Thursday, September 29, 2011


A review of "Going Flexitarian: Are you ready to go ‘mostly meatless?’ "By Sandra Neil in Tastes for Life Sept 2011 issue

It has been a dilemma for many people, the choice to be a vegetarian or continue eating animal products. On one hand, many people enjoy animal products and seem to not be able to live without them. They are in everything they are used to eating. Choosing to even go dairy free is a huge discipline that takes a lot of effort to maintain. But many people also know that there are health concerns to eating eggs for breakfast or indulging in that rare burger. And now people are becoming increasingly aware of how factory farms treat animals and their effect on the environment, not to mention the disgusting practices at the slaughter and processing houses. So what to do?

Sandra suggests you become a flexitarian.  The idea is that you do your best to consume vegan foods during the day and eat animal products in your dinner meal only, and if you can avoid that, you do. The idea is to cut back, buy local and ethically produced products and consume them occasionally not at every meal and eventually not even daily. You can have your roasted turkey on holidays, barbque on the weekends with your family, but the difference is you are buying the meat local and being aware of how your choices effect the world around you and your health. Buying locally grown, organic meat is pricey, so that is another reason to keep it to a minimum.  

Sandra shows us a report from Vegetarian Times that  says they “believe that 70 percent of its subscribers are vegetarians who occasionally eat animal flesh.”  She shares that 3.6 years could be added to your life if you practiced eating a vegetarian cuisine and even weigh 15% less than carnivores. Even Michael Pollan thinks that flexitarians can experience the same benefits of a true vegetarian.

Sounds like a compelling suggestion that people could feel good about. These kinds of changes take time and discipline and most of all, realization. It usually isn’t until someone has experienced a health issue that they take a look at their diet and see how they can prevent it from getting worse. We need to look at our diet and not wait for things to go wrong and know we can get better before we break down! Sandra’s suggestion of taking baby steps creates the feeling that this is something that can be accomplished without feeling the change too much. Some of us already have started doing this and not realizing there is a name for it. So trade in your eggs and bacon for fruit and rice cereal over coconut milk, take a bean burrito for lunch and enjoy that pork roast later tonight knowing you made a difference in your health and the environment AND in your pocketbook!

Carla and how she won the arguement

This was a writing assignment for my arguementative writing class. The essay was about arguement history and how I may have thought one way and changed my mind after listening to a different point of view.

I used to think that holding a license to practice a skill, such as herbal medicine, acupuncture or midwifery was the right thing to do in order to ensure the safety of the public. It seemed that this form of regulation could make sure that those people providing these services were held to a certain standard, had to have a reasonable amount of qualified education and that someone was looking over their shoulder to make sure they were doing the right thing. I figured this would protect the public and the practitioner alike.

I even held a license as a massage therapist. After 600 hours at school learning the very basics of anatomy and physiology, bare minimum techniques, paying a few hundred dollars and completing a state test, I was set out to the public to practice massage in a variety of settings from chiropractic offices to five star hotels and spas. I thought I knew it all. Then I realized there was a lot I didn’t know and that the schooling had not prepared me for the real job and the variety of issues I would encounter in the people who lay on my table. In fact I was less qualified out of 6 months in school than I would have been had I learned from an apprenticeship in an office that dealt with the kinds of ailments I wanted to specialize in. And I sure had no clue how short lived my career as a Licensed Massage therapist would be or how hard I would have to work to earn a living or the types of obscenities I would have to deal with because of misconceptions about the scope of practice of a professional massage therapist.

Now I am pursuing a career in midwifery. Most people view midwifery as much more encompassing of a medical profession than massage therapy is, and certainly there is more contact with bodily fluids and some bigger risks involved, but to be honest, it is not too much different. But the common perception is that anyone helping pregnant women deliver their babies should have at the very least a nursing degree and many years of school. The requirements to legally practice midwifery are different state to state and in Oregon licensure is currently voluntary. Licensed midwives are required to pass a state exam after meeting some requirements including attending a minimum of 40 births and being capable of doing some clinical skills like blood draws, suturing, CPR and neonatal resuscitation. Dues are paid to the state and you become a member of a council. The board of directors that run the state regulatory entity are compromised of a few midwives, OBGYNs and public figures. ( note that there are no midwives on the OBGYN board of regulation) They determine the scope of practice and give midwives permission to use controlled substances (like medicines to stop hemorrhages) and carry oxygen. They also restrict the services of midwives to certain low risk clientele, as well as make the determination of who falls into that category.

I thought this was a perfectly reasonable way of regulating the safety of the public as well as making sure that midwives were practicing in a way that they couldn’t get themselves in trouble. I thought this was a great way for doctors to feel comfortable supporting midwives as a back up physician in the case that the midwives needed to refer a client to them or seek help in complicated situations. This system also allows for midwives to be paid through insurance companies, both private and state funded. What I didn’t realize was that the board of people who made the decisions on who can practice what on and what category a woman falls into (High/low risk) were not taking into account the most recent scientific data available that would allow for a broader range of practice. That is until I read a well spoken argument from the director of the school I am now attending to become a midwife. Carla Hartley is a long time educator of midwives and activist for rights of parents to choose how and where they birth and who attends their births. When I first encountered her and started reading the blogs she has posted about the subject of licensure in midwifery, I thought she was an extremist and she was out of her mind. I listened because part of me knew that what she said made sense, but I had no clue just how much until I started apprenticing with licensed midwives in the state.
During my apprenticeship, I watched one of my preceptors struggle with upholding her duty as a licensed provider and give the best possible service to her beloved moms. I watched as the boundaries the state put on her work were stretched as she consulted with physicians, researched, and served her clients who were also consulting, researching and doing everything they could to ensure the safe delivery of their baby. Under Oregon law, a licensed midwife has to refer her client to an OBGYN if the pregnancy exceeds 42 weeks. A mother who was on the cusp of being “high risk” due to her age had hit that mark in her pregnancy and labor was not coming on anytime soon. She had no other “risk” factors with the exception of one high blood pressure reading that resolved on its own and could have been caused by the stress of knowing that if she didn’t produce a baby in the next few days her plans of her dream home birth with her trusted midwife would be ruined by red tape. This mom and dad tried everything to self induce so they could legally have their chosen care provider perform the duties they hired her for, despite all the scientific research that said she was safe and could have patiently waited for her baby to arrive. I honestly believe that the pressure to perform and the inability to just relax and surrender to her body and baby prevented her from going into labor, like an animal being watched who just wants a private spot in safety to give birth to their baby. After a week of fighting and even refusing a scheduled cesarean, she finally surrendered to the pressure and submitted to a cesarean to birth a healthy, normal weight, baby girl.
Other restrictions that are deemed safe by the WHO and several colleges of OBs include extended labor and 2nd stage, VBACs (vaginal birth after cesarean section), and in some states multiples and breech presentations. For some parents, the idea of going to the hospital and risking episiotomies, major abdominal surgery, infection, and even death is too much and they prefer the comfort and familiarity of their home and family as support people. Restrictions that hospitals put on people and policies made to protect the hospital and staff can and do create many problems that they are supposed to prevent in low risk women. Home birth has risen 20% since 2004 due to these very factors. Licensing midwives in a way that prevents them from practicing their skills on a case by case basis is taking a choice away from mothers who deserve the right to choose what they and their babies are exposed to during birth. Statistics show again and again that planned home birth is as safe as a hospital birth and in some cases safer for low risk mothers. Many of the issues that have been presented as high risk or outside of normal are not as risky as these deciding boards have been making them out to be and these decisions seem to be more about filling the pockets of the doctors and hospitals than about the actual safety and concern of the mothers who want the choices.
I was absolutely blind to these circumstances until I read Carla’s take on it and then saw for myself how the one-size-fits-all laws restrict perfectly healthy, educated women from making decisions in their own best interest. My husband likes to argue that regulation of midwifery is necessary and if the problem seems to be the way in which we are regulated, than I should seek to change the implementation, not licensure, but I still think that licensure is the problem because our culture will never allow natural medicine, alternative therapies and non western medicine to be autonomous. There is too much money and power to gain in surgery and pharmaceuticals and if a cheaper, safer way of maintaining one’s health became widely accepted in our culture, they have too much to lose. I don’t see how this paradigm will be shifted until people start becoming educated about their choices and demanding to have access to them as well as holding themselves responsible for the choices they make. If people were encouraged to be responsible for their decisions, they couldn’t blame the doctor’s or midwives when something doesn’t go as planned, they would have to see how their choices effected their outcome and how they can do better next time around, if they are lucky enough to have a next time.

Wednesday, September 21, 2011

September check in

Hello ladies! I am on the home stretch of phase 2 and about a week away from requesting phase 3. I wrote a research paper on why we should lower the cesarean rate and hve ben looking for a way to publish it. This was an assignment for my technical writing class and I got an A. I consulted with my writing teacher and she has said that this is a totally publishable paper and I would like to send it out to be published, just don’t know where to send it to. She was very impressed with my research and writing skills. I have attended one more birth since my last check in. It was a friend of mine. It was a great home birth, my first water birth attended and I learned very valuable lessons. The mother self induced with herbs and castor oil a week before her due date and the baby was tiny and covered in vernix which leads me to believe she easily could have stayed pregnant another 2 weeks. She had a long latent phase and was anxious. The baby’s head was not in a centered position and so she really had to work with the small contractions and encourage her baby to move into a better position. The other student midwife had an optimal fetal position book that they were going over and so Mom tried a few different things like side lunging during contractions and sitting with her body positioned forward to better engage baby’s head. Once she was in active labor thing moved well. The biggest lesson I learned about birth at this experience is that no matter who you are or how much you know or think you know about birth, when you are in the moment and you can’t surrender, it is easy to become frightened and irrational. There was a period during transition when Mom was trying to escape labor and I knew what was happening and was in awe at the power of the body’s chemicals to disrupt someone’s conscious thoughts and beliefs. I was supporting the family members present and comforting them while it was difficult to listen to mom fight her labor. They were worried and I encouraged them to trust that this is a normal part of transition and it just means that she has some things to overcome and that she and the baby are fine and she will be pushing soon. I asked them to trust that the midwife would not put her in danger and is monitoring her well, knows her well enough to know if she needs to transfer and they are doing fine. This period lasted about 15 minutes and then mom started pushing. Baby was out in 45 minutes, caught by dad, in the water, it was fantastic. The midwife did a great job of supporting Mom only when she needed it and staying hands off the rest of the time. It was a beautiful birth. It was amazing to watch the Mom, her mom and sister, and her husband all work together and have to overcome obstacles in their own thinking to surrender to the power of birth and allow things to happen as they were intended to. I came away from that birth recharged and fully engaged in pursuing more apprenticeship opportunities that will work with my schedule as they come available. I have been invited to come to an office in Albany for prenatals and office work and will be called when I can come to a birth. I am excited about this and think that it will work out for the time being. I have also been invited to attend a birth with Lennon and went on a prenatal appointment with her to this client’s house. This one is a VBAC. Apparently 4 out of the 6 moms she knows who planned a home birth transferred to the hospital so she is doing her best to trust and try her hardest to get ready for this birth. This will be a journey for sure and I am looking forward to watching her transform through it all. I have some confusion about a situation that happened in my area about a baby dying at a home birth with an unlicensed midwife. The newspapers are vilifying her, but I see the most issue with the mom who didn’t do enough research and was not empowered or supported through her decisions. I have so many concerns and probably misconceptions because of lack of details. I am planning on attending the OMC meeting on Friday in hopes of clarification and to monitor the situation as the volunteer licensing in Oregon might be at stake if this mother gets her way. It irks me because if she thought she was hiring a licensed midwife, why didn’t she look her up? Why didn’t she ask questions at the prenatal appointment about what equipment the midwife uses and her policy about transfers? I guess I just want the comfort of knowing that this midwife did everything in her power to help this mom and I hope the papers are wrong. I feel horrible for the mom and her family for the loss of their baby. I only wish that she would have had the care from the beginning taht she deserved and that this situation can be prevented through proper education and practicioners honoring their clients wishes and empowering them with information so they can make decisions that are right for them. The resources are there, people need to be encouraged to use them. So based on all that, I am also concerned about how I should proceed with my education. Do I need to be preparing for my NARM and Licensure? Do I need to step up my studies to obtain these papers faster than I had intended working on it before? How should I plan things out, what if they take away the option of apprenticeship and I have to go to a different school? I am committed at AAMI and prefer this method of schooling, especially considering I am already going to a University for my BA in Human Development and Family Sciences, should I be looking at nursing instead now? I would prefer to be learning psychology and neuroscience, not nursing…. I think that the psychology is more pertinent to midwifery than nursing at this point. Ughhh the decisions…. Let’s see…. Well, I am also planning trip to Haiti for next December to go to the Mamababy Haiti birth center. I sent an email with questions about how I can legally organize fundraisers and plan for a group of me and a few friends to go and haven’t heard anything back. I read through the website and the handbook and FAQs and am trying to get prepared as much as possible. I think 2 weeks there could take out a year of waiting to attend births here and will help me get closer to my primary care under supervision part of training if I am indeed needing to prepare for the NARM. I also am motivated by the non technological aspects of working in Haiti with minimal resources and learning real midwifery skills without the safety net of a prestigious hospital within a few miles… real life midwifery in a setting that requires it. On the side lines, I am also working on filing a complaint with the State of Oregon Medical board about hospital policies surrounding the unnecessary removal of my daughter’s appendix a year ago. It is very much a mirror to unnecessary cesareans, circumcisions, and tonsillectomies… The whole, you should be glad it wasn’t worse/had a healthy baby/you don’t need that part of your body anyway/ there was no real loss mindset of our culture. Lawyers won’t pick up the case because there is no $$ value in it and all I can do is fight the board for policy change about informed consent and how when information changes, so does consent, and how a child is anesthetized. My daughter has a right to her body, her whole body, even if an appendix is perceived as not having any use, if you go in expecting to see an infected appendix and you go in and see a normal appendix, you don’t remove it “just because we were already there” and don’t come in laughing telling me “at least you don’t have to worry about appendicitis anymore.” Oh! And my favorite book find since I last reported was a CDROM collection of 34 antique midwifery books from the 1700-1800’s (for $5 on Ebay)! The few I have browsed were fantastic! It amazes me how much we had to “advance” in medicine to learn that they already had it figured out pretty darn good in the 1700’s, even the male doctors in Europe had respect for birth and knew when not to intervene. The writing is almost poetic in some of the books. I was really surprised!

Sunday, September 11, 2011

Birthing Choices and Perceptions of Choice

A review of:
The Ties that Bind
How Belief Creates Birth Realities
by Kim Wildner
In the article published by Midwifery Today, "The Ties that Bind," Kim Wildner is talking about how one’s belief in birth, choices, and what is actually capable of happening will no doubt affect the choices one will make, even so far as to what choices that person perceives are available. She discusses 3 women who were convinced they could not refuse interventions, could not seek out other health/birth care providers, and that they had, “no other choice” in the matter, when in fact there were, they just weren’t prepared to make those choices.

This is a common occurrence in our culture. From early on, as children, we are taught to submit to doctors, that doctors know best and that to ask questions was disrespectful. After all, they are the ones who went to college and they know what is right for you. We teach our children to sit still and be quiet and it is not a big deal, they are professionals, it doesn’t matter if it hurts, it is what is best for them and they will thank us later. While there are certainly times when a child needs to cooperate and there is no way they can possibly understand that sometimes things are going to hurt for a good reason and you still need to do it (like setting a broken bone or pulling an abscessed tooth or a life saving procedure) it is our duty to make sure they are comfortable and informed and respected through the entire ordeal, allowing them room to breathe and time to consider and prepare for what is going to happen. From my own experiences I can testify that this type of treatment is an exception, not the rule, when children have been “cared for” by medical professionals. Because of this tacit rule, people grow up thinking they just have to submit, no matter what, for anything, under the guise of a doctor’s prescription. This has inevitably created generations of disempowered people willing to “shut up and take it” out of fear and “respect” to their perceived authority.

Women, in general, are afraid to tell someone NO. They are afraid they will be in trouble, that they will hurt the feelings of this person who they believe is trying to help them, who they want to trust and believe that they mean the best. They are afraid that the authorities will see them as negligent and God forbid something happen because she said NO, she will be demonized for not listening to the advice of the Doctors. Even when presented with cold hard facts that dispute the doctors’ advice, many women are so unconfident that they don’t understand what the choices are. They are not willing to risk all the “what ifs” thrown at them throughout their lives by family, friends and other medical professionals. It is easier to go with the flow, easier to be victimized, easier to complain than to fight and stand up and change the way we are “cared for” by the medical establishment.

Furthermore, in our culture, to be a boat rocker, to be a whistle blower, to stand up for yourself is such a minority position, it is hard to relate to your friends and family, to tell your story and to be able to be proud of your accomplishment without being chastised for “causing a scene.” They ask you, “why don’t you just listen to your doctor?” And anything you say to defend your actions is ushered away as not as important as the safety of medical advice or technology. You are perceived as a rebel, with a problem for authority, or you are attention seeking… People frown upon the strength of others in these situations because it makes them have to be responsible for the decisions they made that allowed them to be victimized, they have to look at themselves and wonder, “what if I had said no to that pitocin/epidural/ vaginal exam/AROM?”

People do this after the baby is born as well, they believe nothing is wrong with their babies when they hit all the milestones that their pediatricians’ chart shows them, but they still can’t figure out why the child has problems digesting their food, sleeping, or leaving the room. They don’t understand why they won’t stop crying and still wet the bed at 5 years old. Why they aren’t gaining weight or are gaining too much, why years later they have teenagers with severe depression and anxiety disorders, who are not attached to their families and can’t hold a decent friendship with anyone around them. As these children grow into adults, they have a hard time maintaining relationships or jobs, they get into drinking and drugs, they are thrill seekers or hermits and the parents wonder why, they did everything by the book and this person they brought into the world has never been able to adjust according the ideas they thought were supposed to happen. They couldn’t possibly look back at the decision that they made that built the foundation of their child’s psyche, that shaped the way their emotional brain would develop, their digestive system, their immune systems… How many people have to suffer through mental and physical illnesses that are undiagnosable before people start looking at how this person’s brain and body were formed and introduced to life?

Even scarier to me is that women who find the courage to seek another provider or refuse to go to the hospital for birthing only conquer the one step of the fear of saying no, they still have to conquer the fear that something is going to happen that will put them or their baby in harm’s way. They now have to manage all the scary things inside their heads that they have had preached to them their whole lives about how dangerous natural birth is, how painful it is going to be, how they are bound to suffer and they have to believe in themselves. How many women who find the empowerment and encouragement from their family to home birth, still go into it believing they are going to experience the most excruciating pain imaginable and have never even thought about the idea that birth can be pleasurable? As someone who was a victim of their own mind, I can tell you, I went into my first home birth expecting pain and misery and every single sensation I felt I perceived was pain and reacted accordingly. When I went into my 2nd home birth with a clear head and more experience and knowledge of pleasurable birth, I didn’t experience an ounce of pain because I stopped expecting it at every contraction. My mind set made the biggest difference in the world. Belief, perception, stories, ideas, experience, education, knowledge, understanding…. All of these things play a part in how a woman will choose to experience her birthing process and each is as important as the latter.

We all have choices and as the article says, we have more information at the click of a button, ready for our consumption, several sides to a story to figure out and weigh in with, than in any other time in history. It is a privilege to live in the technological world we live in and we have all paid a hefty price for this knowledge, years of research, years of doing things that were not the best of options to prove that they were not, millions of hours of electricity and resources spent on this knowledge. To not use it is the biggest waste of resource our planet has ever seen, to allow the continuation of industrialized birthing in low risk mothers because a doctor or insurance company is not willing to take the risk or live off the money they make and does not want to go out of business or stop driving expensive cars is unacceptable. We need to stop dramatizing the birthing experience and start normalizing it. We need to share stories, we need to call our grandmothers and talk to them and ask questions about what they now of their grandmothers, we need to find the truth, reach out to each other support each other and take birth back from the cult of misinformation meant to scare the daylights out of you so you submit to an even scarier ordeal.