Category Archives: Childbirth

Wall Street Journal on Midwives

Hey Gals — We made the Wall Street Journal! Mainstream American press acknowledges what Europe’s health care system practiced all along! Midwives are best for supporting and encouraging the normal.

See today’s Wall Street Journal article “Healthier Births and Babies – With Midwives”.

Of course, we could also discuss why the Wall Street Journal publishes this information when a man writes a book about it, without having publicized the same information as previous published by women. However, this essay is not about gender discrimination.

According to Nathanael Johnson, author of soon-to-be-published by Rodale Books, All Natural: A Skeptic’s Quest to Discover If the Natural Approach to Diet, Childbirth, Healing, and the Environment Really Keeps Us Healthier and Happier, “Something has gone wrong with the way that we handle birth in this country, deliveries are now getting more dangerous rather than less so… Globally, we are tied with Belarus in maternal mortality.”

Johnson’s article also states, “The great strength of American-style obstetrics is in reacting to catastrophe. But we’re terrible at preventing catastrophes before they happen. While our traditional obstetric mode is reactive, the style of midwifery demonstrated by the Frontier Nursing Service is proactive. A low-tech, high-touch approach has been shown to effectively lower rates of C-sections and early births in several modern cases. Moreover, this personal, coaching approach is the most effective way to address chronic problems like obesity and diabetes.”

Let us laud mainstream acknowledgement of balanced evaluation, otherwise known as “evidence based practice”, to support normal healthy human reproduction, encourage health promotion, avoid unnecessary intervention, and accept appropriate life-saving interventions.

While the midwife au-natural birth community celebrates mainstream acknowledgement, I must add that safe midwifery practice requires a respectful professional relationship with obstetricians for inevitable transfers of care, such as are designed within safe European midwifery models.

Thank you, Nathanael Johnson, for addressing this topic and bringing it (again) to public discussion.

For those in the Bay Area – Nathanael Johnson will speak at Book Passage Bookstore’s Ferry Building location, San Francisco on January 31st. You can make a reservation which includes an autographed copy of his book by clicking here ($35 in advance or $40 at the door).

“I Cain’t Go Home”

(The following essay was written several years ago, inspired by a patient affected by another senseless murder. Identifying information was changed. )

“They killed my brother this evening! You cain’t send me home!” Ashana insists. Her right forearm flicks up and down rapidly at her side. “I’m not safe! I might hurt myself!”

19 year old Ashana refuses to leave the triage hospital bed. A few hours ago, an ambulance brought her to our unit. She is due to give birth to her second baby in a month or so. We determined that she and her unborn child are healthy. She’s not in labor and is medically cleared to go home.

“Why would you hurt yourself?” I ask, resting one palm upon her denim covered shoulder.

“I might do something. I don’t trust myself now.” Her fingers click as her right arm absent-mindedly flails, alternately thumping the mattress below and swatting her own ripe abdomen. She turns her head side to side. “No, no, I have to stay here!” She stops moving for a moment. “I don’t know what I’ll do if you send me away. I’m upset. The cops, they don’t do nothing. It ain’t right! He just be walking down the street, someone shot him from a car and drove away. Ain’t nobody seen nothing and my brother be dead. I need to stay here. I’m afraid I might hurt myself or do something to hurt my baby!”

Ashana agrees to wait a few minutes for me, while I negotiate on her behalf.

I find Sean, with furrowed eyebrows, walking down the hall.

“Are you available for a non-urgent consultation?” I ask, approaching my obstetrician partner for the night.

After Sean nods for me to talk, I begin. “I have someone in crisis because her brother was just murdered. She’s medically stable at 36 weeks gestation. I want to admit her overnight for a Psych evaluation in the morning.”

“We can’t keep her.” Sean responds as I expected. “There is no medical indication. We are too crowded already. And no insurance nor medicaid will pay for a psych admission on an OB unit. We have too many non-billable expenses. She’s a Psych case, not an OB case.”

“Sean, you know the Psych unit won’t accept patients this late in pregnancy. She needs to stay overnight and get a hold of herself. Her brother was just murdered, for God’s sake.”

Sean shakes his head, “We practice obstetrics. She doesn’t need us today.”

“Sean” I flirtaciously lock his eyes with mine,“We dedicated our careers to keeping mothers and babies healthy. Ashana is asking for our help. She had nowhere to go. She is here alone. Believe me if I could avoid this, I would. Unfortunately, this hospital’s protocols require me to consult with you for a non-labor situation.”

“I won’t authorize it.” He responds, “We are not a psych unit!”

“That’s news to me!” I smile and tilt my head to the right. We both roll our eyes and chuckle remembering various family dynamics we daily encounter. “Seriously Sean, I refuse to discharge her home. So, it’s your choice. I can transfer her to you right now. Then you can discharge her. Let’s see how you feel when she’s found injured or dead after you sent her home.”

Sean leans his head back, looking toward the ceiling. He doesn’t have time for this. “If we admit her, the chart will be reviewed for a non-billable diagnosis.”

“Fine.” I quip. “I’ll talk with the hospital’s interrogation board the same way I’m talking to you.”

“What do you suggest?” He sighs.

My cheeks broaden to a smile, knowing I’ve won my friend over, “I’ll keep her overnight for fetal observation, per your consultation. She’ll eat dinner, then I’ll order either Ativan for anxiety, or Morphine to knock her out for a night’s sleep. In the morning, Psych can make a plan for her. She’ll be here less than 24 hours so the cost will be minimal.” After a brief pause, I add, “Sean, your heart knows this is the right thing to do.”

Sean’s shoulders relax. He nods assent.

I give him a quick thank-you hug, then turn to walk back to triage.

Sean calls out, “Don’t make a habit of this!”

First and last breath – May holiday murders bring renewal

This week the western world prepares to celebrate the birth of a child born into poverty from an underage teenage mother who was traveling with an older man. After he grew to adulthood, this baby was crucified because he dared preach of a peaceful world.

The recent plight of America’s holiday murders finally opens public discussion about firearm access. America must face ugly realities already familiar to inner cities because an armed madman opened fire on innocent children and teachers at Sandy Hook Elementary School. America is shocked that this happened in the mostly caucasian middle class town of Newtown Connecticut. Only the week before there was a shooting at a shopping mall in a Portland suburb, and today another in small town Pennsylvania.

Sadly, American inner cities are accustomed to the slow slaughter of their youth. This video, less than 8 minutes long, addresses the increasing homicides in Oakland California and grass roots efforts toward solutions. Increasingly, children are collateral damage to the casual violence.

These inner city deaths occur with such frequency, either singularly or with only a few victims at a time to poor people with brown skin, that the press does not celebrate them. Murderers usually escape without investigation. Their annual death toll come to many times that of last week’s innocent deaths in Newtown Connecticut.

As of late November 2012, Oakland’s homicide count alone was already at 115 (link here).

The problem is greater than “gun control”. It’s a multifactorial issue of poverty, lack of opportunity, lack of direction, lack of educational resources, deeply embedded anger in a growing segment of our population, and more.

A nurse co-worker of mine recently posted this photo on facebook:

Oakland photo by Jennifer Carraher, November 2009, printed with permission

Oakland photo by Jennifer Carraher, November 2009, printed with permission

My work gives me the privilege of welcoming new babies in the economically and racially diverse Bay Area. Every week families discuss memories of a recently murdered loved one who will never meet the new baby to be born into my hands. The absent family member who was murdered within the last year is usually a husband, brother, father, cousin, nephew, uncle or son.

Bystanders are also shot but not necessarily killed. One laboring woman incessantly scratched at a tangled scar which had grown over shrapnel embedded in her arm. Several years before she did her best to dig shrapnel out of her arm herself, after she tired of the 10 hour wait to be seen in Highland Hospital’s emergency room. She had been splayed in crossfire because in her words “I was walking down the wrong street at the wrong time.”

Too many of my patients say, “It’s not safe to walk in my neighborhood” when I suggest they take a daily walk as part of an exercise regimen to help their diabetes or blood pressure.

Our nation is complicit in senseless shootings through collective acceptance of easy access to firearms and inadequate educational and work opportunities for the poor. Social inequities, lack of opportunity, mental illness, and poverty have historically been a recipe for small and large revolts. Small constant revolts have been occurring in America’s inner cities for years. The media pays attention now that this violence spills over to white communities.

During this season of rebirth, may we remember the only guarantee when a baby takes his or her first breath — there will be a last breath. Society can minimize the chances of a premature last breath caused by preventable violence.

Hopefully the mourning community of Newtown Connecticut inspires national discussion and some active solutions. For all our sakes.

Maybe therein lies today’s celebrated end of the Mayan calendar – the end of the world as we know it.

Selling Sizzle, not the Steak

This “Africa for Norway” video exemplifies feel-good sizzle to successfully fundraise without substance. Many charities use feel-good promotions and exploitative stories without real plans, directions or accountability.

Read more about this creative team highlighting racism and charity abuse here.

The fairy tales “The Wolf in Sheep’s Clothing”, “The Pied Piper” and ancient Greece’s myth of Persephone’s seduction by Hades also warn about this eternal issue.

Cults, bogus charities and many many others, masterfully apply unethical marketing methods. Here is today’s TM-specific sister post on TM-Free Blog.

For safety, financial responsibility and mental health, Please learn about the steak behind any campaign’s sizzle. Don’t just donate or buy something based upon feel-good advertising. Always question celebrity-studded good intentions.

Evaluate the merit of any campaign, whether self-help, a health craze, charity, politics, sleek new car, or a fabulous online dating profile. Sizzle is often short on ethics. Ethical programs provide detailed plans, measurable results, credentials and financial statements. Do your homework and don’t be duped!

Wishing everyone a Happy Thanksgiving. Thankful for independent thought, lifelong learning, the loss of naiveté and so much more.

Robin Lim Accepts Birthkeeper Award

Robin Lim, CPM and 2011 CNN Hero of the Year, accepts the first Jeannine Parvati Memorial Birthkeeper award from the Association for Prenatal and Perinatal Psychology and Health, in San Francisco on November 16, 2012.

Robin Lim is an outspoken advocate for accessible and gentle maternity care. With unstoppable dedication, she authored over 20 books and speaks around the world, trains midwives and physicians to provide respectful competent maternity care. Robin founded Bumi Sehat, a nonprofit organization which provides perinatal care, birth services, a host of ancillary services such as literacy education and geriatric yoga groups in Nyuh Kuning Village outside of Ubud Bali, Indonesia. Bumi Sehat was among the first responders to provide health care services in Aceh, Indonesia after the 2004 tsunami devastation. She works exhaustingly to run her organization and promote accessible and gentle maternity care.

Conference attendees clamored for photo opportunities with CNN’s midwife hero. Yet, there was a notable absence of journalists for Robin’s scheduled press conference. Robin used the time to speak extemporaneously with a group of admirers. She discussed her work in Bali and the e-votes which created a consumer landslide for her 2011 CNN Hero of the Year award. As always, Robin encouraged health advocates to continue working for accessible health care, health maintenance and preventative programs. She told birth stories and discussed challenges of working cooperatively with Indonesia’s health care system.

As birth guru to those who promote healthy and respectful childbirth, especially home birth. Robin Lim and Ina May Gaskin are living embodiments of the women’s self-care revolution that began in the 1960s and 1970s.

Robin spoke of the importance of love, sparking a personal cord in the hearts of her listeners. She said birth advocates should love adversarial physicians and legislators, rather than speak against them, to build bridges for midwifery practice. Some of Robin’s admirers openly criticized and validated one another’s remarks such as, “Hospitals take the baby away,” “Hospitals don’t treat women as people,” “There is no privacy,” rather than seeking common ground from which to build rapport between health care providers.

Stemming my own frustration at a destructive us vs. them mentality, but honoring Robin’s authority, I contributed only, “There are respectful providers within the hospital system also.”

Robin’s admirers’ awe reminded me of ancient Birth Cults. While good can be wrought from inspirational movements, one should never relinquish critical thinking.

Robin and I have a deep and abiding friendship, commitment to each other’s families, and are passionate about our work. Like many close friends, we don’t always agree.

Our long complex history began in 1974 at Goleta’s Dos Pueblos High School near Santa Barbara. Robin was the young campus political activist while I was the teenage ideal respresentataive for Maharishi Mahesh Yogi. We were in awe and intimidated by one another. Robin’s mother would not allow her to visit my home because she feared the cult of Transcendental Meditation. I lived with my mother at Maharishi International University’s makeshift campus in a rented stucco apartment building in nearby Isla Vista.

In time, Robin and I both spent time on the fringes of Maharishi’s Transcendental Meditation (TM) Movement where our lives crossed every few years. We were teenage destitute mothers who divorced abusive meditators. We both coincidently became midwives who practiced midwifery in Fairfield Iowa’s TM community (at different times). Thanks to Robin’s support, she allowed me to conduct medical anthropology research in 1997 (over 20 years after we met), documenting indigenous birthing practices in Bali for my graduate thesis through the University of California, San Francisco.

One of Robin’s favorite topics is Lotus Birth. “Lotus birth” means never cutting a newborn’s umbilical cord at birth. Robin speaks of lifelong attachment trauma from severing the cord. Robin advocates keeping the placenta attached to a newborn baby until the cord and attached placenta fall off, possibly a week after birth. At the minimum, Robin suggests to delay cutting the cord for several hours after birth. Robin referred to, in her view, needlessly “violent” images of scissors cutting an umbilical cord in otherwise lovely photos of gentle births.

Robin promises a peaceful future from the practice of Lotus Birth. This makes no sense! The placenta is an organ to support life inside the womb only. Every mammal cuts or eats the umbilical cord and placenta at birth. It is a far stretch to imagine lifelong trauma from cutting an umbilical cord.

Lotus birth is not scientifically valid, nor is a delay of several hours after birth before cutting an umbilical cord. For all of Robin’s fabulous work, it’s a shame that she avidly promotes this. The extreme practice of leaving a dead placenta attached to a baby can be hazardous. There is a very real risk of causing coagulopathy (dangerous clots or bleeding) by keeping a newborn attached to a dead useless placenta for a prolonged period. “Lotus birth” is a modern new-age ritual that lacks scientific basis. Promoting such radical practices can undermine the credibility of any well-intentioned health care provider, and can prove risky for babes.

Research and logic value delaying cutting the umbilical cord until it ceases pulsing oxygen and blood into a newborn (the number of minutes varies with each birth). Placental function keeps a newborn brain oxygenated while the lungs adjust to extrauterine life. Placental blood is baby’s blood; it maximizes newborn iron stores. But dead meat, e.g. a nonfunctional placenta for a mythical “Lotus Birth”, creates a needless risk.

Last evening, Robin invited me to join her for dinner with other home-birth goddesses : Nan Koehler, Robbie-Davis Floyd, and the adult children of late luminaries Jeannine Parvati Baker and Mary Kroeger.

Robin laughed with the group over dinner, “Of course I vote from Iowa, it’s a swing state. Every vote counts.”

Robin still lists the Transcendental Meditation community of Fairfield, Iowa as her American address, voting from Indonesia via absentee ballot. Earlier this week, Fairfield Iowa’s mayor declared November 13 as “Robin Lim Day”.

Robin then reached across the table, holding my hand. She smiled “Gina, can you imagine? I spoke about orgasmic birth, women’s health, sperm and contraception to Maharishi School and in Fairfield High School’s packed gymnasium. I thought of you all those years ago, as the first ‘Ru to attend high school there when you were the only TM teenager.”

“Something good is happening” I responded, quoting Maharishi. We laughed, raising our beer and hot sake to toast for divine retribution over grilled Ahi. Others at the table would never imagine our family’s shared victories over twisted cult histories.

Only last week, Robin spoke at several events in our former home-town, the home to Transcendental Meditation’s Maharishi University of Management (MUM). Robin is an inspirational, funny and charismatic speaker. Her heart warms to share her passion with a community that was integral to her family. Decades ago, the TM community valued celibacy and families were marginalized. She is (as am I ) gratified to see Fairfield’s meditation community acknowledge the importance of women and children’s issues. After our battles for children’s issues years ago, maybe there is hope. Our beloved community is awakening. Robin plans to actively maintain connection with her Fairfield supporters.

In the early 1980s, the TM community marginalized Robin, a few others, and me for our outspoken advocacy on behalf of children. Our concerns conflicted with Maharishi’s instructions to abandon children for hours daily to attend group Program (meditation) and Maharishi based meetings, atop necessary employment. Robin’s home, others’, and mine became de-facto orphanages for many TM neglected youth. Many young adults who were raised in Fairfield during those years developed very real problems.

Ironically Maharishi University of Management’s website now highlights Robin’s recent Fairfield honor, as can be seen here. MUM capitalizes on any local notoriety.

In her public talks in Iowa, Robin decried that her Fairfield honor is in a state where the practice of (non-nurse) midwifery can be tried as a felony, for practicing medicine without a license. Whereas, Certified Nurse-Midwives, like myself, are legally recognized in Iowa. A side note, Ina May Gaskin, the original advocate for home birth through her influential hippy-era book, Spiritual Midwifery, is an Iowa native.

Robin’s husband, Wil, and I stood behind Robin’s adoring crowds during the AAPPPH conference events. We caught up on family news while Robin met with other friends and adoring fans.

“That sport coat looks great on you!” I complimented Wil on his elegant jacket of raw silk.

“I picked it up at Fairfield’s Bargain Box for four dollars.” He said. We laughed with shared memories of a favorite thrift shop, where penny conscious shoppers purchase the pre-owned cast offs of Maharishi’s wealthy followers.

“That makes sense. That’s a used Raja jacket.” Bowing with my hands in prayer position over my heart, “Raja Wil. You are beaming today.” I teased him as a lofty Raja, a title with gold crown bestowed upon those who paid one million dollars for several months of prolonged meditation with Maharishi.

Will shrugged, “No one here knows that.” Fortunately, Wil never learned Transcendental Meditation.

“Hey, You can’t beat four dollars for a tailored silk jacket. That’s even less than it originally cost for custom tailoring in India.”

Old friends are the best!

For those in the Bay Area — On Sunday evening November 18, 2012, a fundraiser to support Bumi Sehat’s work, will be held in Santa Rosa, California. For information about this event, please look here.

Donations to Robin Lim’s Bumi Sehat foundation can be made here.

Robin Lim, Midwife, CNN 2011 Hero of the Year!

It is fitting that during the Christmas Season, On December 11, 2011, Ibu (Mother) Robin Lim was honored as CNN 2011 Hero of the Year!

Robin’s honor is also a victory for marginalized childbearing women and those who serve them everywhere!

Every December, Christiandom’s most celebrated holiday honors an unwed pregnant teenager traveling with an older man who was refused a room at the Inn because they were of the wrong ethnicity. Thus, Christianity’s deemed son-of-God was born with little notice in a barn. Despite religious honor given the eternal story of childbirth under duress, there has been little public recognition of the real problem of inaccessible maternity care for the world’s marginalized women.

Robin’s public recognition as a CNN hero this recent holiday season marks a media milestone for the importance of women, babies and families.

Like many midwives the world over, Ibu Robin cares for impoverished, abused, hungry, poor marginalized childbearing woman. Robin’s articulate passionate voice unrelentingly brings these issues to public attention with gentility and respect.

Many congratulations to Robin Lim for her well-deserved acknowledgement!

Robin began serving pregnant and birthing women on the island of Bali years ago because needy women came to her. Robin did not intend to become a hero; she simply could not deny the women who came to her. At that time, Robin thought that minimal care was better than none. Beginning on a shoe string, with their own life savings, Robin, her husband Will, and a few close friends and family began a rudimentary service to provide no-cost midwifery care for the needy near Ubud, Bali, Indonesia. She began attending homebirths on Bali’s dirt floors, eventually enough donations came to construct a clinic. For nearly 15 years Robin has worked tirelessly on behalf of the families dependent upon her care, often with little support and meager funds.
CNN “Portrait of Hero, Robin Lim”

Robin’s public writing and speaking on behalf of her passion slowly nourished growth of Bumi Sehat Foundation. By 2011, CNN’s team had narrowed their hero-finalists to a field of 10 heros, each are well-qualified altruistic award finalists,
Robin Lim was awarded the final “CNN 2011 Hero of the Year” $250,000 gift (in addition to $50,000 granted to each of the finalists). Robin’s nonprofit organization, Bumi Sehat Foundation International will use the funds for a much-needed expansion of existing services – clinics, birth centers and youth programs – in both Bali and Aceh Indonesia.

Click onto this line to view Robin’s post-award interview with CNN’s Anderson Cooper.

Bumi Sehat models low-cost health promoting care through education, support services, nutritional guidance, exercise programs, risk screening and transfer for medical intervention when appropriate. Funds and supplies come through donations.

Thanks to gentle consistent childbirth education and health maintenance programs, the majority of Bumi Sehat clients give birth with minimal or no medical intervention at Bumi Sehat’s birth center.

Robin’s nomination for CNN’s awared was supported by Christy Turlington Burns with her organization “Every Mother Counts”. Christy’s own harrowing experience with a retained placenta and life threatening post-partum hemorrhage, after a lovely peaceful birth, made her aware that other women in the world might not be so lucky as she. Christy thus founded her own organization to promote global access to maternal-infant care, “Every mother Counts” :

More information about Robin Lim’s work can be gleaned from the film Guerilla Midwife produced by her daughter, Deja’ Bernhardt :

Everyone in the field of maternity care hopes that increased publicity will expand access to preventative and gentle maternal-infant health programs.

Thank YOU Ibu Robin, dear old friend, for your contributions! You inspire us all, and motivate others to consider their priorities.

Society grows healthier from the micro the macro by beginning at the beginning.

The Twelve Nights of L & D

(Sing to the tune of “The Twelve Days of Christmas”)

On the Twelfth Night of L & D, the shift gave to us :

12 Sets of Twins

11 Triage Patients

10 Drunken Guests

9 Hypertensives

8 4th Degrees

7 Code Storks

6 Vocera Failures

5 …. CAT teams now…..

4 Nicked Bladders

3 Birth Plans

2 G-D-Ms

And a healthy baby in its mother’s arms…