Introducing the Mid-Columbia Birth Network

In a former post, I mentioned that I’ve been working on starting a non-profit. Actually, I can’t take full credit – me and a few other local birthy-types have been working on this something. It’s part of why blogging has been unusually slow for me.

Back when I first started birth work – you know, WAYYYY back in June – I took a very hospital-friendly stance. I would not stand up to doctors, get in their way, respect their medical opinions. This is still true in many ways, as during a birth is, I still strongly feel, absolutely the last place I should be an activist. If I stand between her and her doctor, I’m just one more person speaking FOR her, telling her what’s best for HER, and she’s just another patient without an opinion or authority to speak for herself for her care. Although I know what a woman’s general birth preferences are when I’m at a birth, I also realize that a lot can change in the middle of it all. And I still think that my kindness and compassion to a woman is my biggest tool to help foster a positive birth memory. If I’m creating tension with doctors and nurses, I’m not doing my job.  My best tools in the room are to help the mother formulate questions they can ask the medical staff to get some answers about how urgent a situation is, what happens if they do nothing, what risks are involved, and what alternatives they have.  I can also suggest they ask about specific alternatives.  I will never talk for a mother.


I’m also learning that there is a big difference in being a pain in the ass in the delivery room and being a pain in the ass outside of it. The more I learn about birth in our country, the more I realize that many things need to change. The United States, for all our wealth and technology, has pretty poor maternity statistics when compared to the rest of the developed world. Case in point – let’s check out the statistics from the World Health Organization in 2007:

Neonatal Mortality Rate (rate of death in the first 28 days of life, per 1000 live births):
The United States ranks behind Iceland, Singapore, Japan, the Czech Republic, Finland, Monaco, Norway, San Marino, Slovenia, Sweden, Belgium, Cyprus, France, Spain, Andorra, Austria, Denmark, Germany, Greece, Israel, Italy, Luxembourg, the Netherlands, Portugal, Switzerland, Austria, Canada, Malta, New Zealand, the United Kingdom, and Belarus. We are number 31. Sure, the point spread isn’t horrible, but just tell that to the families whose child would have lived if it had been born in Iceland or Singapore.

Maternal Mortality Rate (rate of death of a woman while pregnant or within 42 days of termination of pregnancy, from any cause related to or aggrevated by the pregnancy, per 100,000 live births):
1) Ireland – 4
2) Finland – 5
3) Spain – 5
4) Austria – 5
5) Italy – 5
6) Canada – 5
7) Australia – 6
8) Denmark – 7
9) Switzerland – 7
10) New Zealand – 7
11) Qatar – 7
12) Sweden – 8
13) Portugal – 8
14) Czech Republic – 9
15) Germany – 9
16) The former state union of Serbia and Montenegro – 0
17) Japan – 10
18) Norway – 10
19) Belgium – 10
20)Greece – 10
21) Slovakia – 10
22) Croatia – 10
23) Poland – 10
24)United Kingdom – 11
25) Hungary – 11
26) Kuwait – 12
27) Israel – 13
28) The former Yugoslaw Republic of Macedonia – 13
29) United States of America – 14

The Netherlands and France are the only European countries who rank below us in this regard – Iceland doesn’t report maternal deaths, but looking at the rest of their numbers I would highly doubt they rank worse than us. Maybe Iceland doesn’t report this number because it is so low it isn’t even on their radar screen?

Yes, our numbers are still fairly high when compared to countries with poor nutrition and maternal care (Sierra Leone reports 2000 maternal deaths out of 100,000). But there is room for improvement.

We spend the most per person on maternal health care, but our outcomes are not representative of this. What are these other countries doing that we are not?

First off, American populations generally eat less whole foods and living more sedentary lifestyles, highly reliant on their cars to get even a few blocks. This could increase morbidity (general health), raising risk factors for things like preeclampsia, for example.

But sometimes, all that technology at our fingertips is actually getting in our way. We look at a machine to measure contractions instead of looking at the woman. We induce labor, just to be safe, but actually increase our odds of things going wrong, such as a prematurely born infant that we induced too soon or a stressed infant because of the strong, unnatrual contractions caused by Pitocin, Cytotec and other drugs used for induction. We use Cesarean birth far too often, sometimes because we can say that “we did everything we could” and avoid a lawsuit, but outcomes might have been better for that mom and child if her body was trusted that it knew what it was doing. We think of a Cesarean as no big deal any more as they are so common, but it is still MAJOR SURGERY. It leaves a woman with a poor start at motherhood: long recovery times impact her ability to parent, her ability to breastfeed and her chances of postpartum depression.

I’m not saying that all medicine in obstetrics is a bad thing. Far from it. Inductions, cesareans and the like have saved countless lives when things go wrong. I don’t think that OBs deserve all the hate that some midwives and doulas carelessly throw in their direction. They entered the field, most always, with a respect for women and a joy for childbirth.

It is interesting that many of the countries ranked above us heavily utilize a midwifery model of care for normal, uncomplicated pregnancies and births. Many countries give home birth as an option. And their success rates are higher than our own. How do they do it? Less interventions, not more. Every time we use a piece of medical equipment or perform a medical task, we are putting a woman at a risk (albeit small). And the more machines and cords a woman is hooked up to, the more she must remain in bed. Unable to move to cope with the pain. Unable to change positions much to facilitate a vertex (head down), occuput anterior (baby’s face towards the tailbone) position. Unable to use gravity to her advantage during the second (pushing) stage of labor. And cesareans have proven to be more risky than vaginal births, even if it is a repeat cesearean.

It’s hard to work with pregnant women when they don’t know all this information. I want to be a part of the solution, not a part of the problem. I want to help. So please welcome my latest entry in the world of activism. Welcome the Mid-Columbia Birth Network.

And if you live in my area, stop by the TRAC in Pasco at the Kidz and Baby Expo this weekend to say “hello”. If you are pregnant, you’ll get a free rice sock and a foot massage, and a whole lot of local support.


10 Responses to “Introducing the Mid-Columbia Birth Network”

  1. 1 Cheeky January 31, 2008 at 1:18 pm

    That is so awesome!!

  2. 2 2 Sides of the Story February 2, 2008 at 3:20 pm

    I understand and appreciate that Doulas’ and Midwives are wonderful in helping the birthing process. I understand and appreciate that Doulas’ and Midwives are great advocates for birthing moms. But I am also disappointed and frustrated and the negative stand Doulas’ and Midwives tend to place on the medical community.

    You mentioned a lot of statical numbers in your blog but did not give enough details pertaining to them. How many of these women received adequate prenatal care from a midwife or a doctor throughout their entire pregnancy? How many never received any prenatal care? How many only received care when they were ready to deliver? How many women were addicted to drugs and/or alcohol prior to getting pregnant? And of those women, how many continued to abuse drugs or alcohol during their pregnancy? How many women had fertility issues? How many developed conditions such as pre-eclampia or diabetes during their pregnancy? How many of these women were tested and treated with group strept B prior to delivery? How many of these women succumbed to infection because they were not screened for group strept B? Do the studies conducted factor in all these factors or simply healthy women with great prenatal care? Do the studies conducted all have the same test subjects or do some only test healthy women and other studies factor in indigent care? You see I have many questions about the numbers you provided before I can be in awe or can agree to the limited facts provided.

    I also have concerns for women who are so guilted into the so called ‘natural birth’ that they feel horrible if they even think about asking for pain medication or an epidural. I am also concerned about women with such a low pain tolerance who is unable to relax even with great coaching in relaxation technique who have a horrible birth experience because they feel they will be a bad mother if they don’t have a ‘natural birth’. Last I check, unless the baby is coming out of your head, it is a natural birth.

    And before the Doula/Midwife community further condemns the medical community, I have a few thoughts from the medical community. Do you know what it is like to have a birth go perfect and then to deliver a dead baby that was saved because trained medical professionals were there? Do you know what it is like to recognize fetal distress from medical equipment, perform an emergency c-section, deliver a baby on the brink of death saved only by the fast thinking doctor and trained medical staff? Do you know what it is like to lose a mother to an amniotic embolism knowing that everyone that could have saved her life was there to do so and it was her time to be called home to God? Do you know what it is like to have a mother deliver a baby vaginally after having a previous c-section only to have her uterus rupture and have her life saved because trained medical staff were there to promptly perform a hysterectomy and replenish her with blood and fluids? Do you know what it is like deliver a preterm infant and know that the only reason that infant is alive is because of medical science?

    I personally wish the there was a different stand between the medical and Doula/Midwife community. I wish that women were properly educated to the BENEFITS of BOTH MODERN MEDICINE and DOULA/MIDWIVE method of birthing. Yes there is NEGATIVE aspects to BOTH MEDICINE and DOULA/MIDWIFE methods of birth. But there are also POSITIVE aspects to BOTH MEDICINE and DOULA/MIDWIFE methods. Why does there have to be a battle? Why aren’t we unbiasedly educating women to both methods and letting them choose what will work best for them without these women feeling guilty no matter what they choose. THAT is how we empower women, through thorough education not one-sided education.

  3. 3 Kristina February 3, 2008 at 9:50 am

    I emailed “2 Sides of the Story” to let him/her know that I appreciate and welcome the comments they left. I wholeheartedly share the sentiments that both the medical and the midwifery model of birth should be presented to a woman fairly, with real evidence to support it – and that the woman should make the final shots for her care. This sort of open dialog is beautiful and I hope we can continue it. I want to remind anyone who might want to leave a response to 2 sides’ comment that in order to be productive and learn (and I agree – there is so much that both sides can learn from each other) we need to be civil. Look for my response in a day or two, either as a comment here, or as a new blog post.

    We all want the same thing – healthy, happy mothers and babies, and women who are educated on both sides so they can decide what the “right” answer is for them. I sincerely hope we can all come together to make that happen.

    So – readers – play nice 🙂

  4. 4 Erin February 3, 2008 at 12:48 pm

    Midwifery Model Doesn’t Necessarily Mean Anti Medical

    I don’t want to write a novel, and this subject can go on and on with both sides simply agreeing to disagree.

    -In countries like Ireland… The hospital birthing wards are staffed by midwives, if you choose to have a hospital birth you will most likely be attended by a midwife. There are OB (specialists) for high risk and emergency births at the hospital if the need arises for them.

    -In America, if one chooses to have a hospital birth with a midwife. If it is wanted by the mother or deemed NECESSARY midwifes order inductions, epidurals and cesareans. Midwifes and Doulas are not ANTI medical procedures we just believe that Interventions have their place and UNnecessary procedures cause more risk than benefit.

    -In America, if one chooses to have a home birth with a CNM or a NMD or even a GP that does home births, these care providers are aware of the MEDICAL health of their clients. Aside from recognizing high risk pregnancies and providing quality prenatal health care before birth, during birth they regularly check heart rates and blood pressure and are highly skilled at recognizing complications that are beyond their scope of practice. In my state, home providers are required to carry with them emergency equipment and drugs such as oxygen and pitocin.

  5. 5 2 Sides of the Story February 4, 2008 at 1:39 am

    I realize that many Doulas’ and Midwives may not be Anti-Medical but it has a tendency to sound like they are and that leads those in the medical community to get defensive.

    Thank you Kristina for your initial response. I would like to share the other comments I emailed you, plus a few more, with your readers.

    I have a friend that is a doula and I have learned a lot from her. It has helped me rethink about my views on birth and how I talk about it. I have also had personal experience in seeing the miracles that modern medicine can offer. But people remember the bad experiences and negative outcomes and focus only on that.

    I also see 3 types of patients. One type puts complete faith in their physician and never questions anything. The second type has no faith in their physician, questions everything and trusts no one. The third is the type a patient everyone should be. They ask questions until they understand and trust those taking care of them so that together they can make the best decisions for themselves, the patient.

    Another key is, as I said before, is adequate and thorough education. I try to educate my patients so they can understand why they are in the hospital and how I can best help them. Through education, patients are better able to be an active participate in their care. I always encourage my patient’s to ask questions until they understand. The same can be said about the birthing process. By being educated and asking questions; a women can decide if a c-section or an induction is necessary or if the doctor is making the delivery fit his schedule. They can decide how risky or safe it is to deliver at home. They can decide whether they want to try relaxation techniques or an epidural. And just like every pregnancy is different, the best birthing plan is different for each woman. But for them to choose the best plan, they need to understand all their options so they can choose what will work best for them.

  6. 6 Erin February 4, 2008 at 12:34 pm

    I completely agree with you 2sides :)!!!

  7. 7 Kristina February 4, 2008 at 10:18 pm

    2 sides, I could have written your last two paragraphs of the above comment. 🙂 Our Birth Network is all about education and letting women decide what is best for them. I find so many women in categories one and a handful in three but very few in category two. As a doula and as a birth activist (two separate titles), I’d like to help get them there.

  8. 8 Agatha February 7, 2008 at 11:54 am

    2 Sides of the Story – you make a lot of valid points, but I think you’ve missed the most important point… Kristina & Co are setting up a non-profit to help women make informed, autonomous choices. If you look at the website, they actively encourage links from like-minded doulas, midwives & OB’s.

    I feel you over-reacted. There are few women trained as doulas in the US who are as open, honest & as willing to work within a multi-disciplinary healthcare team as Kristina.

  9. 9 2 Sides of the Story February 7, 2008 at 1:59 pm

    Agatha, I hope you didn’t think I was personally attacking Kristina & CO. I simply wanted to provide a different view point. If you read throughout the blog, I have mentioned “I realize that many Doulas’ and Midwives may not be Anti-Medical but it has a tendency to sound like they are and that leads those in the medical community to get defensive.” I could have stewed at home with my thoughts and been turned off by the Doula/Midwife community but I didn’t. I took the time to think about and present a different viewpoint that opened up communication. As a result, positive communication has occurred.

    I’m sorry you feel I over-reacted. I saw it as an opportunity to discuss a subject that so many of us are passionate about. It was also wonderful to see how many points Kristina and I agree on but present or approach them differently. That’s why discussions such as these are helpful so that we are working together instead of against each other.

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