Tuesday, April 17, 2012

Personal Update

A lot of this blog is about sharing information that I find that's new or interesting, and not as much about personal doula updates anymore. I used to do a lot more back at the beginning of the blog when I was just starting out. I even posted some or my doula birth stories! But when I got some flack about sharing too much personal information, I sort of stopped.

Also, as I'm in grad school, I don't take on a lot of clients. My semesters have really been ramping up the longer I am in this program, and I just haven't felt like I could handle being on-call.  As a result, I don't want to come on here all the time and write about my meetings or births or impressions just in case my professional identity can be linked to this blog, and my clients get upset about something I say on here. Also, because I don't take on a lot of clients, there's less to share in general!

But since I haven't done a personal doula life update (or a "doula journey" post) in a while, I thought I'd take the time to write one down.

I've recently taken on some fabulous clients that are due this summer. One client interviewed and hired me at only 10 weeks gestation! So it has been an interesting experience having a client that long. I worried about the potential for having to go through a miscarriage with her (which thankfully didn't occur), and also about how to keep the relationship over such a long time (I'm used to the meetings all occurring in the last trimester of pregnancy - sometimes even the last month only!). So far it has worked out. I went on a hospital tour with them, so it was great to see them and chat then. She has kept up with e-mailing me with photos of her baby bump, the baby's sex, and lots of questions, so that's been great, too! They also invited me to a baby shower, and we will soon start our prenatal appointments together.

Two additional clients are both due in the same month, so I am glad to have some back up support from my wonderful back-up doula. With the first, the husband seems very concerned that he will have a highly active role to play, that I will just be there to give him reminders of what to do. Until I spelled that out multiple times in several different ways, I didn't see his smile. Dads are always all-business, while moms do most of the talking. My other client is of an older age, and I always find that the older moms who are pregnant for the first time do a LOT of talking. She tells me everything! I think it is really great. She is also delivering at a birth center that I haven't been to, yet, so I'm excited to meet the midwives there and have that experience.

Recently my doula friend who is still certifying asked me if she could shadow me on one of my births. She has already asked the permission of my client and gotten it. I have never had a doula shadow me, and I'm not sure how that will go! I almost don't feel like I'm seasoned enough to provide guidance for a doula-in-training, and I'm wondering how it will change the way I doula. Can anyone give any advice on this?

Once my semester ends I'll be taking a 5-day Certified Lactation Counselor (CLC) training. I'm very excited for this, as I've wanted to add additional breastfeeding training to my skill set, and also because I'm hoping it will provide hours for my birth doula re certification requirements with DONA.  If you're a DONA doula and you'd like more info on re certification requirements, they recently made a webinar on this topic! Additionally, serving as a preceptor at a birth with a doula-in-training counts as an alternative method to obtain continuing education contact hours!

In other news, I am officially Certified in Public Health, now that I've found out that I passed my CPH Exam!

Saturday, April 14, 2012

The Baby-Friendly Rap

A Tale of Two Births: The Baby-Friendly Rap
See birth at a Baby-Friendly Hospital versus a Typical Hospital. 
Cosponsored by the Breastfeeding Coalition of Oregon and the Massachusetts Breastfeeding Coalition.

Um, I definitely love that the breastfeeding success all depends on the presence of the Super Doula!

Want to know more about what this "Baby Friendly" hospital means? Here's more info on the Baby Friendly Hospital Initiative

Saturday, April 7, 2012

Cesarean Awareness Month

April is Cesarean Awareness Month!

Sponsored by the International Cesarean Awareness Network (ICAN). Check our their suggested advocacy recommendations:

Be an Advocate for Women

  • Search ICAN’s Hospital VBAC Policy Database to find out if your local hospital bans VBACs or not.
  • Does your local hospital have a VBAC ban in place?  Please contact ICAN with a short description of your situation and any specifics about the situation.
  • Write your elected officials. We provide template letters for your use and links for you to easily contact your specific legislators, as well as recommendations for who to write about Health issues.
  • Ready to start reversing VBAC bans?  Read 50 Ways to Protest a VBAC Denial and contact Barbara Stratton, ICAN’s VBAC Ban Chair.
  • Unhappy with how you were treated while in the hospital?  You might think you have no options but you do.  Read ICAN’s primer on how to file complaints about your maternity care.
  • Have you lost or been refused medical insurance because of a previous cesarean?  Please contact your state insurance commissioner to file a complaint and if you are willing to speak to the media, contact the ICAN Advocacy Director.

Check out this Public Service Announcement for more info on Cesareans and Vaginal Birth After Cesarean:

Also, raise awareness of what is happening with C-sections in the U.S. by sharing these publically available hospital cesarean rates.

How to Avoid a Cesarean Section

Thursday, April 5, 2012

"Sometimes we just like to let our clients BE"

A snippet of a blog post from MotherWit Doula called "Where the Magic of Doula Care Lies" in which she explains why "the magic of doula care lies in the relationship between the doula and her clients."
In my years working as a doula, I've come to understand that sometimes it can look to an unsuspecting nurse or doctor that we don't know our doula skills because we're not doing the general things they've learned about to support their patient. For example, sometimes, even though moms "should" be upright a lot through labour and "should" use the bath or shower in active labour to relax and reduce pain, it's important for caregivers not to assume we're ignorant of the application of these comfort measures simply because we're not suggesting them. My way of being a doula is to NOT be over-solicitous, meaning I don't with every contraction ask Mom to get up, change positions, haul out a ball or massage oil, or suggest things. Why? Because after a while it becomes a pain to hear the mosquito buzz of questions in your ear in labour. Sometimes we like to just let our clients BE. It's also important for caregivers to realize that our client has already probably pretty strongly let us know what she needs. Perhaps she's lying on her side because this is her "happy place" and is indeed progressing just great as she is. We can be trusted to ensure she's getting up to pee once in a while and in the process shaking her pelvis around a little. Unless a mom is clearly trying to avoid the hard work of active labour and needs a little energy reversal to shake things up, leaving her to it is often a wise choice.

I've heard doulas have encounters with nurses who thought the doula was acting very strangely, even ignorantly, by fully supporting the mother's insistence upon a seemingly early epidural, and were chided by the nurse who wanted to give them a crash course in comfort techniques. When (with the clients' knowledge and permission of course) the doula took the nurse outside the room and explained the mother was a survivor of sexual abuse and that they had in advance of the labour come up with a plan to demand an epidural when the pain started triggering feelings of emotional instability, the nurses immediately did what was asked, recognizing the value of the doula/client relationship. I remember walking the hall of a hospital and the mom stopped for a contraction, leaned over, and I rubbed her back in the way we had discussed, due to an issue with her sacrum. A nursing student ran up, and said, "Let me," and proudly "showed" me how to do a sacral press because I guess she had learned it was better, even though it was wildly inappropriate for this particular mom. I've had a couple of students chewed out by hospital staff for looking like they weren't doing anything for a mom who had just clearly told them she wanted to rest quietly for a while.

Doulas craft their relationships with their clients painstakingly and lovingly. We find out what coping skills they have to weather the sensations of labour, find out whether or not they prefer fancier breathing techniques, what kind of essential oils they like, and what scares them.

I particularly like this excerpt because I have had been in similar situations, where the hospital personnel seemed to imply that I wasn't doing enough. The reason for this is exactly as explained here above. 

Doulas, have you ever had this experience?  

"It may surprise some to know that our magic may run just a little deeper than double hip squeezes and lavender spritz."

Tuesday, April 3, 2012

Breastfeeding and Feminism

The 7th Annual Breastfeeding and Feminism Symposium in North Carolina was AWESOME!

I thoroughly enjoyed the conference last year, and this year was also incredible. It is such a great forum for dialogue with like-minded people on an engaging topic. It is also wonderfully transdisciplinary!

I'm sharing here some of the things I wrote down in my notes throughout the 2-day symposium.But before I do that, I want to introduce why breastfeeding is a feminist issue.

Is Breastfeeding a Feminist issue?

Read these great posts for more information on why breastfeeding is a feminist issue. I've included some quotes below, but I encourage you to click over!

Breastfeeding Medicine blog:
"Breastfeeding is not a “choice.”  Breastfeeding is a reproductive right. This is a simple, but remarkably radical, concept. Here’s why: When we frame infant feeding as a choice made by an individual women, we place the entire responsibility for carrying out that choice on the individual woman. "
"Feminists abhor cultural norms use guilt and coercion to label a woman’s behavior as “good” or “bad.” And breastfeeding advocates who focus on individual mothers, rather than systemic barriers, leave many women “booby trapped” between what they are told they should do and what is possible in the context of their lives. A choice that is not also a right is not really a choice — it’s a privilege." - Alison Stuebe, MD, MSc

From an editorial in International Breastfeeding Journal:

"Although research on breastfeeding has established that it is a maternal and child health imperative, yielding optimal short and long term health outcomes for both mother and child, breastfeeding is not fully recognized as a feminist, women's rights or women's reproductive health concern. Most second wave feminist scholarship and activism has presented breastfeeding as an "option" or a "choice" that is generally presented as not very different from formula feeding. A limited number within the feminist community has recognized breastfeeding as a women's health issue or a reproductive right. In fact, global support for women's rights generally ignores the rights and importance associated with all of women's roles as mothers, opting instead to concentrate primarily on other important issues such as employment and reproductive freedom." - Miriam H Labbok, Paige Hall Smith, Emily C Taylor
• Breastfeeding is a social and biological process wherein women must have the right of self-determination;
• Breastfeeding is a maternal and child health imperative and reproductive right;
• It is important to re-orient the paradigm from the current view that breastfeeding is a "lifestyle choice," to a paradigm that views breastfeeding as a reproductive health, rights and social justice issue so as to ensure the social, economic and political conditions necessary to promote success;
• Women's decisions to breastfeed should not result in the loss of their economic security or any rights or privileges to which they are otherwise entitled. 

From a World Alliance for Breastfeeding Action sheet:
"Breastfeeding is an important women's issue, human rights issue, and feminist issue, since breastfeeding empowers women and contributes to gender equality. Women who wish to breasted their babies but cannot - because of inadequate support from family or health workers, constraints in the workplace, or misinformation from the infant food industry - are oppressed and exploited. Groups and individuals interested in fighting for women's rights and human rights should take action to change this situation, and recognise breastfeeding as a woman's right" - Penny van Esterik

From Motherwear Breastfeeding blog:
"There are, however, several different feminist views on breastfeeding.  I'll summarize them here:
Liberal feminism:  In this view, breastfeeding is a social arrangement.  Lactation - making milk - is a distinctly female biological function which only women can perform, but feeding the baby is a form of social labor which can be negotiated.  Proponents of this view question claims of superiority of breastmilk over formula.  McCarter -Spaulding says that in this view, "Breastfeeding is seen as a gender difference that stands in the way of liberating women.  Bottle-feeding in this perspective would be seen as liberating."
Cultural feminism:  In this view, breastfeeding is seen as a special female role which should be protected.  In this view, complete gender equality may threaten those things that are uniquely female and male.  McCarter-Spaulding states, "Cultural feminism strives to reconfigure social and economic structures to accommodate this gender difference without resorting to biological determinism."
Feminist health activism:  In this view, breastfeeding is part of a political agenda which is aimed at helping women take control back over their bodies with information and support (think Our Bodies, Ourselves, but also La Leche League).  Viewed as a unifying perspective, this approach focuses on removing barriers which constrain women's choices, such as lack of paid maternity leave, the absence of break time or facilities to pump at work, and the particular challenges faced by disadvantaged women." - Tanya

Breastfeeding and Feminism Symposium - My notes:
They are going to be a little disjointed, but they are things I want to remember.
  • Paid maternity leave is a feminist issue
  • "Doctors are fountains of misinformation when it comes to breastfeeding" - train doctors and residents!
  • Why are practical solutions re: bedsharing not being taken up, as in other countries where they provide safety guidelines for c-sleeping?
  • The Ad Council "Babies were born to breastfeed" ad was so controversial it only ran for 2 years (most Ad Council ads run for at least 2 decades - Smokey the Bear, Friends Don't Let Friends Drive Drunk, etc)
  • I loved an anti-cows milk for infant feeding campaign from the early 1900's that shows why babies die. There is a tube coming from a cow's udder to the bottling location to the train station to the train to the town to the milk truck to sitting on your front porch to being fed to baby, all with no closed containers or refrigeration. There was also an ad showing home pasteurization method (this is historian Jacqueline Wolf's presentation, by the way). 
  • "y'all breastfeed, ya hear?" - country music radio station ad for breastfeeding - hilarious 
  • Industrialization - people began to look at clocks and schedule feedings instead if relying on the rhythms of life
  • Carbon footprint of breastfeeding
  • The words we use to describe breastfeeding (this is Miriam Labbok's presentation) - used to be "nursing" or "mothers feeding" and now its breast feeding. why "breast" milk? We say "cows milk" not "udder milk." 
  • Only in 1 in 5 breastfeeding papers published in peer review include any definition of breastfeeding. Focus is generally on the milk, not the feeding process. very different physiologically. women as breasts, not as whole humans. Women should be recognized as opposed to just a piece of the body or organ system.
  • Do women envision their feeding their child as an action by their breast, or by themselves? How do the words we use inform women and what do they mean to them? "pumping oneself" as opposed to "expressing milk"
  • Feminist emphasis on "choice" - breastfeeding, c-sections, but NOT car seats and other things that benefit moms and babies health! Choice - informed and based on un-biased info. It's a choice to exercise, but recommendation exists to do so, because its what's optimal. 
  • Rights framework - baby has the right to feed, mom has the responsibility to feed. BUT she doesn't have the responsibility if her rights are not supported!
  • Prevalence of maternally reported breastfeeding problems and/or concerns were reported most at day 3. Mom's reporting support are less likely to report concern prenatally and postpartum with bfing. If we could eliminate anyone reporting difficulties at day 3 we could get rid of 25% of stopping by day 60 (statistically significant relationship)
  • Moms can overcome lack of support, but they shouldn't have to
  • If Step 6 of the Breastfeeding Friendly Hospital Initiative is not followed (formula supplementation and formula samples) there is a 10.5 week reduction in breastfeeding duration. If mom got formula she breastfeed for about 10.5 weeks less than if she hadn't (hospital followed step 6). Combinations for 2 steps - If not provided Steps 4 & 9 together (not able to BF in first hour and provided a pacifier) 11.8 decrease in BF duration. If not provided 8 & 9 together (not fed according to hunger cues and provided pacifier) 6.3 week decrease in BF duration. If not provided 7 & 8 (did not room-in and not fed according to hunger cues) 5.7 week decrease in BF duration. Step 6 is the most challenging for hospitals - $$$. Maybe other step combos could serve as attainable step if formula stop is not. 
  • First few days are KEY! 
  • Kenya - mother's that exclusively breastfeed must be HIV positive - stigma
  • Mothers who breastfed and who formula fed and who were pregnant all viewed formula ads. Quotes - "is my breast milk doing all that formula does?" formula is a panacea, solves all problems like fussiness. "can't change my milk but I can change my formula" best science, technology. Message is you can't manage on your own. High failure rate assumed "we're gonna try" - disempowering. "Doc wouldn't give it to me if it was wrong" Docs say breastfeed but give formula - contradictory. Women from exclusive BF group more likely to question the validity of studies cited to support claims made in advertisements - what is it about these women? high self efficacy? where does this come from?
  • Men in the work force is decreasing, moms in the the workforce is increasing
  • Breastfeeding at the breast and pumping are not the same - baby is not necessarily present at pumping, breastfeeding is a public or private activity while pumping is a private activity - can be easily hidden. Research doesn't distinguish between. (Paige Hall Smith's presentation - Does feeding method matter at work?) Really interesting emergent ethical analysis - unfair or discriminatory comparison, comparison with other biological needs, employment status, etc related to breaks to pump or feed. Body as functional (peeing, smokers, diabetics) - fewer restrictions. Body as sexual - more restrictions. Feminism: biology-based discrimination. woman's body is a greater issue than having baby on-site. Avoid policies that regulate women's bodies!
  • A spanish "unnecessarean" site! 
  • Gendered profession of lactation consulting - depersonalization of biomedical male (male OB is ok but not IBCLC). 
  • Sympathy for the baby initiated change in OB practices, not the mother.
  • NICU peer breastfeeding counselor program - shared experience was more important than shared demographics
  • Haiti - belief that colostrum is poisonous, BF can cause intestinal parasites and diarrhea and is stopped if this occurs. Changing view of colostrum as a natural "lok" - something to help pass the meconium
  • Realize that it is a slow and steady process to change cultural norms
  • Women want to stay productive while pumping at work. Support from colleagues vary from very supportive to actively malicious "I don't want to even see your black pump bag because I know what you're doing" Staff made moo-ing noises in front of pumping employee

Related Posts Plugin for WordPress, Blogger...