Guest Post Ashlea- Mother Friendly Care

From Kellie: Ashlea is Birth Boot Camp instructor I recently met and she is very knowledgeable about all things birth! She spoke a little about the Mother Friendly initiative and I knew this was something really important for us all to be aware of-  and for our (your) daughters and grand-daughters. For me, the basic premise of this movement is to reinstate the norm to be the natural process of birth and to use science when necessary- not let it completely take over (which it seems to be doing). I would like to see a day when all birth experiences/requests are accepted and welcomed in hospitals. I would like to eliminate pressure to conform to a certain type of care, and where Midwifes were just as accepted as OBGYNS..and covered by insurance.  Rant over? Not hardly, but this is a Guest post, lol, so I really should get to Mrs. Ashlea's post......

Mother-Friendly Care

When I was pregnant in 2013, I never considered researching a midwife or OB/GYN to find out if they were mother friendly. I assumed, insert play on words here, if they are caring for a pregnant woman, they must all be mother friendly.  Not the case at all!  It’s quite telling of an era when you actually have to seek out care-providers who are classified as “mother-friendly”.  Even more shocking, this has to be grounded in evidence based practices; they actually researched what benefited mothers throughout pregnancy and birth.  Naïve, pregnant me thought these were “duh!” moments, but this is not at all the case.  When you stop to reflect on where birth in our country has come from, it is totally amazing that the Coalition for Improving Maternity Services was founded. 

(photo reference: www.truthaboutnursing.org

In the 1900s, approximately 90% of all births took place in the home.  Hospitals were not widely assessable, and mothers were attended by both midwives and doctors.  But from 1910 and 1920, the midwifery model of care was tossed to the side as the medical model of care became prevalent.  Instead of focusing on the physical, psychological, and social well-being of a mother, the medical model is geared toward pathology (identifying what’s wrong) and diagnosing from patient symptoms. Childbirth was no longer considered a normal time in a woman’s life.  Dr. Joseph B. DeLee wrote and published an article in the American Association for Study and Prevention of Infant Mortality (1914-1915) where he (and others) discuss opposition to any movement to perpetuate the careers of midwives.  They are considered a “drag on (obstetric) progress as a science and art” are “not necessary at the present time” and “is a relic of barbarism”. As this field of obstetrics grew and the home birth midwife discredited, fear of childbirth and the pain associated with it helped encouraged women to birth in the hospital.  Today, 99% of U.S. women birth in the hospital (the majority with an obstetrician). 

Simultaneously, “twilight sleep” was introduced, and through a combination of morphine (pain medicine) and scopolamine (amnesiac), a laboring woman would have no memories of giving birth.  Considering this happens about the same time women are fighting for suffrage, it was widely welcomed among upper-class women. These unconscious women were strapped to beds, given a cut in their vagina (episiotomy), and their babies pulled out with forceps.  Today, only few women are unconscious for their births, but many of these practices carry over:

• ·         Laboring  flat on your back
• ·         Interventions to “speed” labor
• ·         Treating mother as the passenger in her birth rather than the driver 

As fewer births took place at home, women weren’t able to see what a natural birth is like from aunts, sisters, and friends.  Soon, women would labor without having ever seen a birth and this created the fear of the unknown. They would most likely not know that the body releases endorphins when a woman labors without drugs.  Naturally released oxytocin crosses the blood-brain barrier and causes the uterus to contract and the endorphins allow you to cope with these contractions.

Fast forward to the modern birth climate:

• ·         The U.S. cesarean rate is 36%.
• ·         The U.S. epidural rate is 76%. 
• ·         The U.S. maternal mortality rate is four times greater for African-American women than for Euro-American women.
• ·         The U.S. spends more money per capita on maternity and newborn care than any other country and falls far behind most industrialized countries in perinatal morbidity and mortality.

Holy cow! Well, as a result, the Coalition for Improving Maternity Services (CIMS) has set out to make a difference. Individuals and national organizations, who are concerned for the care and well-being of mothers, promote a wellness model of care to improve these outcomes (and save money).  I love that CIMS is a group of people working towards the same awesome goal: quality care for mamas and their babies.

There are 10 Steps of the Mother Friendly Childbirth Initiative for a hospital, birth center, or home-birth midwife to fulfill before receiving the CIMS distinction:

A mother-friendly hospital, birth center, or home birth service:

1. Offers all birthing mothers:
• Unrestricted access to the birth companions of her choice, including fathers, partners, children, family members, and friends;
• Unrestricted access to continuous emotional and physical support from a skilled woman—for example, a doula,* or labor-support professional;
• Access to professional midwifery care.
2. Provides accurate descriptive and statistical information to the public about its practices and procedures for birth care, including measures of interventions and outcomes.
3. Provides culturally competent care—that is, care that is sensitive and responsive to the specific beliefs, values, and customs of the mother’s ethnicity and religion.
4. Provides the birthing woman with the freedom to walk, move about, and assume the positions of her choice during labor and birth (unless restriction is specifically required to correct a complication), and discourages the use of the lithotomy (flat on back with legs elevated) position.
5. Has clearly defined policies and procedures for:
• collaborating and consulting throughout the perinatal period with other maternity services, including communicating with the original caregiver when transfer from one birth site to another is necessary;
• linking the mother and baby to appropriate community resources, including prenatal and post-discharge follow-up and breastfeeding support.
6. Does not routinely employ practices and procedures that are unsupported by scientific evidence, including but not limited to the following:
• shaving;
• enemas;
• IVs (intravenous drip);
• withholding nourishment or water;
• early rupture of membranes*;
• electronic fetal monitoring;

other interventions are limited as follows:

• Has an induction* rate of 10% or less;†
• Has an episiotomy* rate of 20% or less, with a goal of 5% or less;
• Has a total cesarean rate of 10% or less in community hospitals, and 15% or less in tertiary care (high-risk) hospitals;
• Has a VBAC (vaginal birth after cesarean) rate of 60% or more with a goal of 75% or more.
6. Educates staff in non-drug methods of pain relief, and does not promote the use of analgesic or anesthetic drugs not specifically required to correct a complication.
7. Encourages all mothers and families, including those with sick or premature newborns or infants with congenital problems, to touch, hold, breastfeed, and care for their babies to the extent compatible with their conditions.
8. Discourages non-religious circumcision of the newborn.
9. Strives to achieve the WHO-UNICEF “Ten Steps of the Baby-Friendly Hospital Initiative” to promote successful breastfeeding:

1.      Have a written breastfeeding policy that is routinely communicated to all health care staff;

2.      Train all health care staff in skills necessary to implement this policy;

3.      Inform all pregnant women about the benefits and management of breastfeeding;

4.      Help mothers initiate breastfeeding within a half-hour of birth;

5.      Show mothers how to breastfeed and how to maintain lactation even if they should be separated from their infants;

6.      Give newborn infants no food or drink other than breast milk unless medically indicated;

7.      Practice rooming in: allow mothers and infants to remain together 24 hours a day;

8.      Encourage breastfeeding on demand;

9.      Give no artificial teat or pacifiers (also called dummies or soothers) to breastfeeding infants;

10.  Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from hospitals or clinics

† This criterion is presently under review.

What can you do to ensure your location/provider is “mother friendly”? In my opinion, take a Birth Boot Camp class. Childbirth education is well worth your time and money.  We cover red flags of care providers and talk about how to be confident when choosing a birth location.  Ask some important questions regarding “standard” procedures: episiotomies, group B strep, pushing positions, and so many more. 

Your baby’s birth day will only happen once.  Carefully and thoughtfully consider your desires.  A mother friendly care provider will respect you, your wishes, and honor the sacredness of your special day.  ~Ashlea

Visit Ashlea's website
http://anindulgentbirth.com/