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Tuesday, November 27, 2012

Changing Your Married Last Name

Recently, two blogs - The Feminine Mystique and from two to one - started The Last Name Project in which they profiled "a diverse set of individuals and couples who are single, engaged, and married about how and why they decided on their last names." 


I came across this project via Molly at First the Egg, who shared her story. She writes of "the historical resonance of the femme covert, of marriage as the transfer of not just a woman’s property but of a woman as property, of her loss of her legal standing and identity along with her original name" and that she is "suspicious of the rhetoric of free choice and interested in the structural and institutional forces that constrain people’s choices." She writes,

It’s hard not to notice that the vast majority of hetero couples who want ‘a family name’ choose the male partner’s surname. Sometimes specific factors of personal history or values make that the best option; sometimes the couple outright acknowledges not wanting to swim upstream; but often, friends making this choice insisted that they just coincidentally preferred the man’s name. This obliviousness to the historical and cultural pressures at play in one’s decision, to the larger statistical realities in which this individual drama plays out, worries me.
The Huffington Post picked up the project and posted a slideshow with some quotes that represent some of the opinions of those who contributed to the project about changing married last names. The  explanations include why the women and men decided to do the various options, both for themselves and for their children: The woman keeping her name, Changing her name, Hyphenating, Taking both names un-hyphenated, Keeping a name professionally but changing it legally, Being undecided, The man taking the wife's name, Alternating names, and Choosing an entirely new name. If you want to read the stories from any of these categories, they are all laid out here. 


Long before my fiance and I became engaged, we discussed what we would do with our last names were we to marry. For me, hyphenating was out of the question (I'm just not a fan of everyone ending up with hyphenated names, including the kids. And then the hyphenated kids growing up and marrying hyphenated kids - ahhh!) I told him I didn't feel particularly attached to my last name (it is kind of boring and short, and has lame jokes associated with it, and was changed in my family's recent history so I don't feel like it connects me to my roots). He told me that he wasn't particularly attached to his last name, either, and he didn't want me to have to change my name just because I'm the woman. So we discussed choosing an entirely new name!

We toyed with ideas like choosing a really cheesy last name so we could be "The Darlings." We also thought it would be funny to pick a traditionally ethnic-sounding name, like "The Zhangs" so that when people saw our name before meeting us in person, they would be incredibly confused that we weren't Chinese. Ok, lame, but they made us giggle.


I was excited to find, through the Last Name Project, that we weren't the only ones with this idea. For example, [Abby] and her husband chose the last name Phoenix for a variety of reasons including the word's symbolism and that it sounds really cool. [Sue]  and her husband combined their last names into one word. [M] and her husband shared an Irish heritage, so they pulled out the Gaelic Irish dictionary and picked a name that had meaning for them both. [Mike] and his wife [Danielle] also picked a surname that had meaning for them, and kept their old last names as their middle names. Click on their names if you'd like to read more about what went into their decisions and how their families have reacted.



Unfortunately, in my case, neither of us have a strong heritage that we'd like to express with our last name. I think picking a new name entirely would be fun, but I wonder if I'd ever get used to it as a name rather than the random word we chose. I understand the historical context that Molly brings up above, but feel that choosing a random name would be just like choosing his name - neither of them mean, to us, that he "owns" me. Since we're not married yet I still have time to reflect on this.

What do you think? Do you have a last name choosing story to share? What do you think of all the different options laid out above? 




Sunday, November 18, 2012

WHO Code, No Nestle, Conflict of Interest

Recently, news broke that the World Health Organization accepted money from corporate sponsors such as fast giants, such as Nestle, to fund its obesity-fighting campaigns. Oh, the irony.
A Reuters investigation found that WHO's regional office has turned to the very companies whose sugary drinks and salty foods are linked to many of the maladies it's trying to prevent.
The office, the Pan American Health Organization, not only is relying on the food and beverage industry for advice on how to fight obesity. For the first time in its 110-year history, it has taken hundreds of thousands of dollars in money from the industry.
Accepting industry funding goes against WHO's worldwide policies. Its Geneva headquarters and five other regional offices have been prohibited from accepting money from the food and soda industries, among others. 

This is a conflict of interest - Food and beverage companies donating money to nonprofit groups that are fighting the very diseases that their products have helped to create. The WHO is unwilling to accept money from tobacco agencies, why should this situation be different? 

The news went viral, and social media users began to tweet their outrage:


From the article on Breastfeeding Science Outrage sparks Twitter battle between UN health watchdogs WHO, PAHO:
After fighting industry for years to uphold an international code to protect moms and babies from predatory marketing, there was outrage when it was learned PAHO accepted $150,000 from Nestlé. This is a direct violation of what is known as the WHO Code and moms and breastfeeding support workers are furious.
No Nestle
Nestle violates the WHO/UNICEF International Code of Marketing Breast-milk Substitutes, which it agreed to abide by in 1984. Nestle unethically markets infant formula to poor mothers in developing countries, where babies are more likely to suffer and die from gastrointestinal issues caused my feeding their babies formula (often with un-clean water) than breast milk (which protects the baby from illness). They promote infant formula unethically, providing gifts to health providers to promote their product, and they distribute free formula in hospitals (disrupting lactation) which poor families must then continue to pay for after there are no more freebies. (Click for more on the Nestle boycott)

Using Social Media for Powerful Change
The Lactation Matters blog, in the post  World Wide Impact in 10 Minutes or Less: Using Social Media for Powerful Change, wrote that the WHO began to respond to tweets:


Breastfeeding Science posted a tweet where PAHO responded to the WHO, but interestingly, it has been deleted from their Twitter page. PAHO does have different standards than the WHO regarding business partners, and they have been cash-strapped on programs dealing with obesity due to budget cuts.

Clearly, social media can have an impact. As Anthropologist Margaret Mead is famously quoted “Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it’s the only thing that ever has.” 

Join the conversation!
1. By joining the Facebook group Friends of the WHO Code and 
2. Tweeting about it! This is one example of how Twitter can be really useful. If you have a twitter account, just copy and paste:


#WHOCode protects women&babies from predatory marketing. Shame @Nestle for trying to buy seat at the @PAHOWHO table #nonestle #breastfeeding

Tell @PAHOWHO to give back @Nestle $150K #nonestle #WHOCode #breastfeeding #conflictofinterest http://t.co/nnWJCIfX @WHO

We will not be bought! @PAHOWHO please return the money to @nestle Stand up for mothers and babies. #WHOCode #breastfeeding #nonestle

Regulation
It is important to note that the WHO has no regulatory authority, and many nations lack legislative reinforcement. So while this is a conflict of interest, pressure on PAHO and especially Nestle may be the biggest ways to have an impact. Don't let this move undermine the Code. 



Saturday, November 17, 2012

World Prematurity Day



Did you know that no one knows why some babies are born premature? The exact cause remains unknown. 

Some things are associated with the risk of preterm labor and birth, but correlation does not equal causation. These include infection, placental abruption and bleeding, multiples, a short cervix, and too much amniotic fluid. Young or old mothers are at increased risk, as are women who have had a previous preterm birth. It has also been associated with women who are unmarried, low-income, and African American.

EDIT: I just found a recent study published in the Lancet that found that the following five interventions can reduce the preterm birth rate from about 9.6% of live births to 9.1% and save $3 billion in the process:
1.Discouraging elective C-sections and labor inductions unless there’s a compelling medical reason
2. Reducing the number of embryos transferred during fertility treatment
3. Helping pregnant women give up smoking
4. Providing women with high-risk pregnancies with progesterone supplementation
5. Performing cervical cerclage, a minor surgical procedure, on pregnant women with short cervixes

Many people don’t realize the statistics of preterm birth: 15 million babies are born preterm around the world every year—that’s 1 in 10. More than 1 million babies die due to complications of preterm birth and many of those who survive face a lifetime of disability.



The U.S. map is looking a bit different than it was last year. This year there is more than 1 state that has an "A"! But, the same four states still have an "F"
March of Dimes 2012 U.S. Premature Birth Report Card


Learn about Premature birth all over the World:




The World Prematurity Day facebook page has some pretty photos posted from other countries for World Prematurity Month:

N Ireland

Brazil


Macedonia

Slovakia

Monday, November 12, 2012

You Learn Something New Every Birth

artwork (c) Amy Haderer mandalajourney.com

I'll admit, I don't usually back my doula bag until my client's are 40 weeks. I know this isn't perfect doula practice, but there are two reasons: 1. My bag stays almost entirely packed with my doula tools all the time anyway (I just have to add things like toiletries, snacks, medications, phone charger, sweater, etc), and 2. My clients never seem to go into labor before 40 weeks.

This is another reason that I find the whole "40 weeks is your due date and then after that you're late" thought-process to be completely flawed. Nearly all my clients have gone into labor AFTER their 40 week mark. There is no timer to go "ding!" that means you are "done" at 40 weeks! (but for more on estimated due dates, see this other post, or this one)  And not just first time moms!

Back when I was a brand new doula, my bag used to be packed at exactly at the 38 week mark. I was also more paranoid in general - not a single drink during my on-call period, no foods with onion or garlic (so my breath wouldn't smell bad), obsession with checking my phone all the time and with every single plan I made (can I go to the movies?), and so forth. I remember each birth that occurred prior to the due date:

I had a first time mom go into labor before 40 weeks, but that was an effort on her part - she asked her midwife to sweep her membranes at around 39 weeks (see bottom of post for an explanation if you don't know what this is), and it worked the very same day. I knew in advance why she wanted to go into labor earlier than her due date and she kept me informed of her techniques.
A third time mom went into labor at 38 weeks, a week after I met her and she hired me.
I also had a first time mom go into labor on her exact due date, which is so rare that it was shocking.

And then just recently, with no warning at all, I got a phone call in the middle of the night from a mom who had no major warning sign that she would give birth before 40 weeks (other than the fact that she really didn't want to be pregnant anymore, which is like most women), and had to scramble around and pack my bag! I found out that she was taking evening primrose oil capsules, on her midwife's advice. I'm not sure why she was taking them, or why the midwife advised her to take them, prior to her estimated due date. Perhaps the midwife always prescribes it. Perhaps the mom was incredibly impatient and so that's why the midwife suggested it.

Evening Primrose Oil is a supplement that can ripen the cervix because it is high in prostaglandins. Prostaglandins are sometimes administered directly in the vagina by a doctor to prepare for a labor induction. Semen also contains prostaglandins, which is one reason why they say sex can start labor! Evening primrose oil doesn't exactly induce labor; it helps soften the cervix in preparation for labor. I don't know much about EPO so I asked about it on twitter.  Respondents said that it can have side effects and should not be used routinely and perhaps not unless an induction is looming for post dates, and that there is not a lot of research on EPO. Apparently side effects can include upset stomach and headaches.

A quick survey of the literature came up with a retrospective quasi experimental study of 108 low-risk nulliparous women that found:
Findings suggest that the oral administration of evening primrose oil from the 37th gestational week until birth does not shorten gestation or decrease the overall length of labor. Further, the use of orally administered evening primrose oil may be associated with an increase in the incidence of prolonged rupture of membranes, oxytocin augmentation, arrest of descent, and vacuum extraction.
Another article on midwives' use of herbal preparation for stimulation of labor found that there were no reported complications in the use of evening primrose oil or red raspberry leaf tea and that evening primrose oil was the most efficacious herbal preparation for cervical ripening. Most else of what I could find just says that there is a lack of evidence. Basically, that more research is needed.

Anyway! She went into labor prior to 40 weeks and the labor and the birth went well. I always tell my clients that I will come when they feel they need me. Sometimes in the middle of the night I really hope that even though they're calling me, they'll see that their contractions are still "early labor" contractions and they won't "need me" right now. With this one, I did end up getting to her house a bit before an active labor pattern was established. This has happening to me a couple times. This is hard for a couple reasons: First, now everyone feels like we're in active labor mode and it's hard to not feel rushed once the doula is there and you feel like everyone is waiting on you and watching you labor. Second, it would be nice if everyone (mom, partner, and doula) all got some more sleep, but now sleeping arrangements are awkward. And third, several other things are also awkward - instead of needing active help all the time, we're hanging around at home watching TV and making lunch, etc. But the second ones are more about me, and so... see number one!

But it is also highly beneficial for me to come early in several instances. Once, it was because mom and dad had me meet them at the hospital and mom was only about 4 cm dilated. They walked around trying to decide what to do: Be admitted and be in the hospital the entire labor, being pressed for time and to adhere to the ridiculous "1 cm per hour" rule? Or go home and try to sleep, and hope that in their own environment labor would move along at a comfortable, un-stressed pace. Perhaps if I hadn't been there at the hospital to discuss things they wouldn't have gone home (and ended up having a great labor!)

Most recently, I was glad to sacrifice my time/comfort/sleep/whatever to be with mom and dad early in order to reassure them and keep them at home. This is a big one. I have been told so many times, "if it weren't for you, we would have just gone to the hospital at [2 am, 4 am, etc]!" And mind you, this is JUST after labor contractions start. You really shouldn't go to the hospital at the start of labor, for a multitude of reasons. 1. they might send you home if you're not 4 cm or more anyway, 2. hospitals can be stressful places where labor actually slows, 3. if you want a natural labor, the longer you are in the hospital the more likely things will be done that make this harder (i.e. stay in bed the whole time, pressure to get pain meds, you aren't allowed to [eat, drink, pee, use the shower for pain relief, etc], let's manage this labor a bit more with drugs, etc), 4. you will be rushed for time (it's been ___ hours since ___ so we need to do ___) even though there is no medical reason to do so, and 5. I could probably think of more if I wanted but I'll stop there.

Several times if I hadn't showed up right away mom and dad would have just listened to some direction (that always changes) like, "come in when contractions are 5, 1, 1" or "come in when your water breaks" or "come in so we can see how far you've progressed" which have no basis other than they just want to manage labor. I have been told a million times, "I am so glad we labored at home," and "this is really great laboring at home," and "I'm glad we didn't go to the hospital right away." And even from hospital midwives, who are impressed that the mom comes in at 8 cm or 10 cm because that is so rare for them (and I've even got a "way to go, doula!"). But it is hard, especially for first time parents, to want someone there with them to can reassure them about what is normal and answer a million questions about labor positions, eating and drinking, whether or not they should try sleeping or walking, and of course the big one - when should we go to the hospital? [And in this instance, interestingly, many a question was answered along the vein of "is this going to make the contractions worse? Such as "Is a cold beverage going to make the contractions worse?" and "Is a shower going to make the contractions stronger?"] I have witnessed many many more labors than they have and I know what a contraction pattern or mom's temperament means.

Just as an aside, I always let the couple decide when it is time to go to the hospital. I give advice if asked, but if they feel it is time, we go. The only instances in which I say "ok it's time to go now" are when mom says her first "I feel the urge to push"! And I should also add, here, that we've left while mom felt like pushing many times and always made it to the hospital in time (even with a third time mom); They have all still had to actively push for a period of time in the hospital. This is always a big worry, but the stories you hear about babies being delivered in the car are rare (though I'm not denying that is possible to wait too long to go, or to have an exceedingly fast labor).

Talking about doula self-sacrifice - my body was really aching after my last doula labor! Whoever thought that becoming a doula was all fun and babies, you should really recognize how hard being a doula can be, sometimes.

I also wanted to mention that a recent labor was attended at a Baby Friendly Hospital. I want to share this experience, because it wasn't quite what I thought it would be. Firstly, the nurses asked the mom immediately after delivery if she would be bottle feeding or breastfeeding. This is interesting in two ways:  1. I did actually think it odd that a hospital with the highest support for breastfeeding there currently is is even asking a mom if she is breastfeeding, instead of assuming that she would do the norm (and yes, wanting to breastfeed is the 'norm' - 75% of women in the U.S. initiate) and only require formula in case of complications (which is what formula should be used for), but...  2. For the people who say that going baby friendly hurts moms who want to bottle feed because it pushes breastfeeding on everyone, clearly if they are asking moms, this isn't true.

Secondly, I was under the impression that BFH's do uninterrupted skin-to-skin and make sure mom has help in trying to initiate breastfeeding in the first hour after birth. I was under that impression... (Perhaps you see where I am going with this?) This mom had her baby on her maybe 20 minutes of the entire first hour and twenty minutes of baby's life. They were doing the usual - weighing, measuring, drawing blood, eye ointment, letting dad take photos, etc in the baby warmer instead of letting all that wait and giving mom the chance to warm and feed and bond with the baby, all of which is good for both the baby's blood glucose levels and the breastfeeding relationship. Oh, and they did the typical swaddle the baby and we had to un-swaddle him to put him back on mom, and then they took him off a second time. And the entire time no one was helping with breastfeeding but me! Until finally a baby nurse came back in and then repeated EVERYTHING I had just been saying and doing. Grr. So frustrating. I do think this nurse was trained in lactation, luckily, but I don't know if all the nurses are, because all she said is "you can ask any nurse for help with breastfeeding." Which is what they all say everywhere, even if the nurses aren't trained in lactation.

The point of all this is... you learn something new every birth. Or many somethings. For instance, I also learned that if a mom is GBS+ she should really get the IV antibiotics in her system at least 4 hours before delivery (so don't wait too long to go to the hospital with a GBS+ mom).

Or sometimes, many things are affirmed. For instance, you really can't tell if a mom is going to take one hour or several hours to go from ___ cm to 10 cm. Or like how sometimes L&D nurses are all the same. And sometimes they're idiots (Sorry, just really annoyed at an L&D nurse who told my client to tell her if she had a continual urge to push,  even in between contractions, which is NOT how it works. And then wouldn't let mom stand beside the bed when she felt pushy because she was afraid she'd have the baby on the floor, even though she had just checked her and she was only 8 cm and was not going to push a baby out that fast. Ok, rant over).

Ok, POST OVER! Thanks for sticking with it til the end :)


--> A membrane sweep, or stripping the membranes, is not the same as breaking the bag of waters (amniotic sac). It is done by inserting a finger between the membrane that goes around the amniotic sac and the wall of the uterus to loosen the membranes from the wall. Sometimes this stimulation of the uterine wall can help to start labor. It doesn't work for everyone, may or may not be uncomfortable, and can sometimes cause the water to break.

Wednesday, November 7, 2012

Third Blogaversary: It's Time to De-Lurk

Well, it's about that time again! Happy Blogaversary to me! Or, Happy Birthday, Anthro Doula Blog!

Every day hundreds of people visit my blog from various places around the globe (amazing!) and I have no idea who you are! Some people come stop by once, but some of you stick around or return again and again. I really appreciate that! I know most of you don't comment, and that's OK. I'm not a big blog commenter myself, unless I really feel like I have something I need to say.

But on this, my third blogaversary, I'd really love it if you would de-lurk (or in other words, say hello!) Let me know a little about yourself. Why do you read? How did you find me? What are your favorite topics? What would you like to see?

I really appreciate the feedback!

Photo source

When I started this blog three years ago, I really didn't know that I would keep it up this long. I also had no idea that so many people would come to follow it! I really appreciate you, whether you follow on Facebook, twitter, or directly to the blog.

At the moment, I am excited to have more than 170 Google Friend Connect followers, 680 Facebook fans, and 2,443 twitter followers.

I am averaging 255 page loads per day, and I had about 1,154 first time visitors this past week. Recently, you have come not only from the United States and Canada, but also Singapore, Malaysia, Philippines, Cambodia, India, Brazil, Portugal, Sweden, Ireland, Germany, Spain, Iraq, Pakistan and the UK.

A lot has happened in the past year. I've gotten another year of grad school under my belt, and the end is in sight. I've worked on community projects related to the March of Dimes and to also breastfeeding. I've met some amazing people in MCH and public health. I've been a certified doula for over a year now, and added CLC!

I've also had a real life local doula client hand me a print out of one of my blog posts at our doula interview (completely without knowing that it was my blog)! That was pretty thrilling. It's kind of like coming full circle, in a way. And makes me feel like the information I put on this blog is helping women!

It has also been a great way for me to share the things that I learn, read, and experience.

Thanks for celebrating with me!

- Anthro Doula

Friday, November 2, 2012

What's going on in my world

If you're a doula, do you compensate/get compensated for being back-up on call? A while back I agreed to be back up for another doula and she paid me a small amount just for being on call, even though she attended the birth herself. In the past my back up arrangements have just been a pay-if-you-go type thing. I think everyone has a different system for this, and I'm just curious! Please share :)

I recently attended a birth where we labored at home until the mom felt an urge to push. We made our way downstairs, into the car, and all the way to the hospital and mom was doing great. We entered through the emergency room entrance, which is always how I've entered with clients at this particular hospital. When we entered, the woman at the desk asked "how far apart are her contractions? does she feel like she has to push?" So I calmly replied, "her contractions are about 2 minutes apart, and she is feeling a little bit like pushing." For some reason the emergency room (guy? tech? nurse? doc? I don't really know) decided that this meant she was about to have her baby, and wheeled the mom in her wheelchair over to an empty room and put on a face mask and gloves. I thought perhaps they were just going to check her dilation down there and then we'd go up to labor and delivery, but I realized that he had thought the baby was coming NOW. He turns to the mom as she's standing up from her wheelchair and says "do you feel like pushing?!" and she calmly says, "every now and then I feel the urge to push with a contraction, but not every one." And he's like "oh." And everybody stands down, and we are handed over to someone and taken to L&D. haha. I found it highly amusing. Have you ever had this happen before?

I've been analyzing my thesis research data lately and I keep thinking of one mom who described breastfeeding as "animalistic." Interestingly, exactly 1/3 of the women I interviewed had a cesarean section birth (the exact same as the entire United States).

If you're a spanish-speaker, what word is most often used for "breast pump"? sacaleches? bomba? pompa? I say pompa because I've heard it used, but when I actually look it up I get the first two.

A month ago I received a phone call inquiring about my doula services. The woman started the phone call out with "is this... the doula?" Apparently she forgot my name as the phone was ringing. But it didn't seem she paid much attention to my website anyway, since she apparently had no idea what a doula is or does. She proceeded to ask me whether I go with her to all of her doctor's visits with her throughout her pregnancy, and if I do ultrasounds. I sure hope she figures it out sooner rather than later. I haven't heard back from her!
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