January 19, 2011
Volume 13, Issue 2
Midwifery Today E-News
“Cesarean Prevention”
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In This Week’s Issue:

Quote of the Week

“The cesarean is not easier for anyone, except the doctor.”

Mortimer Rosen

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The Art of Midwifery

When considering the various choices for birthing positions, the mother needs to understand that her choice may not be based solely on cultural preference. It may, in fact, have a physiological rationale. If left to choose her own mode of delivery, the mother will usually opt for the one that feels most comfortable, instinctively working with her body and baby for a successful delivery.

Justine Dobson, DC, LMT
Excerpted from Midwifery Today’s Wisdom of the Midwives, Tricks of the Trade, Vol. II
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Jan’s Corner

Birth and Technology

I have a dream for this new decade: That we change birth practices all around the world and that every woman who births does so with attendants who love, honor and respect her. Dreams and visions for the future are important guidance points that bring us along in working on our goals. We in the birth field all know we have a tremendous amount of work to do to get to critical mass but I believe this is the decade of possibility. I know Midwifery Today has written against technology in the past, and in birth practices I’m still mostly against it. There are circumstances where cesareans can be lifesaving, but typically birth works best with very little technology. Look at the cesarean rate in the US, which has climbed steadily from 5.5 percent in 1970 to a record 32.9 percent in 2009.

However, technology that changes culture and spreads the word to the world about better birth is available and it’s amazing. I love a recent TED talk (Technology, Entertainment and Design) with Chris Anderson and I am recommending it to you because it shows how technology, appropriately used, can change the world, and fast. I am thinking about the ways we can and already do use technology to change birth.

Midwifery Today has a YouTube channel and we are just beginning to share some of our conference material. Many people who have lovely birth videos are putting them on YouTube to help and encourage others. If pregnant moms see lots of beautiful videos of babies being born it may affect them as much as TLC’s A Baby Story adversely affects so very many mothers. This may be another factor in the high cesarean rate; Ina May tells pregnant women not to listen to bad birth stories because they can negatively pollute the mind and might affect a woman during birth.

As midwives, we can use video technology in ways that will guarantee more motherbabies will have good births. It takes not just well-grounded moms, but practitioners who treat motherbabies and birth with love and respect to share their experiences and knowledge in the many parts of the world where there is little love and respect for birth. I think information from the TED talk I’m recommending can help us craft plans for change as fast as video changed dance. Please watch the video and let me know your visions and dreams. I thank Barbara Pellegrini Rivera for bringing this work to my attention with her vision and dedication. Watch the full TED talk here.

Jan Tritten, mother of Midwifery Today

Jan Tritten is the founder, editor-in-chief and mother of Midwifery Today magazine. She became a midwife in 1977 after the amazing homebirth of her second daughter. Her mission is to make loving midwifery care the norm for birthing women and their babies throughout the world. Meet Jan at our conferences around the world, or join her online, as she works to transform birth practices around the world.

Jan on Twitter: twitter.com/jantritten
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International Alliance of Midwives on Facebook: facebook.com/IAMbirth
Midwifery Education: Caring and Sharing: facebook.com/MidwiferyEducation

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Cesarean Delivery Rate at Record High

Preliminary data on US births in 2009, published by the Centers for Disease Control and Prevention (CDC), reports a record high cesarean delivery rate. The cesarean delivery rate in the US rose 2% in 2009, to 32.9%. This is an increase of nearly 60% since 1996. The percentage of cesarean deliveries rose across all race and ethnic groups, with the largest increase among black women. Half of all births in women 40 years or older were by cesarean.

— Hamilton, B.E., J.A. Martin and S.J. Ventura. Births: Preliminary data for 2009. National vital statistics reports Web release; Vol. 59 No. 3. Hyattsville, MD: National Center for Health Statistics. 2010. Accessed 28 Dec 2010.

Editor’s Note: For more information on cesareans in the US by year, please visit: http://www.acog.org/departments/dept_notice.cfm?recno=20&bulletin=264

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Main Article

Problematizing Choice in the Elective Cesarean Debate

A consideration of Henci Goer’s research around the issue of elective cesarean surgery in the United States reinforces the contention that the popular representation of elective cesarean surgery as a choice over which women are demanding more control is in fact both misguided and misinformed. Goer suggests that the research that is cited to buttress the claim that women prefer cesarean surgery over vaginal birth “supports nothing of the kind,” cites ten different studies that have been conducted to ascertain women’s preferred mode of birth and concludes that rather than electing or requesting cesarean surgery, the vast majority of women “merely agreed with the decision…or wanted [a cesarean section] in belief that it would be safer for themselves or their infants” (Goer 2001, 34).

What emerges is the recognition that the representation of elective cesarean surgery as a safe and equal alternative to vaginal birth that women are demanding the right to choose is reinforced by existing ideologies and power systems rather than based on any clear picture of scientific evidence. However, because perceived science is the dominant and authoritative voice that surrounds birth within a Western medical model of care, this representation is accepted as true and serves to further a picture of cesarean birth as normal and safe, despite the fact that, upon investigation, these claims appear to “contravene everything known about the comparative risks” (Goer 2001, 34).

The result of placing the debate about elective cesarean surgery within the context of a rights-based discourse is that cultural ideologies about equality and autonomy are employed without any consideration for the broader economic, social and bureaucratic factors that surround and contribute to the lived experiences of women. Admittedly, it is possible to imagine a situation in which a woman, in conjunction with her doctor’s advice and information, pursues and receives cesarean surgery, is happy with her decision and pleased with the outcome of a live and healthy baby. However, the contention here is that, while this scenario is imaginable, it is a far cry from the “groundswell of consumer demand” (Goer 2001, 35) that the Western media representation of the debate would have us believe exists. The hegemony of a biomedical perspective relies, in part, on the public perception of its knowledge as right, true and the best information on which to make decisions and take actions.


Goer, Henci. (2001) The Case Against Elective Cesarean Sections. Journal of Perinatal & Neonatal Nursing 15(3): 23–38.

Lisa Weeks
Excerpted from “Problematizing Choice in the Elective Cesarean Debate,” Midwifery Today, Issue 73
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Learn how sexual abuse affects women during pregnancy and childbirth and what you can do to help.

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Web Site Update

We got some very good news from the European Union recently. A victory for Ágnes, the Hungarian midwife-physician, and for Anna, the mother who took her case to the European Human Rights Court in Strasbourg, France, where we had our last conference, whose theme was “Birth is a Human Rights Issue.” You can read about these victories on Midwifery Today’s homepage for the next couple of weeks.

Read this article from the brand-new issue of Midwifery Today, Winter 2010/2011:

  • Midwifery Education: Trauma or Transformation? by Elizabeth Davis
    An excerpt from Midwifery Today’s new edition of the book Paths to Becoming an Midwife: Getting an Education, this article guides aspiring midwives toward an educational program that will “midwife” them in a way that prepares them fully and totally to midwife others.

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Special Preview

MorningStar Midwifery

Editor’s Note: The following is an excerpt from Sister MorningStar’s upcoming book, MorningStar Midwifery.

Prenatal Care: The Interview

Within the initial interview between you and a mother is the opportunity to find out if you understand one another. When you ask her questions or she asks you questions, do you feel curious, interested, energized by the experience? Are you easy in her presence? Is she easy with herself or with others who are with her? If there is uneasiness, does it grow or does it diminish as you open up to one another? The more you reveal and the more you learn about her or from her, do you feel better and better about working together in a potential life/death/life cycle? Do you feel worse?

Never underestimate your instinctual feeling about a relationship or situation. If you decide to work together, this is the most important visit of all the prenatal visits you will have with her. It lays the foundation for how you will be with one another. Mutual respect must start now.

My “inner-view” is generally three to four hours, or sometimes two sessions rather than one. It is a big decision to work together. Once you are a midwife, you are a midwife to that family for life. I have adult friends who introduce me as their midwife, feeling strongly about that primary relationship. I get Christmas cards from around the world with photos of babies I caught a generation ago, now with their baby in their arms. Several families call every year on the anniversary of their child’s birth. You will be fielding happy or urgent calls long after the baby is born, has her first tooth or cold, is weaned, toilet trained and has learned to read. That first visit may last a lifetime.

Take all the time you need to establish that relationship. If it isn’t right, let it go. Make your inner peace and make your referrals and bless her on her journey. After a three-hour interview with a mother I liked very much, the father asked, “Well, now, who do we sue if something goes wrong?”

“Not me,” I answered, sitting up straight in my chair. I made my referrals and wished them well.

Sister MorningStar lives as a Cherokee Hermitess and Catholic Mystic in the Ozark Mountains of Missouri. For more information about her, go here.

The Power of WomenSister MorningStar is also the author of The Power of Women, a book filled with healing words and empowering stories, designed to help women listen to their instincts during childbirth. Buy the book.

library book stack graphic

Make the vision of natural birth available for all to see.

Ask your library to order natural birth and midwifery books for you. The more information about natural birth is available for the public, the better a mother can make educated decisions about how she wants to birth her baby. Making requests is easy; here’s how.

Think about It

In the late 1800s, physicians’ guilds and associations in Western Europe and North America resolved to drive midwives from the profession, both to protect the economic viability of their own practices and to subject the large groups of lower socio-economic patients normally served by midwives to medical research and testing.(2) Many midwives defied the authority of these doctors and suffered the consequences—unemployment, mockery and even imprisonment.

Today, midwives continue to practice civil disobedience by working in areas where laws have not been passed to differentiate midwifery from the practice of medicine. Midwives are arrested annually, usually not because of a complaint from clients or negligence, but simply because it comes to the attention of the medical community that midwives are practicing without medical training and approval.(3) Even though convictions are rare, the expense and scandal these charges cause can ruin a midwife’s reputation in a community she’s been serving for years.


  1. Banks, A.C. 1999. Birth chairs, midwives and medicine. Jackson, Mississippi: University Press of Mississippi.
  2. Arms, S. 1994. Immaculate Deception II: Myth, Magic & Birth. Berkeley, California: Celestial Arts.

Sarah Jean Carter
Excerpted from “Breaking the Law: Midwives and Civil Disobedience,” Midwifery Today, Issue 94
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Dear Madams & Sirs,

I’m writing to ask for help in ending what many view as the disturbing and consistent Facebook practice of deleting pro-breastfeeding pages and images on their site while at the same time truly explicit nudity and possible underage pornography pages are up and running.

It’s my opinion that Facebook continues to discriminate against breastfeeding support pages, as well as users who have a pro-breastfeeding stance by deleting photos of babies nursing and the pages they are posted on. There have been many examples. I’ve included a link that describes the situation more closely by a person whose page was deleted:

Please consider looking into this unfortunate situation. It’s upsetting to find out Facebook doesn’t delete and/or takes it time to delete sexually explicit pages, and instead goes after nursing babies. It’s my hope that the anti-breastfeeding corporate Facebook culture will evolve into one of support and understanding, not only to support nursing mothers but their children as well.

Please help.

Thank you,
Heidi Ripplinger
Crystal, Minnesota

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