Wednesday, March 30, 2011

Birth Among the Nacirema

Miner (1956), an anthropologist, published a case study about the Nacirema that takes an outsider's look at the beliefs and practices of this culture. Riordan (1991) further examined the case study:

"Nacirema women deliver their babies in temples - slatipsoh - and the babies are taken to a separate room shortly after birth to be cared for by members of the Gnisrun tribe. She describes the rituals of a tube being pushed through the nose to remove gastric contents. Then babies are given sugar water to fill their stomachs. The breasts of the Nacirema women are consider sexually arousing, so they are kept hidden and bound under cloth until the baby cries to eat."

This is a re-blog of the post "Cultural Case Study" by the nurse at At Your Cervix blog. It is an excerpt from a book by author Jan Riordan, in which she takes the ideas behind the original essay on the Nacirema society and applies it to birth and breastfeeding practices.

I read the original text of "Body Ritual Among the Nacirema" in college, as many people have. What strikes you about this excerpt?

I encourage you to read the full text, if you haven't already. It is frequently assigned in sociology, anthropology and english courses as a way to take a look at cultural relativity, ethnocentrism, and defamiliarization.

Sunday, March 27, 2011

Weekend Movie: The Perfect Vagina

The Perfect Vagina is a film made in the UK. I heard about this movie about Labiaplasty, or the surgical reduction of the labia minora or majora of the vagina, from Student Doula. I'd actually read about vaginaplasty procedures in Cosmo magazine. This is a type of plastic surgery that is on the rise, and is disturbing for a number of reasons. It seems to be an extreme form of the effect that society has on women disliking their bodies.

The movie, though a little long (about an hour), is worth a look. It has several parts, which are all included in the video embedded below. Filmmaker Heather Leach takes a look at the whole phenomenon of women disliking their vaginas and wanting to change them with plastic surgery. Its also fascinating because, really, how many women actually see other women's vaginas? Real women, not those in porn? The reality is vaginas vary just as much as women do. If you'd like to see some varying vaginas to see what I mean, watch the part where women get molds done of their vaginas!

The video is also enjoyable because of all the really great British slang words for vaginas throughout!

The perfect vagina from heather leach on Vimeo.

Oh, but I should warn you: the first part of the film shows a labiaplasty procedure. I just thought I'd let you know so that you can look away if you want to!

What are your thoughts about this film? and labiaplasty?

Thursday, March 24, 2011

CIMS/Breastfeeding & Feminism Conference!

Ok I am FINALLY getting down to blogging about the Coalition for Improving Maternity Services/Breastfeeding and Feminism Conference that I attended...  two whole weeks ago now!

"Reframing Birth and Breastfeeding: Moving Forward" Conference, co-hosted by CIMS, the Carolina Global Breastfeeding Institute at UNC Chapel Hill, and the Center for Women's Health & Wellness at UNC Greensboro.

This was the very first time that the two organizations joined together to present together at one conference. Essentially, there was a Mother-Friendly Childbirth track and a Breastfeeding and Feminism track going on concurrently, with a few joint sessions at the beginning and end of the conference.

At times it was very tough to decide which track's talks to attend! Everything was so interesting. To get an idea of what the days looked like and who the speakers were, check out the pdf of the schedule.

The keynote session was by Eugene Declerq of Boston University School of Public Health, one of the "big names" in the birth world, and very big into "the numbers."
Some things I took notes on:
  • Home births increased in 2008 by 6.9%, especially in white mothers (88% of all home births). Among other races, home births tend to be "unplanned" (the oops! baby came too fast! births)
  • Home births are a rural state phenomenon 
  • Closing Certified Nurse Midwife groups in hospitals made the C-section rate increase more and faster than hospitals that opened CNM services
  • The gestational age in the USA has shifted down from 1990-2008 without better outcomes
  • Planned home birth has a normal gestational age curve (majority at 40 weeks, with about 2 weeks on either side) 
  • VBAC rates might be better than we think they are because of frequent documentation errors
  • Florida has the second lowest VBAC rate (2.8%). the highest is Alaska (18%)
  • Its not about the mothers, its about Practice, Culture, and Institutions!
  • Half of mothers have no interest in VBAC at all
  • Who is the patient? the fetus or the mom?
  • A lot of women and OB's don't see that there is a problem with maternity care
  • Decisions are not based on evidence, they are based on CULTURE
    • we can gather as much evidence as we want, people are still going to make choices based on cultural beliefs

A big thing that kept coming up in many of the talks was the idea that we can't just keep focusing on women at the individual level - we have to make society and policy level changes. That we have to get the attention of the policy makers, which is frequently achieved through the media.

This is where Danielle Rigg and Bettina Lauf Forbes from Best for Babes stepped in and talked about giving breastfeeding an image make-over. If you don't already know about the breastfeeding booby traps, take a look.
  • They argued that we need a complete culture change. 
  • Women "know more about which stroller to buy than how to feed their baby." 
  • More money needs to be spent on breastfeeding marketing in order to promote a positive message. 
  • "cultural squeamishness--> social disapproval (esp. of nursing in public) --> condemnation"
  • Pressure on moms to breast feed and hidden booby traps = a negative personal experience which leads to a backlash against breastfeeding -- a vicious cycle! 
  • This is a human rights issue, not a freedom of choice issue
  • Trying to market breastfeeding the way that other products have images have been successfully branded by logos, ads, etc in order to make breastfeeding desirable.
  • use of shock value and media combo
The Best for Babes talk was one of the most talked about of the whole conference. Many people had a problem with their using sex imagery to sell breastfeeding, saying it perpetuated the idea that breasts and women's bodies are sexualized, so breastfeeding is a sexual act. Also the use of "babes," which has a certain connotation about women. On the other hand, you could understand their argument - branding does work in our culture and it can contribute to some changes in regards to attitudes toward breastfeeding. Whether that helps beat the booby traps, I don't know, and whether it will actually change the culture rather than perpetuating the current gender power divisions, we shall see. 

Some good quotes from the conference:

"If every woman knew she was as powerful as the ocean, the world would be a better place" - Danielle Rigg
"I don't like the term 'pro-breastfeeding.' Are you pro-breathing?" - Keren Epstein-Gilboa
"2/3 of VBACs end in vaginal birth, but keep in mind 2/3 of all births end in vaginal birth these days!" - didn't write name down
Feminism's issue with breastfeeding - "do we want to think about women as the same or different as men?" - Bernice Hausman
"When breastfeeding was the societal norm, women had fewer problems breastfeeding." - again, I forget! But this is such an important idea... its not your body, its your social environment that is causing breastfeeding failures.
"Doula support has always been evidence-based. Not so for Electronic Fetal Monitoring, which is more prevalent... EFM or Doulas?" - Penny Simkin

There was a fascinating panel discussion on the breast pump and the role of consumer goods in breastfeeding support. One of the things that I was really interested to learn was the results of a study that took a look at Formula Samples vs. a Manual Breast Pump being given in Hospital Discharge bags (formula samples in bags are currently the hospital norm, which is also in violation of the WHO Code of Marketing Breast-Milk Substitutes, and undermines breastfeeding). The study methods assigned mothers to a formula sample bag group, a breastfeeding information bag group, or a manual pump plus breastfeeding information bag group. Infant feeding methods were measured at 2, 4, and 12 weeks postpartum.

Women who received the information bag and the pump bag had the same mean duration of breastfeeding, which was about 2 weeks longer than the routine formula sample bag women. Meaning, as long as there was no formula, women breastfed longer! Women who were given a pump and breastfeeding info were more likely to be engaged in any breastfeeding at 3 months than the info bag alone, and both were more than the routine bag. Exclusive breastfeeding from 2 weeks to 12 weeks was sustained more in the two breastfeeding bags than the formula bags, with the women who received pumps having a much smaller drop in exclusive breastfeeding than both the other groups - most consistent. How interesting! The idea that pumps might make a significant difference is an important one, but most of all this study reinforced the fact that routine discharge bags with formula samples given to women every single day all over the country and the world have clear negative effects on breastfeeding success.

Other fabulous moments of the conference included Robbie Davis-Floyd's talk on the 10 Steps to Optimal MotherBaby Maternity Services, and an update on the International MotherBaby Childbirth Initiative at various hospitals all over the world. I also got to sign up to go out to dinner with her, which was awesome! Such an academic/birth nerd moment when I asked her to take a picture with me :)

Also incredible for me as a birth junkie and a doula was seeing Penny Simkin speak and also getting a photo with her! She talked about Birth Doulas Today: History, Status, Successes and Challenges. She talked about how rogue doulas, doulas who go beyond what she believes is the appropriate scope of practice for doulas, are a huge problem for advancing doula leadership.

Click here to watch a great 20 minute video RISK: Consequences of a Near Term Birth - very powerful!

Overall I had a great time at the CIMS/Breastfeeding & Feminism Conference. I am so glad the two conferences came together to offer both tracks at the same time - it is really what motivated me to attend. I learned a lot for my doula practice use and for my academic use. Definitely worth it!

For more photos, check out the Coalition for Improving Maternity Services facebook page album.

EDIT: I've just noticed that Public Health Doula attended the conference as well and blogged a little bit about it! To read her summaries and opinions on some of the talks, here is Breastfeeding and Feminism Day 1 and  Breastfeeding and Feminism Day 2

Thursday, March 10, 2011

Choosing a Hospital Birth? How to make it AWESOME

I practice my doula services from the perspective that every woman has the right to choose, and that I am here to help her achieve her ideal birth. Whatever that means to her, I am here to support her. It is HER birth, not mine. Even though I do a lot of research and I've developed a lot of opinions over the last year, I would never tell a woman what she should or shouldn't do, or that her choices are wrong. If she asks, I tell her everything the evidence has to say about every option, and I try to uphold her wishes.

Though I do not think a hospital birth is right for myself, I know that it is where doula support is needed most. I will continue to help women labor and deliver in hospital settings, especially because 99% of women in the USA choose to do so in a hospital.

Every birth is unique, and while the presence of a doula or other factors can't guarantee a wonderful hospital birth (as some things are out of my control), there are a few common factors that can help women have the best chance at the birth they hope for.  

Having an AWESOME hospital birth

via Vita Mutari

1. The first thing is to hire a care provider that they love and that has a reputation of being respectful. It is so important to go into this with the attitude that you are a TEAM working towards the same goal…not that the doctor/midwife and hospital are the enemy to be conquered. Having a great RELATIONSHIP with your care provider and trusting them to respect you and your baby is the best start to a joyous pregnancy as well as a birth free of animosity and stress.

2. Take a good childbirth preparation class! What makes a good class? One that’s not in the hospital. I know that there are good classes that may be in the hospital…but those are the exception rather than the rule. It’s not the instructors’ fault, they are often restricted in what they can teach by the hospital. The class should run a minimum of 12 hours….not a quick little 2-4 hour class.

3. Hire a doula that you (and your partner) trust and adore. Interview with several – in many ways it’s like dating again! When you go out on a date with “the one”, you should know it. It should be someone you look forward to seeing! Someone you are excited to share this experience with. Someone you trust…someone that makes you feel good when you are around them. It’s also super important that your partner have the same level of trust, as many find that the doula helps dad MORE than she helps mom through this process!

4. Only invite people to your birth for YOU…not for them. Don’t invite someone because you feel obligated, or because you think it would be neat for them. The only people who should be at your birth are people with a PURPOSE! They should be there to photograph, or to rub your back, or because they make you feel safe…it should be for you, not as a gift to them.

5. Regardless of where you intend to birth – go into this rested!! The worst thing a mom can do if she thinks labor is beginning is to “try to help it along”. I saw mothers who would walk the neighborhood or mall, scrub the floors, make love with their husband…not because they wanted to but because they want to encourage labor to keep going. If it’s labor…IT DOES NOT NEED YOUR HELP!! We have a hard time STOPPING labor when you don’t want it! If you think labor has begun, then this is the beginning of your baby’s birth story!! Make it the BEST story you can by filling it with pampering and joyful things for you – take a bath, sip some tea, watch the sunset, watch your favorite movie…but most of all, take it easy!

6. Stay in the moment! Did you know that pain relief is not the most common reason that epidurals are requested? The most common reason for a first time mom is 1) fatigue (see #3 above) and 2) fear of what’s to come. They get an internal exam and are found to be 5cm and they think, “I can’t do this for another 10 hours!! I’ve been doing this for 10 hours and I’m only halfway there!” or they think, “If it feels like this at 5cm, how will I do 9cm??” They can do *this*…they can do *here* and *now*….but they want an epidural because they fear what is to come. Stay in the moment…take each one as it comes! STAY here and now…don’t jump ahead in your labor.

7. Pick and choose your battles. I often see frustration when someone chooses a hospital birth but rejects all that a hospital means. If you want to avoid everything a hospital does, then why are you birthing in a hospital? If you feel a hospital birth is safer, then why are you demanding that they don’t do the things that they do with hospital births? And how can you possibly be making it safer by taking them out of their routine, out of their comfort level, and trying to demand that they abandon all of their protocols and procedures? And if you think that all of the protocols and procedures aren’t helpful, then why are you birthing there? If you choose a hospital birth then I hope that you also understand that the hospital is doing what they feel will make your birth safer. If there’s nothing you want from the hospital….then again I ask, why are you there? You are there for a reason so why create animosity for them trying to do their job?

8. Remember that this is YOUR baby! May seem silly to you that I say that…but it always amazed me how easily “ownership” of the baby is handed over to the hospital. I hear women complain that the baby will be taken from them immediately….but they can’t TAKE the baby, you must GIVE them the baby. I’ve seen a healthy baby laying in the warmer, nurse leaves the room, and a cleaned up mom say, “When can I have the baby?” only to have dad say, “Want me to go get the nurse?” Why would he need to get the nurse?? It’s HIS baby…he can pick his baby up anytime he wants! Why would he need permission to pick up his baby and hand his baby back to the mother?

9. If this is your first time breastfeeding….schedule an appointment to see a lactation consultant. Make sure it’s actually a lactation consultant, not a nurse who likes helping moms breastfeed. Is she an IBCLC? (stands for International Board Certified Lactation Consultant) That’s a good question to ask….”are you an IBCLC?”  See if you can find an IBCLC who will come out to your home a few days AFTER the birth to evaluate how things are going.  And while we’re at it…I wouldn’t have ANY formula in the house!! You can buy formula 24 hours a day in a store – and a baby is NOT going to starve to death in the 30 minutes it takes for dad to run down to a store and buy it if you fear for the baby’s safety or if your IBCLC believes formula is needed – there’s no reason to have it. That’s like getting married but having the divorce papers drawn up ahead of time “just in case”.

10. Enjoy your blessings!! Your gorgeous baby, the beauty of having your family together…


Monday, March 7, 2011

My Thoughts on Hospital Birth vs. Home Birth

On the heels of a 21 hour birth with a client, my longest yet (and also finally a birth that counts as my last birth for certification! yay!), I am going to share some thoughts.

Here are a few things about Hospitals Births that solidify my desire to have a Home Birth:

1. I HATE directed pushing. Hate it. You do not need to be told when and how long and how strong to push in order for your baby to come. You also do not need to "know" that you are 10 cm and then be "allowed" to push. You will know when it is time to push. You will feel the urge!

I think women push much more effectively when they follow their bodies. They breathe more than they do with directed pushing, which gets more oxygen to the baby and themselves. They do not push so hard that they are not letting their perineum tissue stretch, and so they tear less. They tend to push in more effective positions, especially if they are not in a hospital confined to the bed (which is more convenient for the doctor).

I told my client recently who was experiencing a nurse who was telling her not to push during a strong pushing contraction because she had to "give the baby a rest, she's having her head compressed a lot," that this was HER show. She needs to push and breathe when she feels it is right.

2. Monitors. Constantly attached and tethered, constantly beeping and squeezing, constantly readjusted. I think they are so freaking obnoxious. They also haven't been shown to identify and prevent what they are "supposed" to (see my post Where's the Evidence Based Medicine?) How can I labor effectively if I am so profoundly irritated?

I don't think the blood pressure cuff, thermometers, contraction monitors, heart rate monitors, etc etc really help my baby have a safer labor and delivery. I think they hinder that which creates a healthy birth, namely, a mother who is at peace and as comfortable as possible, a mother who can get up and more around and be in any position she likes, a mother who doesn't feel encumbered or worried.

3. Not being able to eat or drink whatever I want. Again, there is no evidence that eating and drinking during labor is bad, but its certainly true that not being able to eat or drink lowers your energy level and also makes your labor unpleasant. I'd much rather eat and drink what I want for energy than be attached to a painful IV.

I also think its ridiculous that we withhold such a thing from a laboring woman. Its like its some power trip to be able to control their eating (and their peeing, too, if mom has to have a urinary catheter).  All part of the Rite of Passage (see: Robbie Davis-Floyd).

4. People telling me where and how and in what position I can labor/birth. Uh uh, no. I am going to labor how I damn well please. I am not going to stay still in that bed just so YOU and the hospital record room can have a "nice strip on the monitor." I am not going to lay here and suffer pain that would be alleviated by moving or a hot shower just so you can fill in your charts with my blood pressure. That's bullshit.

I'm also going to push in whatever position feels the most comfortable for me. I don't care if its hard for you to catch the baby that way - I don't actually need you! I can catch my own baby! Or my husband can do it! One does not need a medical degree to catch a baby. That baby is coming whether we like it or not, and its coming in whatever position I choose at that moment.

5. The hospital atmosphere. Strange smells, weird sounds, the fact that hospitals are full of illnesses and germs, and being in someone else's territory. I've never liked the sterilization smells of doctors offices and hospitals. They just remind me of being sick and uncomfortable. I don't think I could fully relax in an atmosphere where people can come and go as they please, touch me and tell me what to do whenever they please, and me and my family have to "ask" to be able to do things or go places. I also don't want to feel embarrassed during my labor, and I don't want people there that I don't know. That atmosphere can stall a labor, and I've seen it happen.

I should emphasize, also, that all of these things also solidify my decision to have a home birth because I want a natural birth. If you want a natural birth, STAY OUT OF THE HOSPITAL.

What about you, what do you think? Other than the "safety" or "fear" aspect of the hospital vs. home birth debate, tell me what prompted you to make the decision you did!

Sunday, March 6, 2011

A Family-Centered Cesarean

This is a great video on how the Cesarean section can be family and woman-centered and as positive an experience as possible. This is a method that can and should be implemented universally. Its possible!

Wednesday, March 2, 2011

More Reading than You'll Know What to Do With

Hello! Happy March!

I know that there are many followers of this blog who follow the blog itself, some who follow facebook only, and some who follow me only on twitter. I also realize that there are various combinations of the three; for instance, following the blog and facebook but not twitter, or just facebook and twitter, etc. I do different combinations of following of blog content, myself! But I just thought I'd let all my google friend/RSS reader followers what happens over on facebook in case you don't overlap.

Facebook is great because even though with a busy grad schedule I can still post interesting things and have discussions, even if I don't have time to write a whole blog update!

We had a great conversation on the facebook page about whether or not, and how, anthropologists should or can be Activists/Advocates.

Link Roundup: Wrapping up February Edition
Here are some great links that I shared recently, but didn't blog about, that are worth checking out (in chronological order):

Too Many Babies are Delivered Too Early - Hospitals Should Just say No via Time Healthland
The LeapFrog group recently released info on elective deliveries have soared 40% and more and more babies are being born TOO EARLY. The March of Dimes is working on a campaign to stop hospitals and doctors from ordering/performing inductions/c-sections prior to 39 weeks if not MEDICALLY INDICATED.

This is because babies are being born too early when elective deliveries are performed before 39 weeks. Inaccurate measures of gestational age is common, with ultrasound estimations done in the last trimester being off by up to 3 weeks.

Babies who are born before mom goes into labor naturally have more health problems: Risk having immature lungs and respiratory problems, cannot suck and swallow adequately, and are less alert (especially if born by c-section). They spend more time on ventilators and in NICU. If the baby is delivered at 37 weeks and it turns out the baby was actually only 35 weeks gestational age, the baby will have all these problems and more, such as birth defects, autism, learning disabilities, chronic health problems.... They are also more likely to die.

They also cost more. Even born at 37-38 weeks, premature infants cost 10 times more than a full-term newborn. Reducing early deliveries to under 2% could save close to $1 billion in health care each year.

Fascinating post on the Health Care Blog on "Cultural norm-ing of Defensive Medicine."  Its pretty long, so the Unnecesarean has given us a few quick paragraphs of the main idea... But definitely read the full article if you can!

 The Doula's First Time Mama Advice Kit
Written by the Public Health Doula, this is an AWESOME MUST-READ. She has included everything in this advice kit!

 Is Breastfeeding Advocacy Anti Feminist? An essay by Katherine A Dettwyler
Anthropologist Katherine Dettwyler studies biocultural anth and breastfeeding and dicusses them in this article, and feminism!

The Blonsky Apparatus for Facilitating the Birth of a Child  via Unnecesarean
My boyfriend found these images of the Centrifugal force machine mentioned in the book "Pushed" and I was going to post them to my blog this week, but The Unnecesarean beat me to it! Check this crazyness out!
Pain, Suffering, and Trauma in Labor and Subsequent Post-Traumatic Stress Disorder: First of Two Posts by Penny Simkin  and
Part Two: Pain, Suffering, and Trauma in Labor and Subsequent Post-Traumatic Stress Disorder: Practical Suggestions to Prevent PTSD After Childbirth
The Fabulous and Famous Penny Simkin on Pain vs Suffering (important distinction!) and Birth Trauma and PTSD on Science and Sensibility blog.
Evolution and C-sections
I think it could happen over time, but I don't think its happened already. There are other factors contributing to the current small increases in birth weights. Wouldn't that be a scary thought, though - every single future birth ending in a cesarean section because everyone evolved to have cephalopelvic disproportion??
 Continuous Support for Women During Childbirth - Cochrane Systematic Review
Check out the new Cochrane Review on Continuous Labor Support "The good news about doulas just got better! Fewer cesareans, fewer instrumental vaginal births, less need for pain medicine, less dissatisfaction with birth and better Apgar scores for baby." Via Childbirth Connection
Anthropology Without Doctorates
More and more graduate students in anthropology are not completing their PhD and are working outside of academia. What happens to terminal MA's in anthropology?
Making the Case for Delayed Umbilical Cord Clamping: A Grand Rounds Lecture by Dr. Nicholas Fogelson
50 minute video lecture of Dr. Fogelson speaking to his peers about why umbilical cord clamping should be delayed.

Women in Control of Epidural in Labor Use 30% Less Anesthesia
Important find! If women could be in control of their anesthesia, they'd feel more in control of the whole experience! And if they end up using less anesthesia, all the side effects would be less. I think it would be a blessing for those who want an epidural but fear the potential side effects, like a groggy newborn or too much numbness.

 Incredibly Moving Birth Photography of a Home Water Birth

I hope this isn't too much reading... it definitely covers a whole range of potential interests!

If for some reason this is just not enough to satiate your appetite (if you're like me, ha), I do re-tweet even more interesting articles on Twitter. I also sometimes use Twitter to talk about being a doula or with other doulas. To get involved I encourage you to join in on #doulaparty every Friday and some Sunday afternoons, or simply search the #doulaparty hashtag and read up!
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