Saturday, July 31, 2010

Water Birth

Though I've mentioned water birth before, and read a lot about it, I realized I've never really blogged about water birth!

Water Birth has been shown to provide excellent birthing experiences for both mother and child. The mother experiences a more relaxed environment in which she feels in control and free to follow her body's urges. The buoyancy of the water does wonders to alleviate labor pains without the need for IV pain medication. Perineal trauma is also reported to be less severe. Additionally, you don't have to worry about clean-up or stains... everything goes out with the bathwater.

Advocates for water birth also state that a water birth eases the transition for the baby from the birth canal into warm liquid that resembles the intra-uterine environment.

- Water birth can take place at home, in a birthing center, or in a hospital. 

- Temperature of the water: should be somewhere between 95 and 100 degrees, so that the mother is comfortable.

- The cost to purchase or rent a birthing pool runs between $118-375 plus shipping.  However, it's possible that your insurance company may reimburse the pool rental or purchase fee. If you give birth at a hospital there is no need to bring your own. Types of birth pools


Want to read/watch some Water Birth stories?

Kristen at one of my fave blogs, Birthing Beautiful Ideas, writes about her In-Hospital VBAC Water Birth

A Beautifully-made video of a Water Birth

Rixa at Stand and Deliver blog writes about the birth of her second child at home, including video. 

A video of an "unusual" water birth in a hospital where the couple are left quite alone.

A short video where mom catches her own baby.

Waterbirth International has a page with several water birth stories.

I will definitely labor in water, an excellent form of pain relief that has no negative side effects but a multitude of positive effects.


Frequent concerns with water birth:

- Infection: Hospital staff, especially L&D nurses, will frequently cite "infection" as the reason for not getting into a bathtub, either to simply labor or to give birth. Some will say you can only get in if your water has not yet broken, others will say not at all. Most OB's will refuse water births because they do not want to deliver a baby by bending over by the tub.
(The truth is, YOU can deliver your baby in a tub, simply by reaching down and pulling your baby up once he/she is born. Or dad can! Moreover, with a full birthing tub (as opposed to a regular in-wall bathroom tub), your support team and midwife, etc can be all around you 360 degrees, and can be wherever they are needed, such as to help deliver the baby.)
As long as the bath has been cleaned, there is little to no risk of infection for the baby. Also, the baby will be colonized by its own mother, anyway, on the way out, and by her skin and breast immediately after.

- Slowed Labor: There is a possibility that the relaxing effects of the water, and the tendency to lay immobile for some time, sometimes slow labor. For this reason, many professionals suggest that mom wait until 5 cm dilation to enter the tub. If you are birthing at home and not receiving cervical checks, I would recommend entering and exiting the water whenever you felt like it.

- And the big one...
What prevents baby from breathing under water?
There are four main factors that prevent the baby from inhaling water at the time of birth:
1.  Prostaglandin E2 levels from the placenta which cause a slowing down or stopping of the fetal breathing movements. When the baby is born and the Prostaglandin level is still high, the baby's muscles for breathing simply don't work, thus engaging the first inhibitory response.
2.  Babies are born experiencing mild hypoxia or lack of oxygen. Hypoxia causes apnea and swallowing, not breathing or gasping.
3.  Water is a hypotonic solution and lung fluids present in the fetus are hypertonic. So, even if water were to travel in past the larynx, they could not pass into the lungs based on the fact that hypertonic solutions are denser and prevent hypotonic solutions from merging or coming into their presence.
4.  The last important inhibitory factor is the Dive Reflex and revolves around the larynx. The larynx is covered all over with chemoreceptors or taste buds. The larynx has five times as many as taste buds as the whole surface of the tongue. So, when a solution hits the back of the throat, passing the larynx, the taste buds interprets what substance it is and the glottis automatically closes and the solution is then swallowed, not inhaled.
For a more complete description, click "read more."

Friday, July 30, 2010

A History Lesson: Breastfeeding and World War II

Photo credit: Jennifer James


World War II is Responsible for the Decline of Breastfeeding in the U.S.

 

Infant formula was invented by Henri Nestle in 1860, but it didn’t actually become popular until the 1940s. The main cause for this sudden increase in popularity was World War II. Before the war the vast majority of women were homemakers who stayed home with their children and left the jobs to the men. As the war continued, women were called to the workforce to support their country by doing the jobs that men who went overseas to fight had left behind. In fact, the number of women in the labor force increased 210% from 1940 to 1985. It was this sudden desire and ability for women to leave the housewife life behind that formula companies saw and capitalized on by starting huge advertisement and free sample campaigns to normalize bottle feeding and, of course, get rich in the process.




Kathryn Davis, age 60, is the daughter of a decorated WWII veteran. A self-proclaimed history buff, Kathryn has spent her entire life studying WWII and its effects on the population of the United States:


"I think World War II was the biggest influence on the decline of breastfeeding. It was the first time in U.S. history that women could really enter the workforce. They needed them to build the planes, bombs, tanks, and munitions but if they were breastfeeding babies they couldn't do that on the scale needed. Formula and bottles became quite popular at that time because they needed to be able to leave their babies behind to help the war efforts. The baby boomer generation is really the first generation to have been bottle fed on the large scale. The attitude was that the more intelligent, educated, and sophisticated people bottlefed. If you saw someone breastfeeding you automatically assumed that they were an ignorant country bumpkin. It wasn't that breastfeeding was uncommon, it’s just that the bottle was more common. When my sister had her kids in the 60s they were automatically bottlefed and she was even given a shot to dry up her milk. By the time the 80s came around and I was having my children people were beginning to become more educated about breastfeeding. My doctor didn't influence me either way but basically told me that breastfeeding for the first month was good enough. Of course, I was given tons of formula samples and free bottles at every doctor visit."


Nurses Preparing Formula Bottles in the Hospital, 1942

Thursday, July 29, 2010

Here's how NOT to Support Breastfeeding

An Italian pharmacist was told that she cannot bring and breastfeed her 3-month-old baby at her Lactation Assistant Examination because it would be distracting. WHAT?!

Pozzi Perteghella was going to sit for the 5 hour exam, given worldwide by the International Board of Lactation Consultant Examiners, and wanted to be able to feed her baby on demand.

She writes:
I was informed … that only examinees and examiners may get into the room, so I would have to let my baby out: I might go out and breast-feed him, but the time it took could not be made up for, or I could express my milk and have it fed to the baby by someone who looked after him outside the room. The reason for this procedure is that the baby might disturb the other examinees.
The blog “Mama Is …”  by artist Heather Cushman-Dowdee has several excellent comics about the irony of Pozzi's situation, including this one:


Cushman-Dowdee also describes her own defense of her master’s thesis several years ago:
My second daughter was born 5 weeks before I had my thesis defense scheduled. I attended the grueling 2 hour event with her tucked in the sling. I answered questions, stood and rocked her when she seemed a little restless, and even turned around for one second to latch her on so that she could nurse and go back to sleep. I was in front of a large audience of professors and professionals. And she didn’t interrupt in any way and if she would have I would have asked for a minute or two to regain our composure, I feel sure that my thesis committee would have cut me a break. How can we expect any less from a “pro- breast-feeding organization?”

To read Pozzi Perteghella's story and why she won't sit her IBCLC exam, visit her webpage: HOW NOT TO PRACTISE WHAT ONE PREACHES

Wednesday, July 28, 2010

Birth = Sexual Intimacy

The text below is a re-blog of an excellent post about how childbirth is related to sexual intimacy. Not understanding this often causes us to "get in our own way" when it comes to going into labor.


Getting in Our Own Way

by the midwife at Vita Mutari Blog


I am about to explain to you why a woman who is past her due date and feeling anxious to have her baby and is TRYING to have her baby….is actually less likely to go into labor.
There’s the bombshell…the concept that is new to a lot of people…so let’s explore this phenomenon.

We hear a lot of analogies when it comes to birth – it’s like a marathon, it’s climbing a mountain, it’s like intimacy, it’s like…..

The truth is, it’s unlike anything you’ve experienced. Try as you might, it isn’t something you can relate to until you’ve experienced it. To that end I say, “It’s like an orgasm…we can try to explain to you the physical response of an orgasm, but until you’ve experienced one you can’t truly understand.” Explaining labor/birth to someone who has never experienced it is like trying to explain the color blue to someone who was born blind.

HOWEVER – when it comes to the physical transformation that occurs, it is most related to sexual intimacy. Now wait…get back here…let me explain….


WAYS IN WHICH LABOR/BIRTH IS SIMILAR OR RELATED TO SEXUAL INTIMACY

* It uses the same hormones: Prostaglandin, rich in semen….oxytocin, the hormone responsible for orgasm….yep, same hormonal cocktails during birth!
*  It uses the same parts of the body: how the baby gets in is how baby gets out.

*  It uses the same part of the brain: different parts of the brain offer their expertise to different functions of life….and the part of the brain that takes over during intimacy, the part that forgets about everything else in life, the part that no longer lets you care if your legs are shaven or if you are making sounds….it’s the same part of the brain that does those things in labor. You’ve heard of women talking about how they had no modesty during labor? Yup…that part of the brain! Men learn very early that their thoughts can have a huge effect on this part of the brain, slowing down its ability to function. Have you ever heard of a guy “doing math in his head” or “thinking baseball scores” in order to slow down and make the intimacy session last longer? That’s because he knows that the THINKING part of his brain competes with the part of the brain engaged during intimacy and can keep it from working well. I’m sure you’ve experienced this, too…ever been intimate and gotten a phone call? Both parts of the brain can’t function at the same time…they compete! To function optimally so that you can achieve orgasm, you MUST allow that part of the brain to take over, you MUST feel safe and open and allow it to happen, you MUST release all control in order to become primal and in the moment…..
You will notice that the part of the body involved most with sex is the mind….that’s why I wrote so extensively about it above. People think of sex as a physical act and don’t stop to think about how much of it is mental. If it were mainly a physical act, then we couldn’t have sexual dreams that culminate in an orgasm – and we can, and do. Simply with THOUGHTS we can have such a huge physical response such as orgasm!!

Uh oh…I’m getting long-winded…I’ll try and reel it back.

So if I’ve been able to get you to truly understand and agree that yes, labor/birth requires a lot of the same functions of the body as sexual intimacy…..lets now explore the mother who is 40 weeks pregnant and “trying” to have her baby….and why that can actually be detrimental and keep her pregnant longer!

IMAGINE THIS
You wake up in the morning, snuggle in with your partner– and it becomes apparent to you that he wants more than just a quick kiss good morning. You glance at the clock and think, “Uh oh, I have 20 minutes before I have to get up and get ready for ________” (meeting? Appointment? Breakfast date with friends? School function? Doesn’t matter what)
Okay…so you want intimate relations with your husband…but you feel a time crunch. You began to physically respond, but a quick glance at the clock reveals you are down to 10 minutes. You will your body to respond…you do everything you can to “make it happen”….you can feel the time ticking away….come on, body, finish! You are doing all of the tricks that have worked before, your husband is doing everything right…but still the time is ticking away….COME ON BODY!

Ahhhhh……I can see that the wheels in your brain are spinning even without me explaining the analogy! Yes, the woman who is 40 weeks pregnant and who is walking miles each day, scrubbing floors, eating spicy foods, having sex…all with the express intent of causing labor to begin…is actually undermining her body’s ability to do it!! And boy, are we Americans good at getting into our own way (and I think a lot of it goes back to that dreaded “due date” – which is not an expiration date!!). We are so very good at over thinking this and mistrusting our bodies. Is it any wonder so many MANY women go into labor in the middle of the night, when we shut our brains off and our bodies can finally take a deep breath and say, “FINALLY….she is getting out of my way….phew!”

(until we wake up to a contraction, get excited, and interfere with our body’s ability to finish the job – BAH!)

I will even take the analogy further….a person NOT IN LABOR that is trying to go INTO labor is like a person sitting in a room alone, fully dressed, assuming different sexual positions in an attempt to cause her body to become aroused and close to orgasm. Over-thinking it, and without the assistance of a very important partner in this process! (did you know that it’s the BABY that initiates the delicate hormonal cascade that is labor and birth? That it’s not just YOUR BODY that is laboring, but that it’s communicating with the baby the entire time and that the baby is the initiator and the conductor of this symphony…)

Long-winded….apparently I don’t know how to be otherwise. Fine…let me sum up…

STOP TRYING TO HAVE YOUR BABY….trust your body, it’s done a good job for you so far…and just enjoy the anticipation rather than trying to control and rush the process. The best way to get yourself to go into labor is to stop trying to go into labor, release control, and just enjoy being in the moment. Jeez…why didn’t I say that in the first place??

Friday, July 23, 2010

Great Links

When I don't check my Google Reader for several days I fall behind on the latest women's health news, and only find myself with enough time to share links to the best articles with you. I hope that you'll click over, read, learn, and maybe comment!


Trusting Birth, Controlling Birth by the midwife at BirthSense - I highly recommend you click over and read this post.  Is it a ridiculous idea to trust birth? Should birth be controlled? I love what she has to say!


PhD in Parenting writes a great piece titled "Smoking, Breastfeeding and Public Health" as part of a collaborative effort that seeks to demonstrate why smoking in public is not an appropriate analogy for nursing in public (N.I.P.).


Interesting article at Our Bodies, Our Blog about incarcerated women being shackled during labor and delivery:
Shackled During Labor: Nothing to Lose but Your Humanity


A White Baby girl with a mop of Blonde hair and Blue eyes has been born to Black Parents. Read about how this is possible at BBC Health News


Comedic, if somewhat sad, video called "Advice for Young Girls from The Little Mermaid"

 


"Like" the Anthro Doula Ambitions Fan Page on Facebook!

Thursday, July 22, 2010

ACOG Issues Less Restrictive VBAC Guidelines!!

This is huge news! The birth world is going crazy! The American College of Obstetricians and Gynecologists has issued less restrictive VBAC (Vaginal Birth After Cesarean) guidelines! And while they're not 100% perfect, they are an excellent step in the right direction.


Here is yesterday's press release, which explains the risks of repeat cesareans and provides a great overview of the changed thinking (
emphasis mine):
Washington, DC -- Attempting a vaginal birth after cesarean (VBAC) is a safe and appropriate choice for most women who have had a prior cesarean delivery, including for some women who have had two previous cesareans, according to guidelines released today by The American College of Obstetricians and Gynecologists.

The cesarean delivery rate in the US increased dramatically over the past four decades, from 5% in 1970 to over 31% in 2007. Before 1970, the standard practice was to perform a repeat cesarean after a prior cesarean birth. During the 1970s, as women achieved successful VBACs, it became viewed as a reasonable option for some women. Over time, the VBAC rate increased from just over 5% in 1985 to 28% by 1996, but then began a steady decline. By 2006, the VBAC rate fell to 8.5%, a decrease that reflects the restrictions that some hospitals and insurers placed on trial of labor after cesarean (TOLAC) as well as decisions by patients when presented with the risks and benefits. 


"The current cesarean rate is undeniably high and absolutely concerns us as ob-gyns," said Richard N. Waldman, MD, president of The College. "These VBAC guidelines emphasize the need for thorough counseling of benefits and risks, shared patient-doctor decision making, and the importance of patient autonomy. Moving forward, we need to work collaboratively with our patients and our colleagues, hospitals, and insurers to swing the pendulum back to fewer cesareans and a more reasonable VBAC rate." 


In keeping with past recommendations, most women with one previous cesarean delivery with a low-transverse incision are candidates for and should be counseled about VBAC and offered a TOLAC. In addition, "The College guidelines now clearly say that women with two previous low-transverse cesarean incisions, women carrying twins, and women with an unknown type of uterine scar are considered appropriate candidates for a TOLAC," said Jeffrey L. Ecker, MD, from Massachusetts General Hospital in Boston and immediate past vice chair of the Committee on Practice Bulletins-Obstetrics who co-wrote the document with William A. Grobman, MD, from Northwestern University in Chicago. 


VBAC Counseling on Benefits and Risks

"In making plans for delivery, physicians and patients should consider a woman's chance of a successful VBAC as well as the risk of complications from a trial of labor, all viewed in the context of her future reproductive plans," said Dr. Ecker. Approximately 60-80% of appropriate candidates who attempt VBAC will be successful. A VBAC avoids major abdominal surgery, lowers a woman's risk of hemorrhage and infection, and shortens postpartum recovery. It may also help women avoid the possible future risks of having multiple cesareans such as hysterectomy, bowel and bladder injury, transfusion, infection, and abnormal placenta conditions (placenta previa and placenta accreta).
 
Both repeat cesarean and a TOLAC carry risks including maternal hemorrhage, infection, operative injury, blood clots, hysterectomy, and death. Most maternal injury that occurs during a TOLAC happens when a repeat cesarean becomes necessary after the TOLAC fails. A successful VBAC has fewer complications than an elective repeat cesarean while a failed TOLAC has more complications than an elective repeat cesarean.

Uterine Rupture

The risk of uterine rupture during a TOLAC is low—between 0.5% and 0.9%—but if it occurs, it is an emergency situation. A uterine rupture can cause serious injury to a mother and her baby. The College maintains that a TOLAC is most safely undertaken where staff can immediately provide an emergency cesarean, but recognizes that such resources may not be universally available.

"Given the onerous medical liability climate for ob-gyns, interpretation of The College's earlier guidelines led many hospitals to refuse allowing VBACs altogether," said Dr. Waldman. "Our primary goal is to promote the safest environment for labor and delivery, not to restrict women's access to VBAC." 


Women and their physicians may still make a plan for a TOLAC in situations where there may not be "immediately available" staff to handle emergencies, but it requires a thorough discussion of the local health care system, the available resources, and the potential for incremental risk. "It is absolutely critical that a woman and her physician discuss VBAC early in the prenatal care period so that logistical plans can be made well in advance," said Dr. Grobman. And those hospitals that lack "immediately available" staff should develop a clear process for gathering them quickly and all hospitals should have a plan in place for managing emergency uterine ruptures, however rarely they may occur, Dr. Grobman added. 


The College says that restrictive VBAC policies should not be used to force women to undergo a repeat cesarean delivery against their will if, for example, a woman in labor presents for care and declines a repeat cesarean delivery at a center that does not support TOLAC. On the other hand, if, during prenatal care, a physician is uncomfortable with a patient's desire to undergo VBAC, it is appropriate to refer her to another physician or center. 


Practice Bulletin #115, "Vaginal Birth after Previous Cesarean Delivery," is published in the August 2010 issue of Obstetrics & Gynecology.



TOL = trial of labor
TOLAC = trial of labor after cesarean



The guidelines are 9 pages long, so here is a bit of summary of the highlights:
 

"TOLAC should ideally consider the possibility of future pregnancies."

"The preponderance of evidence suggests that most women with one previous cesarean delivery with a low transverse incision are candidates for and should be counseled about VBAC and offered TOLAC."

"...if, for example, a patient who may not otherwise be a candidate for TOLAC presents in advanced labor, the patient and her health care providers may judge it best to proceed with TOLAC."

"More than one previous cesarean delivery... given the overall data, it is reasonable to consider women with two previous low transverse cesarean deliveries to be candidates for TOLAC..." (this is a reversal of the 2004 VBA2C ban unless the woman had at least one prior vaginal delivery)

"Macrosomia (big baby)...suspected macrosomia alone should not preclude the possibility of TOLAC."

"Gestation beyond 40 weeks.....gestational age of greater than 40 weeks alone should not preclude TOLAC."

"Previous low vertical incision...patients may choose to proceed with TOLAC in the presence of a documented prior low vertical incision."

"Twin gestation....may be considered candidates for TOLAC."

"Induction and augmentation of labor...remains an option for women undergoing TOLAC."  (mixed blessing, they did say no Cytotec)

"External cephalic version (to rotate a breech baby)...is not contraindicated if a woman is at low risk of adverse maternal or neonatal outcomes..."

"Analgesia (painkiller)....for labor may be used as part of TOLAC, and adequate pain relief may encourage more women to choose TOLAC."

"Other elements of intrapartum management..."Most authorities recommend continuous electronic fetal monitoring.  No data suggest that intrauterine pressure catheters or fetal scalp electrodes are superior to external forms of monitoring..."

"Delivery...There is nothing unique about the delivery of a fetus or placenta during VBAC."


"What resources are recommended for health care providers and facilities offering a TOLAC?"
 
And here is where they loose points: They recommend facilities be capable of emergency delivery.  "ACOG...has recommended 'immediately available' some have argued that this...limits women's access to TOLAC...particularly in rural areas.  Restricting access was not the intention of the past recommendations...Although there is reason to think that more rapid availability of cesarean delivery may provide an incremental benefit in safety, comparative data...are not available.  ...the College recommends that TOLAC be undertaken in facilities with staff immediately available to provide emergency care.  When resources for immediate cesarean delivery are not available, the College recommends that health care providers and patients considering TOLAC discuss the hospital's resources and availability of obstetric, pediatric, anesthetic, and operating room staffs."

They then go on to say if the setting is not ideal, the "best alternative may be to refer patients to a facility with available resources...or create regional centers...However, in areas with fewer deliveries and greater distances between delivery sites, organizing transfers or accessing referral centers may be untenable." (duh) 

"Respect for patient autonomy supports the concept that patients should be allowed to accept increased levels of risk
...Referral may also be appropriate if, after discussion, health care providers find themselves uncomfortable with choices patients have made.  Importantly however, none of the principles, options or processes outlined here should be used by centers...or providers or insurers to avoid appropriate efforts to provide the recommended resources to make TOLAC as safe as possible for those who choose this option...Respect for patient autonomy also argues that even if a center does not offer TOLAC, such a policy cannot be used to force women in labor who decline to have a repeat cesarean delivery."

The news world is buzzing with responses. A few reactions:

The International Cesarean Awareness Network (ICAN) says:

 
However, more than a revision of the VBAC Practice Bulletin is required to reverse the over a decade long trend of increasing cesarean rates and decreasing VBAC rates. ICAN challenges ACOG to take an active role in educating both women and practitioners about healthy childbirth practices; practices that not only encourage VBAC but discourage the overuse of primary cesareans.

The LA Times
says:

"But, no matter what the medical evidence says, whether the attitudes of doctors and women will change to favor a less-invasive and medicalized — as well as slower and less convenient — approach to childbirth remains to be seen.”

The NY Times
says:

"Women’s health advocates praised the new guidelines because they expand the pool of women considered eligible for vaginal births, but they expressed doubts about whether the recommendations go far enough to change a decade of entrenched behavior by doctors, hospitals and insurers...

Maureen Corry, executive director of Childbirth Connection, an advocacy group, said, “Overall, it’s dubious that these guidelines will in fact open up access for women.”
Debra Bingham, president-elect of Lamaze International, an advocacy group for natural birth, said the “immediately available” wording might still pose an obstacle"


Gina at the Feminist Breeder writes about how the ACOG didn't come to this decision on their own in BREAKING NEWS: ACOG Admits What We Already Knew

Monday, July 19, 2010

Being a Doula in Ireland

This article was published in International Doula, the quartlerly publication of DONA International, volume 18, issue 2, 2010.

Being a Doula in Ireland
by Tracy Donegan, CD(DONA)

As Ireland's only DONA approved birth doula trainer, I thought I would share my experiences of the Irish birth scene and give you a little flavor of the life of a doula in Ireland.

I began the first doula service in Ireland four years ago, and we continue to be faced with strong opposition from doctors and midwives. This situation is very frustrating for a DONA approved birth doula trainer, as most doulas cannot attend hospital births unless they are the designated birth partner - making the mom choose between her partner and her doula. Some of the less-busy hospitals are slightly more accommodating, but we are always aware that we could be asked to leave a birthing room at any moment without any justification.

Preparing for Birth in Ireland

Of course, the US favourite, What to Expect When You're Expecting, is very popular with Irish moms-to-be. There are two Irish pregnancy books. One of these is my own, The Better Birth Book: Taking the Mystery (and Fear) Out of Childbirth. My second book is due out this summer and is a guide to cesarean birth and VBAC in Ireland. Another popular book in Ireland is The Irish Pregnancy Book, written by Peter Boylan, a former Chief of Obstetrics. This book is extremely medicalized and recommends episiotomies, birthing on the bed, rupturing the membranes routinely, Pitocin and immediate cord clamping.

Childbirth classes are provided free by the hospital and by several independent providers. I teach an antenatal class called GentleBirth, which incorporates birth hypnosis, active birth and informed decision-making. I have also created a positive birth preparation program as a home study class.

Birth in Ireland

Similar to the United States, arond 98 percent of babies are born in the hospital. Homebirth services are very limited and are provided by a few self-employed midwives and a couple of hospital homebirth programs.

Approximately 75,000 babies are born in reeland every year. Around 26,000 babies are born in the capital city of Dublin, but there are only 30 birthing suites available. You can imagine what that means for moms who want to labour in their own time! A natural, unmedicated birth in uncommon unless the mother arrives at the hospital in advanced labour.

There are two Midwife Led Unites (onsite birth centers) in Ireland. There are curently no stand-alone units, but this is something I would like to establish when I finish my midwifery degree in two years. Doulas are generally accepted as additional birth partners within these units as the care is much more focused on mother-friendly practices.

The active management of labour protocol began at our National Maternity Hospital in Dublin and is still very common in Ireland (waters are broken on admission and if mom is not following the one centimetre per hour dilation rule, she is augmented with Pitocin). Approximately 40 percent of first-time moms attending our National Maternity Hospital are augmented. There are roughly 8,000 births in this hospital, but there is only one shower in the labour ward and no bath. So, being at home with a labouring mom can really help her stay comfortable and in control of her own environment.

Maternity care is free to European citizens. About 40 percent of healthy moms will choose private obstetric care and will pay approximately $6,000 to their doctor, who may or may not attend the birth. All of the care during labour is provided by midwives.

Evidence-based practices are very limited and not all the staff appreciate those parents who do their homework and express particular birth preferences, such as delayed cord clamping. Informed choice is almost non-existent.

Although most moms give birth in a private room, they will sometimes labour in a ward with 12 or more other women.

Water birth is only available at a homebirth with a self-employed community midwife. Two of our largest hospitals have beautiful pools but refuse to even let moms labour in them. I organized a water birth study day in July 2009 with a UK expert on water birth for students, midwives and doulas. None of the staff from the two hospitals that have birth pools attended.

Ireland's cesarean rate is approximately 25 percent to 30 percent in some places and is increasing. VBAC rates vary widely depending on the hospital and can be anywhere from 6 percent to about 70 percent. Episiotomy rates are still high and range from 10 percent to 40 percent in places.

Unlike in the United States, all healthy babies room in with their moms in the hospital. Even so, postnatal care leaves a lot to be desired. Often, post-cesarean moms are unable to reach their crying babies or are too medicated to take care of a newborn; and the shortage of night staff makes this situation even worse. Moms get little privacy after birth, and a woman can sometimes share a postnatal ward with up to eight other moms and babies.

Breastfeeding rates leaving the hospital are very low (around 35 percent) and artificial feeding is the norm. Although we have quite a few Baby-Friendly hospitals, breastfeeding rates remain low.

Ireland's Birthing Future

There are several active doulas in Ireland, but in some areas there are no doula services available. It is my hope that as more mothers demand that doula care be an option available to them in hospitals, we will see an increase in the accessibility of doula services and more options available to birthing women.

Saturday, July 17, 2010

What you can do right Now to have the Birth you Want

Pregnant? There's so much to think about and so much information to process. You've got your Midwife/OB's advice, the advice from your pregnancy/birth books, and all the info there is here on the internet. Information overload might actually make you shut down and take none of the advice! So what quick bit of advice is the most important to follow, and what should you be thinking about doing or looking into now? Here's a helpful guide from a childbirth educator and doula.


Top Ten List, by Sasha at bellabirthing.com

What You Can Do Right Now to Have the Birth you Want

1. Practice relaxation daily. 20-30 minutes, preferably with your birth partner.

2. Eat well. 100 grams of protein, whole foods, whole grains, lots of fruit and veggies, good fats, and plenty of water. Eat protein with every meal and snack (3 meals, 2-3 snacks).

3. Talk to your partner about your fears, needs and desires for your birth. Let him/her know what he/she can do to help you.

4. Talk to your provider about your birth choices. Make sure she/he knows your wishes. Check out Childbirth Connections online, Choosing a Caregiver.

5. Care for your sleep and rest. Nap when you can. Go to sleep and wake at the same time each day and limit “screen time” for 1 hour before sleep.

6. Walk daily. Fresh air, sunshine and exercise are good for your spirit. Walking helps strengthen your birthing muscles.

7. Insulate yourself from negative influences. Be selective about TV, movies, books, online sources, especially about birth. Limit your contact with people who are not supportive about your birth choices. Create positive affirmations about your pregnancy, labor and birth.

8. Think about hiring a doula. She can help comfort you physically and emotionally, provide you with information and support your birth decisions, while working along side your birth partner to help you have the best birth possible for you and your baby.

9. Find a counselor - if you have anxiety or depression, are a survivor of abuse or simply need someone to talk to about your life and choices.

10. Utilize positions to help your baby find the best position for labor and birth. Check out Spinningbabies.com for great information about an easier labor.

Friday, July 16, 2010

Naming Traditions in World Cultures

Naming Traditions in Different World Cultures


Though a popular tradition among Americans and Europeans, naming a baby after a parent or grandparent almost never happens in Asian cultures. To call out a parent's first name is considered a sign of disrespect, which is why naming a child after an elder is considered inappropriate. Unlike other cultures, Asian traditions tend to be more low-key. For instance, the Japanese hold baby-naming ceremonies on the seventh day after a baby's birth. The simple tradition includes giving baby a first and last - but no middle - name. 


Jewish names often are given to honor family members. Ashkenazi Jews (Jews of Eastern European and German descent) traditionally name children after deceased relatives, while Sephardi Jews (Jews descended from the Iberian Peninsula) traditionally name children after their grandparents or other relatives, whether they are living or dead.
In America, Native American's traditionally have named their babies by something that has inspired them in nature. Many modern Native American's still follow this practice. Each tribal tradition varies, but the theme of nature is common to all.


In Japan girls are often named after virtues, such as purity, morality, dignity and so on. Boys have more inventive names or are named by the position they hold in the family. For example, Ichiro means "first son." 
In Greek families the children are named on the seventh or tenth day of birth. They have traditions of naming their children after relatives. The first born of either sex usually takes on the paternal grandfather's or grandmother's name.
For Hindus who practice the Namkaran or Hindu naming ceremony, the first letter of a baby's name is based on the time and place of the baby's birth. 
For the Gikuyu people in Kenya, the first-born boy is named after the paternal grandfather. The second-born boy is named after the maternal grandfather. Girls are named similarly, after grandmothers.

In Switzerland, many people believe it's bad luck to tell anyone the name you choose for your child before the birth.


A current trend in China is to take the five elements (gold, wood, fire, water, and earth) into account when choosing a name. According to the Chinese classic The Yi Jin, or I Chin, depending on exactly when a child is born, he'll be strong in certain elements, and this will shape his destiny.
Chinese characters, or letters, also bear characteristics of the five elements — a character may have the quality of wood, for example. Many parents believe that the characters in a name can compensate for elements that are lacking. If a baby "lacks water" because of his birth date, a character representing water in his name would make up for that shortcoming. Parents commonly pay an expert to help them identify the appropriate name for their baby.

 
People in Spain and other Latin countries have historically named their children according to Catholic tradition — "Maria" has always been a common name, for example. Boys are traditionally given their father's or grandfather's name.


Traditionally, Italian parents have chosen their children's names based on the name of a grandparents, choosing names from the father's side of the family first and then from the mother's side. 



What traditions inspired your baby naming choices? Did you/Would you follow any of the customs above?

Thursday, July 15, 2010

More My OB Said WHAT?! Gems

A selection of the more ridiculous and shocking things that real people have said, as posted on My OB Said WHAT?!


“Warm water will burn the baby.” -L&D Nurse to laboring mother after her doula suggested a bath to cope with labor pain.

“Do you want anti-depressants?” -OB to mother who was emotional about wanting to VBAC after two cesareans, at her 25 week prenatal appointment.

“So, you were a total failure then?” -Primary care physician to mother who had a home birth transfer and cesarean at her first appointment after birthing.

“You really surprised me here! Six hours into your labor, I was in the OR sharpening my knives–but you actually pulled it off.”-OB to a VBAC mother.

“You just sound pregnant to me.” – OB to a mother who was sharing how poorly she had been feeling at 37 weeks.  She was later diagnosed with HELLP and severe pre-eclampsia.

“I like to get you in here at 37 weeks and induce you, so I can be in control of your labor.” -OB


“You’d better not have a baby more than about 6 pounds. You certainly won’t be able to fit much out of there!” -OB during pelvic exam at the first prenatal appointment of a mother pregnant for the first time.



And some nice ones from Thoughtful Thursdays:

“I like when people are willing to wait after their due date.  It is just an estimate, after all.  You bake them longer.” -OB to mother who birthed her baby a week past her due date.

“Stop holding your breath, honey, your baby needs you to breathe, your body will do this on it’s own, just breathe your baby down.” -OB to a mother who had always been told to do “purple pushing” during her prior births.


To view the daily posts, follow MyOBSaidWHAT on Twitter

Wednesday, July 14, 2010

Monday, July 12, 2010

Lots o' Links

Link Roundup:

* PhD in Parenting talks about perceptions of Nursing in Public in Germany, using both personal observances and public poll results


* Rixa at Stand and Deliver writes an extremely well-put post on the "All that matters is a healthy baby and healthy mommy" rhetoric that is heard so frequently, and why it is both tyrannical and tautological.   Read about why.


* The midwife at Vita Mutari wonders how we can get women to quit being birth perfectionists and realize how awesome they are.


* Lately I've been seeing a lot of mentions of the Feminist Hulk. In case you haven't heard about this, the Feminist Hulk is a twitter account with this bio: "HULK SAYS FUCK PATRIARCHY. HULK HERE TO SMASH GENDER BINARY."  Be sure to check it out.





* Survey of Domperidone and Metoclopramide Use in Breastfeeding Mothers:

If you are or have been a nursing mother using either Reglan or Domperidone to participate in this quick survey. It is very important that research such as this be done to enrich our knowledge of how to better assist mothers with insufficient milk production.Thomas Hale & Kathleen Kendall-Tackett, co-investigators.

We are pleased to announce our new online research study, a survey of women's experience with the drugs metoclopramide and domperidone, which can be used to stimulate milk production. We would like to collect side effect information on both drugs from as many mothers as possible worldwide.

The survey link is: http://surveys.ttuhsc.edu/wsb.dll/s/60g759 For more information about the study, contact Dr. Kendall-Tackett at: kkendallt@aol.com

The survey takes 20-30 minutes to complete and is confidential. It has been approved by the Institutional Review Board at Texas Tech University Health Sciences Center, Amarillo, TX.

Friday, July 9, 2010

Ouch




Alt text: Cue letters from anthropology majors complaining that this view of numerolinguistic development perpetuates a widespread myth. They get to write letters like that because when you're not getting a real science degree you have a lot of free time.

Tuesday, July 6, 2010

Anthropology and Birth Activism


I love Robbie E. Davis-Floyd. I even wrote a post some time ago called Love Robbie Davis-Floyd.
Its no surprise that I love her so much - she is a medical anthropologist specializing in anthropology of reproduction. I am currently reading her book Birth as an American Rite of Passage, a book about birth and culture that only a scholar would pick up. 

Here is a great article written by Robbie Davis-Floyd, brought to my attention by theunnecessarean.com and posted on Mindful-Mama.com.  It is a thought-provoking look at the difference between birth activism and anthropology. 



Anthropology and Birth Activism: What do we Know?
By Robbie Davis-Floyd

"Anthropology and Birth Activism: What do we Know" was reprinted with permission from Robbie Davis-Floyd. It was originally published in 2005 in "Anthropology News" 46(5):37-38.

A while back, I attended a dinner for birth activists in Seattle. The 14 women (and one man) gathered there held our glasses aloft as a doula (a woman trained to provide support to the laboring mother) made the last toast — "For all the women who don't know."

My reactions trembled on the existential brink. As both an anthropologist and a birth activist, I am trained to honor and respect women's choices and the knowledge systems on which they base those choices, but also to deeply question the cultural conditioning underlying all "choices." And in both roles, I heard just as deeply the pity in the doula's voice, the regret, the sadness — this was not a toast of celebration made "to" these women, but rather one of longing, a hope "for" these women (who constitute more than 90 percent of the American childbearing population) that they may come to "know" — to see the light and truth of what birth activists are sure they are missing — the deeply embodied, tremendously empowering experience of giving birth on one's own, without the artificial aids of drugs and technologies.

Birth Activists and Birthing Women

The sadness and pity that birth activists feel for women who "miss out on birth" is unappreciated or unnoticed by most American birth-giving women. The 100 interviews I conducted in the late 1980s and early 1990s clearly showed that only about 25 percent of my U.S. interviewees even wanted a fully natural childbirth. 75 percent either desired or were relatively content with their highly technological birth experiences. These data have been recently amplified by a 2002 Harris Poll survey of 1800 American women designed by the Maternity Center Association, which showed that 63 percent of survey respondents received epidurals, 93 percent received electronic fetal monitoring and many other forms of technological intervention during labor, and more than 90 percent expressed satisfaction with their childbearing experiences.

There was a 10-year period during which "natural childbirth" as a social movement flourished in the U.S. and women welcomed the efforts of birth activists, who succeeded in their efforts: achieving hospital humanistic rights to the supportive presence of family, friends and doulas, making more comfortable environments for labor and birth, and providing breastfeeding support. The current generation of U.S. birthing women takes these rights for granted, right along with the epidural and the fetal monitor, which have served to ensure that American mothers use their choice and agency to reinforce biomedical hegemony and the increasing technologization of birth.

The endless dialogues birth activists engage in about how to effect changes in childbirth center around the need for education: if women "only understood" the disadvantages — the dangers — to their bodies and their babies from drugs and technologies, then surely they would be asking for better births. They would seek out midwives who can offer these better births, and who presently attend only 9 percent of American births because women don't demand them and doctors don't want the competition. They would give birth at home and in birth centers, where a holistic model of birth prevails and the focus is on facilitating women to give birth on their own, as well as on avoiding unnecessary interventions. But in spite of the demonstrated safety of out-of-hospital birth, it has remained for the past 25 years at less than one percent (.006).

Evidence vs. Practice

Birth activists have mountains of scientific data on their side, but this data has made little difference in the practice of birth. Routine electronic fetal monitoring remains pervasive, even though it does not improve outcomes but does raise the incidence of unnecessary cesareans. Induction of labor increases prematurity rates and labor complications, but its use has skyrocketed in the past decade to more than 53 percent. Epidurals can slow labor, generate fevers, and necessitate further interventions for both mother and baby (who will end up in the NICU if the mother does develop a fever). Cesareans generate higher rates of infection and other complications (including death) than vaginal birth, but the cesarean rate in the U.S. is at an all-time high of 27.6 percent. Editor's note: the cesarean rate in the U.S. is now 32 percent. The cesarean rate in Brazil (39 percent) has long been cited as the highest in the world, but it is not. The cesarean rate for Mexico is 40 percent, for Chile, 43 percent, for Puerto Rico, 48 percent; for Taiwan and China, 50 percent. Cesarean rates in rural areas "underserved" by modern medicine are generally low, so in urban areas, the rates are much higher, especially in private hospitals, where they often range between 70 percent and 90 percent.

Given that much of what I have long called technocratic birth emerged and was transmitted around the world from the American technocracy, it is ironic that the U.S. cesarean rate is lower than that of various Third World countries. Birth activists claim the credit for this fact, noting that there have (until quite recently) been no large and organized activist networks in the countries with the highest cesarean rates. They believe that their outcries against unnecessary interventions were what held obstetricians back from raising the U.S. cesarean rate beyond 23 percent for 23 years (from 1979 until 2002). The present increase in the U.S. can be traced to recent studies generating a decline in the once-popular vaginal birth after cesarean (VBAC) and the growing number of women choosing elective cesareans, an option the American College of Obstetricians and Gynecologists recently declared ethical.

Ethnography as Activism

Interestingly enough, although feminists sometimes accuse birth activists of essentialism, the large and growing body of anthropological ethnography about birth supports birth activist positions, often from feminist perspectives.

From the 1960s to present, anthropologists have reported similar responses to biomedical birth ways from women in developing countries around the world: "They shave you, they expose you, they cut you, they leave you alone to suffer and don't let your family members be with you, they give you nothing to eat or drink, and sometimes they yell at you and slap you." In the remotest rural clinics and the biggest urban hospitals, impoverished laboring women lie on narrow cots as (sometimes reused) IV needles drip pitocin into their veins. The pain from pitocin-induced contractions can be terrible, and there are no doulas to mitigate it or epidurals to take it away.

Not surprisingly, many rural women resist hospital birth, leaving development planners to shake their heads over this regressive unwillingness to use modern facilities, attributing it to ignorance and close-mindedness. But Soheir Morsy notes that in Egypt's Nile Delta, the choice to birth at home with a traditional midwife is not a result of being tradition-bound, but rather a "measured judgment" about the inadequate care provided to the rural and urban poor in modern clinical settings — a conclusion confirmed by my own research on urban Mexican traditional midwives and by that of many others.
All anthropologists engaged in cross-cultural birth research criticize development policies that foster increased biomedicalization, often taking activist roles by working to improve these policies, support traditional midwives to remain viable in the contemporary world, and end the biomedical abuse of Third World women.

Coercion and Choice

In contrast to women's Third Worldly experiences, American women seem to have all the choice and agency in the world. These choices and agencies are the result of real struggles by resourced activists, from contemporary middle-class women seeking to bring humanism to technocratic birth, back to the Boston upper-crust ladies who worked hard in the 1920s to bring scopolamine from Germany to the U.S. and to convince doctors to use it. Such choices were for decades denied to the American poor and underserved (who were "supposed to suffer"), who then turned around to demand all the technology they could get as soon as they had access to it. Because the privileged women had it, they "knew" it was the best.

Now that knowledge blankets the planet, convincing women that they should want techno-birth, and justifying its infliction if they don't. What is choice and privilege in one setting becomes an almost invisible coercion in another. What obstetricians know is that women are choosing drugs and technology, so forcing drugs and technology on women who don't choose them can be easily coded as "giving women what they want" and "respecting a woman's choice." Choice in the "First" World — the world of the resource-rich in every country — paradoxically serves to obscure and mystify coercion in the Third World of resource-poor.

Doctors "know" that they are giving women "the best care," and "what they really want." Birth activists, including myself, know that this "best care" is too often a travesty of what birth can be. And yet on that existential brink, I tremble at the birth activist coding of women as "not knowing." So much anthropological research on reproduction highlights the carefully thought-out strategies behind the decisions women make within the context of their lived realities — an insight that must apply as equally to the American woman who schedules a cesarean as to the Tanzanian woman who returns to the traditional midwife. Teasing out the difference between birth activism and anthropology, I return to the core of our discipline: birth ethnographers only really know what the women they study show and tell them. It is our job to specify, contextualize, and render meaningful the choices these women make in all their diversity, so that we can tell the world what women know.

Robbie Davis-Floyd PhD, senior research fellow, Department of Anthropology, University of Texas Austin, and Fellow of the Society for Applied Anthropology, is a medical anthropologist specializing in the anthropology of reproduction. An international speaker and researcher, she is author of more than 80 articles and countless books. Her research on global trends and transformations in childbirth, obstetrics and midwifery is ongoing. Robbie currently serves as editor for the International MotherBaby Childbirth Initiative (www.imbci.org) and member of the Board of the International MotherBaby Childbirth Organization (IMBCO).


Thursday, July 1, 2010

What is Medical Anthropology?

As noted on my "About Me" page, I am an aspiring Medical Anthropologist. I have always loved Anthropology, in various form, even before my university days. I loved reading prehistorical fiction novels, like a big nerd, even in middle school. I know a lot about how ancient tools were made, canoes were built, and animals were domesticated by early peoples. I know what animals they hunted and how they built their homes.

In college, Anth courses were definitely my favorites, and I learned a lot about socio-cultural anthropology. Cultural anthropology is what I focused on for my senior honors thesis, and I loved conducting ethnographic field world abroad. 


(Ethnography: A research method of the social sciences in which data collection is often done through participant observation, interviews, questionnaires, etc. Ethnography aims to describe the nature of those who are studied.)

But my most recent passion is, of course, birth culture. So, naturally, I'd love to combine my love of birth, breastfeeding, women's health, pregnancy, and so forth, with my love of cultural studies. And that is what I am working towards. 

The combination of cultural studies and women's health, is, in effect, my intended area of medical anthropology.

The Society for Medical Anthropology, of which I am a member, defines Medical Anth: 

Medical Anthropology is a subfield of anthropology that draws upon social, cultural, biological, and linguistic anthropology to better understand those factors which influence health and well being (broadly defined), the experience and distribution of illness, the prevention and treatment of sickness, healing processes, the social relations of therapy management, and the cultural importance and utilization of pluralistic medical systems. The discipline of medical anthropology draws upon many different theoretical approaches. It is as attentive to popular health culture as bioscientific epidemiology, and the social construction of knowledge and politics of science as scientific discovery and hypothesis testing. Medical anthropologists examine how the health of individuals, larger social formations, and the environment are affected by interrelationships between humans and other species; cultural norms and social institutions; micro and macro politics; and forces of globalization as each of these affects local worlds.

Medical Anthropology research tends to have enormous potential to be turned into implementing community health programs. "Local and qualitative ethnographic research is indispensable for understanding the way patients and their social networks incorporate knowledge on health and illness when their experience is nuanced by complex cultural influences," it says on Wikipedia. 

Thus, Medical Anth is often strongly connected with the field of Applied Anthropology. Applied anthropology refers to the application of method and theory in anthropology to the analysis and solution of practical problems. Applied Anth applies anthropological research to contemporary issues. For instance, with a health slant, a research project on how cultural factors influence the spread of HIV. This has a lot to do with another field that also researches and implements change in health, Public Health. 

I hope that I explained all the intersections well, in an attempt to explain the dual degree Applied Anthropology and Masters of Public Health Program I am starting in the fall.


What is Public Health?

Public Health Doula recently wrote a whole post explaining public health, part of which I have copied here, because it is a great explanation:

What is public health?
- Public health deals with populations, rather than individuals

- So public health professionals tend to work on programs, policies, administration, and research - not with personally delivering services to individuals

- Public health focuses much more on prevention than on treatment

I can't speak to all programs, particularly more technical ones, but I think I can safely say most MPH programs generally aim to equip you with a good understanding of how diseases and health conditions occur on a population level. Other focuses can be on how to administer public health programs (e.g. a vaccination campaign) and how to monitor and evaluate those programs (e.g., devise a plan to make sure that the vaccination campaign is reaching the populations it was targeting, and then assess whether it made a difference on vaccination rates in those populations, and whether the difference was big enough to justify spending all that time and money). They may also cover particular content areas (e.g. courses on epidemiology of infectious diseases, or an overview of HIV globally) or skills (e.g. advanced statistical modeling techniques).


A master's in public health is more practice-oriented than research oriented (versus a doctoral degree in public health) - generally considered a "professional degree" like, for example, a master's in social work. While some people in an MPH program may be there as a stepping-stone to a doctoral degree, most are there to go right back out into the workforce. So a master's program generally will have less emphasis on research and more on practice. This isn't to say that MPH grads don't go on to do research, but they also go on to do a huge range of other types of work.

The area I am focusing on in Public Health, so that I can study maternity care and breastfeeding, will be Maternal and Child Health.

Maternal and Child Health:
Providing information and access to birth control; promoting the health of a pregnant woman and an unborn child; and dispensing vaccinations to children are part of maternal and child health. Professionals in maternal and child health improve the public health delivery systems specifically for women, children, and their families through advocacy, education, and research.

So one day I hope to be able to use these forthcoming degrees to bring about positive change in the areas of public health, and eventually enter a PhD program to become a Medical Anthropologist. 
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