Beyond Birth

Never owned a crib? Join the Club.

2011-03-09T08:55:00.000-08:00

What works for your family? Each family must do what works for them, but I'm a huge advocate of basing what you do on your instincts rather than on what is popular or more comfortable when talking to friends and grandparents.

Here is a wonderful, simple explanation about why it's totally normal to sleep with your babies and kids.

Mayim Bialik: Why we let our children sleep in our bed

Two kids, no cribs... no problem? Sharing a bed with your kids isn't the norm in the U.S., but former "Blossom" actress Mayim Bialik explains how it works for her family -- and why she doesn't think it's so weird.

Denise Herrick Borchert

By Mayim Bialik, Ph.D., TODAY Moms contributor
We sleep with our two kids. They are 5 and 2, and I have never owned a crib or a bassinet. Our family bed consists of two futons on the floor side by side: one with black sheets, the other adorned with knights, castles and dragons. We don’t co-sleep, which means sleeping in the same room; we sleep in the same bed. That’s called bed-sharing.... read the rest of the article at: http://moms.today.com/_news/2011/03/07/6212018-mayim-bialik-why-we-let-our-children-sleep-in-our-bed

From Pam England "Embodied Teaching"

2011-03-08T11:20:00.000-08:00

The Birthing From Within Difference:

Read Pam's post on her blog: http://birthpeeps.blogspot.com/2011/03/change-21-embodied-teaching.html

Here is an excerpt "When I began midwifery school, I started in my heart. I had a vision, hope, and trust that filled my being. Of course, every journey begins in Innocence, Trust and as the inner Child, and and some of the initial naivety and innocence is modified in any worthwhile journey. But it was beyond a wholesome modification and maturation. By the end of my training, I was midwifing from my head, disconnected from intuition, and, over time, far from being intact in body, mind and spirit. From my own disembodied being, I taught childbirth classes to parents, from my head to their head. I gave them mixed messages about trusting their body, but separated them from their body with all the heady information. It makes sense that I gave birth the first time from my head, "evidence-based" all the way to the operating room."

Blue Cross Pays For Out Of Hospital Birth

2010-08-01T12:29:00.000-07:00

By Kimberly Rivers

All of us need to ask for what we want. Birthing women must let hospitals, doctors, nurses, midwives, doulas, family members and insurance companies know what they want. They must keep asking, over and over in some cases. This is my story of how I sued my insurance carrier Blue Cross, when they refused to pay for my birth at a birth center. I won, and they paid.

My Investigation Begins

I knew that I wanted an out of hospital birth before I was pregnant. And I interviewed midwives before I got pregnant. I had a standard PPO plan with Blue Cross. We had made sure that the policy I had included maternity coverage as we planned to get pregnant. We understood that the midwife I had chosen was willing to bill Blue Cross, but she prepared us to expect very little in the way of compensation, even less than the 50% it states the insured is entitled to when they visit a “non-participating provider”.

During the first month of my pregnancy, I realized I had to actually read my policy. You know that thick booklet that is constantly being revised and updated. A daunting thought I know, especially with the early pregnancy nausea and “placenta” brain. But I only had to read the pages pertaining to maternity care. The most important part for me ended up being in the list of definitions at the end of the booklet. When I looked up the definition of “licensed care provider”, I was happy to find that it included midwives. There was no distinction made in the booklet between Certified Nurse Midwives (CNM) who usually attend births in the hospital, and Certified Professional Midwives (CPM) or Licensed Midwives (LM). The only requirement was that they be licensed to practice in the state. My midwife was an LM.

Next I needed to know if there were any midwives in my area, who attended births out of the hospital and who were participating providers for Blue Cross. Imagine my complete lack of surprise when I found none. I wanted to put this finding “on the record” so I called Blue Cross customer service. Luckily I spoke with a very helpful and seemingly competent man who understood exactly what I was looking for. He assured me that he could find a participating provider for me. I waited. And I waited some more. He spoke and said something like “Well there doesn’t seem to be any midwives in your area who are on the list. Here’s what you can do…” He proceeded to tell me to write a letter and request a ‘special grant’. The letter should explain why I am choosing this particular midwife, and why another type of care provider, who is a participating provider would not be best for me. He let me know that when approved, a special grant can be used to provide my normal insurance coverage for what is normally a non-participating provider. The man gave me a fax number to send the letter to and a phone number to use to follow up after I’d faxed it. Like I said, he was very helpful. This sounded perfect. But it did have to be approved. None of us held our breath.

Blue Cross Approves Special Grant

So I worked on my letter. It became four pages of why this midwife was the best care provider for my baby, and me and I presented the cost of the birth. I even chose to compare the price of having my baby at the birth center versus the cost of having my baby at a hospital. I called the local hospital and endeavored to find out what they bill to insurance companies for a birth that did not entail any medications. This was much harder that I had planned on. Eventually a supervisor in billing was able to decipher what I wanted. As I expected, the prenatal care with an OB, a non medicated birth, and an overnight stay in the hospital would cost the insurance company much more than the combined cost with the midwife for all the prenatal care, birth at the birth center and postpartum care and visits.

Ok, hold on, it’s about to get confusing.

In case you are not familiar, it is common for midwives to lump all their services into one “fee”. And if they offer birth center births (in addition to home births) they commonly have an additional “birth center” fee (this makes sense when you think about the preparation and cleaning that needs to take place after a birth occurs at the birth center, as well as the overhead costs associated with maintaining the center). So included in most midwife’s fees are ALL of the prenatal visits, all care during birth, usually a midwife assistant present at your birth, any immediately needed postpartum care , APGAR exams, weigh and measure). You can get any and all tests that you want with a midwife. She draws blood, or does the “swab”, and the sample goes to a lab. Usually the lab is the same lab used by local OB’s and the lab fees are generally covered by insurance. If you require an ultrasound while seeing a midwife, she will generally refer you to her backup OBGYN, again generally covered by insurance, but you are free to go anywhere.

Can you see the great difference in billing? OB’s and hospital births require that things be billed separately. Each prenatal visit , each procedure and intervention during and after birth, all billed separately. Considering this it's no wonder hospitals and insurance companies require HUGE billing and claims departments, especially when you take into account that more people (women usually) are admitted to hospitals in this country for maternity related issues than for any other reason.

So, back to my story. I wrote my letter, faxed it in. I got a call from a woman indicating to me that my request for a special grant was approved. I would be receiving a letter shortly to that affect, and to make sure that the bills from the midwife were sent to a certain address and fax number. I took it all down, thanked her and blew a sigh of relief. Oh, another note; I kept very detailed phone records. I noted the time, date and name of the person I spoke with and if there was an important statement made, I would ask them to wait a moment while I wrote it down. So I was approved. Blue Cross had agreed to pay my normal coverage of 70/30 for my birth center birth. AND, this was the kicker; they agreed to pay the birth center fee. But, the woman from Blue Cross instructed me that it should all be billed “together”; do not separate out the birth center fee. No problem.

I received the letter. But the language was very confusing, I wasn’t exactly sure that it said what I thought it said, and what I was told it would say. Make sense? So I called customer service. I told them I received a letter that is supposed to be approving my request, but that I did not understand it. The woman, (and here is where my phone notes became vital) informed me that yes, my request had been

"totally approved, and that any and all services performed by the midwife, so long as they were within the scope of care for a midwife would be covered at my normal “contracted” rate at 70%".

I actually made her repeat that sentence so I could write it down word for word. Ok, moving on.

So I was blessed with a normal, uneventful pregnancy. I did have an early ultrasound to confirm the estimated due date. It was covered under my normal maternity coverage, so I paid the full negotiated rate. Wait a minute, what about my insurance coverage? They are supposed to pay 70% of the negotiated rate, and I (the insured) pay 30%. Nope, well at least not yet. I feel for us insurance newbie’s that a little description of how insurance works might be helpful here. I knew nothing about how health insurance works, and I still get confused anytime I have to wrap my brain around it. So using an ultrasound as an example here’s a brief lesson on insurance coverage. So you’ve got your deductible. My deductible at the time was $1500.00. And Blue Cross had a special Maternity deductible of an additional $1,000.00 on top of that. Then after ALL the deductibles are paid, the insurance “kicks” in. That means that only after we are out of pocket $2500.00 will my coverage kick in. This would have been the case if we had our baby in the hospital as well. So generally ultrasounds are covered during maternity care. And mine was. BUT since I had not yet paid my deductible, our insurance did not “kick in” yet, so we had to pay out of pocket, but we got the negotiated rate. Which in most cases is a tiny fraction of the “non negotiated” rate that the OB would charge to an uninsured woman. So we paid for the ultrasound, and it counted toward our deductible. Since the midwife combines all her services into one “bill”, nothing would get billed until after the birth. We did make deposits to the midwife, so that she has some assurance that our bills will be paid, but these didn’t “count” toward our deductible yet. Is this making sense?

So my due date arrives. And goes. I am fine. Baby is fine. We do the non stress tests (NST) with the midwife, and see the backup OB for some ultrasounds. All normal recommended “procedures” for my situation. We paid; it was put toward our deductible. All was normal we waited. My labor began normally, exactly 14 days after my estimated due date. Textbook labor. Baby born. Family goes home.

Several weeks after the birth, my midwife lets me know that Blue Cross had sent in some payments. But after some more time went by it was clear that there was a problem. I called Blue Cross. During my pregnancy the midwife had incorporated her business. So this caused some confusion. It seemed to me that any intelligent person could look at the records, and see that while the special grant was approved for an individual midwife, and that the bills were coming from the name of a birth center (now a corporation) that the address and phone number was the same, but apparently I had to point this out to their billing department. So we got that cleared up. We waited. Again, there was a problem.

I should mention that this midwife used a billing service that deals exclusively with midwives. They are used to dealing with insurance companies and out of hospital births. But my situation was a bit different. When I looked at the paperwork, I could tell that the billing service was separating things out. They were trying to make similar to a hospital bill, so that the insurance companies could understand it, and fit it into their system better. At least this was my idea of why. I called that billing service and faxed them a note about how Blue Cross had instructed me to bill in one lump sum and to include the birth center fee in with the overall fee for everything else. The billing service was sure that the birth center fee would not be covered, (since it never had been in the past) and I had to reassure them that I had received word from Blue Cross that it was in fact covered and to please bill it. The billing service did as I asked.

But Blue Cross stopped making payments. I made several phone calls. Wrote several letters. I received letters back. Lot’s of letters. Letters from different people in different departments. Letters telling me they were continuing to investigate my claims, and other letters telling me my file was closed and if I had a complaint to submit it to the body that deals with complaints about HMOs. I was told to fax information to a fax number that was not working. I was told to leave phone messages at phone numbers where I could not leave a message. I truly felt that I was literally being given the run around.

I was in a unique situation in that I have some familiarity with the legal process and I had great support. I worked with attorneys, and had an interest in the process of law. I decided I wanted to file against Blue Cross. It was my position that they approved my request, and now they were failing to do what they promised. Since the amount I would be suing them for was less than $5,000.00 it would be in small claims court. So no attorneys are allowed. The filing fee is small. And the process is fairly clear.

By this time we had paid our midwife in full, so we were out of pocket well over our deductible. I compiled a packet of evidence. This consisted of my phone records, the confusing approval letter and a clear typed timeline of events. The timeline included all of the correspondence that I had with Blue Cross. When I did the calculations, we ended up suing Blue Cross for about $2,000.00. They had made some partial payments, but they were supposed to pay 70%. I filed in Ventura County. In California all the forms you need are online. You fill them out, print them out, file with the Court, pay a fee and “Serve” them on the other party.

I appeared in Ventura County Court with my packet of evidence. And I had prepared a copy of my evidence for the Blue Cross rep as well. The first appearance was in front of a Commissioner. While considered a Judge in the courtroom, with all the “power of a Judge, they are not truly Judges. A Commissioner is a respected local attorney appointed by the judges to handle small claims matters. But in small claims, we have the option of requesting a Judge be assigned, and that is what I did. Which meant coming back another day. Remember, Blue Cross cannot send an attorney to speak on it’s behalf in small claims matters. They will send someone from their legal department, maybe a paralegal, or other person hired to show up for these matters. So he had to make the trek back up from Los Angeles as well.

So I appeared in Court for a second time, now in front of a Judge. I had a hint that things were going my way when our case was first called and the Judge asked if we had exchanged documents. Upon entering the courtroom I had handed my documents over to the Blue Cross rep (as is the proper thing to do), but he had not given me anything. So when he answered no to the Judges question, and the Judge instructed him (with an irritated tone) to hand them over to me I felt that was a good sign. I then requested some time to review the documents and the Judge agreed. An attorney friend of mine came to court with me and helped me review the documents. The phone records were there (I had subpoenaed them), and they corroborated my phone notes, but the contents, the words, the actual transcript had been deleted. It showed the date, time and person I spoke with, but the words had been deleted. I thought that was very odd, and very telling.

When the Judge called us again he first asked for a description of events from me. I had been instructed to be very brief and succinct. I focused on the letter and the phone conversations. My special grant had been approved, I was told so by a Blue Cross customer service representative. I don’t think I spoke for more than a minute. When the Blue Cross rep in court spoke he went into the contract language and how approved fees are based on what is normal and appropriate. Upon questioning from the Judge the Blue Cross rep was forced to say that Blue Cross is the body that determines which fees are normal and appropriate. The Judge frowned on this. Then he got to my documents. For me the most memorable moment came when the judge said, while talking to the Blue Cross representative

“I consider myself an intelligent person, but when I read this letter from Blue Cross to Mrs. Rivers, and when I read it again, I find that I have no idea what it says.”

The Judge went on to say that I acted “as any reasonable person would have” (another good sign) he asked both of us questions and listened to our responses. I must admit I was nervous. And was so relieved when he cut off the other guy, and said he had made his decision. And he actually took some time to mention that he used to work for insurance companies, that he knows about the language and tactics used. He found in my favor, and Blue Cross was ordered to pay the full amount I was asking for. The entire hearing lasted about 15 minutes.

As we were walking out, the Blue Cross rep commented to me “be ready for an appeal”. I replied, “I am”. I had expected them to appeal if I won this stage. I admit I was very surprised when I had a check by the end of the week.

After sharing this story with some friends, they indicated to me that similar events happened to them. They were bombarded with paperwork, forms, mountains to deal with after their birth, and they gave up. I do recognize that I was in a good position and had great help and support from attorney friends to take this on. But women can and must do this.

I don’t know how recent health care reforms will ultimately affect the way that insurance companies compensate for out of hospital births. But we must ask for what we want, and demand that we get what we were assured of. In the long run if insurance companies come around to our way of thinking, we know it will bring down costs, and at the same time provide more options for more women.

*I am happy to provide support and consultation for women who are trying to get their insurance company to pay for an out of hospital birth. Contact me for more information.

Copyright 2010 Kimberly Rivers. Permission needed to reprint, or use in any way. Please inquire, as I mostly just want to know where folks are using. Thanks.

Is a Doula Worth The Cost?

2010-07-01T11:58:00.000-07:00

By Kimberly Rivers

*please note: that I use the word “dad” for ease of writing and it is not meant to exclude the presence of partners, friends, family member or other loved ones whom a laboring woman chooses to have at her birth. And some women choose to have only a doula with her.

In the interest of full disclosure I will remind readers that I am a doula, and I offer childbirth classes. So yes, I earn money for these services. For this reason, some may consider me a biased source. Fine. But I firmly believe in my bones that this is a valuable and important service or I would not devote my time to it. And if I could do it for free, I would. It’s time spent away from my family, it’s time and money spent on ongoing training, driving, reading, networking, researching. It’s time spent pulling myself out of a cozy bed at 2:00 am to drive to a hospital to support a family during one of the most amazing, exhausting and at times challenging experiences in their lives, for me it’s priceless, but frankly, worth every penny and then some.

I also had a doula at my birth, and so when I recommend a doula for every birth (all types of birth) it simply comes from my experience and feedback from clients. I also want to acknowledge that I have heard about cases where there is negative feedback about a doula at a birth. I would like to remind folks that in all professions, in all “lines of work” there are individuals who simply don’t meet the high standards of the profession. And, even with those who are considered excellent and skilled in their work, everyone is subject to imperfection. The best of us can make mistakes. The best of us can fail to meet our clients expectations. And probably fail to please everyone present at the birth. But pleasing all family, friends, care providers and hospital staff is not the doulas role.

Recently, especially with the economy the way it is, everyone is trying to cut back and save money. Trying to only pay for what is needed. In our society it is a fact that for most families having a baby costs money, sometimes lot’s of money. So is hiring a doula for your birth a good value? I think so and here’s why.

Please note that I am not going to go down the list of ways that having a doula at a birth reduces the chances of certain interventions and outcomes and thus reduces the actual monetary cost of a birth. Because for me, that means that the doula is responsible for those things. And I simply don’t believe that to be true. There are studies that show certain interventions and outcomes are more or less likely when a doula is present, but I think it has more to do with the unpredictable nature of the million unseen and unknown aspects of birth that contribute to what happens on the birth path, than whether or not a doula is present. Too many factors contribute to each moment of a birth to give one person credit, or blame for what happens.

One of the Dad’s that I recently supported during the birth of his first child, commented to me during labor “Doulas are way underpaid”. I agree with him. Doula fees vary greatly depending on experience and location. Many new doulas who are working toward certification often attend births for free or “voluntary donations”. And some very experienced doulas in urban areas are paid a couple thousand dollars. The rest of us are somewhere in between. Many may ask, “A couple thousand dollars? To hold her hand? To do what Dad or Grandma can do?” I think these comments come from a complete misunderstanding about what a doula actually does. Family can be a great source of comfort and support, but they also bring along their own stories and ideas about birth, and the relationship with mom as well. Doulas have stories and ideas about birth too, but for me, I try to leave most of my personal stories at the door, and open myself to the story unfolding in front of me.

So in determining the value of something we can look at the time output our money gets us, and then examine whether or not we actually think the “service” provided benefits us. Let's look at the time involved, and at some of the aspects of a doulas role, then you decide if the time and services provided seem like they are of benefit and worth the cost.

Prenatal Visits

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This is when the parents go over what they hope for and hope to avoid during the birth. It’s a valuable time for the parents to get to know their doula better and become more comfortable with her. With my clients I also explore what they expect of me and of each other. I also listen carefully about where mom and dad may be holding any “fears” and I try to fish out the questions that they haven’t asked anyone yet. I also take time to do some Birthing From Within processes from the classes that I do. Sometimes this involves practicing some pain coping skills, or exploring our held beliefs about what is “allowed” and “not allowed” during labor and birth, both for moms and for her partner. This might incorporate some art making, to help flush out our stories of birth, and bring to light how those ideas may affect the way we approach our birth, and how we form expectations of birth. I spend at least 4 hours of prenatal time with clients.

Email and Phone Correspondence

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Most if not all doulas provide ongoing support throughout pregnancy by phone and email, and in person if needed. Doulas are a resource. If mom is having swelling, new back pains, sciatica or any of the myriad of normal pregnancy complaints many times her doula is the first “responder”. Providing an ear to listen, and then suggestions on how to remedy, and reminding mom of her options including to call her care provider for more information. For many pregnant women, dad, friends and family will respond lovingly to most concerns with a “don’t worry so much about that, it will be ok”. Many woman find little comfort in this well meant response. I strive to really listen, and to ask questions, to validate her concerns and help her find her own solutions or if it’s something that can’t be “solved”, as many things in pregnancy and birth are, I guide her in exploring her inner resources, asking questions like:

“How do you know to be worried about that?”

“Why would that be a problem for you?”

“How might you cope with that if it did happen?

"What kind of help might you need to accept?

"What might you have to do that you don’t plan or want to do if that happened?”

I have also helped clients find pregnancy support groups, moms groups, breastfeeding classes/support groups, sources for a certain type of diaper or other needed baby item, information on things to do in pregnancy that can help get baby in the best position for labor and birth, information on options when things come up that need medical attention, suggestions and support for negotiating with family about their involvement in the upcoming birth. Often times I help mom process information she has received from her care provider. I would estimate that on average I spend about 3-4 hours on this type of support with my clients.

On Call Time

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24 hour On Call time. This means no leaving town, no wine with dinner, keeping your phone on your hip and always looking to see who is calling, not making any “real” plans because you can be called away at any time. Keep in mind, doula frequently are on call during holidays, and family birthdays, and have missed important events to be at a birth. Being on call can also affect our sleep. Our phone near our heads, doula bag ready to go, knowing that we could (and many times do) get the call in the middle of the night. And for those of us who have families, it also means they are “on call” too, ready for a shift of schedule and any plans being thrown out the window cause mom has to get to a birth. Some doulas with young children need childcare when we are at a birth, this may have a monetary cost as well, but regardless that childcare has to be available at a moments notice. I provide two weeks of 24 hour on call time, meaning I am on call 24 hours a day beginning two weeks before the due date.

So if we tally the time up, even before labor has begun, it is about 336 hours of on call time (24 hours x 14 days) plus four hours at prenatal visits plus about three hours for email/phone support that comes out to 343 hours. If we use the minimum wage for California $8.00 ($9.79 in San Francisco) that comes out to $2,744.00. And this is all before labor has begun. Still not convinced that a doula is worth what she’s being paid? Well let’s see what happens once labor has started.

Labor Support

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Let’s jump to the point where the clients are asking for the doula to come. So the doula arrives. When I arrive (whether it’s at home or the hospital) I try to come in quietly, with minimal disturbance and I observe. So long as mom is in her “groove” and many times she is, I watch. I see how those around mom are doing and how mom is responding. I notice what mom is doing and how it’s working for her. The body language of a laboring woman can tell us a lot. It might be pretty early on, and so it might make sense for me to give some suggestions and go home. I listen. Not only to the laboring woman, but to her partner and any other people present. Other times I sense a need to jump right in, with counter pressure, visualization support, maybe labor has hit a shift and mom needs suggestions on something different to do, or maybe she just needs to look into a woman’s eyes, who knows what she is feeling, who has seen other women go down this path and to tell her

“You are doing it, your body is doing just what it needs to, you can keep doing it”.

Dad may also need some reassurance, he may be seeing and hearing things that are a bit out of his comfort zone. Having someone say that all is well and normal can be a great comfort and allow Dad to experience the process coming from a more aware place, instead of a place of fear. It may be time for a walk, for all fours, for a shower or a bite of food. It may be time to turn off the lights and “rest while you can”. It might be time for Dad to make sure the car is packed, the house is locked while I am helping mom down the stairs. Laboring at home can be any length of time, a few hours, or many many hours. One of the things I watch for are the “Gates” along the way to Laborland. Most women display certain stages, signs along the path of labor. For example, the modesty gate. At some point, many women (not all) get to a place, where they not only don’t care who sees them naked, but where they want to be naked. They leave their clothes at that gate and move further into Laborland. It signals to me that the oxytocin is flowing, the endorphins are kicking in as her body is opening. It generally means labor is moving along well. So in the doula role, I am working to support that, to keep her body moving. Creating an environment conducive to opening. Frankly, it's a lot more than just holding her hand.

If the birth is not taking place at home, at some point the decision to go to the hospital or birth center is made. If needed a doula can ride in the car with mom. Once at the birthing place I’m able to be with mom as needed while Dad communicates with those who need to fill in paperwork. Once admitted, we settle in, following moms cues as to what’s needed, as well as setting a tone of calm for her to labor within.

Allowing space for her to get as wild,

deep into herself as she needs to.

Knowing that anything she needs to do,

any sound she needs to make is welcome and accepted.

I help facilitate the communication between mom and dad and care providers. Making sure mom and dad understand the information they receive and any suggestions or advice that is given. I remind them of options, of their intentions and then give them space to make decisions that fit where they are at that moment

So let’s jump ahead a few hours. Labor is moving along. We’ve walked the halls, been in the shower, tried the birth ball, had a massage. And now whether mom is nearing the part where she pushes, or if labor has taken a different path, her support team also needs to meet the shift in energy. The journey of labor makes turns, sometime long arching turns and sometimes fast and tight turns, the support team provides a buffer at those “corners” so mom has a hand to hold, a calm face to connect with as she walks, climbs, crawls, or runs around the corner to meet the next unknown part of her journey.

Labor can take a long time. Or it can be just a few hours. But it’s more common for a woman to be laboring for the better part of a day. Remember we are looking at the value of a doula, so let’s even use a conservative time estimate for the length of labor, let’s say a nice eight hours. Add that to our tally above and we’ve got 351 hours. Calculate with the minimum wage, and a doula would be paid $2,808.00.

And I have not even begun the postpartum time spent, helping with breastfeeding, holding moms hand during any needed sutures, making sure mom and dad get something to eat, and have time to rest, checking in during the weeks and continuing to be a resource as needed. And should anything unplanned or unexpected happen a doula is there to listen, hug and even cry with.

I barely scraped the surface in describing the skills and "tools" a doula brings to a birth consider my story a small sampling. So what do you think, is a doula worth the cost?

Next Month: A story of suing a BIG insurance company to cover an out of hospital birth, and winning! Why everyone should be able to have an out of hospital birth who wants one.
Copyright 2010 Kimberly Rivers. Permission needed to reprint, or use in any way.

New Blog Design.

2010-06-17T12:18:00.000-07:00

Thank you for viewing my new blog. I'm so pleased to introduce my new blog design and layout. This is the place for the current listing of my class & workshop schedule and other notices and info that I think will be of interest to my clients and the birthing community in which I serve.

I'm also so thankful to my friends Tasha & Keith Cleaveland of Beyond Images Photography for sharing images with me for my blog and website. All photos shown are shot by them (unless otherwise noted). Please visit their website and explore all that they offer, including unique and artful announcements.

Happy Summer, Kimberly

Women Are Not "Empowered" By Their Birth!

2010-04-21T10:47:00.000-07:00

Women Are Not Empowered By Their Birth!
by Kimberly Rivers

I know that is a pretty surprising statement coming from a doula and a president of a birth activist organization. But since I have been diving into this work I have used the word empower a lot. In the info I send to new doula clients I told them “I will work to empower you…” And just this week, through a wonderful class I am taking (Birthing From Within Birth Art Process) we began a discussion about the concept of women being empowered in their birth. I came to a realization that when I use that word, I really don’t know what I mean.

So this idea was presented to me by one of my mentors. The idea that women are not actually empowered by their birth, even those “perfect” births. That it may begin a process, an opening that can lead to understanding, but “empowerment” is something different. I began to digest this. What does “empower” mean?
In an online dictionary (wiktionary) empower is defined as “ To give permission or power to do something”, or “to give confidence to do something”.

The word empower seems to suggest an
outside force or being which “gives permission or power” to another.

How can I possibly think that as a doula
that my role is to give permission
to a woman to do anything?

The only person who can do that, is SHE, herself.

And it hit me, WHAM.
What I can do is to guide & support her along the journey to AWARENESS.

I realized that contained within that now tainted (for me) phrase of “being empowered by birth”, I really meant “becoming self aware by your experience of birth”. There is a very different feeling, a different energy behind those statements. And I am still in the process of clearly understanding that difference.

Perhaps, A woman already has any power within herself that, and the act of birth, any birth, does not “create” or “give power or permission” to her, but it, the birth, can bring awareness to her. And it may take many years, many more experiences for her to find that awareness, that realization. And that no one else can tell her what it is. She has it within her.

I became aware that when I would use the word empower in relation to birth, that it was tightly bound to an image of a particular kind of birth, a particular outcome, or a particular reaction on the part of the mother to her experience, it was based on MY expectations of those things. An idea that if a woman has a particular kind of birth, is able to “achieve” that, she will be empowered or that she should be empowered. But I also knew that women can have a birth different than what they were hoping for, and walk away with a new sense of themselves, a new understanding. This is a new awareness.

A woman may gain a deeper sense of herself, and confidence from experiencing HER birth, she may realize that she can do anything. But that is something other than “empowerment”, it is something from within herself.

And it cannot come from anyone
other or anything outside of herself,
Not her doctor, not her birth,
not her partner, and certainly not her doula.

I am continuing to digest and let this idea bubble. But already, it has brought an awareness to my work that opens up more possibilities in my mentoring.

kimberly rivers copyright 2010

Dance as if...

2010-04-01T09:56:00.000-07:00

No One is Watching.. by Pam England

Click here to view article on the Birthing From Within website.

Ancient peoples danced to sanctify life, to celebrate rites of passage such as marriage. They danced and drummed in soulful preparation for physical ordeals, such as hunting or war, and, we might imagine, birth. Not so long ago, before families became isolated in television-addicted nuclear units, it was part of life for couples to dance socially, often in communal festivities: barn dances, street dances, and weddings. I think the joy and exercise of dancing must have had a positive impact on health during pregnancy, birth, and postpartum.

Reflect on the shocking, historical meeting of two worlds in the late 1800's: when "lady-like" American women bound in corsets that deformed their bodies beheld the sensuous and unselfconscious Middle Eastern dancers who arrived in New York and introduced Oriental dance, more commonly known now as Belly Dancing. Even today, some women are restrained physically and psychologically by abiding with a tacit agreement to "act like a lady," "keep your legs together," "be quiet, don't make a scene" and "for heaven's sake, don't move sensually."

What prevents most of us from dancing are the same assumptions and judgments that make us shy away from painting or writing poetry (or perhaps even laboring in our own way). Even kids are in on our cultural agreement to defer creativity to the professionals; and the rest of us only wish we were good enough to participate. If you ask kindergartners who can dance, who can paint, who can sing, every child raises their hand enthusiastically. By the time a child is in middle school, if you ask, "Who can dance?", only the gifted ones or the ones enrolled in classes would dare raise their hand!

I wonder how this attitude and collective hypnotic passivity affects the way women move through pregnancy and labor? Would you like to experiment with moving your body…moving your mind…moving your heart?

Make no effort to imitate professional dancers.
Dance Your Divine Feminine.
Dance Your Prayers.

Let the music move you. Begin with small, slow movements. Maybe your hands will dance first, then your wrists, elbows and shoulders. Or it might be that this music speaks to your right foot, ankle, and knee first. So, go with that: dance with your right foot and leg until the music moves both feet, both legs, and suddenly you find yourself in a free turn, stomping with wild abandon or jumping with joy. Let the music and dance, Dance You!

There is no "self" judgment when you dance your Divinity; "you" are not dancing; now, you become the activity of dance. You experience ecstasy; you experience the ecstasy of the music and being in your body.

Dance is essential preparation for childbirth.

During pregnancy, the joints loosen a little and the hips widen; the legs must carry extra weight. The deep, rhythmical movements of Oriental, African or Ecstatic dance strengthen and tone abdominal, back and leg muscles. Bending your knees, you become flexible in mind; you might spring into a new idea! Taking up space in a wide twirl, claim your right to be here; feel joy. Dance your feet; feel the earth. Breathe blessed life-giving energy into your body from the earth.

Some time ago Nicholee Froese, a doula, wrote me a letter describing the power of music and movement she witnessed during a labor she attended:

"I had been giving the mother therapeutic massage since the end of her first trimester and was honored to be present as she labored and gave birth. Four people supported her through labor. She wanted to be touched, preferably by about six hands at a time, through each contraction. Although she was working hard, labor was progressing slowly. A doula suggested a change in the music-from a calm, relaxing melody to something more upbeat. We put on a CD of African drumming and chanting."

African women bring to birth the tremendous strength they acquire from years of night-long, even week-long spirit dances. They dance to the lively beat of drums, big drums that sounded out the entrancing pulse of the universal heartbeat. It's no surprise that the rhythm of drumming, dancing and contractions are interrelated.

Nicholee continued,

"We coaxed the mother out of her safe position in bed, and, with one person on each side of her, we all began dancing to the beat of the drums. We put our hands on her hips and helped her move them to the rhythm. We all danced that baby out. It was a poignant experience."

When Dr. Michel Odent was medical director of the maternity clinic in Pithivier, France, he described (in his book Birth Reborn) the weekly sing-a-long with 72-year old Marie-Louise. It was the one weekly event he,

"wouldn't skip for the world…When she sits down at the piano, notes drop like pearls. Her voice rings out like pearls. Her voice rings out, singing for all the unborn babies and [their] mothers…She adjusts her glasses on her nose, and she's off again, into the celestial spheres of nursery rhymes and lullabies."

As the evening progresses,

"Marie-Louis steps up the rhythm. The melodies move faster and faster…In a flash, she is asking us to dance, to clear away the chairs, to float freely in the melodies of her guitar. And soon we are all dancing. When expectant mothers sing, they exercise their diaphragm muscles and learn to completely breathe out; they also learn unselfconsciousness and get in touch with their emotions. When everyone sings and everyone dances, it breaks down the hierarchy between professionals and parents. We share a community."

The universal healing power of music and dance

The healing power of music and dance is universal; we can receive it or share it with others without speaking the same language, without having to first explain what is troubling our heart. The healing comes mercifully when we immerse ourselves in the music, the rhythm and Move! The power of dancing grief is beautifully portrayed in an unforgettable passage in a favorite book of mine, Grace and Grit, by Ken and Treya Wilber. Ken writes of his experience in Germany, where they went for aggressive chemotherapy treatment in a final attempt to find a cure for Treya's breast cancer.

"I began walking the back streets of Godesberg feeling sorrier and sorrier for myself. At this point I was not so much thinking of Treya as I was wallowing in me. My whole life is in shambles and now Treya is going to die.
"As I walked and emoted I heard polka music coming from several blocks away. I followed the music to a cute little pub about six blocks out of town. Inside were perhaps a dozen men, all of them somewhat elderly, maybe in their late sixties, rosy cheeks from years of starting the day with Kolsch (beer). The music was lively…I loved this music. There were no women, and no younger men. About half the men were dancing together in a semicircle, arms over each others' shoulders, a type of Zorba-the-Greek dance, it looked like to me, every now and then kicking their legs up in unison…A few of the men danced in my direction and gesture for me to join them. No, thank you, no, I gesture back. A few beers later they gesture again, only this time one of them takes me by the arm, in a friendly way, and tugs…Awkwardly, very self-consciously, I join the men dancing, arms around those on both sides of me, moving back and forth, kicking our legs up every now and then. I start laughing, then I start crying, then laughing, then crying. I would like to turn away, to hide what is happening to me, but I am locked arm-and-shoulder into the semicircle. For about fifteen minutes I seem to lose all control over my emotions. Fear, panic, self-pity, laughter, joy, terror, feeling sorry for myself, feeling happy about myself they all come rushing through me and show on my face, which embarrasses me, but the men keep nodding their heads, and smiling, as if to tell me it's all OK, young man, it's all OK. Just keep dancing, young man, just keep dancing…Somehow, in that short period, it all seemed to come to a head, to rise up and wash through my system, to be exposed and to be accepted…I would like to claim that my big satori about accepting Treya's condition, that my coming to terms with her likely death came from some powerful meditation session with blazing white light and spontaneous insight pouring over me. But it happened in a little pub with a bunch of kindly old men whose names I do not know and whose language I did not speak."

Once, in a favorite childbirth class of mine, I played the soundtrack to Zorba The Greek. A dear father, a beautiful, soft-spoken artist from Bulgaria, so naturally gestured us to overlap our arms and forming a circle, we kicked-and-stepped in unison. We looked at one another, smiled at one another; the waves of love were palpable and melted away any residual fear or loss.

So, Don't Just Sit There and Think About It,
Get Up and Dance!

Put on a veil, a long colorful scarf, or a full swishy skirt. Put on the music; turn the volume up. Become the music; let your body BECOME the notes. Dance! Dance as if no-one is watching. Dance the way you want to live, the way you need to labor.

Videos:
•Prenatal Bellydance, an exercise video built on belly dance moves. Naia from New York leads the workout.
•Dance To The Great Mother, a video featuring a performance by Delilah when she was 8 months pregnant.

Copyright 2005, revised 2007 by Pam England and BIRTHING FROM WITHIN^®

NIH Conference on reaching consensus on the issue of VBAC

2010-03-10T13:38:00.000-08:00

"Lamaze International is encouraged by the NIH panel’s focus on an unbiased informed consent process that would include, at minimum, a model of shared decision-making between women and their healthcare providers. The panel acknowledged not only the pressure exerted on women to agree to unnecessary cesareans by their p...roviders, but the conflicts physicians have in providing unbiased information to their patients. Physicians have financial incentives to perform more cesareans, see performing cesareans as protective against lawsuits and liability fears, and cesareans are more convenient for physicians with busy practices."

For a report summary, and link to full report click here.

Time Magazine: Obstetrics, Cutting the Cord Too Soon

2010-02-16T15:13:00.000-08:00

A Time Magazine article quoting an article that supports delaying cutting the cord.
Love this quote from the end of the article:

Delay allows a gradual change from fetal to regular circulation without putting stress on blood vessels in the lungs and elsewhere in the body. The carefree manner in which the newly born infant is "disconnected" from his mother, concludes the report, "is in sharp contrast to the meticulous care with which the thoracic surgeon separates his patient from the heart-lung machine."

A Favorite Quote

2010-01-29T10:38:00.000-08:00

"While all of your (birth) planning may spin a cocoon of security,

in actuality, the course of your labor is unknowable...

your critical task is to prepare for a birth that has NO script." --Pam England

Reasons to take a childbirth class with someone NOT affiliated with the hospital.

2010-01-08T09:50:00.000-08:00

Here is a link to a wonderful explanation about why you might want to consider taking a class other than the free or low cost one at the hospital. Tell me what you think:

http://bellybelly.com.au/articles/pregnancy/independent-birth-education

What is a Birthing From Within Class Like?

2010-01-07T10:15:00.000-08:00

An Insider's Look at a Birthing From Within Childbirth Class

by Virginia Bobro, Managing Director & Workshop Facilitator

Many people, both expectant parents and birth professionals, contact us ,wondering what makes a BFW class unique. They ask, "What do your classes actually look like?" So I thought I'd write a bit about how our Mentors teach, and share an overview of the structure and content of a typical BFW six-week childbirth class series. Most women who take our classes are pregnant for the first time and bring a partner with them (husband, doula, mother, friend, etc). Because we emphasize learning about birth from four perspectives (mother, partner, baby and culture), it is enjoyable and very helpful for the birth partner to come to class.

When parents enter the room, they may find themselves sitting on the floor on comfy cushions, with candles or soft music. Their Mentor may serve them tea. They may notice tiger sculptures, small fairies, art supplies, or bowls of ice-cubes around the edge of the room. Perhaps there is a labyrinth or other birth art hanging on the wall. Parents get comfortable, introduce themselves, and get ready for an interesting and fun learning experience!

The first class often starts off with a bang! A touch of Labor Theater, perhaps?

The Mentor often re-enacts a "transition contraction" to stimulate questions and get right to the nitty-gritty of birth. Parents share their beliefs and expectations about what labor might feel like, and how they think they might react to these sensations and emotions. Parents may even meet the "Birth Fairy," who reminds us to be present to the process of birth, not only the outcome.

At this point, parents have had a bit of a wake-up call. They are motivated to learn some more ways of coping with labor. Next up: "Breath Awareness," which is a mindfulness practice to deepen focus and enhance endurance. As parents learn and practice, their confidence increases. Another surprise: the Mentor passes out ice cubes! During an "ice-contraction" (parents hold the ice in their hand for one minute)--to discover how their ability to cope is affected by an unpleasant physical sensation. Next up, birth partners practice supporting the mother-to-be while she holds the ice. Music, movement, touch-relaxation, back massage, and/or encouraging words all get a test-drive; then moms gives feedback, so partners can hone their skills before "game day." Learning and using a different mindfulness practice is something that happens in class in the series, so parents finish the series not with just "tools," but rather with a strong "pain-coping mindset."

It just wouldn't be a Birthing From Within class without making art! After a break for tea and cookies, parents return to their places, and discover large pieces of white drawing paper and a boxes of colorful chalk pastels. The Mentor draws a Laborinth what parents can do as labor unfolds. Time is spent adding symbols or more colors to their labyrinths, so that when they leave class, they have a powerful, personal image of their upcoming birth journey. These drawings often make their way into the labor bag and onto the birthing room walls. on a board, and shows parents how to draw one too. She may share some history of labyrinths, and how this relates to the journey through labor and postpartum. Parents learn about the stages of labor, and what kinds of physical and emotional changes they may experience during birth. A discussion of practical birth information and group sharing follows, with a focus on

As class winds down for the evening, the Mentor may offer a closing poem, story, or visualization. Parents have gained a better understanding of what birth will be like, and what they can do to make it a positive and profound experience. They leave with a closer connection to their partner and baby and a sense of excitement and empowerment about their upcoming births.

Birth Retreat in March 2010

2010-01-06T16:59:00.001-08:00

Enter the Birth Cave, during a two weekend retreat.

Two Saturdays in March, 2010
March 6th & 13th

10:00am – 4:00pm
Sliding Scale $175-$275 per couple
Led by two Birthing From Within
Childbirth Mentors,
Laurel Connell MA &
Kimberly Rivers, Certified BFW Doula

Space is limited, Reserve your space now by calling:
805-727-1393 or email kimberly.rivers@gmail.com

At Nan Tolbert Nurturing Center
555 Mahoney Avenue, Room 2, Oak View, 93022
just a 10 minutes up the road from Ventura

CLASSES AVAILABLE IN OAK VIEW & VENTURA,
CONTACT ME FOR INFORMATION
Private Classes Available

"Birth Cave" Retreat at Nan Tolbert Nurturing Center, Oak View

2009-04-17T17:25:00.000-07:00

Enter the Birth Cave, during a two weekend retreat.

Two Saturdays in January, 2010
January 9th & 16th

10:00am – 4:00pm
Sliding Scale $175-$275 per couple
Led by two Birthing From Within Childbirth Mentors,
Laurel Connell MA & Kimberly Rivers, Certified BFW Doula

Space is limited, Reserve your space now by calling:
805-727-1393 or email kimberly.rivers@gmail.com

At Nan Tolbert Nurturing Center
555 Mahoney Avenue, Room 2, Oak View, 93022
just a few minutes up the road from Ventura

CLASSES AVAILABLE IN OAK VIEW & VENTURA,
CONTACT ME FOR INFORMATION