Changing the Climate around Birth: A Kickstarter campaign for 'Why Not Home?'

I'd like a share a guest post by Jessicca Moore, a family nurse practitioner and filmmaker in Petaluma, CA, where she lives with her husband, two children, and two sheep. I met Jessicca in Boston recently, where she was screening a not-yet-finished feature-length documentary, “Why Not Home?” The film follows hospital birth providers who chose to give birth at home. You can watch a trailer and get more information here to support the project on Kickstarter, as I did.

(photo by Erin Wrightsman)

By Jessicca Moore

Our current system of birth is unsustainable. A system that spends 111 billion dollars on maternity and newborn care annually is not sustainable. A 33% c-section rate, while sustainable in some sense, is not without significant consequence.

As a family nurse practitioner, I’ve done work in healthcare improvement over the past 10 years. “Every system is perfectly designed to get the results it gets,” is a common saying in improvement work. Keeping this in mind, it’s not surprising that we have ended up here.

I am not a conspiracy theorist. I don’t believe there is one player at fault. The factors at work in the system are complex.

Instead of looking at hospitals, doctors, or insurers, I’m interested in how we as a culture have colluded with the system to sustain it and how we might change the cultural conversation around birth.

Currently the message many women hear about birth is, “Birth is painful. You can’t do it. The experts know what to do, let them handle it.” What if instead women heard something like this, “Birth is an intense transition to motherhood. You are powerful and capable. You have everything you need within you to do this. If you need help, a trusted guide is here to help you.”

We live in a culture that values technology and progress, speed, efficiency, and expert advice. While these values have led to significant improvements in many areas of science and medicine, they don’t translate very well when it comes to birth. Our outcomes have made this evident. The judicious and appropriate use of technology is too often replaced with a one size fits all overuse of technology. Still, there is reason to hope.

There is a growing movement that questions these cultural assumptions and the way they are broadly applied. We have the power to change the climate around birth. We can choose to slow down and honor birth and it’s place in the family and community. We can do this at home and in the hospital while improving quality outcomes and the experience for women and families.

Breeches and rickets: Lessons from Episode Two of the PBS Series Call the Midwife

Episode Two of PBS’ Call the Midwife gave us two births that most contemporary pregnant women don’t have to deal with. (You can read my post on Episode One here.)

The show included a woman with rickets, which is a vitamin D deficiency that was common among poor women who did not have a proper diet. The affliction can cause bones to bend – often noticeable in bowed legs, as in below – but can cause the pelvis to be misshapen as well. Sometimes the deformity could be so bad that there was no way for a baby to be born vaginally.

The mom in Episode Two had had a fatal outcome with a previous pregnancy but was able to have as c-section this time around thanks to the National Health Service covering the costs. If there is ever a time for a c-section, that would be it.

The other interesting birth was a breech, shown coming out “ass first,” as nurse Chummy (below) deadpans during the delivery. 

The scene shows how breeches can be born safely if patience, wisdom, experience and the right birth positions are applied. Today, sadly, very few women with breech babies are allowed to give birth vaginally by their doctors – mostly due to a lack of experience in knowing how to gently guide the baby out. It’s an artful midwifery practice we are losing – and shouldn't.  I’ll leave it to the sage midwife Ina May Gaskin to explain why.