Saturday, September 24, 2011

Weekend Movie: Birth and Indigenous Identity in Ecuador

I saw this very interesting documentary at the Society for Applied Anthropology meeting in Seattle earlier this year: Cañar, Ecuador: Birth and Indigenous Identity in the 21st Century.


Ecuador is a country of extraordinary beauty and diversity, captured in this stunning film about a group of indigenous women in the Andean Highlands. Preview this documentary produced by anthropologist Suzanne Morrissey and film maker Patricia Keith. The stories of mothers, midwives, and nurses trace the complex relationships between indigenous politics, social change, and health care choices. Why in spite of a strong resurgence of native midwifery in the past decade are women like Lucinda, Veronica, and Rosa choosing to give birth in hospitals rather than at home, electing pain medications and epidurals while respecting and desiring traditional practices? How does Mama Mariana, revered midwife and Ministry of Health nurse, convince the State to allow midwives to assist in births at the public hospitals?

I'm busy this week reading and planning for a class discussion in my reproductive health anthropology class - the topic is birth and breastfeeding! More on that later :) 

Thursday, September 15, 2011

Meconium

I've done a post on vernix, and one on the "ring of fire," among other useful things to know about childbirth that you may not know about, and now its time to do a post all about meconium!

Meconium is the first poo of a newborn. It is thick, sticky, brown and sometimes dark greenish. It is made up of what the baby was ingesting inside mom's uterus (like water, amniotic fluid, cells, vernix, etc) and is pretty sterile. It usually passes after the first couple days of the infant's life, turning into the more liquidy poop of a milk-fed baby.

If you're going to be a parent, you'll be seeing a lot of this!

I also just learned this interesting information:
The term meconium derives from ancient Greek meconium-arion, or "opium-like." Aristotle developed the term because he believed that it induced fetal sleep.
I've been asked a couple times about whether the baby poops or pees inside the uterus before being born. The answer is generally "no," but also "sometimes."

Occasionally, the meconium will be present in the amniotic fluid when the membranes rupture (a.k.a. when the water breaks). About 15-20% of babies are born with meconium in the fluid among term-pregnancies, and is increased to 30-40% among post-date pregnancies.

There are a few reasons why this would occur:
1. Women who are truly post-dates are more likely to have a baby that has "meconium-ed" in-utero. This is because their digestive system and bowels have reached maturity and started working.
2. Cord or head is being compressed during labor, which can cause heart rate decelerations, and is a normal physiological response and can happen without fetal distress.
3. True fetal distress. One theory is that the baby either isn't getting oxygen (hypoxia) or is stressed for another reason and poops in response.
Fetal distress can be present without meconium, and meconium can be present without fetal distress. The best indicator of fetal distress is abnormal heart rate, especially if coupled with meconium, and especially if the meconium is thick rather than thin.

Unfortunately, any presence of meconium in the amniotic fluid is cause for alarm among hospital staff. If meconium is discovered in the fluids, the laboring woman will be confined to labor attached to the monitors, with her movement restricted, which reduces her ability to move with her contractions to help the baby down through the pelvis and also restricts her ability to walk or use the shower for comfort. A time limit is also placed on the labor, and the risk of augmentation, c-section, or instruments to speed along the birth are increased. Once the baby is born, the cord will be immediately clamped and the baby will be whisked away from mom, rather than placed on her chest, to be vigorously suctioned.


The suctioning is done for fear of meconium aspiration. Meconium aspiration is when the baby inhales her own meconium, which is extremely rare but can be fatal. It is unlikely that the baby will inhale meconium in utero, unless the baby is extremely hypoxic, in which case they are gasping for air and might inhale their own stool. So, once again, meconium alone may not be a problem, but an oxygen-deprived baby showing other signs of distress may have a problem.

So, if this newborn poo during labor and birth is such a cause for concern, don't you think that care givers would do everything they could to reduce this occurrence? Unfortunately, in the U.S. at least, they do not. It is common practice to do procedures that have been scientifically shown to increase the chance of hypoxia, fetal distress, and meconium aspiration syndrome. For example, (via Midwife Thinking blog):
  • Inducing labour if the waters have broken (with meconium present) and there are no contractions or if labour is ‘slow’ in an attempt to get the baby out of the uterus quickly.
  • Performing an ARM (breaking the waters) to see if there is meconium in the waters when there are concerns about the fetal heart rate.
  • Creating concern and stress in the mother which can reduce the blood flow to the placenta.
  • Directed pushing to speed up the birth.
  • Having extra people in the room (paediatricians), bright lights and medical resus equipment which may stress the mother and reduce oxytocin release.
  • Cutting the umbilical cord before the placenta has finished supporting the transition to breathing in order to hand the baby to the paediatrician.

To reduce chances for complications from meconium, try to avoid the above. For more suggestions on what to do when there is meconium in the amniotic fluid during labor, click over to the post linked above! She has even more information about how the airways are cleared during vaginal birth as the baby is squeezed through the birth canal!

The biggest piece of advice I would give is to avoid artificial rupture of membranes early on in labor unless there are other serious indications of fetal distress. Once meconium is discovered, the whole birth plan changes, even if the baby is doing fine!


References:
http://www.sciencedirect.com/science/article/pii/S1751721410001120
http://www.hon.ch/Dossier/MotherChild/labor_complications/birth_meconium.html
http://midwifethinking.com/2010/10/09/the-curse-of-meconium-stained-liquor/

Tuesday, September 13, 2011

Being a Doula is Hard

I don't think I've ever found a blog that talks about how hard being a doula is, but I think I'm going to be the one to do it.

Most doula blogs talk a lot about why they love being a doula, as I've done before myself, but don't always get into just how difficult the lifestyle can be. And since I've recently inspired someone to begin their doula training, I've been thinking lately about whether or not the doula life can seem too romanticized (at least to birth junkies).

Now, don't get me wrong, I really do find doula work rewarding. But I think its important for doulas to understand that the reality is you're probably going to lose sleep, have physical aches and pains, miss events you were looking forward to, and cry.

What are some of the potential worst parts of the job for a doula?
Nervousness about being called at inopportune times, being woken up at all hours of the night, working on very little sleep, having to be in hospitals all the time, dealing with difficult care providers, being emotionally and physically supportive to someone else in their most vulnerable time, and having to be the most attentive you've ever been.
There's also the fact that doula work is not always steady, many people don't always want to pay a reasonable fee (under-appreciated), having to find childcare, and sometimes you're just treated like crap by people.

In my case, I think its the extremely emotional nature of the job that has affected me the most.

There are some truly wonderful, magical births out there that will make you feel like you're floating on a cloud. And then there are some truly agonizing and stressful births that will leave you upset, angry, and possibly traumatized. To quote a good doula friend of mine, "We become collateral damage."

Women can have post traumatic stress from birth experiences, and doulas can have it from attending births. And sometimes, the doula is hit hard emotionally, while the mother feels OK. Its not always clear what is going to upset you.

You will have births that will keep you awake at night agonizing over how it could have gone differently if only you had done ____, the mother had done ____, or the doctor had done ____. Or you may not know, and spend weeks wondering why and how. 

You will have clients who frustrate you to no end for a multitude of possible reasons, such as 1. they refuse to take childbirth education classes or read the books, because they are simply relying on you/the nurse/the doctor to get them through it, 2. read everything there is to know about the risks and complications of induction/cesarean section/whatever and choose it anyway, 3. will soak up everything you say about how they can make their own, refuse any procedure, and what is evidence-based, but then ignore it all and agree to everything their doctor says anyway, 4. get upset when you do or don't do something even though its clearly stated in your contract that they signed, and so on.

Doula work has been the most emotional work I've ever done. It has made me feel elated - "I'm making a difference!" and completely depressed - "I'm not making a difference at all." I think the hardest thing is that doula work is usually done because of the doula's passion for improving women's birth experiences. And for me, in particular, its about making a positive change in maternity care. And many times I feel myself losing the fight.


How can a doula deal with all this emotion so that she doesn't get too burnt out? Some doulas turn to things fixes such as only taking out-of-hospital births. For me, though, the only things that help are:
1. Have a doula friend or two to vent to! Bitching and moaning about U.S. maternity care or just crazy clients, or simply discussing a birth and getting help processing what happened is really the best thing you can do for your emotional health.
2. Getting online or picking up a book and reading inspirational ways in which change is being made and can be made in maternity care, and birth stories of women who had beautiful, empowered births.

What are some of the hardest parts of the job for you, doulas? And what are ways that you like to process and decompress after stressful doula-related events?

Saturday, September 10, 2011

Wednesday, September 7, 2011

Doula Anthropologists


While to some (i.e., my family) it may not seem obvious that doula work and the study of anthropology go hand-in-hand, there are actually quite a few doula anthropologists out there in the world! 

Some are doulas who have studied anthropology in the past, some are now midwives, some are anthropologists who used to be doulas, and so on in many combinations of identity. 
You know that website, This is What a Doula Looks Like? This is like my own mini version of "this is what an Anthro Doula looks like!"

From a quick, cursory search, I have found on the internet the following fellow "anthro doulas":
Melissa Cheyney, PhD, CPM, LDM, professor of medical anth

Michelle L’Esperance, Certified Professional Midwife and Doula, anth alum
Nancy Madr, postpartum doula, MA medical Anth
Brandy Segin, Birth doula and childbirth educator, BA Anth
Beth Rees, postpartum doula, anth alum
Tara Kenny, CPM, CLC, doula, BA Anth
Risa, doula, Anth doctoral student
Vanessa Pisias, PPD and CBE, BA Anth
Megan Davidson, PhD Anthropology, Doula, CLC, PPD

And probably a lot of YOU, my readers! If you are an Anthro Doula yourself, please introduce yourself in the comments!
Even though this photo is used a lot for "doula," I identify with it anthropologically because it evokes "traditions" and "culture" imagery in my mind.
(If your name is on this list and you would like it removed, please let me know. These are all just links via a google search)

Sunday, September 4, 2011

Weekend Movie: One World Birth

One World Birth is a unique free video website featuring evidence-based information and opinions from the world's leading birth experts including:

Ina May Gaskin, Sheila Kitzinger, Michel Odent, Elizabeth Davis, Debra Pascali-Bonaro, Cathy Warwick (RCM), Mary Newburn (NCT), Marilyn Curl (Lamaze International), Dr Sarah Buckley, Professor Soo Downe, Professor Lesley Page, Professor Cecily Begley, Professor Kerstin Uvnas-Moberg, Professor Ngai Fen Cheung, Associate Professor Denis Walsh and lots more leading midwives, academics, obstetricians, authors, doulas, birth educators and birth warriors around the world.

About One World Birth:



"Each month One World Birth will follow a particular theme. This month’s theme is The Big Picture of birth issues today. We have created short, edited videos as well as individual clips – no lengthy, indigestible text, just videos which you can browse so that you can watch what you like, when you like. What we want you to do is to grab videos that appeal to you and share them on social networks and put them on your own blogs or web sites."

Check it out!




and Happy Labor Day!
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