Launching a New Wave of Awareness

On Tour with Our Bodies, Ourselves: Pregnancy and Birth

by Judy Norsigian, May 2008

Traveling around the country for our new book, Our Bodies, Ourselves: Pregnancy and Birth, has been both a privilege and an eye-opener about how options for childbearing women can vary so greatly from one city to the next. I have met with hundreds of midwives, obstetricians, family practice physicians, childbirth educators, pregnant women, recent moms, and expectant parents. Many contributors to this comprehensive evidence-based resource also participated in these events.

Feedback on the new book has been overwhelmingly positive and a tribute to the 130 or so writers, reviewers, and other contributors. Their careful research, thoughtful input, and attention to detail have resulted in an extraordinary endorsement by Dr. Timothy R.B. Johnson, chief of ob-gyn at the University of Michigan Health System in Ann Arbor. (His endorsement letter explains why they have purchased 4,000 copies of the book to provide to every woman seeking prenatal care there in the coming year).

Some women especially appreciate that we have included the oft-neglected concerns of women with HIV, lesbian mothers, women dealing with domestic violence, women with disabilities, and others with special needs. Many women came up to me describing how much they loved the first chapter, which creates a “climate of confidence,” offsetting a disturbing “climate of doubt and fear” that seems to pervade our present culture. They appreciated the straightforward information, the absence of condescension, and the avoidance of language that might foster guilt in a woman whose birthing choices or experiences turned out to be not as she had hoped.

Some communities lamented recent cutbacks to or elimination of nurse-midwifery services, while others celebrated expanded midwifery services and new training models that included nurse-midwifery faculty for both medical and midwifery students. Many noted the stellar outcomes of nurse-midwives. For example, at Group Health in Seattle, where nurse-midwives attend about 60% of births, the cesarean section rate is now about 12%, roughly a third of the national average.

Many noted the growing lack of access to VBACs across the country as one reason for the alarming rise in cesarean rates. Some women I met in Texas told me that their main reason for choosing a free-standing birth center (there are more than 40 in Texas) was to avoid an initial cesarean, so they would not have to face the prospect of a forced cesarean during a second or third birth. (The latest medical research has confirmed significantly greater risks for moms with each subsequent cesarean section delivery, making cesarean prevention more important than ever.) One of my favorite “activist” stories at the end of Our Bodies, Ourselves: Pregnancy and Birth is the campaign launched by Barbara Stratton and her colleagues to restore VBAC option in their local Maryland hospital. She ended with an excellent strategy that women are now considering to restore VBAC options in hospitals across the country.

In mid-April, one woman I met in Philadelphia mentioned the now-infamous Time/CNN article titled “Choosy Mothers Choose Cesareans.”  With distorted articles like this downplaying the true risks of cesareans, it is not surprising that so many women (and men) have an inadequate understanding of the risks of surgical birth.

In Madison, WI, where 60 people gathered at A Room of One’s Own (one of the few independent women’s bookstores left in the country), two women shared profoundly moving stories. One, with her healthy 3-month-old baby in arms, told of her attempted home birth and her nervousness about transferring to a hospital when it became clear to her midwife that it would be necessary. She found the caregivers at the hospital to be supportive and sympathetic, making the birth experience more positive than she had expected. Most important, she did not at all feel like she had “failed” or was somehow “inadequate,” demonstrating the importance of good counseling throughout labor, birth, and postpartum. Another woman whose first birth ended with a stillborn baby described how she kept producing milk for weeks afterwards and donated it to a local breast milk bank – the “gift” of her son, as she put it, even in his very short life. She was near the end of her second pregnancy when we met and looking forward to having a healthy baby.

In Wisconsin, which is now one of 24 states that recognize and/or license Certified Professional Midwives (who attend women primarily in the home setting), more than 1,200 women chose home births and free-standing birth centers. It also became clear to me that respectful collaborations between midwives and doctors were an important ingredient in making home births as safe and satisfying as possible. Interestingly, several people approached me about the supportive language on home birth in the statement published jointly by the Royal College of Obstetricians and Gynecologists and Royal College of Midwives in the United Kingdom and wondered why it was such a contentious issue for most obstetricians in the United States.

In so many ways, it is clear that our new book will be useful as an advocacy tool and a practical resource for individual women and their families. For example, a short sidebar about reintroducing nitrous oxide into U.S. hospitals as one option for coping with pain during labor has generated interest in advocating for nitrous oxide in several hospitals and health care systems. This controversial topic is more fully explored at our popular blog. The book will also be useful in several states where advocates are now working toward the licensure and regulation of Certified Professional Midwives (trained direct-entry midwives who practice primarily in the home setting). Illinois, Massachusetts, and Missouri are three such states.

At a reception hosted by the Centers for Disease Control in Atlanta, staff mentioned their increasing interest in disaster-preparedness and what communities will have to do in the instance of pandemic flu. Since pregnant women at term would not be able to give birth in local hospitals dealing with pandemic flu, emergency home birth kits and greater access to free-standing birth centers could become especially critical resources. Later, a reception and panel presentation at the Feminist Women’s Health Center prompted further discussion about the need to restore the once-thriving nurse-midwifery practice at Grady Hospital.

The new book has prompted an invitation from the journal BIRTH to write about some of the challenges in the “making” of Our Bodies, Ourselves: Pregnancy and Birth. Kiki Zeldes, OBOS web manager and co-editor for this new book, is the lead author for this article, which will be published early next winter. Stay tuned.

Seattle-area childbirth advocates and birth book contributors gathered at the University Bookstore in Seattle to celebrate the release of Our Bodies, Ourselves: Pregnancy and Birth.  From left to right: Toni  Weschler, April Bolding, Judy Norsigian, Penny Simkin, Janelle Taylor, and Christine Morton.