birth vaginally with hardly any medical intervention. The largest and most rigorous study to date, published in the British Medical Journal, found that in North America, babies were born at home just as safely as in the hospital.

Organized medicine can't believe this. Dismissing the research evidence, the AMA resolution states that "the safest setting for labor, delivery and the immediate postpartum period is in the hospital" or an accredited birth center. In its own statement earlier this year, the American College of Ob/Gyns went even further, implying that women who choose home birth are selfish and irresponsible: "choosing to deliver a baby at home ... is to place the process of giving birth over the goal of having a healthy baby."

Compare that to this information in Britain's NHS-issued handout my friend was given at her first prenatal appointment: "There is no evidence to support the common assertion that home birth is a less safe option for women experiencing uncomplicated pregnancies." In a joint statement last year, the Royal College of Obstetricians and Gynecologists and the Royal College of Midwives said, "There is no reason why home birth should not be offered to women at low risk of complications, and it may confer considerable benefits for them and their families."

The AMA's statement calls for legislation that could be used against women who choose home birth, possibly resulting in criminal child-abuse or neglect charges. The group says this is about safety, but with no credible research to back up its claim, this argument falls flat. Women are simply caught in a turf war over the maternity market, and it would appear that the physicians' groups are perfectly willing to trample the modern medical ethic of patient autonomy -- grounded in our legal rights to self-determination, to liberty and to privacy -- in their grab for control.

If these groups were truly making maternal and child health a priority, they'd be reforming standard maternity care, not strong-arming women into it.

Jennifer Block is the author of "Pushed: The Painful Truth About Childbirth and Modern Maternity Care."

Midwifery Update

noreply@blogger.com (Asheya) — Thu, 21 Aug 2008 02:59:00 +0000

This update is long overdue, as I have been extremely busy with a new baby and a new business. You can read Eowyn's birth story (at home with midwife Christina) in the previous post. My husband and I have started Due North Delivery, a baby and maternity store that offers customers 5% of their purchases as a credit towards doula and midwifery services. We decided to start this business in large part because the government has been slow in funding midwifery services in the Yukon. You can access the store at www.duenorthdelivery.com

The last midwifery working group was held in June, at which time a new policy analyst from Health and Social Services was introduced. I have not yet received any reports or documentation from our meetings, although Health and Social Services should be preparing a document.

I personally feel that Yukoners for Funded Midwifery is at a bit of a crossroads. Having been through the working group meetings and discussing the idea of regulation at length with the midwives, government personnel, medical workers, and other consumers, I do not believe it is in the best interests of women who wish to use midwifery services in the Yukon for midwifery to be regulated. This is mostly because regulation of midwifery in Canada has a history of limiting women's choices surrounding birth with a midwife, which in many cases is contrary to the safety and well-being of the woman and/or her child. However, I would like to see midwifery services become a more accessible choice for women in the Yukon through funding and for midwives to have status at the hospital to better meet the needs of women who either choose a hospital birth or require transport to the hospital.

The government has said repeatedly that the only way to funding is through regulation, but I am wondering if perhaps we should challenge this. What I would ideally like to see is a government program of reimbursement, where the women who receive midwifery services are reimbursed for their bill, rather than the government dealing with the midwives. Does anyone know of any program that would set a precedent for this? I would like to propose to the government that they have a list of midwives (which right now would be the two practicing midwives in the Yukon, Christina and Heather) whose services they will reimburse women for. The Canadian Midwifery Regulators Consortium has a standardized Canadian Midwifery Registration Examination, and the government of the Yukon could require midwives who would like to be on the list to pass this examination. The hospital could establish a set of guidelines or protocol for the interactions between midwives, doctors, nurses, and hospital staff when a midwife is attending a woman at the hospital. Does this seem really outside the realm of possibility? I've always liked to dream big! If you think this would best serve the needs and enable the choices of women in the Yukon please email me back! And come to a meeting! The government takes action in response to what we, the consumers, want and the more the better. We need to figure out a way to really get our voices heard and get the message through that this is what we want. We can discuss ideas at the next meeting.

The next meeting will be on August 26 at 7pm at my house, 17 Redwood St. in Porter Creek. Please feel free to email me at info at yffm dot ca or call me at 456-7711 for directions. We need to hear your voice!

Eowyn's Birth Story

noreply@blogger.com (Asheya) — Wed, 06 Aug 2008 01:52:00 +0000

This is Eowyn's birth story, submitted by Asheya Hennessey, the founder of Yukoner's for Funded Midwifery. It's long and detailed!

I am writing Eowyn’s birth story on April 2, 2008, and she is right here with me sleeping in the sling. Eowyn’s birth story starts with the choices I made about my prenatal care and where I wanted to give birth. I chose to have a home birth with a midwife as my health care professional, Christina Kaiser.

I had mildly painful contractions on Wednesday night, and during the morning on Thursday, March 20. I let Eric know. At about 11 am I started nursing Elias, as he had hurt himself and needed comforting. While he was breastfeeding I had some more strongly painful contractions, but they were manageable lying down, and I decided to let him continue nursing. He nursed for about twenty to thirty minutes. As soon as I stood up from nursing him I felt a gush, and went straight to the bathroom. There on my underwear was a huge blob of bloody something, and I had a lot of blood that was going into the toilet. I felt calm but excited – this was definitely happening! I called out to Eric, who was working from home, “I think my water broke!” He came in to look, and of course Elias was there too. Eric brought me the phone and I called Christina. I didn’t remember what my mucus plug had looked like with Elias, but I thought this was rather bloody. When I told her that the blood was bright red, she told me she would be there in an hour, and that I should feel for the baby moving and watch for any gushes of bright red blood. If the baby moved I should call her, and if I started bleeding I should call her. At this point I could blot up blood on the toilet paper, but I wasn’t actually bleeding into the toilet.

I spent an anxious twenty minutes lying on the couch waiting for the baby to move. Finally, I felt something! Just a gentle movement low in my belly, but definitely a movement. I called Christina, and a few moments later felt a little more activity. Having felt the baby move helped me to be calm while I waited for Christina to arrive. I felt anxious about the blood, but knew Christina was on her way.

By the time Christina arrived the fluid I could wipe on toilet paper was pink, not red. I had saved the bloody blob in a jar, and Christina confirmed that it was my mucus plug. She said it was the bloodiest mucus plug she had ever seen. There was a lot of blood in the toilet, but I was not still actively bleeding, and Christina’s presence helped me to feel reassured. She also confirmed that my water had broken, and smelled the fluid on a pad, telling me it had a somewhat sweet smell. I couldn’t smell it, really, but I was glad she could. At this point I was having some mild contractions, which I couldn’t feel at all unless I was lying down. Christina stayed for about an hour, asking questions, taking my blood pressure, listening to the baby’s heartbeat, and giving instructions and information. She also brought in all of her equipment for the home birth and showed us what was in her kit, which included all of her emergency supplies (such as pitocin and oxygen masks for mom and baby) as well as basics for the birth (such as sterile scissors and clamps for the cord).

I remember when she asked me how I felt, I told her that I felt pretty normal, which I thought was strange since my water had broken. She told us that after the water breaks labour usually starts within 24 hours, but it can be as long as three days. She said I should only dab, not wipe, when I went to the bathroom, to try to keep as sterile an environment around my vagina as possible, to prevent infection.

I called my mom to let her know that my water had broken and that labour could start anytime, since she would be coming over to look after Elias during the labour and birth. She dropped by later in the afternoon with some more sheets from the Thrift Store and some grocery items, such as green grapes. She also brought me a dozen red tulips, which were absolutely gorgeous! I kept in touch with Christina by phone, and let her know that nothing had changed.

All day Thursday I tried to rest and eat as much as I could, since I knew I would need energy for the birth. The contractions were still mild, but even though I didn’t feel much pain I still felt a little worn out from them. What does that song say? “Waiting is the hardest part.” At one point on Thursday evening I remember I was lying down, trying to rest, and I just felt so lost. Birth is an uncontrollable event, and I didn’t know what was going to happen when. We went for a walk as a family at about 9:30pm, and I hoped that this might help speed up contractions and get things going. In fact, the opposite happened! My contractions slowed down to about every 10 minutes. My sister Emily came over and brought the movie “Enchanted,” which she had just bought and which I hadn’t seen yet. I sat on the birthing ball, and we only watched part of the movie as we were all getting tired. I went to bed at around 11:30 pm, and woke up every half hour to an hour to go the bathroom. I could feel the contractions, but was able to get back to sleep.

At 3 am on what was now the morning of Friday, March 21, I woke up with contractions that were more intense and I knew I couldn’t sleep through. I got up, had a bowel movement, poured myself a big glass of apple juice, got a bowl of chocolate chip mint ice cream, and went downstairs to see if I could watch some of a movie. I turned on the little white Christmas lights that we had set up in the rec room, and put the tulips on top of the dryer. I watched all of 30 seconds of “Enchanted” and realized that it was only making things worse. I decided to wake up Eric, since I wanted some company. I went back upstairs, and at this point had to stop and breathe through contractions while I was leaning against the wall. I woke Eric up around 3:30 am, and called Christina to ask her to come around 3:45 am. At this point my contractions were about 3 minutes apart, lasting about 45 seconds, and I had to stop and breathe through them.

Eric put the plastic on the futon, and made the bed with the sheets I had bought at the thrift store. When I had a contraction he would stop and put his hand on my shoulder. With the presence of his hand on my shoulder I would feel myself relax. I tried to sit on the birthing ball, but it wasn’t working for me the way it had with Elias’ birth, probably because my water had broken so there was more pressure. Eric started pumping up the birthing pool (an inflatable kiddie pool from Canadian Tire!).

Christina arrived around 4:15 am. I was managing a lot of my contractions by leaning against the washing machine, making low moaning noises, and trying to breathe deeply and relax. I would also move my hips and bend my knees during a contraction. Christina started helping to pump up the tub. *** Stopped writing and am now starting again on June 22, 2008. I am referring to Christina’s record of events now as well as my own memory as I write this.*** Either Eric or Christina would pause what they were doing to come over to me during a contraction, and lay a hand on my shoulder. I was trying to notice when the baby moved, as Christina had told me that movement is an indicator that the baby is doing well, and if the baby is moving there is no need to check for a heartbeat. I hadn’t paid any attention to movement during my first labour, but now that I was trying to feel it I definitely noticed when the baby moved. The baby moved before Christina arrived, and I let her know. I felt the baby move again at 4:53 am.

I had been feeling like throwing up since eating that chocolate chip mint ice cream, and at 4:55 I threw up. I never throw up, so this was an uncommon and unpleasant experience for me. I threw up until I was dry heaving; luckily Christina had brought a bucket out from the bathroom and it was on the floor at my feet. I had been leaning on Christina with my arms around her neck during a contraction when I started throwing up, and she brought the bucket up to me. Then we went over the sink in the bathroom. At some point after this I asked Christina how far along she thought I was. I didn’t want an internal, and she didn’t want to give me false information based on her guesses of how far along I was, so at that time she didn’t tell me. Later she said that many women throw up as they are entering transition, and that I was probably about 8cm dilated at that time. But, some women throw up at 3cm, 5 cm, and 8 cm, so the throwing up was not necessarily a sure indicator.

My contractions were getting pretty intense at this point. It was sometime after this that I remember thinking, “Why did I think this was going to be so great?” I had been so excited about having a home birth, and I knew it was going to still be painful, but time erases the memory of the pain I had felt during Elias’ birth. I just wanted to lie down and go to sleep. I knew lying down would only make things worse, but I decided to try it anyway. I lay down on the futon in between contractions, and instead of trying to get up as a contraction was starting I just stayed there. That one really hurt! I didn’t stay lying down during a contraction again, although I would lie down between and then get up so I could cope with the pain during the contraction.

I drank quite a bit of water and apple juice while I was in labour, and I tried to eat some grapes. Christina had thoughtfully bought me some frozen grapes (I really liked eating frozen things during the pregnancy!). At 5:23 am I went pee on the toilet. Sitting on the toilet during contractions has never worked for me, so I didn’t stay there but got back up and went back to leaning on the washing machine. I really appreciated having the tulips there that my mom had brought; they helped to remind me of beauty in the midst of my pain.

I started to feel a bit like pushing soon after this, around 5:30 am. Christina asked me if I felt “pushy at the peak,” which is a good way to describe it. I didn’t feel like pushing during the whole contraction, but I had the urge to bear down in the middle of the contraction. I followed my body and just did what felt right. I started to really, really want to get in the tub, and if the tub wasn’t ready I wanted to get into the shower.

There had been some difficulty in hooking the hose up to the faucet in the sink in the bathroom, which I didn’t pay attention to, but Christina and Eric had both been busy trying to get the tub filled with water. One of them would always come back to me during a contraction, and I would instantly feel more relaxed as soon as I felt a hand on my shoulder.

I asked Eric to call my mom and ask her to come, as things were getting pretty intense and if Elias woke up I wanted her to be there to look after him.

At 5:35 I got into the tub, and it was instant, warm relief! Of course not all the pain was taken away, but that first minute was intensely soothing. I thought I felt the baby move at around 5:36, but I couldn’t be sure. At 5:46 Christina asked if she could listen for the heartbeat, and used the fetoscope. She heard the heartbeat and it was around 120bpm – 130bpm, totally normal. At this point I was starting to really feel more like pushing, and there was a lot of pressure. I was hoping the bath would help to take the pressure away, but being in the tub during labour is not the same as relaxing in the tub when you’re not in labour! At one point I said, “It hurts,” and whimpered a bit. Christina said, “You’re doing so well.” Christina asked me if the contractions still hurt in front, and by 6:00 am they didn’t and I was fully pushing. Again, I just followed my body and did what felt right, without outside direction. I tried different positions in the tub, like kneeling and squatting. I was trying to find a position that would take advantage of the buoyancy of the water and help relieve the pressure. Christina suggested I lean back against the tub and squat, and this ended up being a good position for me.

I started wondering where my mom was, and asked Eric to call her again, which he did. She said she was just leaving the house.

Elias woke up sometime around 6:00 am, and Eric went upstairs to attend to him. We had the monitor on. Eric came back down and said Elias was back in bed. I told Eric to go get him, as I thought we were getting pretty close the baby being born. Elias came down, and was quite enchanted by the fish on the tub! Soon after this my mom arrived, and started talking to Elias. I asked them both to be quiet – I didn’t want any noise interrupting my concentration on coping with pushing.

To cope with the pushing contractions I vocalized strongly, in a higher pitch than when I was having dilating contractions. In between I would rest and ask for water to drink. Eric was in the tub with me at this point.

I put my hands down near my vagina so I could feel if the baby’s head came out. I felt the baby’s head, and then it went back in. Eric asked if he could touch the head, but I said no, since there was no head there to touch. With a few more pushes the baby’s head came again, and I told Eric he could feel it.

At 6:22 am I had a contraction and pushed and could feel the baby’s head coming out! Christina advised me to slow down, so I tried to hold back on the pushing so I wouldn’t tear, although it was very hard and I just wanted the baby out! I didn’t know if I had slowed down or not, as the baby’s body was born into Eric’s hands! He scooped the baby up out of the water and placed her on my chest. I felt pure joy, a moment of pure emotion, and I started crying as I looked at my sweet, beautiful baby! In that moment I was totally in the moment, totally myself, fully vulnerable and overcome with intense feelings of joy, delight, and relief.

A few moments later we looked and found out that we had a girl, a daughter! She was so peaceful, and just lay on my chest. I thought she was breathing, but she wasn’t crying, so I asked Christina just to be sure. Christina reassured me that our girl was fine. She let out a few little cries a couple of minutes after she was born. Eric was so happy too, and we both talked sweetly to our precious new daughter.

I invited Elias over to touch her, and he was very gentle with his new baby sister. I wanted a few photos of her when she was first born, so Christina and my mom took a few pictures. About twenty minutes after she was born, Eowyn started leaning toward my left side. I made sure my breast was out of the water, and supported her neck. She found my nipple, latched on, and started nursing!

Very soon after she started nursing (about three minutes) the placenta was born. I had wanted to stay in the water until the placenta was born. Christina told me she would like me to get out of the water soon so that she could see how much I was bleeding, so at 6:48 I got out of the tub, with Eowyn still nursing and still attached by the umbilical cord to the birthed placenta, which we put into a bucket. I went over to the futon and lay down on my side, with Eowyn still nursing. We snuggled in bed as a family for a bit, and Elias got to kiss and hug his new baby sister! Then my mom took Elias upstairs to get him some breakfast and give us some time to settle with Eowyn.

Eric cut the umbilical cord at 7 am, and Christina inspected the placenta. The placenta was a little bit small and had some calcification, but it wasn’t too small. Calcification is an indicator that the placenta was wearing out, which would explain why Eowyn was born two and half weeks early. The amniotic sac was broken right next to the placenta, where there were also some blood clots. This is unusual, as the sac usually breaks on the opposite side of where it is attached to the placenta. This shed some light on the bloody mucus plug when my water broke and the early delivery. Implantation had probably occurred very low in my uterus, close to my cervix, so that the placenta grew into the mucus plug. If this is what happened, then I would have had placenta previa marginalis, but not full placenta previa as the placenta was not covering my cervix. Eowyn had been head down for some time, and her head was probably against the placenta preventing more growth, which would account for the calcification. She was very engaged when my water broke, and so her head acted as a plug stopping any bleeding that might have happened from the torn vessels that were part of the mucus plug.

If I had had a routine ultrasound, which I didn’t want, the doctor who viewed it may have been concerned about a vaginal birth given the placement of the placenta, and recommended a c-section. I am so glad that I did not have an ultrasound! And I am so glad that I had Christina to assess me when I was in labour. If I had been actively bleeding she would have recommended we go to the hospital, but everything was fine and there were no symptoms that would cause alarm. I am glad that I had a healthy vaginal delivery without interventions, and that I had a health care professional I trusted to assist me. I have realized that I cannot have a doctor as my primary care giver for any of my subsequent pregnancies because I simply do not trust their recommendations for what they might consider necessary interventions.

It’s interesting that I had Braxton-Hicks contractions early in my pregnancy when I would do simple things like carry a relatively light basket of laundry down the stairs. I think my body was telling me to take it easy, possibly because of the placement of the placenta. I listened, and stopped doing things that gave me Braxton-Hicks or that made me feel uncomfortable.

I had some pretty severe afterpains while Eowyn was nursing, which I always find really annoying because they are just as bad as labour contractions but I am lying down nursing through them , so they are difficult to cope with. I have to breathe deep and slowly, but it’s still really painful. I took some cramp bark tincture, but that didn’t seem to have any effect so I took some ibuprofen.

I wanted Eowyn to stay right with me for at least an hour after she was born, so we didn’t weigh and measure her until 9:00 am! She was 7lbs 5 oz and 19 ¾ inches long. Even though she was born a little early she had no signs of prematurity. She was healthy, pink, and fast asleep after nursing for about half an hour, which is why we waited until she woke up to weigh and measure her.

I had a small one degree tear just inside my vagina, which I opted not to get stitched. I guess I did a pretty good job of slowing down, considering I had a third degree tear almost to my anus with Elias’ birth! Because I decided not get stitched I had to mostly lie down with my legs together for a week, which I thought was a good thing anyway to make sure I rested and bonded with Eowyn. Those first few days are so fleeting, and so precious.

I am overjoyed with the way Eowyn’s labour and birth went, and I feel empowered and confident in myself as a women through the experience. I feel satisfied that I was able to bring her into the world in the best environment possible, with dim lighting, gentle sounds, people that I knew and trusted, the loving hands of her daddy to catch her, and the comfort of my skin and my breast in the first hours of her life.

SOGC makes changes to guidelines for vaginal birth of breech babies

noreply@blogger.com (Fawn) — Tue, 22 Jul 2008 19:28:00 +0000

This is not strictly midwifery related, but it is an interesting development in the world of maternity care. My friend Robin has been working hard in the last few years to make vaginal birth a viable option for women with breech babies. (C-sections still have their place, of course, but there are some breech presentations that are suited to normal vaginal delivery, but many women are never given the information let alone the choice. You can learn more about it at the Coalition for Breech Birth website.)

Last week, Robin got this great response from the Society of Obstetricians and Gynaecologists of Canada.

Dear Ms. Guy:

Thank you very much for your letter dated June 25th, 2008 regarding Breech Birth in Canada. Your letter was perfectly timed as the Society of Obstetricians and Gynaecologists of Canada’s (SOGC) Council Committee has just discussed and approved new guidelines that will offer choices to women who want to have a vaginal birth when there is a breech presentation. The breech guideline is now being copy-edited and will be published in the fall in the JOG. At that time, it will become official SOGC policy. A full press release will be prepared and we would be happy to have you, or someone from your group, participate.

The SOGC had a guideline in 1994. In 2000, given the results and the publicity surrounding breech delivery, we felt it was necessary to warn our members about the study and suggested they discuss it with their patients. At no time did the SOGC ever recommend cesarean sections for all breech presentation. I regret these comments reported by physicians and we will certainly work hard to correct these impressions.

The SOGC will also collaborate with the Association of Professors of Obstetrics and Gynaecology (APOG) to make sure that Breech Vaginal Delivery is taught properly in all medical schools in Canada.

Thank you very much for sending this information to me, I will circulate this information to SOGC Council. I will also put you on the mailing list for our guidelines, which are printed in the JOGC as well as being available on our website.

Yours Sincerely,

André B. Lalonde, MD, FRCSC, FSOGC, FACS, MSc
Executive Vice-President

Veronika from Dawson - Birth Stories

noreply@blogger.com (Asheya) — Tue, 01 Apr 2008 03:15:00 +0000

Thank you to Veronika, from Dawson, Yukon, for sharing the birth stories of her two daughters with us!

In Prague, Czech Republic, I spent most of my working life in marketing business. The closest I ever got to the “birthing” was while working for Procter & Gamble, Pampers being my main brand. I visited lots of hospitals and even picked one for my own delivery. It amazed me with all its services – there was big hot tub, jumbo bouncing balls, single rooms with beds not only for mum and the baby, but for dad too.

Then I came to Yukon, met Tom, got pregnant and started to ask about Whitehorse Hospital. All the information I had got was pretty much positive – except for the rate of c-sections. That figure shocked me – for European it was unheard of. In spite of being pregnant for the first time I knew that I was built to bring my baby to this world in a natural way… and then I heard of midwives – midwives that were in Czech banished when communists took over and never established their practice again. That settled it.

I met Christina Kaiser in seventh month of my pregnancy. We spent whole day, we talked, she loaded me with advice and delicious brownies, checked on the baby, helped with leg-cramps by applying acupuncture. All felt very natural.

The day we arrived to Whitehorse next time, my labour started. It was at 9 am, August 18^th 2005, and I honestly did not realize what had been happening until about 3 pm. We called Christina and headed for Mendenhall, where she lived. When we arrived, “our” little cabin was ready, kids swimming pool was ready, and so was my midwife. I plopped myself into a soothing warm bath that took most of the initial pain away and enjoyed the peaceful atmosphere ( so peaceful that my husband actually fell asleep :o). When the bad pain came, Tom held my hand when I needed and Christina was massaging my lower back making the pain go away, talking me into breathing and, above all, telling me over and over again that I was doing a great job. At 1:51 am, August 19^th, Sofia was born. Pink, beautiful, those big dark eyes starring at me, perfect. Tom cut the cord.

Most of the necessary checking then went without us noticing – uninterrupted in our joy we spent hours with our new baby before we all hit the bed. It took us almost a month to leave Christina’s little cabin – month full of advice and practical help. Thanks to Christina I turned from literally all-that-everyday-baby-stuff illiterate into quite a confident mum.

… and so when Eva let us know she was there, we did not hesitate about where this one was to be born. But how different two pregnancies can be! While I hardly noticed with Sofia, Eva was giving me a really hard time. Problems culminated in the eight month with hemorrhoids so bad that after unsuccessful treatment with the only two ointments available and heavy painkillers, I ended up with a letter from one of the Dawson Medical Clinic’s doctors pleading Whitehorse Hospital staff to do a surgery on me. I called Christina instead. She gave me a shopping list and since very little could be purchased in Dawson, she went shopping in Whitehorse and found a way how to deliver that big box full of goodies (herbs, ointments, barks and lots more) to me. In two days I was able to operate again! (All the shopping, driving and phoning was part of the $2500 fee!)

Just like with Sofia, Eva decided that the dreadful trip from Dawson to Whitehorse was enough. The labour started at about 1 pm, December 8^th 2007.We went to Christina’s and again – my little pool was ready :o) Kids and daddies got together and ladies started to work. Eva was born at 8:17 pm, December 9^th.

It was a long and painful journey completed fully naturally only thanks to Christina. To each of mine “I can’t anymore!” she replied “Yes, you can.” and she would never let go of my hand or stop saying something about a great job :o) After teas, acupuncture and a brisk walk outside, we used an up-and-down the stairs method to enhance the contractions that subsided every time I went for the soothing bath. Eventually, we walked our way back to the pool and after quite a bit of pushing, Eva finally decided to come out. Tom ran in to see her coming, Sofia joined us right after.

Unfortunately, as exhausted as I was, I could not take care of Eva right away but there was somebody who did it for me: my midwife. Thank you, Christina, from all my heart!

Whitehorse Daily Star Article - March 17, 2008

noreply@blogger.com (Asheya) — Wed, 19 Mar 2008 05:44:00 +0000

Women Look for Midwifery Reimbursement

by Stephanie Waddell

Two local women have submitted invoices to the Yukon government for a reimbursement of the money they paid to have a midwife oversee their childrens’ birth, rather than a doctor.

“It should be funded,” Asheya Hennessy, who last year formed the Yukoners for Funded Mid-wifery group, said in an interview this morning. “It is a primary health care service.”

Hennessy has chosen to use a mid-wife for the birth of her second child, while Desiree Pinkerton went to a mid-wife for the birth of her first baby.

Both sent letters and invoices in to Health and Social Services Minster Brad Cathers on Friday requesting reimbursements for the bills this year.

Hennessy said she requested reimbursement for the $2,500 service because it is an important part of health care in the country with numerous other regions, including Ontario, B.C., Manitoba, Saskatchewan, Nunavut and the Northwest Territories funding it as part of the health care system.

“It is so good for women,” she said.

While the government is looking at regulating mid-wifery in the territory, it is not funded.

Hennessy expects the territorial government will argue against funding until regulations are in place, which could take a couple of years.

As she noted though, Nunavut is devising regulations, but is also funding mid-wife care as part of the health care system.

She, Pinkerton and local mid-wife Christina Kaiser all stressed in separate interviews the mid-wife approach to births is based on informed choice, with the mid-wife pointing to the options and the risks and consequences associated.

One of the biggest differences Hennessy has noticed in dealing with a mid-wife compared to a doctor is that her mid-wife comes to her house for appointments instead of having to go to an office.

“I don’t have to wait,” Hennessy said.

Once the mid-wife is there, Hennessy is able to go over anything on her mind and ask questions, with her mid-wife taking the time to answer and point to Hennessy’s choices in various matters such as what tests to have and so on.

“A woman feels cared for,” she said.

With Hennessy just sending out the letter and invoice on Friday, she noted a week or two for Cathers to reply is fairly reasonable.

Pinkerton chose to go with a mid-wife’s care over a doctor for the birth of her daughter after speaking to a number of women who praised the care they received from midwives during their pregnancies.

Originally from Ontario, where it’s covered by health care, she soon learned it was not the same case in the Yukon.

“I was initially shocked that it wasn’t funded,” Pinkerton said.

That prompted discussions with her husband about whether they would pay for the services of a mid-wife.

After meeting local mid-wife Heather Ashthorn, Pinkerton said she put her “foot down.” She decided to pay for the birthing services that would enable her to make choices that worked best for her, such as giving birth in a hot tub at home, and make her feel confident in those choices.

Sending her invoice into Cathers was an opportunity to make a point that funding should be provided regardless of whether there are regulations in place and that process should be speeding up.

Kaiser has seen some women consider using a mid-wife for the birth of their child, only to opt out once they learn they must pay for it themselves.

“Of course it’s an issue,” she said, before noting that women who are determined to use a mid-wife’s services usually find a way to do so.

Hennessy and Kaiser argued there are flexible payment plans established for each patient, but it still remains a barrier for some women, especially Canadians who are accustomed to primary health care being funded by government.

Patients from Haines, Alaska, for example, are usually more willing to pay for Kaiser’s services, and it is usually cheaper to use a mid-wife than a doctor if a patient isn’t covered.

Kaiser would like to see her services available to all women, but with funding comes the issue of regulations.

If funding was to be provided without regulations, Kaiser would like to see it funded immediately.

Kaiser is part of the committee looking at regulations with the Yukon government, but that process is only at the first step of questioning whether regulations are needed.

Though becoming regulated could have advantages in terms of the industry being able to get insurance, Kaiser noted there could also be disadvantages in that with regulations, there are often restrictions.

“(Right now) we can do whatever we want,” she said of providing options for clients. “We do what our clients want.”

In other regions, however, there are restrictions such as no home births for women who have had Caesarian sections in the past.

In the Yukon’s case, Kaiser can tell her clients who have had Caesarian sections the risks involved in a home birth, leaving that choice up to the client, she noted.

“Mid-wifery is about informed choice,” she reiterated.

Cathers did not respond to the Star’s request for an interview on the subject this morning.

CBC Radio One, March 12, 2008

noreply@blogger.com (Asheya) — Thu, 13 Mar 2008 17:35:00 +0000

Here's a transcript of the news stories about midwifery that CBC Radio One aired the morning of March 12. I also did an interview for the afternoon show at 5:10 pm on March 11. We will be continuing with media exposure, including contacting the newspapers, after we have submitted our invoices for midwifery services to the government and potentially received a response from them.

1. Saskatchewan midwives had a reason to celebrate last Monday. The proclamation of the Midwife Act made them a provincially recognized self regulating and publicly funded profession. Midwives in the Yukon are not so lucky. Their fees are not covered by Yukon medicare and the debate over whether they should be regulated is ongoing. Asheya Hennessey is the president of the Yukoners For Funded Midwifery. Her group is meeting with the department of Health and Social Services to discuss midwife regulations since last fall. Her organization is primarily concerned with ensuring midwifery is government funded but a lack of regulations could delay that goal. (Hennessey) "The department of Health and Social Services has definitely been very willing to work with us towards looking at midwifery services being integrated into the health care system and they do seem quite optimistic about it happening but we are going through this process where there will be a decision around whether it should be regulated and that may affect the length of time that it takes for midwifery services to be come fully integrated." The NWT has already passed legislation and Nunavut has draft legislation in place.

2. (6:30 a.m.) Saskatchewan has made midwifery a publicly funded profession on Monday. The president of the Yukoners For Funded Midwifery hopes that the territory will follow the lead. (Keitha Clark) Asheya Hennessey had her first baby in the Yukon two years ago. She wanted a midwife to help with the delivery but says it was too expensive. (Hennessey) "I think as Canadians we're just not used to paying for health care." Hennessey is due to have her second child in April and plans to have a midwife present to deliver her baby. She says it remains expensive but it's something she wants to do. Currently Yukon doesn't fund midwife services. When Hennessey founded Yukoners For Funded Midwifery in 2006 she hoped to change that but first the debate over whether to regulate the service must be wrapped up. She says if midwifery is not regulated it may become more challenging to obtain government funding. Her group has been meeting with the department of Health and Social Services since last fall to discuss this issues. (Hennessey) "This process where there will be decision around whether it should be regulated or not may affect the length of time that it takes for midwifery services to become fully integrated." The meetings wrap up next month which Hennessey says will be followed by public consultation on the issue. Hennessey is optimistic about the process, however, even if the regulation debate is wrapped up and funding is legislated she says that doesn't provide a financial solution for women like herself who are paying for a midwife right now. Hennessey hopes to submit a bill for her midwife services to the Yukon government later this week. (Hennessey) "It's hard to say. I mean it's worth a shot. I think it just demonstrates that we need the midwifery services now." NWT has already regulated midwifery and Nunavut has draft legislation in place.

*note, I changed the spelling of my name in these transcripts so it is correct - Asheya Hennessey

Evolution of childbirth practices

noreply@blogger.com (Fawn) — Tue, 11 Mar 2008 19:07:00 +0000

Those of us who are involved in birth advocacy issues are very concerned about the medicalization of pregnancy and chidbirth, unnecessary medical interventions, rising Cesarean rates. It can be somewhat encouraging to consider how much better the whole child-bearing experience is for most women in Canada compared to 50 years ago.

I just read a great story about Norman Morris, a professor and obstetrician in the UK, who apparently had a huge impact on attitudes and practices surrounding childbirth. He died last month, so his career was chronicled briefly in the Telegraph.

Here's a taste:

Throughout his life Morris was guided by a deep humanism. He felt that the way in which women were traditionally treated by the health service was inhumane, and that the psychological stress involved often militated against the best possible outcomes and tended to increase demand for artificial pain relief.

Thanks to Kimberly from The Trial of Labor for the link.

Natural Birth and Homebirth Thoughts by Michel Odent

noreply@blogger.com (Asheya) — Wed, 20 Feb 2008 05:06:00 +0000

This is a post by Michel Odent relating to natural birth and homebirth which I found at http://www.mothering.com/sections/experts/odent-archive1.html#natural-birth

My sister and I were discussing childbirth. She is very influenced by her friend, a nurse, to have an intrusive, medicalized birth. What kind of resources can I share with her to show her that a natural childbirth is a wonderful and safe birth choice?

Michel Odent: You might first explain to your sister and her friend that a natural childbirth is not a choice. This term can only be used in retrospect, when a woman has given birth without any drug and without any intervention. The environment where you give birth is the real choice. You must explain that your main objective is safety and that according to common sense an easy birth is safer than a difficult birth. So your priority is to make the birth as easy as possible thanks to an environment that can satisfy your basic needs when you are in labor.

Your basic needs are easy to explain in the current scientific context. Physiologists, scientists who study the body functions, tell us that adrenaline (the emergency hormone we release in particular when we are scared or when we are cold) makes difficult the release of oxytocin, the hormone necessary for effective uterine contractions. You can explain that you release a lot of adrenaline when you are in an unfamiliar and clinical environment. You can add that, in contrast, you can imagine yourself giving birth in a familiar environment, with - for example - nobody else around than an experienced, motherly, low profile and silent midwife knitting in a corner. It is probable that in such an environment your body will work well.

The second aspect of the safety preoccupation is: what to do if there is something wrong? In the age of the safe c-section and widespread cell-phones, there is usually an easy answer to this question, which should always be the second one.

Many health professionals need to learn to think in terms of 'ratio of benefits to risks'. Where out of hospital births are concerned, they immediately ask: 'what will you do if…' instead of asking first: 'how to make the birth as easy as possible'.

You are asking what kind of resources you can share. You might share data about the Dutch birth statistics. In Holland, where 82% of the midwives are independent primary care givers, about 31% of the births occur at home, and an autonomous midwife attends many of the hospital births. The rates of c-sections are around 10% for the whole country and more than 90% of the laboring women do not need an epidural anesthesia. The birth outcomes are much better than in the USA (number of babies alive and healthy at birth).

Do not recommend books about 'natural childbirth' because they are usually written for the converted. Instead you might suggest updated books focusing on one of the main aspects of industrialized childbirth, such as 'The Caesarean. Free Association Books 2004'. In order to help your sister and friend to learn to think long term, you might indicate the 'Primal Health Research Data Base' that is specialized in studies exploring the long term consequences of what happened at the beginning of our life. It appears that the way we are born has life long consequences and that, today, in spite of the safe caesarean, we have good reasons to try to rediscover the basic needs of women in labor and of newborn babies.

YFFM Meeting, Saturday, March 1

noreply@blogger.com (Asheya) — Mon, 18 Feb 2008 20:18:00 +0000

Come out and have a voice in what happens with midwifery in the Yukon! Babies & children are welcome – since we are meeting in the library, I would suggest bringing toys for them to play with.

When: Saturday, March 1, 2008 @ 10:30 am
Where: Whitehorse Public Library, Meeting Room 1

My Prenatal Experiences with a Yukon Midwife

noreply@blogger.com (Asheya) — Fri, 15 Feb 2008 17:49:00 +0000

***by Asheya Hennessey***

When a home pregnancy test confirmed my pregnancy with my second child this past summer, one of the first people I called with the good news was Christina Kaiser. Christina is one of two practicing midwives in the Yukon, where midwifery services are currently not funded by the government and not integrated into the health care system. Christina was happy to hear my news, and we booked an appointment for a few weeks later. She has been my primary health care provider during this pregnancy ever since.

I am now seven months pregnant, and I thought it was about time that I shared my experiences. There are so many things I enjoy about having a midwife for my prenatal care, it's hard to know where to begin! I think this will end up being a bit of a compare and contrast, as a doctor was my primary health care provider for my first pregnancy, and I can't help but see the differences. I think my previous experience with a doctor has also helped me to appreciate Christina's care all the more.

One of the first things that struck me as being different from the prenatal care I received from a doctor is that Christina comes to my home for appointments! I can remember waiting over an hour in the doctor's office for a fifteen minute appointment, but Christina sits in my living room and we usually talk for over an hour. I love having the time to tell her how I am feeling, both physically and emotionally, and to ask tons of questions about different pregnancy and birth related options, such as what remedies I can use for heartburn, or what the pros and cons of a water birth are. There are different things to discuss at each stage of the pregnancy, such as whether or not I want to get an ultrasound, or if I want to get tested for Strep B, or if I prefer an active or passive approach to the third stage of labour, and as each topic comes up I can ask Christina for information and then I get to make the decisions without pressure from her. With the doctor it was quite different: it was more of a 'this is the way things are done' and if I wanted something different I felt I had to argue my case.

I also really appreciate how Christina remembers what I've said in previous appointments. For instance, I knew I didn't want to listen to the baby's heartbeat with the Doppler, which is an ultrasound device. I was okay with waiting to hear the baby's heartbeat until it could be heard with a fetoscope. When I was pregnant the first time, I told my doctor right away that I didn't want to use the Doppler, but she kept forgetting and I had to keep saying 'no thanks,' which felt a bit awkward. Once I told Christina that I didn't want to use the Doppler it was never an issue, and I still felt that if I changed my mind I could always ask for it.

A typical appointment starts with Christina asking how I am feeling, so I share my different pregnancy related woes, such as nausea, heartburn, backache, fatigue, mild cramping, cravings or whatever else I have been experiencing. It's great having someone listen to you complain, and you know that it's actually part of what you are supposed to be doing! My sense is that asking how the woman is feeling is an important part of how a midwife takes care of her client, because not only does it make the woman feel cared for, but what the woman is feeling may reveal something that is a symptom of a problem, which will allow the midwife to catch it and be able to address the problem. My pregnancy is perfectly healthy and normal, but it's reassuring to know that I'm being listened to in case there is a problem.

After we discuss how I am feeling, we usually discuss some informational sort of topic that has to do with my options, such as remedies to treat my complaints, or tests in pregnancy, or options in childbirth.

Christina takes my blood pressure and my pulse at every visit, and she gives me the choice of whether or not I would like to be weighed. I always opt to be weighed because I like knowing how much weight I've gained in the pregnancy. Similar to how it's done at the doctor's, I pee in a jar and she checks my urine with one of those little strips of paper that gives information about pH and leukocytes and other things that could be indicators of potential problems. Once my belly got big enough, she started measuring it at each appointment.

I like how our appointments are casual, and if there's something I've been meaning to mention but forgot about, there's lots of time to remember. Another aspect of the care I'm receiving that I really appreciate is that I can call Christina if I have questions or concerns in between our appointments. I called her once because I had taken a bath with eucalyptus essential oil, and felt quite sick. I was concerned, because of course after I'd taken the bath I looked up eucalyptus and saw that it was contraindicated in pregnancy. She was able to provide me with information and advice over the phone. I've also called her when I've been feeling really emotional and scared that I was going to lose the baby - this has happened to me in both pregnancies around 22 weeks, and it was really nice to have a professional to talk to at length this time! I've called her with a few other concerns as well, and it's always so comforting to know that she is easily accessible.

Having my two year old son around for the appointments, in the familiarity of our own home, has also turned out to be a bonus that I didn't anticipate. He can play with his toys, get a snack etc. while we visit, and he also gets to participate in some of the 'new baby' activities, like using a stethoscope to listen to my heartbeat, measuring my belly, and listening to the baby's heartbeat with the fetoscope. I think that being part of caring for the baby while the baby is still inside me helps him to bond with the baby and feel even more excited about the birth of the baby. We are planning a homebirth, so I think it's also really great that he can get used to Christina being in our home, and it is helping to prepare him for her presence at the birth.

I believe that Christina's philosophy about pregnancy and childbirth is very similar to mine, which is that pregnancy and birth are a normal part of a woman's life, and it is better not to interfere or use interventions unless there are actual problems that need to be addressed. This is a pretty basic tenet of the midwifery model, while the medical model tends to come at pregnancy as an abnormal condition, which only makes sense because doctors are trained to address and find solutions for states of ill health. It's very relaxing for me to be working with a health professional who has a similar philosophy, because I don't feel that I have to convince her into my way of thinking or fight her about the decisions I make. I also don't feel intimidated by her; I can ask questions and express my thoughts without feeling like there is a hierarchy and I'm on the bottom. I think this sense of equality is demonstrated in something as basic as how I address her: I call her by her first name, whereas doctors are most commonly referred to by their last name with the title of 'Dr.' in front, which sets up the hierarchy before you even meet the person.

I am very happy that the health professional who will be attending the birth of my baby is someone who I have gotten to know and like, and that she similarly knows me. When I gave birth to my son in the hospital I was quite anxious because I didn't know who would be my nurse or even which doctor would be attending. And I knew that they wouldn't know me, which would make it harder for me to communicate my choices. I am eagerly anticipating birthing this child at home, surrounded by people who know me and who I know. And not having to drive to the hospital when I am having contractions is just a bonus! I trust Christina, and I think this is very important. I know that research indicates that fear can make labours longer and harder, and so I am very grateful to be able to give birth in an environment where I feel safe, and where I trust that my health professional will listen to me.

If you would like to know more about Christina and how to contact her, you can visit www.yffm.ca/midwives.htm

Clara's Birth Story

noreply@blogger.com (Fawn) — Fri, 15 Feb 2008 03:58:00 +0000

Here's a birth story that was sent to me by a friend in southern B.C. Clara is her first daughter and she was born at home this past summer.

It's interesting to read about what midwives do in other places and to see the range in philosphies. For example, Paige mentions that her midwives considered doing an episiotomy, a procedure our two Yukon midwives probably rarely (if ever) practice. As we move forward in the regulation process, we're trying to ensure that we leave as many options open as possible so that women will be able to have the kinds of births they want, and midwives with all sorts of different philosophies will feel comfortable.

Here's Clara's birth story:
The home-birth went amazingly well, and definitely because of the amazing support we've had from our mid-wives. I can't say enough about the care we received from them, and wish you all the best in advocating for them in the Yukon.

Our home birth was planned (phew!). I was at 41 weeks and 3 days, so was due for a 'non-stress test' at the hospital in the afternoon. Fortunately, we'd had an appointment the day before where the mid-wife did a 'stretch and sweep', gave us some evening primrose oil capsules (one to take orally, and one internally by the cervix) and provided the recipe for the labour 'cocktail' to help promote labour. It worked!

I had my first contraction at about 4am, although I was able to stay sleeping until about 6am when I normally woke up in the summer. My water broke at that point, although not as a big gush, so I wasn't sure of it at the time. After that, it was obvious that I was having contractions, although not in any particular regular pattern. I made up the cocktail and took that - vile, but did the trick! My contractions became quite regular by about 10am.

We called the mid-wife to cancel the non-stress test, and she came by at about noon. While all this was going on, the rest of the farm folk had gathered outside for their regular lunch, and I could hear their excitement in the background - "here we are eating lunch, and Paige is in labour up there!". I got in the pool sometime after that, and eventually got out of it again because I was too relaxed in there. After some moving around, I settled on our couch (safely covered in a plastic sheet) and fairly quickly gave birth to little Clara (who was not so little, after all!).

Our regular mid-wife had called her back-up at some point. I recall her showing up while I was in the pool, although I was too concentrated to really see her. I could hear them consulting and recording every time they monitored the baby's heartbeat, and there was a little concern that it was going slowly (I ended up pushing for nearly two and a half hours). Once I made it to the couch, the second mid-wife took the lead in coaching me, and I remember her voice cutting through and being really clear - push NOW! HOLD IT! PUSH AGAIN! I couldn't believe it when the baby slipped out (at 5:04pm).

They'd frozen my perineum in preparation for cutting, but fortunately didn't end up needing to. I tore a bit, but not badly. They also had to give me a shot of pitocin to encourage contractions to deliver the placenta, but I was on such an adrenalin rush and so relieved that labour was over, I hardly noticed. The placenta delivered fine, and they put me back on the couch with Clara on my chest where she started nursing while they sewed me up. What a trip!

Chris had started calling family by then. My mom was with us, which was great, and Chris' folks got to hear some of her first cries, which they were pretty over the moon about. That moment when you go from being pregnant to having a baby on your chest is so incredibly miraculous. I remember stroking her, hearing her crying, seeing Chris crying, telling her we loved her and were glad she had arrived safely, and just being so amazed that I was done with labour. The preparation we'd had with the midwives about labour was so helpful. I don't remember it as being particularly painful exactly, because I was able to experience it as the culminating event of pregnancy and the process of my baby's arrival. Mind over matter, indeed!

...and we're back!

noreply@blogger.com (Fawn) — Sun, 20 Jan 2008 04:12:00 +0000

Wow, time has flown and there hasn't been ~~much~~ any activity on this blog for quite a few months. My apologies. We've had a pregnancy (Asheya), a miscarriage (me), and lots of travelling and holidays and unfortunately this blog sort of fell through the cracks. But there has been lots going on in our work to get midwifery integrated into the Yukon health system.

In a nutshell, there have been meetings with Health and Social Services, a process established for getting midwifery regulated, a working group put together to work on that process, as well as two meetings of that working group.

Asheya is working on a summary of what we've accomplished so far, and that should be posted soon. We have ideas for more education campaigns we can do over the next little while, and we're still thinking about getting a screening of the movie I wrote about in my last post. Plus we have some birth stories that are getting polished up that we'll be able to share with you soon.

Stay tuned!

The Business of Being Born

noreply@blogger.com (Fawn) — Thu, 11 Oct 2007 20:57:00 +0000

I just heard about this exciting new childbirth advocacy movie. The article below has been copied from the "Navelgazing Midwife" blog. I think I'm going to run off now to see how we can get a screening here in Whitehorse!

“The Business of Being Born” & Its Effect on Audiences
by Barbara E. Herrera, LM, CPM

I’ve watched fourteen audiences walk into and then out of Ricki Lake’s childbirth advocacy movie “The Business of Being Born,” and the word that stands out is transformed.

Natural birth advocates leave natural birth fanatics.

Pregnant women walk into the movie as patients at local hospitals and walk out with resolute plans to leave their doctors and find a midwife for a birth they know will be safe and respectful.

I’ve role played with women who want out-of-hospital births (or out of unsupportive doctors) after seeing the film, but whose partners (who wouldn’t attend the screening) are fearful – helping them with ideas to get their loved ones to the movie.

And families who were initially hesitant to support a midwifery-attended birth have become ardent supporters intent on converting their misunderstanding friends.

I’m finding it challenging to get the press to either view the movie or to cover the importance of it in our community. It seems some people find natural birth not newsworthy… a big ol’ yawn.

But, how can any thinking person who cares about the effects of hormonal attachment/detachment that occurs during birth in our culture find this unimportant? How could someone yawn about the economics of slicing a person open for convenience's sake (the convenience of the clock, the wallet and the courtroom)? I would think that someone with any semblance of a heart would "get" that birth as it stands today is abhorrent and a complete overhaul is needed.

This movie explains why it goes far, far beyond having or having not medication at birth... it is an entire mindset of respect for a woman's autonomy and the understanding that choices in birth create the most amazing human beings that walk in our neighborhoods. Damaged women and babies do nothing but hurt the world... why foster the continuation of such cruelty?

If the right people saw the movie, the word would get out. That is what is so challenging about the publicity surrounding this movie. It has amazing amounts of well-documented –and jaw-dropping – information that relatively few know about. The people seeing the movie could quote the statistics chapter and verse! It’s those that haven’t seen the movie that need to plop their butts in the seats and then they need to tell others about it from their points of view.

If you’re reading this, you can do your part by either attending the movie yourself if it is in your area (check www.thebusinessofbeingborn.com) or sponsoring a viewing.

If you are so inclined to educate the public about the movie, write letters and send fliers to whomever you can – the press, letters to the editor, your email lists, friends, family, support groups, children’s pre-schools, middle and high school health and sex education teachers, women’s studies programs, child development programs, psychology classes, childbirth education teachers, local midwives (including Nurse-Midwives), La Leche League leaders, head nurses on Labor & Delivery floors, friendly obstetricians, chapter leaders of the International Cesarean Awareness Network, local leaders of midwifery organizations, natural clothing stores, cloth diaper suppliers, childbirth educators and lactation educators as well as putting fliers on bulletin boards at natural food stores and attachment parenting baby stores, Babies R Us and other kid-friendly stores and locations.

Together, we can bring more people to know what we’ve known for far too long. Birth can – and should be – an honored and cherished experience, no matter where, or how, it occurs. It is in the knowledge of options and in the light of respect and humanity that birth becomes perfection.

Perfection is rightfully ours.

"Sorry guys, tits are for kids"

noreply@blogger.com (Fawn) — Tue, 18 Sep 2007 16:16:00 +0000

Did anyone find that offensive? Well then you might not want to look at the offensive blog post I'm about to link to. It's a great, tongue-in-cheek look (no pun intended) at a society that thinks nursing in public is somehow obscene.

I've heard of places in Whitehorse who have asked nursing mothers to leave (well, one place) but thank goodness it's generally a breastfeeding-friendly town. Let's see, places I've nursed in Whitehorse include: the library, Klondike Rib & Salmon, Giorgio's, La Gourmandise, Wal-Mart, Superstore, the Health Centre, the Women's Centre, Shopper's Drug Mart, Qwanlin Mall, Mac's, and my office (Yukon Government Public Service Commission - and after an interview, no less).

Check it out (and don't miss the comments, either, from which I pulled the title for this blog post):
http://mamamojo.wordpress.com/2007/09/12/breastfeeding-in-public-warning-offensive-content/

Seventh Annual Health and Wellness Fair and Festival

noreply@blogger.com (Fawn) — Fri, 14 Sep 2007 22:32:00 +0000

What a busy weekend in Whitehorse! It seems that there are all sorts of activites now that fall is in full swing. YFFM will be participating in the Health and Wellness Fair at the High Country in on Saturday and Sunday. The theme for the fair is “Our Bodies, Our Earth: Healing from the Ground Up”.

There will be speakers, health care resource people, booths, workshops, consultations/sessions with practitioners, silent auction and product sales in a family-friendly environment. This year, organizers are adding a new element by giving the event a bit of a festival twist, with outdoor activities, face-painting, clowning, and crafts.

Come check out this fun event and swing by the YFFM booth to say hello!

Yukon Wholistic Health
& Wellness Fair…
… and Festival !!!

“Our Bodies, Our Earth:
Healing from the Ground Up”

Sat. Sept. 15 (10am-4pm)
Sun. Sept. 16 (10am-4pm)

High Country Inn & Jim Light Park
Whitehorse, Yukon

Opening Ceremony: Sat. Sept. 15, 10:00 am

Yukon News Article - August 15, 2007

noreply@blogger.com (Fawn) — Thu, 16 Aug 2007 21:39:00 +0000

Expecting moms poorly served in rural Yukon
By Chris Oke News Reporter

Roxanne Ladue was hoping for a girl. And who could blame her? The expecting mom had been sharing a hotel with her husband Brian and their four sons for nearly two weeks. The Ladue family is from Watson Lake where there is a hospital but no maternity ward. So, for the fifth time, the family packed up the car and drove five hours to Whitehorse – the only hospital in the Yukon where women can come to give birth.

“It’s a safety issue,” said government spokesperson Dennis Senger. It’s a question of having the doctors available. There are specialists in Whitehorse that can’t be in every community.

“That’s why they’re expected to come in. To make sure everything goes well.”

“There seems to be a memory loss in the modern era,” said Senger. “People have forgotten how dangerous (childbirth) is; we take it for granted.”

Even though her due date was last Saturday, Ladue expected to stay a little longer.

“I haven’t had any of my kids on my due date. They’ve all been 42 or 41 weeks. Then we’re here for three or four weeks, in a hotel.”

“It’s stressful,” she said.

And it could be this stress that caused her children to be overdue. Her doctor told her that many of the women coming from the more distant communities, such as Dawson City and Watson Lake, experience the same problem.

The stressful final trip isn’t the only visit to Whitehorse that expecting mothers have to make. Prenatal monitoring can be done by nurses in the communities, but moms still need to make at least three trips to Whitehorse to see a doctor. They then need to arrive two weeks before their due date.

As a First Nations person, Ladue’s hotel bills are covered under non-insured health benefits. Everyone else needs to pay for a hotel or go to the Victoria Faulkner Women’s Centre, she said. However, the women’s centre isn’t an option for many families.

“You can stay there and your husband can stay with you, but your children can’t,” she said.

Even with First Nations benefits, Ladue has been told that as soon as she goes into labour her hotel room is no longer covered.

“If you go into labour at 4 o’clock in the morning, who’s thinking about packing up their stuff and checking out?”

Ladue knows of at least five other expecting mothers who will be coming to Whitehorse this month from Watson Lake alone. Watson Lake used to have a specialist but the doctor has since moved away and now only returns every few months, she said.

One possible solution could be midwives.

For the last two years, there has been a movement to get midwifery accepted in the territory. There are currently only a few practicing midwives in the territory, such as Heather Ashthorn who owns and operates the Almost Home Maternity Centre in Whitehorse, which offers prenatal and postpartum services.

However the Yukon government doesn’t fun midwife services and they don’t come cheap. Private midwife care will set a family back by $2,500.

Ladue suggested that the First Nations and government come together to build a facility, so that families such as hers can have a place to stay while they wait to give birth. She also recommended providing programming for the family, or at least a children’s playground. Trying to keep four boys from getting bored has been expensive in the Yukon’s capital city, Ladue said.

“A lot of people can’t afford to come to Whitehorse for a month at a time.”

Then there’s the loss of work time. Brian Ladue is a contractor in Watson Lake, and the two-week trip to Whitehorse is affecting his job.

“It’s the most difficult part of your pregnancy,” said Ladue. “Being away from home and cooped up in a hotel room only makes it worse.”

(Ladue gave birth to a healthy baby boy on Tuesday.)

Spencer's birth story

noreply@blogger.com (Fawn) — Tue, 07 Aug 2007 18:17:00 +0000

For those of you who enjoy birth stories, here's one that I recently came across in my Internet wanderings. The writer is in Hamilton (another Ontario story - they must have a lot of mommy bloggers out that way) and there were three midwives and a doula involved in this homebirth. I thought it was a beautiful story that highlights how amazing our bodies are, how beautiful birth is, and also how important it is to take charge of your own care.

Happy reading!

Birthing Spencer: The Whole Story

Caesarean rates follow-up

noreply@blogger.com (Fawn) — Fri, 27 Jul 2007 19:01:00 +0000

My friend Robin is very involved in birth advocacy, particularly in educating women (and the health system!) about the advantages of vaginal birth for breech babies. I admit it sounded a bit wild to me when I first heard about it, but when you actually look into it, it turns out that, for certain breech babies, the risks of vaginal delivery are no higher than C-section deliveries. (You can find out more about this at the Coalition for Breech Birth website: www.breechbirth.ca.)

Anyway, I am bringing Robin in here because The Ottawa Citizen ran a story very similar to the CBC story I posted earlier, and she wrote an excellent letter to the editor about the risks of having a high C-section rate. You can read her letter without having read the related Citizen article, but if you're interested in it, here's a link.

Good afternoon!

I was delighted to read your article this afternoon regarding concern over the rise in caesarean rates.

I am one of the co-founders of the Coalition for Breech Birth, an Ottawa-based grassroots coalition working for the re-normalization of breech birth.

I admit that I was shocked to read that Andre Lalonde suggested "there has been a recent push to encourage women with breech babies to deliver vaginally." It is nearly impossible to achieve a vaginal breech birth in Ottawa, especially in the hospital (homebirth with a midwife is an option most women are not aware of). Just this past Monday, a woman who contacted us was forced to fight tooth and nail to achieve a vaginal breech birth at the Civic. She was lectured, coerced, and threatened by the doctors, residents, and nurses, and told (incorrectly, according to the published evidence) that she was endangering her baby. How is this "encouraging" a woman to birth vaginally? It's not even "supporting" an intelligent woman who has already done her research and has made an informed decision about the best birthing mode for her baby. In addition, unless there has been a very recent change, the guidelines of the Society of Obstetricians and Gynaecologists of Canada still state that the standard of care for breech birth is Caesarean surgery, and most obstetricians fear professional censure should they openly offer options that go against their organization's recommendations.

I was also astonished and disturbed to read your quote by Dr. Walker: "Is a 25-per-cent C-section rate a bad thing? I don't think there's the data out there to qualify that it's bad ... What we want is healthy mothers and babies. That's the outcome we want." While it cannot be argued that "healthy mothers and babies" is the basic goal of childbirth, this is the most basic of goals, and "healthy" is a subjective term. A mother who experiences surgical birth unnecessarily walks into the hospital healthy, and leaves the hospital permanently injured, with a uterine scar that makes many obstetricians recommend that she not attempt vaginal birth in the future.

The long term physical and emotional ramifications of surgical birth go far beyond the limited 6 week follow up period for which obstetricians typically follow women. Every surgical birth a woman experiences increases the liklihood of another surgical birth; and with every subsequent surgical birth, the risks grow higher for the mother. Ultimately the number of babies a woman can carry is limited by surgery; a woman who has had 3 surgical births is generally told not to have more children, because her uterine strength has been compromised by the repeated surgeries. Peer-reviewed evidence shows that women who experience surgical birth are more likely to suffer from post partum depression, experience difficulty bonding with their babies, are much more likely to have difficulty breastfeeding, develop painful or even debilitating scar-tissue adhesions, experience bowel or bladder incontinence, have varying degrees of permanent nerve damage, and are three times more likely to die in childbirth. The World Health Organization has stated that no developed nation should have a caesarean rate of over 15%. This means that nearly half of the surgical births in Canada are not needed, at great detriment to the families trying to adjust to a new baby and recover from major surgery simultaneously. What data Dr. Walker is still waiting for is very unclear.

As a woman who experienced both an unmedicated vaginal birth, and surgical birth for no medical indication other than encountering an obstetrician on call who was not qualified to catch a breech baby, I can attest that a "normal" recovery from this surgery, and the recovery from normal vaginal birth, are worlds apart. Mothers are often very traumatized by surgical birth, especially if they have done their homework and know, or even suspect, that the surgery was not needed. Doctors who treat surgical birth as "equal to or better than" vaginal birth demonstrate that they are exceptionally short-sighted and out of touch with the needs of birthing families. There is far more to having a baby than the simple extraction of the child. Treating birth as a pathology that needs to be cured, and that has no merits of its own, is a fundamental disrespect of a natural and safe process of the female body, and demonstrates a paternalistic and condescending attitude towards the woman and her family. The complete, accurate information, and the choices, belong in the hands of the people who live with the consequences of the birth.

I invite you to visit our website and read our stories, as well as the peer-reviewed research presented on the Articles page regarding the safety of vaginal breech birth. I would be delighted to discuss the issue further, and would be deeply grateful for any exposure you can give to this issue.

Best regards,
Robin Guy
613 820 7995
*******************************
Coalition for Breech Birth: www.breechbirth.ca.
Please visit and consider signing our petition to have the SOGC change its breech birth guidelines.

"Refusing vaginal breech birth is a human rights violation in that it forces women to consent to surgery in order to obtain medical care. The right to informed consent is meaningless where there is no access to informed refusal." - Henci Goer, author of "The Thinking Woman's Guide to a Better Birth"

More Canadian babies born underweight, by C-section: report

noreply@blogger.com (Fawn) — Thu, 26 Jul 2007 23:07:00 +0000

An article on CBC's website today states that the rate of C-sections continues to increase. While C-sections are, of course, sometimes necessary, it's disturbing to think that part of the reason for the increase is simply that "more obstetrical interventions are becoming accepted".

Here's an excerpt from the article. Click on the article title to go to the full article on CBC's website.

More Canadian babies born underweight, by C-section: report
Last Updated: Thursday, July 26, 2007 2:21 PM ET CBC News

More Canadian babies are entering the world in difficult circumstances — underweight and through caesarean sections, says a new report on birthing trends from the Canadian Institute for Health Information.
.
.
.
The report also finds that the number of women giving birth by C-section in Canada has risen over the past five years, to 26 per cent in 2005-06 from 23 per cent in 2001-02. Though it is lower than the 29 per cent rate in the United States and Australia, it is higher than England's rate of 24 per cent.

CIHI's analysis found that women who had undergone a previous caesarean section had an 82 per cent chance of having a second one, up from 73 per cent in 2001-02.

Heick says that increasing obesity levels among women are resulting in more C-sections, as obesity can lead to dangerous pregnancy complications that require emergency surgery. She also says changing hospital practices are increasing surgical rates. "More obstetrical interventions are becoming accepted," she told CBC News.

Women having C-sections are on average slightly older than those delivering vaginally, the study indicated.

The World Health Organization recommends that no more than 15 per cent of all births should involve a caesarean section.

Outcomes of planned hospital birth attended by midwives compared with physicians in British Columbia

noreply@blogger.com (Fawn) — Tue, 24 Jul 2007 21:39:00 +0000

Thanks to local midwife Heather Ashthorn for sharing this recent study conducted in British Columbia.

The article is a bit technical, but the message is simple. For women with normal pregnancies, births attended by midwives involve far fewer medical interventions than those attended by doctors AND they are just as safe. Healthy mommies, healthy babies, and major cost and resouce savings for our medical system -- what more could you ask for?

Birth. 2007 Jun;34(2):140-7, Outcomes of planned hospital birth attended by midwives compared with physicians in British Columbia.

Janssen PA, Ryan EM, Etches DJ, Klein MC, Reime B. Department of Health Care and Epidemiology, University of British Columbia, Vancouver, BC, Canada.

BACKGROUND: The impact of midwifery versus physician care on perinatal outcomes in a population of women planning birth in hospital has not yet been explored. We compared maternal and newborn outcomes between women planning hospital birth attended by a midwife versus a physician in British Columbia, Canada.

METHODS: All women planning a hospital birth attended by a midwife during the 2-year study period who were of sufficiently low-risk status to meet eligibility requirements for home birth as defined by the British Columbia College of Midwives were included in the study group (n=488). The comparison group included women meeting the same eligibility requirements but planning a physician-attended birth in hospitals where midwives also practiced (n=572). Outcomes were ascertained from the British Columbia Reproductive Care Program Perinatal Registry to which all hospitals in the province submit data.

RESULTS: Adjusted odds ratios for women planning hospital birth attended by a midwife versus a physician were significantly reduced for exposure to cesarean section (OR 0.58, 95% CI 0.39-0.86), narcotic analgesia (OR 0.26, 95% CI 0.18-0.37), electronic fetal monitoring (OR 0.22, 95% CI 0.16-0.30 ), amniotomy (OR 0.74, 95% CI 0.56-0.98), and episiotomy (OR 0.62, 95% CI 0.42-0.93). The odds of adverse neonatal outcomes were not different between groups, with the exception of reduced use of drugs for resuscitation at birth (OR 0.19, 95% CI 0.04-0.83) in the midwifery group.

CONCLUSIONS: A shift toward greater proportions of midwife-attended births in hospitals could result in reduced rates of obstetric interventions, with similar rates of neonatal morbidity.

PMID: 17542818

Health & Social Services met with Community Services

noreply@blogger.com (Fawn) — Tue, 17 Jul 2007 16:27:00 +0000

Everything slows down for the Government of Yukon in the summer because so many people take this time to have some holidays. Despite that, I'm pleased to announce that the Policy Analyst we've been working with at Health & Social Services sent me an e-mail to inform me that she and her supervisor were finally able to meet with some representatives at Community Services on June 28th.

According to her: "The meeting was very useful and we have received their approval (with a few minor tweakings) for the plan I developed. I anticipate being able to provide a further update in the later part of July or early August."

Write to your MLA

noreply@blogger.com (Fawn) — Tue, 10 Jul 2007 16:18:00 +0000

It's important for the government to know that midwifery is important to Yukoners. If you support having midwifery services integrated into our health care system so that all Yukon women will have more choice, then write a letter to your MLA to let him or her know!

Below is a sample letter that you can copy and paste. Remember to fill in your MLA’s name and your name You can find your MLA’s email address at http://www.legassembly.gov.yk.ca/contact.html.

To the Hon. ------

I am a member of your constituency and part of the group Yukoners for Funded Midwifery (www.yffm.ca). I am contacting you to let you know that the integration of midwifery services into the Yukon health care system is very important to me. All women in the Yukon should have choices in high quality maternity care, and funding midwifery services would allow all Yukon women access to the option of midwifery services.

Our group has been meeting with a policy analyst from the department of Health and Social Services, and as midwifery would have to be regulated to funded, the department of Community Services is involved as well, since it is responsible for regulating health professions under the Health Professions Act. We are in the first stage of regulation, which is asking the question, “should midwifery be regulated?” This question will be put to cabinet after an information gathering process.

I’m hopeful that midwifery services will be integrated into our health care system in a way that meets the unique needs of the Yukon. Thank you for your involvement in representing my voice on this important issue.

Sincerely,

Your Name Here