CleanBirth – Saving Lives for $5

As part of our mission to contribute to safe motherhood around the globe, DTP is promoting the work of This organization works to make birth safer in southern Laos, which has the highest rates of infant and maternal mortality in the region[1]. CB1 Mum baby red hat The vast majority of women give birth without a trained attendant or clean supplies, but is making a difference, improving outcomes through simple initiatives that provide life-saving birthing supplies and information.

To promote hygienic birth, partners with a Lao non-profit, Our Village Association (OVA) to train local nurses to distribute Clean Birth Kits – the life saving birth supplies that cost a mere $5 each. The nurses then train a volunteer from each village to distribute and track the kits and spread information about safe birthing practices.

CB2 KitClean Birth Kits have been shown to prevent infection – a major birth-related killer – and village health volunteers have been shown to reduce neonatal and maternal deaths[2-5]. Along with providing these kits, is involved with the education for nurses and Village volunteers. Because they are part of the local culture, they are respected and can provide the kits, explain how to use them and give information on how to be safe during pregnancy and birth.

More kits and more training are needed. A nurse in the Tahoy District trained a local midwife who noted that using the kit is convenient and easy and keeps the mother and baby clean. CB3 Tahoy volunteer

During 2013, supplied 2,000 birth kits and trained 16 local nurses and 20 Village volunteers. To keep up this momentum, has formed an alliance with the Yale University School of Nursing to improve the training. Right now, you can help! is currently fundraising via to fund training for 15 nurses and 20 volunteers by Yale midwives during July 2014, as well as providing 500 Clean Birth Kits.

If you can, please donate to this mission:

  • $5 provides a life-saving Clean Birth Kit
  • $100 trains a Village volunteer
  • $250 sponsors a nurse who serves as many as 1o villages

Think of this as your Valentine present to the world. Safe Motherhood is a major global movement, and organizations such as are the on-the-ground work force that is bringing about improvements in maternal and newborn survival.

Thank you!!

1. “At a glance: Lao People’s Democratic Republic.” Accessed 29July 2013.

2. Brierly, C. “Clean delivery kits linked to substantial reduction in neonatal death is South Asia, study shows,” Wellcome Trust (2012). Accessed 8 August 2013.

3. “Clean Birth Kits – Potential to Deliver.” Accessed 8 August 2013.

4. Gogia S and Sachdev H. “Home visits by community health workers to prevent neonatal deaths in developing countries: a systematic review.” Accessed 5 August 2013.

5. Wilson A et al. “effectiveness of strategies incorporating taining and support of traditional birth attendants on perinatal and maternal mortality: meta-analysis.” BMJ 2011 Dec. Accessed 13 August 2013.

Healthy Moms Having Healthy Babies – the Challenge in 2011

Welcome to 2011! We want to take this opportunity to say, once again, that our main goal here is to provide credible, evidence-based information on how to prepare for a healthy pregnancy and birth, recover quickly and begin your mothering experience in good health. Why? Because that is what you can do to help get your baby off to a healthy start in life.

Helping women be healthy during the childbearing period is our primary goal. Not everything is within your control, especially genetic factors. But your baby’s life is determined – in part – by your behavior before pregnancy, during pregnancy, during birth and in the early mothering stages. More and more, we are coming to understand that the environment within the uterus is largely affected by the mother’s behavior (exercise, nutrition, stress, breastfeeding and avoidance of risky behaviors such as smoking) and environmental exposures (toxins in chemicals, the air we breathe and food products).

We are recommitting to making up-to-date and well-documented information available through this blog. Now and then you will get a rant, but for the most part, we want to help people have terrific experiences during the childbearing period. Of course, since we are part of Dancing Thru Pregnancy and its Total Pregnancy Fitness and Mom-Baby Fitness programs, you will hear a lot about being fit before, during and after pregnancy BECAUSE fitness has more benefits for mom and baby than any other single factor!

Here are some of the well-documented findings about being fit during the childbearing period:

  • assists in healthy implantation and improves placental function
  • reduces the risk or severity of gestational diabetes
  • reduces the risk of preeclampsia
  • reduces the risk of prematurity and low birth weight
  • reduces the risk for childhood obesity
  • may reduce the risk of surgical (cesarean) birth
  • improves long term maternal heart health
  • reduces the risk of postpartum depression
  • increases the likelihood that a woman will be fit in mid life

You can find references for these findings on this blog, on our website ( or through the American College of Sports Medicine and other organizations listed in our blogroll.

Our secondary goal is adding to the effort to assure Safe Motherhood around the globe. We do this, in part, by supporting the White Ribbon Alliance for Safe Motherhood and helping sponsor projects that improve mother’s lives locally. We are also committed to spreading the word that improving the lives of women and children involves a reality change…namely that helping women plan their families, have healthy pregnancies and give birth in safety are more important human goals than wars and violence.

Please join us this year in this important endeavor.

Thank you.

Ann Cowlin, founder/director,, twitter@anncowlin

Safe Pregnancy, Safe Labor, Safe Motherhood

The challenges to safe motherhood vary depending where in the world you live. In some areas the challenge may be to get adequate nutrition or clean water; in other areas, it may be to prevent infection; and in still other locations it may be trying to avoid pregnancy before your body is ready or getting access to prenatal care. In the U.S., it may mean avoiding being sedentary and making poor food choices, or having to deal with the high technology environment of medical birth that can sabotage the innate physiological process of labor and birth.

Birth begins the bonding or unique love between mother and child.

The biology of birth is a complex series of cause-effect processes…baby’s brain releases chemical signals to the mother and the placenta begins to manifest the maternal immune system’s rejection of the fetus.

To help the ball get rolling, relaxation (the trophotropic response) helps promote the release of oxytocin. With the help of gravity, the head presses on the cervix, amplifying the uterine contractions. After an ultra-distance aerobic endurance test, the cervix opens enough to let the baby move into the vagina and the mother’s discomfort moves from sharp cramping into the bony structure as she transitions to the strength test of pushing. She transitions. Relaxation modulates into an ergotropic – adrenal – response to gather her power.

Pushing is an interesting term…more masculine, I think, than the one I prefer:  Releasing. Releasing or letting go of the baby. It’s a catharsis. In this portion of the labor another set of important processes help the baby clear its lungs of amniotic fluid, stimulate its adrenal system and challenge its immune system, as the contractions drive the baby downward. The mother’s deep transverse abdominal muscles – if strong enough – squeeze the uterus like a tube of tooth paste, to aid this expulsion. In the meantime, the labor is helping set up the mother to fall in love and produce milk. When the baby emerges and moves onto the mother’s chest, s/he smells and tastes the mother, recognizing her mother’s flavor and setting up the potential for bonding.

Any way you slice it, there are two parts to safe motherhood. One is a safe pregnancy…healthy nutrition, physical fitness, safe water, infection prevention, support and a safe environment. The other is a safe labor. In a safe labor, there is both an environment that promotes the natural process of labor and the means necessary for medical assistance when needed. Women die at an alarming rate from pregnancy or birth-related problems. Despite some progress made in recent years, women continue to die every minute as a result of being pregnant or giving birth.

What keeps us from having a better record on motherhood is often lack of care in the developing world and too much intervention in the U.S.. They are two sides of a coin. Mothers’ experience and health needs are not on equal footing with other cultural values. In places where basic prenatal care or family planning are low priorities, at-risk women are vulnerable to the physical stresses of pregnancy and birth. In the U.S., machine-measured data is paramount, even if it produces high rates of false positives, unnecessary interventions or counterproductive procedures. We are learning that obesity and sedentary lifestyles have detrimental effects, but fewer pregnant women than their non-pregnant counterparts exercise.

Despite the money spent to support the technological model of pregnancy and birth in the U.S., there are parts of the world – especially Scandinavia, Northern Europe and parts of the Mediterranean and Middle East (Greece, the United Arab Emirates, Israel, Italy and Croatia) – with lower rates of maternal deaths. In fact, in the U.S., maternal deaths are on the rise.

It’s a tricky business. Clearly Western medicine has a lot to offer the developing world when there are medical concerns. On the other hand, importing the U.S. model could create more problems than it solves. Instead, the micro-solutions now being developed in many locations will be observed and evidence collected by organizations such as the White Ribbon Alliance and UNICEF.

There is an effective international midwives model adopted by JHPIEGO, the Johns Hopkins NGO working toward improved birthing outcomes. It assesses the local power structure, social connections, potential for trained birth assistants, and location of available transportation to create a network so that locals will know when a labor is in trouble and who can get the woman to the nearest hospital.

In the U.S., there are in-hospital birth centers that allow low-risk mothers the opportunity to labor and birth in a setting designed to encourage the innate processes. Women are beginning to vote with their feet…staying home for birth. Women are going abroad to give birth. At the same time, women are coming to this country to give birth, believing it is safer than where they are. There are several ways these scenes could play out.

But, I’ll wager, improving outcomes will involve compromise:  Watchfulness and support in most births, plus better ways to assess danger and provide technology. No matter where you live in the world, the solution may be essentially the same.

Birth and Human Survival

Ever wonder if humanity will become extinct sooner rather than later?

Animal Planet program on sea turtles…hatchlings crawl across the sand to the ocean and the commentator remarks that only one in a hundred will survive to adulthood. Those who escape the pelican beaks or salt water crocodiles waiting for them on the sand may meet with sharks or other swimming predators. Not good odds. Conclusion:  No wonder they lay huge numbers of eggs in the sand.

But, what would the result be if the turtles figured out some way to destroy all these predators so that most of each hundred survived?

New Jersey has just completed a brief bear hunting season in which about 500 bears were killed by hunters because another species that competes with them for space and food has over-populated that space. The close interface of bears and humans resulted in a situation in which the natural predator (bear) was overcome by the competing creature (human) who figured out how to destroy the predator.

Human beings have been party to a number of species’ extinctions or near etinctions because of our capacity to use technology to overwhelm the natural process of competing for resources. Nature has a way of balancing out the advantages that one species gains over another, but the use of advanced technology – everything from guns to in vitro fertilization – oversets this natural order. Essentially, we are working on having more and more surviving members. Check it out:

What questions does this thinking raise for those of us concerned about the safety of birth?

How do we make birth safer throughout the world while at the same time address the issue of over-population? There was a time when the capacity to overset nature worked to human advantage. The notion of “go forth and multiply” worked for us much as it currently does for the sea turtles. But that balance has changed. Essentially, the difficulties of establishing family planning as accessible and acceptable behavior for women goes hand in hand with aiding women in having safe pregnancy and birth, as well as supporting infant survival. For directly working on this issue, a thank you    is due the Bill and Melinda Gates Foundation.

How do we balance women’s need to work, the trend in developed nations to delay childbearing, the dangers of childbearing too young, and the need to reduce population? A hard question we need to ask is whether it is a “good” thing to have a child at 55 or 60. We know it is not safe for 12 year olds bear children. Yet, we go to extreme, expensive lengths to permit older women to have this experience while we spend very little on projects to prevent the atrocity of coerced reproduction in young women and girls.

So, the turtles and bears got me thinking scary thoughts:

  • What are the odds that the human population is growing so fast we cannot sustain safe water and prevent or quarantine infection sufficiently to avoid major epidemics that kill most of us?
  • What if engineered food products turn out to be not so good for us?
  • What if we so disturb the food chain by causing extinctions that we upset our food supply and end in chaos?
  • And, how does climate change fit in to all this?

Why would we allow this? Oh, right, greed. Growth is how economies are sustained. Have to work on that, folks.

Okay. I’ll stick to writing about enabling healthy pregnancy for now. But, let’s all work on raising awareness of the need for family planning.

Pregnancy Pathway, Birth – Labor

The First Stage of Childbirth is the long, hard labor. It is the slow process that produces dilation, or opening, of the cervix – the “neck” or outlet at the bottom of the uterus. Once the baby’s head can fit through the open cervix, it is time for the Second Stage, but that is another topic for another post.

Labor is generally a long, slow process...there is no "enter" button for dilation!

Labor is generally a long, slow process...there is no "enter" button for dilation!

Before the baby can leave the mother’s body, s/he must leave the uterus. The opening of the cervix to let the baby out of the uterus generally takes up the most time. For a first time mom it can be 10 or 12 hours…or, yes, a couple of days. Of course, for some moms, this time is difficult and for others it only becomes difficult in the last few hours.

But, you know all this, right? What you want to know is:  Why do I have to go through this? And, if I must, how can I make it the least painful?

Why labor is important. Let’s go to another question:  How important would your offspring be if it was no big deal to drop one out? If you were walking along the sidewalk and you could simply drop a newborn on the pavement, would you even stop to pick it up if you could do it again in a few days, when, of course, it will be much more convenient?

Frankly, pregnancy and labor remind us to pay attention. A newborn cannot survive on its own for at least two years. If we don’t pay attention, it will die.

Okay, now that labor has your attention, what else does it do that is beneficial? It stimulates the baby’s stress response and teaches the newborn to be alert during situations of duress. Each contraction is pulling the cervix, helping it slowly open. If you are upright, each contraction is also alerting the baby to the influence of gravity.

Why is labor painful? So, you need to go through this because it is the bridge from pregnancy to parenthood. Why does it have to be painful?

The first thing to keep in mind about pain is that pain is a combination of sensations and emotion, mainly fear. Fear makes you tense; tension reduces blood flow. Reduced blood flow to the uterus makes the contractions less effective. In addition, cortisol is released, making sensations stronger and evoking greater fear.

Fear is the emotion of fight or flight. Interestingly, the opposite response, the relaxation response, is very effective in promoting labor. So, relax. Breathe deeply and slowly, focus, move through the center of your experience. You don’t have to be in fear if you know what is happening and if you are physically fit and prepared. Both childbirth education and physical fitness teach your body to work with discomfort. By including them in your preparation, you give yourself a tremendous advantage.

Does this mean you will never feel like you want to stop in the middle of labor? No, but it does mean you can do it. It is finite. The notion that the baby will not do well is also tied to your physical fitness…babies of fit mothers less often experience fetal distress. Your care providers will let you know if there is some factor beyond your control that requires medical intervention.

Birth is an empowering event. But, before the baby can be born, it must escape the uterus. It is a classic conflict and the mother’s body is the venue. Give yourself over; go with it. Only women can do this.

Pregnancy Pathway, Pregnancy – Behavior, part 1: Exercise

How lucky is this? Just a few days ago, yet another study was released and has been circulating on Medscape and other medical sites that indicates exercise is beneficial in pregnancy, whether the mother is a previous exerciser or not. Just in time for this entry!

Behavior Affects Pregnancy Outcome

Behavior Affects Pregnancy Outcome

Physical exertion (we call it “exercise” nowadays) is a normal state for healthy humans. Only in the last century has the desire to rest or the need to store extra calories as fat become more possible to achieve than our need to move about to survive.

Pregnancy is a state in which both of these factors (resting and storing calories) are enhanced through organic changes in body chemistry, adaptations that favor fetal survival. The current sedentary lifestyle exaggerates these metabolic changes and results in syndromes that increase the risk for a number of metabolic, cardiovascular and immunological disorders of pregnancy.

When confronted by the idea that it is counterintuitive to think exercise in pregnancy might be safe (let alone beneficial) I am dumbfounded. To me, it is counterintuitive to think that a sedentary lifestyle in pregnancy might be safe!

Burning Calories in Pregnancy Improves Outcomes!

Burning Calories in Pregnancy Improves Outcomes!

What is the evidence that exercise in pregnancy is beneficial? Keep in mind that some studies have been executed more expertly than others. But, what is compelling is that numerous well-respected researchers have sought to test the hypothesis that exercise is not safe, but come away with results that indicate the opposite!

Here are some of the major findings:

• The placenta is larger and has more transport surface in exercisers than sedentary women

• The fetuses of (aerobic) exercising mothers make beneficial cardiovascular adaptations

• Women who do aerobic exercise are less likely to develop severe preeclampsia or gestational diabetes, and the long term health problems that accompany these disorders

• Women who are aerobically fit recover from birth 10 times faster than sedentary women (as measured by time needed to metabolize free radicals produced in labor)

• Women who exercise in pregnancy are more likely to be physically fit in midlife

• Babies of aerobically fit women are at reduced risk for prematurity and low birth weight
So, we have arrived at the take-home message: MOVE!! Pregnancy works best when you move and burn calories in a moderate to vigorous fashion. But, alternate this activity with rest and good nutrition, and be sure to stay well hydrated.
If you want more specifics and resources on this topic, try these:
“Women and Exercise” in Varney’s Midwifery.

Pregnancy – 50% planned; 50% unplanned

So…are you planning to become pregnant? For the last decade, pregnancy has been in a 50/50 situation. That is, about half the pregnancies occurring in the U.S. are planned. The rest? Well, not necessarily unwelcome, but definitely unplanned.

Will this change in the current recession (or as a friend said today, Let us just call it a depression and move on)? So far, it is clear that pregnancy rates are not dropping, despite an unwillingness to spend money on many other things. What does this say?

Once again, despite living in a high tech world, having babies is a primal experience. It does not diminish when resources are scarce.

So, plan to or not, if you have a baby during this depression, do not waste your money. Figure out how to have a healthy pregnancy.

Next on the Pregnancy Pathway: the act of conception.