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Wednesday, October 29, 2008

ICAN Responds to the Coalition for Childbirth Autonomy's Statement on the Cesarean Rate

A cross-post from the official ICAN blog:

The Coalition for Childbirth Autonomy (CCA) released a statement today questioning the World Health Organization’s recommended cesarean rate of 10 - 15%. CCA suggests that a woman should be able to request a cesarean without medical indication. While ICAN supports both updated research on this topic and an increase in patient education and autonomy, we maintain that many women who are choosing a cesarean are making that decision without full informed consent.

Research shows that cesareans introduce additional risk in dozens of areas when compared to a vaginal birth. For the mother, these increased risks include death, hysterectomy, bood clots, increased pain & recovery time, infection, and post-partum depression(1). For the infant, additional risks include respiratory problems, breastfeeding problems, asthma in childhood(1), and type 1 diabetes(2). In addition, there are increased risks in future pregnancies, such as infertility, ectopic pregnancy, placenta abnormality, uterine rupture, preterm birth, and stillbirth(1).

ICAN does not believe that cesarean should be the typical solution for fear of childbirth. With appropriate counseling, most women who fear childbirth are comfortable attempting a vaginal birth (3, 4). Most show long-term satisfaction with their decision to change modes of delivery (4), and with intensive therapy, labor times were shorter (3).

ICAN will continue to work to improve maternal-child health and to protect a woman’s right to ethical and evidence-based care during pregnancy and childbirth.

(1) Maternity Center Association. 2004. What Every Pregnant Woman Needs to Know about Cesarean Section. New York: MCA.
(2) Cardwell, CR et al. Caesarean section is associated with an increased risk of childhood-onset type 1 diabetes mellitus: a meta-analysis of observational studies. Diabetologia. 2008 May;51(5):726-35.
(3) Saisto, T et al. A randomized controlled trial of intervention in fear of childbirth. Obstet Gynecol. 2001 Nov;98(5 Pt 1):820-6.
(4) Nerum, H et al. Maternal request for cesarean section due to fear of birth: can it be changed through crisis-oriented counseling? Birth. 2006 Sep;33(3):221-8.

Tuesday, October 14, 2008

Pioneer Press: Can childbirth be orgasmic?

ICAN of the Twin Cities helped co-sponsor the recent local screening of Orgasmic Birth. The St. Paul Pioneer Press interviewed the filmmaker, Debra Pascali-Bonaro and local doula trainer and midwife Gail Tully who spearheaded our coalition of birth advocates sponsoring the screening. Here is the article:

Can childbirth be orgasmic? Filmmaker Debra Pascali-Bonaro thinks so

A lot of mothers might say their experience of childbirth was intense, maybe even satisfying. But orgasmic?

It can be, according to Debra Pascali-Bonaro, a birthing assistant-turned-filmmaker who was in the Twin Cities recently for a screening of her documentary 'Orgasmic Birth.'

With that provocative title, she is quick to elaborate that while some women do have a sexual experience during labor, she's using the term more broadly.

'How come, in our culture, the common perception is that birth is about pain and emergency and a terrible event to get through?' she said. 'A small percentage of people need emergency care, but for the vast majority, birth is a normal experience. I think we've lost sense of the sensualness of birth as we've moved it into this realm of technology. And I want us to reclaim it as a sensuous and sacred arena.'

Pascali-Bonaro has found a sympathetic audience in the Twin Cities, where a screening earlier this month at the Riverview Theatre in Minneapolis was organized by a coalition of natural childbirth activists, midwives and doulas.

It drew 500 people, a turnout boosted by the fact Minneapolis has the nation's highest percentage of births attended by a doula, someone trained to provide support to a mother during birth. Pascali-Bonaro is a doula.

Individual DVDs of the film go on sale this week, and the film is capturing national and international attention for the way it redefines childbirth.

"It gives us a metaphor for the joy of actual labor," says Gail Tully, a doula and one of organizers of the Twin Cities screening.

So what exactly does birth have to do with sex, other than the obvious fact that one follows from the other?

"The same hormone that we release in lovemaking is also released in childbirth and in breastfeeding — oxytocin," said doula Gail Tully. "It's a hormone that gives us a heightened perception, and it can take the edge off of pain."

The problem, according to Tully and others, is many things that happen during a typical birth in the United States may inhibit the natural release oxytocin, which is necessary to stimulate contractions and dilate the cervix so the baby can come out.

Research suggests oxytocin is released when a woman feels safe and secure, when lights are dim, when there are few disturbances and there is quiet and privacy — not exactly the conditions in most hospitals.

Even routine questions can knock a woman out of the zone, says Tully, such as "What's your maiden name?" or "Is the temperature comfortable for you?"

"We know that if you want an animal to give birth, you don't surround them with bright lights and with a lot of people," Pascali-Bonaro says. "You will disturbthem, and their labor will slow down or stop. The same is true for humans."

In other words, the same conditions that are necessary for making love are necessary for having a baby.

"If we gave couples instructions on how to have an orgasm while they are lovemaking, well, we laugh at the idea," Tully says. "We understand that it would disrupt them, and they wouldn't have that hormonal release. You don't have sex with a cheering crowd. But we accept that at birth because we think it's necessary for safety."

Some women will experience an actual orgasm during birth, Pascali-Bonaro says, though that's obviously not a goal.

"I'm getting e-mails like crazy from people saying thank you for talking about this," Pascali-Bonaro says. "There are women who are saying, 'I literally had the most incredible orgasm, and I never told anyone because I thought it was kind of unusual.' It's not the kind of thing that you tap your doctor on the shoulder and tell him about. Many women hadn't even told their partner."


Medical interventions have become commonplace at most births in the United States. Nearly one in three births is by Caesarean section, even though many researchers say the medically necessary rate is closer to 10 percent to 15 percent.

Inductions are also on the rise. For example, a study published last month in the journal Medical Care found one in four pregnant women had labor induced at a scheduled time rather than waiting for contractions to start on their own, a rate that has tripled since the 1990s. The use of the artificial hormone pitocin to start or intensify contractions is now nearly routine.

"There are times when all our medical technology has a benefit and is life-saving for the mother and the baby," says Pascali-Bonaro, who lives in New Jersey. "But I know some hospitals are using pitocin 80 percent of the time. We need to question why that is. Are we in a rush?"

Pascali-Bonaro interviews nurses, doctors and midwives in the film who point out possible negative consequences of these interventions — higher rates of postpartum depression for women who have Caesareans, for example, or research that suggests women who deliver vaginally respond differently to the cries of their newborn babies than women who have had a Caesarean.

But the real focus of the film is on the couples in the United States and abroad who gave permission for Pascali-Bonaro to film their births. The film opens with a woman who gives birth outside on the deck of her house with her husband close at hand.

Most of the subsequent births, which are edited tastefully and artistically, are also home births without pain medication or medical interventions. Whether you question epidurals or embrace them, it's difficult to walk away unmoved.

The point of the film, says Pascali-Bonaro, is to show women, especially young women who have not yet given birth, an empowering image of birth that may certainly include pain but isn't about suffering.

"I hope it touches people in an emotional level to open their heart to see that birth is not just a day to say OK, we've got to get through it," she says. "It's a day to really think about and to really make an informed decision about. I hope it's a day that people will begin to enjoy so we can welcome our babies with absolute joy, ecstasy and bliss."


Pascali-Bonaro, who has worked in childbirth education nationally and internationally for 26 years, says she literally woke up one morning from a dream and knew she had to make a film.

With no cinematography experience, she enrolled in filmmaking classes. At one point, she had the opportunity to pitch her idea, along with dozens of other aspiring filmmakers, in front of a panel of established producers and directors.

"It was sort of like the 'American Idol' of film," she said. "You got 10 minutes to stand up and explain your idea."

When her turn came, she told the panel she was working on a film called "Ordinary Miracle: Global Models of Care." A panel member brusquely told her to sit down and said, "What makes you think anyone would be interested in that?"

She was humiliated. A friend happened to be with her who had heard her speak at a workshop about birth and sexuality. The friend nudged her and told her to stand up again and say, "Orgasmic birth."

"I figured, well, this is my one opportunity, and so I jumped up and said, 'Orgasmic Birth,' and the entire auditorium laughed, and the panel said, 'Is that for real? Because if you can make that film, you've got something,' " recalled Pascali-Bonaro.

She knew she was on the right track after she met with a focus group of young men and women. She asked if they would watch a childbirth film. A third of the women said yes, and none of the men did. When she asked if they would watch a film called "Orgasmic Birth," everyone raised his hand.

Pascali-Bonaro and a few other doulas filmed the births themselves, but the finished product is anything but amateur.

One of the women filmed in labor is the wife of composer John McDowell, who wrote the soundtrack for "Born Into Brothels," which won the 2004 Academy Award for best documentary. His soundtrack for "Orgasmic Birth" is sung by Sabina Sciubba, lead singer for the Brazilian Girls. Producer Kris Liem, who has won three Emmys for film editing, signed on to edit after being wowed by the music and raw footage.


Stephanie Johnson and her husband Andre Fischer of Minneapolis were at the screening.

"I haven't been thinking about the nursery or names, things that other people ask me about," says Johnson, whose first child is due later this month.

"All I've been thinking of is that day of labor. I liked what someone said in the film, that pain of a contraction isn't a warning sign, something to get over. It's squeezing and embracing the baby."

Her husband, Andre Fischer, who has children from a previous relationship, was also moved by the film.

"I cried, because not all the other births of my children were like these," he said. "It was very emotional for me."

Maja Beckstrom can be reached at 651-228-5295.


Debra Pascali-Bonaro is collecting birth stories on her Web site for a companion book to the film. In that spirit, the Pioneer Press talked to Liz Abbene, 28, of Lakeville about the birth of her third child, Lucia, born this summer.

Abbene is a doula and agrees with Pascali-Bonaro that women need to share their positive birth stories so other women facing childbirth can go into the experience with less fear and more confidence.

Abbene's first two children were induced, the first because Abbene didn't know the exact due date and the second because doctors feared the baby was getting too large. She had an epidural for the second, pushed for three hours, and the baby had to be taken to neonatal intensive care. As she recalls, "It wasn't a good experience."

This summer, when she went to her midwife appointment, she was nearly two weeks overdue and knew the medical staff would want to induce her the next day. The midwife "swept her membranes," a simple technique that can release hormones and lead to contractions. She explains:

"It just kicked my contractions into high gear. I went into labor in the hospital at 4 p.m., and my husband and I were not prepared for it. We thought we were going to go home again. So, we called a friend to bring our stuff to the hospital.

"My husband and I were alone in the room for a while. And as soon as I could get out of bed, we just hung out in the bathroom. We had made a birth playlist on my iPod, and we played Ray Lamontagne's "Be Here Now," Joe Cocker's "With a Little Help From My Friends" and Bob Marley's "Three Little Birds."

"I wanted to be really present for the birth. I wanted to feel exactly what was happening in my body.

"The contractions weren't painful. It was an intense feeling but nothing painful. I only felt it in my back. Within an hour, I was a couple of more centimeters dilated.

"Two hours into labor, my mom arrived. She used to be a labor and delivery nurse. She was using the shower head on my back, and I realized as I was standing in the shower that the feelings I was having were those feelings you have after you have an orgasm. I was like, 'Oh, this is kind of cool.' It wasn't ever painful, it was just intense.

"When I was about 7 centimeters, I got into birthing tub. Then, things picked up and got intense. Whenever I had contraction, I had my husband's hand touching my face. I felt very, very close to him. The midwife said, 'I can tell you're nearing the end of the labor.'

"I had one more contraction. I felt a pop. My husband put my hand down, and I don't think I even pushed. The head came out, and he received the baby and laid her right on my chest.

"We didn't know if we were having a boy or a girl. It was incredible. Just so relaxing and such a moving experience. It was so completely different from my other two births. I could never give birth any other way now.

"I think so much about birth, being a doula. And I think so much of the experience is in your mind. I teach childbirth preparation classes, and we talk a lot about fear and about how fear is what creates pain. Any time you're afraid of something, the more tension you have, and the more tension you have, the more pain you have. It's a vicious circle.

"You have to decide to let go and not be afraid.

"I always tell women, 'The power to give birth is within you.' If you're fortunate enough to get pregnant, your body knows what to do to give birth."

-- Maja Beckstrom

Saturday, October 11, 2008

Consumer Reports: High tech birth = poor outcomes

Consumer Reports has published a summary of a study recently released by the Childbirth Connection on the overuse of high tech interventions in childbirth:

Back to basics for safer childbirth
Too many doctors and hospitals are overusing high-tech procedures

Mother and child
Noninvasive measures can mean better outcomes for baby and Mom.
When it's time to bring a new baby into the world, there's a lot to be said for letting nature take the lead. The normal, hormone-driven changes in the body that naturally occur during delivery can optimize infant health and encourage the easy establishment and continuation of breastfeeding and mother-baby attachment. Childbirth without technical intervention can succeed in leading to a good outcome for mother and child, according to a new report. (Take our maternity-care quiz to test your knowledge.)

"Evidence-Based Maternity Care: What It Is and What It Can Achieve," co-authored by Carol Sakala and Maureen P. Corry of the nonprofit Childbirth Connection analyzed hundreds of the most recent studies and systematic reviews of maternity care. The 70-page report was issued collaboratively by Childbirth Connection, the Reforming States Group (a voluntary association of state-level health policymakers), and Milbank Memorial Fund, and released on Oct. 8, 2008.

Overuse of high-tech measures

The report found that, in the U.S., too many healthy women with low-risk pregnancies are being routinely subjected to high-tech or invasive interventions that should be reserved for higher-risk pregnancies. Such measures include:

  • Inducing labor. The percentage of women whose labor was induced more than doubled between 1990 and 2005
  • Use of epidural painkillers, which might cause adverse effects, including rapid fetal heart rate and poor performance on newborn assessment tests
  • Delivery by Caesarean section, which is estimated to account for one-third of all U.S births in 2008, will far exceed the World Health Organization's recommended national rate of 5 to 10 percent
  • Electronic fetal monitoring, unnecessarily adding to delivery costs
  • Rupturing membranes ("breaking the waters"), intending to hasten onset of labor
  • Episiotomy, which is often unnecessary

In fact, the current style of maternity care is so procedure-intensive that 6 of the 15 most common hospital procedures used in the entire U.S. are related to childbirth. Although most childbearing women in this country are healthy and at low risk for childbirth complications, national surveys reveal that essentially all women who give birth in U.S. hospitals have high rates of use of complex interventions, with risks of adverse effects.

The reasons for this overuse might have more to do with profit and liability issues than with optimal care, the report points out. Hospitals and care providers can increase their insurance reimbursements by administering costly high-tech interventions rather than just watching, waiting, and shepherding the natural process of childbirth.

Convenience for health care workers and patients might be another factor. Naturally occurring labor is not limited to typical working hours. Evidence also shows that a disproportionate amount of tech-driven interventions like Caesarean sections occur during weekday "business hours," rather than at night, on weekends, or on holidays.

Underuse of high-touch, noninvasive measures

Many practices that have been proven effective and do little to no harm are underused in today's maternity care for healthy low-risk women. They include:

  • Prenatal vitamins
  • Use of midwife or family physician
  • Continuous presence of a companion for the mother during labor
  • Upright and side-lying positions during labor and delivery, which are associated with less severe pain than lying down on one's back
  • Vaginal birth (VBAC) for most women who have had a previous Caesarean section
  • Early mother-baby skin-to-skin contact

The study suggests that those and other low-cost, beneficial practices are not routinely practiced for several reasons, including limited scope for economic gain, lack of national standards to measure providers' performance, and a medical tradition that doesn't prioritize the measurement of adverse effects, or take them into account.

Thanks to Emily Ward for the link! Send us your blog ideas:

Wednesday, October 8, 2008

Birth Stories - Monday, October 13th

Birth Stories Night!

Four recent VBAC (vaginal birth after cesarean) mamas will share their stories at our upcoming support meeting.

Join us!
Monday, October 13th
Holy Cross Lutheran Church
1720 E Minnehaha Pkwy, Minneapolis

Each mama will share about her preparations for VBAC, how the labor and delivery went, and lessons she learned. Come to be inspired and encouraged!

There will also be time for general support and discussion. Childcare available with a $5 donation!!! Please email to RSVP for childcare:

Thursday, October 2, 2008

Orgasmic Birth!!!

WOW—what an amazing night! It was an honor to work with the other groups in presenting Orgasmic Birth. Gail Tully from Spinning Babies, Emme Corbeil—midwife, Susan Lane—activist and doula, Donna Corbo—childbirth educator, and Monica Matos—founder of Ten Moons Rising. And there were many more, so I don’t mean to leave you off. But it was an amazing evening that left me energized and excited for the possibilities of birth. I left believing in my body’s ability to not only birth a baby (this is due to a successful VBAC), but to even enjoy it, to love it, to feel ecstasy from it—and why not? Isn’t that what it is all about? Making love, joyfully birthing our love and then raising them with unconditional love for the rest of their lives? Yes, it all comes together so perfectly.

So this is the beginning of organized birth/mama/baby/dad events in the Twin Cities. We are next going to work on a website, and a march in March, and a fundraising walk next summer and much much more. I will keep you all posted as things materialize. In the mean time, if you would like to order Orgasmic Birth, I have purchased 50 copies. Please email me at if you would like one. They are $40.

Everyone needs to see this film!

See you soon,

Newsflash! Orgasmic Birth will be featured on ABC's 20/20 on October 24th, barring any preempting news stories. Plan to tune in!