"At 5 A.M. on a cool Boston morning not long ago, Elizabeth Rourke—thick black-brown hair, and forty-one weeks pregnant—had her first contraction."
(http://www.newyorker.com/printables/fact/061009fa_fact) She did not wake her husband Chris. She was joyful that she would soon hold her newborn daughter in her arms, but she knew that right now, she needed to rest. She had prepared for entering motherhood for months now. Her midwife had emphasized it 100 times: ` If you have a few contractions, get into bed in a dark quiet room, and try to rest.`
She was a week past her due date, and she could cope with the pain because she knew that it signaled a new era of her life: Motherhood. She welcomed it. She liked to write poetry for fun and pulled out her diary and started a poem to honor this moment. The pain was welcomed with her scribbled words, a new poem for a new soul that was starting to be born. She thought about putting the words to music. During the interval between contractions she relaxed all her muscles consciously one at a time. She felt the baby moving, which was reassuring. She closed her eyes and rested for an hour. When the contractions woke her, she wiggled her toes and counted to 10 slowly and let the feeling ride over her body. It seemed to come out of her lower back and wrap around her abdomen, like bad period cramps. But she focused on her fingers, counting them one at a time, focusing on her rings, remembering where she had bought each one as she looked at it, marveling at their colors- just as she had planned to do while planning for this birth day. Just the way she had practiced. It worked.
She was carrying their first child. So far, the pregnancy had gone well. She had taken prenatal vitamins for 6 months before conception and attributed to this the fact that she suffered no tiredness or nausea or vomiting during the first trimester. Her hemoglobin count was 13.5 when her pregnancy started and had dropped down to 12 now at the end of her pregnancy as expected. An internist, who had just finished her residency, she had landed a job at Massachusetts General Hospital a few months before and had managed to work until this day.
Rourke called her midwife at eight-thirty in the morning to tell her that she was having irregular contractions every 7 – 15 minutes. She had taken private classes from her. Most childbirth classes prepare a woman for the hospital routines and interventions which Elizabeth knew too well. Her midwife told her that there is no rule as to when to call her because all labors start in their own individual way. But the midwife had said that there is no need to wake her if the contractions are every 20 minutes, but to call immediately if her water breaks. Elizabeth got the idea. She respected her midwife. She knew that her midwife was totally committed to Elizabeth, but her loving kindness should not be taken advantage of.
"I`ll be over in half an hour to check the heartbeat, and we can talk about what next," said her midwife.
"OK."
Elizabeth just laid there for 30 minutes. In 30 minutes, she had 7 contractions lasting half a minute each- that’s 3 1/2 minutes of pain and 26 1/2 minutes to rest. "I can do this," she said.
"During her medical training, Rourke had seen about fifty births and had delivered four babies herself." The births she had watched were mostly cesarean surgeries. The obstetrics and gynecology rotation focused on surgery. Elizabeth learned first hand: Obstetricians aren’t trained to do normal births. They are trained to do surgery. Normal birth needs patience, love and belief in a woman`s power to birth. Doctors are trained to be experts at high risk births, and overuse medical interventions on normal births, mistaking them for risky births.
Elizabeth wanted to be a pediatrician and work with sick children. She knew the value of hospitals and research for sick people. But she did not consider birth an illness. Her mother had been born at home with a granny midwife in Ireland. Her mother had had a gaggle of children, some at home and one in the hospital, and never complained about the pain. Elizabeth was born at home. Elizabeth`s mom told her that her hospital birth was far more primitive than her homebirths. At the hospital they expected her to deliver on her back on a tiny bed, with an IV in one arm and a monitor all across her nice belly. How was she supposed to birth like that! "Nothing like doing it in the privacy of one`s home. That’s where birth belongs," her mother always said. "The hospital is full of fear. Invite fear and you invite the devil," was her mother`s motto.
During the first cesarean which she watched, she cried beneath her mask when she watched the newborn baby in a lonely bassinet staring at the ceiling looking for her mother. Rourke wanted a nice, normal vaginal delivery. She didn’t want an epidural anyway because she had read on the consent form that 1 in every 250,000 women is paralyzed for life and 5% of women have a migraine headache afterwards. That was not her idea of good odds. She decided to invite a midwife to her home and instead of being a guest in someone`s hospital ward.
She had considered hiring a doula in addition to the midwife—a birthing coach—to stay with her through delivery. Instead she decided to have her mother and her husband there instead.
The midwife arrived promptly and they chatted. They were very familiar with one another by now from all the many meetings they had had leading up to the birth. She listened to the fetal heart and when she had heard 3 accelerations of the fetal heart of 15 beats per minute each- she told Elizabeth that the heart beat was reassuring and wonderful. She took Elizabeth`s blood pressure which was fine. She told her, the head is down and the baby`s weight is about 8 pounds- which is fine. She told Elizabeth, "This is your baby`s birthday! What do you want to do?"
Elizabeth decided to go shopping for baby clothes with Chris. The midwife left and Elizabeth ate a big healthy breakfast and got dressed and went shopping, all the while walking and breathing thru her contractions. The midwife told her to walk stairs when ever possible because the rocking motion of the hips on stairs helps the baby`s head get into a good position in the pelvis. Elizabeth took the stairs wherever they went.
By midday, her contractions hadn’t really speeded up; they were still coming every seven minutes, maybe every six at most. She was finding it best to walk around and breathe during her contractions.
Finally, at four-thirty in the afternoon, the contractions began coming five minutes apart. She called her midwife.
"Do you want me to come yet?" the midwife asked.
"No, I just wanted to tell you what`s going on." Elizabeth said. Chris is here and my mother is making me my favorite birthday dinner. I may bake some cupcakes myself. I mean every 5 minutes, means that I have 4 minutes to spend thinking about what a miraculous day this is! My birthday into Motherhood!"
The care that the midwife had given Elizabeth during pregnancy was completely individualized to her needs. Elizabeth wanted a copy of all the research examining the safety and risks of planned homebirth. All the medical studies to date of planned homebirth have found it to be equally safe for low risk mothers to deliver at home with a trained attendant as to deliver in hospital. The research also show that planned homebirths involve less medical interventions. Any research showing homebirth to be dangerous erroneously includes unplanned, unattended term homebirths and unattended unplanned homebirths premature births, in which the baby is not necessarily mature enough to breathe without help.
The midwife brings the entire delivery room in her birth bag. The bag contains all the emergency equipment that the hospital has: a canister of oxygen and a mask ($60), Ambu resuscitation device for the baby ($30), a liter or 2 of IV fluids and the tubing for the IV ($10), and pitocin and methergine ($10) to contract the uterus in case of a post-partum hemorrhage and syringes to give it. The rest of the equipment is standard stuff: fetoscope($50), blood pressure kit($50), cord clamps(0.25 cents), scissors, receiving blankets ($5), a scale to weigh the baby ($5), suture kit if there is a tear ($15), and disposable gloves ($1), disposable underpads to make it easy to clean up($2), a thermometer to make sure the room is warm enough for a newborn, and a plastic bag to put the placenta in. For $250, a midwife can outfit herself up with everything she needs to deliver term babies as safely as in the hospital. Most of the equipment is reusable. 95% of low risk births at home will require little outlay in medical equipment: a pair of gloves, a few underpads, and cord clamps for a total cost of about $5. Scissors can be resterilized after every birth. The blankets and baby clothes can be laundered and reused. In 2% of cases, there is a hemorrhage and the midwife will have to use pitocin and methergine, and perhaps start an IV, increasing her cost by $20. The labor and delivery department is the most profitable in the hospital. A healthy woman comes in to carry out a physiological function that her body was designed for. The safety of birth starts with the grandmother`s nutrition when she was pregnant with the mother. If she didn’t have enough food to eat, her daughter might be born with a contracted pelvis, which will make her births difficult. But this is rare in our society. The safety of a mother`s pregnancy depends on the mother`s nutrition before and during pregnancy. Best outcomes happen if the mother is not anemic, not a teenager who is still growing, and not having babies every year.
The mother needs to have enough iron, vitamins and protein to grow a baby, exercise, and not smoke, drink or take drugs excessively. In short, she needs a healthy lifestyle and no underlying disease. She needs to be screened for blood pressure problems and diabetes if she shows symptoms or a family history of diabetes. If she does not have a healthy lifestyle, then there are countless complications that can be considered- from domestic violence to AIDS and drug addiction. Unfortunately these syndromes occur more and more in our society.
But our Elizabeth is not a drug addict. She is a doctor. She didn’t need to get off drugs. She needed information. The midwife provided it and more. Elizabeth received research about all the prenatal tests and the effects of ultrasound on the fetus. She read everything. She made her decisions about what to do and what not to do. She could ask her midwife anything and the midwife took the time to answer.
Although Elizabeth had gotten married late in life, she wanted to have several children quickly now that she had finished all her studies and had a profession she loved. She loved children. Her husband was ready to do more than half of the childcare, while she worked.
Since Elizabeth knew she wanted more than one child, she knew that cesarean delivery added risk to subsequent pregnancies. Having a cesarean increases the risk of subsequent infertility. Having a cesarean doubles the likelihood of a late third trimester stillbirth on the next pregnancy. Elizabeth had seen up close the trauma that stillbirth causes in women. She wanted to avoid that like the plague. She was aware that 50% of her doctor colleagues had given birth by cesarean. But most of them would have only one child, so future pregnancies were not part of their decision making. Elizabeth knew that after 2 cesareans, on the third pregnancy, the rate of uterine rupture was about 5%. If the uterus ruptured, she would have a 20% chance of having a hysterectomy, losing her fertility for ever. Worst of all was the fact that in the past 3 years, maternal mortality was on the rise in Western countries for the first time in 60 years.
The UK Maternal Death rate for 1997- 1999 was 11.4 per 100,000 maternities. The overall maternal mortality rate for the United Kingdom for 2000-2002 is 13.1 maternal deaths per 100,000 maternities.
http://www.cemach.org.uk/publications/WMD2000_2002_ExecSumm.pdf
Even though the rate is not dramatically increased, the number of women
dying as a result of cesarean surgery is increasing. The number of women who
are dying from bleeding and anesthesia increased in 2000-2002. Pregnancies
after cesarean have much higher rates of placenta previa and placentas
implanting into the uterus at the scar. All the women who died of placenta
previa between 2000-2002 had previous cesareans.
In the US, this statistic is unavailable because there is no law requiring reporting of maternal death by cause. All pregnant women who die fall into one big soup of maternal mortality, including traffic accidents, violent crimes and suicides. Maternal mortality has also been shown to be underreported in most countries.
Her professors had taught her the solutions for shoulders getting stuck that doctors had come up with. In her new reading, she read about how a midwife named Ina May Gaskin had found that delivering the woman in hands/knees position usually relieved stuck shoulders. Funny that she was not taught this midwife trick in medical school, but rather only maneuvers named for doctors.
Elizabeth had seen in the hospital how sometimes women entered in active labor with good strong contractions and soon after arrival, their contractions stopped. Sometimes it followed a rough vaginal exam. Maybe it was the smell of the halls. Elizabeth could relate to this. Although Elizabeth was accustomed to the hospital, she wasn’t comfortable there thinking that all the people who knew her would now be looking at her as a patient.
She had coined the term "Fear of Hospitals syndrome" or "White coat syndrome". She had seen how people`s blood pressure sometimes sky rocketed in the hospital, while when measured at a home visit, it was normal. These women do not fair well in the hospital, because when their labor stops they have to either go home and come back innumerous times, or stay and have their labor induced artificially. However this syndrome still has no title in the medical textbooks. Despite all the psychological syndromes that doctors have enumerated, Fear of Hospitals during birth is not well documented.
There are 3 ways to induce labor in the hospital: stripping the membranes from the cervix, intracervical prostaglandin or intravenous pitocin. Midwives induce labors at home more gently by having the mother drink castor oil or with nipple stimulation.
In the midwifery textbooks, it is taught to only do vaginal exams if the results would change your midwifery management. Routine frequent vaginal exams have been found to increase the rate of uterine infections. Midwives need to check dilation before giving medical pain relief for example. If the woman is close to fully dilated, you can talk her through the last bit, rather than give her pain medication which will put the baby at risk for breathing problems when he or she is born. Or one might check dilation before the woman gets in the bathtub. Research has shown that being in the bathtub is calming, but if you go in before 5 centimeters dilation, it can slow down labor. It is good to know how dilated you are before going in the bath. Otherwise, there is no need to check the dilation. If the fetal heart beat is reassuring, it doesn’t matter how long a woman is in labor. The tiredness can and must be coped with individually.
Some people say- don`t worry- you will know when you are in labor. You won`t sleep thru it. But Elizabeth read incredible stories about women who took 45 minute naps at 5 cm dilated by willing themselves to sleep through the contractions in quiet, undisturbed home environments. In fact it seemed like every woman found different and individual solutions to deal with labor.
Elizabeth and her midwife spent many hours discussing different ways to deal with pain. Elizabeth had never had a really painful experience in her life- no surgery, no stitches, and no close family members who died. The midwife told her that the more she prepared different ways to deal with labor the better it would go. They discussed hypnosis, birth coaches, and fragrances like rosemary oil. They talked about pictures to stare at, which images calmed her, which images alarmed her. They talked about silence and talking as little as possible. They talked about buying a birthing pool for transition- perhaps one big enough for Elizabeth and Chris together. Her midwife told her confidently that Elizabeth could do this labor thing. She said she had seen it thousands of times and had complete faith that Elizabeth could do it. The first time the midwife said that Elizabeth was very skeptical. She didn’t think she could do it at all. But the fourth time they met the midwife said again that she was completely confident that Elizabeth could have the birth of her dreams. Elizabeth came home and repeated this to herself, almost believing it.
Then she went about covering the mattresses, putting ice chips in the freezer, buying yogurt, ice cream and her favorite organic almond juice for labor. She washed the bathtub thoroughly. She made a cake for after the birth. She put her favorite CDs in a special bag in the corner. She checked that the heaters all worked. She looked around and made sure that she liked what she saw. She repeated to herself the words that the midwife had told her so confidently- `I have complete confidence that you can have the birth of your dreams Elizabeth.` It sounded like her mother talking to her. She realized that when you are in labor, you are vulnerable as a child. She liked the idea of this midwife mothering her into motherhood. Plus she wanted her mother there also.
That evening, Elizabeth`s mother made her lasagna- her favorite and she ate with gusto between contractions and drank wonderful fresh squeezed apple juice on the rocks. Chris rubbed her feet during contractions. Elizabeth went to the bathroom frequently. She also rocked on the rubber birthing ball. After dinner, she slept for 5 minutes between contractions- taking 3 five minute naps. Then she got up again walking in circles in the living room. The foot massages and walking were nice, but at 10:30 pm, she decided she needed her midwife. She was lying sprawled over the birthing ball with music playing when her midwife walked in the room. She was moaning with a very long hard contraction, but when she saw her midwife`s confident face, she sighed with relief. A minute later with no warning, her water broke, and warm clear water ran down her legs and the ball onto the floor making a small puddle. The water was clear which was reassuring because it meant that the baby did not pass meconium inside the sac. Elizabeth was in shock. She could not believe her water broke. She did not have a contraction for 10 minutes while her body and mind absorbed this new situation. Before the water breaks, there is sometimes a bulge of water in front of the head pushing on the cervix with every contraction. But after the water breaks, the bones of the baby`s head are pushing against the cervix. In theory, a hard head is more forceful than a water balloon, and the cervix might open more quickly. Perhaps rolling on the ball helped the baby get into place. In any case, Elizabeth was suddenly wide awake and full of adrenalin.
"My water broke!" she said in amazement, as she reached for a great big towel to catch the stream. "What does this mean?!" she said grinning.
The midwife listened to the fetal heart every 15 minutes with her fetoscope, finding it very reassuring. In between, she whispered to Elizabeth from time to time about how wonderful she was doing and how she was opening up so beautifully. She told her how beautiful she looked and that too bad they didn’t have a camera to take pictures of her in this beautiful state.
Elizabeth relaxed every muscle after every contraction in response to the midwife`s reminder to do so. During the contraction she cleared her head of thoughts and just breathed. The midwife would remind Elizabeth that she was above time. That time meant nothing to her. There was just one contraction and she just had to breathe thru this one contraction and then it would be over and she could rest. Sometimes it was completely silent for a quarter hour except for quiet breathing. For some time, the midwife stepped out and Chris and Elizabeth nuzzled each other like 2 primates who discovered each other for the first time. After a while, Chris called the midwife in to see her progress. Elizabeth was starting to grunt during contractions. The midwife smiled at them both. Chris winked at Elizabeth. Remarkably, using all her will power and strength, after the contraction ended, Elizabeth winked back at Chris and smiled. Then she closed her eyes and went in her mind to the place where she always felt best, her childhood safe house, her grandmother`s kitchen, and smelled the aroma of home.
At this point she had been having contractions for eighteen hours, and was exhausted from sleeplessness and pain. Her midwife said, "Everyone feels like they cannot take one more minute at the end. Everyone is pushed to their limits. You will make this. In a little while your baby will be in your arms and you will see what she looks like. You will meet her. Use the breaks between contractions to rest. You are going to have the baby soon. Go empty your bladder and get ready."
In the past 30 years many advances have been made for women who suffer from childhood diabetes and high blood pressure. There are great advances in neonatal care for premature babies. But for the low risk, well fed, healthy woman, who has emotional and social support systems in place, the outcomes are about the same as they always were with midwives who washed their hands and didn’t interfere. Feed a woman adequately in pregnancy, for a pregnancy that the woman desires, and if she or the baby don`t develop any problems during pregnancy, 95% of the time the delivery will go well with no medical assistance whatsoever. The purpose of the trained birth attendant in the case of a healthy mom with excellent nutrition between 37 and 42 weeks pregnant is to treat the 2% of postpartum hemorrhages, the 1% of newborn breathing problems, and rare occurrences like cord prolapse and shoulder dystocia.
"Over the years, hundreds of adjustments in care were made, resulting in what’s sometimes called “the obstetrics package" wrote Dr Gawande."And that package has produced dramatic results." There is no research to back up this oft-repeated statement associating modern birth interventions with dramatic improvements in neonatal or maternal outcomes. As said previously, all the published research is in agreement. Planned homebirth with a trained attendant is as safe as hospital birth for low risk women. Low risk has been defined by several risk scoring tools developed over the year and always changing slightly with new research. The simplest definition of low risk is: one fetus, head down, 37-42 weeks gestation at birth, estimated to weigh 2500 or more, 4500 grams or less, no childhood diabetes or high blood pressure. The more sophisticated scores like Edwards score, further define low risk as not including Rh sensitized mothers, 2 previous prenatal losses, incompetent cervix, polyhydramnios, 2nd or 3rd trimester bleeding, anemia under 9 gm at the end of pregnancy, heart failure, and thyroid disease this pregnancy. The latest addition since 2002 is including the 30% of pregnant women who culture GBS positive into the high risk category, but more research is needed about the use of prophylactic antibiotics for low risk women. Although the rate of GBS infections is going down with prophylactic antibiotic treatment in labor, antibiotic resistant bugs are now causing more infections, so although less babies are dying of GBS, we have not managed to decrease the total number of babies who are dying of infections.
"Yet almost nothing else in medicine has saved lives on the scale that obstetrics has," wrote Dr Gawande in The New Yorker in October 2006. There is no research to back up this statement. There is evidence pointing to the possibility that the improvement of the infant mortality and maternal mortality rates are a result of nutrition, antibiotics, hand washing and sanitation, not obstetric management of birth. At the time when birth was moved into hospital, there was no control study looking at whether this was a medically good move to make, comparing home versus hospital safety. Birth was moved into the hospital for convenience and profit. It is convenient. Ask any homebirth midwife how she likes being on call 24/7 and never having a real free day to herself.
Doctors lobbied midwives out of existence. Not on the basis of safety but profit. Nevertheless, it is not important how or why we came to industrialize birth. What is important is our present situation. Elizabeth is moaning with pain and sure that she is about to die and sure that a baby will never come out of her. She has the look of a scared wide eyed animal. The midwife curses her choice of profession and wishes she had gone to beauty school instead. She is alone with all the responsibility for 2 lives on her shoulders. Then Elizabeth raises her head as the contraction begins and says, "I have to PPPUUSHHH," as she exhales. As she pushes, a sense of relief comes over her. "I have to PPPUUUSHHH," she says again in a higher register of voice. And when the contraction finishes she collapses and silence reigns again.
The midwife concentrates on her own breathing. She hops to the bathroom knowing that as Elizabeth pushes, she will be unconsciously pushing with her, and if she doesn’t use the bathroom she will wet her own pants. Besides, she wants to be fully focused on Elizabeth with no distractions. The moment is here. The midwife is all alone. She knows that there is always a one in a million risk that this baby has soon fatal defect in her heart or lungs that was not seen on ultrasound and no matter where or who delivers the baby it would die. She ponders the possibility that this woman will bleed heavily and not respond to the pitocin to contract her uterus. Statistics give likelihoods but say nothing definitive about the case in hand. Low risk women at home or in hospital are unlikely to have problems, but anything is possible. These thoughts can`t help but cross the experienced midwife`s mind. However, knowing how `Fear invites the devil` the midwife thinks positive. Elizabeth ate right. Elizabeth worked hard to get here and here she is and lets give her all the positive vibes to slide out this new life into the world. The midwife focuses on the business at hand. She squats obsequiously in the corner, consciously relaxes her shoulders, relaxes her cheeks, lightly smiles and waits.
In midwifery school they teach that a good midwife is fat, because if the labor goes slowly, then it`s good to have a snack and eat something to pass the time pleasantly with the laboring woman. Better to eat than interfere. This midwife is thin but the image is helpful. Always good to relax and take a break. The baby will come. Waiting is the game and a midwife has to be an expert at waiting.
Dr. Gawande wrote, "But if medicine is an industry, responsible for the safest possible delivery of millions of babies each year, then the focus shifts. You seek reliability." The error here is that midwifery, not medicine should be responsible for the safest possible delivery. Midwives, in collaboration with doctors, are the experts at normal birth. Most births are normal. Midwives who know how to be patient and listen to women should be. Mothers who are empowered at birth may be better prepared for the challenging task of mothering. Birth can help mothers understand waiting. Isn`t child rearing all about patience?
Just after seven-thirty pm, in the thirty-ninth hour of labor, the real Elizabeth Rourke had surgery to deliver her baby. But the Elizabeth, who hired a midwife to help her deliver, delivered at 2 am after 21 hours of labor. It was one day of labor although hours of mental, physical and emotional preparation preceded it. The baby`s head was not obstructed because Elizabeth had continued walking, continued eating, and the head moved dynamically down with contractions. There was no lying on a bed with an epidural to make contractions less effective at pushing the baby into the right place. There was less fear working to close her up.
Even though the outcomes for planned homebirth and hospital birth for low risk women are the same, if anything happens at a homebirth, our medicalized society quickly condemns homebirth. If anything happened in the hospital at the cesarean section, it is considered collateral damage. 5% of surgeries are complicated by serious infections. 4% of women after cesarean are rehospitalized after the woman goes home. Sometimes the bladder is nicked. In 1% of cases the baby is slit with the scalpel knife. You can`t sue for those complications because they are known beforehand that that is a risk you are taking. You sign a waiver that you were informed of the risks. If anything goes wrong at a homebirth, the midwife can be charged and spend years in court defending her license. If the midwife needs to transfer the woman to the hospital, she is rarely greeted with helpful camaraderie of fellow workers who are all trying to carry out safe obstetric protocols. Anything bad that happens at a homebirth is the fault of the midwife for attempting such a thing. Anything bad that happens in the hospital is business as usual.
“I watched, you know,” the real Rourke says. “I could see the whole thing in the surgical lights. I saw her head come out!”
I am not going to describe the final moments of Elizabeth`s homebirth. It is too intimate, too true to share. It is a moment when a spiritual truth is apparent even to the non-believers. Anyone who wants to understand it will have to experience for themselves, in their own way. But I will say, at the real homebirth Elizabeth didn’t watch. She birthed. She didn’t tear because she had done strong perineal massage for a few weeks before the birth. Maybe she even grabbed the baby as it was coming out. Maybe she pulled it up to her ecstatically happy heart and burst with joy and tears upon seeing her baby`s face cry for the first time. She is awash with natural love hormones that make her love this baby naturally and strongly. But she also learns to love herself more for her accomplishment as well as those around her for standing by her.
The real Elizabeth who had a cesarean, said exactly what many cesarean victims say “I felt like a complete failure, like everything I had set out to do I failed to do. I didn’t want the epidural and then I begged for the epidural. I didn’t want a C-section, and I consented to a C-section. I wanted to breast-feed the baby, and I utterly failed to breast-feed.”
This midwife works day and night to decrease the number of women who willingly sign up for medical management of their healthy bodies without completely investigating all the possibilities. There is a lot of room for variation. Just as everyone cries a little differently in grief, everyone connects to birth differently and has different needs that often cannot be met by institutions. Create and share a new birth ritual that will grow and be copied by others so that one day, a new young generation will face birth with life affirming, non-medical rituals. Even if the newspapers continue to cover only head-on collisions and death, that doesn’t mean that you cannot celebrate birth in your own personal individual, intimate, empowering way. Of the deepest most ecstatic miracles, birth is it. Demand not to miss it.
P.S. Thanks to the reader for reading this. Give birth a chance. Judyslome@hotmail.com
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