Category Archives: Pregnancy & Birth

My thoughts, ideas, and commentary on various aspects of pregnancy and childbirth…

Vaginal examinations: a symptom of a cervical-centric birth culture


I have never been one for lots of cervical exams. As a nurse and a midwife I see them as something to be used only when necessary. They are uncomfortable and really have little bearing on the plan of care. Its crazy the numbers of exams women are forced to endure before and during labor. I had two cervical checks during my pregnancy. One when I arrived at the hospital with a ruptured water bag and another three days later when I said in the midst of labor “i think the baby’s coming” and I was ready to push.

One of my biggest pet peeves is the prenatal cervical check. I am always on a soap box about how unnecessary they are. They are painful and can be very damaging psychologically for a woman. Most women leave there prenatal appointment after a cervical check saying “my cervix is still posterior :-(” as if that is a problem when its perfectly normal.

This great post goes into the labor cervical exam and how unnecessary they are. Its a good read.

Originally posted on MidwifeThinking:

This post is about routine vaginal examinations (VE) during physiological birth ie. an uncomplicated birth without any medical intervention. The VE is a useful assessment in some circumstances, but it’s routine use in an attempt to determine labour progress is questionable. As birth knowledge evolves, and research challenges the current cervical-centric approach to labour progress, there is an opportunity to shift practice. I’m hoping this post will inspire readers to reconsider their beliefs and practices regarding cervixes and VEs.

History: the rise of the cervix

How did we get fixated on what one small area of the body is doing during the complex and multidimensional birth process? An article by Dahlen et al. (2013) discusses the history of VEs. It seems that midwives (and others) have been performing this intervention throughout recorded history. However, for most of this time VEs were carried out in response to suspected pathology eg. an obstructed labour or an unusual…

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Share Your Birth Wisdom…

April 28, 2015
Shafia Monroe

It is fitting that the 9th International Black Midwives and Healers Conference (IBMHC) 2015 will be commemorated in Portland, Oregon, because Portland is also the headquarters of the International Center for Traditional Childbearing (ICTC) and the original site of the first IBMHC in 2002.
The ICTC is seeking presenters for the 9th International Black Midwives and Healers Conference (IBMHC), “Honoring Our Past, Embracing Our Future.” The conference is October 9-11, 2015 in Portland, Oregon, the headquarters of the International Center for Traditional Childbearing (ICTC) and the original site of the first IBMHC in 2002.
More than three-hundred attendees comprised of midwives, nurses, physicians, public health professionals, community health workers, lactation consultants, doulas, birth workers, and students representing over ten countries, will gather in Portland in October at the University Place and Conference Center in downtown Portland.
The conference is an important convening to engage with one another and create safe spaces to develop solutions to a number of key issues, including: diversifying the midwifery, doula and birth worker workforce; creating employment opportunities in community-based outreach and care for women of color, with the multiplier effect of helping to eliminate poverty; reducing infant and maternal mortality in communities of color; discussing advocacy for breastfeeding practices and engaging our young people to enter midwifery; addressing the field of birth work through the lens of civic engagement; and understanding the global community of maternal, newborn and infant needs.
According to the Center for Disease Control (CDC) 24,000 infants died before their first birthday. This is called infant mortality. The infant mortality rate is two and half times higher for African American infants compared to Caucasian infants. According to Amnesty International’s “Deadly Delivery,” women of color suffer disproportionate rates of maternal mortality ( And the 2011 Oregon Black Birth Survey quantitative analysis revealed that over thirty percent of black women felt unsafe, frightened or discriminated against during the birth of their baby ( Convening a conference of Black midwives, doulas, birth workers, physicians and nurses, is a critical step to addressing the health inequities that create these persistent disparities in the Black community.
The conference will address the impact of racial inequity on birth outcomes in communities of color and the underrepresentation of birth workers of color in health care institutions and schools. While the research shows that midwives lower the infant mortality rate, there remains a shortage of midwives of color to service their communities in culturally appropriate ways that improve birth outcomes. “Currently the national profile of midwives is majority white women, with less than 2% being black women with only 13% black women being served by certified nurse midwives (CNMs) compared to 57% of white women being serviced by CNMs.” (Goode, K.L., 2014).
The ICTC invites midwives, birth workers, lactation consultants, educators, credentialing organizations and policy makers to create strategies to increase enrollment of people of color into the midwifery, doula and birth worker professions. Over three days, the midwifery model of care for better birth outcomes will be highlighted with increased civic engagement to promote cultural competency, with an emphasis on racial equity to reduce infant and maternal mortality. It will celebrate the past accomplishments of midwives of color and embrace the future of midwifery and doulas in communities of color to improve birth outcomes.
The conference agenda aligns with the latest research by the March of Dimes on strategies for decreasing health disparities include:
* Using educational approaches that serve the needs of diverse populations
* Ensuring cultural competence among health care institutions and professionals
* Maintaining diversity within the health care team
* Conducting research to better understand the needs of patients from various cultural groups (March of Dimes ©2010)
The 9th International Black Midwives and Healers Conference is endorsed by local, national and international partners: Sister Song, Midwives of Color Committee/ACNM African Alliance of Midwives; Oregon Midwifery Council (OMC); International Cesarean Awareness Network (ICAN); Midwives Alliance of North America (MANA); Doulas of Color; Doula Caribe Internacional; Muslim Midwives, Doulas and Childbirth Educators; the National Association of Professional and Peer Lactation Supporters of Color (NAPPLSC), and Shafia Monroe Consulting.
To learn more about the conference visit
To submit an abstract visit or contact Shafia Monroe at or 503-460-9324

Subscribe! | Black Women Birthing Justice Quarterly Newsletter

Originally posted on Midwives of Color:

Black Women Birthing Justice is a collective of African-American, African, Caribbean and multiracial women who are committed to transforming birthing experiences for Black women. Our vision is that that every woman should have an empowering birthing experience free of unnecessary medical interventions. Our goals are to educate women to advocate for themselves, to document birth stories and to raise awareness about birthing alternatives. We aim to challenge medical violence, rebuild women’s confidence in giving birth naturally and decrease disproportionate maternal mortality.

Subscribe here.

Check out the Spring 2015 issue here!

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Its National Midwifery Week!! I didn’t even realize it. WOW! I am so out of the loop sometimes. And that’s why I am happy that I get emails from others who are IN the loop. Many thanks to the Midwives of Color blog for sharing this great video put together by the American College of Nurse Midwives. As a CNM it’s nice to see and especially wonderful to see it featuring Midwife extraordinaire Marsha Jackson who was one of one of my very first mentors :-)

Originally posted on Midwives of Color:


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Nourished Living Summit


Click here to visit Nourished Living Summit.

Join us as we Renew Rebirth & Retreat

A couple of years ago, while hosting a meeting of black birth workers and birth advocates in New Orleans we decided we should create a campaign to educate our community about the benefits and value of doulas and normal birth.  As the conversation continued, and as we outlined a plan, it dawned on me… it will be great to get our sisters motivated and informed about natural birth and doulas but when they ask “Where can I find a doula?”  what will our answer be?

You see in 2012, when we had this meeting, I could literally count the number of working doulas in New Orleans and the black doulas working in New Orleans… I could count with my fingers.  In a city that has a population that is nearly 70% black… that was a problem! To make it even worse, there were NO local doula trainers.  Not ONE. Every so often a trainer would visit from afar and unfortunately, I have heard most left lots to be desired.

The way I saw it, we definitely had a problem and I set my mind to do something about it. Fast forward to today, and I am preparing to do my third official Sista Midwife Productions’ Birth Sister Training in New Orleans starting May 16.  This is the first of three I am planning this year.  The beautiful thing about my training is that while it is certainly not exclusively for black women, the black women in my community who are drawn to this work are also drawn to my training.  I am proud that my first two classes combined included a total of 16 students, 13 of whom identify as black and more than half of them attended on scholarship.

I am proud that my training is endorsed by individual birth advocates, as well as local doula and community groups. I am proud that I am making a difference by expanding the reach of birth work in my community.  Recently all over web there have been articles and questions about where are the birth workers of color? Where are the trainers of color? *Raises hand* We are here. We are learning and growing. We are working hard to do our part.

“Nicole’s passion for birth work and women’s health rights is infectious! During her training I couldn’t help but be engaged, and afterwards I left feeling like I, and all other women, could shake and move the world.” ~ Shayla B. – Mississippi

Since I conducted my first training, I have been asked… Are you going to take your training on the road? What can I do to get you to Texas, California, Florida, Georgia? And my answer has been, I don’t really know but build it and I will come.  Most recently, I have been asked about conducting a training in Tennessee. AND… when I said “build it and I will come” my sister Angelique “Sobande” Greer, herbalist and founder of Natural Choice Botanica School of Herbalism and Holistic Health took me at my word.

With that said, I am very pleased, proud, and excited to announce that my first “on the road” doula/birth sister training will be taking place June 17-June 22, 2014.  This VERY special event will be far more than a doula training as women come together from various parts of the country to RENEW – REBIRTH & RETREAT.  We will come together to learn, relax, bond, and grow within a serene  retreat center.

Now… not only is my sister Sobande the reason I am travelling to TN, she is also a spiritual teacher, healer, and herbalist who will share her wisdom with us during the phenomenal event.  I had the pleasure to learn from her during the last Wise Women’s Herbal Conference in Ashville NC and she is bout it! Throughout this retreat she will share with us her wisdom, her passion for healing, and her love of nature.

This event gives YOU a unique opportunity to receive my full 36 hour Birth Sister/Doula Training and training and guidance from Sobande all while we sit at the feet of mother nature.  Throughout the training we will incorporate time for self guided meditation and facilitated retreat activities. Whether you are at the beginning of your journey into birth work and you are looking for a foundation, OR you are an experienced doula/birth sister and you want to increase your knowledge base and re-ignite your fire, this training is for YOU!  The back drop for this retreat is the serene Penuel Ridge Retreat Center which sits on 135 acres in Middle Tennessee a short drive outside of Nashville.

I promise you this is an event that you do NOT want to miss.  In order to make sure this is an enjoyable experience for everyone, registration is VERY limited.  The registration for this event is only $850 and this includes EVERYTHING… your training, your lodging, your meals, and your serenity.  Registration is currently open and today you can reserve your spot for $100.  As the training dates approach, the registration rate for this event will increase so reserve your space today!  I look forward to seeing you there and experiencing growth, love, knowledge, joy and laughter with you!  Let’s come together and #BirthSomethingBeautiful!

“My Doula training experience was great! Nicole is a wonderful trainer and I would recommend Sista Midwife Doula Training to anyone!”
~ Queen Hope Parker  – New Orleans

Patience is a Virtue: Six is the new Four

Its still April and its still Cesarean Awareness Month and I still want to talk about prevention.  The most common reason a first time mom has a c/section is labor dystocia. Labor dystocia may be diagnosed if a mother stops dilating while she is in labor. Labor dystocia may also be the diagnosis of choice if a provider believes a woman is not dilating fast enough.  And “fast enough” is relative.

Recent research tells us that the common time limits given to women based on out dated data collected by Dr. Friedman should be done away with.  Recent research shows us that giving women more time to labor before making a decision to do a c/section can be what she needs to achieve a vaginal delivery.  I have definitely seen a couple of extra hours be all a woman needs to move to 10cm.  It was never on purpose but I have seen times when two mothers “needed” a c/section; One because she was experiencing dystocia and one because her baby was having distress. Of course the mom with the fetal distress gets her c/section first. And low and behold… by the time the first c/section was over, and the operating room was cleaned and made ready, the second mom has progressed to completely dilated and is ready to birth her baby.  Watching this experience always made me laugh.  Now I want you to watch this video and get some more insight into the reality of being patient in labor.

Recent research does not always translate into practice change. With that reality in mind, my goal is to provide YOU with information so that if your doctor/midwife is not aware of this new research, you can educate them about it.   Don’t be afraid to ask questions and to share this information with your provider.  Its critical and can be the difference between the birth you envision and a c/section.  Remember six is the new four and patience is a virtue :-)