Friday, February 25, 2011

Doula Mentor Videos

Doula, Childbirth Educator and Doula Trainer Janice Banther has created a series of videos she calls "Doula Mentor" videos. They are extremely informative and helpful videos, especially for new doulas!

You can view all of her videos on her YouTube channel:

Doulas and Phone Calls

Doulas: What to Wear?

Doulas and Elevator Talk

Doula: What Helps During Hard Economic Times

Doulas and Scheduling Births

Doula: Have you Read?

Doula: Helping a Client with a Panic Attack

Doulas: Working With Sexually Abused Moms

As with any advice, you have to decide what will work for you and what you don't identify with. But its always nice to have a mentor!

Wednesday, February 23, 2011

Covering Up is a Feminist Issue

Annie at PhD in Parenting made this fabulous video about how Covering Up is a Feminist Issue, and I quite agree.

From her blog:
There is a wide range of opinions on what constitutes good judgment with regards to how women dress themselves and how much they should or should not cover up. Any time a woman is told to cover up or told to undress, I see that as an attack on her person. Telling women to cover up and telling women to strip down are frequently used tactics for oppressing women. There are both practical and philosophical reasons why no one other than the woman herself should decide how covered or uncovered to be.  It is easier for onlookers to avert their eyes than it is for a woman to dress in a way that makes her feel uncomfortable.
This is true of how much skin we show in dress and how much skin we show when breastfeeding.

As she writes in the video, "Beauty may be in the eye of the beholder, but when it comes to dressing and breastfeeding, appropriateness should be decided by the woman."


Sunday, February 20, 2011

Re-Blog: Eating and Drinking during Labor from a Medical Anthropologist's Perspective

In this article, we see Robbie Davis-Floyd's explanation for the restriction of food and drink during labor as reinforcing the liminal status of pregnant women during her rite of passage into motherhood.

Re-Blog: Restriction of Food and Drink in Labor from a Medical Anthropologist’s Perspective via Birth Activist Blog
The recent Cochrane review, Restricting oral fluid and food intake during labour, analyzed five studies and concluded that women should be free to eat and drink in labor at will.
Since the evidence shows no benefits or harms, there is no justification for the restriction of fluids and food in labour for women at low risk of complications. No studies looked specifically at women at increased risk of complications, hence there is no evidence to support restrictions in this group of women.
The rationale behind denying laboring women food is that the danger of aspiration and the potentially lethal complication known as Mendelsohn’s syndrome while under general anesthesia is greatly reduced.

Medical anthropologist Robbie Davis-Floyd wrote extensively about the cultural myths about non per os and childbirth in the 1992 book, Birth as an American Rite of Passage. Mendelsohn’s original 1946 article reported several cases of aspiration and subsequent pneumonia, but no deaths. Davis-Floyd cites Baggish’s 1974 study which showed that at most 2 percent of maternal deaths were caused by aspiration under general anesthesia and Scott’s 1978 work that placed the risk of death at 1 in 200,000 women.

So what purpose would denying food and drink to all laboring women serve more than six decades after Mendelsohn’s work and with the great improvements made to regional anesthesia? Davis-Floyd wrote:
According to Feeley-Harnik, “persons undergoing rites of passage are usually prohibited from eating those highly valued foods that would identify them as full members of society” (1981:4). In rites of pregnancy and birth across cultures, food tabus serve the purpose of marking and intensifying the liminal status of the pregnant woman. The pseudo-foods (ice chips and lollipops have no nutritional value) allowed in the hospital are often fed to the laboring woman by her partner as if she herself were the baby, a symbolic process that can heighten her own sense of weakness and dependence.
In a recent article in Birth, Broach and Newton (1988) address the question of why laboring women are still prohibited from eating and drinking in labor in spite of mounting evidence that such prohibitions are medically contraindicated. Pointing out that this custom started in the 1940’s when general anesthesia was widely used for childbirth and the danger from aspiration was therefore higher, they posit that its continuance is the result of “culture lag”—that is, of “culturally patterned behavior that continues to be practiced long after the reasons for doing so have disappeared” (1988:84).
Davis-Floyd views denying food in labor as indicative of the confirmation of a woman’s initiate status as a dependent of the institution.
On the contrary, I would suggest that this custom forms an integral part of the technocratic tapestry of birth in the United States, continuing as routine procedure not because of culture lag but because it serves so well to legitimate and further necessitate the technocratic interventions we investigate here as transformative rituals. To deny a laboring woman access to her own choice of food and drink in the hospital is to confirm her initiatory status and consequent loss of autonomy, to increase the chances that she will require interventions, and to tell her that only the institution can provide the nourishment she needs—a message that is most forcefully conveyed through the “IV.”
Restriction of food and liquids in labor was the subject of many discussions last year following the American Congress of Obstetricians and Gynecologists’ press release that women should be allowed “modest amounts” of water and clear liquids in labor, with physicians defending IV use and telling women to calm down their rhetoric and fight for things that matter.

Thursday, February 17, 2011

A Doula for Your Cesarean Section

Yesterday I had an extremely awkward conversation with my pregnant professor. It was one of those moments where I maybe should have kept my mouth shut, and refrained from spewing the birth-related word vomit all over someone who didn't ask for it. It happens! Especially when the topic of elective cesarean sections come up.

An elective cesarean section is one that is schedule ahead of time by the doctor and mother.

Reasons for this are:
1. suspected macrosomia (big baby)
2. mother and doctor want the convenience of picking the date and time of delivery
3. mother is tired of being pregnant
4. mother is "overdue"
5. baby is breech
6. medical conditions for the mother (hypertension, etc)
7. medical conditions for the baby (suspected deformity, etc)

Birth workers get very touchy when the idea of an elective cesarean section comes up if it is not for reason 6 or 7, above. The first 5 reasons (with some grey areas, like going past 42 weeks) generally create more dangers for mom and baby when compared with spontaneous vaginal labor and delivery.

Having a Cesarean before labor begins on its own increases the chance that a baby will be born premature (as due dates are merely estimates and can be wrong, and ultrasounds in the third trimester are known to be off by up to 3 weeks and 2 pounds). Premature and low birth weight infants, especially those born by cesarean section, have respiratory and sucking problems and spend more time on the ventilator and in the NICU. They also cost billions of dollars in health  care.

When cesarean is elective with no emergency present, the woman's chance of dying from the procedure it self is nearly three times that of a vaginal birth. Moreover, the mother has a much longer recovery period from the major abdominal surgery, which makes caring for her newborn much harder.

When an elective cesarean section occurs for a medical reason, such as fear of uterine rupture (after considering VBAC!), one can still create a Cesarean Birth Plan and Bring a Doula!

Which is what my birth-related word vomit was all about yesterday - the support a doula can provide for a mom and her partner during a cesarean section.

Informational Support
For a planned or even the possibility of an emergency c-section, a doula can provide a ton of informational support. The biggest of which is helping you to create a cesarean birth plan. How can I plan for a surgery in which I will play little to no part? you might ask. Many people do not know that they have many options and a doula can inform you of these.

Would you like to specify a double suture as opposed to a single suture? Or have your urinary catheter placed after your spinal epidural? 
Would you prefer that the surgeons keep the chit-chat to a minimum? (I have heard stories of women lying there scared and uncomfortable while the doctors and nurses talk about things completely unrelated to the procedure)
Would you prefer that your baby be brought to you (if baby is healthy) as opposed to immediately placed on the warmer?
For more help with cesarean birth plan options, see this post (or talk to a doula! :)

Additionally, a doula can help you and your partner know what to expect with a cesarean section, and also inform you of the newborn options that you are allowed to decline if you wish, and so on.

Emotional Support
The doula can help allay fears before, during and after the surgery. If you are disappointed that you have to have a cesarean section rather than a vaginal birth, the doula is there to discuss your feelings with you and your partner She can help you practice relaxation techniques, and talk to you during the procedure to keep you calm. She can help keep partners calm, especially during prep time, so that they are effective support for mom as well. She can still be your advocate in the ER - remind the surgeons to please describe, or not describe, the procedures as they are doing them, that mom would like to do skin-to-skin as soon after birth as possible, etc.

After the birth, the doula is there for you while you process your feelings about the birth. While in the recovery room, the postpartum room or at home, its great for moms to have someone to talk to. She can recommend resources like ICAN and other support groups.

Physical Support
Just having someone else there can be a bigger help than is realized. If dad wants to photograph and touch his baby while the baby is in the warmer, the mother is left alone on the surgery table. If the baby must go immediately to the NICU, and dad goes with the baby, the mother is also left alone. This can be a scary time to be alone - the procedure continues for around 45 more minutes as the surgeons suture you back up, and you continue to feel discomfort and concern for your baby. The doula can stay by your side throughout all of this, if the obstetrician allows. This varies from doctor to doctor and must be discussed ahead of time.

The doula can also help with breastfeeding after birth. This is no small feat after having abdominal surgery! The doula can help you figure out how to hold the baby and get the baby to latch, in addition to all the regular breastfeeding support typically provided postpartum.

You will be surprised how much having this kind of support can really help with your recovery!

photo: doula network of fort wayne, which also has on their webpage a story written by a mom who was glad she had a doula at her cesarean section!

So, who knows if I positively informed my professor, and helped her consider the support a doula can provide even for a c-section, or if I just annoyed her with unsolicited advice. Its a fine line we walk sometimes!

Sunday, February 13, 2011

Considering a Doula? This Should Solidify Your Decision

Several bloggers discuss the new Lifetime show "One Born Every Minute." I didn't get a chance to view the episode they are referring to, but reading about it really got my blood boiling. 

Gina at the Feminist Breeder got the ball rolling with her post Lifetime TV Shows Us There’s One (Unnecessary Intervention) Born Every Minute.
She goes through the outrageous things that happened in the show, which, admittedly, was edited for the most outrageous content. The show perpetuates all the ideas that the media do these days about childbirth, and its no huge surprise that birth advocates would watch a show like this (like A Baby Story) and yell and shake fists at the screen. But the thing that really got a lot of people angry was the way they portrayed a couple that was informed about evidence-based medicine, wanted a low-intervention birth, and brought a doula. From TFB:
Mom/Dad/Doula are all chanting “open, open, open” during her pressure waves.  The nurse has NEVER seen anything like this and wants to know what they’re doing.  Then we see the rest of the staff looking visibly annoyed because they can hear the mom vocalizing her labor.  This is NOT the WAY they like doing labors here, and they make sure she knows it. But the mom is changing positions and using a birth ball, and working hard with her team to keep her labor going the way she wants it.  The nurse then suggests that the mother lay on her back, and the doula responds that the mother preferred being upright.  The mother agrees that she prefers to be upright, and the nurse gets an attitude.  The nurse goes back to her station and complains incessantly about the doula getting on her nerves and preventing her from “managing” the mother’s labor.
Gina writes that everything in this show "is 100% REAL LIFE, and the things happening on that show are absolutely representative of what’s going on in EVERY labor and delivery unit where the staff and providers do not practice evidence-based medicine or the midwifery model of care."

Then Public Health Doula wrote a commentary about Gina's post and the show, which can be seen here: 100% real life, as seen by doulas
In this post she includes content from a follow-up post that Gina included with more information about the interactions between the only couple on the show who brought a doula and practiced evidence-based medicine... which caused their nurse to get very upset with them.  There is also a video, and PHDoula writes, "In a follow-up post, Gina has a clip of one of their interactions with said nurse - or more accurately, their doula's interactions with the nurse. If you are planning to give birth in a hospital setting you suspect or know will be hostile to an unmedicated, low-intervention labor, you need to watch this."
And if you click through to Gina's follow-up post, you will see that she had an interview with the mother from the show, who talks about how wonderful her doula was despite the hostility she had to deal with.

Kristen at Birthing Beautiful Ideas also writes a wonderful post about this show called Dear Lifetime: It’s not Weird, it’s Normal
In this post, Kristen writes out the "behaviors and choices that are, in my opinion, completely normal during labor. But "One Born Every Minute's" producers would have you thinking that they are a) abnormal, b) cah-RAZY, and/or c) worth of finger-pointing, eye-rolling, and general balls-to-the-wall mocking." Its a great read!

And Danielle at Momotics wrote about how the show really does perpetuate ideas that the couple "defying" the nurse by bringing a doula and being in the shower instead of the bed and refusing vaginal checks was really totally crazy, because women on mommy forums really are saying things like "The hippy couple drove me nuts" and "I was upset for the couple who seemed to have it out for the nurse the whole time." Read Danielle's post Normal? What is Normal in Childbirth? for more. 

This is all an excellent portrayal of the state of maternity care and the ideas our culture perpetuates about childbirth. If you plan to give birth with wishes of low-intervention, full social support and evidence-based practice, BRING A DOULA.

Monday, February 7, 2011

News in my Doula World

Unfortunately, I haven't had much time to write a long, detailed post in awhile because of extreme business in grad school... but also in doula-ing!

I've got a lot of great news on the doula front. I've got a client due the end of February, one due the first week in April, and another due the first week of June. I am so excited! Spring is definitely the big time for births and doulas, at least in my work so far. All the births I did before I moved for grad school were also in the spring.

I was nervous meeting and interviewing with my potential clients, as these are my first ones in several months. But getting to do a prenatal meeting again was AWESOME and it really got me vibrating with excitement. I love being a doula!

Edit: Two of my professors are pregnant, could it be that the pregnancy goddess is sending birth vibes to me this spring?

In other excellent news, I've done some great networking with a few doulas in the area. We are hoping to start up a birth/doula co-operative and really get to networking with the entire birth-related community (obs, prenatal yoga instructors, massage therapists, childbirth educators, doulas, midwives, birth centers, lactation specialists, mom meet-up groups, etc etc!)

To the aspiring doulas out there following along... don't forget that I have a whole bunch of posts under my "doula journey" tab that illustrate how my starting out as a doula has gone... I hope it helps.

Also, my new doula friend that I just met asked me for ideas on what to put in one's doula bag. Here is a list of things that I have definitely used, for myself and for the mom, during labor:
  • battery powered fan
  • wet wash cloth
  • peppermint oil on cotton ball (for nausea)
  • preggie pops (for nausea)
  • ipod and speaker
  • clipboard for note-taking and cert. forms
  • labor progress handbook by Penny Simkin
  • pleasure book for down times
  • money to eat from the cafeteria
  • birth ball
  • knee pad
  • sweater for cold hospital
  • lots of snacks and water
  • cold can of soda, but then switched to freezer pack (back labor)
  • heated rice sock (back labor)
  • breath mints (for me and dad)
  • toothbrush/paste and contacts/glasses to feel refreshed after a long night
  • lip balm (for me) and lansinoh ointment for moms lips
  • camera
  • my hands :)
Things I suggest you also bring:
  • Extra hair ties (lent mine to 2 moms already, seems to be an important thing that is always forgotten)
  • Straws, in case the parents forget their own... these are so useful!
Things I have brought (because they were suggested) but never used:
  • A hand-held mirror in case mom wants to see the baby crowning
  • bathing suit in case mom needs me to get in the shower or tub with her

Friday, February 4, 2011

Weekend Movie: Black Women Breastfeeding

For my semester paper project in my Social and Behavioral Sciences Applied to Health course I intend to research the topic of African American breastfeeding.

The public health problem, in particular, is that despite rising initiation rates, breastfeeding success at 6 months is still extremely low in the U.S. Additionally, African Americans have the lowest rates of breastfeeding in the country. This has to do with a multitude of factors, including larger social and policy problems that affect the breastfeeding success of every woman in the country, in addition to the particualr socio-economic status, community and individual influences on black women in particular.

If anyone can help me gather some sources for my research paper, I would be forever grateful! What I need most are peer-reviewed journal articles related to this topic, but anything related to African American-specific "booby traps" would also be extremely helpful!

To get us all started on my journey into this problem, here is an excellent video called Black Women Breastfeeding: A Multi-Generational Story (thanks to Micky @nashvillebirth!)

To read more about why Breastfeeding is a Public Health issue, click here.
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