This past Saturday my non-profit, The Arizona Birth Network did a special screening of the film The Business of Being Born – produced by Ricki Lake and directed by Abby Epstein.

It was a total success and I’m still riding on the rush of not only pulling off such an event but having it go so very well. We were hoping for 100 people, and to tell the truth, I thought we were being overly optimistic. In the end – we had 154 people attend, organized a panel discussion that included some incredible birth and wellness professionals, including one of the finest OB-GYN’s in the city, pulled in over $2500 in awesome raffle donations, and raised our profile in the community AND a more than respectable amount of money for the organization.

The Birth Network is my baby. Mani and I started it almost three and a half years ago with very humble plans for a small birth circle in her living room. We told ourselves we’d be happy if five people attended. Somehow, someway I became the co-founder and Director of a full-fledged 501c3 organization that holds four monthly birth circles, a monthly doula networking group, publishes a high quality newsletter and organizes special events like the one this past weekend. It is my proudest accomplishment, the first time in my life I took a dream and made it reality – not on my own of course, but with the help of so many incredible women who share my passion for women and birth.

This weekend, seeing all the hard work and dedication come together like that….I can’t even express what it meant to me. It’s easy to get discouraged when you take on such a huge thing, when there always seems to be so much work to do and so few people to do it. But right now I’m on fire with inspiration and ideas and I’m ready to go. Right now, I feel like we can pretty much do anything.

I’m going to post the speech I read as an introduction to the film. We have a video of it, so as soon as I can figure out YouTube I will post that too. I was pretty nervous, as my life does not afford me too many opportunities to practice my public speaking skills – but I think I did okay in the end.

If you have a chance to see this film, please, please, please do.

__________________________________________

My name is Jeanette LeBlanc, and I am the Director and Co-Founder of the Arizona Birth Network. I want to start by thanking my utterly fabulous Board of Directors for their energy and hard work over the last few weeks as we pulled this together. In particular, a huge thanks to Danielle Muns, who spearheaded the efforts, and who kept us all on track with her enthusiasm and belief in this project.

The Business of Being Born doesn’t pull any punches, it doesn’t sugar coat the realities of mainstream maternity care as it currently exists in the US. Some parts of this movie might not be easy for everyone to hear or watch - they directly challenge the status quo and may even cause some feelings of defensiveness. For the birth professionals in the audience - those of us who have dedicated ourselves to serving women and families in birth - the film echoes the truths we have experienced time and time again, and these truths need to be told.

This documentary also shows us glimpses of ‘alternative birth’, which appear even more dramatic juxtaposed as they are with scenes of ‘mainstream’ birth. It shows us birth as it is, and as it can be. We know that birth is often painful, difficult, a lesson in strength and endurance, a life-altering event. In this film we also see birth as we know it can be – beautiful, empowering, euphoric, ecstatic, triumphant and awe-inspiring. We see women who are transformed through their births, and hear the impact that this has on their lives.

For some of you here, the information in this movie may be coming to you for the first time. I urge you to keep your minds and hearts open to its message. For those of us who live in the world of birth, this information is not new. For us, the importance of this film lies not only in it’s powerful content, but in the audience it is reaching, and will continue to reach. This video will be released in theaters in the New Year, and will be available to the public on Netflix early in 2008. There has never been a birth film that has gotten this much attention, or that has been this available to the general public. I hope that after you leave here you will spread the word about this powerful film, so that more and more women seek it out.

Bottom line: the way we give birth matters. The way we are born matters. It matters to us. It matters to our babies. It matters to our society. Birth is a personal issue, it is a cultural issue, it is a healthcare issue, and it is a feminist issue. It is an issue we cannot afford to ignore.

Isn’t that the most perfect, powerful, incredible baby name in the whole entire world? My dearest Leigh-Leigh birthed baby Indi yesterday. Go say contrats - won’t you?

Today we headed down to our house to do a walk through and make a list of all the things that needed fixing (oh, so many things need fixing). Sam hunted through the computer desk and procured an old notebook and pen and we set off. When we got in the car I opened the book, looking for a clean page to begin making notes. I was flicking past some of the first pages, filled with hastily written scribbles, when a word caught my eye and I turned back to read.

What I had happened upon today, almost two years after her birth, were the notes I made the day that Julianna was born. Time stopped for a moment as I quickly read through the words I had written that day, intended at the time to become the basis for a birth story not yet written. In an instant I was taken back to the day of her birth, remembering little things long since forgotten. What a gift those words are, especially since her chaotic birth wiped me of most detailed memories, and because the passage of time had blurred the edges of the memories I had held on to.

I didn’t intend for it to go this long. I always thought that eventually/very soon/maybe next week/month/year I’d get around to sitting down and really fleshing out the story, just like I did with Bella (a 19 page birth story is a lot to live up to). The poem I wrote for Jules IS the story of her birth, and is probably more meaningful to me than anything I have ever written - but it’s a poem, not a narrative, and there is so much left unsaid between the lines. I want so badly for Jules to have a record of her birth, but for some reason could never quite bring myself to the place I needed to be to write it. Over time it seemed less and less urgent, more and more difficult to begin - until here we are, approaching the end of her second year…no closer to a story than I was when she was born.

Finding these notes, notes I barely remember writing, was such a gift. I have a bad habit of thinking that if I can’t do things perfectly or completely then I just shouldn’t do them at all. In my mind, that means that everything I do I do well. What that means in reality is that a lot of worthwhile, necessary, wonderful things get left undone. I still don’t have the time I need to sit down and write it out completely or perfectly but I thought that for now, I’d just begin. I’ll begin by transcribing the notes I found today, writing them exactly as they were written, without changing format or structure, and interjecting my own thoughts (thoughts formed with two years of distance, insight and processing) here and there. These notes are choppy, often in shorthand, and give only the barest details. Still - it’s a start, and every story has to start somewhere.

[My current reflections in italics]

…
August Two
Contractions through the night - wake up, contract, pee, sleep. A different quality than the other night, harder.

[The weekend prior to her birth I had a night of contractions just like this, but as soon as the sun came up, everything stopped. ]

421am - in the bathroom again. Felt mucus when I wiped, turned on the light to see that it was tinged with blood. I shoot my head and thought “What do you know - August Two”.

[From my very first trimester Bella was absolutely sure that she was having a baby sister, who would be born on ‘August Two’. Nothing could dissuade her from that belief. Remind me to tell you what she said after the birth]

Contractions q8-12m, breathing through them now. “Inhale Peace, Exhale Tension”. Tried to get back to sleep, but my brain is awake now. “Slow, Gentle, Peaceful Birth”

[I used affirmations like the ones above often in my last few weeks of pregnancy, I had not remembered at all that I used them during labour. For those who don’t use medical shorthand q8-10m is just ‘every 8-10 minutes)]

5am - Sam woke from my breathing, at the end I said “Aug. Two” and he leaned in to kiss me.

[I never would have remembered that, and I smile now every time I think of it. What a delicious moment as we savoured this new beginning.]

Two ctx on toilet - did not like.

[So funny since I spent hours of Bella’s labour sitting on the toilet and would not budge even when the midwives tried their darndest to get me into different positions].

Facing fears…510am Things began spacing out q15-20 just as it became light. I know I would be crushed if this was not it, but have to admit this is out of my hands.

[For anyone who read my blog during this pregnancy, control was a big issue for me. Surrendering, and giving myself up to the experience was difficult. Having that night the week before where I was so sure things were beginning and then have everything totally stop was so hard for me. The idea that this could be happening again, five days after my due date was really hard for me to accept. Releasing this experience was a huge step for me, one I really needed to take.]

6am - downstairs to see what would happen

No ctx from 6-8. Cannot believe this is happening again. Feel like crying. Sam stays home from work so I can rest.

Ctx come back again, but sporadic. I get some sleep and Sam wakes up Bella around 9.

[That kid will sleep as late as you let her. She also does not like to go to bed at night. Her natural body clock does not fall in line with the one I’d like her to have - more control issues. Sigh.]

Between 10 and 11, ctx q15m.

[When I say every 15 minutes, that was such a rough estimate. They would come every 10 minutes, then twenty, then a half hour would go by without one. They would be short, then long, then short again. Always mild though, I remember talking to Marybeth on the phone at some point during the day, her holding a seven day old Sula Pearl, and hearing her tell me that I was in labour. I didn’t believe her, didn’t believe it was real, was afraid to believe it was real. I also remember taking a phone call from a mama who had been a part of the birth circles, and who was also awaiting the birth of her baby- I remember having a contraction while talking to her and thinking it was so bizarre that she couldn’t even tell].

11am - up to call birth team, both Marinah and Mani are so positive. Marinah says rest during day since this baby likes things to heat up at night. Ctx seem to keep coming as I am up and active, feel horrible on toilet, a little more pinkish mucous. Vampire baby, scared of light.

[I so clearly remember having that vampire thought. At that point I really didn’t think this was the real thing - it was so different than my experience with Bella - which was totally textbook in terms of timing and the stages of labour. I totally expected that it would be the same, maybe quicker, but still sensible. It was so odd how things would start a night and then grind to a total halt as soon as the sun was up. It was like the flip of a switch.]

1pm - Sam fills the tub

[That birth tub ROCKS, heated, soft sides, jets. Ahhhhhh….. It seems so cool to be to think that now; the very same tub is set up in Leigh’s bedroom, just awaiting the arrival of her Voodoo baby.]

Bella says “Is this labour for you?”

[I never would have remembered this, what a cute thing to have recorded. Such a small thing, but so meaningful. Having her involved in the birth preparations, and in the birth itself was an incredible experience]

I vacuum to kill time.

[Must have been in labour. Anyone who knows me will tell you that this is certainly not something I would normally do to kill time.]

4pm - ctx continued q10-15 getting stronger, 45-60sec. in shower, which helped. Last few ctx had been difficult, not breathing well, feeling light headed. Ctx changed to frequent but very short/mild. Checked cervix in shower - ?? effaced?? 2cm? Could feel bag of water. V. empowering. This morning I was still thick, slightly more than fingertip.

[Holy %$#2 it is hard to check your own cervix while lying in your bathtub at 40weeks 5 days pregnant. I cannot even begin to tell you the contortions necessary to accomplish this. I first learned to check my cervix when we were trying to conceive Bella - and I was learning the ins and outs of natural family planning. Not pregnant it’s fairly easy - not so much in early labour. This was huge for me though, having checked in the morning and then again in the afternoon, and being able to feel a difference (however small) was the first sign I had that maybe this was really happening after all. I wrote that it was very empowering, and it was. It was empowering when I first learned about NFP and gained that understanding of my body, and it was exponentially more so to be contracting, and to feel with my own hands what my body and baby were doing. Amazing.]

Had Sam make rice sock - heat on lower abdomen felt wonderful. On bed H&K leaning over pillows listening to music.

[I had a flash of memory about this, I remember trying to moan and playing with vocalizing during contractions. I remember the music in the background. I had made up a playlist of music on our computer, and listened to it constantly during the end of my pregnancy. Wonderful, relaxing music, filled with words and melodies that spoke directly to me. Someday maybe I’ll copy the list over here to share with you all. I also listened to these wonderful tapes every night before bed - but I don’t think I played them in labour, although I had ever intention of doing so. After the playlist ran through, we didn’t put on any more music. I wish I had been focused enough to ask for it, I had practiced relaxing to that music and those affirmations so often, I wonder if it would have helped me later on. H&K = hands and knees]

Sam’s handwriting - 5:23pm - entered pool

[I remember Bella floated with me in the pool somewhere around this time. There is a picture of us both smiling gently and leaning against the side of the pool. This was before my digital days and I have no idea where it is, but it was a lovely time for us to be together as mother and daughter one last time before Julianna was born. At this point, I still didn’t fully accept that this was the real deal. There was no rhyme or reason to things, they would space out, get closer together, get tough for a short period and then get mild again. The whole time I remember being so afraid to trust that it was really happening]

6pm - out of pool q5-8min 45-60.

…..
And that is the end of the notes.

Sometime between that last note at 6pm and 9:52 when Julianna was born, things got crazy. Fast. One minute I wasn’t sure I was really in labour and thought things could take forever, the next minute I was upside down with my eyes closed trying to figure out which way was up - at least that is how it seems in my memory. Now that I’ve at least got this started, I’m going to try to piece together the timeline of those last four hours and the time immediately following her birth.

Before she starts Kindergarten, I promise

Just a quick post tonight - just got home from Birth Circle and don’t have the energy to actually write anything - but wanted to direct you all to The Birth Ecology Project - not just because Julianna’s Birth Poem is posted in the Journal Section - but because it is a pretty impressive collection of information and resources for all you birthy types out there.

Now - off to bed I go.

Real post tomorrow, promise.

Bella and her friend Brenna holding a sign at the Midwives Rally held on the lawn of the state capitol on Friday - International Midwives Day. Nobody asked them to, nobody told them what to do - these two little homeborn girls found a sign, picked it up and held it up on the sidewalk for all to see.

Those two little girls ARE the change we hope to see in the world of birth. Imagine the power of two little girls who will grow up believing in birth, and in the power and wisdom of the female body. Two little girls who will never doubt that their bodies were perfect, just the way they are, because they witnessed from birth onwards just what women can do. Two awesome little girls who know that their bodies can grow and nourish a baby in pregnancy and beyond. Two little girls who will grow up knowing the powerful feeling of women in community, of women coming together to create change.

Just imagine that.

More photos from the rally:

Midwife Marinah with Leigh’s daughter Kaia

Homebirth Junkie Leigh - who helped organize the rally, and who put together a simply amazing slideshow of midwife attended birth photos.

My beloved Mani and the incredible Robin - now teacher and apprentice (I feel like a matchmaker)

Leigh, the girls and another supporter hold up signs for vehicles passing the capitol building.

Bella’s friend Adri, her baby sister Sara was born at home on 4/25- and I got to be there!

From Pub Med:Five years to the term breech trial: the rise and fall of a randomized controlled trial.

CONCLUSION: The original term breech trial recommendations should be withdrawn.

How many of you have heard about this? Probably very few. This is probably one of the most significant findings in the world of birth in recent years, and I don’t think it made even a mild ripple outside of the birth community.

That pisses me off.

Research studies that support the current birth paradigm - regardless of how flawed the methodology or how harsh the criticism drawn (see the Pang homebirth study or the 2002 JAMA study on VBAC) are splashed across the mainstream press with enough sensationalistic headlines, partial information, incorrect conclusions, and utterly mind-boggling gaps in information to make me want to puke. The media machine that is ACOG has powerful influence over national media. (That ain’t conspiracy theory folks - them’s just the facts).

On the other hand - studies and new information that fall in line with the other side of the birthin’ coin seem to be swept under the rug faster than you can say ‘Obstetrician-Gynecologist’. ACOG finally released a practice bulletin recommending against episiotomy (hooray, sometimes I really, really do like ACOG) – but when the JAMA episiotomy study was released last year, I watched in vain for widespread media coverage – it didn’t come. Likewise for the BMJ “Outcomes of planned home births with certified professional midwives”. Although the poorly designed Pang study mentioned above gave the mainstream press plenty of dead baby sound bites – this comprehensive and well-designed research (the best data the North American homebirth community has probably had since the 1977 Mehl study) captured comparatively little attention. I suppose healthy babies born at home just don’t make the news.

Good data sometimes isn’t quite as interesting as bad data. That is just too bad, because in an area like childbirth – where the term ’evidence-based obstetrical care’ is often as much of an oxymoron as ‘definite-maybe’ – we need all the good data we can get.

This new information, whether it be about breech birth, episiotomy or homebirth, is so vitally important that it lifts my heart to read it. To know that there are people out there sifting through the data and performing rigorous analysis to get real answers into the hands of the women that need them. Scientific data that supports the truths the birth community has been working with for years is a gift to all who devote themselves to supporting women in birth.

We need to shout this information from our rooftops, email it to our friends, bring it up in conversation at the playground. We need to spread the word because true change can only come from us – the women who give birth, from women who are medical consumers, from women who carefully choose our care providers and birth places. When we learn of new information that impacts our birthing future we need to take it upon ourselves to do further research, and then we need to take this research to our care providers, and open a dialogue with them about the data. Sometimes, if people still are not listening, we need to force the issue.

We also make our voice heard by the choices we make in our healthcare, by giving our healthcare dollars to providers who pay attention to the research, providers who pay attention to us. We need to choose providers who are able to look beyond the headlines and the powers that be at ACOG and take time to do a critical analysis of current research. We need to choose providers who are willing to change their modus operandi to reflect changes in evidence. - even when that evidence does not jive with the party line. We need to choose providers who are astute enough to know the difference between good science and bad science, and who are willing to listen to the women they serve to fill in the blanks that science can never completely fill. We need to demand that the people we trust with our care at our most vulnerable moments are willing to step back from their education and what they accept as fact if new evidence supports a different conclusion. We need to stand behind the providers in our community who are willing to put themselves on the line to support us they way we deserve to be supported. When we do this, our money speaks for us. And money, my dear friends, has a very loud voice.

I’m thrilled to think that the new information about breech delivery might increase options for women in the future. I’m cautiously optimistic that some renegades out there might take this information to heart and change they way they practice and the advice they give women. I am realistic, because regardless of how much data we find supporting the safety of vaginal breech, we’ve got a generation of doctors who are not trained or experienced in the nuances of breech delivery, and (because of state laws prohibiting midwives from serving at a breech delivery) a generation of midwives that are in grave danger of loosing this skill as well. I am cynical, because despite what the data might say, a c-section is still viewed as the safe and controlled option for any birth that might not be completely straightforward (and thus, in the eyes of many, the safe and controlled option for ANY birth, period). We’ve got a plethora of information about VBAC safety, but frighteningly low access to VBACs. My prediction is that the issue of breech birth will be much the same.

Mostly, I am sad. I am sad whenever options are taken from women, whenever choice is withheld. I am sad that we live in such a litigious society that dollars almost always win over the autonomy of a woman (and her baby) to choose her birth. I am mostly sad for my sweet Leigh, she of beautiful spirit and purity of heart, whose daughter Kaia was born by cesarean after a perfect pregnancy and a perfect labour, because midwives in Arizona are not permitted to catch breech babies, and because the doctor who met her at the hospital when she transported did not give her a REAL choice.

And that pissed me off.

________

More information on the Term Breech Trial below from the Citizens For Midwifery Grassroots E-Newsletter.

Grassroots Network Message 602003

Term Breech Trial flawed

Dear Friends,
The infamous “Term Breech Trial” (Hannah et al, “Planned cesarean section versus planned vaginal birth for breech presentations at term.” Lancet 2000. 21:1375-83), published five years ago, claimed that planned cesarean was safer for breech babies than vaginal delivery. The study had a dramatic effect; quickly it became difficult to find any OB in the US who would “allow” a vaginal delivery for a breech baby

Now the Green Journal (American Journal of Obstetrics and Gynecology) has published a stinging critique that concludes the original study was deeply flawed and its conclusions completely suspect (Glezerman M, “Five years to the term breech trial: The rise and fall of a randomized controlled trial.” Amer J Ob & Gyn (2006) 194, 20-5). The article, published as a “clinical opinion” in the journal, thoroughly itemizes the methodological flaws and clinical problems with the Term Breech Trial. The conclusion: the recommendations of the original trial should be withdrawn. He found that “most cases of neonatal death and morbidity in the term breech trial cannot be attributed to the mode of delivery.”

The author is pessimistic that even withdrawal of the original study and its recommendations will make any difference, because the recommendations were so in line with what American obstetricians wanted – a planned cesarean is easier and carries less legal risk for the OB.

However, even if this critique does not change hospital policy, it is still a powerful tool for both midwives and mothers. Now we have a paper published in a peer-reviewed journal pointing out that the term breech trial in fact did not find any difference between vaginal and cesarean deliveries of breech babies. Furthermore, the article articulates some of the drawbacks inherent in randomized controlled trials (RCTs); that not all research questions can be answered with this “gold standard” research technique is important to understand.

One mother wrote to me: I am glad to have a refutation like this finally published but I am deeply saddened for all the women, including my daughter, who were forced to have c-sections based on the now-discredited article.
Sincerely,

Susan Hodges, “gatekeeper”