The Business of Being Born tells the history of birth and obstetrics in America in a humorous and captivating way. I could even hear my husband chuckle, especially at the Monty Python hospital sketch and the cartoonish portrayals of a typical experience of hospital delivery. However, in the evolution of the film, the product becomes personal as the director finds herself in the very midst of making her own decisions regarding her first pregnancy and birth, and choosing to film her journey even through its unexpected end.

The Business of Being Born makes a thought-provoking case for the resurgence of midwifery care in America. To date, a very small percentage of pregnant women will choose the care of a midwife, and even smaller yet will these women choose an out-of-hospital birth experience. The midwives model of care is a key element which differentiates the most successful maternity cultures in the developed world from those which, like ours, have fallen short of expected goals. Through striking and sensitive birth footage, The Business of Being Born depicts the very real differences through the different potential avenues of giving birth, from home to birth center to hospital, and even cesarean surgery.

The Business of Being Born is available now through Netflix, and is being released in a limited number of theaters nation wide. Every pregnant mother in America deserves to see this film!

Recently when my sister became pregnant, and she was trying to decide between two very different options, I finally discerned an effective way of discovering the type of knowledge that will help a consumer evaluate the actual type of care a Birth Attendant gives and their beliefs and philosophy of birth. Using questions we developed together, she was able to make a clear decision based on information she gathered, rather than a feeling about a particular care giver, or suppositions at the beginning about what may happen at the end.

My list of questions is substantially shorter than most lists you will find. The important point may not even be the questions themselves, but the purpose behind each question and that they are all open-ended. I recommend you tell the practioner as little about yourself and your desires as possible before discussing these, to avoid having the Birth Attendant tailor her answers, either consciously or not, to your own desires. Keep in mind, however, that if you are interviewing a Birth Attendant in group practice, you may not be interviewing the individual who will actually attend your birth. You may want to follow up some questions with how it relates to the practice as a whole. There can be a widely divergent set of views on any particular topic in one practice.

1. What does a typical birth under your care look like? If you are as lucky as my sister, this one question will answer most of the usual questions about practice. It will also uncover the underlying philosophy of birth, to which you can decide how well it parallels your own beliefs. A practitioner who quickly launches into what may be done about this or that complication probably has a higher degree of expectation for complications than one who describes their practices or enumerates your choices.

2. How do you feel about doulas? Whether or not you desire to have a doula present, asking a practioner how she feels about them will tell you a great deal about her views of a woman’s need for support during labor or pain relief.

3. How do you feel about home birth/unassisted birth? If you are interviewing a hospital- or birth center-based practice, ask both questions; if you are interviewing a home birth practioner, ask the second. Both these questions help to define the level of trust a practioner has in the birth process. Again, it is up to you to evaluate whether their beliefs are in line with your own. Asking the question does not indicate your own level of comfort with either of these choices.

4. What are your personal statistics regarding…(cesareans, episiotomies, VBAC, breech, twins, or any procedure you are particularly concerned about)? Personal statistics are preferable to hospital statistics in determining the type of care a practitioner provides. You may desire to follow up with the hospitals statistics because hospital statistics can give you insight into the nursing care at a particular facility. How a nurse conveys the progress of labor to the Birth Attendant can have a great impact on the course of action or inaction decided upon by the Birth Attendant.

5. What are my options regarding…(Group B Strep, IVs, Rhogam, eating and drinking in labor, labor positions, birth positions, assisted deliveries, pain relief, or any other topic you are particularly concerned about)? This question should elicit the typical informed consent conversation a practioner would have with you concerning these particular topics, without the pressure of having to make a care decision at that point in time. The best thing would be to pick one or two that have not been previously addressed and that you may know a lot about. Determine how thorough the practioner discuss the options and pros and cons of each, and whether or not she leads you to a particular option.

6. When is the best time to cut the cord? The answer to this question sheds light on where the practioner believes the focus should be after birth, whether on the newly forming relationships, or on speedy completion of the birth process. Additionally, this question identifies the practices of a Birth Attendant during the third stage of labor. There is controversy over immediate clamping versus waiting for the child’s full transfusion of blood, with pros and cons in both camps.

These questions should facilitate a thorough and helpful conversation with your potential Birth Attendant(s). You may or may not have to use them all, or you may want to develop your own. Whatever you choose to do during your interview, remember that achieving satisfaction in the birth is largely a matter of choosing a Birth Attendant in line with your own beliefs and desires. You are purchasing the type of care they practice. Is it the care you want? If not, keep looking until you find what you want.

Teaching your baby to sleep well can be one of the most stressful periods of parenting. A parent can handle so much more when getting adequate sleep, and conversely, so much less when not. Here are some things that I have discovered in parenting my five. Some were good sleepers off the bat and didn’t require much effort on my part, and some were not.

Develop a routine and stick to it. Doesn’t matter what it is, as long as it’s used consistently for bed and nap.

Put baby in bed as soon as he gives any signals of sleepiness. Sometimes you have to be persistent in catching these little signs for awhile so baby will fall asleep quickly and easily in bed, then after awhile, the baby will learn that bed means sleep.

Make sure that baby has an early bed time. Even if that is 6 or 6:30 pm. 8 is usually too late for little kids. If you follow tip #2, you will often find the baby showing signs of sleepiness around 6:30.

A little late for her, but for anyone else reading that needs tips for helping kids sleep well, try to put your baby in bed while awake, even from the little itty-bitty brand new period. If you ALWAYS nurse baby to sleep, baby will not learn to fall asleep by himself. Doesn’t mean you never nurse to sleep, but let baby learn sometimes. If baby looks sleepy, put him in bed.

Tell baby you expect him to go to sleep now. Let him know that if he can’t sleep, you will come comfort him, but now is the time to sleep. When baby cries, lift him, hug him, pat him, and PUT HIM BACK. Next time, just pat his back or rub him (if baby sleeps on tummy, a really good method of soothing is to push him up and down on his bottom in a rocking motion). Allow him time to cry and then settle himself, so maybe check every 5-10 min, and leave. After an hour, if baby hasn’t settled, then nap is over. Try again in a couple hours.

Set up a consistent nap schedule. Young babies should be asleep again about 2 hours after they wake in the morning, and then roughly three hours in between naps/bed. Older babies will be able to stay up a bit longer after waking in the morning, but at a year, should still be able to get two naps in a day. Depending on waking time, I’d try a nap at 10 am, and then 1 pm or so.

Sometimes a lovey helps. It can be anything from a teddy to a blankie. By 1 year, the child may have already shown an attachment to something. You can foster an attachment by keeping the lovey between you while breastfeeding, or sleeping with it yourself for a few nights, so that it comes to smell like you (I’ve even heard of moms using one of their own t-shirts, but keep safety in mind). Then, always put baby to bed with the lovey. Don’t forget it at home if you are going out for the day and baby will nap elsewhere. The lovey will help baby be able to sleep anywhere.

Sometimes baby needs help falling asleep, and you may find yourself doing very strange movements. One of my children needed to be rocked front-to-back, swung side-to-side, and bounced all at the same time. But it worked. Be creative!

I hate turning to antibiotics unless absolutely necessary. And especially on the weekend, it is my goal to avoid seeking medical help, since I’d have to go to the ER in the next county, 30 minutes away–a long, dreary and painful ride when one is suffering chills of fever. So far, I’ve managed to battle four incidences of mastitis with nary a prescription med yet.

It’s important to identify true mastitis, though, because if traditional treatments fail, it is important not to delay medical treatment too long. There are three “level” of breast maladies that may befall a lactating woman. The first is a plugged duct, commonly caused by inefficient emptying of the breast, or too restrictive clothing. This is characterized by an achy spot in the breast, with a reddened area of the breast over it. If not removed, the plugged duct may become mastitis. Mastitis is accompanied with fever and flu-ish feelings. Mastitis is frequently a rapid onset, though, while a plugged duct evolves more slowly. Occasionally the breast may secrete pus. This is a breast abcess, and is the most serious of the three conditions.

There are three key components to successful treatment of mastitis, whether one chooses medicinal or non-medicinal treatments: rest, emptying of the breast, and reducing inflammation.

Often mastitis occurs because the mother is overdoing. Infection forces her to rest. While treating the breast infection, and for a day or two following, the entire focus should be on breastfeeding. Take baby to bed, and call someone if necessary to take over the running of the household and the care of older children. It seems the greater number of children one has, the greater the potentiality for mastitis…because it occurs when the mother is overdoing.

When the breast is infected, there is usually a blockage somewhere. It is important that the blockage is removed. While the baby nurses, massage the spot(s) towards the nipple, seeking to expel the blockage. Baby should nurse on the affected breast first, because the suck is strongest at the beginning of a feed. It is often helpful to drain the breast in the bathtub. Fill the tub with hot water, lean over until the breast is fully immersed and then hand express. The water equalizes the pressure within and outside the breast, and the milk will flow more easily. Sometimes it will take a couple of attempts to fully express any blockages.

To battle the infection itself, we need to treat the body systemically. To reduce fever and inflammation, I usually turn to a faster acting OTC medication, preferably Ibuprofen. Tylenol should be avoided as it is damaging to the liver. To support the bodies natural processes, though, I also use high dose Vitamin C therapy. I have been told that Vitamin C in excess of 4000 mg reaches anitmicrobial levels. Vitamin C has also been shown to be safe at levels far above RDA. From the onset of symptoms, I will dose about 500-1000 mg of Vitamin C, 4-5 times daily. These levels should not be used long-term however. Other methods I’ve used of supporting the bodies natural defenses while creating an anti-microbial environment include ingesting raw garlic (I’m told green olives stuffed with garlic slices are yummy) and grape seed extract. I prefer Vitamin C simply because of ease of use, lack of unpleasant side effects, ease of storage and low cost.

If these methods show no signs of relief within 24 hours, it is highly recommended to get medical evaluation. An abscess can occur in which the pus cannot be stripped from the milk ducts, which can jeopardize the current milk supply, as well as ability to make milk in that part of the breast in the future. If this occurs, the breast can be drained by an incision, and breastfeeding on that breast need not be hampered, but it needs to be done in a timely manner.

Don’t let mastitis be the end to your breastfeeding relationship with your child. It is a temporary, albeit painful condition, but it is best resolved by continuing to breastfeed. If antibiotics become necessary to treat, bring your body back into natural balance by supplementing with probiotics, most easily found in yogurts with live cultures. Take this impediment as a sign to slow down, relax and spend more time with your baby. Your body and baby will thank you.

Unquestionably, the best way to ensure your odds of achieving your goals through your child’s birth is to hire a care provider who already practices in line with your beliefs. Sometimes it can be hard to determine what your care provider’s beliefs might be at the start of care (but see “Interviewing a Birth Attendant” for tips), but usually throughout the prenatal process, one gathers a feeling for what they may expect of their provider. It is good to keep in mind that if you feel your provider is not going to serve your needs, you always have other options. If you need assistance with determining these options, I’m here to serve you.

Also, in some respects a birth plan may too deeply root a certain picture of what your particular birth is going to be. Birth is not predictable, or controllable, really. I’ve found that no matter what a family’s desires are, whether they intend a natural birth, or have already requested an epidural at their 38 week visit, when birth does not go as “planned” there can be disappointment, regret, and even feelings of failure, even when everyone comes through in good health.

So with all of that in mind, I have included for my clients some helpful tools and ideas for reviewing your birthing options. The primary intention of those who prepared these was for the creation of birth plans. Instead, I would encourage you to think through these, pray about them if that is your belief, and create a document to share with me, listed from what is most important down to what is least, but still desirable. Keep in mind that you need to consider the unexpected as well, and what your desires might be if labor does not follow along with your expectations.

If you still desire to include an official birth plan in your medical chart, I will certainly help you create one that is positive and oriented toward your desires. The simpler, the better, to create an effective birth plan.

Perhaps the most widespread method, these days, is the sympto-thermal method (STM) taught by the Couple-to-Couple League (CCLI). This method helps a couple calculate her fertile period through the cross-checking of several bio-indicators, most uniquely the basal body temperature (BBT). One’s BBT is taken first thing upon awakening in the morning, before moving, talking, rising, brushing one’s teeth, etc. The temperature is recorded on a chart, upon which other indicators are also added, among them the presence of cervical mucus (CM), and/or position of the cervix. In addition to the observations of bioindicators, each woman’s cycle history is also kept in mind. If a woman generally has short cycles, for instance, she likely ovulates sooner than a woman with longer cycles. If one wishes to become pregnant, one makes use of the identified fertile period for marital intimacy, and if one wishes to avoid pregnancy, the couple abstains from physical intimacy during the fertile period. This method is good for couples when all the women’s fertility signals are correlative. Because it is so widespread among American diocese, it is usually easy to find an instructor within easy access of any Catholic parish.

However, the Sympto-thermal Method may not be the best choice for all couples. Sometimes the BBT is not a reliable indicator. Many things can throw off the accuracy of the BBT: illness, earlier or later rising, time changes, lack of adequate sleep, and breastfeeding (primarily due to the lack of adequate sleep). While the STM includes mucus observations, it is not intended as a mucus-only method.

There are other methods available to the couple who wishes to explore alternatives. The original mucus-only method is the Billings Ovulation Method. This method was developed by a husband and wife doctor team in Australia. Daily observations of cervical mucus and sensation are charted on a special chart to identify the fertile period.

The Billings Method was further standardized, and this became the Creighton Model of NFP, also known as FertilityCARE. Creighton specifies exactly how observations of CM should be made, and has a unique notation for charting. The charts include stickers to indicate the phase of the cycle one is in. The advantages of a mucus-only method are that the observations are not likely obscured by everyday occurences as easily as BBTs may be (though some medications can impact CM). The method is completely prospective, focusing on where the women is at in her fertility cycle NOW, not influenced by what happened in a previous cycle. The charting is more easily interpreted by the husband, since it charts only one symptom, is color coded, and includes abbreviation definitions on the back of the chart. Creighton Model users also have access to specialized fertility care if conception is problematic, known as NaProTechnology. All of the services provided through NaProTechnology are completely moral and licit according to the Catholic Church.

Since Billings and Creighton are not as well known or widespread as CCLI, it may be more difficult to find an instructor. However, distance training is available and easy to use and access.

There are other methods being developed all the time, and as new methods develop old methods fall out of favor. One of the most notorious of these methods is the Rhythm method. The rhythm method depended almost entirely on a woman having very consistent cycles, and would calculate the woman’s fertile period according to the length of previous cycles. Since the second half of a woman’s fertility cycle is more regular than the first half, and the first half can easily be thrown off by stress or other factors, the rhythm method became notoriously ineffective. By contrast, the other methods mentioned are nearly as effective as hormonal contraceptives in preventing pregnancy, and are very effective in acheiving pregnancy.

At Marquette University, Prof. Fehring has developed a new method of fertility awareness which has been dubbed the Marquette Model of NFP. This method makes use of the Clearplan Fertility Monitor to help identify the fertile period. As technology advances, so too will our ability to recognize the woman’s fertile period and the effectiveness and specificity of natural family planning.

While most parents believe that the advantages of screening are obvious, are they worth placing our precious children in the system, subjecting them to often inaccurate and unpredictable test results, and the same parents to increased worry and potentially “insensitive and rude” advice from consulting physicians? If these trends continue, how are we to be sure that our “unfit” children, once born, are given the same quality of medical care as more “perfect” children? By prediagnosing them, do we place them at risk? There is very often nothing that can be done before birth to correct birth defects. While giving birth to a child with unknown defects can be a shock, it can also be a blessing. I’ve known through a birth professional friend, of a family whose first child was born, shockingly afflicted with Trisomy 18 (despite having many typical prenatal screens). They felt that they had received a blessing by not knowing, because they acheived the pregnancy and birth experience that they desired and were not pressured to take other courses of action which the medical professionals may have deemed appropriate, but would have stolen something vital and precious from their child’s short life and birth.

I believe these tests serve more to protect health professionals than they do to increase the health and well being of our children. In the interest of disclosure, I’ve not had any of my 5 children tested prenatally except for the first. It is a great blessing that they are all healthy (or I assume the one I am still carrying is, and I trust in God’s provision), but the tests did not make my first son healthy. However, it is proven that too much testing can, in fact, create health problems where none before existed. For instance, amniocentesis and other early invasive diagnostics, have a very high post-operative miscarriage rate. Frequent ultrasound testing has been shown to lower birth weight. Testing can also leave parents with worries that are completely unnecessary. Should a woman be off dates by as little as a week or two, blood tests may show that the budding soul in her belly is afflicted with Down’s Syndrome or other genetic mutations, when the baby is perfectly healthy. Even ultrasounds can be misread, and lives have been lost which were perfectly healthy, because the ultrasound exam data was misinterpreted.

By accepting prenatal testing as a routine matter of course, are we encouraging doctors in the view that our children are a product that should be tested for flaws before being reliquished to the hands of consumers, when we take our precious unborns in for their routine exams? Even ACOG warns, “Casual use of ultrasonography, especially during pregnancy, should be avoided,” and perhaps even more ominous, “In addition, first trimester ultrasound examination can lead to earlier detection of clinically unsuspected fetal malformations and earlier detection of multiple pregnancy. These effects have not been shown to improve ultimate fetal outcome, although studies have lacked power to assess for secondary outcomes. Improvements in technology, increasing experience, and refinements in visualization should make the detection of anomalies in the first trimester more efficient at a time when termination of pregnancy is possible and private.” [ACOG ultrasound recommendations; emphasis added] So that, the purpose of early identification of fetal anomalies is not to improve the health of our children, but to destroy “bad products” before consumers are burdened with them, rather like an assembly line in a factory.

In all honesty, there is little risk to avoiding all invasive prenatal testing. A baby who moves well, and whose heartbeat is strong, together with a healthy mom whose urine tests, bp, measurements and weight gain is normal, will almost always be a healthy baby. Abnormalities can usually be identified through non-invasive methods which doctors and midwives have practiced for centuries. High tech evaluation can be helpful after an anomaly has been detected through noninvasive means, and may sometimes offer solutions which can improve outcomes. But routine testing is not for the purpose of increased health of mothers and babies. It is to cover the backside of physicians who might be threatened with lawsuits, or to guarantee the quality of the “product”.

Doctors who do not warn mothers about their fetuses’ defects run the risk of being sued. One article quoted the publication Medical Malpractice Law & Strategy: “[C]ourt rulings across the country are showing that the increased use of genetic testing has substantially exposed physicians’ liability for failure to counsel patients about hereditary disorders.”

It’s rather haunting, isn’t it?

But beyond this, the idea is also expository of the current mindset toward children and childbirth. Focusing solely on the health of the baby produced minimizes the absolute value of human life, as the only acceptable “product” of birth is a *healthy* baby. What about the babies who are not so lucky? Do they not count as fully human, fully loveable, and full of dignity?

There are two problems with this mindset. The first is indicative of the assembly line, mechanistic medical model of childbirth. If anyone hasn’t read much about this, I highly recommend Davis-Floyd’s Birth as an American Rite of Passage (though it is dense). I hear Wagner’s Birth in America (Born in America, maybe?) is an easier read on the same subject. In brief, transformative life events are commonly and traditionally recognized by all cultures through ritualized events. In our modern technological society, our rituals are subsumed by medicalized childbirth, indicated by the establishment clinging to practices long proven by science to be counter-productive and harmful–episiotomies, lithotomy position, IV fluids leading to electrolyte imbalances, limiting women’s intake during labor, and on and on. This point of view de-humanizes women and babies, viewing them as imperfect machines (according to modern medicine, man is the ideal machine, woman an imperfect model) highly likely to fail in the process, with a measurable outcome of success-the healthy baby. Also, in this view, birth is a societal event, in that society has a significant interest in the successful outcome and should society’s standards not be met, society will make retribution. [As an aside, this last point indicates why midwives are likely to be prosecuted for a single bad outcome beyond their control, while physicians are a protected class. Midwives are not abiding by society’s unwritten protocols, even should they be explicitly following normative written protocols.]

As pro-lifers, the second problematic extension of this idea is that a *poor* outcome should be avoided or remedied at all cost. Once mother and child have been dehumanized to mechanistic organisms, a known *defective* baby is better terminated, thus avoiding a bad outcome currently in assembly. The logical extension of this is free access to euthanasia for anyone no longer meeting the current criteria of health. When we as a society have marked certain individuals as an inferior product, therefore not worthy of life, love or compassion, we have lost the purpose of society, to love, cherish and protect all members in order to contribute to the salvation of mankind. This indoctrination is being played out hourly in our hospitals, in our prenatal care visits, in our TV programs.

As the above anthropologists, and others have illustrated, rituals are an intrinsic part of group society, but they are not immutable. Rituals are changeable over time as the dynamics and priorities of a group changes. We can be an active part of that process. As Christians, we need to demand to be cared for as full human beings, making whatever decisions that requires us to make. We need to be more selective of our chosen care-givers or place of birth. We need to be prepared to refuse treatments that dehumanize us, such as those which reduce children to a collection of chromosomes, or screens which have no treatment. The foundation of society needs to be returned to the family, which intrinsically (under normal circumstances) understands the value of its members and that immeasurable quality of the human soul, which endows dignity upon all humanity through the image of the Creator.