Episiotomy in Childbirth: A Thing of the Past?

by Jessi Vining I was nineteen the first time I saw a woman cut without her consent. As a wide-eyed baby doula I watched, my mouth hanging open, while the doctor sliced into my client’s flesh without using any anesthesia. She cried out in pain and surprise, and looked up at me in shock. This wasn’t supposed to be happening anymore, I thought.  I had just finished reading Episiotomy and the Second Stage of Labor by Sheila Kitzinger and Penny Simkin – a small book summarizing the research and evidence showing routine episiotomy to be harmful, rather than beneficial for parent or infant. That book had been published in 1984, and so I had assumed that by 2011 most (if not all) doctors would have abandoned the surgical procedure altogether. Sadly, no.The last eight years of birth work have shown me that the practice of routine episiotomy still hasn’t been eradicated like I once assumed, or even truly restricted to the “emergency-only” status many care providers like to claim. The History of Episiotomy An episiotomy is a surgical cut to the perineum with scissors or scalpel to increase the size of the birth canal and hasten the birth of the baby. The procedure is done during the second stage of labor. Though first described by a Scottish midwife in the 1740’s, episiotomy didn’t become a routine procedure in the U.S. until the 1920s. It should be noted that this was long before it was considered necessary to have research or evidence that a procedure was beneficial before adopting its widespread use. Despite the lack of evidence, episiotomy would remain a routine practice in the United States for the remainder of the century and by 1979, the overall rate of episiotomy in birth was 60%. Finally, in the 1980s and 1990s the first research papers on the effects of a procedure that had been used for decades were published and made available to practicing physicians.  There have historically been two primary reasons used to justify episiotomy: 1. To prevent severe tearing and promote better healing by creating a clean, controlled cut and 2. To reduce trauma to the fetal head or reduce the length of time the head is in the birth canal (such as in cases of fetal distress). It was immediately clear from the research that routine episiotomy did not carry the benefits many physicians believed, and in fact resulted in MORE severe tearing, increased pain and serious complications with healing postpartum. There were no clear benefits of routine episiotomy for the…

Read More

High Risk, or Racial Diss?

lab supplies for prenatal care

by Rudy Johnson How many of you have hopes and dreams? And I am not talking about flying to the moon or visiting Mars, but practical down to earth dreams. When young, our dreams are more outlandish. As an adult, practicality hits, as does the drive to live a purposeful life. Here in the United States, we’re given the chance to dream. As a citizen of this “developed” nation, we’re taught to shoot for the stars, and to grab a piece of the proverbial pie. For most, the goals would be to raise a family, and gain financial success. But this fairy tale life is just that for too many of the “citizens” of this great nation. For minorities, getting to the family part can literally result in death. Specifically when you look at the disturbing gaps between the care we seek for pregnancy/childbirth and the care we actually get. For people of color, that disparity occurs at a staggeringly higher percentage. Why Choose Birth Work? Knowing why you choose this realm or profession may start the process of how you work within the job. Birth work is innate, deeply rooted, yet has been crowded by overconfident credentials and pervasive thinking. We now overshadow the wisdom that was once passed down from person to person, the village mentality or passing of the baton. Doulas, Midwives, OBGYN’s, you should re-frame your thoughts regarding pregnancy. Mary Poppins comes to mind with her magical satchel. Anything you needed, either unspoken or verbalized, she would materialize, and she did so without judgement. We could all be holistic Mary Poppins, respecting parent’s birth plans, listening, toting essential oils, suggesting healthy foods, utilizing non-western medicine (such as crystals, implementing yoga, and incorporating meditation). You want the future family, that is both partners, to visualize a calmer future, where they are content with becoming someone’s parents. They should be echoing your positive affirmations, be totally trusting in your bond. All their fears dissipating, along with their distrust of the birth process. Being Black & Pregnant is Revolutionary Being a part of something you know, when going in, could very well result in your death is a revolutionary act. So when a person of color elects a system, or even more specific a provider, that doesn’t desire to treat them is immensely brave in and of itself. There is a sort of unspoken racism that is occurring before…

Read More

Top 4 Places To Get CEUs To Improve How You Care For LGBTQ+ Families in 2019

Are you in need of continuing education units this year? Do you also want to do better in caring for LGBTQ+ clients as a birthworker? We have some ideas for you. Midwifery Care for Every Body: Integrating Gender Inclusive Practices for the Benefit of All Clients You have to act fast for this one! This introductory level course from queer midwife Ray Rachlin will be held this Saturday (October 19th, 2019) in Philadelphia, PA. Topics include vocabulary related to care for transgender clients, approaches to informed consent, inclusive infant feeding, and more. Space is limited, but still available, at $70 for those needing CEUs. A sliding scale is available for birthworkers of color. 2 Contact Hours (ACNM) Contraception Care for Transmasculine Individuals on Testosterone Therapy This course focuses very specifically on a single topic that is exactly as the title suggests: contraception for people who were assigned female at birth and currently on testosterone therapy. Course content is available online through Wiley Health Learning, with content pulled from the Journal of Midwifery & Women’s Health (the official journal of the ACNM). Access requires a membership or subscription that may result in additional costs, but the CEU granting course itself is $20 for members and $25 for nonmembers. 2 Contact Hours (ACNM) Providing Culturally Sensitive Care for LGBTQ Families This online course from Seattle, WA based MAIA Midwifery & Fertility covers a broad range of topics relating to caring for LGBTQ+ clients, starting from planning and conception, all he way up to the postpartum period and infant feeding. This course discusses both common situations for non-heterosexual parents, and information specific to gender identity and expression, and a section fully dedicated to approaching care with cultural humility. It is notably longer than any other on this list. The course is $225. 7 Contact Hours (MEAC and ACNM) Clinical Care for Transgender and Gender Nonconforming Patients This course is not birthworker specific, but it does specifically address reproductive health. It’s overall focus is on providing better informed consent, evidence based practice, and culturally appropriate care for those who are gender nonconforming or transgender. Course is available online with a $12 fee for CEU certificates. 1.5 Contact Hours (CNE or CME)

Read More

The Faster Than Expected Home Water Birth of Lucia

by S. Bower I’m finally writing my birth story, almost twelve weeks later! I meant to since the week after Lucia was born, but more went into it than I expected! But I am so excited that I finally got my home water birth! I woke up on July 3rd feeling a bit miserable. I had another night of pain in my pelvis, backache, and needing to pee every few minutes, and mild waves that I’d been having for over two weeks! I was planning to take my son to the zoo that day, but I was so tired. My mom came over to visit and brought us breakfast, and I ate almost a whole box of kolaches myself! We took for a walk and joked about how I would probably birth that day since I was already exhausted. But the waves stopped while I was up and moving and the rest of the walk was calm except all the kolaches gave me really bad heartburn. I got really grumpy as the day went, and guessed I was just tired from not sleeping great for several days. I needed to do some paperwork that was already over due, so after mom left and I put my son down for a nap I sat down to fill it all out. I couldn’t focus on anything at all! I gave up after a few tries and laid down to take a nap instead. I woke up to waves that I couldn’t sleep through. I didn’t want to say to the hubby or mom that this was it because I though it was still early and I knew they would both want to come back to the house right then. I started getting the pool ready and moving some birth supplied around. My midwife had suggested we keep the birth kit together with some towels, extra sheets, and other stuff on her supply list, but it had all gotten scattered and now I couldn’t remember where I put everything. I was still so tired, but I couldn’t sleep and laying down was miserable. Finally, I stopped messing with the birth stuff, and sat on my knees by my bed so I could rest against it and lay my head down. I put my a Hypnobirthing affirmation track on and tried to breath through rushes that were really intense. I tried to lay on…

Read More

Not All Families Are Built The Same: A Look At Surrogacy

by Chelsea Lanai Kimball Surrogacy In Pop Culture: Over the past few years, surrogacy has started to be made more public. In pop culture, and on the news, we have started to hear more about surrogacy in a positive, and negative light. The first thing that comes to mind is movies and television. “Baby Mama” the 2008 rom/com starring Tina Fey and Amy Poehler. Hilarious, but problematic to the reality of surrogacy. When the Bough Breaks (2016), A Surrogate’s Nightmare (2017), and A Deadly Adoption (2015) are the first movies that pop up if you google “Surrogacy Movies”. All problematic and unrealistic. On the other hand, a lot of celebrities have gone public with tales of how their families came to be via surrogacy. Tyra Banks, Elizabeth Banks, Ellen Pompeo, Nicole Kidman, Elton John, Ricky Martin, and others have all been quoted, gushing about their experiences using a gestational carrier (a surrogate who is not biologically tied to the baby). Far from the images we see on television. How Surrogacy Actually Works: With so little explanation of how surrogacy actually works in the limelight, it’s no wonder the general population doesn’t fully understand how surrogacy works. First, surrogacy is not legal in all states and countries. A misunderstanding of how the process works is a large problem in seeing surrogacy being legalized everywhere. The celebrities above all used a GC (Gestational Carrier) for a multitude of reasons. Single parents, infertility (in many forms), or LGBT+ parents. Surrogacy can help anyone in any situation actualize their dreams of a family. Not everyone is qualified to be a GC. Recently in New York, where surrogacy remains to be illegal, prominent feminists including Gloria Steinem, have condemned the legalization of commercial surrogacy. Some have said it draws a parallel to “The Handmaid’s Tale” and only exploits women. What Ms. Steinem fails to understand is that there are rules, and no one is selling babies or bodies, and surrogacy is about bodily autonomy in every form. In order to qualify to be a GC, you must meet the following requirements (these vary by state): Aged between 21-39 years old BMI between 18-32 Non-smoker in a non-smoking household Must pass a drug test No history of criminal activity Surrogate and partner (if partnered) must both pass a psychological evaluation Must agree to a home check Have given birth to and be raising at least one…

Read More

What Is A Pelvic Floor Physical Therapist?

by Tulsi Desai (Physical Therapist) A lot of birth workers have heard about pelvic floor. They know it’s important. Some are very well aware about what it exactly means either because they have been in the birthing profession for a long time, or have friends who are pelvic PT, or some have personally gone through pelvic floor rehabilitation after their babies. But there are so many others who think they kind of know what pelvic floor is? But not really. And they are not sure who to ask for more accurate answer. My name is Tulsi Desai. I am a pelvic floor physical therapist. You would ask why is pelvic floor physical therapy any different from regular physical therapy? Hope I can answer this as accurately as possible. Every physical therapist has to go through basic physical therapy degree either Bachelors, Masters (common degrees for more experienced therapists who graduated long time ago) and/or Doctorate in physical therapy/DPT (I won’t go into too much detail about the degree itself). Regardless of the designation, everyone has to take a board exam and get a PT license to practice in United States. Pelvic Floor or Women’s Health Physical Therapy is a super-specialization where a physical therapist has to go through advanced training in pregnancy, postpartum, menstruation, menopause and anything related to women’s health that includes reproductive system, urogenital system, gastrointestinal system, hormones and their effects on every tissue in the female body which is very different than the male. We get trained in unique needs of pregnant and high risk pregnant patients in order to provide them safe physical therapy treatment for back pain or any musculoskeletal problems they have. Human body is a complex structure and human pelvis accommodates a lot of organs mainly bladder, uterus, ovaries, fallopian tube, and colon as well as various nerves, blood vessels and lymphatic system. It also accommodates the growing baby during pregnancy. Pelvic floor is a termed used for a group of pelvic muscles that support all the above mentioned structures inside the pelvis and keep them in place. Pelvic floor plays a huge role in maintaining bladder and bowel continence. It also plays a role in sex and orgasm. Pelvic floor muscle problems or dysfunctions can lead to complications like urinary or bowel incontinence (varying from a few drop leakage to full incontinence), urinary urgency, urinary frequency, multiple chronic UTIs (urinary track infections),…

Read More

Postpartum Depression Tried To Kill Me, Community Saved Me

by A. Jones Content warning: mention of traumatic birth, attempted suicide, postpartum mood disorders, unplanned cesarean, and failure to thrive in a newborn. My baby was born in the hospital that was across the street from my apartment. My OB was the first one that came up on my insurance’s website. They were convenient, and I trusted their credentials completely. They knew what they were doing, so I didn’t have to. I didn’t take a childbirth class because my doctor reassured me they only help women who are trying to suffer through without an epidural. I didn’t hire a doula because my doctor promised me they would start an epidural as soon as I had contractions and I would sleep through labor. I came in for an induction on my due date. I never went past 2cm dilation. I had a cesarean for failure to progress. After, a nurse reassured me that I would never have to go through labor again. Any other births would be scheduled surgeries. I had never wanted an intervention free birth, but I felt heartbroken. It all felt wrong. I developed postpartum depression, but didn’t know what was going on. I felt like a failure as a mother as all of my expectations went bust. I tried to kill myself. While I was hospitalized, my husband filed for divorce. I didn’t care. I felt like he and our son were better off without me. The fact that they were apparently doing okay without me cemented the thought. I had every intention of trying again once I was released. While I was still in inpatient care, my incision was not healing well. The nurse who came to help with wound care talked to me while she worked. She told me about her own cesarean, and how traumatic it was for her. She told me about the VBAC (vaginal birth after cesarean) she eventually had and the support she got from other VBAC parents. No one had talked to me before about how traumatic an unplanned cesarean can be. Everything before had been “but you have a healthy baby”. After a few talks, I broke down crying and released everything that I’d had bottled up since my son’s birth. She taught me that you can love your baby and hate their birth at the same time. She also put a flier for a VBAC support group in…

Read More

Podcasts for Birthworkers

Looking for some new listening material? Check out a few of these birth, birthwork, and midwifery themed podcasts. The Full-Spectrum Doula Circle Podcast This podcast is an extension of the Full-Spectrum Doula Circle. The podcast started out in the fall of 2018 as a means of improving access to interviews that had previously been done for webinars by the same creator. Since starting, new content has been added also. past interviews include activists, authors, care providers, and more, including Melinda Morales, Indra Lusero, Mishka Terplan, and Renee Bracey Sherman talking about subjects like nonjudgmental support for pregnant teens, abortion doulas, and drug use in pregnancy. Find it on Apple Podcasts and Spreaker. Birth Kweens A doula and midwife teamed up to create this San Diego, CA based birth podcast. While their primary audience seems to be birthing people more than birthworkers, topics like the history of how menstruation has been managed, weight stigma in pregnancy, and nuances of practicing informed consent will likely appeal to both. Episodes include interviews with birth attendants, other birthworkers, and gestational parents sharing their knowledge and experiences. Find this podcast on Stitcher and Apple Podcasts. Masculine Birth Ritual Created by a self identified transmasculine birth parent, this podcast offers exceptional insight into the experiences of queer families, nonbinary folx having babies, and masculine leaning gestational parents. Episodes include topics like trying to conceive as a trans man, buffering the impacts of discrimination, and meeting people where they are. This is one of the few birth podcasts that uses language that acknowledges the broad range of people that become pregnant. This one also has written transcripts available if podcasts aren’t your thing! Dr. Stu’s Podcast Co-hosted by Dr. Stuart Fischbein, MD OB/GYN and Blyss Young, LM CPM, this podcast where the two interview various birthworkers about topics including coercion versus consent, community based birth, breech birth, and more. Find this one on iHeartRadio and Apple Podcasts. Birth Stories in Color Birth Stories in Color is, much like its name suggests, a collection of birth stories from people of color. The concept is based on a combination of the power of storytelling and the need for a space where birth stories that aren’t being heard elsewhere to be shared. Co-hosts Laurel Gourrier and Danielle Jackson are both doulas and reproductive justice advocates who share stories ranging from cesareans to unassisted births, and triumphant, empowering experiences to heartbreaking…

Read More

Intact Cord Resuscitation: An Infographic Review

A new study out of Nepal has found what many a midwife already knows: babies can be resuscitated with their cords intact, and often fare better when they remain connected to their placentas during resuscitation. You can find the full study here. Of note in this study, while both groups had comparable rates of NICU admissions, the mortality rate was 0% in the group where cords were left intact and newborns were resuscitated at bedside, versus a 3.1% mortality rate among newborns where the cord was cut immediately and baby moved to a resuscitation station.

Read More

Finding Connection Through Resistance

by Aliena “Ali” Davis, DC She was born in 1941 and died in 2013. Into those 71 years, she packed more life experiences than most could fit into three lifetimes. In all honesty, she is still influencing the world in a way that makes her unforgettable, mischievous grin surface readily in my mind. In fact, it’s her influence in large part that brought about the reason for this article. She proudly bore the title of my “Gramma” – although we had no blood relation, she was more a part of my family and my life than most who did share a blood relation, and continues to be even in her absence more present than some who are still physically present. As a child, I would marvel at her fascinating, and at times erratic, speech. Later I would learn that she had lived with mental illness in a time that was even less kind to people with mental illnesses than our own time currently is. In my battles with my own mind, I reflect on her experiences with awe and gratitude, drawing inspiration to tackle the next project, protest, and sometimes just the next day, as the reality often is for those of us who share this strange life companion. My teen and early adult years were filled with late night calls with my nocturnal Gramma, listening to her stories of resistance during the Civil Rights movement in the 1960s and her impassioned hopes and visions for racial equity. When I began to struggle academically, she was there, with the smile, encouragement, and advice that eventually leads us to the topic of this article. One day, in a moment of frustration, I expressed to her how difficult it was to quiet my anxiety and ask questions during class when I needed to. With a knowing look in her eyes, she said “Oh, honey. Look, if you have a question in class, just ask. Chances are that if you have that question, someone else has the same question and is just hoping someone else will ask!” While this conversation took place with the high school version of me, it is the exact perspective that led to the creation of an inclusive birth workers group in one of the largest conservative counties in Texas. In late 2016, I was a new business owner and I had brought my passion for racial equity, LGBTQIA+ equality, reproductive justice,…

Read More

thebirthmag