Ina May Gaskin, America’s Leading Midwife, has a new book out this month titled Birth Matters: A Midwife’s Manifesta. And I am in tears from just finishing it.

I am sure many of my reader’s are familiar with Ina May and her life’s work of not only providing phenomal midwifery services to women at The Farm, her community in rural Tennessee, but also her dedication to promoting the midwifery model of care to improve women’s birth experiences.

Ina May’s Guide to Childbirth truly made me believe in my ability to birth my son at home.  It made me realize that I needed to “let my monkey out” while laboring, as Ina May so famously suggested.  I needed to tap into my primal self, the self that instinctively knows how to birth a baby.  The self who, if she didn’t realize she was pregnant and suddenly doubled over in pain and thought she had to make a gigantic bowel movement, would assume the position and birth a baby.

And I did. I moaned, I swayed, I paced, and knelt, and reached, and I grabbed that baby -at home- with the care of 2 great midwives, a doula, and my husband by my side.  So thank you, Ina May.

Birth Matters is different from her other books because it is a history of birth, an exploration of why birth changed from midwife driven to obstetrics and surgery, and how we can get it back to being about women, not profit.  Birth is not only a feminist issue, it is person issue.  Birth shapes mothers and fathers; and how babies are born can shape them as well.  Birth should be respected and honored, not treated as a medical issue in need of solving.

The US has a serious problem.  Our Motherhood Morbidity rates far exceed other nations with comparable technology and wealth.  As it stands, we are at 15.1 maternal deaths per 100,000 births in 2005, up from 7.5 per 100,000 in 1982.   Even sadder, the rates are likely higher than even we know since the CDC reports that two thirds of maternal deaths are not represented because the method of reporting deaths has no standard and is not being done properly.  We are behind 40 other countries.

To understand where we are, where we have been, and where we need to go Ina May documents her own journey to midwifery, the witch hunt and near total eradication of the midwife culture in the US, the resurgence of midwifery care thanks to the Natural Birth Movement, and how we still have a long way to go to get midwifery care to all mothers who desire it.

I myself had to travel 1.5 hours away to receive care in order to have a homebirth. Was it worth it?  Yes!  Would I do it again?  Absolutely.  Should I have to?  No. And NY isn’t the worst in terms of laws regarding midwifery care.  At least here midwives are now legal to practice and Certified Nurse Midwives can be covered by insurance.  Others have it far worse than I did.

So much of this book took me back to my own hospital birth.  In a way I am grateful for it because now I see why hospitals aren’t the best place to have a baby.  The OB/GYN model of care treats women as “ill” who need to be monitored, tested, and have their birth’s practically mapped out if the baby won’t come on their “estimated due date.”  Even the EDD’s are changing.  When once the expectation was that a mother would have her baby around 40-42 weeks, we have shortchanged mother’s by 2 weeks and say 40 is the max!  Just in my own life, the mothers I know who chose an OB and delivered in a hospital usually ended up delivering in the 37-40 week timeframe.  Many ended up with inductions.  Of the women I know who chose a midwife and/or a homebirth, most delivered in the 38-41 week time frame, or later.

I appreciate technological advances but where do we draw the line?  Ina May relates many of the “advances” in medicine and technology that have in fact done great harm to mothers and babies.  She even discusses the new phenomenon of stopping periods with birth control.  It seems the research on many drugs and procedures prescribed to women are lacking the long term studies they deserve.  Examples include DES (the hormone pill given to women to prevent miscarriages which has given two generations, maybe more, a rare cancer), X-Ray’s on pregnant women that were once all the rage, forcep deliveries for nearly every birth at one time, twilight sleep (women were drugged and given amnesiacs, tied down, and went totally crazy.  They gave birth tied down but never remembered it, thus thinking it went well and was painless, when in fact it was not).  Then there is the technical advance of Electronic Fetal Monitoring and the pain relief drug, the Epidural.

The last two can be useful, but with overuse they cause more harm than good.  EFM in particular seems wonderful, but it has replaced nurses and doctors with a beeping machine.

And what about the Cesarean? I don’t think even the most staunch natural birth adovocate will deny that the C-Section has a place in this world. It can and has saved countless mothers and babies.

It has also become commonplace, accepted, and normal.  It is no longer just a life saving measure.  It is prescribed for virtually all breach babies, multiples, and of course, for any women who has had a previous C-Section.

The World Health Organization says C-Section births should be no higher than 10-15%.  The US stands at 32%, nearly one in three women! Some hospitals have rates in the 60-75% range.  When the C-Section rate reaches its highest point at 5:00-6:00 PM we know something is wrong.

Ina May and others are proposing we change the broken maternal healthcare system.  Easier said than done, right?

There is a new Mother-Friendly Childbirth Initiative, and this is laid out in the book.  Among other things, to be classified as a CIMS hospital, free standing birth center, or homebirth practice, C-Section rates cannot exceed 15%, but the goal is 5%.  Inductions (a topic close to my heart) should not exceed the rate of 10%, episiotomies should not exceed 20% but the goal is 5%, and VBAC (vaginal births after Cesarean) should be at least 60% but the goal is 75%.  The VBAC rate finally has a chance to increase thanks to the recent ruling by ACOG saying every woman has the right to a trial of labor to achieve a vaginal birth after cesarean.

Other goals are to treat women with the respect their deserve, to give more women access to midwives who want it, to let women labor and move about freely, to let women eat or drink, and so on.  Things that you would think are common sense, yet they don’t happen in many hospitals.

The CIMS hospital would also discourage non religious circumcisions, follow the WHO-UNICEF’s “10 Steps of the Baby Friendly Hospital Initiative”  for successsful breastfeeding, and mothers would receive adequate post-partum care including homevisits.

I am almost in tears again reliving the story told in this book (and many other places) of a woman who died of a post-partum hemorrhage a few years ago in NY.  Her mother was concerned about her, and last time they spoke the woman complained of a head ache.  When police finally broke down her door many days alter (after being asked to many times) they found the mother had bled out and her newborn had died of dehydration and starvation.

Had there been a postpartum homevisit her condition would have likely been discovered.  And at the very least, the baby would have been discovered in time.  In the book the number of babies born to single mothers is reported to be nearly 50%.  Many probably don’t have family to check on them.

The US has a problem. There is a solution.  God-willing one day this broken system will be fixed and the needless deaths of mothers (and babies) due to inadequate care, botched C-Sections, and post-partum complications left undiscovered will cease.

That is why I will be joining the Rally at the U.S. Capital with Ina May Gaskin and The Safe Motherhood Quilt.

Find out more information on The Motherhood Quilt and its mission.

You are damn right Birth Matters.  So let’s fix it.

You can find a copy of Birth Matters from my affiliate Amazon.com.  If you buy from my link you can help fund my trip to DC!  I am also hoping to attend her speech which has a hefty ticket price and would involve an extra hotel night.

I received a copy of this book in advance from the publisher for review. I also devoured it in 3 days.  Clearly, I enjoyed it and I think you will too.

This is part one of a two part post.  Tomorrow stay tuned for a Q&A with Christine Gross-Loh about her book.

My journey to Elimination Communication has only just begun, and since I came to it knowing little, to nothing about how EC works,  I decided internet research alone could only go so far.  The internet did lead me to an excellent book to read which has helped my journey tremendously.  The Diaper-Free Baby: The Natural Toilet Training Alternative, authored by Christine Gross-Loh, is an invaluable tool to anyone hoping to practice EC.  The most important thing that the book hopes to get across is this: EC is not an all or nothing endeavor.  When my friends find out about my son using a potty at 6 months old, I can only imagine what images run through their minds.  Do they picture me holding him captive on a potty while he screams and squirms to be released from my icy grasp?  Or, do they imagine my son naked, spraying his urine wildly in the air like a fire house, with no control over his bodily functions?  Maybe they think I am constantly scrubbing my carpet?  I honestly don’t know what they think, nor do I care.  I only wish they would all read this book!  Christine breaks EC into categories, or tracks, based upon the time and effort you wish to put into it.  You can practice EC on a full time basis.  A full time ECer would aim to catch (a term ECers use when referring to their child peeing on a potty, or into a diaper) virtually all of their child’s eliminations.  A part-time ECer wants to practice when they can, but probably won’t let their child be completely diaper free.  They would also probably not practice EC out of the home.  They may also only catch bowel movements, which for most children are the easiest to predict.  An occasional ECer may only catch 1 pee or poop a day, if that.  They may be working parents who have only evenings and weekends to attempt.  Or, they might just offer a potty break during prime times like in the morning or at a diaper change.  Between the three tracks there is tons of wiggle room.  That is what I love about EC!  My first day I caught 7 pees!  I was extremely intent on my new hobby.  But, life gets hectic.  If I am running errands I fall back to diapers and only attempt potty time 1-3 times that day.

My son practicing being diaper free. You may be able to see the pee in the potty.

The book is laid out based on these tracks, and also the time at which you have decided to start trying EC with your child.  I found it extremely helpful that the book was organized as a reference tool.  If you didn’t start until your child was in middle infancy, you could turn to that section.  She went over the basics all over again, briefly, and then offered suggestions on the best ways to begin EC with a baby at that age.  And, if you started from birth, you could skip to how to practice at that moment, without reading the introductions.  I had no idea there were so many ways to practice EC.  If you began from birth, she discussed the different holds you could use to position a newborn over a toilet or sink.  As the baby ages and potties can be used, there are tricks on how to make potty time fun.  All of these things will help in my journey.

When I had just barely read the introduction, I started my first “half” day of EC.  I had just gone to Babies R Us and purchased my little potty, and was ecstatic to begin using it.  I knew that day my son needed to have a BM.  I had him sitting on his potty, but he wanted to stand.  He kept his legs straight, and his knees locked.  This is not conducive to being a boy, and peeing.  When he did pee, he peed on me.  This, my friends, is what you call a “miss”.  Except, instead of not knowing he had to go, and letting it happen in a diaper or on the floor, it happened on me.  While I focused on the fact that he must have some more pee coming… he was focused on something else.  He secretly, and very quietly, with no facial expressions or grunts, crapped on the front of the potty, and on the floor.  I had no clue until I felt the crap- with my foot.

A few nights later I finally got the time to read more of my book.  I was feeling pretty bad about my only experience with EC.  My hopes were high that The Diaper Free Baby could give me some miracle answer to save my EC attempts in the future.  I wouldn’t call it a magic answer, but I did learn things that saved our EC journey, and put it back on track.  First, it suggested to try offering the potty at certain times of the day, when babies are most likely to pee.  Of course!  I offered the potty to my son the morning after I read this.  He peed!  Oh how exciting, I cannot even express how cool that was!  I continued offering him the potty after he awoke from naps, and after nursing.  By just offering at those times I caught 7 pees.  I missed about 4 in diapers which were placed on him, or under him.  The next tip: use “cues” to help baby understand when to potty.  Basically, every time your baby pees, even if it is in a diaper, you should make a “psst” noise, or say pee.  And for poops, a grunting noise, or say poop, or whatever you want.  Eventually, your baby will associate the noise to the action, and can then be “cued” to do it by the noise!  If you think that is crazy, it isn’t.  My son has a pavlovian response to the click of my nursing bra.  His mouth opens, and he gets into position!  Maybe I am imagining things, but after a few pees with the “psst” noise, I noticed he began contracting his stomach muscles and forced himself to pee when I cued him on the potty.  It wasn’t always like that, but it happens sometimes.

The book also lays out some essential tools you will need for practicing EC, and some not so essential, but helpful, items.  I remember my uncle telling me how odd it was to see babies and toddlers walking around China wearing crotchless pants.  Of course now I realize these babies were ECing, and the parents decided to make life easier by letting them be diaper free, but decided to keep their legs warm!  I already owned Baby Legs, which make diaper changing easy; they also make diaper free time easy as well!  Potties are mentioned as well.  I purchased the Baby Bjorn Little Potty.  She even gives a mini introduction to cloth diapers, and outlines the types and functions of the diapers available.

7-08-09 My son finally sat on the potty to pee!!!

To anyone even slightly curious about Elimination Communication, go to your library and check out The Diaper Free Baby.  Or, purchase your own copy.  It is an invaluable resource for someone starting EC, and a good read for anyone just curious!  By reading the book, you aren’t guaranteed success, and it won’t impart to you the perfect way to EC.  Every child is different, and so far I have been very lucky.  We may hit a potty pause, which is also addressed in the book.  For now, I am enjoying keeping my son comfortable and dry, and saving myself some diaper laundry.  The book also notes that just because you EC, if doesn’t guarantee that your child will be potty TRAINED at an earlier age than other children.  Your chances of that are very high, but not guaranteed.  So, if you are intrigued, please give EC a chance in your home.  Just try putting your child over your own toilet once, just once, first thing in the morning.  You may catch a pee, and be hooked!

*** I really debated about whether or not I should show this video I took of my son peeing on the potty.  I may take it down quickly, but I wanted to show what EC looks like.  A word or warning, there is full frontal baby nudity.  Obviously this is not a sexual thing, but if you are offended by a baby penis then don’t click on the video.  Also, I want to add that since taking this video he has learned to sit on the potty to pee.***

If you want to purchase a copy you can find it on amazon.com

If you are a green mommy, you must own this book! This is one of the stories I enjoy reading to my son most; and it is guaranteed to get a tear or two.

It has a simple but effective message that is so important for our kids to learn: every action has a consequence. Yes, what we do in this life and on this earth impacts everyone. Teaching our children responsibly is paramount. Now that we are informed we are gradually improving the damage inflicted by our more naive predecessors. This book is a colorful way to impart green ideals to your children while they hear a great story.

I am getting teary eyed just thinking about it.

“Plant a truffula tree. Treat it with care. Give it clean water. And feed it fresh air.” -Dr Seuss.