March of Dimes

This morning I walked in my first March of Dimes March for Babies! It was a fun and pleasant walk.
I feel this fundraiser, though it is one of many and has been running for quite a long time, it an important one.

The reason I think the March of Dimes is an important initiative is because as a doula, a future public health worker, and an anthropologist, too many babies are being born prematurely (as the MoD phrases it "too soon, too small"). The March of Dimes raises money so that moms will have healthy full-term pregnancies.

"Our country has one of the highest rates of pre-term birth in the world" - U.S. Surgeon General

From the MoD website:

Prematurity has been escalating steadily and alarmingly over the past two decades. In 2006, nearly 543,000 infants were born prematurely. In 2005, the United States as a society paid at least $26.2 billion in economic costs associated with preterm birth (medical and educational expenses, loss in productivity).

Preterm birth is a complex disorder, like heart disease or diabetes, with no single cause. Consequently, it requires a multifaceted approach. The six priority areas are:

1. New epidemiologic studies focused on the risk of extremely preterm births to identify the factors that predispose women to very early labor and delivery.
2. Genes and their interaction with the environment that, together, lead to preterm birth.
3. Racial and ethnic differences. While prematurity affects all socioeconomic groups, there are significant racial and ethnic disparities. For example, in 2006, non-Hispanic African-Americans had the highest rate of premature births at 18.5 percent, well above the national rate of 12.8 percent. We know very little about why these differences occur.
4. The roles of infection and immune response to those infections.
5. The effects of stress on the mother and fetus.
6. Clinical trials to assess the impact of potential treatments, to identify the women who could most benefit, and to determine the best time to provide treatment during pregnancy.

The Prematurity Campaign investigates the causes of prematurity and ways to prevent prematurity.

The part of the campaign that interests me the most is their initiative to stop hospitals and doctors from ordering/performing inductions/c-sections prior to 39 weeks if not medically indicated. They propose that the phrase “late preterm” be used when describing neonates born between 37 and 39 weeks. Their initiative is working at hospital, health system and statewide levels. Past and current initiatives have been shown to be create effective change.

The campaign also focuses on educating mothers that a full-term pregnancy lasts 40 weeks for a reason. To read about why, see my post Baby is NOT Term at 37 Weeks.


The March of Dimes money does not only go to prevent prematurity - it is only one of their campaigns. They have this great page where you can check out how the fundraiser helps babies in all ways here: http://www.marchforbabies.org/howyouhelpbabies.aspx



"Remember, 40 weeks is a full-term pregnancy" - U.S. Surgeon General

How Much Time Will You Spend With Your OB? Less Than You Think

Many women know very little about pregnancy before they are pregnant, and they assume that they will be able to get all the information they need from their Obstetrician - why not? they're the expert, right? They'll tell me what I need to know, right?

Its hard sometimes to let my clients and pregnant acquaintances know that, in reality, you're not going to spend a lot of time with your doctor, and they are not going to be able to give you all the information you need. In fact, PHDoula wrote a great post encouraging partners/husbands to attend prenatal visits to the obstetrician with their wives/partners because it takes so little time that not very much work will be missed! Here is her math:

Taking a typical low-risk prenatal visit with an obstetrician (duration of about 15 minutes) and the timeline of maternity care outlined by Drs. Sears, assuming the first prenatal visit is at 8 weeks gestation as noted by BabyCenter (not unlikely, as your missed period is at 6 weeks), you will spend approximately 2 3/4 hours locked in a room with this midwife or obstetrician. And that is a conservative estimate.

Here's the math:
One visit per month from weeks 8 to 28 = 5 visits
One visit per 2 weeks for 8 weeks (weeks 28 through 36) = 2 visits
One visit per week until born (weeks 36 to, say, 40, which is average) = 4 visits
Total visits = 11
Visit length is 15 minutes each, times 11 visits = 161 minutes = 2 hours, 41 minutes

Only a total of 2 hours and 40 minutes spent with your doctor over your entire 9 month pregnancy!!

And tacking on the 5 minutes they are in the labor and delivery room to catch the baby, plus the 25 minutes spent to stitch up your perineum, we can maybe add on 30 minutes to the end, but that is after the pregnancy is over, so does that count?

How could you possibly have time to ask all your questions or even get to know them in only 2.75 hours?

This is a great incentive to1. Hire a midwife, who spends much more time with patients, and/or 2. Take a childbirth education class, where you can have in-person education and conversations with your instructor for hours and weeks on end, and 3. HIRE A DOULA!

All of these will give you more time to interact with a professional trained in childbirth, ask questions, learn things you may not have known before, and practice for birth.


I also want to make a plug for PHDoula/Dynamic Doula blog, which I only recently discovered. She has great posts like birth/breastfeeding book reviews, personal experiences with doula births, and other great insights. She also clearly likes her math - she has a post called "How Many Contractions are there?" (answer: only 324 ;) Check it out!

Birth Doula Anniversary

Yesterday was the anniversary of the very first birth that I attended as a doula all on my own (without my mentor). It is not the anniversary of the first birth I ever attended, but it was my first home birth. It was also the first time I ever held a person who had only been in the world for a few minutes.

In honor of my milestone, I invite you to read the birth story from my perspective, through my very new doula eyes, as I wrote it a year ago: My First Solo Birth as a Doula

<3 <3 <3 <3

Happy Earth Day, Mother Earth!

In honor of Earth Day, I am going to re-blog one of my favorite and popular posts. It is a beautiful poem from one of my favorite book series, and it combines my two loves: Anthropology and Birth.

Happy Earth Day, Mother Earth! Here is my post from last years' Earth Day, "The Great Earth Mother"

Earth Day makes me think of Mother Earth, Gaia, and how all Women have the capacity to be an Earth Mother, bringing forth life, and nurturing it in the great circle of life. I know this is a very hippie moment, but it is also an anthropology moment! I love Creation Myth stories. Every culture has one, and many are extremely similar, which is a fascinating point for anthropologists. 

Some common motifs of creation stories are: 

• a primordial universe and life is made from nothing or ex nihilo, 
• several stages of creation occur, 
• the earth (or universe) is the bodily remains of the creator or deity, and
• humans are created by this deity. 

One of my very favorite creation stories is the Mother's Song, which appears in Jean M. Auel's Earth's Children Series. In her book, the people worship the Great Earth Mother, because she gave birth to all of Earth's creatures. Because women also have the power to give life, as the Mother did, they are venerated.

Below I have typed out the entire creation story, The Mother's Song. Click 'read more' below to view it in its entirety, after the jump.

The Mother's Song

by Jean M. Auel

Out of the darkness, the chaos of time, 

The whirlwind gave birth to the Mother sublime

She woke to Herself knowing life had great worth,

The dark empty void grieved the Great Mother Earth.

The Mother was Lonely. She was the Only.

From the dust of Her birth She created the other,

A pale shining friend, a companion, a brother.

The grew up together, learned to love and to care,

And when She was ready, they decided to pair.

Around Her he'd hover. Her pale shining lover.

Chimps Give Birth Like Humans, but Don't have Midwives

I can't believe it is almost the end of April! This month totally got away from me. I promise I will make up for the lack of posting soon!

Are humans unique in the way they give birth?

A few months ago I wrote a review of the book Ancient Bodies, Modern Lives by Wenda Trevathan.
This book takes a look at women's reproduction from an evolutionary anthropology perspective

In this review I wrote: 

Trevathan provides a captivating analysis of the medical implications for childbirth of the evolution of bipedalism and large brains and the trade-offs that must be made as a result. Walking upright meant a restructuring of the pelvis, which made it narrower than that of our ancestors and made fitting our larger brains much more difficult during childbirth. Furthermore, the shape of the pelvis changed so that the infant rotates more than once in order for the head and then the shoulders to make their way down into the birth canal. As a result, the baby is born facing the mother’s back, which makes it difficult for the mother to catch her own child without causing damage or death to the infant. Trevathan argues that this accounts for the nearly universal practice of having birth attendants present at birth to assist the mother in catching the baby.

All primates except humans give birth to occiput posterior, or forward-facing, infants, and are able to catch their own newborns. Or so it was thought.

 
It has recently been discovered that this trait of giving birth to occiput anterior infants is not, in fact, unique to humans. An article in Nature Chimps Give Birth Like Humans describes that chimpanzees have been observed giving birth to babies that face the mother's back. This had not been previously known because until now no one had observed chimpanzee parturition, because "they get very nervous" with company around. Probably because the company is some strange human staring at them. I would get nervous, too, if a monkey watched me give birth!

The scientists, who were able to make the chimp comfortable by sleeping in her quarters every night, hadn't even realized that chimpanzees giving birth to occiput anterior newborns was anything special.

 It was only thanks to a discussion with a human-childbirth researcher that the importance of their observations came to light. "She was very surprised to see the orientation of the baby, so we decided to write a paper about it," Hirata says.

The article notes that chimps seek out solitude to give birth to their babies, which the author says "calls into question the argument that backwards-facing babies were an important factor in the evolution of midwifery in humans."

Trevathan says, "I have never said assistance is a necessity in human childbirth, but rather that it's beneficial,"
and she thinks that the pertinent question is not why humans have evolved midwifery, but rather why chimps have not.

From the article:

"It's taken 25 years for people to start reporting some observations that help confirm or refute my hypothesis," she says, "so I'm glad that finally we've got some observational data on chimpanzees — it's advancing science."
 
Trevathan says there are still aspects of human labour that make it "unique, or at least very unusual". "One is the series of rotations that the fetus undergoes as it is born — I'm not sure that's been called into question," she says. "Another is routinely seeking assistance."

She adds that the orientation of the human infant still provides a compelling explanation for the evolution of midwifery in humans because "assistance definitely facilitates delivery when the baby comes out in that position".

If you 'd like to watch the chimpanzees giving birth to their backwards facing babies, which just land on a pile of straw and are then picked up by the mama chimp, there is a link in the article, or you can click this link. Or you can watch it here:



Enjoy!

Thinking about Becoming a Childbirth Educator

Lately I've been contemplating becoming a childbirth educator more and more. As a doula, I encounter families kind of late in pregnancy. Some have had childbirth education classes, some haven't. Some take a several week series of classes from an independent educator, and some take a one day hospital staff-led course. They have varying levels of knowledge, which means I do varying levels of childbirth education in my prenatal visits. And sometimes it is not enough time to inform them of everything they should know, or its too late to help them or change minds, etc, for the better.

As a childbirth educator, I would be able to reach families when they are earlier in their childbirth planning, most willing to be filled with childbirth-related knowledge and open to new ideas. My work would have a large effect on their having a positive birth experience, fully informed of all their options. Knowledge is power is a very important concept for me.

Furthermore, childbirth education is a lot more flexible than doula work. I would be able to make my own schedule, teach as much or as little as I'd like, still doula, and not have to worry about being on call for a month at a time and unable to go out of town. The benefit of also being a doula means I can still be with mothers and couples during their actual births and can bring extra knowledge to my childbirth classes.

I've been honored to be able to attend one Bradley childbirth education class in a series with one of my past clients. The class seemed so much fun - surrounded by other couples who are also pregnant with whom to chat and share experiences with, learning everything one step at a time with your partner present, having videos, charts and models to assist in visual learning. Also, getting to physically practice childbirth coping techniques and labor contractions, and being able to ask questions of the instructor as they came into your mind. I loved it!

I am also honored to be able to be currently attending a Lamaze class with a client. I've only been to one so far, and it was very different from the Bradley class. This one took place in the instructors home, and there were no other couples present. It was excellent one-on-one time and the couple was able to feel completely relaxed and ask as many questions as they wanted. The instructor was also really happy to have me there, and included me in all question answering and solicited my opinion and experiences. I had a fabulous time hearing/learning/thinking birth for 2 hours, and I can't wait for the next class! I also learned a lot from the instructor, a more seasoned doula. And the clients benefited from both of us discussing our knowledge and experiences with them (more than they would have gotten if I hadn't been there!)

All in all, I get really jazzed when I think about teaching childbirth education. I feel like its a logical step to take in the world of birth work, and it would feed my hunger for birth conversations all the time! And helping new moms!

The next step is to choose which organization I would like to certify with! Many doulas go through CAPPA to add on CBE (childbirth education), I think because it is quick and easy. Another option is Bradley, which I really enjoyed attending and I like their natural birth philosophy, but I'm not sure about because the tag line is "husband coached childbirth." I'm just not sure that's how I want to "sell" my CBE. Another option is Hypnobirthing, which I think is cool, but not something I think I want to be an instructor of. Lamaze is, of course, the big one that everyone has heard of. The process looks a little bit harder and longer, and I do worry that when people think Lamaze they think of an old type of childbirth ed with all the funny breathing. But Lamaze has recently gotten really big on doing some great research and evidence work on childbirth, and I really like their healthy birth practices concept. There are others, like ICEA and so forth, that I don't know much about, and some new ones like Brio birth, but I feel like they all start to sound the same at some point.

The names that keep popping up on pregnancy sites that talk about childbirth education are Bradley and Lamaze, so those seem like the big ones to consider.

Does anyone have any insights on the varying childbirth educator certifying organizations and philosophies?  Or on being a childbirth educator in general? Does anyone know if some of these (like Bradley) require you to have given birth yourself? Thanks!

Some Links!

 It is finals time in grad school, so this week you get a link round-up! :)


Call for Submissions - Positive C-Section Stories
Danielle, blogger at Momotics, is looking for submissions to a blog carnival of positive stories of medically necessary c-sections! If you have one of these, please share!

How Toy Ad Vocabulary Reinforces Gender Stereotypes
Check out these word clouds of words used in commercials for toys geared towards either boys or girls. The results, while not shocking, are interesting to see.

The Smarter You Are the Stupider You Look 
Annie at PhD in Parenting posted a really in-depth analysis of the study that was going around about how images of breastfeeding moms were perceived as being less-competent than non-breastfeeding mothers.

Epidural Use Tied to Length of Prenatal Care?
A study by the National Center for Health Statistics found that the more prenatal care you had, the more likely you are to use epidural anesthesia.Why would this be?

Support Global Mother's Health
Christy Turlington's new documentary No Woman, No Cry is heading around the country, and it looks excellent. Has anyone seen it? Check out the trailer at Dou-la-la's blog, and read about how buying a CD at Starbucks can help support global mother's health.

...and I thought this XKCD comic was cute! Someone should try this with the L&D nurses when they ask this question :)

Cesarean and Sexual Assault Awareness Month

April is Cesarean Awareness Month.  

Sponsored by the International Cesarean Awareness Network (ICAN), "It is a time for awareness for all pregnant women, all mothers, and all women everywhere. The risks of surgery are not felt only by the women who have cesareans, but by our society as a whole. We owe those women the access to knowledge and the availability of information and support." 



The National Center for Health Statistics reports that the cesarean rate in 2007 was up 53 percent from 1996.   The most significant increase is among women under 25, up 57% since 2000.

The current United States Cesarean rate is 32.9% (1 in 3 births) and rising. The World Health Organization recommends C-section rate of about 10% of all births for healthy moms and babies.

Currently, the VBAC rate is less than 8 percent, with evidence showing that 60%-80% or more of women having a VBAC trial of labor will be successful.   This decline is driven by the continually growing number of hospitals banning the VBAC option.


The Birth Survey is an on-going, online consumer survey that asks women to provide feedback about their birth experience with a particular doctor or midwife and within a specific birth environment. Responses will be made available online to other women in their community who are deciding where and with whom to birth. Take the time to fill out the survey about your experience.

The International Cesarean Awareness Network (ICAN) is also holding its bi-annual conference in St. Louis, Missouri on April 8-10, 2011.



April has also been designated Sexual Assault Awareness and Prevention Month. 

The goal of SAAM is to raise public awareness about sexual violence (focusing on sexual assault and rape) and to educate communities and individuals on how to prevent sexual violence.


Find a SAAPM event near you! 

RAINN Statistics:

• 1 in 6 women and 1 in 33 men will be a victim of sexual assault in their lifetime.
• College age women are 4 times more likely to be sexually assaulted.

• In 2007, there were 248,300 victims of sexual assault.
• Every 2 minutes, someone in the U.S. is sexually assaulted.
• 60% of sexual assaults are not reported to the police.
• Reporting has increased by 1/3 since 1993.
• Approximately 73% of rape victims know their assailants.
• Only 6% of rapists will ever spend a day in jail.

Please REPORT any experience in which you were taken advantage of physically or sexually. Speaking out about an experience with sexual violence is difficult, but it is also empowering, and it can help prevent future abuses.


The same goes for Birth Trauma. If you feel you have been violated due to a Cesarean experience, please contact your local ICAN chapter or visit http://www.solaceformothers.org/ for help.


Original post

Racial Disparities in Adverse Birth Outcomes

Really interesting article in the lastest issue of Social Science and Medicine! If you have access to the journal, I encourage you to check out the full article.

Explaining racial disparities in adverse birth outcomes: Unique sources of stress for Black American women

References and further reading may be available for this article. To view references and further reading you must purchase this article.

Lisa Rosenthal and Marci Lobel
Volume 72, Issue 6, March 2011, Pages 977-983

Abstract

The infant mortality rate for Black Americans in the US is more than twice the rate for White Americans, with similar racial disparities existing in rates of low birthweight and preterm delivery. Survivors of these adverse birth outcomes have poorer development and health in infancy, childhood, and adulthood. Increasingly, evidence suggests that maternal stress is an important risk factor for adverse birth outcomes. We offer a novel perspective on racial disparities in birth outcomes suggesting that Black American women are subject to unique sources of stress throughout their lives and particularly during pregnancy based on their multiple identities as women, Black, and pregnant. We draw on interdisciplinary work to examine three unique sources of stress for Black American women that elevate their risk for adverse birth outcomes: 1) abuses of Black American women by the medical system and issues of power in obstetrics that disadvantage Black American women; 2) contradictory societal pressures exerted on Black American women about whether they should have children; and 3) historical and contemporary stereotypes about Black American women related to sexuality and motherhood. We discuss implications of this analysis, including applications to research and intervention. Developing a better understanding of the experience of Black American women during pregnancy and throughout their lives offers insight into ways to reduce racial disparities in adverse birth outcomes and their lifelong consequences.

Highlights

► Provides a novel perspective on racial disparities in birth outcomes emphasizing Black American women’s unique sources of stress. Examines Black American women’s intersecting identities, their association with discrimination, and effects on adverse birth outcomes. Implicates poor treatment by the health care system, contradictory societal pressures, and stereotypes in contributing to Black American women’s stress. Suggests implications of Black American women’s unique sources of stress for research and intervention

Keywords: African Americans; Birth outcomes; Black women; Pregnancy; Discrimination; Health disparities; Stress; Racism; USA