International Symposium Toward the Humanization of Childbirth
Panama City, Panama
Saturday, 30 May 2015
Thanks, Greetings, and Opening Remarks
Hello! I am so excited to be invited to speak to you today!
Thank you to Emilia for inviting me, and thanks to all of you who dreamed big and worked hard to make this day a reality, and to you and your families, who made it a priority for you to be here today to support the big idea of more humane childbearing. More choices. More support. More respect. More freedom. Thank you!
I am supposed to be learning to speak Spanish, but sadly, after a year south of Texas, I am only competent to order pizza in Spanish, and will give this talk in English, with the translation over head. Many thanks to Michelle, and to Silvia Vidaorreta, for editing and translating my talk.
When I wrote this talk, I thought I was to fill an hour, but I have needed to shorten it to 30 minutes. My full talk, as I originally wrote it and had it translated, is on a Facebook Group, Donde Sea Y Con Quien Sea. On this website I have also put other resources, and a way for us to continue our conversation, since I will not have time for questions.
My name is Corrine Flatt. I am Christian. I have been married for 26 years to my husband, Jason, who is a Drupal/PHP web developer. Because all of his work is on the computer, he has been able to do his work from the beautiful beaches of Latin America. I am the mother of seven children, ages 6 to 22. All of my children have always been homeschooled, and five of my children are with us here in Panama. My family has been traveling for the past year to see the beautiful places, and to meet the beautiful people, in the lands south of Texas. We left Las Vegas, NV, over a year ago, first heading to Texas, then we left the US from Brownsville, Texas, traveled south along the Gulf of Mexico, around the Yucatan, along the Caribbean to Belize, then through Guatemala, El Salvador, Honduras, Nicaragua, Costa Rica, and now Panama. In a few weeks we will be leaving Panama to head up the Pacific coast, probably taking another year or more for the return leg of our journey.
I am a midwife from Las Vegas Nevada. I have been a midwife since 1998. I am also a Bradley Method childbirth teacher, a DONA trained doula, a La Leche League Leader, and the founder of Pinkpeas Pregnancy and Parenting Care Center.
La Leche League was my first love as a mother, and continues to be at the center of my heart, and strongly influences the way that I practice every other work I do with mothers. I believe with all of my heart that if you CAN be a La Leche League Leader, that you SHOULD. Not just because the world needs more LLL Leaders, but because, through the training process of becoming a LLL Leader, you gain skills of listening to mothers, and communicating with mothers gently and respectfully, that ensures that they feel heard. This feeling of being heard and respected builds trust, and this trust is what ensures that they can hear your message, as well. You also learn mothering truths that have been distilled from thousands of mothers that go way beyond breastfeeding. If what you know about mothers begins with LLL and with good knowledge of breastfeeding, and the skills of truly listening to and respecting mothers, you are on solid ground for learning and working with families in any other area.
The Midwifery Profession in the New Millennium ~or~ About Modern Midwifery in the US
The United States is a confusing combination of UNITED and STATES. I’m not going to go too deeply into US politics, but for now know that midwifery is one area where the states are still in charge of making up their own rules. In some states, midwifery is essentially illegal, although in some states midwifery is highly regulated, and in some states midwifery has very little regulation. I am fortunate to practice midwifery in Nevada, which is one of the freest states in many ways, including the practice of midwifery.
There are many paths to midwifery. Some midwives begin by getting a 4 year nursing degree, then go on to get a 2 year advanced practice degree in midwifery. Some midwives attend a 3 year midwifery school, including an internship with an experienced midwife for 1 or 2 years of that time. Some midwives participate in a distance learning program while apprenticing with an experienced midwife preceptor, and some midwives just study under, and apprentice with an experienced midwife for 2 to 5 years, or typically until they have attended 100 or more births. All of these paths to midwifery result in excellent, skilled, and highly trained midwives. As with any profession, such as hairstylists, plumbers, teachers, and doctors, most are excellent, because excellence is something that most of us strive for in all of our work, and it is rare to find someone who has trained and studied for years who is a “bad apple” but it does happen in the field of midwifery, as in every other profession.
There are many ways that midwives work with mothers and babies. Many underfunded and understaffed hospitals hire nurse-midwives to deliver women who don’t have a private doctor, or whose doctor is in surgery, or otherwise unavailable. Those “hospitalist” nurse-midwives often also do much of the training of the student doctors. Busy doctor’s offices love to hire nurse-midwives to see pregnant women in the office, freeing the doctors to handle a larger number of women. Most non-nurse midwives have their own practices, some with shiny clinical offices, some with warm and comfy offices, some with home offices, and some midwives who do home prenatal visits. Most non-nurse midwives either have birth centers or attend homebirths.
Prenatal care with a midwife typically includes the same modern care choices found in doctor’s offices, but women in the care of a midwife are able to have a more active role in deciding which tests and procedures are right for themselves. Midwives also are able to spend much more time with their clients. Doctors will often only have 5 to 10 minutes with a patient, while appointments with midwives are typically 30 to 60 minutes or longer.
At the time of birth, women in the hospital are cared for by nurses until near the time of birth, their nurse keeping the doctor apprised of the progress of the labor, and then the doctor arriving just minutes before the baby. When a woman has her baby at home or in a birth center, the midwife is typically there from the time she is called, whether that is many hours (or sometimes days) or just a few hours, until the birth, and then for 2 or more hours after the birth, until mother and baby have transitioned well, and breastfeeding has been established.
My practice has evolved over the years to a nearly exclusive practice of group prenatals. In my office, Pinkpeas, there is a bathroom, a small kitchen area, and a small private room, but the main feature of Pinkpeas is the very large front room, easily large enough for 12-20 moms, dads, friends, and lots and lots of children. Because mothers - almost by definition - come with children.
In my practice, I schedule 2 or 3 times per week for mothers to come into the office for a two hour group prenatal. Mothers are welcome to bring the whole family, and even friends. Everyone is expected to arrive on time, and stay for the whole two hours. Many mothers do their own weight, blood pressure, and urine check as needed, either before or after circle time, then we spend an hour or more having a group conversation, and then toward the end of our time, the mothers come, one at a time, to the side of the circle for individual questions and a quick check of baby growth, position, and heartbeat. No scheduled appointments are offered or needed, mothers just show up as often as they wish, and are able to call me at any time between appointment times for urgent questions.
With group prenatals, childbirth classes, La Leche League Meetings, and so many more opportunities, mothers often spend 30 or more hours in my office before labor begins. She knows me and the other women who will attend her birth, and we know her and her family. We have had many hours of ORDINARY CONVERSATIONS with her, her family, and with many other mothers in her presence. She has heard first-hand birth stories and breastfeeding beginnings. She has seen good (and not-so-good) mothering from many mothers with children of all ages. I trust these mothers to sort out for themselves, over time, what is good and right for her family, and what is not. Mothering is learned from mothers. Birthing is learned from mothers who have birthed. Breastfeeding is learned from mothers who have breastfed. The good, the bad, and the ugly stories. ORDINARY MOTHERS, having ORDINARY CONVERSATIONS.
Toward the Humanization of Childbirth
However, I didn’t come here to sing poetically about the romantic and beautiful utopia of midwifery and birthing in the US, the lovely birth stories and photo blogs you have seen on the internet, and the yearning which is the reason for this gathering. I came here to tell you my little piece of the truth, which is that the hurdles you face here in Panama, and the similar and different hurdles that I have heard from the mothers in Mexico, Guatemala, and Costa Rica, are the typical reality in the US, as well, and that the US continues to slide backwards, toward less freedom, and less humanization in childbirth. I believe that it is possible to change this backwards slide, here in Latin America, in the US, and everywhere, and move forward toward more humane childbearing. More choices. More support. More respect. More freedom.
When I started to write down what I wanted to tell you today, I wrote a very different speech. That first speech was harsher and stronger. It was about birthing freedom, yes, but also ordinary freedom and the ordinary freedom of ideas. You see, it is in the freedom of ideas, and how we think about each thing, that true freedom exists, and I wanted to tell you to be very careful that you understand what you are wishing to achieve in these next years. That you have a clear understanding about whether you wish to have birthing freedom, or whether what you wish for is merely softer chains of bondage. A drink of water, or a fluffy pillow, or permission to move around a bit in your cage.
In our Facebook group, Donde Sea Y Con Quien Sea we can continue our conversation in English and in Spanish. In my office, I usually have about 30 hours to help moms and dads to understand these things, but I am going to attempt to do this here for you in the next few minutes. Hang on and stay with me!
People Who Wear Funny Hats, and ORDINARY PEOPLE
When thinking about freedom, and specifically birthing freedom, there are two kinds of people. I will call them ORDINARY PEOPLE, which are most of us here in this room, and the other kind of people I will call People Who Wear Funny Hats, who are governmental legislators, licensing bureaucracies, insurance policy writers, hospital administrators, and the doctors who make up the boards of physicians. I like to think of the People Who Wear Funny Hats as the generals in the army of thoughts and ideas, and their soldiers, then, are comprised of most (though not all) of the following groups: teachers, priests, police, social workers, doctors, and media writers or “journalists.” Most of these “soldiers” in the army of thoughts and ideas, I believe, also have not really thought about these things. People Who Wear Funny Hats believe that it is their job to govern, administrate, police, and otherwise “manage” ORDINARY PEOPLE. This is done mostly by managing how and what we think from early childhood. The People Who Wear Funny Hats and the ORDINARY PEOPLE all generally believe that this relationship is good, and right, and natural because we have all been told it is so from earliest childhood, on television, in what we read, in school, in church, and from the People Who Wear Funny Hats, themselves.
Hard Truth or Softer Chains?
I am a big fan of educated mothers making informed choices for safe birth with skilled, experienced, and highly trained attendants to assure good outcomes. I am highly committed to supporting all of these goals. Does everyone here agree? However, would you agree that when you hand these goals, expectations, or demands to the People Who Wear Funny Hats, that what you get is the OPPOSITE of freedom? People have RIGHTS. These People Who Wear Funny Hats have the illegitimate POWER to restrict your RIGHTS.
►► Who should get to decide? ◄◄
Freedom means that your neighbor gets to choose to do that which you abhor. Freedom means that your pregnant neighbor has the right to remain uneducated. To make ill-informed choices risking the safety of herself and her baby. To hire untrained, unskilled, unsafe attendants, and to possibly suffer a bad outcome.
If you want birthing freedom, you must completely stop talking about the safety of birth. Nobody can guarantee a good birthing outcome. Babies and mothers are harmed, and sometimes die in the best hospitals with the best doctors who have the best intentions. Bad things happen to nice people who do everything right. Talking about safety in childbirth means that you expect the People Who Wear Funny Hats to make a guarantee, or to “manage risk”. That is the opposite of freedom.
Freedom means supporting everyone’s right to choose to birth
Wherever, Whenever, and with Whomever.
Please hear me and believe me. I am highly committed to supporting educated mothers making informed choices for safe birth with skilled, experienced, and highly trained attendants to assure good outcomes, AND I BELIEVE we can have both. I believe in mothers. I believe in ORDINARY PEOPLE.
My hope here today is to gently and peacefully PROPOSE that birthing freedom is not something that will EVER happen in the realm of the People Who Wear Funny Hats. Birthing freedom is something that will happen individually in the heart and mind of each individual ORDINARY PERSON. Birthing freedom already exists here in Panama. It is just a matter of CHANGING your MIND.
A Brave New World ~or~ Wherever, Whenever, and with Whomever
We live in a new age of the internet. I gently and peacefully PROPOSE that we no longer need the People Who Wear Funny Hats to protect us from making bad choices. Every ORDINARY PERSON has the ability to educate themselves, and to become informed, and every ORDINARY PERSON should have the right to make informed choices for herself. However, every ORDINARY PERSON should also have the right to remain uninformed, and to make uneducated choices.
There are non-governmental certifying agencies for everything from hairstylists, to plumbers, to teachers, to physicians. There already are organizations that do a great job of training and certifying birthing professionals right here in Panama, and if the ones that already exist aren’t willing to step up, then create a new one. Right here. Right now. We no longer need the People Who Wear Funny Hats to provide licensure, thereby restraining association and trade in every field and institution. There are specialized ratings services for every type of service, and there are prominent general ratings features in every major search engine and social media service from Google and Facebook to Kudzu and many more. There are certainly some well-known and popular ratings services exclusive to Panama or Latin America that I don’t even know about. If an ORDINARY PERSON were to be in the market for a new car, refrigerator, or smart phone – or stylist, plumber, teacher, or physician – we do not rely on the People Who Wear Funny Hats to make those choices. We ask our friends and neighbors for word-of-mouth recommendations, and we do our own research in person or on the internet, and we do it pretty well. Certainly there are now and will always be products that are not what they are advertised to be, and there are service providers who are unscrupulous or incompetent. Wouldn’t we be better off and even safer if we stopped relying on the People Who Wear Funny Hats for the misleading fallacy that we can rely on their having a greater interest in our own well being than we have for ourselves and our own families?
The only action worthy of pursuing with the People Who Wear Funny Hats would be to simply, and continually insist that the phrase, “Wherever, Whenever, and with Whomever” is placed, not just in birthing laws, but into the laws governing every association of every ORDINARY PERSON with and in every institution of humanity, and to, over time, remove all forms of governance, licensure, and restraint of association and trade from everyone, everywhere. All people should have the right to be able to associate and exchange Wherever, Whenever, and with Whomever they wish.
A Few Thoughts
Regarding Midwives – There are already grandmother midwives in the interior areas of Panama. One estimate is that there are at least 25 parteras working in the outlying areas. Find them. Love them. Figure out how to get them the training that YOU wish for them to have. The simplest help would be the most helpful. The first knowledge that a midwife needs most is knowledge that is abundant here in this room right now. Nutrition. Hygiene. Basic anatomy. Determining baby’s position through external palpation. Recognizing and helping with basic breastfeeding challenges. Then get training videos from anywhere you can get them, and take them around to these brave, pioneering midwives. Then, once they know and trust you, make a special midwifery conference or a series of skills workshops just for them. I know that there are plenty of knowledgeable and experienced midwives in the US – many who speak Spanish – who would be honored to work with you to provide training for these midwives. Approach your traditional midwives with humility and love and respect. Listen to them, learn from them, and don’t let their knowledge and wisdom die, like we did with our traditional midwives in the US.
Doulas – figure out what the People Who Wear Funny Hats believe to be who a midwife is, and what a midwife does, and do not ever allow yourselves to cross that line until the time comes when the rules are changed. Learn all that you can learn, but do not cross that line.
Aspiring Student Midwives – Create a study group. I will help you find or create an affordable distance learning program. I will help you find Spanish-speaking midwives and others who you can bring in to do skills workshops here in Panama or Latin America. If you can get a dozen students in a class, it might be cheaper to fly your teachers here to Panama than it would be to fly all of you to the US for conferences and hands-on workshops.
How to Negotiate with Hospitals, or NOT – You are in a sticky situation with the hospitals in Panama, in which you can offer no financial incentive for change. Whether you have your baby at a hospital or whether your baby is “accidentally” born unassisted in a romantic, candle-lit waterbirth at home, there is no financial advantage or disadvantage to your hospitals or doctors. I’m not sure what to do about that, except to very peacefully and calmly and continuously ask for the hospitals to change. If you are paying privately for a physician to attend your hospital birth, you can put tremendous pressure on him to help you negotiate for a “labor and delivery” room equipped with a simple regular bed and two chairs for the doctor and the nurse to sit on while you and your husband and your doulas go about the work of letting the baby come out. Stay home as long as possible. “Accidentally” have your baby in the car, or in the hospital parking lot. Regardless of your birthing choices, take every opportunity to let yourself be interviewed by the television news station, and be simple and clear about what you wish to change about the way birth is done in the hospital. Maybe seek out those parteras who, according to the rules set forth by the People Who Wear Funny Hats, must remain far away from the cities and hospitals, and go have your baby in the interior. A birthing vacation! A Homebirth Away from Home!
Regarding your Local Heroes – There are some local heroes here today. Doctors, nurses, lactation consultants, educators, authors, and others, who have been brave pioneers on the cutting edge of humanizing childbirth and the treatment of mothers and babies. Continue to love, honor, and respect them, and be inspired by them. However, do not ask too much of them. They already, daily, risk their reputations, and livelihood with the good work that they do. Do not ask them to become one of the People Who Wear Funny Hats, and do not ask them to become political in opposition to the People Who Wear Funny Hats. They have already risked more than their peers would deem safe or wise.
Yeast – ORDINARY CONVERSATIONS with ORDINARY PEOPLE – How to Change the Culture of Birthing
It has been my experience, my accidental discovery, that carving out deliberate time each week, or maybe just each month, to have ORDINARY CONVERSATIONS with ORDINARY MOTHERS has changed the culture in my little corner of the world. There are at least 7 practicing midwives who either apprenticed with me, or for whom I was their midwife before they moved on and trained elsewhere. There are at least 20 women who have become La Leche League Leaders either with my help or after discovering their love of La Leche League in my group. And there are countless other mothers who found their niche in the world, and have their own little or big services or businesses that I have enjoyed watching and encouraging as they have grown. Each of these women are continuing to change the world every day through ORDINARY CONVERSATIONS with ORDINARY MOTHERS. But that is just the tip of the iceberg. That is not “culture” – it is just a symptom of culture – it is just the part that you can see. The real change is the much, much larger part that is below the surface. The ORDINARY MOTHERS, the ORDINARY fathers, the ORDINARY grandmothers, sisters, neighbors, and friends. These ORDINARY PEOPLE are the yeast of the culture. The change in the hearts and minds and understanding amongst these ORDINARY PEOPLE, and the ORDINARY CONVERSATIONS that they continue to have, and the true, good, beautiful, and just ideas they continue to discover is where the culture changing magic can really be found. Helping people see that ideas are also consumer goods, and that they don’t have to “buy” every idea that they learned in school, see on television, or have handed down by the People Who Wear Funny Hats. That is the true yeast. That is the true culture changing magic.
For me, I began accidentally by scheduling one day per month to go to the park with my children, and to invite any mother who wished to come along. I also scheduled one late night each month to go to an all-night restaurant, again, inviting any mother who wished to come along. At these times, I began to see the power of positive encouragement. When a mother said something that was true, or good, or beautiful, or just, I had the power to strengthen that idea not only for the mother who was speaking, but for the mothers who were listening, by agreeing.
I also found it helpful to begin to collect and memorize small truths, which then became easy to say, with practice. Many came to me as I read, or sometimes the few words I needed to isolate and contain important truths came to me in the middle of the night, after a difficult conversation. My long-time friends tell me that they often find themselves repeating those same phrases.
Phrases such as:
• Mothering through breastfeeding is the most natural and effective way of understanding and satisfying the needs of the baby.
• Mother and baby need to be together early and often to establish a satisfying relationship and an adequate milk supply.
• In the early years the baby has an intense need to be with his mother which is as basic as his need for food.
• Human milk is the natural food for babies, uniquely meeting their changing needs.
• For the healthy, full-term baby, breast milk is the only food necessary until the baby shows signs of needing solids, about the middle of the first year after birth.
• Ideally the breastfeeding relationship will continue until the baby outgrows the need.
• Alert and active participation by the mother in childbirth is a help in getting breastfeeding off to a good start.
• Breastfeeding is enhanced and the nursing couple sustained by the loving support, help, and companionship of the baby's father. A father's unique relationship with his baby is an important element in the child's development from early infancy.
• Good nutrition means eating a well-balanced and varied diet of foods in as close to their natural state as possible.
• From infancy on, children need loving guidance which reflects acceptance of their capabilities and sensitivity to their feelings.
Those things all come from La Leche League. My first love as a mother.
Other bits of truth I often say, from sources mostly unknown to even myself, and collected by my friends in a Facebook “Roast”:
The more you add to breastfeeding, the more likely you are to fail.
You can homeschool your children with a Bible and a library card.
Who owns you? Who owns your baby?
The woman with the leaky breasts gets to hold the baby.
There is a difference between IMPOSING your beliefs and PROPOSING your beliefs.
Screaming gets your baby out.
I prefer indiscrete public nursing.
And then, we go to Denny's and talk about you.
I'm a midwife – I can sleep anywhere.
Bad things happen to nice people who do everything right.
I don't believe in big babies.
Chocolate is a perfect food.
Yes, thank you, that would be lovely.
Culture is changed through ordinary conversations with ordinary people.
I have 7 kids – your kids don't scare me.
That's not on the test.
There are no handles on your baby's head.
Apples are a healthier choice than apple pie, however, a piece of apple pie is better than an apple Pop Tart, but if you just have to eat an apple Pop Tart, then eat it and enjoy it!
It’s your husband's job to be your knight in shining armor.
Your baby will not break you.
Land of the unfree, home of the unbrave.
You GOT to hold your baby? Excuse me???
Wherever, Whenever, and with Whomever.
You can park a Volkswagen in there.
Words have meaning.
Here is the list of things you DON’T need to get for your baby.
Freedom means defending your neighbor’s right to do that which you abhor.
I'm not afraid of your baby.
That's a great idea. You're in charge.
I personally hold the record for the biggest baby I know.
I'm a midwife. God is not going to let me win the lottery.
It's okay to let your baby out now.
The party starts when you get there.
All babies should come with a teenager.
N.E.V.E.R CALL THE POLICE.
Help your husband with his energy.
Pick the most annoying thing, go six weeks forward on the calendar, write "I will not stand for (...) anymore"... By the time you get to that day, it will be all better.
Change your face.
No one has ever been pregnant forever, your baby will come out.
Easy. Like a tube of toothpaste, not like a rocket ship.
I love you, and I always will.
What is TRUE deserves to be known and believed.
What is GOOD deserves to be imitated and embodied.
What is BEAUTIFUL deserves to be enjoyed and loved.
What is JUST deserves to be exposed and defended.
Seeking out, studying, and sharing what is true, good, beautiful, and just will change the world. It will change the culture of birthing, and bring birthing freedom to Panama.
“Not to engage in the pursuit of ideas is to live like ants instead of like men.” ~Mortimer J. Adler