When I first entered the world of natural birth I was educated to believe body weight had no effect on maternal or infant outcomes.  The organization I trained with was equally adamant that gestational weight gain was a useless measure that predicted nothing. I believed them. I made this belief a part of my life and looked the other way when I was obese for the first time in my life after my second pregnancy.  I spread this belief to other mothers, believing I was protecting them from fat shaming, from a non-evidence based health system, from the poorly researched advice they would get from otherRead More →

Progress with research is slow, and I am beginning to accept that. I don’t even mean the time it takes for research to be adopted into practice.  I’m talking about the work of creating and running a study all the way through publication of the results. Ideas come fast. Ideas have multiple possibilities.  But when the hard work of turning the idea into a legitimate study begins, pieces don’t always come together well. And sometimes they just come together slowly. Like the last 18 months…during which I began several projects that didn’t seem to be moving anywhere fast – and a dissertation that needs toRead More →

I’m a little behind, so you might have already seen this article from an obstetrician who accepted a challenge to stay in lithotomy position for an hour as part of the 2015 NHS Change Day. The easy thing (as a doula or midwife) when reading this article is to say, “Of course, I can’t believe you never thought about this.”  But remember it makes sense an OB might never think about this because her training focuses on mastering the skills she needs to save lives. When everyone around her during training accepts the practice as normal, useful, appropriate…she has little to no reason to questionRead More →

Earlier this week, the Lancet published international estimates of stillbirth rates. The conclusion of the authors was that progress in reducing stillbirth is slow. This is especially true  in my home country of the United States where stillbirth is now more prevalent than infant death. I don’t want to minimize the reality of the numbers; but I do want to acknowledge the importance of actually calculating these numbers.  Why? Because the deaths must be counted before action is taken.  It happened this way with neonatal mortality — it was ignored because there was an assumption that you couldn’t really count it.  Some brave advocates refused to acceptRead More →

There are many ways to advocate for change. I began as a woman who advocates to inform citizens through grassroots events. I have (slowly) become a midwife who advocates politically. This week, I received an email from a woman who advocates through art. No doubt you’ve encountered other pieces of art that begins discussions about maternity issues; you may have seen The Vagina Monologues, Ina Mae’s Cesarean Quilt, or photos from any number of organizations that want you to be aware of the issues facing pregnant women in low resource settings. This current project is about the costs of maternal health care in the UnitedRead More →

My students took their pathology final exam yesterday, which means I finally have a few moments to reflect on what I learned about concepts which are easily confused. When I studied as a nurse, I already had a degree in physiology.  This means I came into the program having already learned the basic biology, chemistry, and physics of normal human function.  Many of our students (and many direct entry midwifery students), don’t have a strong background in these sciences. I don’t know that I would call it a deficit…they certainly do not need the level of understanding I have to be successful.  But it does make understandingRead More →

Part of any PhD program is the requirement to teach. This seems normal when you consider in many disciplines a PhD is what qualifies you to teach at the college level.  It also seems normal when you consider that many PhD trained individuals will do research at academic centers and so have the dual role of adding to the common knowledge (research) and passing on that knowledge (teaching).  At my university they refer to this as scholarship, and include training in education as part of the PhD curriculum. I’ve completed all my coursework and moved into candidacy, which means I’ve completed my education training and canRead More →

If you have taken your journey to midwifery along a path that has you employed in a hospital, you are likely familiar with the Joint Commission.  If not, you need to know how this organization improves perinatal care. The Joint Commission is an organization that accredits hospitals for meeting certain benchmarks, they call these the core measures.  The idea is the core measures represent what is expected in an institution which provides high quality, evidence-based care. This accreditation is one of the most powerful bits of advocacy for high quality care in the US.  Why?Read More →

The problem with epidemiological associations is the wide variety of things which may be driving them.  For example, a new study  reports an association between hospital geographic location and the variation in primary cesarean delivery rates in the United States. This phenomena is not limited to the United States, a study published in the European Journal of Public Health reports evidence of local drivers of cesarean rates. How much do all these factors matter?  In the cesarean study, almost 40% of the variation in adjusted relative risk for primary cesarean — in plain terms, these factors mattered quite a bit. The question is, what are these local drivers?Read More →

No one really believes the Friedman Curve represents timing of cervical dilation anymore.   Modern researchers have used more sophisticated techniques to identify problems with the Friedman Curve, generally about the slope of the line which represents the speed or progress of dilation. What remains from the Friedman Curve is the idea that labor has a line that can represent the normal process of dilation. This line becomes the basis of judgement of normality of labor. In some places the labor progress is charted in a partograph to allow visual comparison of the progress to the line. Decisions to intervene are made based on deviation fromRead More →