Tag Archives: pregnancy

Princess Clover’s Birth Story

Born June 4, 2016 1:28 a.m.

9 lbs 6.5 oz, 21 1/2 inches

Midwives of Hale Kealaula; Selena Green and Jaymie Lewis

Photos by Jenna Toilolo; Captivating Creation Photography https://m.facebook.com/captivatingcreation

It all began a few weeks prior with a few light surges during the early morning hours and I was sure that this little ‘boy’ (I swore up and down that I was carrying a boy throughout the entire pregnancy lol) was going to arrive earlier than his EDD.

However March 27th came and went and still no Clover baby.  Of course, being a Midwife in training I knew that ‘he’ would come in his own good time.  Daddy however was getting a bit anxious and wanted to make sure that I had a ‘Plan B’ should baby not come by 42 weeks.  I assured him that we had pre-registered with Queen’s hospital so we could go there if our OB (wonderful Dr. Bliss Kaneshiro, who I heard isn’t accepting new patients at this time) thought it was necessary.

The morning of June 3rd, I picked up my children in Kapolei, did some errands and went grocery shopping all while having some pretty consistent surges 🙂  Walking through the isles of Sack n Save in Nanakuli pausing and holding on to the cart while telling my son to hold on a second lol.  Of course my wonderful Midwife; Selena Green was aware and had told my amazing Midwife Sister; Jaymie that I was having some surges.

When we got home we put things away and settled in to have dinner, still having some surges once in a while; and then while sitting in my seat on our ‘new’ couch, my water broke.  Daddy was a little surprised as he was setting up the grill outside to BBQ some ribs and was a little taken a back by the liquid on the ground (I stood up after the first gush).

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My midwife called to double check how fast my births were after waters broke and I told her that both my previous births were 5 hours.  So she let Jaymie and my beautiful friend Jenna who would be taken these amazing photos know that it was time to come.  As predicted the surges came stronger and longer, though I was able to eat and drink fine, joke around and help give daddy some directions on what could be done before the Midwives arrived.

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After that is basically a blur but I do remember holding everyone’s hands while laboring in the pool.  Getting an ice pop, laughing, being on hands and knees and moaning but most of all as it was getting to the most intense point.  Jaymie was whispering in my ear to let the energy go down and out, so when the surges came I did just that.  It helped tremendously and I remember pushing not long after that, it seemed like not very long but it was probably about an hour of pushing her down.

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When her head emerged, I thought it would be quick that she would slide out as my previous to babies did.  However little Clover’s shoulders were stuck and Jaymie had to get her little arm out first before she was fully birthed at 1:28 a.m. on Saturday June the 4th.  As soon as she came out she wasn’t breathing for a bit so we rubbed up her back but still no breaths, so I gave her a few puffs as we are trained to (just the air that’s in your mouth, not big breaths) and I heard her first little gasp.  We gave her a little bit of O2 also and she slowly came around and began breathing on her own.

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We didn’t know the sex of our baby yet, so I quickly flipped her bottom over to see and saw that I had been wrong the entire pregnancy.  My ‘boy’ was a little girl, my daughter Cierra and daddy were quite happy with the news!  I was in complete shock lol

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Then I saw that there was quite a bit of blood in the water and I could hear Selena and Jaymie saying that I needed to get out of the pool so they could monitor my bleeding.  I got a shot of Pitocin, some Hemhalt tincture and eventually a placenta shake to control the bleeding.

As soon as I was out of the pool and on the couch-bed in the living room I felt the most horrible migraine I have ever had come on.  (Towards the last days, I finally got upset and actually cried out to, “bring it on!”  It hurt so bad, it honestly couldn’t get any worse)

After that I was in a fog and just knew that I was in pain.  Everyone tried to help remedy the pain but it just wouldn’t subside and finally I called my beautiful friend Mileka to ask if she would please come and massage my migraine away.  She was a God sent and the migraine subsided enough that I finally felt I was able to enjoy this little baby girl.  After a few days I noticed that my thirst could not be quenched no matter how much water I drank and I was hospitalized for dehydration.  We began loading me up with electrolytes and soon I felt like there was hope at the end of the tunnel.

The migraine still persisted so I called on the chiropractor I had seen prenatally and that we send all our clients at Hale Kealaula to; Dr. Christine Lipat at Niu Health Chiropractic.  She adjusted baby and I and we both were SO much happier, Clover had been a bit fussy at the breast for a while but after she was adjusted was doing wonderfully.

Of course after all of that, my breastfeeding was a bit hampered and I had to start little Clover on some formula (which still kills me a bit) and we are now doing well with both.

Fast forward to today and Princess Clover is a very expressive, talkative, loving, happy and beautiful baby’s in the world 🙂

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We have had so much support since pregnancy and we wouldn’t have been able to be sane and doing well without you all:  our co-workers (too many to list), family; the Yadao ohana especially Aunty Roxanne and Aunty Noella who were one of the first visitors we had and the Skal ohana who have been supportive and sending their love and support from day one, love you all.

We’re most grateful for our birth team who had to come almost every day post-partum for one reason or another with me (we always say birth workers/body workers are always the ones that need the most care lol and it was no different with me!)  Selena, Valerie, Jaymie…Adam and I are so eternally grateful for all your care and love.

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Photos by Captivating Creation Photography https://m.facebook.com/captivatingcreation

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“Bait and Switch” Maternity Care

Many women have had this happen.

Whether they knew something was not quite right and didn’t know who to tell, or just didn’t think it was ‘ok’ to say anything against the doctor.

I’ve had conversations with so many people saying how their doctor promised things that were music to their ears to hear, that made them think this was the ’empowering doctor’ they have been looking for.

Only to have the doctor do a 180 turn and do exactly what the parents said they didn’t want to happen, say they didn’t have a choice, or that they were putting their child’s life in jeopardy if they didn’t listen.

Please share your stories, read this article and share with all you know ❤

http://birthmonopoly.com/caroline/

An excerpt:

“I interviewed an OB/GYN at Brookwood during my first trimester. He told me the interventions I received during my first three births were unnecessary and risky. He criticized routine use of the drug pitocin (medication to speed up labor and control hemorrhage). He said there was no need to be confined to the bed, not even during monitoring. He explained how laboring in upright positions alleviates pain, increases blood flow, helps position the baby properly, and opens up the pelvis. He told me research showed no benefit in continuous monitoring for low risk women like me; in fact, intermittent monitoring was recommended. He told me that letting the normal physiological process play out would be safest for my baby and me—which aligned with all of the research I’d been doing. Finally, after much thought and prayer, I switched hospitals during my 20th week of pregnancy. I hired a doula, read a big stack of birth books, exercised, and ate a healthy diet. I carefully made a birth plan based on best medical research, approved my doctor. I was ready! Fast-forward to the night of baby Jack’s birth in 2012. After laboring freely at home for several hours through some mild contractions, I arrived at the hospital and met my nurse. And that’s when it all started: “Put on your gown and use the restroom now because you won’t be able to get out of bed for the next twenty minutes, and possibly for the rest of your labor.” “But my doctor said I could labor however I wanted.” “Well, your doctor’s not on call.” What?! The contradiction between the marketing and the reality was so shocking that for a second I thought to myself, have I walked into the wrong hospital? I knew there was no medical evidence for what she was asking me to do. I asked her where the birth tub was because my birth plan included water birth, and she informed me my room didn’t accommodate a tub. I told her over and over that my doctor promised me I could walk around during monitoring, but she continued demanding I get in the bed on my back so she could hook me up to the wired monitor instead of the wireless one I was promised.”

http://birthmonopoly.com/caroline/

“I Speak for the Baby!” An OB’s Fetish with Power and Control

One of the most trying aspects of birth work is servicing families within the framework of Western medicine ideology.  As with most things in our society, money has come before common sense, ethical treatment and even basic truths.

Women have been birthing for thousands of years, OB/Gyn’s have been around for a few hundred.  Granted we need they’re expertise as we evolve and medical technology assists with variations from “normal”, they are trained surgeons and look to solve issues.

However, when there is no real issue or concern with a pregnant woman sometimes issues are created in order for the OB/Gyn to feel relevant or to ‘put the mother in her place’ as being the ‘unknowing lay person, compared to his grand knowledgeable self’.

Once we begin to remember and have trust in what our ancestors knew before us and what are bodies still hold within us, we will be better empowered to encourage our providers to be our partners in our care, not our dictators.

From Birth Anarchy:

There is no “shared” decision making in women’s healthcare. Bodily autonomy means I decide. Shared decision assumes consensus, and we’ve seen what happens (and who loses) when there is not consensus.

Source: “I Speak for the Baby!” An OB’s Fetish with Power and Control

Last week, (yet another) article came out detailing the case of a woman who is suing her doctor for pressuring her into a cesarean against her will. There is so much to deconstruct within the narrative of that story, but I want to focus on the commentary from the Obstetrician in the case.

I have two patients. I don’t have just one patient …that is why I disagree with the statement of your, of the American, whatever, ACOG [the American Congress of Obstetricians and Gynecologists], that the desire of the mother has to supersede the desire of the fetus. I disagree with that. …I have an obligation now toward the baby. I’ve gotta speak for the baby because that is my second patient.”

The ACOG “whatever” that she is referring to is ACOG’s Ethics Committee opinion statement on “Maternal Decision-Making, Ethics, and the Law.” It reads, in part:

…practitioners should recognize that in the majority of cases, the interests of the pregnant woman and her fetus converge rather than diverge,” and that, “Pregnant women’s autonomous decisions should be respected. Concerns about the impact of maternal decisions on fetal well-being should be discussed in the context of medical evidence and understood within the context of each woman’s broad social network, cultural beliefs, and values. In the absence of extraordinary circumstances, circumstances that, in fact, the Committee on Ethics cannot currently imagine, judicial authority should not be used to implement treatment regimens aimed at protecting the fetus, for such actions violate the pregnant woman’s autonomy.

11205560_10206749414198073_401034867845902740_n (2)I was asked to speak in May of this year at an action staged outside of ACOG’s annual conference in San Francisco. What I chose to speak about was exactly this Ethics Committee position statement. Because, at face-value, this position lends to a perception that obstetricians are true allies to women. And to be fair, physicians have been overwhelmingly supportive – some on the front lines, risking their very lives – in the struggle for safe and legal and accessible abortion. But, somehow there is a disconnect in the Obstetrics community in what autonomy looks like at the beginning of a pregnancy vs. what it looks like at term.

For those of us who have given birth in the U.S. Maternity care system – for the staggering number of us who would describe our births as traumatic – we know that ACOG’s position statement is in conflict with an overwhelming number of their member’s actions. The OB in the referenced lawsuit isn’t an anomaly. She is part of a paternalistic Obstetrics network that fancy themselves as baby-saving superheroes.

The Good of the Baby

Every minute of every day, multiple women in multiple places experience coercion and abuse at the hands of their care providers all in the name of the “good of the baby.” Somehow, when a woman finds herself, feet in the air, strapped to an L&D bed, the fight for her dignity and humanity and autonomy have been tossed in the biohazard bin to the left. This socially accepted culture of violence that permeates birth is ground so deeply into our psyches that even unwavering feminists use phrases like, “I was allowed” and “he let me” in the narrative of describing their births without even a flinch.

BiohazardAn obstetrician’s obligation begins and ends with the pregnant and birthing person, and there is no need for an obstetrician to “speak for the baby.” The person carrying that baby – the one birthing that baby – is the only person who could possibly hold the most investment in that child’s health and life. Blatant disregard for a woman’s autonomy during pregnancy and birth – and overt disregard of ACOG’s position on a woman’s authority – demonstrates a fetish with power and control.

It is no coincidence that the field of medicine most rife with force and abuse is one in which women are tied to the beds with cords and wires, told to lay back, spread their legs, and do as they are told. It is this very imagery of historical and present-day dominance over women that makes all people who suffer under this system, victims of this form of gender-based oppression and violence.

Read the entire article at: https://birthanarchy.com/i-speak-for-the-baby-an-obs-fetish-with-power-and-control/

Home Birth #12…

I need to go back

and look at my records to see which number birth this was exactly but I’m pretty sure this was #12 😉

This mama is so cute and very fiesty

She had her first baby in the hospital and had such a bad experience that she was going against all her family’s statements of fear of the unknown, the fear of the misconceptions and accusations and had her second baby at her home.

Waking in the early morning hours she wondered if what she was feeling was ‘real’, a few hours later, she called her Midwives.  We arrived about an hour later, set up, did the usual vitals, set up the birth tub etc.  She was so strong and did excellent with every surge and continued around the house, cooking, making sure her mom was on a plane over and everyone else was taken care of and had breakfast. 

When transition came and the pool was ready for her.  She had read that pushing felt good to some women but for some reason she REALLY didn’t like it…until later.

Toilets are really under appreciated tools for labor and birth 😉

Mom needed time alone to herself and sat on the toilet for a few surges, then yelled for Selena to come in.  Baby was born a few minutes later.

We got her on the bed, nursing , as she ate and drank.  Older sister came in with daddy and they huddled on their bed, sister already protecting her baby brother.  As we did his newborn check, she made sure to tell us to be gentle and that he didn’t like it cause he was crying lol…such a great big sister.

As soon as he was born, her first words were, “I did it!”, “We did it baby, we did it together!”, “I can’t believe I did it”, “I feel so amazing, I could do it all over again.”

Mom thanked us and said she couldn’t have done it without us and Selena told her that she did, she did do it without us.  Mom just said, that we got her to a place where she could be by herself for a bit and then have her baby and that she was extremely grateful.

He looks just like his strong sister and mom and they gave him a great strong name too.

We left them all in their bedroom together, watching t.v., mom eating and baby resting soundly on her chest.

Nothing compares to the joy, love, reverence and overwhelming amazement of witnessing women, babies and families being created in so much love, right in front of your eyes and being able to hold the space for it to unfold.

Except for being the birthing mother

Improving Birth-Rally for Change Honolulu

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Why I’m rallying to improve birth

Hearing my grandmother’s and my mother’s birth stories, I realized first hand what was being talked about in “The Business of Being Born”.

My grandmother had given birth in a hospital where she remembers only being shaved, given drugs and waking up to my mother in her arms.  My mother is an only child.

My mother would tell my birth story to me a few times in my life and it was always with no fear and with a sense that birth was just a natural part of life.

In the BOBB, we learn about the “Twilight Sleep” era, then during the 70’s the resurgence of natural births and breastfeeding.  Unfortunately, my births were also very ‘mainstream’ after not listening to my intuition, I had both of my babies at a hospital.

While my experiences were not as horrific as others, for me, my daughters birth felt stolen.  I didn’t know who to tell, what to do, or that I had a ‘reason’ to feel the way I did.

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After seeing “The Business of Being Born”, doing research, taking workshops and submerging myself into anything that had to do with birth, I realized that women are still being used as experiments.

My reason for rallying, is that this madness needs to stop.

Our daughters deserve better, our babies deserve better, we deserve better.

Birth matters

6th Home Birth – 5th Year of Blogging

Wednesday Evening

Marked the 6th home birth I was privileged to have witness, while assisting Selena with Grace and watching this powerful mama give birth to her second child and first daughter.

This birth was interesting in that mama had her mother come for the birth to help with their son and keep him occupied as mama birthed.  There was a feeling of being crowded and mama didn’t feel comfortable and after about a week, her mother decided to leave before baby was born.  As soon as her mother was on the plane, her contractions started and we all knew baby would be born that night.  Sure enough 5 hours later, their baby girl was born into the world, as mama stood half squatting at the end of the bed as she did with their first born.

Today we visited her at home and both mom and baby are doing great and felt really good about the birth, saying it was much better than even their first home birth with their son.

To top of the day, a Sex Ed class asked Selena, Grace and I to speak again at UH.  Among the class, there were two young women who were asking the most questions.  After the class finished, one was asked to walk us back to the car to retrieve the parking pass.  She shared with Grace and I, that she and her husband were thinking about having a baby but she was so terrified of the pain of labor.  She also asked about whether her birth of being born by cesarean was actually necessary as her mother was told that she was stuck.

We got to share with her that we couldn’t say for sure but that her mother was probably not allowed to move around, which would’ve helped her to come out.

We also let her know that we thought it was great timing that she got to hear us speak and now has Selena’s information to work through her fear of pain during birth, before she gets pregnant.

Got 2 people to watch the Business of Being Born today, 5 years since the film changed my life forever

…all in all, this summer solstice brought about affirmation that the shift I have been hoping to see and be a part of with this blog is coming to pass.

Here’s to all of you on this journey to see peace on earth, one birth at a time. ❤ ❤ ❤ ❤

The Saga to Accept Nature

The Fifth Home Birth

I was blessed to be a witness of a birth that is the most thought provoking one for me so far.  First, the parents were planning another hospital birth after their first born, a son, was born there.  However mom had a feeling she wanted to do things a different way.  She got in touch with a childbirth educator, who brought her to a talk featuring Midwife; Selena Green from Hale Kealaula.

From her first words of introduction she had tears.  Tears for what she knew she wanted for her baby and for herself with this birth and the feeling of not having an option or support brought the tears.

Luckily she continued to go back to learn more about cloth diapering and took a childbirth education class, which only empowered her thoughts of birthing out of the hospital.

She connected with Selena again and she and her husband decided to birth with her and at Hale Kealaula.  They came to their first Centering Pregnancy group, which brings together all the families birthing with Selena and talking about their experiences and thoughts/questions.  At their second, it branched into a father’s group and a moms group, so both got more information and confirmation they were doing what was right for them.

The Birth

Mom and dad were a little nervous when they first arrived and anxious too.  He did well listening when we let him know he could rest and provided her with comfort measures and reassuring words when she needed them.  There came a time when mom needed to let go and surrender but her fear and desire for it to be over NOW made progress slow for a little while.  But Selena let her know that she would have to be patient and that she was safe and cared for her in that place where she felt vulnerable.  She got to the place of being in the trance and pushed her baby girl out in the caul in only 30 minutes, with dad there to catch his first daughter on Father’s day.

Provoking Thoughts

As soon as baby girl was born, her grandfather called (the only call that came in) from the continent asking to see how mom was doing.  He was greeted by the first cries of his first grand-daughter.

A little while later, dad shared his thoughts about the differences he noticed between having had his son in the hospital and his daughter at the birth home.  He first mentioned that of course the drugs were not there, so the availability of them to be brought up and used was not an issue (nor would it be offered several times throughout the birth).  This made him think about the differences in the way his babies were treated when they first arrived.  His son, was limp and didn’t respond right away and had to be taken to the warmer immediately after birth.  We know this is in large part due to the epidural and pitocin given to mom and not only that but the handling of his babies was VERY different.  He understood now that giving baby to mom right away makes the most sense, after all she had been in her mother for nine months and would be comforted by her smell, heartbeat and breathing sounds.  Where as his son was jostled and handled like a piece of meat and not given to his wife until much later after he was born.  Even the temperament difference in his two babies at birth, he saw that his daughter was much more content, where his son was crying more and seemed under stress…dad had been a skeptic from the beginning and it wasn’t until he saw and felt with his own two eyes and heart, that they had made a great decision and the one that made them both feel more content.

Mom got to speak with her mother after the birth, who also happens to be a NICU nurse.  Of course most of her fear and anxiety came from her mother telling her the horror stories she sees in the NICU every day and just the shear number of them.  After the birth however, her mother shared that she was glad she had chosen to have baby at the birth home, where the hospital couldn’t interfere.  For that week at the hospital she worked at,  she had seen a few babies who had been so mishandled by the hospital that they ended up going to the NICU because of it.

A few hours after baby was born, the family slept, mom showered and ate and they packed up their belongings and went home to share their new baby with the family and big brother (who wouldn’t eat breakfast cause he was worried about mommy).

This may not sound like an epic saga to you

When I think about that place they came from in their thoughts and fears and how mom persevered and dad trusted his wife, how beliefs were changed and molded, trust was built and strengthened, a  family gained a member and the world stepped ONE BIRTH closer to LOVE, PEACE and normalizing nature, can’t think of a greater story.

Doula Tea

Doula Tea

Doula Tea has been taking place at Baby aWEARness for quite some time and grows with each subsequent gathering.

It’s so great to see families, women and partners, coming together to get questions answered and bring ease to their minds about the birth they envision having.

Please share with all you know about the next Doula Tea happening this coming Sunday, from 1 to 3 p.m. at the Baby aWEARness store in Manoa.

Look forward to seeing you there!

Via Baby aWEARness site:

Doula curious?

Enjoy some tea samples while learning all about doulas.

Stop by the store and meet some of Honolulu’s finest certified doulas and get all your questions answered. Find out how having a doula can be helpful to you and your partner and baby-to-come.

A few questions and topics to think about and explore:

Who should come to my birth?
Why hire a doula?
What are the benefits of having a doula?

Coping with labor, the doula way

Cesarean Mama in the Birth Goddess Club

Cesarean Mama in the Birth Goddess Club

Days like yesterday are the counter for the negative aspects of this story.  
Students we spoke with at UH wrote 4 amazing pages of little notes thanking us for coming…that brought what ever single person striving for betterment of births, home.  Most spoke of options, how they’re glad we shared, that they learned so much.
Then nursing students visited Hale Kealaula and after speaking with Selena, supported their friend who is hapai, rather than siding with fear and doubting her decisions.
Mother’s from all stages, gathered yesterday at the birth home with their partners and families, sharing experiences, encouraging one another, validating that inner voice that’s been telling them they have everything they need to grow and birth their babies.  

Doctors know about what to do when the wrong things happen but rarely know how to treat a woman when things are normal.  

What’s normal for you?  Midwifery discovers with you what that is, empowers you to explore it, know it and be it for your birth.

It’s YOURS and your babies, please don’t try to give it away…

Birthing Better

Birthing Better

Mahalo to Tiffany, for writing such a wonderful article

I knew the back lash from printing such truths would be great and so it has but like all things where profit and money vs. love and truth, the latter will always win.

 

Birthing Better

Hawai‘i’s mothers-to-be are taking charge of their deliveries.
by Tiffany Hervey | Mar 20, 2013

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Cover image for Mar 20, 2013

Traveling through Waianae and into Makaha, Hawaii’s natural rawness settles on the skin, combining Leeward air, ocean salt and primal electricity. It makes sense that Hale Kealaula, the first birth home on Oahu, has taken root here.

“We should be coming away from birth feeling like we did this, we can do anything,” says Selena Green, Hale Kealaula’s founder.


Instead,” conventional hospital birth procedures make women “feel like we can’t trust ourselves, can’t trust our bodies to do what they were designed to do,” says Green, a certified professional midwife (CPM), who opened Hale Kealaula in September 2012. “Hale Kealaula arose from an invitation from a local kupuna,” says Green, who’s also CEO of Sacred Birth Angels Foundation (SBAF). The kupuna had travelled from Oahu to Oakland, Calif., for the births of two great-grandchildren, delivered by Green at SBAF’s original birth home, Sacred Birth Place. The third was delivered at Hale Kealaula.

Representative of a global movement that’s gaining momentum in Hawaii, the birth home’s goal is to increase women’s access to certified midwifery services. In other developed nations, midwives usually preside over low-risk, normal births, but in the U.S., birth is largely overseen by OBGYNs.

Midwife-led care, which emphasizes prenatal care and a natural, medication-free birth, is becoming a popular option among low-risk pregnant women–those without hypertension, diabetes or other medical disorders that could cause complications. After 14 years of decline, the percentage of home births with midwives rose by 29 percent from 2004 to 2009, the highest level since data collection began on this in 1989, according to the U.S. Centers for Disease Control and Prevention (CDC).

Invasive means

What’s been taken from women, and what midwives bring back, Green says, is the ability to birth with dignity, respect and informed decision-making. Currently in the U.S., one in three babies is born by major abdominal surgery, and one in two women receive drugs to artificially force labor progression.

Despite our spending more than any other country on health care, and more on maternal health than any other type of hospital care, a woman’s chance of dying in childbirth is higher in the U.S. than in 49 other developed countries, according to Amnesty International’s 2010–11 publication Deadly Delivery: The Maternal Health Care Crisis in the USA. More than two women die every day in the U.S. from complications of pregnancy and childbirth. More than half of maternal deaths occur between one and 42 days following birth. The report asserts that postpartum care in the U.S. is inadequate, generally consisting of a single visit to a physician weeks after birth. Many women’s participation is restricted in hospital settings: They are not given a say in decisions about their care and do not get enough information about signs of complications and risks of interventions such as induced labor or cesarean delivery (C-sections). The risk of death following C-sections is more than three times higher than for vaginal births. The U.S. C-section rate is twice as high as recommended by the World Health Organization, which maintains that a 15 percent cesarean rate is optimal for mother and baby health.

C-sections

Hawaii mirrors the national average with a 30 percent cesarean rate. C-section rates continue to climb because for most of the 20th century, once a woman had undergone a C-section, doctors believed her future pregnancies required surgery due to risk of uterine rupture.

Despite this trend, the medical evidence, as referenced in the June 2010 issue of Obstetrics & Gynecology, reveals that women who try for vaginal birth after cesarean (VBAC) are at decreased risk of maternal mortality compared to elective repeat C-section. The article concludes that standards of care should be based on medical evidence, not the patterns of litigation that have been the norm, and that attempts to increase the VBAC rate make little sense without addressing the root of the problem: reducing the number of primary cesareans.

Beginning in January 2014, The Joint Commission, which accredits and certifies more than 20,000 health care organizations in the U.S., will require reductions in cesarean rates for first-time mothers in U.S. hospitals with more than 1,100 births a year.

“One of the great benefits of this requirement is that, since some hospitals actually ban VBACs, to avoid the first cesarean is logical,” says Summer Faria, co-leader for the Hapai Hawaii Birth Network, a local chapter of the national nonprofit BirthNetwork National.

Cost of birth

Half of all births in the U.S. are covered by private insurance, while Medicaid covers some 42 percent. “The Healthcare Costs of Having a Baby,” a study commissioned by the March of Dimes Foundation, found that approximately one-third of 45,450 deliveries were C-sections, which were almost 50 percent higher in cost than vaginal deliveries. For women insured through large employer private plans, the average cost of having a baby vaginally in the U.S. was more than $8,000. Hospital payments accounted for more than half the total costs and one-third of patient out-of-pocket costs.

Unlike well-child care or mammography, prenatal care was generally not considered a preventive service. Therefore, these health plans impose cost sharing and high deductibles on prenatal care services, according to a study by the Henry J. Kaiser Family Foundation.

In juxtaposition, birth centers saved the health-care system $30 million in facility fees alone for the 15,574 births tracked in a study by the American Association of Birth Centers. The study concluded that if more pregnant women delivered their babies at midwife-led birth centers, the nation’s C-section rate would go down and cost savings would go up, reversing the current twin trend of rising health care expenditures and numbers of cesarean surgeries. And be alert to the “estimated total increase in cost of about $2,000 when you have an epidural,” which “the hospital and its staff have financial presure to encourage,” according to Suzanne M. Smith, CPM and owner of Better Birth LLC.

While private insurance and Medicaid do not cover services at a midwife-led birth home like Hale Kealaula, the out-of-pocket payment can be lower: Hale Kealaula’s prenatal, labor and birth and postpartum services are less than $3,000 total.

Ordinary miracles

Having a midwife or healthcare provider that supports your vision of birth can prevent unnecessary interventions, even in the hospital,” states Dr. Heather Schlessman, associate professor at Chaminade University’s School of Nursing. “A hospital, by nature, is where sick people go to get better. Birthing isn’t an illness. A birth center or home has an entire wellness focus.”

“I recommend that a woman see an OB to get her initial labs and physical to rule out [high risk] situations, [and that also she] go to the 28- and 36-week appointments,” Green says, pointing out that, should problems arise in labor, the woman will be “in the system already, so transfer of care would be smoother,” and, if in a hospital, covered by insurance. Comprehensive care at Hale Kealaula includes prenatal care, labor, birth and postpartum services. Prenatal appointments are every two weeks until 36 weeks, and then every week thereafter. A pregnant woman learns self-care at prenatal visits, checking her own blood pressure, urine sample and pulse at the beginning of each visit. “She learns to do this in order to know what’s normal for her body and be an active participant in her care,” Green explains.

Prenatal appointments are an hour long, which allows time for midwife and mother to discuss nutritional, emotional, physical and social factors in the process of growing a baby and preparing for birth. Women are referred to ultrasounds when and if necessary. Otherwise, the midwife feels the stomach for size, the position of the baby and amniotic fluid levels and listens to the heartbeat with a Doppler.

However long labor lasts, Green sends new mothers and their babies home four hours after birth if both are doing well. “I want my moms comfortable in their bed in their home for a week after, bonding strong, breastfeeding well,” she says. She goes to their home 24 hours after birth for a checkup, then visits the home again after three days, five days, two weeks and six weeks. By contrast, postpartum care for a woman who delivers vaginally in a hospital in Hawaii usually consists of a two-week and eight-week checkup. “Birth is an ordinary miracle,” says Piper Lovemore, childbirth educator, doula, and owner of Baby Awearness. “If everything goes as it should–and it does in an overwhelming majority of births–you really just don’t need a whole lot of intervention.”

Midwifery

Barbara Ehrenreich, in Witches, Midwives and Nurses: A History of Women Healers (Feminist Press: 2010) describes how in the early 20th century, conflict between surgeons and midwives arose as medical men pushed for a legal monopoly on obstetrics. As a result, midwifery became heavily regulated or outlawed throughout the U.S.

In Hawaii, while midwives licensed as independent primary care providers can work collaboratively with other health care providers located in hospitals, there are no licensed birth centers. By law, an OBGYN with admitting privileges must serve as the medical director of the birth center.

“This has proved to be a problem, as OBGYNs have been unwilling or unable to support a birth center due to malpractice issues or distinct philosophical differences,” says Roxanne Estes, president of the Hawaii affiliate of the American College of Nurse Midwives. In the absence of centers, birth homes like Hale Kealaula offer a much-needed alternative as “a safe place to deliver out of the hospital in a more controlled setting, decrease cesarean rates, decrease preterm labor rates, decrease intervention rates and increase maternal satisfaction,” Estes says.

Progressive places

There are some hospitals that allow midwives to work within an OBGYN’s practice, and some that have midwives on staff. Kaiser Moanalua Medical Center, which sees up to 1,600 deliveries annually, started a midwifery service in 2009, currently has eight CNMs [edited to correct error in original article] and plans to add one more in 2013. The primary C-section rate for first-time moms there is 10.9 percent. It also allows VBACs.

Also on Oahu, Tripler, Castle and Kapiolani also offer midwifery services. On Hawaii Island, North Hawaii Community Hospital offers midwifery services, but has a limited capacity and serves only women who live in the immediate area. Molokai General has a midwifery program. Hospitals on Maui, Kauai or Lanai do not offer midwifery care.

“As far as hospital births go, I see much fewer complications with unmedicated or natural births,” maintains Estes, who has attended almost 1,200 births in and out of hospitals in her career. “Complications tend to arise with each medical intervention added. Widely used interventions like continuous fetal monitoring and IVs limit a mother’s movement, which assists optimal fetal positioning as the baby transitions down the birth canal.” Interventions that limit movement, she adds, “can lead to other interventions like Pitocin, a medication used to speed up labor [and whose] routine use contributes to poor or less-than-desirable outcomes. Epidural use, which is widespread these days, can increase length of labor and can lead to more interventions like cesarean section,” she warns.

Estes adds she believes that increasing access to midwives has the potential to drive down costs in Hawaii’s overburdened health-care system while also ensuring safe, quality care in pregnancy and childbirth.

Then there are the unquantifiable, but very real, benefits. Green smiles as she stands in the breezy backyard of her Makaha birth home. “The woman you see going into labor is different than the one that comes out after birth. When she participates in this sacred journey, she knows she can do anything,” she says.