the big book of birth & realbirth blog

A frank approach to reporting

Stillbirth is a sad subject, and not a popular front page topic. One thing I appreciate about the British paper The Guardian, and also the BBC, is that they routinely address women and baby wellbeing in their journalism; articles on pregnancy, birth, postpartum, working mother benefits and child welfare statistics show up with much more frequency than in American papers and media.

While I recognize that a system of national health such as they have in England has its problems, one thing that Americans do not seem to realise is that mother-baby outcomes are predominantly determined by access to care. Duly, in America your economic or educational status determines your likelihood of a serious problem when it comes to pregnancy, birth, postpartum and your baby’s well being. Because there is already a cultural and economic system in a place in the UK that acknowledges a basic right to heath care, it seems the press covers these topics with much more gusto, thoroughness, more factual basis and quality than we get in American papers.

So when the BBC reports on the need to improve baby outcomes what gets called for is: (shocking I know) but more prenatal care access for all women, longer visits so pregnant women get the attention they need, more nurses and midwives and consultant doctors, and one-to-one care for sick and premature babies. These are all things that in the United States would be buried by fear of the cost, accusations of socialism, the insurmountable liability premiums, and the time suck that we do not consider valuable.

But ultimately, when you have a government with limited budget not designed to profit off its health care, rather than a profit-oriented private industry, accountable for health care cost, it seems that evidence-based medicine which achieves good outcomes at effective costs, wins. For example, the UK has gone from 1% to 2% homebirth rate in the last few years due to a specific education and practitioner push to make homebirth more accessible. For women having low risk pregnancies (i.e. normal pregnancies) the Royal College of Obstetrics agrees it’s a cost effective safe way to give birth as compared to crowded, busy hospitals where infection rates are climbing.

Yet the primary difference in the article is the call to action, the request for more support for medical care, the numerous possibilities suggested that could change outcomes for the better - not finger pointing, victimization, lawsuits or an ‘it’s just too big of a problem’ attitude. It allows one to read the article with compassion and hope that - even while it’s a sad and devastating topic - we can make a change.

In reading the recommendations from the BBC for more staffing and longer prenatal visits, I am reminded of the hundreds of times in my fourteen years of teaching I have heard students complain about their cursory abrupt visits with their practitioners. Most women sigh and resign themselves, believing that this is the standard in our current system for prenatal visits. What is important for families to know is that there are many doctors and midwives who take time with each visit to answer questions, and update the woman as to what she should be looking for at this point in her pregnancy. Practitioners that say "we will talk about that later" or "let me worry about that" are the practitioners that are not encouraging women to educate themselves and really understand the variables in pregnancy and birth.

What practitioners who patronize women in this way fail to understand is that this is less likely to create an environment of trust. And trust is vital in this area. It’s important if something out of everyone’s control happens that the client actually does trust that the doctor or midwife did everything they could to help because the women and practitioner together understand how the process works.

If you want info on the range of care and how to know if you are getting great prenatal care than check out our Real Baby, Real Body Talk and find out why raising your expectations in the short term creates better health in the long term!

VBAC to the future

There’s a great article on VBACs (or Vaginal Birth After Cesarean) in last week’s Time Magazine. You can read it here.

Pamela Paul does a good job laying out the lines of thought from practitioners who are wisely concerned about overuse of surgery and loss of skill, to those who have put aside medical pragmatism for fear of increasing liability premiums. The liability insurance industry is basically, at this point, determining access to and quality of obstetrical care in this country. By raising premiums to an unfathomable level, doctors and midwives who take time with their patients-which is documented to improve outcomes-are being put out of business. When will medicine and healthcare get some balls and become ‘by the people for the people’?

Luckily, for our cesarean “veterans” as the article calls them, we know many experienced midwives and dedicated doctors who are achieving great success at supporting women in their VBAC’s. The largest body of evidence shows that if possible, it is wise to decrease the woman’s risk of additional surgery both for her and her baby’s well-being. If you have questions about VBAC, birthing options in NYC or need a VBAC class call us for more information and resources!

Birth or vote?

A few days ago, I was contacted by a student who had questions about absentee ballots. It seems that a woman who has a due date near or on Election Day is eligible for an absentee ballot but according to the NYC Board of Elections her partner is not! Rather odd that at a moment where the future of the country is more personally relevant than ever, a partner may have to make a last minute choice to witness their child coming into the world or participate in our great democracy. Here’s my advice partners, dads and husbands - LIE and get an absentee ballot for travel. It’s time to get your votes in there, parents!

And of course, don’t forget to get an absentee ballot yourself if you’re due soon!

New York Family Magazine

Over the summer, I had the pleasure of coffee with Eric Messenger, the Editor of New York Family Magazine. As a beautiful glossy ‘zine, New York Family is redefining the freebie family publication in NYC. Focusing on entrepreneurial moms, and trying to list every possible resource for parents whether it’s practical, educational, consumer or just plain fun, their writers are networking around the city to find the real lowdown in a way I haven’t seen journalists try to do in a long time.

In fact, even though we’ve been covered numerous times by major media - The Today Show, Time Out Kids, and New York Magazine to name a few! - one of my favourite quotes comes from a story in New York Family magazine. The writer was a mother who had actually used some of our programs so she had experienced first hand how helpful they could be.

The mom interviewed me at a moment where I was bogged down by training staff, running two physical spaces, and compiling reports for investors, but her interview reminded me of just how much we had accomplished! How often does a reporter remind one of the bigger more important picture when caught up in the daily minutia of living ones dream?!

“We’ve helped five thousand families feel like they’re not going crazy”
- New York Family article on Realbirth, April 2008

New York Family is doing a Family Expo over the next two weekends. For all of you out their with new babies through to big kids, I encourage you to check it out and see what’s happening around town. Events are happening on the Upper West Side, Upper East Side and in Brooklyn, and you can register to win a vacation and attend. Oh, and you can also always find free copies of New York Family at Realbirth!

Trying To Take Back Childbirth

Abc.com recently published an interesting article entitled "Trying to Take Back Natural Childbirth," written by Susan Donaldson James. The article takes a look at both sides of the childbirth debate - the mom who is planning a natural childbirth, and another mom who is planning to have an epidural.

Although the article was sparked by a staff member at ABC who was surprised at how hard it was to find a doctor in New York City who would be supportive of the couple trying for natural childbirth, the piece does well not to show bias and instead explains the different perspectives regarding what a woman needs or wants from her birth environment in order to cope.

What I find funny about conversations about "the woman who wants to do natural childbirth" and "the woman who wants an epidural" is the defensiveness. Saying that women are trying to take back childbirth, and yet implying that the way to take it back is through advocating natural childbirth is still missing the point. 'Taking back childbirth' isn't about how we decide as individual women to cope. Instead, it's about understanding what happens to our bodies and being respected enough in a moment of vulnerability that the professionals around us will have what we need - whether that's medications or jacuzzi's and massage. The article does a good job explaining the frustration women are having at finding practitioners and facilities that understand that individuality and provide a range of coping choices.

The more critical aspect of 'taking back childbirth' is about curbing our race to excessive surgery. A woman now has a one in three chance of a surgical delivery, according to the recently released 2006 NYC Department of Health statistics. Don't get me wrong, surgery has a time and place, but not 31% of the time – and this is a surgical shift that has occurred in just one generation. If we're going to take back birth, we need to start understanding why it's a good idea to have a baby come out of our vagina - both for our body and for the baby. Our vaginas are multi-use works of evolutionary perfection, and women need to have equal access to doctors and midwives who are skilled and trained to birth babies out of them.

When women understand how their body works, how their baby works, how reproduction works, how evolution worked and how medicine can support them but not play god, they no longer live in fear of the myths and the pain, but rather see it as a process that is doable in one way or another. That's taking it back.

Beginners Dictionary: Word 1

There is so much pregnancy and birth terminology that we're always getting asked what certain words and phrases mean. Much as the Realbirth staff are always happy to answer any questions you have, I thought it would help if I explained what some of them mean in a new regular series on this blog, starting with…

 

DOULA

There are two types of doulas when you are having a baby. A labor doula who provides physical and emotional support to the laboring couple, and a postpartum doula who supports and cares for the postpartum mother.

 

With our students, one of two** consistent things that I hear at our class reunions is either "thank god for our doula" or "I wish we had used a doula". While at reunions birth stories are often like being dealt a hand of cards eg "my water broke/it didn't break/ it was artificially broken" or "I had/did not have/loved/hated the epidural" etc, the doula feedback is strong and consistent. Most people who used a doula found them to be an invaluable resource - or else the couple retrospectively wished they had had one.

 

This makes sense when you look at the data: the numbers are overwhelmingly in favor of having a labor doula. In a recently published study* of a randomized controlled trial of continuous labor support the rate of cesarean delivery was shockingly affected.

In this study, couples were randomly assigned to have a doula who arrived shortly after hospital admission and remained throughout labor and delivery. Doula support included close physical proximity, touch, and eye contact with the laboring woman, and teaching, reassurance, and encouragement of the woman and her male partner. The doula group had a significantly lower cesarean delivery rate than the control group: 13.4% vs 25.0%. Among women with induced labor, those supported by a doula had a lower rate of cesarean delivery than those in the control group: 12.5% vs 58.8%. On questionnaires the day after delivery, 100 percent of couples with doula support rated their experience with the doula positively.

 

In both our Realbirth classes and in The Big Book of Birth, we fully explain the role of support. A doula doesn't have to be a paid professional, it could be as simple as a girlfriend who had a positive experience with birth and is willing to drop everything and be there for you one hundred and ten percent!

 

*A randomized controlled trial of continuous labor support for middle-class

couples: effect on cesarean delivery rates.

SK McGrath and JH Kennell

Birth, June 1, 2008; 35(2): 92-7.

Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio, 44106, USA

**The second piece of consistent feedback we get is how helpful 'The Big Book Of Birth' and the Realbirth classes were!

Adopting Parents: Education Required!

I taught a very inspiring class to an adopting couple yesterday. Realbirth offers a Newborn Care for Adopting Parents class, something that has basically come out of the growing presence of soon-to-be-adopting couples in our Newborn Care classes. Yet the educational needs of a family that is birthing and postpartum compared to a family that is adopting are slightly different, so we’ve now created a class specifically for adoptive parents. What amazes me about this group is how much more is demanded of them (education-wise) than from those of us who are non-adopting families. In addition to paying untold thousands out of pocket (since adoption is not covered by health insurance), adoptive parents are often required to take parenting and child development classes-unlike all the rest of us breeders. The couple that I met with yesterday had already taken a ten hour class on child development, bonding and building family which was required by their adoption agency. And even then they were still required to take additional classes (which is why they are with us at Realbirth.)

I find this really interesting, but I also find it an odd bias. I’m all for parent education yet here are these dedicated couples who want to share the love in their lives and be parents, and yet they are required to jump through hoops to prove their financial, emotional and intellectual ability to parent. Meanwhile the rest of us conceive, birth and parent often without any formal input, and classes are often considered an extra-or bonus- rather than a absolute core necessity. Although don’t get me wrong, I truly believe preparation classes and new parent support in our current culture are a necessity! 

While the Realbirth community attracts phenomenal parents and parents-to-be who do understand they need some sort of road map through the unknown, wouldn’t the world be a better place if we were all encouraged to have some sort of formal parenting education and postpartum support?

Incidentally, if you’re adopting a child or you know somebody who is, and would like to get more details on our Newborn Care for Adopting Parents class, please do call us at (212) 367 9006 and we’ll be happy to help.

Raising the bar

One thing I’ve noticed recently is that since Ricki Lake and Abby Epstein’s docu-movie 'The Business of Being Born' came out, about 20-30 percent of our students are changing providers. Not necessarily to a homebirth which the movie advocates (although some are), but rather they're raising their expectations about the quality and treatment they feel they should receive from a doctor or midwife. Classes that used to begin with get-to-know everyone introductions are now a hotbed of questions, concerns, confusion and adamant opinion that didn’t used to surface until later in the series.

As an educator for almost fourteen years now I’ve never seen a piece of media have the impact that this movie is having.
 
The fact that parents have been slow to realize that they deserve a certain level of care is because most people are only passionate about it for an extremely short window in the last trimester of pregnancy - and then they are through it and on to the all-consuming task of parenting!

Since any area that is primarily a woman’s health or social issue has often required steady organization and commitment over a long period of time to affect change, pregnancy, birth and postpartum have often been left off the major political map. But ‘The Business of Being Born’ is having an impact on parents in a wide spectrum - especially in terms of raising the bar on the level of attention they get from visit to visit.

For many years I have heard women justify the rushed or cursory clinical care they get by saying “but he/she is a good doctor”. I find this double standard we apply to ourselves as pregnant women so odd. We would never tolerate our child’s pediatrician being rushed or cursory simply because they were thought to be a good clinician. I know so many great doctors and midwives who are great clinicians as well as being patient and nice. Why settle for just half of the equation when we are already vulnerable in pregnancy and birth?

Back at last!

Welcome back! I’m feeling very guilty after leaving this to blog to wallow without new postings for the past six months, after what I’d like to think was quite a dedicated start. I once read that a huge percentage of blogs quickly go to seed, so maybe I have a chance of redemption as I am now reviving this as a forum.

 

To be fair (and kinder to my workaholic self) we’ve been crazy busy with lots of wonderful happenings! So what’s been going on since I last wrote?

 

Well my book ‘The Big Book of Birth’ has enabled us to reach thousands and thousands of women – around the world – in the nine months since it was published - educating the same number in those nine months as we’ve managed to reach in the first four years of running a pregnancy education center in NYC! So that feels pretty good for everyone at Realbirth.

 

And I’m very happy to say that ‘The Big Book of Birth’ continues to get great reviews, such as this one:

 

Towards the end of last year, Realbirth opened its second Manhattan location at 49th Street and 9th Ave. You can read about this on the home page of our new website, which tells the whole story about NYC’s largest eco-friendly baby store (complete with beautiful teaching space!).

 

What’s REALLY exciting is that we were named “Best Parenting Resource” by New York Magazine! You can read the review here:

 

And Time Out wrote us up in their Pregnancy Guide:

 

As you can see lots of great things are happening to Realbirth. And on top of all that rewarding work, I even found time to get married last fall! After seven years as a single mom (translate - not having to listen  to another opinion at home that counts equally as much as mine!) I am now adjusting to having a partner in crime. I must say, I highly recommend this marriage thing! My kids, ages almost fourteen and ten are thriving having another adult to torture, and as a parent it’s nice not being outnumbered anymore!

 

So it’s been a busy year…a book, a new space and store, a new marriage…who knows what will happen next…

The Today Show

Well after I gave a little bit of a hint in my last entry, I can now tell you that our sibling preparation class for second time around parents was filmed by NBC’s Today show this past Saturday! It will be airing TOMORROW (Tuesday March 27^th) in the 9am hour of the show.

The filming went really well, with Giada De Laurentiis being an incredibly gracious hostess/anchor! She even hung around a few minutes extra at the end so that my daughter could get her picture taken with her, since my daughter loves the Food Network and just happened to be at a cooking class at the Natural Gourmet Institute around the corner.

I also have to say it was the most well-behaved group of three year olds I've seen in a long time - really great kids and caring parents. The sound lady, a very cool person named Helen (as she clipped the mic to me before the shoot she said, "Are you ready for your fifteen minutes? Well don’t blink your eyes!" which made me laugh) said afterwards that I had the patience of a saint. I doubt my kids would say the same thing. Nothing like a camera to instill patience!

If we can we will figure out a way to link the segment with the blog so you can see it but tune in to NBC tomorrow morning and check it out!!!

Sibling preparation classes

If you're in New York City and you get the chance, have a look at the March edition of Time Out New York's Kids edition. They've done a great piece on Realbirth's sibling preparation class - those of you outside New York can have a look at it here. I actually was just in communication with the author of the piece yesterday who is holding her own with a brand new baby and a toddler by repeating to herself what I had told her in the interview!

Since one good deed leads to another (thank you Time Out Kids New York!), a major nationwide morning TV show is coming to Realbirth in the next few days to film one of our sibling preparation classes, to be aired on the show sometime during the week of March 26!

As soon as I know exactly when it will be on air, I'll post news here so that you'll know when you can see us on TV and which show!

In the meantime, if you want more information on Realbirth's sibling prep classes, just click here.

New York Post

Just found out that the book was reviewed in the New York Post this weekend. William Georgiades describes the book as "EVERYTHING you ever wanted to know about birth, but were afraid to ask". And even better, he says that he only wishes that "this reassuring, humane and endlessly useful handbook had been in print when my daughter was born".

It's a great review, and it's rewarding that people are reacting so positively to the book. If you missed it in the paper, you can read it online here.

Realbirth in Brooklyn

It's been a few days since I posted on here - as you can probably imagine, it's been hectic with the release of the book and the construction to expand into an additional space. Thanks for all your support with the book so far, the positive feedback has been amazing and is deeply appreciated. And thanks to everybody who has read the blog to date, or passed on the link to friends and family!

A couple of you have left comments, including Lori Ungemah who wanted to know when we're going to be opening a Realbirth in Brooklyn.

What a great idea! We are actually looking for the right space and have been for quite some time. However, we do actually already run some of our childbirth education, breastfeeding and newborn care classes in Brooklyn, at Ola Baby on Court Street in the Cobble Hill/Carroll Gardens area. Take a look at the Realbirth website for details of the classes and the schedule.

A conveniently located Brooklyn space of our own is the long-term goal! However, it's a huge challenge to find affordable space in New York City (as we all know!!), since running parent education classes and postpartum support groups isn't exactly Wall Street! We will keep you posted though, I agree there is a need!

Ask Moxie

I'm sure that lots of you have read the Ask Moxie blog, a great online resource in which Magda helps people troubleshoot their parenting problems. She took the newborn care class at Realbirth before the birth of her older son, and then our sibling preparation class before the birth of her younger son, so she knows plenty about the way we operate!

Well one of her latest posts on her blog is a glowing review of The Big Book Of Birth, which you can take a look at here. I'm really grateful for the support, and it's nice to know that people like the book and think that it can be a valuable resource. The feedback to the book since it came out last week has been so good, and it's great to hear how people are reacting. Feel free to leave a comment here on the blog letting me know what you think.

And as ever, please do let your friends and colleagues know about the book. You (and they) can buy it online from Barnes & Noble by clicking here, or at Amazon by using this link. Or just visit your local book store and buy or order it there!

The big day has arrived!

The Big Book Of Birth is finally on sale! You can order a copy of it online from Amazon here, at Barnes & Noble here, or go into your local bookstore - big or small - and either pick it up there, or order a copy to pick up later!

Realbirth: the future

Realbirth continues to grow, you'll be pleased to know. We are opening a second location in April, at 49th St and 9th Avenue. We will contine to expand our great programs, and we are adding a “green” parenting and baby store called “Bump to Baby”.

We'll still be functioning as normal at 22nd St, so make sure you pop in to see us very soon.

Life as a mom

When I go places with my kids, they assume I know every pregnant woman they see or just about any one with a baby. I taught in my neighborhood hospital for years, and they grew up with me answering breastfeeding questions in the frozen food aisle of the grocery store, or sleep questions on the way to the park.

My daughter is already phenomenal with kids and is going to be the most in demand babysitter ever. My son just rolls his eyes at our high estrogen household and finds refuge in his pet turtles, frogs and computer.

And 2007 brings tremendous personal change as well as professional. I am getting married in October and while I’ve been a single mom for seven years, this woman has got to say that she’s a fish who likes to ride her bicycle…

Illustrating the book

One thing I always knew about the book was that it needed illustrations. About the time I was looking for an illustrator, a student called Matt Wimsatt said during introductions in class that he was a medical illustrator and that he had seen a lot of pictures of births. He was talking about the shift in his intellectual process of needing to draw something using his skill and experience, as opposed to now needing to understand what might actually happen in labor, and the physical and emotional reality for him and his wife.

I tucked that information into the back of my mind, and after class I asked him about his illustration work. It turned out that Matt had the perfect blend of art and experience for the book. He had the technical skill to do anatomical drawing, but he had also done a lot of illustrative work as well. So using him for both types of drawing was possible. I had been worried about providing a visual consistency for the book, but here was the perfect solution.

I asked him if he could make the figures look a little bit like the “For Better Or For Worse” cartoon, in that I wanted soft figures that women could really relate to. Pictures become so dated so fast and illustrations can sometimes show us a bit of our humanness, without being as confrontational as a photograph. And Matt did an amazing job, and was great to work with – so much so that he also designed the new Realbirth logo with me. I'm really pleased with the results.

For more details on Matt Wimsatt and his work, click here.

The first review

The first review of a book is a terrifying thing, but thankfully the Library Journal Review have been incredibly supportive and positive in their look at The Big Book Of Birth. Take a look at the review below.

Library Journal Review

Lyon, Erica. The Big Book of Birth. Plume: Penguin Group (USA).

There are a plethora of books available on the topics of pregnancy and childbirth; however, few are devoted entirely to the stages of delivery from the end of the third trimester through postpartum. Here, Lyon (childbirth educator; founder & director, Realbirth Ctr., New York) addresses this critical time. She states in the first chapter, "This book will help you to understand how to trust your body, protect your baby, and navigate your journey to motherhood." Her book is not only thorough but written in a warm, coaching style, which makes for easy reading. She takes women through the stages of labor, providing information on everything from pain medications to relaxation techniques to choosing your midwife or doctor. Line drawings and clear illustrations augment the text; personal anecdotes are well used throughout. Lyon's straightforward style makes this book a welcome addition to consumer health collections; highly recommended for public libraries.

-Mary Grace Flaherty, Sidney Memorial P.L., NY

Sadly the Library Journal website is subscription only, but you can get more information on the publication from their homepage here.

The cover

So, whats the most frequently asked question so far? That's easy - who is the baby on the cover?!

Well, the adorably cute, slightly pensive baby is not one of mine, or one of my students (as far as I'm aware at least - there have been thousands so far, to be fair!). But I am on the case to discover the mystery baby's identity...and I will let you know as soon as I find out.

I do love the fact that on the cover of a birth book is a baby rather than a pregnant woman. That's not to dismiss how important the mother is in the process - it is her doing most of the work after all. But I do believe that it is important to keep our focus on the baby as we cope with labor - it is often a primary coping tool in labor focusing on our soon to be seen baby. Keeping our "eyes on the prize" gives us strength we did not know we had that we will need in the raw early weeks of being a new mother.