Sunday, January 31, 2010

Breastfeeding Basics: Physiology

More interesting tidbits from the Breastfeeding Basics learning module that I am taking for my doula certification.

1. Can I breastfeed if I've had breast augmentation?
It depends.
Women who have breast augmentation surgery have a higher incidence of insufficient milk supply. The effect on milk supply depends on the type of incision, cutting the nerves to the nipple-areolar area, the implant type and placement, and any surgical complications. Breast size increases with pregnancy. Consequently, women requesting breast augmentation prior to becoming pregnant, must be counseled on the possible effect of the surgery causing decreased milk supply when lactating in the future. Breastfeeding an infant from breasts with silicon implants in place appears to have no harmful effects on the infant.
Much of this also applies to breast reduction surgery. 

2. The onset of lactogenesis (the production of breast milk) has been shown to be delayed by stressful events around delivery. Women who underwent an urgent Cesarean section or had a long duration of labor before vaginal deliveries were more likely to have a delayed onset of breast fullness in the first days after delivery.

3. How soon after birth will I be producing milk?

Colostrum is a thick, yellowish milk that is secreted by a woman's breast in the first several days after delivery.  Due to its high concentration of antibodies, this milk is particularly valuable for infants in preventing infection.
Transitional milk is secreted between about four days and ten days postpartum. It is intermediate in composition in between colostrum and mature milk. The volume increases during this time.

4. Human breast milk is the ideal form of nutrition for infants. Only the following supplementation is generally recommended:
  1. All infants should receive a Vitamin K supplement in the immediate postpartum period.
  2. Supplementation with 400 IU of Vitamin D is recommended for all breastfed infants.
  3. Women who are breastfeeding should continue their prenatal vitamins for the vitamin D, calcium and iron that they supply.
  4. Once infants reach six months of age supplemental foods should be added. These should include foods rich in iron.

Saturday, January 30, 2010

Study on Birth Outcomes by Location

A study in the American Journal of Obstetrics and Gynecology finds that when compared with hospital births, home births and birth center births showed longer labors and the infants had lower APGAR scores at 5 min. They also found that "out-of-hospital births are associated with otherwise less frequent maternal and newborn morbidity."

Maternal and newborn morbidity by birth facility among selected United States 2006 low-risk births

from the February 2010 issue of AJOG

We sought to evaluate perinatal morbidity by delivery location (hospital, freestanding birth center, and home).
Study Design
Selected 2006 US birth certificate data were accessed online from the Centers for Disease Control and Prevention. Low-risk maternal and newborn outcomes were tabulated and compared by birth facility.
A total of 745,690 deliveries were included, of which 733,143 (97.0%) occurred in hospital, 4661 (0.6%) at birth centers, and 7427 (0.9%) at home. Compared with hospital deliveries, home and birthing center deliveries were associated with more frequent prolonged and precipitous labors. Home births experienced more frequent 5-minute Apgar scores <7. In contrast, home and birthing center deliveries were associated with less frequent chorioamnionitis, fetal intolerance of labor, meconium staining, assisted ventilation, neonatal intensive care unit admission, and birthweight <2500 g.
Home births are associated with a number of less frequent adverse perinatal outcomes at the expense of more frequent abnormal labors and low 5-minute Apgar scores.

Notice how they call a long labor "abnormal." Its only long and abnormal because obstetricians rarely see a truly natural birth.    

So what does this study showing us? Are long labors and low 5 min APGAR scores an awful thing?

This means that home birth women were able to labor as long as was necessary to have their baby, instead of being told at the hospital that they were taking too long and therefore received medical interventions to speed things up. 

This means that at home births the baby's cords weren't immediately clamped, as is usual hospital policy, which means that the baby was getting oxygen from the placenta for a little bit longer and therefore was still a little bit blue. They also weren't being slapped or rubbed to be made to cry, they were simply left to be calm as long as they were noticeably alert. 

APGAR scores:

Five factors are used to evaluate the baby's condition at one min and again at 5 min after birth. Each factor is scored on a scale of 0 to 2. Baby is rated on:
  1. Activity and muscle tone
  2. Pulse (heart rate)
  3. Grimace response/reflex irritability
  4. Appearance (skin coloration)
  5. Respiration (breathing rate and effort) 

An extremely prolonged labor and very bad scores on the above 5 APGAR factors CAN indeed be worrying, but the study is showing that the results of these particular births, all low-risk women, resulted in fewer adverse outcomes. Therefore, there is no huge worry associated with out-of-hospital births for low-risk women.

Friday, January 29, 2010

Internal versus External Fetal Monitoring during Labor

My friend and the biggest fan of my blog sent me a "you might be interested in this!" article on a new study from the New England Journal of Medicine that researched internal vs. external fetal monitoring during labor.

What Electronic Fetal Monitoring entails:

External: two belts around the mother's abdomen. one is an ultrasound device that monitors the baby's heartbeat, the other monitors the intensity of the contractions.
Internal: a spiral wire electrode is placed in the skin of the baby's scalp to detect fetal heart rate and a a fluid filled tube is placed in the mom's uterus to measure intensity of contractions. It requires the amniotic sac to be broken (which increases chance of infection).

Outcomes after Internal versus External Tocodynamometry for Monitoring Labor


Background It has been hypothesized that internal tocodynamometry, as compared with external monitoring, may provide a more accurate assessment of contractions and thus improve the ability to adjust the dose of oxytocin effectively, resulting in fewer operative deliveries and less fetal distress. However, few data are available to test this hypothesis.

Methods We performed a randomized, controlled trial in six hospitals in the Netherlands to compare internal tocodynamometry with external monitoring of uterine activity in women for whom induced or augmented labor was required. The primary outcome was the rate of operative deliveries, including both cesarean sections and instrumented vaginal deliveries. Secondary outcomes included the use of antibiotics during labor, time from randomization to delivery, and adverse neonatal outcomes (defined as any of the following: an Apgar score at 5 minutes of less than 7, umbilical-artery pH of less than 7.05, and neonatal hospital stay of longer than 48 hours).

Results We randomly assigned 1456 women to either internal tocodynamometry (734) or external monitoring (722). The operative-delivery rate was 31.3% in the internal-tocodynamometry group and 29.6% in the external-monitoring group (relative risk with internal monitoring, 1.1; 95% confidence interval [CI], 0.91 to 1.2). Secondary outcomes did not differ significantly between the two groups. The rate of adverse neonatal outcomes was 14.3% with internal monitoring and 15.0% with external monitoring (relative risk, 0.95; 95% CI, 0.74 to 1.2). No serious adverse events associated with use of the intrauterine pressure catheter were reported.

Conclusions Internal tocodynamometry during induced or augmented labor, as compared with external monitoring, did not significantly reduce the rate of operative deliveries or of adverse neonatal outcomes. (Current Controlled Trials number, ISRCTN13667534 [] ; Netherlands Trial number, NTR285.)

Basically what it means is that they thought that internal fetal monitoring with an intrauterine pressure catheter would be better than external fetal monitoring at catching fetal distress and saving the day in women who had induced or augmented labor, but what they found was the data for the two was pretty close. 

The researchers found that the operative delivery rate wasn't significantly different between the internal or external groups (31.3 versus 29.6 percent). Adverse neonatal outcomes, including Apgar score of less than seven at five minutes or neonatal hospital stay of longer than 48 hours, weren't significantly different between the groups, either (14.3 versus 15 percent).

"Internal tocodynamometry has serious risks, including placental or fetal-vessel damage, infection, and anaphylactic reaction. We did not observe any complications of internal monitoring in our study, but it was not powered to detect these events, which in previous studies had an estimated incidence of one in 300 patients and one in 1400," the authors conclude. "The results of our trial do not support the routine use of internal tocodynamometry for monitoring contractions in women with induced or augmented labor."

For the science-minded ones, here is part of Data charts from the study results (click to enlarge):

Thursday, January 28, 2010

Breastfeeding Basics

I've begun a Breastfeeding Basics learning module course as part of my doula certification requirements, and thusly, you have too :) haha. I'll be posting the most interesting/my favorite little tidbits on here as I go!

1. "I heard you can't get pregnant while breastfeeding"
Breastfeeding has been found to delay the return of the menses after childbirth. This is not a reliable method of birth control but it may increase the time between pregnancies.

In order for you to not get pregnant while breastfeeding you'd have to meet these requirements...

The Lactational Amenorrhea (meaning absence of menstruation) Method (LAM) consists of:
  1. Sole breastfeeding in the first six months of an infant's life.
  2. No interval between feedings of more than five hours.
  3. No supplementation for the infant.
Return of menses and pregnancy are very unlikely if all 3 parameters of LAM are present.

2. You're supposed to gain weight during pregnancy. The amount you "should" gain actually depends on your BMI.
During pregnancy most women are advised to gain 25 to 30 pounds. This breaks down as follows:

  1. The baby will weigh approximately 7 to 8 pounds.
  2. Increased uterine blood vessels and amniotic fluid weigh approximately 3-6 pounds.
  3. At least 10 pounds of the weight gain are fat stores that are laid down to enable a woman to breastfeed.
Women who choose not to breastfeed will have to diet to lose those ten pounds.
The 10 pounds of stored fat allow a breastfeeding woman to continue to nurse her baby, eat an extra 500 kilocalories a day, and still slowly lose weight over the first six months of breastfeeding.

3. Breastfeeding for a long time is a good thing. The following are simply 'goals,' meaning even higher numbers would be better!
The Surgeon General's Goal for Healthy People 2010 is that:
  • 75% of women breastfeed their infants at hospital discharge,
  • 50% breastfeed their infants at 6 months of age, and
  • 25% breastfeed their infants at 12 months (1 year) of age.
The 8 states of Alaska, California, Hawaii, Idaho, Oregon, Utah, Vermont, and Washington have achieved the three Healthy People 2010 objectives above.

4. Many women worry that if they breastfeed they'll have to take the baby with them EVERYWHERE and they'll be tied to the baby full time. In reality, many women pump their breast milk and feed the baby with a bottle (or dad or a caregiver can feed the baby breastmilk from a bottle). Also, many women feel that breastfeeding in a public place would be embarrassing for them. There are ways to breastfeeding discreetly and comfortably in public using a blanket over the breast or the baby, or they can use a bottle.

Wednesday, January 27, 2010

Ina May Gaskin and Holistic Maternity Care

I just finished Ina May Gaskin's Guide to Childbirth.  This is such a wonderful book and definitely my favorite out of all the books I've read so far for my doula training.  The first section of the book is full of empowering birth stories, the kind of stories you don't usually get to hear about birth. If you pick up a pregnancy and childbirth book while you're preparing to have your baby, it may be full of a lot of things that can frighten you about birth. These stories are meant to let you know that birth can be good.
The second part of the book is really her "guide." It is her perspective on every aspect of birth - her belief that there is a mind/body connection, the "Sphincter Law," the positive and negative about every prenatal and labor procedure, forgotten vaginal powers! and more.

Ina May happens to be the country's most famous midwife. I'm hoping I'll be able to catch her speaking at a conference someday. She is a little bit "hippie" or "crunchy" or "natural," whatever you want to call it, but I love her methods and am wholly impressed at the results her births and studies produce based on her methods and firm belief in the abilities of women's bodies.

What I love most about her is how holistic her methods are. I want to define holistic here because I feel like many, like myself, read holistic and don't really know what it means.  The Merriam-Webster definition is:  
Relating to or concerned with wholes or with complete systems rather than with the analysis of, treatment of, or dissection into parts.
Holistic medicine attempts to treat both the mind and the body.
 The mind/body connection is very strong and very very important in birth. She gives several examples of how the mind caused women's bodies to behave a certain way, and how she treated the mental symptom and the body responded. For instance:

- a woman, whose labor had stalled, who hadn't mentioned that she feared dying in childbirth because of a relative who had. By simply and finally voicing the fear allowed her body to relax and her cervix to open to full dilation.
- a woman who was in early labor being held by her husband, who whispered "you're marvelous!" into her ear. she asked him to repeat it over and over because she could feel her body responding each time he said it. everyone in the room repeated it until she quickly became fully dilated.
- a woman whose labor reversed (went from 8cm, down to 4) because she was afraid of the intensifying contractions that would come just at the end, but by using laughter she lightened up and managed to fully dilate.

When something occurs during labor that makes us nervous, there is a "fight or flight" reaction which releases adrenaline.  If an animal in labor senses a predator near the labor will stall until the animal can move to safety. If a woman is interrupted or observed or pressured during labor she may have a similar adrenaline reaction that will slow her progress. In this case, a doctor will give pitocin, but the problem could be resolved by taking away the stressor and allowing the woman to relax.  Adrenaline can also speed labor up. I have heard of women, who, when told that their baby would have to be delivered by Cesarean section if they didn't hurry up and give birth already, quickly pushed that baby right out!

Ina May does not look at things from one single perspective... as the body as one system and the mind a totally different one. Its not "your body is taking a long time to birth your baby so there's something wrong with your body and we have to treat your body with some induction meds." It is "something is happening to your body that may be affected by your mind, so lets see if we can address your emotions about your body and see how that works on it first."

This also directly has to do with her ideas about Sphincter Law, which is fascinating to read about, so I encourage you to go and directly read how she explains the thoughts behind it, but here is a summary:
According to Sphincter Law, labors that don't result in a normal birth after a "reasonable" amount of time are often slowed or stalled because of a lack of privacy, fear, and stimulation of the wrong part of the laboring woman's brain.
The Basics of Sphincter Law:
1. Excretory, cervical, and vaginal sphincters function best in an atmosphere of intimacy and privacy -- for example, a bathroom with a locking door or a bedroom, where interruption is unlikely or impossible.
2. These sphincters cannot be opened at will and do no respond well to commands (such as "push!" or "relax!")
3. When a person's sphincter is in the process of opening it may suddenly close down if that person becomes upset, frightened, humiliated, or self-conscious.
4. The state of relaxation of the mouth and jaw is directly correlated to the ability of the cervix, vagina, and the anus to open to full capacity.

Some more background on Ina May Gaskin:
She and her group of midwives founded The Farm Midwife Center in 1971, which is a weird name for what is now a whole village located in rural Tennessee. The village also contains a school, a clinic, a water system, a soy foods production plant, and several businesses. People live there but many people also come and go as they are pregnant and give birth. Many of the children born on the farm return from wherever they are to have their own children on The Farm. And people come from all over the world to birth here as well.

The Farm's birth results and numbers are astounding when compared to the rates in hospitals. Very few cesarean (1.4%) and instrumental deliveries, extremely low rates of induction, high percentage of women with an intact perineum, high rates of breech babies able to be born vaginally, extremely low postpartum hemorrhage, etc etc. And these are normal women from across America and some from other parts of the world as well.

In US hospitals the lowest cesarean rate in 2006 was 18%!
The World Health Organization recommends an optimal C-section rate: "The best outcomes for mothers and babies appear to occur with cesarean section rates of 5% to 10%. Rates above 15% seem to do more harm than good (Althabe and Belizan 2006)."

Anyway, if you have made it this far into this post, and are as impressed as I am, I highly recommend reading anything by Ina May Gaskin!

Tuesday, January 26, 2010

Breast Milk vs. Formula

Some time ago, on a blog far far away, I wrote a post about visiting an acquaintance and brand-new mom who told me that she was only going to breastfeed her baby for 3 months. I was shocked to hear this, but since I was not very close to this woman I kept my mouth shut. Then I went home and looked up more information on breastfeeding, and typed up the following information on Breast Milk and Formula.

Breastfeeding is amazing; it has so many benefits. Here is what I found:

Here is why Breast Milk is recommended:*

1. The nutritional composition of breast milk is ideal for human infants.

2. As your baby grows and his nutritional needs change, your milk adapts to meet these needs.

3. Breast milk is easily digested

4. Breastfeeding is both economical and convenient.

5. Breastfeeding promotes attachment and a close, nurturing relationship between mother and baby.

6. Breastfeeding reduces the incidence and severity of diseases and infections such as ear infection, respiratory infection, meningitis, and urinary tract infections. It also reduces symptoms such as diarrhea and vomiting.

7. Infants exclusively breastfed through three months of age are nine times less likely to be hospitalized for infections compared to formula-fed infants.

8. Breastfed infants have a reduced incidences of some chronic conditions and diseases that occur later in life, such as insulin-dependent diabetes mellitus, Crohn’s disease, ulcerative colitis, and multiple sclerosis. (and celiac desease)

9. Breastfed infants have lower rates of lymphoma than formula-fed infants.

10. Breastfed infants have fewer and less severe allergies compared to formula-fed infants.

11. Breastfeeding enhances the development of the brain and is associated with higher cognitive test scores than feeding formula to a baby.

12. Breastfeeding has been shown to have a protective effect that helps reduce the possibility of sudden infant death syndrome (SIDS).

13. Breastfeeding reduces postpartum bleeding and aids involution (the return of the uterus to its normal size).

14. Reduces the risk of some diseases for the mother, including pre-menopausal breast cancer and ovarian cancer

15. Breastfeeding mothers have fewer hip fractures in the postmenopausal period than women who never breastfed.

Some Concerns about the use of Formula:*

1. Formula has no capacity to enhance the development of the baby’s immune system.

2. The earlier the introduction of formula, the greater the risk for the development of severe allergy (asthma and eczema) and infection in the infant.

3. There are over two hundred nutrients and components in breast milk; most of these components are not present in formula.

4. Occasionally, formula is recalled because of manufacturing errors, which put baby at risk.

5. Various issues with certain types of formulas, such as Soy formula and low-iron formula, etc etc.

* from Pregnancy, Childbirth and the Newborn

Monday, January 25, 2010


I can't get hired. Its not for lack of advertising my services, its lack of experience. Even if women say they want a doula in training for a low fee, they still don't want one who hasn't been to any births. Its like when you want to apply to be a waitress, and they say you need waitress experience first, and you think "well how do I get the waitress experience to be a waitress if I can't get a job as a waitress?!"

I've contacted at least 5 moms by e-mail, even talked to one on the phone, not including the teen mom that I met with, and they like me until I tell them I haven't yet been to a birth. Then they either completely stop responding to emails or they tell me they've decided to go with a more experienced doula. sigh.

So I sent in an application for the Operation Special Delivery program which takes trained volunteer doulas to provide free doula services for military families and pregnant women whose partners are injured, deceased or deployed. I also called a local hospital that has a doula program, which I had been putting off doula because I had only heard bad things about this hospital (for moms and for doulas, they docs and staff are just not doula/birth alternative friendly aka medical model only). Turns out they don't take you until you've had 3 births anyway, so that's no help to me.

Feeling down about all this.

On a different note, check this out: Cover Me Chic: Designer Hospital Gowns

And this birth story, which she splits into a few parts: Baby Dickey Birth Story

Sunday, January 24, 2010

Twilight Sleep

I touched on the topic of Twilight Sleep once before in a re-blogged post, but I learned a lot more about it from The Business of Being Born and I wanted to bring it up again.  This is part of the horrible but true history of birth in western civilization.

This is how the movie describes it:

There was a very strong belief in the idea that women were meant to suffer pain in childbirth because of Eve's transgression.  But the suffragettes and women activists of the early 1900's said "I'm a modern woman and I'm not going to suffer" and so they all wanted the pain-free childbirth that the doctors promised.

Twilight Sleep is the term referring to the state induced when doctors gave women a combination of Scopalamine and Morphine. This method was developed in Freiburg, Germany by Dr. Carl Gauss in the early part of the century (and is sometimes called the Freiburg Method).

Women would wake up, be handed their baby, and have no memory of how it was born. They marveled at how they could have a baby so free of pain. But the truth was the combination of the scopalamine and the morphine merely took away the memory of the period of childbirth. They also made you completely lose all sense of awareness, all self-control and enter a semi-narcotic state full of fear. Women would lash out at doctors and nurses, so they had to be blindfolded, put in straight-jackets and strapped down to a bed for days.

Screenshot from TBOBB

When the straps left marks and bruises on their limbs, doctors and nurses began to use lambs wool restraints so that husbands wouldn't ask questions. They were left strapped there for hours, sometimes laying in their own defecation.

Screenshot from TBOBB

Of course, it wasn't until later that they realized that the drugs were causing serious problems for the newborns. And I guess someone finally realized how inhumane this treatment of women was.

One day we will look back to our own time in history and write that exact same sentence about current obstetric practices...

Saturday, January 23, 2010

"The Business of Being Born" and "Orgasmic Birth"

I finally watched "The Business of Being Born" and I LOVED it.  Everyone should watch it!  In fact, after I turned it off I said, "I'm going to watch that again."

The movie talks a lot about maternity care in the US, sort of a surgeon (obstetrician) vs midwife or hospital vs. birth center type thing. I think if even if you've already decided you don't care about the midwife/home birth side of it and you're hospital gung-ho, you should still watch and see exactly what goes down at both the hospital and the home birth.

Its really a well-rounded investigation, including interviews with all types of people involved in maternity care - male and female obgyns, lone midwives, midwives in a practice, pregnant women in a variety of situations, women attending birth classes, childbirth educators, labor and delivery nurses, researchers, professors, the former director of women's health form the World Health Organization, and so forth.  Oh! and my favorite Medical Anthropologist Robbie Davis-Floyd and the nation's leading midwife Ina May Gaskin.

The movie is made by Ricki Lake who wanted to explore the system of birth as a result of her own births, and the director Abby Epstein who actually gets pregnant while making the movie and includes her birth. They show everything that a hospital birth entails, and everything that a midwife-attended birth entails.  If you thought a midwife only brought some towels to a home birth you will be surprised to see how much equipment she has ready.

The movie's big question: Is our system really whats best for women and babies?
The United States has the second worst newborn death rate in the developed world.
The US has one of the highest maternal mortality rates among all industrialized countries.

I can't emphasize enough how much information is in this movie. Its everything I wish I could tell women that you just don't learn from our culture and our media.  Its what I keep hearing over and over from moms, doulas, nurses, and so forth.

"A woman, as long as she lives, will remember how she was made to feel at her birth."

"Orgasmic Birth" only starts out about how birth can be sensual and sexual in general. If you can get past the beginning (where I feel like if you already thought that home births were only done by hippies than it is only going to reinforce that idea) than you can get into the really great parts of the video, much of which overlaps with The Business of Being Born.  What's nice is the contrast shown between a hospital birth and home births, in both videos. In Orgasmic Birth they really show how much more relaxed and pro-active the women are when they're birthing at home not pressured by anyone to do anything but be in labor. The movie isn't really about orgasm at all, except maybe the sounds the women are emitting (I can guess what my neighbors were thinking if they overheard me watching it), but about finding your own moment of ecstasy.

I don't know if I was really buying the sexual/orgasmic side to birth before watching this video, but I can see now how it can be sensual if you let it be.  I think it has a lot to do with your mindset, your emotions and feelings of safety and comfort and relaxation. You're not going to feel sensual in an unfamiliar, loud room full of people you don't know and tons of interruptions. That's not an intimate space, and you're not going to feel like getting intimate. And the only way it gets sensual is if its intimate - touching, kissing, and so forth. You can't be afraid to relax your body and to moan, just like when you have sex. I see how it can be possible, but improbable for most women who do not give birth in that kind of setting.

My favorite part about the entire movie was the woman laboring with her husband on her lawn. It was so peaceful - quiet, sunlit, and surrounded by trees. Then she moved up onto her back deck to actually have the baby and it all looked so serene. She said "I love being outside. I love having sex outside. I'm pretty sure one of our children was conceived outside." I now totally want to labor on a sun-dappled lawn listening to the wind. (starting to cross my fingers now for a normal, no-risk pregnancy and birth that allows me to have this scenario)

The best part about both these videos is not only all the information that all women should know, but the fact that birth can make you feel powerful and proud and accomplished! That it can be enjoyed, not frightening, and you can feel empowered.

A note: There are birth scenes in both videos, so if bodily fluids make you queasy, don't eat while you watch. I had an observation: it felt like the out-of-water births took quite a long time for the baby to make its way out, whereas in the water births it was like bloop! and baby slid right out. I wonder if that's just my perception or if that's true...

Friday, January 22, 2010

Studies show oral intake during labor has no ill effects!

You may not have already known this, but if you give birth in a hospital they are most likely not going to allow you to eat anything but ice chips. (I always think of Lorelai from Gilmore Girls talking about how she kept pelting the nurses with ice chips). Sometimes you can work out an exception, like drinking clear liquids, maybe juice or gatorade, having a popsicle or a lollipop. 

Frequently the reason is 1. you'll just puke it up. to that I say, I might puke anyway what does it matter whats in it? and what if I don't puke? I might not and then I'll get to have a full stomach. and 2. if you need a c-section and you've eaten there's a risk of aspiration, which the studies have found to be a minimal risk.

If your fluids and blood sugar are down they're likely to put an IV in you, which I would hate. I hate the way IVs feel and I'd hate to have my movement restricted. Plus if you have an IV they might get drug-happy now that you've got a nice easy line already in you! 

 The news that eating and drinking during labor is no big deal is not news to many members of the "natural" birth movement. Women are encouraged to eat before coming to the hospital anyway, as you'll need your strength. Women who give birth at home or in birth centers always eat if they so desire, for the same reason. 

But now, thanks to these studies, maybe hospitals will begin to change their policies!



Eating during labor has no ill effects: study

NEW YORK (Reuters Health) - Allowing a pregnant woman to eat during labor does not seem to have any impact on the outcome of the infant or mother, and doesn't increase the risk of vomiting, according to a new study.

The findings come from a study of 2426 pregnant women in labor who were allowed to eat lightly or to have just water during labor.

Researchers failed to see any significant differences between the two groups. Eating lightly during labor had no effect on the length of labor, the need for assisted delivery, such as the use of forceps, or Cesarean section rates.

Forty-four percent of women who ate a light diet during labor had a spontaneous normal vaginal delivery -- a rate identical to the rate seen in their peers who were permitted to have only water, Dr. Andrew Shennan, from King's College London, and colleagues report.

The cesarean delivery rate was 30 percent in each group, and rates of instrument-assisted vaginal delivery were 27 percent in the eating group and 26 percent in the water group.

The average length of labor was slightly but not significantly shorter in the eating group versus the water-only group (597 vs. 612 minutes).

The incidence of vomiting was nearly the same as well, at 35 percent and 34 percent in the two groups. There were no significant differences in any infant outcomes were observed between the groups.

The study appears in the March 24th Online First issue of the British Medical Journal.

In a commentary on the study, Dr. Soo Downe, from the University of Central Lancashire, UK, notes that the results "reinforce what has already been shown in many observational studies" and show that low risk women may eat lightly during labor.



Restricting oral fluid and food intake during labour 

from the Cochrane Review January 20. 2010



Eating and drinking in labour

In some cultures, food and drinks are consumed during labour for nourishment and comfort to help meet the demands of labour. However, in many birth settings, oral intake is restricted in response to work by Mendelson in the 1940s. Mendelson reported that during general anaesthesia, there was an increased risk of the stomach contents entering the lungs. The acid nature of the stomach liquid and the presence of food particles were particularly dangerous, and potentially could lead to severe lung disease or death.

Since the 1940s, obstetrical anaesthesia has changed considerably, with better general anaesthetic techniques and a greater use of regional anaesthesia. These advances, and the reports by women that they found the restrictions unpleasant, have led to research looking at these restrictions. In addition, poor nutritional balance may be associated with longer and more painful labours, and fasting does not guarantee an empty stomach or less acidity.

This review looked at any restriction of fluids and food in labour compared with women able to eat and drink. The review identified five studies involving 3130 women. Most studies had looked at specific foods being recommended, though one study let women to choose what they wished to eat and drink. The review identified no benefits or harms of restricting foods and fluids during labour in women at low risk of needing anaesthesia. There were no studies identified on women at increased risk of needing anaesthesia. None of the studies looked at women's views of restricting fluids and foods during labour. Thus, given these findings, women should be free to eat and drink in labour, or not, as they wish.

Thursday, January 21, 2010

Placenta Previa and Placenta Accreta

Turns out my mother's birth experience with me involved her placenta not coming out after I did. In hospitals they only wait 30 minutes for the placenta, even though it has been known to take up to two hours after birth to come out safely. However, in the hospitals they worry about placenta accreta, or the placenta remaining attached to the uterine wall, which can cause severe bleeding. Thusly, they anesthetized my mom and went in and got it! So today's lesson, for myself and any readers, will be on placenta accreta.

The condition of the placenta attaching too deeply to the uterine wall is known as either placenta accreta, placenta increta, or placenta percreta, depending on the severity and deepness of the placenta attachment. Approximately 1 in 2,500 pregnancies experience placenta accreta, increta or percreta.

The cause is unknown, though it can be related to either previous cesarean deliveries or a condition known as placenta previa. This occurs when the uterus is covering the cervix and is diagnosed during pregnancy. Placenta accreta is present in 5% to 10% of women with placenta previa. Placenta accreta if difficult to diagnose and is usually not confirmed before labor.

 If it occurs in childbirth, the placenta will be manually removed before there is too much hemorrhaging. In severe cases a hysterectomy, or the removal of the uterus, may be required.

My mother doesn't really remember it, she says she was groggy, so she's not sure if she actually had placenta accreta or maybe just a retained placenta and they were worried about placenta accreta.

There are ways to help your placenta along if it is taking a while. Breastfeeding the baby or nipple stimulation helps the uterus to contract and expel the placenta. Occasionally, changing to an upright position lets gravity help the placenta out. You may also have a managed third stage, where you're given an injection of oxytocin to make your uterus contract.

By the way, I don't recommend a google image search of 'retained placenta.' Its mostly cows.

Wednesday, January 20, 2010

I eat, breathe and dream pregnancy

I got my doula business website up and running! And I ordered business cards! I'm so excited!!!

I'm not going to post the site here, though, because I'd like to keep this blog somewhat anonymous. I'd be worried if the two sites were connected, and then I couldn't discuss my clients situations and any of my concerns on here. I really appreciate having a blog to write on about being a doula and I don't want to breach confidentiality or scare clients away simply by having an informal blog :/

Anyway! This evening I got a phone call from a woman who is looking for a doula really late in the game. She is already 37 weeks and is just now phone interviewing doulas! I'm really hoping that she'll hire me because she seems really nice, but who knows. She has to find the right person for her.

She emailed me last night to tell me she would call me today and this made me so nervous that I was anxious all night long and I couldn't sleep. I kept thinking about what I'd say and how if she hired me I'd have to quick get all my forms ready and buy my doula bag stuff etc etc! When I did sleep some I had a dream that I was pregnant and very unhappy about it. My boyfriend was unhappy, my parents were disappointed, even my grandparents were in it! And I remember that I didn't find out I was pregnant until I was REALLY pregnant and I was so upset. And I was walking around in a hospital (this part was really detailed. I am frequently in hallways in my dreams) and worrying about if I had made my baby deformed because I had been still taking my birth control all that time! Such a stressful night.

What?! That's not just a food baby?!

My OB Said WHAT?!

Found a great site that I've started following called My OB Said What?! that has some really shocking things that people in the birth business have said to their patients. Thought I'd post some outrageous ones here for entertainment:

“Every day past 40 weeks, a baby dies more and more” – Family Practitioner on why they needed to schedule a mom’s induction at 39 weeks and 6 days.
(the length of a pregnancy can be anywhere between 37 and 42 weeks. an estimated date of delivery is ESTIMATED. talk about needless freaking-out)

“Did she put any spells on you yet?” – -L&D nurse to mom, referencing her doula, who was in attendance. 
(oooh I'm going to work my doula withcraft on you to make you think you're having a wonderful birth but really it will be terrible!)

“Cesareans are the safest route of delivery for a mother.” – OB to father who was advocating for VBAC at admission during his partner’s active labor.

“You’re a NICU nurse, so you will be able to handle it.” -OB to mother whose 34 week fetus had a nonstress test that suggested a immediate cesarean might be a possibility.  Mother expressed concern about the baby possibly needing to come early.
(um what?! what mother will ever be able to 'handle it' NICU nurse or not?! cruel!)

“Oh my God, the patient escaped!” -L&D nurse upon entering the room and not immediately seeing the patient, who was in the bathroom laboring in the shower.
(I loled at that one)

“YOU won’t be able to do it naturally!  You’ll be BEGGING for an epidural!” -OB to mother expressing a desire for a non-medicated birth.
(heard this one a lot)

“Contractions can’t possibly last more than 45 seconds.” – OB to mother who has having double peaked contractions lasting 90-120 seconds as observed on the monitor.
(are you sure you are a trained OB?)

“You know what we call people with birth plans?  Cesarean Sections!” -OB to mother during prenatal when asked to discuss birth plans.

“Well I haven’t seen a woman give birth in 8 years without one”. -Nurse Practitioner to mother who wanted it noted in her chart during her prenatal visit that she did not want an episiotomy.

“You should wear a bra as long as you nurse, even while you sleep. Too many nice pairs of breasts have been ruined by breastfeeding.” -OB at a prenatal to 18 year old mother pregnant with her first child.

‘It is illegal for us to leave a baby unwashed…he could rot, I have seen it happen.” -L&D Nurse to a mother who’s cesarean was delayed over her refusal to consent to a newborn bath prior to establishing breastfeeding.
(ew ew ew ew ew that is SO not possible)

and here's a nice one:

“Don’t let them bully you.”  – OB on the morning following a cesarean warning me about the hospital nurses and staff who would likely try to get me to use formula because my newborn would lose weight before my milk came in.  He explained that it is normal and safe for a newborn to lose a certain percentage of their birth weight and that it was no indication for formula feeding.

Tuesday, January 19, 2010

What to Expect When You're Expecting: The Movie

So, ever since I started following all these birth junkie blogs I've heard one very large and resounding cry against the book What to Expect When You're Expecting. And I found it funny that when I went to the Barnes & Noble to look for my doula reading list books they had NONE of the ones on my list, but about 30 copies of WTEWYE displayed on several shelves.

Here are a few things the blogosphere has to say about it, in case you're wondering why it is awful:

This book is chock full of enough scare-tactics and medical promotions to frighten and confuse any mama-to-be right into a panic attack (if not premature labor). I have never seen so many women turned into anxious balls of nervous wreckage after reading this book. Although it contains a lot of relevant educational material, it is delivered in such a way that women are not brought into that knowledge in an empowering and positive way; but instead leads women to believe that there are so many cautions, tests, deviations, and alternatives that something is bound to happen, just wait. Empower and educate, it does not. There are many better options. (from Bellies and Babies: What not to Read)

It repeatedly says that cesarean section is safer than vaginal birth, equating the surgery to a tonsillectomy and stating that “the major reason for the increase in the cesarean rate is not bad medicine, but good medicine.” There is a sharply critical tone throughout at any mention of those types who might question medical authority or practices and strongly encourages women to not really worry if that procedure was unnecessary. If your doctor felt it was necessary, it probably was, so rest assured! The authors call natural birth advocates of the 70’s and 80’s “singleminded women [who] waged war on recalcitrant physicians” then ends the same paragraph with a mention of how “unmedicated birth is still considered the ideal.”  (including image above, from The Unnecesarean: What to expect when youre not expecting to be sued by your doctor)

And now I hear that they're making a MOVIE of What to Expect When You're Expecting! Apparently along the lines of He's Just Not That Into You, it will follow several couples who are, well, expecting! Will this actually make a good movie? Only time will tell.

Monday, January 18, 2010

wonder if Doulas will be featured in the next episode of "The Wire"

My meeting with Shamilia went well! Everything other than the actual conversation was a bit nerve-wracking, but I'm quite proud of myself for getting it done.

I took the Baltimore metro for the first time because she lives right near one of the metro stops and I figured it would the easiest way to meet. I had hoped to go to a coffee shop to get warm so I wouldn't have to stand in the rain or walk through a bad part of town, but I had no such luck. There was NOTHING near the metro when I came out, and I had no choice but to meet her and go to her home. Luckily it was only a 5 minute walk, but unluckily, it was definitely in one of the most scary areas of Baltimore I've ever been in. (Which she confirmed later on in our meeting by saying she can't wait to move out of there and bring her baby up in a place less dangerous. "someone gets killed here every week").  And even though she walked me back to the metro station, she told me to call her when I got home so she knew I made it safely.

She was very sweet though and we got along great. Very much an 18 year old, but also very much excited about having a baby to take care of. And she also told me she can't wait to breastfeed! She said she watches her friend measure out formula and heat up the bottle to just the right temperature and it just seems like way too much work when you can just go 'boop!' (with a gesture of bringing the baby to her breast) and its the right temperature already!

I thought we got along well and were very comfortable together. She is meeting with another potential doula this week, who seems to me to be more experienced than I and like she might be a good match for her beause they have similar family/birth situations. But Shamilia is worried that the fact that the woman has young children would interfere with the time she is able to spend on Shamilia herself. So at the moment I am just waiting and wondering what she will end up deciding.

Tonight I will be attending a meeting of a group of doulas from the Baltimore area who I only know through a Yahoo group. Should be interesting...

By the way, thanks to yesterday's adventure I've now been on a Metro/Subway in 8 different world cities :D

Sunday, January 17, 2010

A UNC birth story!

I am borrowing this birth story from Stand and Deliver's post: Failure to progress or reason to be patient? A birth story because it takes place at UNC (my alma mater!) and also because it shows a positive situation where the mother's wishes were respected, her body was believed in, and her use of an epidural went well. Pictures of the baby can be seen at the link!

From the post:

A few highlights from her birth:

  • She was in labor for over 36 hours
  • She was stalled at 8 cms for 12 hours
  • Her birth plan was followed to a T; the only deviations were ones she chose
  • She had a spontaneous vaginal birth, with total support from her midwives, despite the attending physicians wanting to move to cesarean during her long period of "failure to progress." 
Warning: I am going to tell about the details of Isaac's birth, so if you don't feel comfortable with technical birth terms like "mucus plug" or "cervix", you might want to skip the story to the pictures below.

As Kent mentioned, the entire labor period was rather long. Sunday night [I think she meant Saturday night] I was really achy, so I moved to the couch in the study which is a little firmer than our bed. Around 7:30 am, I noticed a little gush of liquid from my vagina. A few hours later I called the midwife and she agreed with me that it was probably the mucus plug (I know it sounds gross, but this is the real technical term used to describe the material that keeps the cervix sealed so that the baby in the uterus is protected during pregnancy) which usually comes out 2-3 days before people start having contractions.

I clearly was NOT having contractions, so Kent and I went to Church. Since I looked like I had a beach ball in my stomach and people know my due date was on the 17th, we got lots of good luck wishes from people. One of my 8 year old students from the church class I taught last year was so excited about the pending birth, she had announced to her class at school that her church teacher was about to have a baby--she is pretty cute. I now teach the 6-year-old class at church and part of the lesson was playing "Follow the Leader" which invariable involved several variations of hopping. Although a little uncomfortable, I joined in with the hopping but still experienced no contractions.

Later that I night, I had the intense urge to tidy the living room, bake chocolate chip cookies, cook a nice/huge stew for dinner, and finish up some research that I had been working on in the past week and was planning on meeting with my adviser to discuss the next day. I ended up staying up until 1 am to get this done, and noticed some irregular twinges of discomfort in my lower abdomen.

Monday 3:00 am to 7:00 am: I only slept for about 2 hours because around 3 am, I began to have constant contractions, about 8 to 10 minutes apart. I moved to the couch in the living room because I didn't want to wake Kent (which I didn't--he sleeps like a rock). The rest of the night was spent pacing around the living room and trying to rest on the couch between contractions. It felt like just as I was about to drift into a real sleep, the next contraction would hit. I mostly remember that the house was very cold, noticing that the high school students waiting on the sidewalk in the dark for the school bus in the freezing cold at what seemed a horribly early hour, and watching the progress of dawn through the curtain cracks.

Monday 7:00 am- 6:30 pm: Kent finally woke up and agreed that I probably was in the early stages of labor and should cancel my meeting. I felt the strong need to go to Target to get a bathrobe and other things so we went early in the morning before the contractions got stronger. The rest of the day was a blur of pacing around our little house, grabbing on to desks/door frames/sinks, and moving my hips like a hula dancer to help with the discomfort. Because of the age of the house, the floorboards are a little unstable and squeaky in parts, so I am sure our neighbors in the other units were wondering why their floors were wobbling so much. I ate a bowl of cereal in the morning and a 1/4 cup of tomato soup around lunch, but mostly just drank tons of water. As the day progressed the time between contraction decreased and by 6:30 pm, they were occurring about 3 minutes apart and I was having a hard time talking through them so we decided to head over to the UNC hospital!

Monday 6:30 p.m. - Tuesday 1:00 a.m: We got the the hospital and found out I was only dilated to 4 centimeters (full dilation is 10 centimeters) and I was a little disappointed because I thought I would be further along that that. As we walked toward our delivery room, we passed a group of people touring the maternity ward. (Of course a guy said, "Get a chair for the lady!" when they noticed I was in the middle of a contraction. Obviously he has never been in labor because it is much worse sitting still -- or at least it was for me). The irony of seeing the tour group was that we had been signed up to take our tour of the maternity ward that night at 7pm, but instead we came in for the real deal.

We got situated in the room, talked to the midwife on duty and meet the wonderful nurse who would be periodically monitoring the baby and helping us through the night. My goal was to have a natural childbirth with no medication. The nurse and midwife were very wonderful and supportive of my goal and allowed me to not have an IV, agreed not to ask me to rate my pain (I wanted to focus on the positive), and agreed not to ask me if I wanted pain medication as I outlined in my Birth Plan. And then I began my pacing and swaying-it involved a lot of movement which probably used up a lot of my energy, but it was the only thing that really helped me. I tried to sit and rest when I could, but it was only for a few minutes at a time. I found vocalization to also be a good way to deal with the pain--singing parts of songs, saying random vowel sounds, etc. I sounded really weird, but I didn't care about anything other than getting through the contractions. As the night progressed, I stopped vocalizing and was just really really intense and quiet as I focused on getting through one more contraction.

Around 1 am, the midwife checked and found I was dilated to an eight. I upchucked after one contraction They were all sure that I would probably have my baby within the next few hours.

Tuesday 1:00 am - 7:00 am: Kent was so amazing in letting me hold his hand in a death grip, helping me get out of the seat and onto my feet when a contraction hit, and giving me constant positive encouragement letting me know that I was doing well, etc.

Tuesday 7:00 am -11:00 am: At 7 am, there was a shift change which brought in two new midwives and a new nurse. They were really nice and helped me a lot in getting through the contractions. Their help was even more appreciated because the past night had been really draining on Kent. I don't think he realized how hard it would be to see me in pain, but he really did a great job. To make sure he kept up his energy, he quickly ran down to the cafeteria for breakfast. Unfortunately, the exhaustion and stress hit him hard and his stomach rebelled around 30 minutes after getting back to the room. Luckily, the midwives were so involved in helping me cope with the contractions that this allowed Kent to rest a little on the couch to make sure his stomach could get settled. Around 9 am, my dilation was checked again and it STILL was only at 8 centimeters. 8 hours and no progress! Grrrrrrrr.

I decided that it was time to try some of our options and decided to get an IV to make sure I had enough fluid in my body and have my bag of waters broken in hopes of strengthening the contractions.

After two hours, we checked again and no progress. At this point, I was literally falling asleep standing up. I still felt relatively optimistic, but I knew I was exhausted and my body was physically drained. I talked to the midwives and I decided that I would get an epidural so I could sleep and then get some pitocin to help strengthen the contractions and get this baby out!

Tuesday 11:00 am- 5:31 pm: Getting the epidural was fine and in 20 minutes, the contractions were numbed, I could still feel the sensations but not to the point of pain. I fell asleep almost instantaneously. Kent also got some sleep on the pull out bed. The nurse and midwife let me sleep for 3 or 4 hours (I think) and I woke up with so much energy and feeling so happy and ready for the next part. We checked and the pitocin had helped me dilate to 9 centimeters--everyone cheered. Everything started moving quickly at this point and the next thing I knew was it was time to push! The epidural allowed me to feel when I needed to push and how much the baby was progressing, but the pain was minimal. It seemed like we had to wait a long time between each push, but after about an hour of pushing, Isaac came out. We did it! It was so miraculous. They let me hold him immediately and I remember thinking that he felt so soft and warm. I can't describe the awe and wonder of the moment.

The midwives told me after that the doctors all thought I wouldn't make it and were really pushing for me to have a c-section, but the midwives knew I didn't want this and backed me up 100 percent. Apparently there are many places that tend to perform a c-section after 2 hours of no progression in dilation and that letting it go 4 hours is considered liberal. During my labor, I knew it was taking a while, but I had no idea how long it was actually taking because I was focused on each contraction. There was no past, no future, just now. So it wasn't too bad and I am glad I didn't have people telling me they thought I was taking "too long." I took just the right amount of time for me and was very happy with how things worked out.

During the whole birth process and after, I have felt great peace and a deep happiness. We love Isaac so much. I have loved spending this past day with him watching his squashed newborn eyes open and peer around with a look of bafflement, his soft dark hair, being able to comfort him when he cries, and all the other many little things that make him special. He has a talent for sneaking his hand out of his swaddle blanket--like a baby Houdini.

Saturday, January 16, 2010

The Rights of Childbearing Women

The Rights of Childbearing Women
from Childbirth Connection

This statement outlines a set of basic maternity rights that Childbirth Connection has identified and promotes for all childbearing women. It applies widely accepted human rights to the specific situation of maternity care. Although most of these rights are granted to women in the United States by law, many women do not have knowledge of their maternity rights.

The Rights of Childbearing Women

* At this time in the United States, childbearing women are legally entitled to those rights.
** The legal system would probably uphold those rights.

1.  Every woman has the right to health care before, during and after pregnancy and childbirth.

2.  Every woman and infant has the right to receive care that is consistent with current scientific evidence about benefits and risks.* Practices that have been found to be safe and beneficial should be used when indicated. Harmful, ineffective or unnecessary practices should be avoided. Unproven interventions should be used only in the context of research to evaluate their effects. 

3. Every woman has the right to choose a midwife or a physician as her maternity care provider. Both caregivers skilled in normal childbearing and caregivers skilled in complications are needed to ensure quality care for all. 

4. Every woman has the right to choose her birth setting from the full range of safe options available in her community, on the basis of complete, objective information about benefits, risks and costs of these options.*

5. Every woman has the right to receive all or most of her maternity care from a single caregiver or a small group of caregivers, with whom she can establish a relationship. Every woman has the right to leave her maternity caregiver and select another if she becomes dissatisfied with her care.* (Only second sentence is a legal right.) 

6. Every woman has the right to information about the professional identity and qualifications of those involved with her care, and to know when those involved are trainees.* 

7. Every woman has the right to communicate with caregivers and receive all care in privacy, which may involve excluding nonessential personnel. She also has the right to have all personal information treated according to standards of confidentiality.* 

8. Every woman has the right to receive maternity care that identifies and addresses social and behavioral factors that affect her health and that of her baby.** She should receive information to help her take the best care of herself and her baby and have access to social services and behavioral change programs that could contribute to their health. 

9. Every woman has the right to full and clear information about benefits, risks and costs of the procedures, drugs, tests and treatments offered to her, and of all other reasonable options, including no intervention.* She should receive this information about all interventions that are likely to be offered during labor and birth well before the onset of labor. 

10. Every woman has the right to accept or refuse procedures, drugs, tests and treatments, and to have her choices honored. She has the right to change her mind.* (Please note that this established legal right has been challenged in a number of recent cases.) 

11. Every woman has the right to be informed if her caregivers wish to enroll her or her infant in a research study. She should receive full information about all known and possible benefits and risks of participation; and she has the right to decide whether to participate, free from coercion and without negative consequences.* 

12. Every woman has the right to unrestricted access to all available records about her pregnancy, labor, birth, postpartum care and infant; to obtain a full copy of these records; and to receive help in understanding them, if necessary.

13. Every woman has the right to receive maternity care that is appropriate to her cultural and religious background, and to receive information in a language in which she can communicate.

14. Every woman has the right to have family members and friends of her choice present during all aspects of her maternity care.

15. Every woman has the right to receive continuous social, emotional and physical support during labor and birth from a caregiver who has been trained in labor support.

16. Every woman has the right to receive full advance information about risks and benefits of all reasonably available methods for relieving pain during labor and birth, including methods that do not require the use of drugs. She has the right to choose which methods will be used and to change her mind at any time.

17. Every woman has the right to freedom of movement during labor, unencumbered by tubes, wires or other apparatus. She also has the right to give birth in the position of her choice.

18. Every woman has the right to virtually uninterrupted contact with her newborn from the moment of birth, as long as she and her baby are healthy and do not need care that requires separation.

19. Every woman has the right to receive complete information about the benefits of breastfeeding well in advance of labor, to refuse supplemental bottles and other actions that interfere with breastfeeding, and to have access to skilled lactation support for as long as she chooses to breastfeed.

20. Every woman has the right to decide collaboratively with caregivers when she and her baby will leave the birth site for home, based on their conditions and circumstances.

Great Online Doula Forum

I don't think I've mentioned yet on here the great and awesome I was really lucky to find such a great doula forum, and I highly recommend it for any aspiring or current doulas.  It is has been such a great place to have questions answered as an aspiring doula and to see what other doulas wonder about! It even has a great page for free downloads (sample doula business forms or website templates) and also a page with all New Doula FAQ's with things I didn't even have to ask! I know there may be other doula forums out there, which I'd love to hear about if anyone has a recommendation, but I definitely like a LOT.

In other news, I've e-mailed a few moms looking for low-cost doula services but haven't gotten any great responses. It seems even if they don't mind a training doula, no one wants to be my very first birth. sigh. Besides that, I'm meeting with Shamilia tomorrow, and will write about how that goes. When we spoke on the phone to set up the meeting she was a lot more clear and excited sounding than the first time so I feel better about that. She had gotten her first sonogram and was clearly thrilled about that and totally up for meeting with me.

Also, I'm working on getting a website up but am having trouble deciding on a name and a domain name (that isn't already taken). Seems there are a lot of doulas in the world all with the same-type name ideas!

Thursday, January 14, 2010

Birth Junkie buttons!

The Birth Project is a magazine run by birth junkies,, and they have buttons for sale on etsy!

Wednesday, January 13, 2010

How we get the Lowdown on Birth in our Culture

Today I contemplated the reason why am I so interested in pregnancy, birth, and birth culture. I think it is because in our modern American mainstream culture (which I am placing myself in) we do not have the same women's networks that existed in the past, and still exist in many cultures in the world. As a result, we do not grow up hearing about and actually seeing first-hand pregnancy and birth, unless maybe we happen to be the eldest child old enough at the time of our mother's later pregnancies to remember (but even then your mom may not be sharing every aspect with you).  I know there are exceptions, as there always are (extreme on the curve!) but from my perspective most people learn about birth when they get pregnant themselves.

I grew up with little knowledge of birth, the different ways to give birth, and all the different aspects of being a childbearing woman. All that I knew came from tv and movies, and the vague memory of the fact that my mom had my little brother in a hospital. I first heard the term "doula" when I took a Comparative Healing Systems anthropology course in undergrad, which prompted me to ask my mom more about her birthing experiences. Before taking this class, and reading Brigitte Jordan's "Birth in Four Cultures," I never realized that there were differences in birth experiences. I didn't know that you had a choice in where you could give birth, who attended your birth, that there were different positions you could give birth in, that in some countries medication is NEVER given, and so forth.

And from there I wanted to learn more. And learning about myself, and a situation I hope to find myself in in the future, and the capabilities of women around the world has made me want to tell others! Because I want YOU to know all this cool stuff that you probably aren't learning from your female companions and from the media. I want to share with everyone all the information that they may not receive from reading a childbirth book while they're pregnant, and to shatter assumptions that we have been accumulating from our society.

Speaking of childbirth and the media, I really want to get a chance to see this sweet documentary Laboring Under An Illusion: Mass Media Childbirth vs. The Real Thing, made by an anthropologist/childbirth educator!

for more info:

On the topic of where we get our information from, I want to share some of The Feminist Breeder's post called Mominatrix Says: “Consider yourself lucky, you c-section bitches.” about a portion of a sex advice book for mothers and pregnant moms-to-be called The Mominatrix’s Guide to Sex: A No-Surrender Advice Book for Naughty Moms....
I thought we had enough mainstream mommy authors giving us really uneducated advice about the supposed magical powers of epidurals and cesareans, but apparently there is room for one more.  I know Mominatrix thought she was being funny and clever when telling pregnant women to “save your cash for more useful items, like an epidural” but as a natural birth advocate, I find that statement highly problematic.  Actually, as a feminist I find that statement highly problematic.  Why must authors assume that their readers cannot handle labor, and suggest they save up for drugs before they even feel the first contraction?  Are we not selling our sisters a little short?
But it’s a flippant book, Gina!  What’s the harm?
Well, I’ve got a nice sized uterine scar on my belly right now thanks in part to a flippant mommy advice book like this one.  When I first found myself pregnant, I was just like the vast majority of pregnant American women who never get truly informed about the birth process, and instead spend their pregnancies watching “A Baby Story” and reading Jenny McCarthy books.  I got my hands on “The Girlfriend’s Guide to Pregnancy” by Vicki Iovine, which told me that Lamaze was useless, as were all other birthing classes, and what I really needed to focus on was how quickly I could get the epidural.
Yeah — I got the epidural.  The epidural that only went down half my body, that caused me uncontrollable shaking, that shut down my labor, that necessitated more pitocin, which put my baby in distress, which then necessitated a nice, traumatic cesarean surgery.  Yep. That epidural. I’m so glad I saved my money for that epidural, instead of a birth class which would have informed me of the potential risks to my epidural decision.
But Mominatrix doesn’t seem to think that a cesarean is such a bad thing because, according to her, a cesarean means a baby didn’t come through your vagina and wreck it.  She complains that birth causes irreparable damage to the vagina and
“Quite frankly, women who have not had a vaginal birth will probably not experience as much of a change as those who have shot a baby or two out of their vag.  Consider yourselves lucky, you c-section bitches.”
She also says,
“It doesn’t take a rocket scientist to figure out that if you’ve birthed a few seven or eight pounders your vagina will not return to its trim and virginal state without some effort. And even then, it still might be somewhat of a lost cause.”
I would like to let unsuspecting mothers know that I’ve birthed a nearly 10 lb baby, and my vagina is just fine....
I tell you what really ruined my libido and my self esteem for a really long time were the debilitating, bleeding, excruciating, almost-required-another-surgery-to-fix hemorrhoids I suffered through after my cesarean, which were caused by the way they piled all my intestines back in my body (that’s right, did you know they pull all your insides out of your abdomen during a cesarean?)  Now THAT is sexy.
You know what DOES cause damaged vaginas though? Episiotomies, poor birthing positions (like the flat-on-back position so many ignorant medpros push women into), purple pushing (pushing when told to, instead of when your body wants to), and many other avoidable, outdated obstetric practices.
What I want people to get out of this is the understanding that these birth interventions so flippantly recommended in this book come with real risks, and real consequences that should never be left out of the conversation.  No, you should NOT be getting your birthing advice from a funny, tongue-in-cheek Mommy sex advice book — but that also begs the question why it’s there to begin with.

And I loved a comment she got on her post: "Okay I’m gonna be a little TMI here… but I actually enjoy sex more since I have birthed a baby out of my vagina! Is that strange?? I dont think it ruined my vagina at all, I think it made it better!"

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