Birth Day - International Childbirth Education Association

Birth Day - International Childbirth Education Association

International Journal of

Childbirth Education



Where Do We Go

From Here?

Are Unexpected

Outcomes in

Childbirth Normal?

Nurturing Laboring

Women Through

the Years

Poor Knowledge of

Causes and Prevention

of Stillbirths

Featured Educator

Chris Maricle

Book Review

Birth Day

Audio-Visual Review

Understanding Birth

Open Forum

The official publication of the International Childbirth Education Association

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International Journal of

Childbirth Education

The official publication of the

International Childbirth Education Association

Managing Editor

Connie Livingston


Donyale Abe

Heather Jeffcoat

Mary McCoy Wall

Elizabeth Smith


Susan Bash

Erica Konya

Erin Livingston

Candy Mueller

Graphic Designer

Laura Comer

Articles herein express the opinion of the

author. ICEA welcomes manuscripts, artwork,

and photographs which will be returned upon

request when accompanied by a self-addressed,

stamped envelope. Copy deadlines are February

1, May 1, August 1, and October 1. Articles,

correspondence, and letters to the editor

should be addressed to the Managing Editor.

Advertising (classified, display, or calendar)

information is available at www.icea.

org. Although advertising is subject to review,

acceptance of an advertisement does not imply

ICEA endorsement of the product or the

views expressed.

The International Journal of Childbirth Education

(ISSN: 0887-8625) is published quarterly

and is the official publication of the International

Childbirth Education Association

(ICEA), Inc. Subscriptions are $60 a year.

The International Childbirth Education

Association, founded in 1960, unites

individ-uals and groups who support familycentered

maternity care (FCMC) and believe

in freedom of choice based on knowledge of

alternatives in family-centered maternity and

newborn care. ICEA is a non-profit, primarily

volunteer organization that has no ties to

the health care delivery system. ICEA membership

fees are $75 for individual members

(IM). Information available at,

or write: ICEA, 1500 Sunday Drive, Suite 102,

Raleigh, NC 27607 USA.

© Copyright 2009 by ICEA, Inc. Articles

may be reprinted only by written permission

of ICEA.


Indexed in the Cumulative Index to Nursing and Allied Health Literature (CINAHL)


One Thing I learned at the 2009 Conference

By Jenney Rodriguez.............................................................................................................. 8

Where Do We Go from Here ?

By Connie Bach-Jeckell........................................................................................................11

Birth in Israel

By Lissa Szajnbrum..............................................................................................................13

Is Dad Getting What He Needs to Support Mom?...................................................................15

Are Unexpected Outcomes in Childbirth Normal?

By Sherokee Ilse.................................................................................................................. 16

Nurturing Laboring Women Through the Years

By Paulina Perez................................................................................................................. 19

Scenes from the 2009 Conference............................................................................................ 22

Many Thanks to Conference Supporters!..................................................................................24

Letters to the Editor..................................................................................................................24

Becoming a Birth Writer

By Elizabeth Merrell Gross................................................................................................... 25

Poor Knowledge of Causes and Prevention of Stillbirths.........................................................26


The Editor’s Perspective – Thanks and Farewell – By Connie Livingston.........................................4

Across the President’s Desk – Wisdom of the Sages – By Jeanette Schwartz.................................. 5

Executive Director’s Letter – ICEA’s Journal is Evolving – By David Feild.......................................6

Featured Educator – Chris Maricle................................................................................................. 8

Book Review – Birth Day – Reviewed by Jamilla Walker.............................................................. 12

Audio-Visual Review – Understanding Birth, 2nd Ed. – Reviewed by Connie Livingston............... 14


ICEA Announces Doula Insurance Reimbursement................................................................. 10

Follow ICEA Online.................................................................................................................. 21

Journal Submissions...................................................................................................................31

Calendar of Events.....................................................................................................................30

Cover Photo: Photo Contest winner, ICEA member Jan Mallak

Volume 24 Number 4 December 2009 | International Journal of Childbirth Education | 3

The Editor’s Perspective

A New Year,

A New Decade

edi·tor (ed'it∂r) noun — (1) a person who edits; often,

specifically one whose work is procuring and editing

manuscripts (2) the head of a department of a newspaper,

magazine, etc.

As the year 2009 comes to a close, so does my

year as editor of the International Journal of Childbirth

Education. This has been a wonderful revisit to a position

I held in the early 1990s. I am deeply appreciative

to the ICEA Board for this opportunity to serve. I will,

however, remain active in ICEA as an ICEA Approved


I would also like to take this opportunity to thank

my Review Staff: Erica Konya, Erin Ross, Susan Bash and

Brief Writer’s Guides for the

ICEA Journal

Submitted (electronic is preferred) articles (minimum

500 words) should express an opinion, share a teaching

technique or research, or describe an experience.

References are usually not required because the writing

is solely from the author’s opinions or experience.

Accompanying photographs of the people and activities

involved will be published only with accompanying

Photo Permission Form.

The title page should include:

• Title and author’s name

• Academic and professional degrees, institutional

affiliations, and status

• Mailing address, phone and fax numbers, and

e-mail address

Writers are asked to include a photograph, a two- to

three-sentence biography, and a 50-100 word abstract

of the article. If bibliography is attached, please use

Chicago Manual of Style.

Candy Mueller for their

hard work and dedication

to the success of the

Journal during 2009. I

would also like to thank

all of the writers for their

contributions during

2009 as well as Laura

Comer at First Point Resources

for her innovative

design concepts that Connie Livingston

have made the Journal

easy to read with a contemporary spirit.

This final issue for 2009 has as the theme Open

Forum. With this issue is a wonderful centerfold of

photographic contributions from ICEA Convention

attendees. Congratulations to ICEA member Jan Mallak

for submitting the winning photograph for our Cover

Photo Contest! The featured educator for this issue

is Chris Maricle, a veteran childbirth educator with a

rich ICEA history! Another ICEA veteran, Polly Perez

offers a look at Nurturing Laboring Women Through

the Years. In keeping with the international aspect of

our organization, Lissa Szajnbrum gives us a glimpse

of Birth in Israel while ICEA Board member Connie

Bach-Jeckell continues to keep us informed about the

organizational outreach to Guatemala. Elizabeth Merrell

Gross discusses what it is like to be a birth journalist.

Last but not least, Sherokee Ilse, a featured speaker at

many birth conferences, shares about loss and childbirth


As always, it is my intention as editor to inform, inspire

and engage the reader of the International Journal

of Childbirth Education.

Happy Holidays and New Year blessings to you and

your family.

– Connie Livingston

4 | International Journal of Childbirth Education | Volume 24 Number 4 December 2009

Across the President’s Desk

Wisdom of the Sages

By Jeanette Schwartz, ICEA President

A recent birth I attended offered me an opportunity to

reflect on my path in the childbirth profession. I am grateful for

those who have shared their learning experiences with me as it

is this “Wisdom of the Sages” I use to support women in birth.

It was to be my day off. After the third phone call from

the maternity care unit asking me to come in and help, I

was compelled to say “yes”. As I was driving to the unit, I

thought about how the energy of the universe often calls us

for reasons we are unaware. I was called to be of assistance

to a mother to whom I had not originally been assigned. It is

ancient teachings that tell me “there is a purpose to everything

we are called to do and we need to offer our services

for the ‘higher good’.”

I thought of Celeste Phillips, RN, PhD and her work

around Family Centered Care that formed the philosophy

of the unit to which I was coming to work. The unit

was organized around the ICEA principles of “freedom of

choice based on knowledge of alternatives”. This means the

mother’s birth plan would be honored in an environment

where the mother would be respected in her choices.

I was assigned to a first time mother who had arrived at

the hospital an hour earlier in active labor. She was dilated

to three centimeters and was being supported by her mother

and husband. It is Penny Simkin’s teachings that come to

play now. Penny teaches the doula principles of continuous

support, positive statements (“you can do this, you

are strong, you are capable”) and the skills I would use to

help support this mother’s labor. Into the tub would be the

mother’s first choice for comfort measures—Barbara Harper’s,

Gentle Birth Choices, taught me about the benefits of hydrotherapy

and how safe it is to labor and birth in water.

Forty minutes later, this laboring woman was dilated to

six centimeters. She was “very loud” in her breathing…yes,

screaming. Again, I was able to calm her support people as we

listened to this mother’s “rhythm of screaming”. I was able to

reassure them that the mother was, indeed, in complete control

of her labor. It is Ida May Gaskin’s voice echoing in my

head “our birthing centers need to have more noise”. Today

that was going to be true.

It was Marilyn Hildreth’s

suggestion that I used next;

“Ask the mother, ‘What are

you thinking?’” to give clarity

to how the mother is coping

with labor. The mother’s

response: “I think I am going

to die.” In between contractions

I am able to explain

Suzanne Arm’s vision in her Jeanette Schwartz

film Giving Birth- Unveiling

Birth: The Wisdom, Science

and Heart of how for millions of years women have been

birthing and she is not alone in her thoughts. She explains to

me, “I don’t think I can do this.”

I stated, “This is as hard as it is going to be.”

“How can that be?” she says. “I’m not even in transition.”

I now need to draw on my 20+ years of experience

working with laboring women. Over the years, I have

observed women’s actions during active labor are about 20

minutes ahead of their cervix. For instance, in my experience,

if a mother is responding to labor as if she was nine

centimeters dilated, or in the transition phase of labor, a

cervical check might in reality show the mother to be only

six centimeters dilated. If the cervical check is delayed 20

minutes, in many instances the cervix would then be nine

centimeters dilated.

The way this mother was responding to her labor would

have led me to believe she was nine centimeters dilated even

though I knew her cervical check ten minutes ago revealed

her to be six centimeters dilated.

“You are in transition.” I stated. Again I ask, “Tell me

about your loud voice.”

“It makes me feel good.”

Enough said. It was truly inspiring to watch this mother

use all the wisdom of the ages to birth her baby. Dr. Sarah

continued on page 10

Volume 24 Number 4 December 2009 | International Journal of Childbirth Education | 5

Executive Director’s Letter

ICEA’s Journal is Evolving

By David Feild, ICEA Executive Director

This issue of ICEA’s journal, the International Journal of

Childbirth Education, is the fourth one that has been published

electronically. No journals were printed and mailed in

2009. All issues were announced via e-mail to the membership

and posted in a special section of the ICEA website using

both special reading software from Virtual Paper and the

“PDF” file format. You have accessed one of these formats to

read this column.

Although a large factor in the decision to print the Journal

electronically was based on costs, it was hoped that the

new format might eventually bring some added value to the

publication (more on this below). As far as the cost savings

go, this has been a success. ICEA has saved approximately

$26,000 in 2009 in printing and mailing costs and we are

hoping to increase the savings in 2010 by achieving some

additional graphic design and editorial efficiencies.

After the March 2009 issue was published on line,

we asked members for their reaction. As you would guess,

the reaction was mixed. Fortunately, most members were

supportive of the new format and appreciated the money

savings. Not surprisingly, a generational gap was clear from

member responses. The “Veterans” and “Baby Boomers”

were the most vocal about missing the print format. Many

cherished their past issues and had actually archived on

bookshelves issues going back years and years. However,

most said they were trying hard to adapt to the change and

it did give them an excuse to visit the ICEA website more


The younger generations (“Gens X & Y”) were generally

more accepting of the format change and expressed

interest in seeing how an on-line Journal might be expanded

to include additional features. There were, however, a few

exceptions. A couple of ICEA members live in remote areas

of the country where high-speed Internet connections are

not yet available. Reading the Journal with a dial-up connection

is tedious and off-putting. Another problem has been

lack of convenient access to a computer with an Internet

connection. And one member has some religious restrictions

on using modern electronic (computer) equipment.

Staff has produced a limited number of Xeroxed copies to

mail to these members, but undertaking this copying on a

wider scale proved economically prohibitive. A sampling of

members were asked if they would be willing to pay extra for

a print copy and the answer was “no”.

We are hoping in the coming year to take more advantage

of the electronic format. For example, there is no longer

a printing cost difference between black & white and color.

Having full color photos and artwork throughout the publication

is not an expense. As available, the editor and graphic

designer will use more and more color material throughout

the journal pages. Also, our advertisers are now able to run

full color ads for no extra ad cost (as an example, see the

InJoy ad near the back of this issue). We are hoping this will

help generate more ad revenue for ICEA. We are exploring

partnering with several sources of video material to embed

videos in Journal articles. An example are the types of videos

produced by Mindful Mama: http://www.mindful-mama.

com/media/p/26.aspx and, of course, by InJoy. The same

sorts of linkages can also be used for audio material that is

available on line. In addition, Journal authors will be increasingly

encouraged to site worthwhile links to other websites

in their articles. This will help expand credible sources of

information available to our members.

As an example, check out the new website promoting

ICEA’s 50th Anniversary Mega Conference, Celebrating Our

Pasts, Uniting for the Future of Birth celebration next year

with Lamaze in Milwaukee:

The support of the membership in switching the Journal

from print to on line has been greatly appreciated by the

ICEA Officers and Board. They know that adapting to this

change has been a struggle for many, but they remain committed

to not only maintaining the editorial excellence of the

Journal content but also increasing the Journal's use of Internet

“tools” to expand its content and keep it positioned to

take further advantage of enhancements in electronic communication

and publication. We hope that some of these

enhancements will start to become available in 2010. Keep

an eye out for them and be prepared to use your mouse to

click for added content.

6 | International Journal of Childbirth Education | Volume 24 Number 4 December 2009

Featured Educator

Chris Maricle

What was it like to give birth in

1978? In Tulsa, Oklahoma, it meant

that only one hospital in the city allowed

fathers to be present for birth,

as long as it wasn’t a cesarean. It meant

that women were told to gain no more

than 25 pounds and to give up salt. It

meant that most women were routinely

given spinal block anesthesia just as

their babies crowned, and the babies

were delivered with forceps to “protect

their heads.” Twilight sleep, using scopolamine,

was still used. The episiotomy

rate was well over 90%. It meant

that rooming-in was allowed only with

a doctor’s permission. All babies were

routinely given sugar water or formula

and brought to the parent’s room every

four hours. Childbirth classes were usually

held in the instructor’s home, with

many physicians advising their patients

to stay away from them because, as one

doctor put it, “they just want you to

squat out in a field.”

This is the world of birth I entered

when I became a childbirth educator.

As a former teacher, I had taken

birth classes through an ICEA member

group, and those classes had made a

profound impression on me. What a

difference my training had made in

the birth of my son! I had managed to

have one of the earliest unmedicated

“Lamaze” births the hospital had seen,

despite the challenge of back labor.

Afterward, the ICEA group asked me

to become one of their instructors. I

remember thinking I would do this for

knew this was

a goal I wanted

to achieve.

With my

friends Cheryl

Coleman and

Denise Wheatley,

I spent

many hours

studying for the exam. I’ll never forget

my excitement at receiving my ICCE

designation! I have since earned my

certification as an ICEA doula (ICD)

and as an approved trainer (IAT.)

ICEA still means a great deal to

me because it provided me with research-based

information and support

when the medical community in my

area was unsupportive. ICEA has given

me a network of other birth professionals,

a means to verify my knowledge

and skills, and many friends.

During my years as a childbirth

educator, I have taught in many locations

including my home, my church,

physicians’ offices, medical clinics, and

a hospital. I have seen visual aids go

from homemade posters to16 millimeter

film to VCR tapes to DVD’s—and

now online learning. I have seen hospitals

change to a more family-centered

approach. I’ve even taught the second

generation—some of my “Lamaze

babies” have come to me for classes. I’m

fond of saying I will continue teaching

as long as I can still squat—and get back


“a few months” to give me something

to do and to help out a few expectant

families. Several thousand families and

thirty-one years later, I still have a passion

for families, birth, and parenting!

By the time my second and third

sons were born during the 1980’s,

hospital policies were changing. I gave

birth in an alternate birthing center

which was located in a hospital (the

hospital where I still teach!) During

that time, home birth, water birth,

and “gentle birth” were being tried.

Once again the techniques which I had

taught to so many proved their worth

to me, as I had back labor and posterior

babies each time. I delivered using

a “birthing chair,” which was revolutionary

at the time—no one had ever

heard of a birth ball! ICEA’s support

of family-centered maternity care had

impacted the hospitals in Tulsa, and

all of them had adopted more familyfriendly


My first ICEA Convention was

in 1982 in Knoxville, Tennessee at the

ICEA Regional Conference. This contact

with other educators who shared

my passion for natural birth led to my

interest in working for ICEA. I became

the Oklahoma ICEA State Coordinator

and the first Photo Editor of the

International Journal of Childbirth

Education. Later on, I served two terms

on the ICEA Board as the US Midwestern


When ICEA developed a certification

program for childbirth educators, I continued on page 9

Volume 24 Number 4 December 2009 | International Journal of Childbirth Education | 7

One Thing I Learned at the

2009 Convention

By Jenney Rodriguez

I’m glad I went to the 2009

conference. Maybe I’m not the most

experienced person to talk about

childbirth education conferences; I’ve

only been to two or three. But I believe

that every encounter, even the seemingly

insignificant ones, are telling us

something that will ultimately help us

on our journey. The very visible lessons

learned at the 2009 conference had

to do with educating ourselves about

the present state of affairs of childbirth

education and how to stay motivated

and seek out higher standards, all of

which added to my sense of preparedness.

In my classes, I talk about “the invisibles”.

This refers to the many things

that are present in our lives (and in

the course and at the conference) that

aren’t easy to quantify or even define in

concrete terms; but are part of the big

picture that make us connect, accept

and grow. By ignoring their contribution

to our understanding of ourselves,

we dishonor our intuitive nature and

pretend to interact with life in a strictly

rational and mechanical way, which

leads to a sense of dissatisfaction and

imbalance. The feeling of belonging

and the broader perspective we acquire

from our fellow classmates or conference

goers is an important “invisible”;

as is a deeper sense of conviction about

those things we feel are worth striving

for. There are many things we pick up

at an event like this especially when we

are open to learning.

The most consistent understanding

that arose during the event was a

clear divide between older and younger

educators. At 51 with 25 years of teaching

under my belt, I may not be an

elder but I’m certainly not a young’un.

Different than other generational gaps

over history, this one feels bigger and I

suspect it has to do with the snowball

effect of an everyday wider technological

base. To understand this, I reflect on

working with traditional birth attendants

in India and my realizing what

illiterate meant. It wasn’t just that they

didn’t read and write, by not reading

and writing in their unique cultural

setting, they conceptualized everything

differently. Line drawings weren’t the

answer because a depiction of something

obvious to me such as water

signified something else to them. Well,

now I am equivalent to that traditional

birth attendant and the younger educators

are finding me unable to comprehend

their technological world. It’s

not just a matter of using a computer;

it’s the way that using technology

programs our brains to conceptualize

things differently that counts. I came

to the conference armed with all the

reasons why we shouldn’t let go of what

our generation of teaching childbirth

education stands for, believing these

lessons to be invaluable. I came of age

in the middle of my break-out session

when I realized it’s not about what I

believe; it’s about what our students


Both sides of the gap are looking

for validation. In a session about

the myths our couples believe to be

true that trigger a breakdown in the

postpartum period when they realize

they aren’t (for example that maternal

instinct exists said the speaker),

I felt the answer was not to classify,

empower by numbers and medicate

the new mother; but to create better

support systems, teach coping skills

and dedicate more time to properly

prepare for motherhood. But quality

preparation requires more class time,

something that younger couples, used

to instant gratification and superficial

styles of communicating, aren’t always

willing to do. I can stand on my soap

box and mourn the end of teaching as

we know it, or accept that convincing

our students to trust our wisdom when

they want to trust their own, is futile.

The real challenge is to project

what we hold to be sacred via methods

of learning that they can relate to. This

is no easy feat, but not impossible with

creative will power. Everything in the

conference that highlighted our need

to do this was met with interest. In

the panel discussion about possible

new venues for educators, having the

technological needs of the younger

educators mentioned was critical. A

session on teaching the “X” and “Y”

generations was right on. Suggestions

for broadening membership and makcontinued

on next page

8 | International Journal of Childbirth Education | Volume 24 Number 4 December 2009

Featured Educator: Chris Maricle

continued from page 7

I now teach childbirth classes at

Hillcrest Medical Center, and I also

have my own private childbirth education

practice, entitled New Joy Christian

Childbirth Education. Although I

enjoy all my classes, I have found that

including a spiritual preparation along

with the typical birth curriculum provides

a more fulfilling preparation. I am

also a certified parent educator through

the Parents as Teachers program, so I

provide home visits, group meetings,

and screenings to families with children

under three. In some cases, I have been

childbirth educator, birth doula, and

parent educator to the same families.

My style of teaching has changed

too. Now I use PowerPoint and I have a

website, but my commitment to “freedom

of choice based on knowledge of

alternatives” remains strong. You won’t

find me teaching “what to do until you

get your epidural.” I continue to present

interventions from a risk/benefit

perspective, while realizing that the

decisions that my students make are

not necessarily a reflection of me.

I often tell my clients that giving

birth without medications was one of

the greatest challenges of my life, but it

also was one of the most empowering

experiences of my life. Whether expectant

women choose to use medical

interventions or not, my hope is that

through giving birth they will discover

something powerful and wonderful

about themselves and their partners;

and that they will be better parents

because of it. Parenting is a life-long

journey, while birth, although an unforgettable

and powerful experience, is

usually only one day in their lives. So,

as childbirth educators, we are building

families, and touching the future.

So much has changed since I

began my career, but one thing will

never change: the privilege we have as

birth professionals to walk alongside

families during a critical time in their

lives and to provide guidance for them

as they begin a fulfilling new chapter in

their lives. I can’t think of a better place

to be!

One Thing I Learned at the 2009 Convention

continued from previous page

ing conferences viable rallied around

being technologically savvy and offering

a new face of ICEA that reflected

this. Networking and promoting our

work can only be successful if we are on

board with how to do so in a modern

and global world and the openness to

learn how is the first step in honoring

our young students’ reality, albeit an

unfamiliar version compared with our


Personally, I decided to stop

fighting my instincts that Power Point

presentations in class only deter the

student from connecting with the

educator. I am now incorporating them

into my curriculum. If that is what new

students need in order to relate to the

information, I’m there. All of us need

to connect with a sense of immediacy,

give part of our information digitally

and promote ourselves via all the techno

avenues available to new students

that exist today. It’s not about what we

know to be true, it’s about their coming

to their own conclusions because of the

choices they have made, available to

them in a time of unending options, in

a world that is changing faster than we

can imagine. The conference taught me

many things, both visible and invisible,

but this is one of the most important.

Jennifer Kozlow-Rodriguez, ICCE, CD

(DONA) is Director of Previda-Childbirth

and Family Life Preparation , Editor of

Padres de Hoy Magazine, President of

AMSEMA (The Alliance for the Betterment

of Maternity Services) for more than

25 years, in San Jose, Costa Rica.

Volume 24 Number 4 December 2009 | International Journal of Childbirth Education | 9

ICEA Announces Doula Insurance Reimbursement

The President of the International Childbirth Education

Association (ICEA), Jeanette Schwartz, announced October

21, 2009 that the National Uniform Claim Committee

has approved a (new) billing code for doulas in the United

States. The code will enable certified birth and certified postpartum

doulas to obtain an NPI (National Provider Identification)

number to submit reimbursement claims to Medicaid

and third-party provider insurance companies.

Schwartz commented, “This is an important landmark

for ICEA birth doulas and great timing for our new ICEA

Postpartum Doula Program.”

“The birth or postpartum doula will need to provide her

certificate of certification as this is the evidence of certification

credentials necessary to apply for the NPI number,”

continued Schwartz. Only certified birth and postpartum

doulas will be able to use this code to apply for an NPI number

or for reimbursement. Application for an NPI number

can be made using the new taxonomy code at the National

Plan and Provider Enumerator Systems (NPPES) website.

Group practices are able to apply for a number, although the

application process is slightly different.

The new taxonomy code is 374J00000X and is called

“Doula” under the heading of “Nursing Service Related

Providers Type.” While the term Doula is listed under the

Nursing heading, RN or LPN licensure are not required to

obtain the NPI number. The description includes the services

of antepartum, labor doulas, and postpartum doulas. A

definition of doula work is included on the National Uniform

Claim Committee website: “Doulas work in a variety of settings

and have been trained to provide physical, emotional,

and information support to a mother before, during, and just

after birth and/or provide emotional and practical support to

a mother during the postpartum period.”

Schwartz went on to say that standard billing forms

are still being developed, with birth doula forms in the final

stages of development with postpartum forms coming at a

later date. Until forms are finalized, ICEA doulas are encouraged

to use the 1500 Universal Claims Form can be used to

bill for reimbursement. Forms and a free manual of instructions

are available online at websites such as the JustCMS-

1500Forms website. Software to automatically generate the

forms is available also. A sample of the 1500 Universal Claim

Form is available in PDF at the National Uniform Claim

Committee website. “For now,” Schwartz advised, “doulas

should bill clients directly as they have always done, file for

reimbursement, and then offer the clients reimbursement

when it is received from the insurance companies. We hope

to bring you even better news soon, that doulas can bill

insurance companies directly.”

Wisdom of the Sages

continued from page 5

Buckley’s talk on how hormones work in labor was very evident

in this woman between contractions. This mother was in

“near coma” as she completely shut out the outside world and

her endorphins provided the relief she needed. Ten minutes

later she was complete and another 40 minutes a bright, wideeyed

baby boy greeted his mother and father for the first time.

I know that if I had not joined ICEA many years ago,

had not attended the many sessions at international conventions,

and not listened to experts’ share their ideas around

non-medicated birth, this birth would have turned out

differently. I would have encouraged this mother to have

medication or an epidural (even though her birth plan was

very explicit she did not want medication). Her family could

have been in a state of fear—not being aware that rhythmin-breathing

is an important indicator of control, and this

mother may have perceived herself a “failure” because her

choices were not honored.

Of course the story does not end here. Doctors Marshall

Klaus and Nils Bergman have researched infant attachment

and have shared their work for many years. They tell us the

time after birth is a sensitive period for programming mother

and infant behavior. The baby was placed on the mother’s

chest, skin to skin, and remained there for several hours.

Nursing care was completed with baby in his mother’s arms.

Linda Smith’s book, “Impact of Birthing Practices

on Breastfeeding” examines the research and evidence in

detail on breastfeeding outcomes related to birth practices.

Because of this knowledge, I encourage the mother to let her

baby use his ability to latch and suckle on his own.

I am thankful for all who have shared their passion and

knowledge of birth. I encourage you to share your expertise

with others so everyone can benefit…the mother and her

family, the providers of care and the babies welcomed into

our world. We can change birth practices one birth at a time.

10 | International Journal of Childbirth Education | Volume 24 Number 4 December 2009

By Connie Bach-Jeckell

Where Do We Go from Here ?

Motherhood…it’s a universal language.

It makes no difference of nation,

color, creed or race. Our blood types

are the same, our bodies go through

the same physical process…the hearts

of mothers are the same.

In our world right now, women

need information on family planning,

pregnancy and breastfeeding. They need

information on infant care. They have

no idea how to help a choking baby.

Birth is shrouded in mystery, experienced

alone and in fear. There are no

childbirth education classes available.

This age of technology enables us

to better reach out to developing countries.

ICEA was founded as an international

organization. We now have the

capability to easily provide education

to many nations and cultures. It’s time

for us to truly walk in our international

destiny; training and equipping

educators around the world…with the

goal of education and family-centered

maternity care for all women, regardless

of their nationality or ethnicity.

ICEA was founded to effect

change. We once fought for the rights

of fathers to be present at birth…

we pushed hard for family-centered

maternity care…we set a standard for

childbirth education. We still have the

same philosophy…freedom of choice

based on knowledge of alternatives. We

take for granted how much knowledge

we have…knowledge we could share

with someone else. There are other

families around the world who hope

for, and deserve, that same freedom to

choose. They need our help in moving

toward that goal.

It’s also time for some of us to step

out and walk in our individual destinies.

We’ve been brought to this place

in time for a purpose. It’s sad when a

graveyard is the prime place to discover

buried treasures…treasures that were

never delivered to their intended recipients.

Your destiny may be personal,

but it’s not private. Other peoples’

destinies may depend on how you

live out your own. (I am reminded…

if a woman hadn’t started a perinatal

exercise class at a community center

in Memphis thirty years ago; my life

would have been very different.)

Considering our resources, the

birth outcomes in this country are

humiliating, yet we continue to see a

general decline of participants in our

classes. In this “land of plenty,” a huge

selection of resources goes to waste. We

settle for sulfur water, while there’s an

undiscovered, miraculous healing well

flowing just below; but people don’t

seem to want to dig a little deeper.

This “low-priority” attitude,

wherever it comes from, sometimes

has a way of discouraging excellence in

educators, care providers, etc. Teaching

on an international level, although

challenging, can be a “healing experience”

for those of us who need a boost

in our original passion…or for those

who are looking for “what comes next.”

When we get back home we’re

excited about our experience, the

work we’re doing, etc. We’ve improved

ourselves, so our classes improve. In

this way, even the women we’re teaching

here at home benefit because we

stepped out of the box.

Give it some thought…decide if

teaching internationally is for you. If

you’re looking for the adventure of a

lifetime…a chance to grow into who

you’re becoming: step out. Take some

time to give your treasure to yourself,

ICEA and the world. Last August in

Guatemala I saw educators come alive

with an energy they hadn’t felt in a

long time. New destinies were revealed

and lives were forever changed. Even

though the ICEA team is no longer in

Guatemala, peoples’ lives are better

because we were there. (This includes

the team as well as those we served.)

Ours is a mission trip of a different

nature. It is so much more than putting

a small, temporary band-aid on a

gigantic, long-standing problem. It is

promoting the well being of families

around the world. We have a global

touch of influence. We speak that universal

language of motherhood.

I am reminded of a quote from

Suzanne Arms "If we hope to create a

non-violent world where respect and

kindness replace fear and hatred, we

must begin with how we treat each

other at the beginning of life. For that

is where our deepest patterns are set.

From these roots grow fear and alienation

- or love and trust."

Connie Bach-Jeckell, RN, IAT-CE-D-CPFE

is an ICEA Director and chair of the new

ICEA International Relations Advisory

Committee. She served as the Chair of the

2009 Convention Planning Committee.

She recently got married (June 2009) and

resides in Alcoa, Tennessee with husband

Charlie as well as with her children and


Volume 24 Number 4 December 2009 | International Journal of Childbirth Education | 11

Book Review

Birth Day by Dr. Mark Sloan

Book Review by Jamilla Walker

When I write book reviews, I generally try to do some

research on the author. I like to have some context (deeper

than that found on a book jacket) if I’m going to review

someone’s literary baby. However, when one enters “Mark

Sloan, MD” into the Google search engine, one better be

prepared for the abundance of information on Dr. McSteamy

from ABC’s Grey’s Anatomy. After trudging through tons of

interesting but useless information, I settled for his story that

is on the book jacket and cleverly woven through his memoir.

A memoir is exactly what Birth Day turned out to be.

While most of the books on my shelf are cleverly written

commentaries on the history and present day state of birth

in the United States, few are memoirs. These few are my

favorites. These memoirs are the reason I dream of catching

a baby one day, I read them when I need a little motivation.

Ina May Gaskin’s Spiritual Midwifery and Peggy Vincent’s

Baby Catcher are my all-time favorites. I have high standards

when it comes to professional memoirs; I was pleasantly

surprised both by Dr. Sloan’s storytelling abilities and his way

of introducing complicated material.

Birth Day is organized into a comfortable pattern. Dr.

Sloan picks apart every aspect of birth by telling the history,

describing the present and delving a bit into the possibilities

of the future. In this manner, he discusses everything from the

lithotomy position to the amazing role of relaxing to the beginning

of pain relief for childbirth. He admits that the lithotomy

position was first introduced by a fascinated King Louis XIV

who wanted a better view of his mistress giving birth, and is

now becoming an outdated position for pushing. He points

out that general pain relief was thrust into public discussion by

English Queen Victoria who oddly enough hated pregnancy,

childbirth, and child rearing. Pain relief became a major issue

for the feminists of the 1920s who demanded “better” pain relief

options (i.e. “twilight sleep” etc). Sprinkled through his history

of operative birth are all the legends and stories that make

mention to “alternate routes” – Greek mythology, Buddhist,

and Hindu legends. Most refreshing to me is that Dr. Sloan

learned his craft in an environment that treated Cesareans

as the saving grace they were supposed to be – for the cases

that would have resulted in death even 50 years ago, not for

women who’d prefer not to deal with the fear of childbirth. He

succinctly sums up the reasoning for our high Cesarean rates:

“Put them all together – the increase in dystocia, fetal

distress monitoring, repeat Cesareans, advancing maternal

age, and the expectation of a perfect outcome – and it’s

not surprising that the cesarean rates skyrocketed from 22.7%.” (p.81)

This book is not an opinionated commentary on how

childbirth should be, but more an entertaining discourse on

our current cultural views and practices. Dr. Sloan presents

characters in ways many of us rarely see them. He was the

baffled, doe-eyed intern surrounded by sharp, stern nurses

who wrestled patients into stirrups and barked out orders.

His description of his own ineptitude during his internship

made me laugh out loud as few books can do. He uses analogies

to illustrate his explanations of hormones, the transition

between fetal and newborn oxygenation, etc. He points out

that most people think of the newborn transition as similar

to a scuba diver coming up for air (something I’d heard in

my obstetrics rotation), Dr. Sloan points out the problems

with this analogy in a hilarious way:

“If a diver really were like a fetus, his lungs would be filled

with seawater, his air tank would be connected to his belly

button, and half of his blood supply would be floating in a

sac outside his body. On his way up from the depths, he’d

squeeze the extra blood back into his body, force the water

out of his lungs, and permanently rearrange the flow of

blood through his heart. Then he’d pop to the surface,

naked and screaming, wide-eyed with amazement and

anxiety at the new world he’d been cast into. If diving

and childbirth were identical processes, Jacques Cousteau

might never have gotten into the water.”

Dr. Sloan makes no mention as to his target audience.

Other books are obviously written for new parents, neonatal

nurses, midwives, etc. There is so much discussion of medical

practices and procedures that I don’t think the general public

would be as amused as childbirth professionals. However, for

the new doula or educator who is still learning the background

of their craft, this book is fantastic. Birth Day is full

of great analogies and memory hooks that can be used in

childbirth teaching, as well as hundreds of fun little facts that

keep clients entertained.

12 | International Journal of Childbirth Education | Volume 24 Number 4 December 2009

Birth in Israel

By Lissa Szajnbrum

I was incredibly lucky when I gave birth to my first child

22 years ago in Jerusalem. I was lucky that there was a hospital

that gave women freedom of choice and options when

giving birth. I was lucky that I had a wonderful midwife who,

by her expertise, helped me birth my son with no interventions

whatsoever. This empowering birthing experience

changed my life. While living in the United States for my

next two births, I chose a free-standing birth center and only

wanted a midwife to attend to me. Returning to Jerusalem

I gave birth to my subsequent three children in my “dream

hospital”. Now the hospital had a private birthing room on

the top floor; this was my obvious choice. Again, I had a caring

attentive midwife guide me through my births.

Alas, this hospital closed down 12 years ago. While the

many excellent hospitals in Israel claim to support “natural

birth”, the reality is far from this. The birth rate in Israel is

high, with an average of almost 3 births per woman, but there

are many women who give birth to 6 or more babies. Thus,

the maternity wards in Israel are almost always full and busy.

The health system in Israel provides free prenatal care to

every woman, free hospitalization for up to three days after

giving birth, a government supplement for every birth and

three months of paid maternity leave. Most hospitals give

childbirth education classes and there are many options for

pre- and post-natal exercise classes. Israel loves babies and

there are many social support systems in place to help women

before, during and after birth. All births are done by midwives,

unless a woman decides to pay privately for a doctor.

Despite all these options, many women arrive at the

hospital without having any childbirth education classes,

frightened at the prospect of having any pain, and immediately

choose the epidural. This can partially explain why

70-80% of women in Israel have an epidural. Even the staff,

while claiming to support a woman’s choice in childbirth and

“natural birth”, begins suggesting an epidural from the very

beginning of the labor. At a recent birth, I overheard a young

midwife speaking to the staff, exclaiming “Why shouldn’t

she have an epidural? Why should she have a trauma for her

first birth? She won’t want to have more kids!”

Many hospitals even have “natural birthing rooms”,

equipped with a birthing rope, chair, bathtub and a big bed

for labor. Unfortunately these rooms do not get a lot of use,

as the woman has to commit to not using any interventions

in her labor and it also depends on the availability of the

midwives to commit to this one birth, which is often in a

room not adjacent to the other labor and delivery rooms.

Homebirths constitute a small percentage of births in

Israel, approximately 500 a year. There is one free-standing

birth center in the center of Israel, run by a well-known and

experienced midwife. Actually they are little cottages alongside

her home in an agricultural community. These wellequipped

cottages offer a homebirth-like atmosphere; while

still close enough to a hospital. The midwife who began this

is considered a pioneer in Israel. She has authored a book on

homebirth in Israel and offers a postpartum convalescence,

also in cottages alongside her home. There are also a few

other home-based birth centers dispersed throughout Israel.

Doula-training is on the rise, at times the supply outweighing

the demand! There is heightened awareness here

of how helpful a doula can be, and is not just considered a

western-imported luxury. Most hospitals welcome doulas

into the delivery room; yet there are other hospitals who demand

that women use their own hospital-based doulas, often

at a higher cost than private doulas. Some hospitals have

volunteer doulas on call for women who may want them.

Unfortunately, birth in Israel is still highly interventionist.

The cesarean rate as of 2008 was 20%. Episiotomies are

used in 17% of the births and the epidural rate, as mentioned

above, stands at 70-80%. If a woman enters her labor

informed and educated with enough support, it is probable

she will have a positive birth experience. But many women

are passive in their births, depending on the medical staff

to decide for them how to birth their baby. There is a lot of

pressure “not to suffer” during the birth and even breastfeeding

is not always seen as essential.

Israel is a family-centered culture and society and the

government greatly encourages childbirth. Unfortunately

most medical staff still considers birth a “medical event”,

while paying lip service to “natural childbirth”. Many women

don’t know what to expect and depend on the medical staff

to guide them. Progress is slowly being made; there are many

programs available training childbirth educators, doulas,

alternative therapies, and postpartum support. Hopefully

theory and practice will soon meet and then Israel will truly

have a progressive model for childbirth.

Lissa Szajnbrum is originally from San Diego, CA but has called

Israel home for nearly 30 years. In Israel, she works as a doula.

Volume 24 Number 4 December 2009 | International Journal of Childbirth Education | 13

Audio-Visual Review

Understanding Birth

2nd Edition (2009)

Reviewed by Connie Livingston RN, BS, FACCE, LCCE, CD(DONA), ICCE, IAT

Always setting the bar high for

innovation in education, the new

Understanding Birth 2nd Edition does

not disappoint either the educator or

the viewer. Understanding Birth may be

the only DVD an educator will have to

purchase, with its powerful 3D computer-generated

graphics, 4D ultrasound

images showing fetal development,

new birth footage with a diverse mix of

families, and evidence-based information.

This new edition comes with two

discs. The first disc is divided into eight

chapters: (1) Understanding Pregnancy

(which covers the last trimester and

includes fetal development, discomforts

of pregnancy: both emotional

and physical; labor warning signs; and

prenatal exercise), (2) Understanding

Labor (includes signs of prelabor,

onset of labor, stages and phases of

labor with 3D computer animation,

importance of skin-to-skin contact

just after birth), (3) Christina’s Birth

(an unmedicated birth with mother

on hands/knees for the birth, with an

emphasis on natural coping techniques

and partner support during labor), (4)

Understanding Comfort Techniques

(discusses/reviews the use of breathing,

focusing, effleurage/massage, gravity

positive positioning, birth balls, specific

relief techniques for back labor, guided

imagery/visualization, hydrotherapy

and helpful suggestions for labor

partners), (5) Understanding Medical

Procedures (features the importance of

developing and using a birth plan while

discussing induction and augmentation;

fetal heart monitoring; IV fluids;

and pain medication options.), (6)

Understanding Cesarean Birth (explains

the reasons for a cesarean delivery,

shows the surgical procedure with 3D

animation, talks about the feelings and

procedures of an unplanned cesarean,

discusses the feelings and procedures

of a planned family-centered birth, and

describes recovery differences in contrast

to vaginal birth), (7) Understanding

Newborns (explores immediate

post-birth newborn procedures with an

emphasis on skin-to-skin mother-baby

contact, normal newborn appearance

and characteristics, first feedings and

some infant safety), and (8) Understanding

Postpartum (explains involution,

stages of lochia, peri care, rooming

in, postpartum emotions: blues and

postpartum depression, some breastfeeding

and the need for postpartum

emotional/physical support).

The 2nd Edition features all new

expectant parents, not recycled footage

from previous videos which is a plus.

The second bonus DVD is ideal

for more condensed class schedules,

such as weekend classes. Called Understanding

Birth Express, it features four

chapters (1) Pregnancy, (2) Labor, (3)

Medical Procedures, and (4) Cesarean


Along with the two DVD set,

the educator can also make use of the

outstanding “See What You Read”

booklet available for Understanding

Birth. Expectant parents can use this

Injoy Birth and Parenting Education

7107 La Vista Place

Longmont CO 80503

1-800-326-2082 x2

Ages: 13-Adult

135 mins.

Express Class DVD included

48 mins

Price: $449.95

Available in English and Spanish

innovative 70 page booklet to enhance

learning by reading and accessing to review

missed or misunderstood information.

Each booklet comes with a personal

PIN number which gives the expectant

parent exclusive access to the website

for 6 months from the first log in. From

the website, parents can review topics

with more than 50 short video clips

from the comfort of their home, print

out checklists and other handouts, and

obtain additional information from the

web links to connect to other birth and

parenting websites.

The booklet also has photos from

the 3D animation in Understanding

Birth, charts and diagrams, partner tips

and a glossary/index section. With this

booklet, an educator may not need

another class manual.

If educators want one DVD to

cover all of the topics presented in

most childbirth education classes, OR

if doulas want one DVD to review

with clients, this is the ideal DVD to

purchase. And with all of the pluses

connected with Understanding Birth and

Injoy Videos, education just got a lot


14 | International Journal of Childbirth Education | Volume 24 Number 4 December 2009

Is Dad Getting What He

Needs to Support Mom?

Who We Are — We have been helping men wrap their minds

around becoming dads since 1990. We built and now sponsor Boot

Camp for New Dads, the internationally acclaimed orientation workshops

for dads-to-be. More than 300 coaches conduct these “nursery

in a locker room” workshops across the U.S. and have helped

prepare over 250,000 men of all types to be fathers. We publish

Dads Adventure magazine and operate so new

fathers have a place to get information they need and can trust.

A good father is great for babies and brings balance to

the lives of new moms. Mom then has more time and appreciation

for dad, which motivates him to do a better job for

her and their baby, which strengthens their relationship for

the long run. A great way to form a new family.

The alternative is much more prevalent as most relationships

suffer when a new baby arrives – often for the long run.

Mom focuses solely on her baby, has little energy for dad,

essentially pushes him away, and becomes angry that he is

not doing his share. A lousy (but very common) way to form

a family.

Our New Moms Hearts and Minds Project goal is to

strengthen the relationships of new parents. After spending

two decades educating dads-to-be about new moms, we

believe that educating moms-to-be about new dads will help

make this happen. Basically, by understanding and supporting

dad, a new mom will bring out the best in him.

We can only do this with the help of experienced moms

to both help us refine our message, and pass it on to momsto-be.

We also need to know of any advice you have for

new moms on getting the best out of dad. (This is how Boot

Camp for New Dads works – the veteran dads with their

baby on their laps tell the rookies what they have learned.)

Moms have always been our biggest supporters and

we know we can count on you to help us now. To start, we

ask that you review the ten things new moms need to know

about new dads, and tell us how to say it better. The way

we see it, this will help new dads keep mom’s heart (or get it

back after those first tough months), and he in turn will help

mom keep her mind.

We are on a mission to help strengthen fatherhood

across the U.S. (and world now). Mothers set a very high bar

for us fathers, you are fully networked, and are the only real

support a man has as he transforms into a dad. Nothing but

What New Moms Need To Know About New Dads

1. A new mom has a huge array of information and support, including

her mate, friends, family, the healthcare system and the

entire media and retail sectors. A new dad has a new mom.

2. Mothers are the most important factor in a father’s involvement with

his baby. You can facilitate it or hinder it, especially in the months

surrounding the birth when a new dad’s motivation peaks.

3. If you back off on doing everything with the baby and expect

him to do his part, he will. Encourage him to get out of the

house with his baby on his own, which is when they develop a

very special relationship.

4. Men thrive on respect, confidence and love and all are in

short supply as we become fathers. Focus on respect for what he

does right. It will build his confidence and show you love him.

5. Dads bring a unique set of strengths to raising kids and are the

best brain development toys possible. Don’t turn dad into an

assistant mom, encourage him to do it his way. Your baby will

thrive on the difference.

6. Having our babies get excited when they see us, and knowing we

are there for them when they need us, feeds our souls as men. With

experience, our confidence builds, our instincts kick in, and we

start feeling like real dads. It just takes longer than with moms.

7. It’s not about sex, it’s about love. New moms naturally and

dramatically shift their energy, attention, intimacy and love from

dad to their baby. If mom is not happy with dad, and a new baby

generates conflict, the loss in your relationship is more dramatic.

Even if you don’t feel like sex, he still needs to feel the love.

8. OK, it is partly about sex, but we don’t buy the notion that

more vacuuming would result in more sex. If so, we would have

an entire dad subculture built around supercharging vacuums.

Imagine a Dyson with 500 horse power. Focus on the love and

the sex will handle itself.

9. You are well ahead of him on the new parent learning curve, so

bring him along as your partner in caring for your baby. Once

things settle down, refocus on your relationship. This will

pay off in terms of the dad you want for your baby and the mate

you want for yourself.

10. The more he brings your child into his life, the more balance

you get in your life. Dad too. When mom gets more balance,

dad gets more of mom. Everybody lives more happily ever after.

good can come from this mom and dad collaboration.

Do you have comments on our Top Ten list? We’d love

to hear from you at or (949)


Would you like an electronic copy of the DadsAdventure

magazine to put on your organization’s website? Please


Volume 24 Number 4 December 2009 | International Journal of Childbirth Education | 15

Are unexpected outcomes

in childbirth normal and should

they be presented in all classes?

By Sherokee Ilse

The answer to both, I believe, is

‘yes.’ Allow me to explain.

“Just remember, at the end of

this pregnancy and labor, you will

have your prize, your joy, your baby.”

These words, spoken by the assistant

childbirth educator, still ring in my ears

decades later. Sadly, our ‘prize’ was a

baby boy who died a day or two before

birth. We named him Brennan William,

and from that day forward our

whole world changed. And we are by

far not the only ones.

Setting the Stage

In the US alone, close to 30,000

babies die prior to birth in what is

technically called stillbirth. If you add

in neonatal death and even Sudden

Infant Death Syndrome, the numbers

of families who will experience the

death of a baby is staggering in the

21st century in the United States. In

addition, there are so many unexpected

outcomes that occur during pregnancy

short of death. How are parents to

face the many common disappointments

and tragedies that occur in most

pregnancies or even their fears about

them if they are not even discussed by

childbirth educators?

Preparing for birth and parenting...

the dreams, the hopes, and the plans...

is something every parent does. The

hopes are high and the expectations

about the experience, while unique

for every person, are vivid to most. As

young children, most wannabe parents

planned their dream childbirth journey,

seeds planted as they played ‘mommy,

daddy, and baby.’ Over the years, the

dream grew as they watched adults

parent and prepared for their own

family. Pregnancy tests, ultrasounds,

books, videos, and meeting friends’

babies made it come alive. The picture

became more clear of what their

pregnancy would be like (easy, glowing)

how the birth would, or would not go

(short, natural, and pain-free labor) and

what the baby would look like ( Gerber

baby maybe?).

On top of that, today parents

often believe that if they follow the

rules and do everything right they

will control their destiny; they will get

and deserve to have only natural and

‘expected’ outcomes. In most people’s

minds the worst that can happen is a

Cesarean or a long labor.

Are these dreams helpful to cling

to? Does life really fulfill every dream?

Are things fair? Should childbirth

educators allow these parents to stay

naïve and uninformed? And what if all

does not go as planned? What if they

need more pain medication or medical

intervention than planned? What

if their boy turns out to be a girl? How

do people handle change, disappointment,

and yes, even the occasional

tragedy? If the unexpected does occur,

which it does probably close to 90% of

the time, will they wonder if they did

something wrong, blame their medical

caregiver or their childbirth educator,

and will they know what to do and how

to cope?

Until recently, few childbirth educator’s

or medical careproviders wanted

to challenge these perfect dreams or

openly discuss the unexpected. This

once taboo subject is rising from the

darkness. Those who make a commitment

to touch upon this in class and

who learn ways to do it well (it can be

done well, albeit challenging at first),

find much satisfaction and even positive

feedback, after the baby is born

in particular. They often find honest

discussions promote self-reliance in

families rather than a victim mentality.

Parents who have a sense they can

control and face their fears are more

confident and adaptable.

Unexpected outcomes don’t always

have to be negative experiences that

everyone must avoid. Though there

is always some loss when part of the

dream changes, with a good attitude,

support, coping skills, and resources,

losses can become a positive, growing

experience in time.

continued on next page

16 | International Journal of Childbirth Education | Volume 24 Number 4 December 2009

Are unexpected outcomes in childbirth normal and should they be presented in all classes?

continued from previous page

It may be helpful to be reminded

that birth, babies, and indeed life, are

all gifts which people can only partially,

but not totally, control. This concept

is foreign to many prospective parents

who wish to control their lives, their labor,

and their baby’s birth. When something

goes wrong like a long stage three,

or uncontrollable emotions and expressions

of anger, a sick baby, a unexpected

deformity, or even death...guilt, fears,

and sense of personal responsibility can

be intense and long lasting.

Childbirth educators can help by

offering honesty, guidance, and hope

that no matter what happens they will

and can survive. By sharing coping

techniques, resources, and a small dose

of reality, parents can be affirmed in

their sadness and grief at the loss of

their dreams. They can also know who

to call to lean on or ask questions if

the childbirth educator has opened the

door of communication about even

such tough subjects as this.

The reality of childbirth classes in

today’s busy, electronic age puts even

more stress on childbirth educators to

include everything necessary in the limited

class hours. The mechanics of what

is to happen may take precedence, but

I would put forth that empowering

people to face any changes or challenges

that come their way ought to be

near the top, helping them to have a

‘can do,’ positive experience that may

even help them be a better parent.

Breathing techniques, stages of labor,

positions of the baby, physical and

emotional responses after birth, etc.

may seem of less importance to those

who have ‘unfaced’ fears or concerns.

The following experience offers support

for this perspective.

One Childbirth Educator’s

Story of Inspiration

Bobby K., a childbirth educator from

South Carolina, shared the following:

“I had one very memorable class

that taught me a valuable lesson in

‘priorities.’ This group was comprised

of professional people and the class

had met about three times. One night

they met in the parking lot before class,

came in and announced that all of this

‘breathing stuff’ just wasn’t relevant

and certainly wouldn’t do them any

good in labor. I was taken aback for

several minutes! Generally, when

people feel that way, they just stop

coming to class. But these people were

convinced labor was certain to be too

painful to be coped with by ‘breathing.’

Their preoccupation with pain was

unusually high. Somehow we managed

to change the discussion to fear. They

were terrified! Of everything! Instead

of the usual quiet nodding, as I or

others spoke, they blurted out fears

of deformed babies, dying of pain, of

not loving their babies, of fainting, and

even of being in an automobile accident.

The typical fears for health and

life had grown cancerous and invaded

everything. It came out sideways in

their fear of labor.

“So, I asked, “What is the worst,

most terrible thing that can happen to

you because of the pain?” and “What

are you really afraid of?”

“Each person wrote his/her answers

on a slip of paper, folded it, and

put it in a hat. In teams of two (I split

couples, put men with men, etc), they

drew out someone else’s fears and tried

some problem solving. Away from their

partners, they could more freely express

their fears. Each team then read aloud

what was on the paper and shared

their own ideas. Just having someone

else read them validated the fears and

everyone was appreciative and supportive

of someone else’s concerns. Not

surprisingly, many of the same anxieties

were expressed by several people, further

making them seem valid. Though

not verbally expressed initially, the

most frequent written fear was that the

baby would die.

“This class spent over two hours

working through these emotional

needs. It was very difficult for me to ‘allow’

them to direct their own learning.

I kept fingering my charts and glancing

at my watch. In the end, they finished

the series not knowing what a pudendal

was or how the baby turns during birth.

It took awhile for me to realize much

of that couldn’t have been learned until

the wall of fear came down anyway.

This group still wasn’t fond of the

‘breathing stuff.’ But at least their real

needs were met.”

Activities to introduce

unexpected outcomes

After the instructor has made a

willingness and commitment to cover

this topic in class, her comfort level and

positive, gentle, realistic presentation

will affect how it is actually done.

Laying the groundwork in class

can make all the difference in how this

is received. If participants know right

from the beginning that they will be

skirting no issues and that open sharing

is both modeled by the childbirth

educator and expected, the tone will be

set and likely followed.

continued on next page

Volume 24 Number 4 December 2009 | International Journal of Childbirth Education | 17

Are unexpected outcomes in childbirth normal and should they be presented in all classes?

continued from previous page

While there are many, many ways

to present and discuss unexpected

outcomes, one of my favorite activities

is the Card A, B, and C activity.

A quick summary:

Give each person a card. Ask them

to label one A, one B, and one C.

Ask them to write out words or

phrases to express their ‘dream come

true’ plans/hopes for this pregnancy

and this baby on Card A.

On Card B ask them to write out

a “What if scenario of anything they

have been concerned that might happen...minor

types of issues (partner out

of town when they go in labor, labor

starts before they are ready, longer than


On Card C ask them to put down

their biggest fear. You might point out

that everyone has fears and find them

not always easy to express. If they can’t

go to their worst, how about a biggie.

It may not be wise to push someone

too hard who wants to keep their worst

fears buried.

Gather the cards -- Card A’s

together, B together, etc. Then take a

quick break.

During this time you can look

through Cards B and C to see if some

of the tougher fears have come up...if

not, you may want to add in a few.

Upon return, speak about your

hope and wishes that Card A comes

true for everyone, however, it rarely

does. Often little things happen that

deviate from the hope and plan.

When/if Card A comes to pass, consider

it a miracle.

Now pass out a few Card B’s and

more Card C’s to each couple. Make

sure they don’t have their own. Then

ask them to discuss what they might

feel, need, and do if this were to happen.

It’s easier to be less emotionally affected

by someone else’s fear, although

this may also be a very emotional experience,

so do prepare them for that.

A wrap-up discussion of this activity

is vital. This can be a very powerful

and enlightening exercise, so plan for

plenty of time for discussion. Some

parents have even said, “If my baby

dies, I want to take pictures, spend

time with her, invite my other children

to hold her, etc.” This certainly won’t

happen every time, but do keep in

mind that for many people when they

are encouraged to face a concern and

given support and guidance, they can

and do handle it.

Share a few resources (books,

websites, suggestions) for a few of the

fears and let them know that if they

remember nothing else if this happens

to them, or someone they know,

CALL YOU. And also tell them that all

these things have happened to various

people who do survive and have happiness

again...if they understand the

importance of doing their grief work

over what has been lost. Offer them

hope and a belief that they can handle

anything and you will be there to help.

In summary

I am quite convinced that if our

childbirth educators had suggested

some of the following, our experience

would have been substantially different:

• that no matter what happens during

the birth process we would be able

to handle it.

• that if anything unusual or unexpected

occurred we were to call

one of them for help, support, and


• to face our fears rather than avoid

them, thus gaining a bit more control,

• and know that even if our dreams

changed, even dramatically, after

we had weathered the disappointment

and grief, we would find new


After a number of months and

even more so years later, I came to see

that our sweet Brennan had a mission

in life; he was and still is our ‘prize.’

Sadly, he didn’t live outside the womb,

but he lives in our hearts forever. And

he motivates me to continue a three

decade crusade to make it better for

other moms, dads, and families one at

a time. I reach out to each of you and

ask you to go beyond your comfort

level. Gently and carefully help prepare

families to know that unexpected

outcomes are normal and they can be

faced and handled, no matter how bad

they are. Empower them to believe

they can survive and to know who to

call (you or other community resources)

for help while making some of the

most important decisions in their lives.

The above article was adapted from a

small portion of the book, Presenting

Unexpected Outcomes: A Childbirth

Educator’s Guide, by Sherokee Ilse.

Available from ICEA or

online store. Sherokee teaches

childbirth educators practical methods of

how to Present Unexpected Outcomes and

is presently writing a CEU home study

unit on this topic.

18 | International Journal of Childbirth Education | Volume 24 Number 4 December 2009

Nurturing Laboring

Women Through the Years

By Paulina Perez, RN, BSN, FACCE, LCCE, CD

As I write this article, a breeze

blows through my memories of the

last 44 years I have been working in

maternity care. I have cared for many

laboring woman but it was not until

late 1981 that I began to work professionally

as a “monitrice”/doula even

though I had been working in obstetrics

since 1965. As with most other

things in my perinatal career, I began

this work because of the need of a patient.

Someone asked me to help them.

Two fathers in a refresher childbirth

class asked to hire me for labor support

for their wives. Word of mouth spread

fast and I have been doing professional

labor support since then. Being a monitrice/doula

means that you are asked

to drive miles to get to your clients’

homes. You are there late at night when

others aren’t around. You often work

both night and day. Your work takes

you to many different hospitals.

When I began my labor support

practice in 1981, I agreed to accept any

client whose hospital and physician/

midwife OK’d my presence. I had to

find myself in three impossible situations

before I changed my policy. One

of those impossible situations involved

a physician who had originally agreed

to my presence but began to punish my

client during labor. The abuse began

with sarcastic, demeaning comments to

the mother while looking directly at me

and continued with “extremely rough”

vaginal exams. His gestures were abrupt

and fierce. The situation escalated as

I stepped out of the labor room to go

the bathroom. The physician literally

cornered me in the break room

where I stopped to get a cup of coffee

before returning to my patient’s room.

He began to directly verbally accost

and abuse me with implied and direct

threats. His threats ranged from his assurance

that he would see that I could

no longer attend births at this hospital

to a more direct “I will get you.” He

also mentioned that I should watch out

for myself from now on. Boy, this was

a very direct threat to my well-being.

He went on saying that he also would

have someone come to my childbirth

classes and report to him every thing

I said. Any attempts to reason with

him proved useless and just seemed

to escalate his bizarre behavior. It was

after this episode with him that the

extremely “rough” vaginal exams of my

client began.

I feared for not only myself but for

my client. I decided to excuse myself

from this labor. At that time I simply

told my client that I had a emergency

at home. I felt that nothing would be

gained by open confrontation and potentially

much could have been lost by

the mother. I felt that for me to remain

at this labor would put the mother in

danger of receiving less than adequate

care, simply due to my presence. For

that reason, I chose not to tell the

family at that time my real reason for

leaving. I felt strongly that birth should

not ever be a battleground. Before I left

I arranged with

an L&D nurse

friend to come

in immediately

and provide

labor support

to my client.

I did report

the incident

to the chief of obstetrics and as well to

the obstetrical nurse manager at the

hospital. It did not surprise me that no

action was taken against the physician.

The substitute labor supporter I

hired to attend my client did report

that after I left the “rough” treatment

ceased, although the physician

did comment several times about my

absence. He kept saying to the mother,

“Where is Polly? I thought she was so

important to you and your birth.”

I learned this after that birth when

I talked with my client and her husband

honestly about what happened

and my real reason for leaving. They

were very understanding of my reasoning

and felt that I had made the appropriate

decision. They did not discuss

this incident with their doctor as they

felt openly confronting him with this

information would make my position

as a monitrice/doula at that hospital in

even more peril.

I was devastated emotionally

and had nightmares for six months

about this incident. This affected me

continued on next page

Volume 24 Number 4 December 2009 | International Journal of Childbirth Education | 19

Nurturing Laboring Women Through the Years

continued from previous page

so deeply because I felt responsible in

some way for the abominable way this

woman was treated. I have always tried

via all of my professional actions to

help others; so to see someone treated

in a very inappropriate manner simply

due to my presence was and is hard to

live with. Many nights after this incident

I “relived” this obstetrician making

his remarks to this mother as he

did on that fateful day- remarks such as

“If you think you hurt now wait until

later- didn’t anyone tell you this would

hurt?”, while flashing a huge smile and

looking directly at me. Those words

didn’t pierce the surface of my body,

but the memory of them continued

long after the incident. Many discussions

with therapist colleagues of mine

helped me deal with this incident and

helped me make the decisions about

how I would continue to give care.

Within the next six months I had

two clients who had totally unnecessary

cesareans. I did a lot of soul searching

and decided that due to differences

in philosophy about the way labor

and birth should be handled that I

would not attend births at certain area

hospitals and with certain physicians.

I felt, and still feel that I was doing my

potential clients a favor by the strong

statement I was making. By hiring me,

parents felt that they could get what

they wanted from the birth; but the

reality in certain birth settings was that

even with my presence a “good” birth

experience would be very unlikely. I felt

my new policy would make parents become

aware of what they could realistically

expect from the hospital system. I

felt that this has helped many families

realize that they needed to seek a different

hospital or caregiver. I referred

them to physicians and midwives that

I’ve worked with who have the same

philosophy of birth as the client and

also mine. My clients simply wanted to

labor and birth in their own way and

have medical interventions only when

they were medically necessary. This

should have been a simple goal. Most

of my clients seek what I call “basic

birth”: nonintervention unless intervention

is really medically necessary.

After my change in practice policy

about where I would work was made,

I found that the cesarean rate in my

practice lowered considerably. I also

started working with many women that

wanted a VBAC. After my change in

practice policy, the vaginal delivery rate

for the women I cared for who wanted

VBAC also increased to 85.77%. The

largest VBAC baby delivered vaginally

in my practice weighed 10 pounds and

11 ounces. The longest VBAC labor

with which I assisted was four days.

This particular woman had two previous

cesareans with no vaginal births

and one of the cesareans was a twin

pregnancy. She labored at home until

the last four hours. Her obstetrician

was aware of the labor throughout all

of the prodromal time. We had kept in

close phone contact and the obstetrician

even saw the woman once in her

office during the labor. This doctor was

most reassuring to the mother about

continuing her very slow prodromal

stage at home. This woman actually

dilated at a rate of 1 centimeter per

day and went into the hospital on the

fourth day at 6 centimeters of dilation.

I was there with her continuously. I was

there with each position change. I was

there when she was rocking back and

forth on the hospital bed while swinging

her head from side to side as she

coped with her labor. I was honored to

be there when she birthed her VBAC

baby- the one some told her would

never be able to be birthed vaginally.

Labor support has always been important

to me as I see it as integral to

perinatal care. I have always wanted the

women I cared for to know that “I am

continued on next page

20 | International Journal of Childbirth Education | Volume 24 Number 4 December 2009

Nurturing Laboring Women Through the Years

continued from previous page

here and you are not alone”. I wanted

to be there with them when they were

in the deep water of the sea of labor. I

was there with each contraction watching

the birth come closer and closer. I

saw the strength and courage in their

eyes as they knew that I believed in

their ability to birth their baby.

The pressure and harassment

continues for all of us who support a

change in maternity care and believe

in protecting normal birth. Riding

out the bad times takes courage and a

plan. We must take responsibility for

our time with the clients we much care

about. We must decide what we truly

care about. We must have complete

faith in birth and birthing women. We

must think positive. We must weave a

lifetime blanket of trust for the women

who come after us. We must help

renew their spirit and engage their

heart! We must support each other so

that we can continue to help, support,

nurture, and attend laboring women.

We must lift up others and help them

pull through the difficult times.

After giving a speech on labor

support at an area meeting, I received a

letter stating, “Sitting there listening to

you talk, I suddenly realized how much

I truly admire you for your energy and

your spunk, but also for your consistency.

I can see how it must be awfully

distressing for you sometimes, to seemingly

be banging your head on the

walls of hospital rules and regulations.

So when you are on the downswing,

think about how many women you

have helped to give birth positively and

perhaps they, like me, will find maturity

and peace through your influence.”

We fight for such a vital cause

that effect only how we birth, but

how our daughters will birth in ages

to come. Our care makes a difference

in the world of mothers and babies.

Our hopeful and helpful words can

positively change the course of a labor.

We must all remember this and try to

keep the faith!

I have learned how you face the

turns in the road will show how you

face life. I learned that I had the ability

to take things in stride. I have learned

to really know and feel compassion

and empathy for the pain of another

human being. I appreciated the emotional

complexity of perinatal nursing. I

learned that taking the time to listen to

my client’s stories helped me give them

better care. I learned that the quality of

care is what counts. And to this day, I

continue dancing under the rainbow of

perinatal maternity care.

Polly is an internationally known nurse

and public speaker. Polly is President of

C.F.E., Inc of Johnson, Vermont. She is a

consultant to hospitals, universities and

corporations on health care related issues.

Polly has always campaigned for patient

rights and for family-centered care. She

is the author of numerous articles and

books which include Special Women:

The Role of the Professional Labor Assistant,

The Nurturing Touch at Birth:

A Labor Support Handbook, Doula

Programs: How to Start and Run a

Private or Hospital-Based Program with

Success!, Special Women: The Role of

the Professional Labor Assistant - the

video, Birth Balls: The Use of Physical

Therapy Balls in Maternity Care and

Brain Attack: Danger, Chaos, Opportunity

and Empowerment. Polly can be

reached at, www. or www.

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Volume 24 Number 4 December 2009 | International Journal of Childbirth Education | 21

A Photo Essay

Scenes from the 2009 Conference

Doulas demonstrate labor

techniques and exhibitors

interact with attendees.

Photos by Connie Livinston and

Vonda Gates

22 | International Journal of Childbirth Education | Volume 24 Number 4 December 2009

Volume 24 Number 4 December 2009 | International Journal of Childbirth Education | 23

Many Thanks to Conference Supporters!

ICEA would like to thank the

following individuals and businesses

for the success of the 2009 ICEA

Convention in Oklahoma City:

SPONSORS: March of Dimes -

Sponsor for General Session speaker

Jan Figart.

SPEAKERS: Donyale Abe,

Diana Barnes, Donna Beger, Loretta

Bezold, Alison Bishop, Greg Bishop,

Cindy Carter, Christine Cleary, Deana

Dumaoal, Jan Figart, Vonda Gates,

Barbara Harper, Lisa Hayes, Marilyn

Hildreth, Katrina Hubbard, Sandy

Jones, Val Lincoln, Chris Maricle,

Connie Livingston, Patricia Predmore,

Jenny Kozlow Rodriguez, Jeanette

Schwartz, Terriann Shell, Elizabeth

Smith, Linda Smith, Jan Tedder,

Sharon Ward, Denise Wheatley, Kim



Birth Power, Booth Camp for New

Dads, Childbirth Graphics, Cord

Blood Registry, Customized Communications,

Inc., DONA International,

Frontier School of Midwifery and

Family Nursing, Howbility, InJoy Birth

& Parenting Education, Inc., Lamaze

International, Lansinoh Laboratories,

March of Dimes, Perinatal Education

Associates, The Family Way Publications,

The Gideons International.



AUCTION: Because of your very

generous spirit, we were able to raise

over $1700 at the 2009 Silent Auction

which benefits the Scholarship

Fund. Thank you for all that you do to

educate, empower, and advocate for

pregnant mothers and new families.

Wishing you and your business continued


Awaken Your Birth Power, Barbara

Hotelling, “Birth Day” by Mark

Sloan, MD, “Birthing in the Spirit” by

Cathy Daub - Birthworks International,

Bummis, Britax Car Seats, books

from Perinatal Education Associates,

Calomseptine Ointment, Childbirth

Graphics, “Comfort Measures” DVD

by Penny Simkin, Expressiva, “Fathers-

To-Be” by Patrick Houser, “Family-

Centered Maternity Care” by Celeste

Phillips, InJoy Birth & Parenting

Education, Inc., Lansinoh”Laugh and

Learn” DVD - Sheri Bayles, RN, Linda

Smith, Mamalates Nicette Jukelevics,

Pepsi, Pumpin Pal, The Family Way,

“The No-Cry Parenting Guide” - Elizabeth

Pantley, Sandy Jones.

…And our many individual

members and supporters that generously

contributed personal and homemade

items to our Silent Auction!

Letters to the Editor

Thank you for publishing the article Broken Maternity

by Kathryn L. Berkowitz. I received a link to the article and I

was very pleased to hear the insider’s point of view regarding

this subject. It was refreshing (though sad) to hear Kathryn’s

story, but I appreciate the fact that you published it, because

it’s a story that needs to be told over and over again until

people know (in advance) that there is emotional sequelae

that may be expected following an abortion. I am a new grad

CNM and I feel this will help me to have greater insight and

ability to help my clients when I begin to attend laboring

women again.

—Kathy Mercer, CNM

• • •

Thank you so much for publishing Kathryn Berkowitz’

poignant story of her experience of abortion and its

aftermath. My heart ached, as it has so many times as I’ve

listened to women pour out similar stories. Her detailed

description of the pain and subsequent healing gives voice

to the hundreds of women who have stayed silent except

to share behind the closed door of my counseling office.

Abortion is almost always shrouded in secrecy and shame,

sometimes sustained by years of denial until those protections

break down, intensifying the personal devastation.

For two decades now, I have observed these women to

often go on and experience complex layers of further grief.

Because of the physical intrusiveness of the procedures

themselves, it isn’t unusual that subsequent pregnancy and

birth may include a myriad of problems. And then there is

the psychological component so articulately outlined by Ms.

Berkowitz. I was also appreciative of her sharing how she

has found help. Care Net Pregnancy Centers all over North

American offer counseling for women who find themselves

experiencing difficulties after an abortion experience. Additionally,

some houses of worship and private therapists have

become knowledgeable in offering help to these women.

Unfortunately, the scared silence of so many women has

been complicit in our inability to gather hard evidence of the

true nature of abortion aftermath, especially in the face of

the political stridence that accompanies this issue. I long for

the day when we can really dissect these sequelae that I so

frequently see and hear. Meanwhile I think Ms. Berkwotiz’

article should be required reading for all those involved in

assisting families during the perinatal experience.

—Nancy Williams, MA

Certified Childbirth Educator, International

Board Certified Lactation Consultant

Licensed Marriage and Family Therapist

24 | International Journal of Childbirth Education | Volume 24 Number 4 December 2009

Becoming a Birth Writer

By Elizabeth Merrell Gross

A few months ago I received a Facebook message from

a friend urging me to check out a great blog about birth. I

clicked on the link and found myself laughing out loud one

moment and tearing up the next. The author’s description of

her own journey into a world where natural childbirth rather

than the standard “medicalized” birth was the norm was

both hilarious and touching. Heather Armstrong, writing as

“Dooce” turned her successful blogs about her first pregnancy

into a full-length book endearingly titled, It Sucked

and Then I Cried: How I Had a Baby, a Breakdown, and a Much

Needed Margarita. Her breezy style and spot-on depiction of

pregnancy, labor, and birth strikes an empathetic chord with

women who can immediately identify with her experiences.

Heather Armstrong is one of the lucky ones. Blogging,

although immensely popular, carries no guarantee

of success. It is, however, one way to get started as a birth

writer. Blogs usually catch on through word of mouth and

by being forwarded through email and social networks such

as MySpace and Facebook. To be a successful blogger, one

must blog fairly consistently. Readers rarely tolerate sporadic

postings. If you plan on having a successful blog, write often

and encourage faithful friends and family members to spread

the word.

Another way to get started as a birth writer is to submit

articles to magazines that focus on pregnancy and parenting.

The plethora of publications offers terrific opportunities to

share what you know with a select readership. Some magazines

recycle articles and that makes getting published with

them a bit like jumping onto a spinning merry-go-round. Do

you have a fresh perspective on a pertinent topic? What is it

that sets your article apart from the others? Is the publication

looking for anecdotal information or do the editors prefer

research-based articles? Know your audience and take the

time to read a few copies of the magazine to determine if it

is the best venue for what you have to offer.

Giuditta Tornetta, author of Painless Childbirth: An

Empowering Journey Through Pregnancy and Birth (Cumberland

House Publishing 2008) began her writing career as a

performance artist writing one-woman shows. Her advice

for women interested in writing about birth professionally is

to “just do it.” She also urges writers to check their sources

and make sure information is backed up by research. She

says, “This industry is very careful to [use] evidence based

statements.” Writers who publicly publish articles have a

responsibility to present information fairly and accurately. It

may feel good to discharge some emotional rhetoric, but too

many have worked too hard as childbirth educators, doulas,

and midwives to be seen as unrealistic, ignorant, or just plain

crazy. Certainly everyone has a right to express an opinion,

but care should be exercised so that an entire network of

doulas does not find themselves out of work because one

wrote a defamatory article about a particular obstetrician or

hospital policy.

Trends in birth writing have stressed the need to incorporate

a great deal of research and supportive data when discussing

labor, birth, and parenting. Our society has become

more fact-based and there are no shortages of arguments on

either side of an issue. It is no longer enough to simply decry

the overuse of epidural anesthesia or internal electronic fetal

monitoring. New parents and birth professionals need factual

information. Providing women with thoughtful, specific,

concrete data during their pregnancies can definitely help

prepare them for the birth experience. Birth plans (another

form of birth writing) offer women and couples a chance to

articulate their desires and preferences for labor and delivery.

It is comforting to have a plan written down and to know

that it provides a starting framework for handling the challenges

of birth.

As a doula for the last fifteen years, I feel strongly

some of the most important birth writing is encompassed

in the birth story. Penny Simkin stressed the importance of

“preserving the birth memory in a positive light” at my very

first doula conference in Gainesville, Florida. I am dismayed

when I meet other doulas who discount the importance or

necessity of writing a birth story for their clients. Some laugh

at my anxious expression and tell me, shrugging, that writing

is just not their thing. I understand. If Penny had said we

needed to draw a picture of the birth, I may have balked

knowing that any birth drawing I might attempt would look

more like a Rorschach test. But this is where the argument

is made: It is words – spoken or written- where we have

continued on page 33

Volume 24 Number 4 December 2009 | International Journal of Childbirth Education | 25

Poor Knowledge of Causes and

Prevention of Stillbirths

Among Health Care Providers

An Implication for Regular In-Service Training in Developing Countries

AUTHORS: E.O Ojofeitimi, Ph.D+, E.O Orji, MB BS,

FWACS++, E.O Asekun-Olarinmoye, B. Sc.(Hons), MD,

FWACP+, J.O Bamidele, MD, FMCPH+, O.O Owolabi B.Sc.++,

E.A Oladele, MB BS, M. Sc.+, + Department of Community

Medicine, College of Health Sciences, Ladoke Akintola University

of Technology, Osogbo, ++College of Health Sciences, Obafemi

Awolowo University, lle-Ife, Osun State, Nigeria.

CORRESPONDING AUTHOR: Professor E.O Ojofeitimi, +

Department of Community Medicine, College of Health Sciences,

Ladoke Akintola University of Technology, Osogbo, Osun State,

Nigeria. Email:


Introduction: Stillbirths contribute significantly to

perinatal mortality in developing countries where infection,

malnutrition and poor obstetric care are still perennial health

problems. Among the health care providers in developing

countries,there is a dearth of information on the knowledge

of causes and prevention of stillbirths

Objective: To assess the level of knowledge of health

care providers on the causes and prevention of stillbirths.

Materials and Methods: A Semi-structured questionnaire

containing open and close ended questions was

employed to collect data from 201 health workers including

medical students, nursing officers and community health

officers. The two colleges of medicine students who participated

in the study have had full posting in Obstetrics and

Pediatrics while the nursing officers and community officers

in training have had more than eight years experience in

health care delivery at antenatal clinics.

Points were awarded for each correct question and the

maximum possible score was 21. The level of knowledge was

determined by using a scale ranging from less than 5 as very

poor, 5-8 as poor, 9-12 as fair and above 13 as good. Data

were analyzed and Chi-square test of statistics was used to

test for level of significance, P- value was placed at p0.05). Only 36 (17.9%) of the

respondents were able to distinguish between stillbirth and


Conclusion and Recommendation: There is a poor

level of knowledge on the causes and prevention of stillbirths

among all the cadres of health workers. This is a pointer to

the need for (i) regular in-service training among all the cadres,

(ii) review of curricula of all health cadres to lay emphasis

on stillbirths and (iii) increased efforts to improve practical

activities during obstetrics and pediatrics’ postings.

Keywords: stillbirth, miscarriage, knowledge, causes and

prevention, health care providers


Stillbirth either before or during labour is a difficult

experience that occurs in one out of 200 pregnant women

[Onadeko and Lawoyin 2003; Olusanya et al 2006; Kuti

continued on next page

26 | International Journal of Childbirth Education | Volume 24 Number 4 December 2009

Poor Knowledge of Causes and Prevention of Stillbirths Among Health Care Providers

continued from previous page

et al 2003; Njokanma et al 1994; Orji et al 2006]. In fact,

stillbirths contribute significantly to perinatal mortality in

developing countries where infection, malnutrition and

poor obstetric care are still perennial problems [Kuti et al

2003; Njokanma et al 1994]. The perinatal mortality rate

(PMR) in advanced countries where adequate nutrition

health and obstetric care exist, is put at 10 to 20 per 1000

births as compared to 60 to 120 per 1000 births in developing

countries [Kuti et al 2003; Njokanma et al 1994; Orji

et al 2006; Orji 2002; Fasubaa et al 2003; Kuti et al 2003;

Ojofeitimi et al 2008]. The PMR in Nigeria, for example, has

been reported to be very high and it ranges from 30 to 120

[Onadeko and Lawoyin 2003; Olusanya et al 2006; Kuti et al

2003; Njokanma et al 1994].

While several studies have substantiated the common

causes of stillbirths in developing countries to include

teenage and advanced maternal age pregnancy, high parity,

prolonged obstructed labour, high level of caesarean section

refusal, type 2 diabetes, malnutrition, infection, inadequate

prenatal care and lack of emergency obstetric care [Onadeko

and Lawoyin 2003; Olusanya et al 2006; Kuti et al 2003;

Njokanma et al 1994; Orji et al 2006; Orji 2002; Fasubaa et

al 2003; Kuti et al 2003; Ojofeitimi et al 2008; Fretts 2005;

Lawoyin 2007; Adimora and Odetunde 2007; Onwuhafua

and Oguntayo 2006; Sule and Onayade 2006], none of the

studies cited in the literature has ever assessed the level of

knowledge of causes and prevention of stillbirths among the

health care providers let alone among the nursing mothers

and pregnant women. It is therefore pertinent to periodically

assess the level of knowledge of health care providers on the

causes and prevention of stillbirths, especially, in developing

countries such as Nigeria where the PMR, under age

five and infant mortality rates are still very high [Onadeko

and Lawoyin 2003; Olusanya et al 2006; Kuti et al 2003;

Njokanma et al 1994; Orji et al 2006; Orji 2002; Fasubaa et

al 2003; Kuti et al 2003]. After all, stillbirths are preventable

and the health care providers are the custodians of health

information that is required to reduce PMR.

Materials and Methods

Subjects: A total of 201 workers including medical

students, nursing officers and Community Health Officers

were interviewed. The respondents comprised of 134 medical

students, 35 Community Health Officers and 32 practicing

nursing officers. The subjects were purposefully selected from

two health institutions in Osun state, Nigeria. The medical

students have had full posting in obstetrics and pediatrics,

while the Community Health Officers in training and nursing

officers have had more than eight years in health care

delivery at antenatal clinics.

Data collection on assessment of knowledge of

causes and prevention of stillbirths: A semi-structured

questionnaire containing open and close ended questions

was employed to solicit the respondent’s knowledge on

the most common known causes of stillbirths; difference

between miscarriage and stillbirth; some factors that can

increase a mother’s risk of having stillbirth; and steps to be

taken to prevent stillbirth.

Scoring Technique: This was based on the review of

literature as to the commonly known causes of stillbirths,

definition of stillbirth and miscarriage, factors that increase

a mother’s risk of stillbirth and steps to be taken on prevention

of stillbirth. The correct responses were scored a point

each. The total maximum possible score was 21. A total score

less than 5 was interpreted as very poor. A total score from

5-8 was graded as poor. A total score from 9-12 was rated

as fair and a total score of above 13 was interpreted as good

knowledge of the subject matter.

Statistical Analysis: After the levels of knowledge

among the health care providers were scored, coded and

grouped, the following null hypothesis was used: that there

was no statistical difference between educational status,

cadre, marital status, age and level of knowledge on cause

and prevention of stillbirth. The null hypothesis was tested

using Fisher’s Chi-square table. A probability, P

Poor Knowledge of Causes and Prevention of Stillbirths Among Health Care Providers

continued from previous page

Table 1

Socio-demographic characteristics of respondents


Variable Frequency Percent

Professional status

Community health Officers 35 17.4

Medical students 134 66.7

Nurses 32 15.9

Age (years)

21 - 25 59 29.4

26 - 30 84 41.8

31-35 18 9.0

>35 40 19.9

Marital Status

Single 113 56.2

Married 70 34.8

Divorced 17 8.5

Widows 1 5.0

Educational Status

Secondary 10 5.0

Tertiary 191 95.0


Yoruba 176 87.6

Ibo 18 9.0

Hausa 7 3.5

Table 2

Key Variables on Awareness of stillbirths among health care


Knowledge About Stillbirth

Variable Frequency Percentage

Ever heard of Stillbirth

Yes 158 78.6

No 43 21.4

Person who has had Stillbirth

Relative 87 33.3

Nobody 91 40.0

Friends 42 20.9

Self 11 5.5

Can Stillbirth be prevented?

Yes 190 94.5

No 11 5.5

Need more Information on Stillbirth

Yes 145 72.1

No 58 27.9

Level of Knowledge on causes

and prevention of Stillbirths

< 5 (Very poor) 126 62.7

5 - 8 (Poor) 64 31.8

9 - 12 (Fair) 11 5.5

13 + (Good) 0 0.0

As shown in Table 2, about 60% of the respondents

have been exposed directly or indirectly to stillbirth and

practically (94.5%) of them believed that stillbirth can be

prevented. Only thirty six (17.9%) of the respondents were

able to distinguish between stillbirth and miscarriage. About

28% indicated that there was no need for more information

on stillbirth because they were knowledgeable on the subject.

However, 94.5% of the respondents were rated as very

poor or poor on level of knowledge on stillbirths.

Table 3 depicts that level of education, age cadre and

marital status of the respondents were not significantly

related to the level of knowledge of causes and prevention of

stillbirths (P>0.05)

Table 3

Relationship between level of knowledge of causes and prevention

of stillbirths and socio-demographic characteristics of


Socio-demographic Level of Knowledge


Age: (years) Very Poor Poor Fair P- value

21-25 34 21 4 0.235

26 - 30 54 24 8 not significant

31-35 15 3 -

>35 23 16 1

Marital Status

Single 71 34 8 0.557

Married 41 27 2 not significant

Divorced 13 3 1

Widow 1 - -

Educational Status

Secondary 7 3 - 0.713

Tertiary 119 64 11 not significant



Health officers 22 13 - 0.3 77

Medical Students 81 44 9 not significant

Nurses 23 7 2


Yoruba 106 60 10 0.135

Ibo 16 1 1 not significant

Hausa 4 3 -

continued on next page

28 | International Journal of Childbirth Education | Volume 24 Number 4 December 2009

Poor Knowledge of Causes and Prevention of Stillbirths

continued from previous page


Pregnancy is a time of joy for most parents, filled with

hope, excitement and expectations for the future. But

pregnancy can also be a time of worry and fear, particularly

when a stillbirth occurs. Sometimes, the fetus develops

health problems in the womb and as a result, cannot survive

to term. Known as still birth, these deaths can be traumatic

and difficult for any parent to have to deal with [Fretts 2005;

Lawoyin 2007; Adimora and Odetunde 2007; Onwuhafua

and Oguntayo 2006; Sule and Onayade 2006].

The healthcare workers are strategically positioned to

counsel parents on the possible causes and prevention of

stillbirth [Fretts 2005]. However, as our study showed, there

is a general poor level of knowledge on the causes and prevention

of stillbirths among all cadres of respondents. This

is appalling. The implications are numerous. On one hand,

this implies that pregnant woman may not be counseled on

what to do to avoid having stillbirth which implies that the

level of stillbirths would continue to rise. On the other hand,

when the risk factors are present, appropriate timely intervention

would not be instituted because the health worker is

ignorant of the practical implication of such risk factor.

Unfortunately, stillbirth is a fairly common occurrence

in all countries in the world. Though any woman can experience

a stillbirth, there are certain factors that increase their

risks. These risk factors include: having a multiple pregnancy,

having pre-existing health conditions (such as high

blood pressure, diabetes), smoking during pregnancy, using

street drugs during pregnancy and being over the age of 35

[Onadeko and Lawoyin 2003; Olusanya et al 2006; Kuti et

al 2003; Njokanma et al 1994; Orji et al 2006; Orji 2002;

Fasubaa et al 2003; Kuti et al 2003; Ojofeitimi et al 2008;

Fretts 2005; Lawoyin 2007; Adimora and Odetunde 2007;

Onwuhafua and Oguntayo 2006; Sule and Onayade 2006].

Adequate knowledge of these by the health care providers

would assist in counseling clients appropriately.

Due to increased knowledge and better treatment of

maternal conditions, the numbers of stillbirths occurring every

year in developed countries have reduced [Fretts 2005],

clients are counseled to attend all prenatal appointment

where the welfare of mother and baby are regularly assessed

to identify the above malfactors. The baby’s movement is

also noted and infections such as Syphilis, Gonorrhoea,

Chlamydia, Toxoplasmosis, etc are detected and treated early

in pregnancy. Any pain or vaginal bleeding is reported early.

However, in developing countries like ours, the level of PMR

is likely to be on the increase since the health care providers

are ignorant of the causes and what to do to prevent

stillbirth or even detect early warning signs.

In conclusion, this study has shown a poor level of

knowledge on the causes and prevention of stillbirths among

all the cadres of health workers interviewed.

We therefore recommend that medical schools and

School of Nursing/Midwifery should review their curricula to

lay emphasis on practical knowledge of causes and prevention

of stillbirths. Furthermore, regular update and refresher

courses should be organized for the workers rendering

maternity services at all level of health care delivery.


Adimora GN, Odetunde IO 2007. Perinatal Mortality in University of Nigeria

Teaching Hospital (UNTH) Enugu at the End of the Last Millennium.

Niger J Clin Pract. 10(1):19-23.

Fasubaa OB, Orji EO, Ogunlola IO, Kuti O, Shittu SA 2003. Outcome of

Singleton Breech Delivery in Wesley Guild Hospital, Ilesa, Nigeria. Tropical

Journal of Obstetrics & Gynaecology 20(1):59-62.

Fretts RC 2005. Etiology and Prevention of Stillbirth. Am J Obst Gynae

193(6): 1923-1935

Lawoyin TO 2007. Infant and Maternal Deaths in Rural South West Nigeria:

A Prospective Study. Afr J Med Med Sci. 36(3):235-41.

Kuti O, Owolabi AT, Orji EO, Ogunlola IO 2003. Ante-partum Fetal Death

in a Nigerian Teaching Hospital: Aetiology and Risk Factors. Tropical Journal

of Obstetrics and Gynaecology 20(2): 134-136.

Kuti O, Orji EO, Ogunleye IO 2003. Analsyis of Perinatal Mortality in a

Nigerian Teaching Hospital. J. Obstet. Gynaecol 23 (5): 512-4.

Njokanma OF, Sule-Odu AO, Akesede FA 1994. Perinatal Mortality at the

Ogun State University Teaching Hospital, Sagamu, Nigeria. J Trop. Pediatr 40

(2): 78-81.

Ojofeitimi EO, Ogunjuyigbe PO, Sanusi RA, Orji EO, Akinlo A , Laisu

SA, Owolabi OO 2008. Poor Dietary Intake of Energy and Retinol among

Pregnant Women: Implications for Pregnancy Outcome Southwest, Nigeria.

Pakistan Journal of Nutrition 7(3):480-484.

Olusanya BO, Surulere OA, Okolo AA 2006. Still Births in Sub-Saharan

Africa. Lancet 8, 368 (9530): 17.

Onadeko MO, Lawoyin TO 2003. The Pattern of Stillbirth in a Secondary

and a Tertiary Hospital in Ibadan Nigeria. Afr. J Med Sci. 32 (4): 349-52.

Onwuhafua PI, Oguntayo A 2006. Perinatal Mortality Associated with

Eclampsia in Kaduna, Northern Nigeria. Niger J Med. 15(4):397-400.

Orji EO 2002. Analysis of Obstructed Labour at Ife State Hospital, Ile-Ife,

Nigeria. Sahel Medical Journal 5(3): 143-146.

Orji EO, Ojofeitimi EO, Esimai AO, Adejuyigbe E, Adeyemi AB, Owolabi

OO 2006. Assessment of Delays in Receiving Delivery Care at a Tertiary

Healthcare Delivery Centre in Nigeria. J Obstet Gynaecol 26(7):643-4.

Sule SS, Onayade AA 2006. Community-based Antenatal and Perinatal

Interventions and Newborn Survival. Niger J Med. 15(2):108-14.

Volume 24 Number 4 December 2009 | International Journal of Childbirth Education | 29

Calendar of Events

January 14-15, 2010

Cincinnati, OH. Professional Childbirth

Educator Workshop. Connie Livingston RN,


Bowen Center for Womens Health. 11317

Springfield Pike Springdale, OH 45246.



Phone: (937)312-0544 or 1-866-88-BIRTH

January 15-16, 2010

Tifton, GA. Professional Childbirth Educator

Workshop. 8-5:30PM Both Days

(Friday&Saturday). St. Anne’s Episcopal

Church. Vonda Gates, IAT-CE-D.

Phone: (605)343-3203 or (605)209-7115.


January 16-17, 2010

Sacramento, CA. Professional Childbirth

Educator Workshop. Donyale Abe, IAT-CE.

Website: Childbirth Professional Development



Phone: (707) 742-3830

January 22-23, 2010

Midland, MI. Professional Childbirth Educator

Workshop. idney Mueller, IAT-CE-D.

Phone: (269)388-4670


January 23-24, 2010

San Antonio, TX. Professional Childbirth

Educator Workshop. Donyale Abe, IAT-CE

Website: Childbirth Professional Development



Phone: (707) 742-3830

February 5-6, 2010

Cape Girardeau, MO vicinity. Doula and Labor

Support Training Workshop. Exact Location

Coming Soon. Jean McHenry, IAT-CE-D


Phone: (630)877-7482

February 6-7, 2010

Oakland, CA (San Francisco Bay Area).

Professional Childbirth Educator Workshop.

Donyale Abe, IAT-CE

Website: Childbirth Professional Development



Phone: (707) 742-3830

February 7-8, 2010

Cape Girardeau, MO vicinity. Professional

Childbirth Educator Workshop. Exact Location

Coming Soon. Jean McHenry, IAT-CE-D


Phone: (630)877-7482

February 13-14, 2010

Naples, FL. Professional Childbirth Educator

Workshop. JM Birth Consultants. Marilyn




Phone: (703)350-2056

February 20-21, 2010

St. Louis, MO (Airport Location).

Professional Childbirth Educator Workshop.

Donyale Abe, IAT-CE

Website: Childbirth Professional Development



Phone: (707) 742-3830

February 27-28, 2010

Las Vegas, NV. Professional Childbirth Educator

Workshop. Babytime Birth Services.

Diana Peterson, IAT-CE


Phone: (818)693-1513

March 4-5, 2010

Columbus, OH. Professional Childbirth Educator

Workshop. Connie Livingston RN, BS,

LCCE, FACCE, ICCE, IAT. Location: The Inn

at Darby Glen. 14515 Robinson Road Plain

City, Ohio 43064



Phone: (937)312-0544 or 1-866-88-BIRTH

March 6-7, 2010

Portland, OR. Professional Childbirth Educator

Workshop. Donyale Abe, IAT-CE

Website: Childbirth Professional Development



Phone: (707) 742-3830

March 6-7, 2010

Springfield, IL. Doula and Labor Support

Training Workshop. Exact Location Coming

Soon. Jean McHenry, IAT-CE-D


Phone: (630)877-7482

March 8-9, 2010

Springfield, IL. Professional Childbirth Educator

Workshop. Exact Location Coming Soon.

Jean McHenry, IAT-CE-D


Phone: (630)877-7482

March 18-19, 2010

Schaumberg, IL. Professional Childbirth Educator

Workshop. Connie Livingston RN, BS,


Location: Coming Soon!



Phone: (937)312-0544 or 1-866-88-BIRTH

March 20-21, 2010

Baltimore, MD. Professional Childbirth Educator

Workshop. Donyale Abe, IAT-CE

Website: Childbirth Professional Development



Phone: (707) 742-3830

April 8-9, 2010

Dayton, OH. Professional Childbirth Educator

Workshop. Connie Livingston RN, BS, LCCE,

FACCE, ICCE, IAT. Location: Miami Valley

Hospital, Berry Womens Pavilion. One Wyoming

Street, Dayton, Ohio 45409



Phone: (937)312-0544 or 1-866-88-BIRTH

April 16-17, 2010

Bass Lake, CA (near Yosemite National Park).

Professional Childbirth Educator Workshop

(Discount if registered and paid 60 days in

advance). Contact: Sandy Williamson ICCE,



Phone: (559)641-7295

April, 19-20, 2010

Fort Wayne, IN. Professional Childbirth Educator

Workshop. Sidney Mueller, IAT-CE-D

Phone: 269/388-4670


April 23-24, 2010

Toronto, Ontario, Canada. Professional

Childbirth Educator Workshop. Location TBA.

Vonda Gates, IAT-CE-D


Phone: (703)350-2056


continued on next page

30 | International Journal of Childbirth Education | Volume 24 Number 4 December 2009

Calendar of Events

continued from previous page

May 6-7, 2010

Minneapolis/Saint Paul, MN. Professional

Childbirth Educator Workshop. JM Birth Consultants.

Lori Frane-Lake, RNC, WHNP, MSN,

LCCE, ICCE, IAT. Vonda Gates, IAT-CE-D


Phone: (703)350-2056

May 11-12, 2010

Worchester, MA. Doula and Labor Support

Training Workshop. Sidney Mueller, IAT-CE-D

Phone: (269)388-4670


May 13-14, 2010

Worchester, MA. Professional Childbirth Educator

Workshop. Sidney Mueller, IAT-CE-D

Phone: (269)388-4670


May 13-14, 2010

Pittsburgh, PA. Professional Childbirth Educator

Workshop. Connie Livingston RN, BS,


Location: Coming Soon!



Phone: (937)312-0544 or 1-866-88-BIRTH

May 14-15, 2010

Bass Lake, CA (near Yosemite National Park).

Doula and Labor Support Training Workshop

(Discount if registered and paid 60 days in

advance). Contact: Sandy Williamson ICCE,



Phone: (559)641-7295

May 15-16, 2010

Phoenix, AZ. Professional Childbirth Educator

Workshop. Babytime Birth Services. Diana

Peterson, IAT-CE.


Phone: (818)693-1513

June 4-5, 2010

Bass Lake, CA (near Yosemite National Park).

Professional Childbirth Educator Workshop

(Discount if registered and paid 60 days in

advance). Contact: Sandy Williamson ICCE,



Phone: (559)641-7295

June 12-13, 2010

Nashville, TN. Professional Childbirth Educator

Workshop. Donyale Abe, IAT-CE

Website: Childbirth Professional Development



Phone: (707) 742-3830

June 17-18, 2010

Kalamazoo, MI. Doula and Labor Support

Training Workshop. Sidney Mueller, IAT-CE-D

Phone: (269)388-4670


June 26-27, 2010

Ventura, CA. Professional Childbirth Educator

Workshop. Babytime Birth Services. Diana

Peterson, IAT-CE


Phone: (818)693-1513

July 5-6, 2010

Salt Lake City, UT. Professional Childbirth

Educator Workshop. Donyale Abe, IAT-CE

Website: Childbirth Professional Development



Phone: (707) 742-3830

July 9-10, 2010

Bass Lake, CA (near Yosemite National Park).

Doula and Labor Support Training Workshop

(Discount if registered and paid 60 days in

advance). Contact: Sandy Williamson ICCE,



Phone: (559)641-7295

July 23-24, 2010

Petoskey, MI. Professional Childbirth Educator

Workshop. Sidney Mueller, IAT-CE-D

Phone: (269)388-4670


August 6-7, 2010

Bass Lake, CA (near Yosemite National Park)

Professional Childbirth Educator Workshop

(Discount if registered and paid 60 days in

advance). Contact: Sandy Williamson ICCE,



Phone: (559)641-7295

August 19-20, 2010

Minneapolis/Saint Paul, MN. Professional

Childbirth Educator Workshop. JM Birth

Consultants. Marilyn Hildreth RN, IBCLC,



Phone: (703)350-2056

September 17-18, 2010

Bass Lake, CA (near Yosemite National Park)

Doula and Labor Support Training Workshop

(Discount if registered and paid 60 days in

advance). Contact: Sandy Williamson ICCE,



Phone: (559)641-7295

ICEA Calendar listings are free of charge for

events that have been approved for ICEA

contact hours. There is a charge for listing nonapproved

events. To be listed in this calendar,

contact hour applications must have been

approved two months prior to the publishing

of the IJCE and be scheduled to take place

during the three months following publication.

Events scheduled for later months will appear

in the next issue of IJCE.

Journal Submissions

The International Journal of Childbirth Education welcomes your

articles, research papers, essays, and photos for upcoming issues.

June 2010: Celebrating 50 Years

The deadline is February 1, 2010.

September 2010: Evidence

Based Practice

The deadline is May 1, 2010.

December 2010: Breastfeeding

The deadline is August 1, 2010.

March 2011: Open Forum

The deadline is November 1, 2010.

Submissions can be made on

the following topics: Childbirth

Education, Labor Support,

Breastfeeding, Birth Stories, Postnatal

Education, and Perinatal Fitness.

The guidelines for submissions can

be found at:


Please send all submissions

electronically to

Volume 24 Number 4 December 2009 | International Journal of Childbirth Education | 31

Save the Date!

Celebrate the 50-year anniversaries of Lamaze International

and ICEA in 2010 and rejuvenate your passion for safe, healthy

births. We are unifying the birth community by sharing our

ideas and learning from each other to provide committed,

evidence-based care for mothers and their families.

Abstract submissions are being accepted until

January 8, 2010. View all Mega Conference

details at

Becoming a Birth Writer

continued from page 25

great power. At the very least, we can offer a new mother a

timeline of the events of her birth. We can recreate the joy

she felt when her own mother arrived, the laughter when

her husband told a joke, and the love that filled the room as

her support people circled around her and held her during


As birth professionals we cannot change every circumstance,

but we can find the good. In 2003, one of my

doula clients died after an emergency cesarean. I wrote her

husband a birth story and in it I shared the conversation I

had with his wife a few weeks earlier when she told me how

much she loved her husband and how excited he was to be

having a son. I told him that it was a very good thing that he

insisted his wife get to see the baby and touch him before

they took him to the NICU. To this day, I believe it was the

most important writing I have ever done.

Do you have the desire to see your writing published?

There are many ways to accomplish that goal. As Giuditta

said, “Just do it.” You have nothing to lose. For those of you

who have put off writing birth stories, maybe now is the

time to begin. Birth memories fade, but the written words of

encouragement and praise will bring joy for a lifetime.

Elizabeth Merrell Gross lives in the beautiful Florida Panhandle

and has taught childbirth classes and worked as a doula for 15

years. She is the mother of five children and brand new grandma

to two precious grandsons. She also teaches College Success and

composition classes at Northwest Florida State College.

Got Babies_halfpg_IJCE 2009:Got Babies_1/2_IJCE 2009 ICEA 9/1/09 2:01 PM Page 1

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