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PS From Penny Simkin
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October 2009
Volume 1, Number 2
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Greetings!
 Since the first issue of "PS" you haven't heard much from
me, and I apologize for that. It's been a busy several months for me with
teaching, speaking, writing, and some important family matters. I'd like to
tell you a bit about what I've been up to and share some thoughts that I've
been mulling over.
DONA International's Conference
I went to the DONA Conference in July in Atlanta, which was
very exciting because DONA launched its International Doula Trainer Fellowship
program to bring doula leaders from other countries to a DONA International
Conference for training to become DONA approved trainers of birth and
postpartum doulas in their own countries, which included - Czech Republic,
Italy, Netherlands, South Africa, Mexico (2 trainers), and India. We also have
two trainers-to-be from Taiwan and Venezuela, whom I have trained here in
Seattle. These outstanding women
are well-qualified and highly motivated to make doulas available in their own
countries.
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Eco-Friendly Birth
At DONA, I gave a talk on "Eco-Friendly Birth," which
I've been developing over the past year. I examined the physiological processes
that drive normal birth and explored how "usual" birth practices alter the
habitats that are most suitable for the mother (her surroundings) and the fetus
and newborn (the womb and the mother's body and breasts).
As I prepared the
talk and thought about typical birth practices, I was once again reminded of
how well-designed the natural process is and how "usual care" disturbs and
disrupts it in almost every way. I explored the deleterious downstream effects
of usual practices, using scientific evidence to evaluate these practices and
identify better ones. It was a lot of fun (and work) to apply the language and
methods of ecology to birth. Of course, much has already been done by others
regarding the application of ecology to pregnancy and fetal development. Much
study has also been devoted to the disruption of the normal birth process by
medicalization. I merely applied "green thinking" to this phenomenon.
If you're
interested, you can purchase the CD-ROM, which includes the recorded talk
synced with the PowerPoint slides from Network Communications Audio.
My session is #DN T06R, CD-ROM of GS6. The cost is listed as $10. There were
many other great speakers whose talks you might also want to buy.
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Video: Why Comfort Measures?
Some Words from Penny, a Mom and a Doula
Click here to watch the trailer with scenes from the DVD and comments from an expectant mom and a doula.
Click here to watch a brief video about why Penny made "Comfort Measures" including a discussion of pain and "when pain becomes suffering."
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Kudos from a Customer:
Comfort Measures for Childbirth
 As a doula, my priority is my clients. My goal is that they go into
labor with knowledge that helps alleviate fear, allows them to make
informed decisions, and to know that there are multitudes of
things to do that insure comfort throughout the labor and delivery process.
Because Penny is also a physical therapist, she uses her knowledge of how the
body works in the comfort measures that she offers. And because she has pregnant women help her
demonstrate the techniques, the DVD is easy to follow.
 Not only am I able to show my clients numerous comfort
measures, but I have the knowledge
that they will not be hurt through the use of these techniques due to the great
body mechanics Penny uses. I know that if a certain situation occurs for one of
my clients, such as back labor, Penny has suggested several techniques that I can
use to help alleviate the discomfort.
I really love this DVD and hope to share it with
all my clients. Thanks Penny!
~Areline Williams, Doula
Click here to read more about Comfort Measures.
Click here to buy it now.
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Two New Home Birth Studies
Two home vs.
hospital birth studies just published from British Columbia in the Canadian Medical Association Journal and Ontario (from McMaster University)
compared birth outcomes for healthy low-risk women: midwife-attended home
births with midwives (2900 home births in BC, and 6700 in Ontario); hospital
births with the same midwives (4750 in BC; 6700 in Ontario). The BC study
included a third group -- hospital births with physicians attending (5300 in
BC) -- but I will report findings here on only the midwife attended births.
Perinatal mortality rates were the same among the groups, but serious maternal
morbidity and rates of obstetric interventions were lower in the home birth
groups in both studies. Adverse neonatal outcomes were increased for the
hospital group in the BC study but not the Ontario study.
Intervention rates were greatly increased in the hospital
groups in both studies. Why, with the same midwives attending both home and
hospital births were the processes of care and the outcomes so different?
Clearly the motivations of the women differed, and should not be underestimated.
However, other factors such as the environment and the culture and customs
within the environment have a great impact on both the women and the midwives.
For example, the culture and customs of the home are dictated by the woman and
her comfort. The midwife adapts to that culture while retaining autonomy
regarding her clinical care.
In the environment of the hospital, the culture
and customs are dictated by the institution and its leaders. Both the woman and
her midwife must adapt; neither has anything like the autonomy she has in the
home. Midwives comment that protocols requiring consultation or transfer of
care to a physician are clearly defined and inflexible. Customs such as the
woman remaining in bed, use of IV fluids, having a time limit for second stage,
and many others, lead to pressure from the staff on the midwives to adhere to
the usual practices, even when the midwife may feel the practices are not
needed or appropriate.
These studies shed much light on the place of midwives in
the hierarchy of power and authority in at least some hospitals in these two
provinces. In spite of these findings, the excellent outcomes reported for home
births in the well-organized system of maternity care in BC and Ontario
demonstrate the viability of the option of home births in the midst of the
medicalized climate for birth.
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The Labor Progress Handbook
Buy it Now for 10% Off
 We love hearing the success stories from the nurses, doulas, midwives and physicians who have successfully implemented many of the techniques described in the Labor Progress Handbook with women in labor. If you don't have your copy yet, buy one now at a 10% discount. (Enter the coupon code LPHfall09 at checkout.) And then write to us with your story!
From the foreword by Michael Klein, MD, University of British Columbia:
"This little text, which will fit nicely in a back pocket or 'lab coat', provides practical diagrams of normal and abnormal fetal positions that can be identified well before labor, and more importantly, corrected, so as to lessen the malpositions of labor that unleash the 'cascade' of interventions that characterize the experience of so many women having their first babies. It will take much to turn society back from thinking of childbirth as an accident waiting to happen and to help women realize their power and competence, but the authors have given us a tool to help in that process, to help us keep normal birth normal. I am grateful that this book is available and entering its second edition."
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What on Earth is Normal Birth?
The Lamaze Conference was in Orlando in early October --
another exciting conference with many brilliant and stimulating speakers. I
gave another new talk there called, "Yes, Birth Is Normal, but What Is Normal
Birth?" I explored and compared definitions of normal labor and birth which
have recently been issued separately by British and Canadian task forces
comprised of representatives of their professional organizations for
obstetricians, family doctors, midwives, nurses and (from the UK only)
childbirth educators.
In both countries, they went to great effort and expense
to define normal birth as a standard by which to objectively evaluate birth
practices, with normal birth being the gold standard. The two countries'
definitions differed in several areas, but I think it is very significant that
disparate groups in these countries are sitting down together to agree on a
standard (normal birth) against which all interventions should be judged.
Similar efforts to establish definitions and standards of evidence-based care
(rather than normal birth), have been undertaken in the US by Childbirth Connection, the Coalition for the Improvement of Maternity Service, and Lamaze International, but they do not have the buy-in from the most powerful
medical and obstetrical associations in this country.
The definition of normal birth that I really like
is one by Debby Gould, a British midwife. Beyond the World Health
Organization's definition of normal labor (spontaneous onset at term; low risk
throughout labor; spontaneous birth of a vertex presentation; and mother and
baby in good condition), Gould adds that labor and birth involves:
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Strenuous physical work by the mother
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Movement by the mother (seeking comfort and progress)
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Movement by the fetus through the birth canal
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A healthy mother and baby who are ready to adjust
together to their new roles
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Empowerment of the mother
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A sense of achievement from her active rather than
passive role in the birth
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(Gould D. 2000. Normal labour: a concept analysis. J
Advanced Nursing 31:418-427.)
As you can see, Gould includes psychosocial outcomes in her
profound and unique holistic definition. This is the definition that guides me
in teaching expectant couples, doulas and maternity professionals. It also
guides me as a doula and a counselor. Normal birth is by definition hard
physical work by both mother and baby, with great rewards at the end, including
the mutual striving by mother and baby to meet the challenges that come with
adjustment. If any of the features in Gould's definition are missing from a
woman's birth, it is not normal. We should help women and their partners
understand and embrace these truths.
If you want to buy an audio copy of my talk on normal birth,
you can order it from the same company that taped the DONA conference, Network Communications. The Lamaze Conference page is here, and my presentation is at the end of the list. If you can't click the link, you can buy it by clicking here - AL-T36 - $11.
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Upcoming Workshops with Penny
Israel Childbirth Education
Centre, Birth Doula Training
11.1-3.2009, Jerusalem, Israel
Penny will present an intensive 3-day birth doula training.
For more information about the Doula training course, contact
Rachelle@ymca.org.il
Israel Childbirth Education
Centre and Jerusalem International YMCA, "A Day with Penny Simkin"
11.4.2009, Jerusalem, Israel
Penny will present a full day of
workshops.
For more information, contact
greatshape@ymca.org.il
or call 02-6258436.
Washington State Obstetrical
Association, Annual Meeting
12.11.2009, Seattle, WA
Penny will present on
Perinatal Issues for
Patients with Prior Sexual Abuse
Conference Details
Simkin Center for Allied Birth
Vocations, When Survivors Give Birth
02.5-6.2010, Bothell, WA
Two days with Penny Simkin exploring how
to improve the childbearing experiences of women with histories of
abuse.
Conference Details
CIMS,
2010 Mother-Friendly Childbirth Forum & Annual Meeting
02.26-27.2010, Austin, TX
Penny will be presenting on Eco-Friendly
Birth.
Conference Details
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More Popular Products from Penny
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Next month my husband and I
will be in Israel and India for a combination of work and play. Our son and his
wife live there and will be our tour guides, and are also working with
physicians and birth activists to give us a taste of rheumatology (my husband's
medical specialty) and maternity care.
For my new readers and those who joined my list from the start, I invite you to visit my website. Many of my presentations and handouts are posted there for you to download, and my presentation schedule is also posted there. If I come to your area to speak, please come and see me, and let me know you're on my newsletter list. I hope to keep in touch with you informally on maternity care topics that mean the most to me.
I'd love your feedback.
All the best,
Penny |
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