Here at EBBMN we are working toward freedom in birth. Meaning we want each family to be able to make the decisions that affect their birth journey. Each family is so individual in needs and desires. Each family should know and understand their responsibility and choices as they welcome each new family member into the world.
 
Our conversation recently was on how we can help families avoid a 1st cesarean, but I think we need to take a step back and ask ourselves, why bother? Why should we try to avoid it? What’s the big deal? So many women in Minnesota have had one, it can’t be all that bad, right? So, why should a low-risk woman try to avoid one in the first place?
 
We know that vaginal birth is not without its own set of risks and complications, foremost of which is perineal trauma that requires stitches. 
 
But cesarean birth is major abdominal surgery and as such it brings with it risks to the mother.
Including:              Increased risk of death
                                Increased risk of infection
                                More likely to be re-hospitalized
                                Moms less confident with their babies
                                Moms less likely to breastfeed
 
Risks to the baby include:
                                Depressed immune system
                                Hormone level issues
                                Slower neurological adaptation after birth
                                Compromised gut flora and all the issues we are discovering that are related to normal gastrointestinal
                                function.
 
I want to say here that we are very thankful to have cesarean birth available to those who are truly high risk and for the occasion when low risk women need the surgery for truly medical reasons. It has saved many lives and we do not disregard its value in the birth room. But the staggering fact is that 32.2% (that’s roughly 1 in 3) women who walk into a hospital in the U.S. to simply have a baby are discharged having had a cesarean.
 
So how does a healthy pregnant women lower her risk of a cesarean birth if that’s her desire? One very important factor is where she will give birth. Most of us automatically think hospital. At first blush this doesn’t seem to be a major factor. One hospital may have a cesarean rate for low risk women of 19% and another one in the same city has a rate of 35%, while the World Health Organization says that the cesarean rate should be between 10% overall and that “rates higher than 10% are not associated with reductions in maternal and newborn mortality rates.” (2015 WHO Statement on Caesarean Section Rates)
 
Finding this out we then wonder, do we have options and where else do women have babies?  In the EBB workshop we look at the statistics of cesarean births for different birth settings and we take a look at independent birth center vs. hospital “birth center” to see how where you give birth is as important as our next factor.
 
Choosing a Provider
 
So let’s look at the alphabet soup of providers. Ob/Gyn, MFM, FMD, CNM, CPM, CM, DEM, etc. Each of these professionals are trained in a certain area of expertise and each one is vital to the birth community.
 
The United States and Canada stand out as the only developed nations with far more OB’s than Midwives. With most Obstetricians following the medical model of care vs. the midwifery led model of care, how does this affect birth outcomes in the United States? In other words, as the United States stands out at 48th on the list of maternal mortality rates worldwide, we at EBBMN hope to help expectant parents improve this outcome.
 
Some of the stats we find can be intimidating. But our goal is to help expectant parents and birth professionals find good information and a good understanding of the pieces making up the puzzle of healthy birth, improving results as well as the whole birth experience for parents and birth workers.
 
Elaine Switzer, CD(DONA), CLC, Evidence Based Birth Instructor

​During pregnancy women voraciously read books and blogs.  You’re talking to anyone and everyone in your circle of friends and family who has had a baby.  Probably selectively, since Aunt Agnes just tells horror stories.  The women in your world help you define what is normal, what is possible, and your vision of birth and baby.  Perhaps you are going outside your immediate family, or have no near friends, to find women’s stories on the web, or to search for a new/old way to birth as naturally as possible.  You are talking with your health care providers.  You choice about who that would be are also deeply influenced by your community, your values and your health status.
 
So, what are dads thinking?  Or moms might feel, What is this man thinking!@?%?!!!!  You’re way behind on reading!  There’s a baby on the way!!!  

​Face it, new dads during pregnancy lag about six months behind new moms when it comes to getting it.  That is, getting it about the birth, baby and beyond. Not all dads & partners lag, but, well, most do. In the birth community we are asking whether our expectations of men/partners are appropriate, or are we off-base? We are in a grand cultural experiment of asking men to be present at birth, when for millennia birth has been an event of women. Can we expect men to feel, think and behave like women? Or will men and partners define their own roles in birth?    
 
We can start by looking at differences in experience and views of pregnant women and men/partners, at our expectations, and any existing research on the question of men/partners at birth. 

What gives us safety?
We all want the best outcomes for mother and baby.  Whether you are a pregnant woman, partner, grandparent, sister or best friend, we want the best care for birth to ensure the health and well-being to bring this little one in.
 
A woman’s choices in her health care are central to her own well-being. Her own agency, taking the driver’s seat for the care of herself and her baby are the beginning of being a mother. Partners/dads, this is the beginning of your parenting, too, as you are holding a big picture of what is best for your woman and baby and taking part in decisions.
 
Our sense of safety has both emotional and objective components. Let’s respect both. We can start by sorting out. We want to understand how birth works as both an emotional and physical process, so that we are in sync with what a woman actually needs to birth well, however that looks for her. We want good information and reasoning for the objective part of making decisions. We want to respect a woman’s inner world; her values, her vision and her own sense of herself and her baby. And we want good communication, because we care about making decisions together as a new family in formation. 
 
A good conversation to have as a couple is: What gives me – what gives you - a sense of safety? Family members and friends – we can all look at that too. And couples, know that you may be treading carefully through the assumptions of other close folks who care about mother and baby.

By:  Catherine Burns

Looking towards birth for a beloved mother & baby, we all put safety first, without question. 
 
What does safety mean to each one of us?  When we start to unpack safety at birth, it has many dimensions.  Health and well-being of mother and baby are foremost.  Trustworthy medical care, available to support a woman when needed, is a priority.  In any circumstances, including challenging health complications, her well-being is also central for a woman to birth safely. 
 
Trust is fundamental to well-being.  Our trust in a woman’s capacity to bear her baby gives her strength and faith in herself.  This does not mean that every woman makes exactly the same choices about what upholds her. Every woman’s choices in birth planning and in the actual birth are to be honored. 
 
Next up in the Safety in birth blog series:  What gives us a sense of safety?
 
Catherine Burns, Evidence Base Birth® Instructor

​Instead of being in the dark, we were calm & inspired
Cat was the most professional person we met along our birth journey, and once we met her at a Childbirth Collective event, we knew immediately that she was the one.  Let us explain.
 
We hired Cat to be our Doula during Erin’s Spring 2015 pregnancy. To us preparing for childbirth meant education.  We are both consulting scientists in our profession, and we were immediately drawn to Cat’s approach.  It was based on her grasp of the available information, and while her own experience as a mom was indeed part of her skill set, her professional approach as an educator meant that we received the data we needed to confidently and happily reach the conclusion of the pregnancy and begin the birth process. When Freya was born it was not only an emotional event, but also one where Erin and Freya were both happy and healthy, and we just could not have reached that same conclusion without our trusted advisor and friend Cat.