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    Find out what other moms-to-be are asking. Join in the discussion with Henci Goer, whose expertise is determining what the research tells us best promotes safe, healthy birth. If you would like to contact Henci outside of the Ask Henci forum, send an email to

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    Archived User
    Hello Ladies I am a mother of two born by cesarean section in 2003 for high footling breech and in water at home in 2005. Prior to becoming a mother I was a laparoscopic surgeon doing about 400 cases a year. I am currently a fulltime stay at home mom. Following my homebirth, my husband and I were relieved to have navigated seemingly hostile waters to have the birth that was right for us. I have tried and tried to put aside the grief and anxiety every pregnant mother feels with the heavy burden of responsibility of bringing a new life into the world. I have participated in ICAN, API, and even put together a parenting workshop. Then I read the New Yorker article “The Score” by Atul Gawande who is also a surgeon. The article so disturbed me I can think of nothing else and feel that I must do something to help women who are trying to find a path to natural birth. But how can I effect change for a society that just plain refuses to face the facts? All the data is there, yet physicians and mothers alike disregard this information in favor of the highly interventional birth. Why? My interest in this forum is in developing ideas to exploit my credentials to encourage societal changes in attitude. Any help with this will be greatly appreciated! Thanks in advance! TC Ho - mommy of two
    Archived User

    For me this has been becoming a doula (actually not certified yet) and advertising in my neighbourhood. One step at a time. One woman at a time. I refer people to all the places I know that speak of natural birth. I suggest books to read etc. My goal is to foster the birth of a natural birthing community within our community. It takes a village to raise a child, it takes a community of women to embrace natural birth and support the pregnant and laboring woman. I live in a community where there are many natural birth advocates, but otherwise grouping together and meeting and spreading the word would be a good thing. If I were a speaker, I would organize childbirth classes to educate women about their choices, etc.

    Thos women who want to hear will hear. I can't change those who don't :-(

    I am sorry you struggled so much with putting aside' the grief and anxiety every pregnant mother feels with the heavy burden of responsibility of bringing a new life into the world.' as you wrote. Was this related to the c-section? I do not relate to this with normal birth unless you suffer from ppd.

    Archived User
    Yes. I did have alot to work through after my csxn which I had to do before I had my homebirth. After my homebirth I felt free, complete that I didn't have to constantly be "swimming upstream," that I could just enjoy my kids. Surrounded by other moms who are continuing to grow their families, however, I am constantly reminded of that struggle for a pregnant mom who certainly has the most at stake for her child. I see these moms bewildered and dismayed by the system that strives to work against them. I breaks my heart to see someone taking responsibility for their own birth who, despite education and support, still ends up with every intervention. That is the grief I feel now. I have considered doula work/ midwifery but this seems wrong for me. I have an allopathic medical background. In my community there are very very competent people already in those roles. I am looking for a way to support and validate them in their work by "pulling rank" on the OBs in town, by "flashing credentials" to moms on the fence about their decision to homebirth. Imagine the face of an OB when a patient comes for her prenatal check and declines biweekly electronic fetal monitoring and that she is considering homebirth. Then imagine the reaction when she says she has discussed it with me and that I had a homebirth. At first I tried to stay "under the radar" and didn't tell anyone about my homebirth. Now I feel an obligation to tell all my former colleagues. One of my friends who is also a physician decided to homebirth in part due to my husband and my complete and unbridled suport. This was with her first child! wonderful. But this does not seem enough to me. I want to do more. TC
    Henci Goer

    Welcome to the ranks of birth rights activists! One of the wonderful things that I see happening is that the new wave of activists come with a wide range of professional skills. The wave of which I was a part in the early 1980s, when the cesarean surgery rate started to skyrocket, did not, which was a definite handicap. But now we have lawyers, and doctors, and communications people, and accountants and tech savvy people and so on. Their knowledge and experience are real assets in making change, considering the forces arrayed against us.

    Let me think (write?) out loud some ideas that would use your skills.

    ·         Many grassroots groups are looking for Advisory Board members who bring special knowledge and credibility to the organization. Think about volunteering in this capacity for ICAN or CIMS or Citizens for Midwifery, and there are probably others who would welcome you.

    ·         Whenever an article appears in the newspaper or magazine that gets it wrong, write a letter to the editor. The M.D. after your name will boost credibility. Monitor the medical journals and do the same. There too, the M.D. will give you, I think, a better chance of being published. That could be a full-time occupation right there.

    ·         Join “Physicians for Midwives,” a doctors’ group that supports the Midwives Model of Care. The URL is  (Note: I haven’t had direct contact with anyone from this group for several years. I searched on the name to get the website so it is possible it is defunct, but the website is still up.)

    ·         Start (or join) a Birth Network. These are grassroots local groups looking to improve maternity care in their communities. You can find out more about Birth Networks by clicking on the “Advocacy” tab on the Lamaze home page at  

    ·         And, of course, feel free to chime in on this Forum.

    Anybody else got suggestions?


    -- Henci

    Archived User
    Those sound like great places to start. I am starting a dialogue with the childbirth resource network locally and am brainstorming ideas to write something that I can submit to a magazine or journal.

    Right now I have decided to forego the usual rhetoric on educating medical professionals. I feel the information is there. They know it, but it doesn't change anything. I am also not as enthusiastic about trying to "win" people over to our "side." I am, however, very passionate about focusing on those women who are already interested in ALL the options but do not know where to begin.

    I really appreciated the last chapter of your book "Obstetric Myths." Now I am reading "Birth as an American Rite of Passage." It really does explain so much about why so many physicians and mothers "buy in" to a system that is so self contradictory. I'd like to think that we should be able to create an equally compelling alternative contemporary birthing ritual that is uniquely American and feminine especially in a time when our country seems to be yearning for a more family centered way of life.

    Henci Goer
    Good for you! You might like to know that coming soon from the Coalition for Improving Maternity Services is "Evidence Basis for the Ten Steps of Mother-Friendly Childbirth," an invaluable resource for anyone wanting the evidence that backs making change in maternity care. It will be out as the next issue of Lamaze International's Journal of Perinatal Education in March. The document will debut at CIMS' annual meeting, which will be in Atlanta March 8-10 (the announcement on the CIMS website says March -11, but the first and last days are for the Leadership Team.) For more info, go to

    I'm glad you found Ob Myths useful. The book is sadly outdated, though. Amy Romano, who is in charge of the Normal Birth website, and I have started work on a new edition. It'll be a couple of years before it is out, but we are really excited about our plans for the contents, which include chapters on obstacles to change and strategies for overcoming those obstacles.

    Birth as an American Rite of Passage was an "Aha!" book for me too. Being a logical type, I couldn't understand why the evidence wasn't instigating change. Robbie's book helped me understand that it wasn't about logic or science; it was about beliefs, and beliefs don't change in response to logic or science.

    -- Henci
    Archived User
    I was going to recommend writing something to submit to a journal or magazine. I assume your breech c/s birth was a scheduled cesarean. What about writing something, in light of the debate about elective cesarean, comparing your two birth experiences? Also, given that you have insiders knowledge of hospitals, what about working locally to change birth practices in the hospital? I would like it if all healthy woman gave birth at home, but there will always be women choosing to or needing to birth in hospitals and we can work to humanize that experience. A few birth networks have had success lobbying for change in their local hospitals. I'm sure that would be easier if the birth activits had an insider in their midst. Check out the "Birth Network Stories" section of the Advocacy section of this site. Also, be aware that Lamaze gives grants to birth networks. The funding cycle is in the fall. So start thinking about what you would ask for $ for! Also, I want to echo Henci's suggestion that you get involved with birth advocacy organizations. I know Lamaze is always interested in having physicians involved at the Board level or in other initiatives. Thanks for your energy and passion. Sincerely, Amy -- PS, sorry but the computer won't let me format my responses! It's getting fixed supposedly but in the meantime pardon my single paragraph responses. :|
    Henci Goer
    Posted By Amy Romano on 02/18/2007 6:26 AM
     -- PS, sorry but the computer won't let me format my responses! It's getting fixed supposedly but in the meantime pardon my single paragraph responses. :|   
    As Amy writes, the IT people are supposed to be working on this and other problems with the new Forum software. In the meantime, I suggest composing posts in your word processing program and copying and pasting into the reply box. It's also a safety mechanism in case the software eats your post when you go to submit it, which has happened to me.

    -- Henci
    Archived User
    I have met with some of the local members of Chilbirth Resource Network and plan on attending the monthly meeting in March. I have started formulating an outreach program to identify those moms who are interested in "natural birth" options but don't know where to start. How do most groups change the hospital climate? In my surgeon days I would just meet with the nursing supervisor and hospital CEO to make changes I wanted to make. Now I'm not an OB and I no longer have hospital privileges, so I'm not sure what to do. I've thought about helping moms who describe unacceptable care to review their medical records and write letters to the hospital administration, nursing supervisor, and OB. Anone tried that in the past? TC
    Henci Goer
    The Citizens for Midwifery website has some useful documents for the sorts of things you want to do at They also have an article specifically on writing complaint letters at As far as win-win negotiating goes, you can't do better than Getting to Yes, a classic in the field.

    In my own community, Bay Area Birth Information, (BABI), (, one of the CIMS/Lamaze Birth Networks, has an annual BABI fair. The 3rd annual one is coming up, and it has grown every year. Besides exhibits, they have activities and food, and free mini-talks on various topics that go on during the day. The Santa Cruz Birth Network ( holds quarterly Pregnancy Information Nights. Two women have opened Harmony, a birth resources center ( Various classes are held there. A marriage and family counselor who specializes in perinatal mood disorders has her office there. They just expanded their space, and a lactation consultant will now have office space there too.

    -- Henci
    Archived User
    I love it! BABI is exactly what we want to do! I am so inspired - I am working hard to make sure everyone I know has access to the birth that they want. Keep you posted! TC
    Henci Goer

    I look forward to hearing your adventures.


    Archived User
    did your have your VBAC after one or two C sections? I am a little surprised that you are a  physician.. nurses are well represented in the ICAN web site .. who attended your home birth?  I am pleased that as a doctor you are willing to take this one.. as you probably know, your colleagues are not "on board."..ellen
    Archived User
    My first daughter was footling breech. I had an external version during which she became asystolic but then she recovered and i had a scheduled csxn at 39 weeks. My second was a home birth in water attended by a midwife, doula, and my husband (an emergency medicine doc). I certainly found out that my colleagues are "not on board" by the way they reacted when I told them I had an HBAC! I love seeing the looks on their faces and I tell all my friends to tell their OBs that I had an HBAC. Since they all know me quite well from sitting in the surgeon's lounge at work iin the past, they are usually stunned into agreeing to all sorts of things =)
    Archived User

    How do we change a culture? can we? I am a baby boomer who is a CNM. I find the culture that I am practicing in "Wimpy". I lived the life of trying to have a Lamaze birth in the 60's when women were put to sleep and forceps used to "drag" the baby out. Twilight sleep was the norm, we fought to have our wishes known and because more voices were heard they paid attention!!!

    Then a shift happened, those children that I birthed in the 80's are having children but not like we did. they dont want to be strong and realize that birth does have pain but it is worth it. They want epidurals to Participate without pain and since Brittany Sprears elected to have a  c/s hey, I want one too

    Oh by the way I would rather have  it on the fifth of the Month as my mother in law is coming and I want her to help.

    These women grew up in the generation of text messages, computers( I had a typewriter in high school, and if I wanted to use the phone I had to find one, one that wasnt attached to my ear)DSL,Ipods etc,

    We change the culture one birth at a time, one client at a time and hopefully the pendulum will swing the other way. I hope that I will be alive when that happens, because it was a glorious birth and I felt like I could take on the world and that was 32 years ago

    I hope it doesnt take that long to change this culture of birth.

    Henci Goer

    I hear you, but I think it is all too easy to blame the victim. We live in a culture that gives women the subtle and not-so-subtle message that their bodies are incompetent to grow and birth their babies and that labor is an unendurably painful experience. Conventional obstetric management is one long effort to pull the rug out from under the feet of pregnant women. Every visit basically consists of a bunch of tests and measurements asking “Is there something wrong?” “No?” “Come back next month and we’ll do it all over again. The obstetrician's skills and interventions, they are told, are all that stands between their babies and the ravages of that incompetence, while an epidural will spare them the agonies of labor. Better yet, cesarean surgery is the no-muss, no-fuss, pain-free panacea for it all. Why should we be surprised when women have no confidence in themselves and are willing to swallow that message whole?

    You have to remember that things were much simpler back in the '60s and '70s. Birth educators and activists were bringing good news to women: "No, you don't have to be zonked out of your mind on narcotics if you don't want to be," and "Yes, you should be able to have a loved one with you in labor." Both of those messages were common sense ones easily understood by. But electronic fetal monitoring with the false promise of perfect babies and epidurals with the equally false promise of pain-free labor with no downside shifted the ground. Now we are bringing bad news: "No, all those interventions the doctor that you trust tells you guarantee a healthy baby (or, at least, the ob can't guarantee a healthy baby if you refuse them, which amounts to the same thing) do more harm than good," and "Yes, epidurals relieve pain effectively, which narcotics never did, but they carry a whole host of problems in their train." Why on earth would they believe us? It’s like criticizing your daughter’s awful boyfriend. A few teens might listen; most will just get mad at you.

    Add on to that that we are well into the second generation of high cesarean surgery rates. They seem normal to women today. Many of their mothers and aunts and cousins had them as have their sisters and friends. Small wonder that today's women aren't listening to us. But let's put the blame where it belongs: squarely on the shoulders of the obstetricians who have successfully promoted a system of management that benefits them but is provably neither safe nor effective and is incredibly costly to boot.

    For more on this topic, I recommend Marsden Wagner’s book Born in the U.S.A. and Jennifer Block’s book Pushed. They are both great exposés

    -- Henci

    Archived User
    Hello! I wanted to thank you again for all your inspiration. I just recently re-read your rebuttal to Atul Gawande's New Yorker article. I also sent it on to a lawyer who is currently due with her third baby. Last week she was having such strong contractions that she went to the hospital thinking that baby was on its way. I spent the next nine hours reassuring her and her husband that her noninterventional choices were valid and safe. Amazingly, she went home having had only cervical checks after the labor stopped. She is still pregnant and waiting but flabbergasted at the lack of informed choice. She is showing that same spark of interest in birth advocacy that I found last spring. Since then I have started regularly speaking at prenatal yoga classes. Every month I find another woman who had resigned herself to mainstream obstetrical care despite her intuition that this was not right for her and her family. I am grateful that I am able to connect them with a network of people to find an alternative. I have also started to help teach a childbirth education class for homebirthers. I am in a dialogue with some obstetrician friends to teach childbirth education classes at their office. I have tried to get water tubs into one of the local hospitals and failed. I am writing on every topic I answer questions on in the hopes of compiling it all someday. I joined two chapters of ICAN and spoke once. I have met with midwives in our area as well as a retired family practitioner who used to attend home births here. So much to do and so little time. Thanks again for the inspiration!
    Henci Goer

    Wow! I am so excited to hear about all you have accomplished! You are pretty inspiring yourself. I feel honored and delighted to know that I have been part of your journey. Please keep us posted on your activities.

    -- Henci 

    Archived User

    Hi Maria,


    I am looking into becoming a birth Doula and I am not sure what steps I need to take.  I live in the Atlanta area and I am seeing things on line, but I'd love more information.


    CAPPA(?) and DONA were the main two that kept popping  up.  What are you doing? 

    How many hours of classes or sitting in on births or training with another Doula makes you "certified" as a birth doula?


    THANKS for your help!

    - AtlantaMama


    Henci Goer

    I know you wrote to Maria, but I thought I'd put my 2 cents in. I suggest going over the DONA and CAPPA websites to see which seems to be a better fit for you. I would also look up local doulas on the websites and get in touch with them to find out what they liked and didn't like about their training and ditto for their affiliated organization.

    -- Henci

    All Times America/New_York

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