Thursday, June 30, 2011

Excellent Links!

Circumcision and Nursing School

The Navelgazing Midwife responds to an inquiry encouraging open-mindedness. I particularly wanted to share this quote:
"I used to be quite the breastfeeding nazi, really believing ALL women could breastfeed and the ones that said they couldn't really weren't trying hard enough. When I had a client tell me she wasn't going to nurse about 20 times and I kept telling her how great it was and how if she just tried, she'd find out how much she'd like it. She finally leaned over and got in my face, telling me she'd been molested and the primary part of her body molested was her breasts and she was going to bottle feed. It was then I realized, not only is breastfeeding a woman's choice, but that sometimes, the most empowering thing a woman can do for herself is to schedule a cesarean/bottle feed/have general anesthesia/etc. Things I wouldn't remotely consider can be the most empowering to a mom."

Elevating The Natural Vs. Epidural Conversation: An Interview With Erica Lyon

Excellent interview with a childbirth educator with some really interesting answers to questions like, "What are some of the biggest misconceptions among your students about what will happen in childbirth?":
"That it will be short, that tearing is the worst thing ever, that husbands/partners will be grossed out or turned off or useless, that the epidural makes it totally a pain free experience, that providers who are dismissive and brief are the standard (and that they won’t be like that in labor), that this is the worst pain one will ever feel, that she will be in control during the labor."

Get a peek into the high-rollin' life of a WIC peer counselor

on Public Health Doula's Blog. I really liked the post that she sets up and links to on the Leaky Boob - take a look at what the life of a WIC breastfeeding peer counselor is like! 

A Look at the Research: The Link Between Epidural Analgesia and Breastfeeding

This post on Science and Sensibility blog takes a look at the research to help us figure out if there is a link between epidurals and breastfeeding and what it might be. I find it interesting because it takes other factors into account as well.

No Ingles? C-Section for You!

Sad, but true: Many Spanish speakers are not receiving appropriate maternity care. "Surely in the United States of America they are getting the best health care in the world, right?  Frankly, I believe they are taken advantage of by a system -- doctors, nurses, hospitals -- that don't want to deal with them.  They know that these women and families are often scared, and frankly, trust the doctors to take care of them to do what is best for them.  I think they are being scammed."

5 Reasons Not to Take Hospital Childbirth Classes (Or How to Find the Best Hospital Childbirth Class)

Many couples take their hospitals childbirth education course because it is short and convenient. There are a lot of downsides to taking a class through your hospital, though, and I frequently recommend that couples take one outside of their hospital. Here are some reasons why. 

Yale Researchers Pinpoint Reasons for Dramatic Rise in C-Sections

"In one of the first studies to examine the reasons for the rising number of women delivering their babies by cesarean section, Yale School of Medicine researchers found that while half of the increase was attributable to a rise in repeat cesarean delivery in women with a prior cesarean birth, an equal proportion was due to a rise in first time cesarean delivery."

How safe is your medication for breastfeeding? New LactMed app!

An app for your phone that tells you if a medication is safe with breastfeeding! This is really great, as many doctors just don't know if a medication should not be taken while breastfeeding, and therefore tell women to stop breastfeeding (when they might not have to!)

Monday, June 27, 2011

Breast Milk: The Cure

The ultimate low-tech solution for starvation in impoverished countries: Breast Milk. 

A New York Times article "The Breast Milk Cure," states:
What if nutritionists came up with a miracle cure for childhood malnutrition? A protein-rich substance that doesn’t require refrigeration? One that is free and is available even in remote towns like this one in Niger where babies routinely die of hunger-related causes?
Impossible, you say? Actually, this miracle cure already exists. It’s breast milk.

Motherwear Blog recently blogged about the NY Times Piece:

240px-VillageReach_-_mother_and_child_outside_clinic New York Times columnist Nicholas Kristoff is taking a tour of Africa with two readers, and reports this week on the effect of not-breastfeeding in developing countries:
The biggest problem is giving water or animal milk to babies, especially on hot days. Another is that mothers often doubt the value of colostrum, the first milk after childbirth (which is thick and yellowish and doesn’t look much like milk), and delay nursing for a day or two.
One mother near the town of Dosso, Fati Halidou, who has lost four of her seven children, told me that after childbirth, it is best to give a baby sugar water or Koranic water. This is water made by writing a verse of the Koran on a board and then washing it off; the inky water is thought to protect the child.
He notes that an analysis in The Lancet showed that "a baby that is partially breast-fed is 2.8 times as likely to die as a baby that is exclusively breast-fed for at least five months. A child that is not breast-fed at all is 14.4 times as likely to die," and that overall, "1.4 million child deaths could be averted each year if babies were breast-fed properly. That’s one child dying unnecessarily every 22 seconds."
I'm familiar with the colostrum taboo (see a great video which takes aim at it in India), and the belief that babies need water on hot days, but I'd never heard of Koranic water.
You may remember that the New York Times also reported on the dangers of not breastfeeding in Haiti recently.


The mothers' beliefs about the value of colostrum and breast milk when compared to water or animal milk is very important. This is one of the places where we can intervene to help increase the health of women and children in developing nations. It is not exactly the same as the problem we have in developed nations, where women understand the value of breast milk but encounter other booby traps.

The author of the NY Times piece writes:
It’s not clear why a human instinct to nurse went awry. Does it have something to do with the sexualization of breasts? Or with infant formula manufacturers, who irresponsibly peddled their products in the past but are more restrained now? Or is it just that moms worry that their babies need water on hot days? Nobody really knows.
But what is clear is that there’s a marvelous low-tech solution to infant malnutrition all around us.

Helen Keller International’s Infant and Young Child Feeding programs raise awareness among health workers in local communities so they understand the importance of early initiation and exclusive breastfeeding of newborns during the first 6 months of life.

Friday, June 24, 2011

Weekend Movie: Reflections of Motherhood

This is really a really short and sweet video: Reflections of Motherhood

If you could go back to before your first baby, what would you tell yourself?


Wednesday, June 22, 2011

A Doula's Birth Story

A fellow doula, Nicole, aka Sweet Song Doula, has graciously shared a wonderful story that tells not only the story of her own birth, but also the reason she became a doula.

(If you have a doula birth story that you'd love to share, either about how indispensable your doula was or a doula birth from your own perspective, please feel free to send it my way - I would love to feature it!)

Enjoy!

A Doula's Birth Story

The one question I get asked in all of my interviews is “Why did you become a doula?” 

The answer to that question lies in the journey I took to and through my own birth experience, and the incredible support I received from my doula and wonderful husband.

When I became pregnant, I did what most women in the United States do. I made an appointment with an OB/GYN (who was recommended to me by the primary care doc I’ve been seeing since college). I went to my prenatal visits, the longest of which was my intake appointment. I did the early prenatal screening tests. And when the pregnancy finally started to “feel real,” I started to think about a birth experience.

At the time, I didn’t exactly know what sort of birth experience I wanted to have. I knew I wasn’t afraid of birth, and that I was definitely interested in an unmedicated and intervention-free birth. I asked around to see if anyone I knew had birthed without either of those things, and not many had. “Don’t be a martyr,” they said. “Just get the epidural,” I was told. “What’s wrong with a little pain relief?” I was asked. The only people I knew who hadn’t had epidurals and such were women in my mom’s generation. My mom herself, in fact. She’d had her babies (me in 1978 and my sister in 1981) with a forward-thinking female OB who saw no need for mamas and babies to do anything but work together during labor and birth.

This got me thinking. So, being me, I got to reading. I picked up Henci Goer’s The Thinking Woman’s Guide to a Better Birth. I devoured Ina May Gaskin’s Guide to Childbirth (just to name a select few). I read little snippets of information in magazines like FitPregnancy. And it was there, in the pages of a glossy, fairly fluffy periodical, that I first encountered the statistics about how doulas help to reduce the rate of epidurals, c-sections, and a number of other interventions in birth, simply by the virtue of their presence.

That information stopped me in my tracks. I had done enough reading to know that I didn’t want a surgical birth and a medicalized birth didn’t feel like the right choice for me, either. I wanted my baby to be born gently, sweetly, and surrounded by loving supporters who were committed to a mama having an old-school birth (with credit to Toni Negy).

We obviously needed to hire a doula.

Research, research, research. Troll the Mothering.com forums, ask around for recommendations (no one I spoke to had hired a doula, and most had no idea what one was). Fast forward to June. I was five months pregnant and interviewing doulas. We chose three out of a larger list I had compiled and met our first candidate on a dreary early summer evening. Erin welcomed us into her space and I immediately liked her. It was an instant connection. The interview was wonderful. My husband asked as we got in to the car to go home: “Do we really have to bother with interviewing anyone else? I loved her, and I could tell that you did, too.” He was right, but I felt obligated to do our due diligence. We completed our interviews with the other doulas and then called Erin to ask her to be our doula. She said yes!

Prior to meeting Erin, I had realized that the OB/GYN I was seeing for prenatal care wasn’t the right fit for me, so halfway through my pregnancy I switched to a midwifery practice affiliated with a community-based hospital. I was happy with the practice, and felt very positive that I would be well-supported there. But as my pregnancy progressed, I became more and more interested in having a homebirth. The more I learned about birth, the more excited I got about it, and homebirth seemed the way to go.

Then I had my 30-week ultrasound to check on my low-lying placenta, and I learned that my baby was breech.

“Don’t worry!” said the radiologist. “Your baby still has lots of time to turn, and most of them do.” But I was worried, so I went home and I researched some more. To make a long story short, I spent hours trying to encourage my baby to turn. Anything you’ve heard about doing to try to turn breech babies, trust me, I’ve done it: lying on an ironing board, flash light in my crotch, music in my crotch, talking to my baby, listening to hypnosis scripts, moxabustion, accupunture, accupressure, shiatsu, walking, somersaults in a pool, homeopathic remedies, external cephalic version. The list goes on.

Despite my efforts, my baby stayed right were he was, content to have his head nestled up under my heart, all the better to hear it beat.

We continued interviewing homebirth midwives, with the idea that based on the information we learned about the safety of vaginal breech births with an experienced attendant,  we’d still pursue a homebirth if we could find the right fit. But the midwives who were available for our due date and simultaneously a good personality fit, were not comfortable with a breech birth with a first time mom.
We were unable to find any information on doctors in our area who would remotely consider supporting a vaginal breech birth.

I began to realize that I was most likely facing the very birth I had most wanted to avoid: a cesarean. My baby would born out of an incision made through my skin, abdominal muscles, and uterus. I would be an inactive, immobile, and frightened participant. I began to feel sad, overwhelmed, and, quite frankly, cheated out an experience I very much wanted to have: labor and a vaginal birth.

Throughout all of this, my husband and doula remained hopeful that my baby would turn. They encouraged me to continue trying things that might get him to turn, so long as those things felt worth my time and energy. They asked me to talk with them about how I was feeling. Never once did either of them say, “The only thing that matters is a healthy mom and a healthy baby.”

In our second and final prenatal visit, Erin gently said to me that it seemed to her as though we had come to the decision to have our baby in the hospital, and in doing so, that we could be consenting to a cesarean birth. I remember tearing up. I remember feeling angry. I remember my husband rubbing my back, and holding my hand.

I remember Erin saying, “Nicole, I know this is the not the birth you wanted for your baby. It’s not the birth I wanted for you. I know you wanted him to enter the world vaginally. Though a cesarean is not the birth you envisioned, it may be the birth you will experience. And remember, it is still your birth. I am here for you. Zac is here for you. Babies are wise, and perhaps there is a reason yours is so happy head’s up. I encourage you to honor your baby’s wisdom, and to work on making peace with the birth you will experience.”

Erin suggested that we spend some time reading about cesarean births. She told us it would be a good idea to ask lots of questions (if we wanted to do so) at our upcoming prenatal appointment with the midwives. She reminded us that there were still things we could do to personalize our cesarean birth. Did we want to request music in the OR, ask for silence during the procedure, ask that the doctor’s not announce the sex of the baby (even though we already knew it), find out whether or not it would be possible to initiate breastfeeding during the repair, or at least have as much skin to skin contact as possible.

She was right. Zac and I knew that and so I began making preparations for the birth I didn’t want. I told my midwives that I would not be scheduling a date for my son’s birth. It felt cosmically wrong to pick his birthday. One midwife in the practice actually had to present our request for a “trial of labor before cesarean” during a staff meeting to get “approval” from the backing OB/GYN. Ours was not a common request. We were informed of the very short list of “risks” of not scheduling our cesarean: 1. Not knowing the doctor on call (which didn’t matter anyway, because I’d only met the OB/GYN in the practice once and had no real relationship with her). 2. Having to experience a significant amount of labor if labor and delivery was particularly busy that way and couldn’t get us in to the OR in a timely manner. 3. The possibility of a cord prolapse should my waters release in labor.

We reviewed the risks, did not find any that were reason enough to schedule our son’s birth. I spent the final weeks of my pregnancy settling in to the apartment we had recently moved to. I worked full time up until the night my waters broke at 1:00 in the morning on October 16, my son’s official due date.

After my waters broke, I called to Erin to see what she thought we should do, and after speaking with her my husband and I decided to go back to bed and that we would meet Erin at the hospital at 9 a.m. Erin met us at check-in, and rubbed my back while we answered all the questions we’d already answered in our pre-admission forms. She massaged my hands and feet in the ante-natal room, while I was hooked up to the monitor and leaking amniotic fluid into the chux pads beneath me. We joked, told stories and laughed together while we awaited a visit from the OB. Erin reminded us to ask questions that had come up in conversations at our prenatals about pain medication options. She took photos of me and my husband’s last moments as a family of two.

When the time came for me to enter the operating room, I was walked down the hall by one of the surgical nurses. I remember feeling scared, anxious, and ready to see my husband’s and Erin’s faces again as soon as I could. I remember really not wanting to lay on the operating table. I remember feeling very alone.

The prick of the needle in my back was startling, and the numbness that followed was anything but a relief. I hated the sensation of feeling nothing. I lay on my back, staring at the ceiling, listening to unfamiliar sounds: machines, voices, the clinking of surgical instruments.

“We’re going to begin now,” the doctor said.

“No!” I exclaimed. “You can’t! Where is my husband? Where is my doula? I’m all alone in here!” I started to cry. Someone hustled out the doors to usher in my husband and Erin. It still amazes me that no one noticed that I was a woman about to have her baby, and that I was alone. It hadn’t occurred to anyone in the room to bring them in.

Though I’m sure it was only a matter of moments before Zac and Erin were in the room after my saying something about their absence, it felt like a lifetime and I was quite upset when they got there. Erin immediately showed Zac where he could sit so that he could get in very close to comfort me.
To be honest, I don’t remember much that happened between the time they entered the room until the time I was recovery. During the procedure I went inside myself and focused on the feeling of my husband’s hand on my cheek, the sound of Erin’s breath. The warmth of my tears. I mostly kept my eyes closed. I remember my son crying when he was born. I remember Zac going to be with him. I remember Erin by my side, telling me, softly, in my ear, what she could see of my baby. When I expressed upset at the noises I was hearing during my repair, she asked me what was bothering me, sounds, smells, or sensations. I told her the sounds, so she spoke to me, telling me how wonderful things were going, how beautiful my baby looked. How close I was to having him all to myself.

Erin stayed with us for about an hour in post-operative recovery. She helped us with breastfeeding. She did all the things a doula is “supposed” to do. But what I will be forever grateful for is the human connection she forged with me and my husband in a maternity health care model that has all but done away with compassionate one-on-one care and support.

Erin encouraged us to follow our instincts, to trust ourselves, to trust our baby, and to educate ourselves on our options. She told us to ask questions, get answers, seek advice. She fostered communication between me and my husband, and shared with us an enthusiasm and appreciation for family, pregnancy, and the transformative power of labor and birth that is often forgotten in our “What’s on your baby registry?”-focused culture.

And I loved all of that so much, that I wanted to pay forward that same care and support to other mamas, babies, and families. That is why I am a doula.


Thank you for your beautiful story, Nicole!


Wednesday, June 15, 2011

Study Finds that Women Show a Shocking Lack of Knowledge about Childbirth

I was going to simply share this article on my facebook page, like I do a lot, but I couldn't think of what to write in the description as a good summary of the article to compel readers to click on it. I realized, as I scanned for a good quote, that so much information in the article was worth sharing, that I should just share the whole article here on my blog. Please read!




Pregnant women show an amazing lack of knowledge about childbirth options, study shows

Fewer pregnant women and their partners are attending prenatal education classes these days and appear to be quietly following whatever advice the doctor or midwife recommends, researchers said Monday.

Doctors, led by Dr. Michael Klein of the Child & Family Research Institute and University of British Columbia, surveyed 1,318 healthy pregnant women. They found many seemingly unprepared to make their own decisions regarding childbirth options, such as whether to have natural childbirth or a Cesarean section.
Fewer than 30% of the women, all first-time mothers, said they had attended prenatal childbirth classes. Many said they used the Internet or books to become informed about childbirth. Still, a shockingly high number could not answer basic questions regarding the pros, cons or safety issues associated with epidurals, episiotomies, Cesareans and other childbirth options. The women who were receiving obstetrical care from midwives tended to be more informed about their options compared with women receiving care from a medical doctor.

"[E]ven late in pregnancy, many women reported uncertainty about benefits and risks of common procedures used in childbirth," Klein said in a news release. "This is worrisome because a lack of knowledge affects their ability to engage in informed discussions with their caregivers."

The study was published in the June issue of Journal of Obstetrics and Gynaecology Canada.

The type of provider mattered greatly in terms of what kind of care women received. The researchers published a related study in May in the journal Birth that showed younger obstetricians were much more likely to favor the routine use of epidurals and expressed more concerns about the safety of vaginal birth compared with older obstetricians. The younger obstetricians seemed to view C-sections as the preferred option for childbirth, the authors noted. In the United States, efforts have begun to reduce C-section rates. About one-third of all U.S. women have a surgical birth.


This is shocking and yet seems accurate. Women turn their decisions over to their doctor, but don't realize that their doctor is not explaining all their options and providing informed consent/refusal information. DON'T BE PASSIVE! Take charge of your health care!

Don't just rely on the internet, or assume you'll have time to read all those books. There is no substitute for a prenatal childbirth education class, or any in-person education, for that matter, such as breastfeeding. 

And this was a subtle point that I hope you noticed - if you want more information about your pregnancy and childbirth options, hire a midwife!

(the study abstract, in case you are interested, can be found here: http://www.sogc.org/jogc/abstracts/201106_Obstetrics_5.pdf)

Sunday, June 12, 2011

Informed Choice and the BRAIN Acronym

I vary my prenatal visit topics depending on my client's experience and knowledge, but one of the things I talk about with every doula client is Informed Choice and Informed Consent. Specifically, we discuss what it will be like to exercise their right to informed choice during the sometimes highly emotional experience of pregnancy and childbirth in a medicalized setting where informed consent is not always practiced (sad, but true). 

An excellent tool to use to talk about this topic and help clients see what this looks like, especially during labor, is the BRAIN acronym. 

Use Your BRAIN! 

In most instances, there is time to discuss every treatment or procedure with the care provider. This includes the nurses, too, not just the doctor or midwife. The reason this is a great tool is because everything that happens to a patient should include an informed choice, which includes both the option of informed consent and informed refusal. Yes, the doctor has been to medical school, but that doesn't mean that everything she says or proscribes is based on scientific evidence, or that it is your only option. 

Benefits - What are the benefits of this procedure? How will this help me/my baby/my labor?
Risks - What are the risks of this procedure? How might this negatively affect me/baby/labor?
Alternatives - Are there alternatives to this procedure? Are there other options?
Intuition - What is my gut feeling about this?
Need Time, or Nothing - Can I delay this procedure and take some time to think about it/Discuss it with my partner? What will happen if I choose to do nothing for now?

The BRAIN acronym and Informed Consent exercise may seem obvious, but for many people, especially pregnant and laboring women, it doesn't always occur. Many people don't realize that they have the right to ask these questions or even to refuse certain procedures when they are being told they "have" to by a physician with authoritative knowledge. There is a social power play going on, and it is going on while a woman is nervous for her and her baby's health.

I recently had a client use the BRAIN acronym for informed consent/refusal that I had taught her and her partner! Her doctor started talking about induction at her 40 week prenatal visit, and then scheduled some dates for her at the hospital, even though he told her at 2 check-ups that she and baby were doing well. She felt very nervous about it, but also nervous because of the way the doctor talked about "what could happen" to the baby. So she went home and talked to her partner about the Benefits, Risks, Alternatives, Intuition, and Need Time aspects of the decision to induce. Then she called me and told me that the only benefit they could think of was seeing the baby sooner! Which wasn't enough to make them feel comfortable with inducing, so they decided to tell the doctor they'd like to wait until 42 weeks. So awesome!

  • No person should give you a pelvic exam or manipulate your cervix without your prior consent.
  • No person should pressure you into attempting induction unless it is medically necessary.
  • No person should pressure you to dilate faster for his or her own convenience.
  • No person should break your water or cut your perineum without consulting with you
  • first and gaining your permission.
  • You have the right to refuse a course of treatment that you feel is not in your or your
  • baby’s best interest.
  • No person should rush you to make a decision.

These things are true, and childbirth educators and doulas say these sort of things all the time, but they still happen. I see them happen. So it is an important thing to pass on to our clients -  YOU HAVE A RIGHT TO CONSENT TO AND REFUSE ANYTHING THAT INTERFERES WITH YOUR BODY OR THE BODY OF YOUR CHILD.

There are some great informed consent role plays out there, where mom and partner can practice asserting their rights. I really like these (via Prep for Birth), because these are very difficult situations that almost every woman birthing in a hospital will find herself in:
You are laboring along slow but sure. Early labor is taking awhile. Your contractions change and seem stronger. You go to the hospital and are 5 centimeters. Baby looks good on the monitoring in triage, so you are assigned a room. The labor and delivery nurse would like you to stay in bed and not move around or get into the shower/tub. That is ALL you want to do.
What would you do?

 Hopefully, you would use your BRAIN! Let's practice:

B: What are the Benefits of staying in the bed? Well, your labor has been normal and the baby looked healthy on the monitor. Your body is telling you that you would be more comfortable moving around. So why would the nurse ask that of you? There are benefits for the nurse - he/she can keep you securely hooked up to the electronic fetal monitor, the blood pressure cuff, possibly an IV, and all the other gadgets being used to record your vitals. That way she can leave the room to do other things but you are still being "monitored" by the equipment. The nurse has also been told in training that birth must occur in the bed and that the monitor is the best and only way to detect fetal stress, which in her experience happens all the time.

R: What are the Risks associated with staying in bed? Well, you would be extremely uncomfortable the whole time, especially if getting out is all you want to do. Another risk is that staying in bed may make your labor more painful and possibly slower. Moving in response to labor contractions and change of positions makes use of gravity and changes the shape of your pelvis, helping baby make his/her way down. The freedom to move and to use pain coping techniques like the shower gives you an increased sense of control and lessens your anxiety. (For more about the proven benefits of movement during labor, click here).

A: Are there alternatives to this procedure? Can we get more information about why the nurse wants you to stay in bed? If its to keep the baby on the monitor, you can request intermittent monitoring (every 45 minutes or so)? Or maybe something that is portable, like a fetoscope or a telemetry unit, and that way you can even get into the shower. If you have done your research, or if the nurse/doctor does theirs, you will know that Routine continuous EFM provides no benefit for babies and increases the risk of cesarean for mothers.

I: What is my Intuition telling me? Well, that's easy - its I WANT TO MOVE! 

N: Its ok to Need some time to think about it. You might choose to stay on the monitor for a bit and see if you can get comfortable with that. Or, after you gathered all the information you can from your nurse and or doctor on the benefits, risks, and possible alternatives, you just want a few minutes to talk to your partner and your doula about what you're thinking and feeling. There is no rush to decide.
 
 
Here's another scenario:
You have been assured that after your push out your baby, he will be placed right on your belly or chest for assessments even if he needs oxygen without separating you two. After you birth your baby, he is making good effort to breathe, is vocalizing, and his color is just right. The baby nurse wants to take him right away. You ask her to do all his assessments on you and she says no and without your consent takes him off to the warmer.
What would you do?




(Some may recognize this in a different form - BRAND. I like BRAIN better because it includes Intuition, and also because the "Nothing" and the "Delay" of BRAND seem too similar to me, and are encompassed well under "Need time.)

Thursday, June 9, 2011

Breastfeeding and Socio-Ecological Determinants of Health: PART FOUR


Interventions at each level of the Social Ecological Model:





These images may not be reproduced or redistributed. Please contact me for citations.

Tuesday, June 7, 2011

Breastfeeding and Socio-Ecological Determinants of Health: PART THREE


What are the social determinants of the lack of breastfeeding success? 
Here are the "Booby Traps" at each level of the Social Ecological Model:









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Sunday, June 5, 2011

Breastfeeding and Socio-Ecological Determinants of Health: PART TWO

Click here to view Part One


Initiation is not a problem. The benefits of breastfeeding are getting out there. Most moms want to breastfeed!

*Exclusive breastfeeding, for these purposes, means breast milk only. 


Income and educational status are also associated with breastfeeding: low-income women are less likely to breastfeed than middle or high income women; less-than high school education level women are less likely to breastfeed than more highly educated women.
 

These images may not be reproduced or redistributed. Please contact me for citations.

Wednesday, June 1, 2011

Tina Fey and the Teat Nazi's

Recently, I came across Tina Fey's funny and true Prayer for her Daughter and I really enjoyed it. This led me to sample her new book, Bossypants, and then decide to listen to the memoir on audio book. The audio book is really wonderful, because Tina Fey reads it herself so you get all her voice inflections and so on. I really enjoyed listening to Tina Fey's accounts of youth, her early career and her life in the TV comedy business. She keeps a light mood in her colorful descriptions about getting her period, going for her first gynecologist visit, and becoming a mother.
Unfortunately, just as I was really laughing along out loud in my car to her book, things took a strange turn when she got to her chapter on breastfeeding: "There's a Drunk Midget in my House."

She starts out discussing how, like most American women, she was overly exposed to infant formula but she also knew that 'breast is best'. She says that she chose to breast-feed, that it was amazing, really changed her as a woman, and is the most gratifying thing she has ever done. However, Tina Fey hit the usual Booby Traps, and only managed to breastfeed for about 72 hours. She supplemented with formula, and then she decided to pump her milk, which she did for about 7 weeks before switching to all-formula. She claims she pumped while watching Entourage while her baby was in the other room, which, while I don't know if this is true, was possibly the reason she wasn't able to pump very much milk.

All in all, Tina Fey felt like she was "trapped," "attached to a tit juicer," and that she had "failed at something that was supposed to be natural." These are, unfortunately, frequently-heard reactions to the modern-day breastfeeding and early motherhood experience. What Tina Fey, and most women, don't know is that they shouldn't feel disappointed in themselves, they should be disappointed in their culture and institutions that are pressuring them to breastfeed but setting them up to fail.

Tina Fey explains the common reaction that women have when they wanted to breastfeed but "fail." She felt defensive and grouchy whenever the topic came up, especially with women who successfully breastfed, or anyone who touted the benefits of breast milk. Unfortunately, she used these emotions to lash out at these women and call them "Teat Nazis."

These are the women who not only brag endlessly about how much their five year old still loves breast milk, but they also grill you about your choices. You can recognize the TNs by their hand-carved daggers:
“Are you breast-feeding? Isn’t it amazing? I really think it’s how I lost the weight so easily. Did you have a vaginal birth? I went natural and I didn’t even tear. Are you back at work already? Do you feel weird about going back to work? I just love my baby so much I can’t imagine going back to work yet. You’re not nursing? She’s only fifteen months; you should try again!”
Now, let me be clear; millions of women around the world nurse their children beautifully for years without giving anybody else a hard time about it. Teat Nazis are a solely western upper-middle-class phenomenon occurring when highly ambitious women experience deprivation from outside modes of achievement. Their highest infestation pockets are in Brooklyn and Hollywood.
If you are confronted by a TN, you have two options. One, when they ask if you’re breast-feeding, you can smile and say, “Yes. It’s amazing.” (You owe it to your baby to lie.) Or you can go for the kill. The only people who can shame the Teat Nazis are the Adoptive Mommies. If you have a friend who has an adopted child, especially one from another country, bring him or her around, because they make the Teat Nazis’ brains short-circuit: “How can I… feel superior… you… bigger sacrifice… can’t judge…” and their big ol’ dinner plate nipples pop off as they crumple to the ground and disappear.

This is where my enjoyment of the book dropped and I felt annoyed. Here was a mainstream icon and mainstream book encouraging women to be annoyed with women who talk about how wonderful breastfeeding is. No one should keep from discussing breastfeeding simply because it makes others feel guilty. This is like saying that a doctor should not discuss why their patient should eat better or exercise so that they don't make their patient feel guilty about being obese. There are true health effects of breastfeeding or not breastfeeding just as there are for being obese. Tina Fey calling women who love breastfeeding and encourage other women to breastfeed "Teat Nazi's" does little for the image of breastfeeding advocacy and in helping women choose to breastfeed. Stories from friends and public icons about being judged, berated or guilted for feeding their babies formula by militant breastfeeding supporters only contributes to anti-breastfeeding feelings and actions. It is a cultural Booby Trap and undermines serious public health efforts to promote breastfeeding.

Now, I do not think that anyone should judge others for the situations they find themselves in. I think anyone who was openly judging Tina Fey or any woman for trying to breastfeed and switching to formula is out of order.  No one should disparage women for bottle feeding, because they do not know that woman's individual story. But it needs to be recognized that a breastfeeding advocate, a.k.a. "lactivist," does not deserve the title "Breastfeeding Nazi" or any other form of such a term.

I also felt sad for Tina Fey and all the women who experience these sort of emotions, because it is not their fault and it is not the breastfeeding advocates' fault, either. Calling each other names, especially one with the word "nazi" in it, is wrong. Lactivists have not killed millions of people, and equating mass murder with breastfeeding advocacy undermines the lives taken during the Holocaust.

Lactivists encourage women to try breastfeeding in the first place (including educating on the benefits of breastfeeding and the risks associated with formula feeding), to keep trying, and give women the skills and tools to do so. The individuals are not to blame, the system is.  To read more about institutional and cultural booby traps that are setting women up to fail at breastfeeding, check out Best for Babes.
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