Anthro Doula

Childbirth Around the World

2012-01-29T10:20:00.001-05:00

I recently began following a blog called Pregnancy and Childbirth Around the World. It is written by a mom in london who is interested in anthropology and birth practices in other countries. She does her own research on her own time, simply out of curiosity, and writes them up to share!

In a recent post, she wrote "The Bariba culture believes that witch babies can be detected by certain signs at birth... Every Bariba woman approaches childbirth knowing that she might give birth to a witch baby."

In How Much Sex is Enough? She explores the idea that "having sex just once cannot make a baby according to some cultures - they believe that a couple needs to have sex repeatedly over a number of days or even weeks to create a foetus."

In Grass Hut Caesareans she describes how People in Uganda were performing successful Caesareans before they were done in Europe.

Another post is on conception with two fathers - In many Amazonian cultures, people believe that a child can be fathered by more than one man, and many women seek out trysts with many men that they wish to contribute to the biological formation, as well as the social and economical support, of their child.

I also found this interesting site and blog: Birth Around the World. It appears that a couple is traveling to countries all over the world just to look at childbirth in those places! From their website:

We plan to travel to 30 countries in a period of 9 months. While we travel, we'll be capturing on film, photos, and writing the reality of each country's birthing practices. We'll be posting what we find on this website. The information will highlight aspects of the culture in general and those aspects of the culture with beliefs specific to birth and the birthing process. We'll also be sharing birth stories of people we meet along the way, and we'll be sharing important information about maternal and newborn death rates, the health care system, and more. We'll include birth footage; interviews with people on the street, pregnant woman, mothers, fathers and children, health care providers, and others.

I'm joining in late, and it appears that they've already been to several countries. Take a look at their blog to catch up or follow along - they're recently in Australia!

Video: Birth in the Car

2012-01-24T15:37:00.000-05:00

This is what it looks like to have a baby in the car:

I love how totally calm she is!

Doula for a Home Birth

2012-01-15T20:04:00.000-05:00

I think its interesting that most people I encounter who know little to nothing about doulas right away tend to assume that I attend only home births. They'll ask something about if I do mostly home births or if I'll do hospital births, too, or if I only do births in water, or even if I catch babies. "Doula," if its even known, is assumed to be a "hippy" or "alternative" choice, associated with birthing at home. In reality, if I only attended home births, I might not have very many to attend! 99% of women in the U.S. deliver in the hospital. If I want to have any doula clients, in the hospital I must be! And, indeed, the reason many women hire a doula is precisely because they are giving birth in a hospital.

I also think its interesting, then, that many people who do think about planning a home birth do not think that a doula is even necessary at a home birth at all. Many say that they have a midwife, what do they need a doula for? Won't the midwife do everything that a doula does? In reality, this varies. Some midwives may not show up early in labor, and may wait until the time seems close to attend the birth. Or, if they have other clients whose births are imminent, they may have to leave to attend them. Furthermore, if a midwife attends a birth without an assistant, then she isn't likely to be able to check blood pressure, take notes, set up birth equipment, etc AND provide the physical and informational support that a doula provides.

Photo Credit

There are some midwives who work in pairs, where one can take care of the medical side of things and the other can provide doula support. And there are many midwives who want to be there in a doula capacity for a long labor! But this is not true 100% of the time, and many women and partners feel they greatly benefit from having a doula at their home birth.

To read more about perspectives on doulas at home births, check out this post from Citizens for Midwifery: Doulas and Homebirth

What do you think about Doulas at Home Births?

Get Karen to Haiti: Help Ensure Safe Births in Times of Crisis

2012-01-11T06:00:00.149-05:00

On the second anniversary of the Haiti earthquake, certified nurse midwife and instructor of nursing Karen Feltham is planning to return to Haiti and volunteer her services and provide training for local communities to help save women's lives.

Mothers and infants are especially vulnerable groups that are disproportionately affected by emergencies and the negative ramifications of disaster situations. It is well recognized that skilled birth attendants can help save lives.

“The role of skilled birth attendants, in particular midwives and others with midwifery competencies, is widely acknowledged as being crucial to addressing maternal and newborn mortality and morbidity, and to promoting women’s and children’s health" (Maternal Health Task Force)

Karen and other volunteers from Circle of Health International work with and train local maternity care workers, ensuring that birth attendants can recognize and respond to emergency health situations in maternity care.

Even before the devastating earthquake on January 12, 2010, Haiti had the highest maternal mortality rate in the Western hemisphere, with 607 women per 100,000 dying of complications related to childbearing.

Because Karen is donating her time and knowledge, COHI is fundraising to raise the cost of her travel to and within Haiti. This fundraiser is part of campaign to Get Karen There organized by Jeanette and Hillary at Birth Swell.

Help Get Karen There!

For only $10, you can help send Karen to Hait i. And if you donate more, jewelry and other gifts are available as perks for donors who can offer $20, $35, $50 or more!
Share the cause through via Facebook
Promote the fundraiser via Twitter using the hashtag #GetKarenThere

Circle of Health Interational (COHI) works with women and communities to provide access to reproductive, maternal and newborn healthcare, specifically in times of crisis. COHI defines its target population as women in crisis, specifically partnering with women surviving conflict and disaster. I really like that COHI supports all aspects of public health, primary care, and ethnographic research initiatives! They are really committed to improving the quality, access and effectiveness of services to women and their families in these communities.

What's also really great about COHI is that "they work at the grassroots, partnering with the local community to identify their priorities and needs. They respect local cultures and values and focus on building skills in the community with local providers. This means their work is sustainable, long after COHI volunteers have moved to the next disaster," explain the Birth Swell gals.

Karen's goals for her trip are to are to "run emergency obstetric care management drills, review core competencies, and always to reinforce and encourage the midwifery model of care." Important things that she will ensure are 1) a high standard of care and 2) training to recognize and respond to issues such as preeclampsia and shoulder dystocia.

If you'd like to learn more about Karen and her work, read this great interview with her on Our Bodies Our Blog!

Want to learn more about what COHI does, or how to volunteer? Check out their website or follow COHI on Facebook!

Weekend Movie: Waterbirth in a Hospital

2012-01-06T16:12:00.000-05:00

Waterbirth in a hospital - It's possible!

Nursing in Public Advertisement

2012-01-03T11:40:00.000-05:00

Happy New Year!

Take a look at this Nevada breastfeeding promotion video. It may be the first ad to focus on the legal right to nurse in public.

Daley, E. et al. (2010) “Influences on Human Papillomavirus Vaccination Status Among Female College Students” Journal of Women's Health. 19(10): 1885-1891.

Dyer, K. E. (2010) “From Cancer to Sexually Transmitted Infection: Explorations of Social Stigma among Cervical Cancer Survivors” Human Organization 69: 321-330.

Gautham, M., R. Singh, H. Weiss, R. Brugha et al. (2008) Socio-cultural, psychosexual and biomedical factors associated with genital symptoms experienced by men in rural India. Tropical Medicine and International Health, 13(3):384–395.

Philpott, A., W. Knerr, and V. Boydell. (2006) Pleasure and prevention: when good sex is safer sex. Reproductive Health Matters 14(28): 23-31.

Special Populations

Ballard, K.D., M.A. Elston, J. Gabe (2009). Private and Public Ageing in the UK. The Transition through the Menopause. Current Sociology 57(2): 269-290.

Lewin, E. (1995) On the Outside Looking In: the Politics of Lesbian Motherhood. In Ginsburg and Rapp Conceiving the New World Order: The Global Politics of Reproduction. California University Press: 103-121.

Marhefka, S. L., C. R. Valentin, et al. (2011). "I feel like I'm carrying a weapon.” Information and motivations related to sexual risk among girls with perinatally acquired HIV." AIDS Care: Psychological and Socio-medical Aspects of AIDS/HIV.

Smid, M., P. Bourgois, et al. (2010). "The Challenge of Pregnancy among Homeless Youth: Reclaiming a Lost Opportunity." Journal of Health Care for the Poor and Underserved 21(2 Suppl): 140.

Buhi, E. et al. (2010) Quality and Accuracy of Sexual Health Information Web Sites Visited by Young People. Journal of Adolescent Health 47:206-208.

Circumcision

Belisario, O. C. V. (2010). “Muslim Women and Circumcision: A Study of Intergenerational Practice and its Continuity in Southern Philippines." WMSU Research Journal 28(1).

Johansen, R. (2006) Care for infibulated women giving birth in Norway: an anthropological analysis of health workers’ management of a medically and culturally unfamiliar issue. Medical Anthropology Quarterly 20(4): 516-544.

Kurth, E., F. Jaeger, et al. (2010). "Reproductive health care for asylum-seeking women-a challenge for health professionals." BMC Public Health 10(1): 659.

Obure, A. F. X. O., E. O. Nyambedha, et al. (2011). "Interpersonal Influences in the Scale-up of Male Circumcision Services in a Traditionally Non-circumcising Community in Rural Western Kenya." Global Journal of Community Psychology Practice 1(3).

Shell-Duncan, B. (2001) The medicalization of female “circumcision”: harm reduction or promotion of a dangerous practice? Social Science and Medicine 52:1013-1028.

Also, if you are a scholar, MIT Open CourseWare lists tons of anthropology course syllabi and reading lists!

Another Semester Down

2011-12-23T09:34:00.000-05:00

Another semester down...

So I've found that I can hold down 2 part time jobs, doula work, a full grad course-load including 3 group semester-long projects, and not go totally insane. I still managed to get all A's and see my friends at least once a week for dinner. My wonderful SO was there to help me through the emotional breakdowns (I didn't say there weren't any!), and I managed to come out alive. I'm quite proud of myself! This semester was very hard and I'm so glad its over.

I had two fantastic doula clients give birth in the same week. Though it totally messed up my sleep and homework life that week, I thoroughly enjoyed helping both these wonderful families. Here is some of what I experienced and learned:

One was a primip who had switched to a birth center birth during her pregnancy. The birth center was big and beautiful and totally empty while we were there. I was with her and her husband for 24 hours at home and the birth center before the decision was made to transfer to a hospital so mom was able to get some pain relief and some sleep. She had been awake for nearly two days! First time moms never follow this advice which I always give, but you really have to sleep in early labor! She was such a trooper - she would have kept on going if she wasn't just so tired. Really such a sweet couple, great midwife and midwives' assistant at the birth center, and a seamless transfer to midwifery care at a nearby hospital. The transfer was very upsetting, and she did reverse some in dilation. I've heard of this happening before and I'm very sure this is what happened here. It was a beautiful labor that ended up being an asynclitic occiput posterior baby giving her so much trouble! (I learned at this birth that the baby can be OP and the mom might not have back labor).

The second labor was the fastest dilation I've ever seen - another primip who I didn't end up laboring at home with because her husband was very nervous in early labor and insisted they go to the hospital. I met them there and the labor was great - very quiet, calm, peaceful. Very few nurses or doctors bothered us the whole time. Mom, dad and I slept on and off in between contractions. There was also some salsa dancing! I really think this may have been partly responsible for such a quick labor - She actually dilated 5 centimeters in about 2.5 hours. I was definitely jaw-drop shocked when I heard she was complete. I've never seen that before!

Recently I've been contacted by two potential doula clients who are very early in their pregnancies. I've never been hired by someone so early in a pregnancy! So I'm having a lot of doula firsts recently.

Next year I'm going to begin earning my continuing education credits for eventual re-certification... Best to start early! Next year will also be the year I start my internship, data collection and thesis writing. Whew!

Happy Holidays, everyone!

Comment Turned Post: Medical Anthropology and Midwife Rituals

2011-12-20T16:26:00.001-05:00

Medical anthropologist and midwife Melissa Cheyney published an article in the Medical Anthropology Quartlerly called Reinscribing the Birthing Body: Homebirth as Ritual Performance. Apparently this caught the eye of a writer at Science 2.0, Hank Campbell, who decided to bash anthropology and midwifery in an article called Midwife Rituals: Anti-Science Or Just Symbolism?

Campbell seems to fail to understand certain things about anthropology, like the fact that participant-observation is a dominant method of anthropological research. He also calls her analysis of her research "advocacy" when she says "Just as women and their doctors who deliver in the hospital often feel convinced that their birth was the only safe and 'correct' way, women and midwives who deliver at home feel strongly that they have the solution." This is her analysis statement, not a bashing of obstetricians. Additionally, calling aspects of biomedical care "rituals" is not meant to "create false equivalence for female empowerment rituals," as Cambell states. It is a true anthropological concept and theoretical analysis method which has been studied extensively, not simply made up for Cheyney's convenience.

It is a true concept that the female reproductive body has become medicalized in all aspects - menstruation, pregnancy, birth, breastfeeding, menopause, and so forth. The concept that American medicine has of the birthing body is encompassed in the culture of biomedicine and the beliefs of our society. We like to think that it is objective, evidence-based, and the One Truth, but in fact it is only one reality. Robbie Davis-Floyd explored how medicine, obstetrics, and birth in the U.S. is a ritual; a socially constructed rite of passage. If Campbell had read the article carefully, he would have noted that the reason that Cheyney used ritualization as a lens through which to explore homebirth is because it has been a useful tool for reproductive anthropologists in the past. (Rites of passage and rituals have been studied extensively in other areas of anthropology as well). Davis-Floyd showed that birth is "a reflection of a larger patriarchal and technocratic society." Davis-Floyd examined the rituals associated with hospital birth, and Cheyney examined the rituals associated with home birth midwifery. Both are valid anthropological research and theory.

So while, yes, home birth is partly about a rejection of the dominant biomedical tenants about birth and certain types of authoritative knowledge, it is also about embracing a different point of view regarding the way birth is or should be. Biomedicine is only one example of the way birth is or can be. Differing views are not wrong, they are just different, and exploring them for a deeper understanding is what medical anthropologists do best.

The point of this article is not to add to the "which is better, home birth or hospital" debate. The purpose is to explore the rituals involved in home birth midwifery and what they mean. Cheyney believes that what she calls rituals in home birth are intentionally subverting technocracy, and are meant to "reinscribe pregnant bodies and reterritorialize childbirth spaces and authorities." What this means is that home birth midwives are doing the things they do and saying what they say in order to purposefully go against the hegemony of biomedicine and all it says about bodies and where birth should take place and with whom. She says that midwives are, like obstetricians, taking advantage of this liminality of birth to create a certain meaning of childbirth (in the midwives' case, that nature is sufficient; in the physicians', that technology is supreme).

Many of the rituals (“patterned, repetitive and symbolic enactment of cultural beliefs and values") that Cheyney describes include things like including the woman and her family in prenatal care, repetitive birth mantras and other techniques for a drug-free birth, an inversion of the doctor-up, mother-down hierarchy during pushing, and certain postpartum techniques like delayed cord clamping. Cheyney argues that midwives do all these things in order to intentially be diferent from the biomedical model. Its interesting to read her description of them as their own form of "ritual," and I also would not have thought previously about their being used to intentionally be subversive.

Some women do "sidestep obstetric standards of care" and challenge "the hegemony and authoritative knowledge of medicalized birthing care" by choosing birth with a midwive at a center birth or at home. While the idea about which is "better" can be debated until the end of time, the point is that women do make that choice, and have the right to. And though it is not a belief shared by all, it is my belief that women have the right to choose what happens to their bodies and who they hire to provide their health care.

I agree that homebirth is a "medium for the promotion of social change," but I don't think thats the only reason that women choose to birth at home or with a midwife. It has been shown that women who choose home birth are rejecting the technocracy, but this is not always a conscious part of their decision. Furthermore, the reason they do it is not always to be part of political and social change, but simply to make the best choice for themselves and their babies, or because they have no other choice (in the case of the underinsured, for example).

These are my thoughts on the article. Unfortunately, the comments on the Science 2.0 article do not tend to focus on the fact that Campbell's understanding of anthropology is flawed and his analysis of Cheyney's piece is incorrect. Many in the comments section jump into the home birth vs. hospital and midwife vs. physician debate. So, I am going to weigh-in a bit here:

It is not just mothers, hippies, birth activists, and midwives who are pointing out that the biomedical model of birth is potentially dangerous, it is also physicians and health researchers and scientists. Birth models that include midwives and the midwives' model of care have been shown worldwide to be birth models that work.

So what's the big deal if women are included in all processes, from conception to birth and beyond? Is it such a bad thing if a woman feels empowered, capable, strong and in control? What's the big deal if a woman wants warm water immersion and positive birth statements repeated to her, if it works? Arguments against home birth midwifery tend to call all this "woo woo" or "touchy feely." Women should be able to have this kind of positive care whether or not you're with a physician or a midwife. It has been shown that it matters and that it is a good thing. So why does biomedicine reject it?

I encourage you to put your two cents in over at Campbell's article, even if you're not an anthropologist. The infamous Amy Tuteur has even found it worth her while to do so! Most commenters seem to agree with what he says, and we need to turn the tide.

Just One Bottle?

2011-12-19T09:31:00.000-05:00

"Just One Bottle Won't Hurt"-- or Will It?

Marsha Walker, RN, IBCLC

The gastrointestinal (GI) tract of a normal fetus is sterile
the type of delivery has an effect on the development of the intestinal microbiota
- vaginally born infants are colonized with their mother's bacteria
- cesarean born infants' initial exposure is more likely to environmental microbes from the air, other infants, and the nursing staff which serves as vectors for transfer
- the primary gut flora in infants born by cesarean delivery may be disturbed for up to 6 months after birth (Gronlund et al, 1999)
babies at highest risk of colonization by undesirable microbes or when transfer from maternal sources cannot occur are cesarean-delivered babies, preterm infants, full term infants requiring intensive care, or infants separated from their mother
- infants requiring intensive care acquire intestinal organisms slowly and the establishment of bifidobacterial flora is retarded
- a delayed bacterial colonization of the gut with a limited number of bacterial species tends to be virulent
- control and manipulation of the neonatal gut with human milk can be used as a strategy to prevent and treat intestinal diseases (Dai & Walker, 1999)
major ecological disturbances are observed in newborn infants treated with antimicrobial agents
- one way of minimizing ecological disturbances in the NICU is to provide these babies with fresh breast milk (Zetterstrom et al, 1994)
breastfed and formula-fed infants have different gut flora

breastfed babies have a lower gut pH (acidic environment) of approximately 5.1-5.4 throughout the first six weeks that is dominated by bifidobacteria with reduced pathogenic (disease-causing) microbes such as E coli, bacteroides, clostridia, and streptococci
flora with a diet-dependent pattern is present from the 4th day of life with breast milk-fed guts showing a 47% bifidobacterium and formula-fed guts showing 15%. Enterococci prevail in formula-fed infants (Rubaltelli et al, 1998)
babies fed formula have a high gut pH of approximately 5.9-7.3 with a variety of putrefactive bacterial species
in infants fed breast milk and formula supplements the mean pH is approximately 5.7-6.0 during the first four weeks, falling to 5.45 by the sixth week
when formula supplements are given to breastfed babies during the first seven days of life, the production of a strongly acidic environment is delayed and its full potential may never be reached
breastfed infants who receive supplements develop gut flora and behavior like formula-fed infants

The neonatal GI tract undergoes rapid growth and maturational change following birth

Infants have a functionally immature and immunonaive gut at birth
Tight junctions of the GI mucosa take many weeks to mature and close the gut to whole proteins and pathogens
Intestinal permeability decreases faster in breastfed babies than in formula-fed infants (Catassi, et al, 1995)
Open junctions and immaturity play a role in the acquisition of NEC, diarrheal disease, and allergy
sIgA from colostrum and breast milk coats the gut, passively providing immunity during the time of reduced neonatal gut immune function
mothers' sIgA is antigen specific. The antibodies are targeted against pathogens in the baby's immediate surroundings
the mother synthesizes antibodies when she ingests, inhales, or otherwise comes in contact with a disease-causing microbe
these antibodies ignore useful bacteria normally found in the gut and ward off disease without causing inflammation

infant formula should not be given to a breastfed baby before gut closure occurs

once dietary supplementation begins, the bacterial profile of breastfed infants resembles that of formula-fed infants in which bifidobacteria are no longer dominant and the development of obligate anaerobic bacterial populations occurs (Mackie, Sghir, Gaskins, 1999)
relatively small amounts of formula supplementation of breastfed infants (one supplement per 24 hours) will result in shifts from a breastfed to a formula-fed gut flora pattern (Bullen, Tearle, Stewart, 1977)
the introduction of solid food to the breastfed infant causes a major perturbation in the gut ecosystem, with a rapid rise in the number of enterobacteria and enterococci, followed by a progressive colonization by bacteroides, clostridia, and anaerobic streptococci (Stark & Lee, 1982)
with the introduction of supplementary formula, the gut flora in a breastfed baby becomes almost indistinguishable from normal adult flora within 24 hours (Gerstley, Howell, Nagel, 1932)
if breast milk were again given exclusively, it would take 2-4 weeks for the intestinal environment to return again to a state favoring the gram-positive flora (Brown & Bosworth, 1922; Gerstley, Howell, Nagel, 1932)

in susceptible families, breastfed babies can be sensitized to cow's milk protein by the giving of just one bottle, (inadvertent supplementation, unnecessary supplementation, or planned supplements), in the newborn nursery during the first three days of life (Host, Husby, Osterballe, 1988; Host, 1991)

infants at high risk of developing atopic disease has been calculated at 37% if one parent has atopic disease, 62-85% if both parents are affected and dependant on whether the parents have similar or dissimilar clinical disease, and those infants showing elevated levels of IgE in cord blood irrespective of family history (Chandra, 2000)
in breastfed infants at risk, hypoallergenic formulas can be used to supplement breastfeeding; solid foods should not be introduced until 6 months of age, dairy products delayed until 1 year of age, and the mother should consider eliminating peanuts, tree nuts, cow's milk, eggs, and fish from her diet (Zieger, 1999; AAP, 2000)

in susceptible families, early exposure to cow's milk proteins can increase the risk of the infant or child developing insulin dependent diabetes mellitus (IDDM) (Mayer et al, 1988; Karjalainen, et al, 1992)

human insulin content in breast milk is significantly higher than bovine insulin in cow's milk; insulin content in infant formulas is extremely low to absent; insulin supports gut maturation
in animal models oral administration of human insulin stimulates the intestinal immune system generating active cellular mechanisms that suppress the development of autoimmune diabetes
the lack of human insulin in infant formulas may break the tolerance to insulin and lead to the development of type 1 diabetes (Vaarala et al, 1998)
the avoidance of cow's milk protein for the first several months of life may reduce the later development of IDDM or delay its onset in susceptible individuals (AAP, 1994)
infants who are exclusively breastfed for at least 4 months have a lower risk of seroconversion leading to beta-cell autoimmunity
- short-term breastfeeding and the early introduction of cow's milk based infant formula predispose young children who are genetically susceptible to Type 1 diabetes to progressive signs of beta-cell autoimmunity (Kimpimaki et al, 2001)
sensitization and development of immune memory to cow's milk protein is the initial step in the etiology of IDDM (Kostraba, et al, 1993)
- sensitization can occur with very early exposure to cow's milk before gut cellular tight junction closure
- sensitization can occur with exposure to cow's milk during an infection-caused gastrointestinal alteration when the mucosal barrier is compromised allowing antigens to cross and initiate immune reactions
- sensitization can occur if the presence of cow's milk protein in the gut damages the mucosal barrier, inflames the gut, destroys binding components of cellular junctions, or other early insult with cow's milk protein leads to sensitization (Savilahti, et al, 1993)
References

Transforming Maternity Care

2011-12-16T15:10:00.001-05:00

In case you haven't seen this great video, Maternity Care with a Heart, I encourage you to check it out.

Childbirth Connection does great work in their campaign to Transform Maternity Care.

Maternity Care With a Heart from Childbirth Connection on Vimeo.

Why does maternity care need to be transformed?

We pay more for maternity care than any other country, but have higher rates of maternal death, newborn death, and low birth weight than dozens of other nations. We invest too much in overusing high-tech care with no proven benefit and fail to invest in preventive care, or in strategies to address troubling disparities in access and outcomes. Described in 1989 as "the perinatal paradox: doing more and accomplishing less," the crisis in maternity care has fundamentally worsened in the time since.

All women and babies deserve maternity care that is woman-centered, safe, effective, timely, efficient, and equitable. Childbirth Connection is working towards this goal.

To donate to this movement in the season of giving, or donate in someone else's name, go here. All donations will be doubled until December 20th!

Join the Transformation is a campaign for Childbirth Connection. Through the Transforming Maternity Care Partnership, Childbirth Connection works to improve maternity care through consumer engagement and health system transformation. We work with all stakeholders to foster implementation of the landmark "Blueprint for Action," and continue to develop high-quality, evidence-based information for women and maternity care professionals. We're deeply engaged in work to identify and endorse new maternity care quality measures and to develop and test new resources for shared decision making. We're also working at the state and national levels to influence policy, and partnering with employers, payers, and health systems to develop new ways of delivering maternity care that foster quality and value. Finally, we're identifying the people and systems making progress on maternity care quality improvement, and helping to spread the word about these models so others can learn from them.

The Fourth Trimester

2011-12-14T11:04:00.000-05:00

Have you heard of the Fourth Trimester? Perhaps you can realize what it is from the name, even if you've never heard of it!

The fourth trimester is the time period after birth, generally within the first 3 months, where the newborn is essentially just as helpless as he or she was while inside the womb. Compared to other mammals, humans are very fragile and immature at birth. Development continues outside of the womb, and the baby still depends on his or her mother for every need. They still require nourishment, warmth, and comfort from their mother's body, and are happiest when they are kept in a position in which they can listen to mom's heart.

In effect, the fourth trimester is all about recreating the womb experience while the newborn continues to develop his or her brain, breathing, muscles, and other reflexes. Inside the womb, the baby listens to the loud and comforting sound of a heart beat 24/7 and is constantly kept warm and nourished. When an infant is then removed from the warmth, smells and sounds of mother, he/she tends to be very unhappy. Baby will be most calm, quiet and happy when kept on mom's chest (for instance, worn in a sling or baby carrier!) all day long.

The fourth trimester is not just about the baby, though! The mother also goes through a fourth trimester of pregnancy symptoms including changing hormones, changing body, stress and sleep deprivation. The fourth trimester is a time when both mother and child need to be taken care of. For both, the fourth trimester is a time of adjusting to a new life.

Understandably, its not possible for all mothers and babies to always be together for the entire fourth trimester. However, as much physical contact as possible is great for recreating what both mom and baby need after childbirth.

Dad's can help recreate the womb experience, too! Dr. Harvey Karp's Happiest Baby on the Block teaches the 5 S's to soothe infants, and the techniques are easy for any caretaker to use. After all basic needs have been addressed (feeding, clean diaper, etc), these techniques can help trigger a calming reflex: swaddling, positioning him on his stomach or side, shushing loudly in his ear or playing white noise, swinging him to mimic the jiggling motion of the womb, and letting him suck on a pacifier or breast. The swaddling mimics the tight quarters that babies are used to (notice how newborns always tuck their legs up?). Shushing noises mimic the loud sounds that babies hear in the womb, and shaking is like mom's body rocking the baby to sleep. Its all part of the Fourth Trimester technique!

So now, next time you see a new mom you can tell her "Happy Fourth Trimester!"

"Breastfeed" Song

2011-12-11T20:24:00.000-05:00

Funny video with singing and dancing about breastfeeding by the University of Pittsburgh School of Medicine. Enjoy!

Reimbursement for Doula Services

2011-12-05T23:09:00.000-05:00

I recently attended webinar on how a doula can set things up so that her clients can submit a request to their insurance company to be reimbursed for doula services!

If you are a member of DONA you can download their Third Party Reimbursement packet for more information. I really enjoyed the webinar, though, because it explained to me face-to-face how to go about something like this. It made it seem a lot less daunting!

First, a doula needs to obtain an NPI at https://nppes.cms.hhs.gov. The taxonomy code actually falls under Nursing Service Related Providers type. NPI is only referring to doula work. The doula must also have a Tax ID#, or use their SSN, which is for taxes.

The doula can help a client fill out a form with their health insurance company. If the insurance co does not have a form, a universal 1500 form can be used. The code for birth doulas is CPT 59400. A diagnosis code is required - V22.2 Intrauterine Pregnancy

When submitting it is also beneficial to include: A letter from the client, a description of a doula, the DONA International position paper, Standard of Practice, and Code of Ethics. Additionally, details such as the number of client meetings, number of hours in labor, and exact services provided should be included along with your certification credentials, if any. A letter from a provider about the benefits of a doula is a plus; more likely to be reimbursed if you can show that your services helped lower costs for the insurance company! For instance, helping a mom to not require an epidural or end up with a cesarean section is a big money saver!

At the moment, no company is paying consistently, and none have been covered by Medicaid. Some states do have grant money for doula coverage, so look for those!

Remember: the doula does not submit the forms, the clients do. Clients pay the doula in full and then submit request to the insurance company to be reimbursed. Claim submissions can be submitted multiple times up to 12 months after the birth.

Has anyone successfully been reimbursed for doula services? Share your story!

In the DONA packet on Third Party Reimbursement they include an interesting section that I am going to include here as food for thought:

Concerns about third party reimbursement The Third Party Reimbursement Committee will continue to gather information about the potential consequences and challenges to third party reimbursement. At first glance, it may seem to have no drawbacks. However, realistic assessments reveal that third party reimbursement may have costs that are not immediately apparent. The following concerns have been raised.

1. Will the reimbursement for doula services paid by third party payers be too low? Will it force doulas to reduce the fees they normally charge for private, self-paying clients? While doulas would not necessarily be required to accept low reimbursements or require clients to make up the difference between reimbursement and the actual fee, it is possible that financial pressure would cause doulas to consider lowering their fees.
2. What restrictions or responsibilities might be added to the doula’s role by third party payers (e.g., licensing by the state, longer training, proficiency exams, different certification requirements or additional health care training or licensing)? Would doulas be required to carry malpractice insurance and would that make them more likely subjects of lawsuits?
3. What conditions or requirements might be placed on the consumer in order that her doula’s services will be reimbursed? At least one third party payer has already limited the consumer’s options by covering the cost of birth doula services only if the woman agrees to not request an epidural. Birth doulas cannot be put into a position of preventing women from having an epidural or of supporting only particular choices.

It is possible that, if reimbursement were available only for doulas with state licenses, doulas could choose not to seek reimbursement and could remain unlicensed. It is also a remote possibility that it might become illegal for unlicensed doulas to practice in some states. Some hospitals might require certification to support women in their facilities. The benefits of regulation must be balanced against the loss of freedom it entails.

If you are looking for liability insurance - CMF Group has the cheapest (called "postpartum" services)

Baby Blues and Postpartum Depression

2011-12-01T14:48:00.000-05:00

What is the difference between "baby blues" and postpartum depression? Are you at risk for postpartum depression? Is there anything you can do to avoid it? What are the signs to look for, and when?

Baby Blues:

Many women have the baby blues in the days after childbirth. This means that they:

Have mood swings
Feel sad, anxious, or overwhelmed
Have crying spells
Lose your appetite
Have trouble sleeping
Feeling withdrawn or unconnected
Lack of pleasure or interest in most or all activities
Loss of concentration

The baby blues most often go away within a few days or a week. The symptoms are not severe and do not need treatment. These symptoms are a result of having a huge upsurge of hormones, not having very much sleep during labor/in the hospital, and having a new baby to take care of and worry about. Feelings of inadequacy toward new motherhood, lack of self-esteem, a lack of free time and stressful schedules add into all of this.

Postpartum Depression
The symptoms of postpartum depression last longer and are more severe than those of baby blues. Postpartum depression can begin anytime within the first year after childbirth., an occurs in 15% of mothers. In addition to the symptoms above, postpartum depression may include:

Thoughts of hurting the baby
Thoughts of hurting yourself
Not having any interest in the baby

There is a range with PPD - you may have anything on the range between a mild case, where baby blues symptoms continue after 2 weeks, and a severe case, called postpartum psychosis (very rare). Be sure to talk to a doctor if your symptoms of depression last beyond 2 weeks postpartum.

Certain factors may increase your risk of depression during and after pregnancy. If you:

Are under age 20
Currently abuse alcohol, take illegal substances, or smoke (these also cause serious medical health risks for the baby)
Did not plan the pregnancy, or had mixed feelings about the pregnancy
Had depression, bipolar disorder (for example, manic depression), or an anxiety disorder before your pregnancy, or with a previous pregnancy
Had a stressful event during the pregnancy or delivery, including personal illness, death or illness of a loved one, a difficult or emergency delivery, premature delivery, or illness or birth defect in the baby
Have a close family member who has had depression or anxiety
Have a poor relationship with your significant other or are single
Have financial problems (low income, inadequate housing)
Have little support from family, friends, or your significant other

If you take medicine for depression, stopping your medicine when you become pregnant can cause your depression to come back. Do not stop any prescribed medicines without first talking to your doctor. Not using medicine that you need may be harmful to you or your baby.

Women who are depressed during pregnancy have a greater risk of depression after giving birth.

If you're not sure if you have postpartum depression, you can take this Edinburgh Postnatal Depression Scale quiz online.

Tips to Reduce Risk of Postpartum Depression:

Mood changes are common during huge life events. Making sure you have good social support before, during, and after birth, as well as during the "fourth trimester" can make a huge difference in one's ability to deal with these big changes. Don't feel bad about asking for help, getting some free time to yourself, or joining a support group! And don't be afraid to discuss your feelings with your partner. Getting as much rest as you can and not trying to do too much helps a lot! Also, some moms say they've had success consuming their placenta, generally via encapsulation, in improving mood after childbirth.

MORE GREAT RESOURCES
These are some resources for moms who think they might have postpartum depression and are looking for more information:

Postpartum Progress - one of the most widely read blogs on PPD.
Postpartum Voice - stories, resources, and insights
Beyond Postpartum blog
PPD to Joy blog

HAVE YOU EVER WORKED WITH A MOM WHO HAD PPD, OR HAVE YOU EXPERIENCED IT YOURSELF? What advice would you give a doula on baby blues and PPD?

Info source: Women'sHealth.Gov and PubMed Health

Listening to Mothers

2011-11-26T12:06:00.000-05:00

Have you read the findings of the 2002 and 2006 national U.S. surveys of women's' childbearing experiences? The Listening to Mothers and Listening to Mothers II surveys are a great look at U.S. maternity care and mothers experiences in birth.

I have read an referenced these findings before, but here is a summary of the findings. I encourage you to download the Pdf's, read through the complete findings, view the graphs and charts, and develop a better sense of what childbirth is like in America.

The 2002 Listening to Mothers study was the first national U.S. survey of women’s childbearing experiences. 136 mothers of singletons were interviewed by telephone, and 1,447 completed an online survey within 24 months of their birth (Declerq et al, 2002). The survey was repeated in 2006 in Listening to Mothers II (Declerq et al, 2006).

In the 2002 survey, mothers were pleased with the care they received during birth. The majority of mothers felt that they understood what was happening, felt comfortable asking questions, that they got the attention they needed, and were as involved as they wanted to be in making decisions. Technology-intensive labor was the norm, with high numbers of women receiving an IV, epidural, pitocin, artificial rupture of membranes, or stitching. Almost half of women reported that their caregivers tried to induce labor. One third reported a non-medical factor as part of the reason for induction. Five percent of women chose labor induction to be able to give birth with the birth attendant of their choice.

The women surveyed in 2002 reported that obstetricians delivered 80% of babies. This was the same in Listening to Mothers II (2006). Midwives attended 10% of births and family physicians attended 4% of births. 97% of births took place in hospitals. Doulas and midwives were most highly rated providers of labor support, but used only 5% and 11%, respectively. These findings were the same in Listening to Mothers II (2006). Three in ten women had never previously met the person who delivered their baby. Four percent of women had a nurse or assistant deliver their baby (not a doctor).

Nearly two-thirds of women received epidurals and most rated them highly. However, most couldn’t answer questions about side effects of epidurals. Use of the tub, showering, and birth balls was rated high for help with labor pain, but used by only eight percent of women. 71% of mothers did not walk around because they were hooked up to instruments, had pain meds, or were told not to by caregivers. Only twelve percent of women had anything to eat during labor, 31% had something to drink. Most were told by caregivers that it was not permitted. Three quarters of women gave birth on their backs.

Two-thirds of mothers had an unassisted vaginal birth; one fourth of mothers had a cesarean delivery. In LTMII (2006), one-third of mothers had a cesarean delivery. In the 2002 mothers who had a cesarean delivery, 51% were planned (predominantly repeated cesareans). 26% of mothers with previous cesareans had a VBAC (LTMII: 11%). 42%- 58% were denied the option of VBAC. (LMTII: only 1 mother out of all the 1^st time c-secs requested her c-section with no medical reason).

By a margin of more than 5 to 1 mothers thought it was unlikely that they would choose a cesarean for non-medical reasons for a future birth. Women who had given birth more than a year prior to the survey were more likely to express willingness of caregivers to permit VBAC, compared to women who had given birth within a year of the survey.

Compared to women with vaginal births, those with c-sections were less likely to ‘room-in’ with the baby and be breastfeeding at one week, more likely to experience several health concerns after birth. Experienced mothers (compared to 1^st timers) were less likely to attend CBE, use pain med and other interventions, report negative feelings during labor, have a physician as a birth attendant, give birth by cesarean.

In the 2006 version of the survey, researchers found that first-time mothers identified books as their most important source of information. More mothers were exposed to childbirth through TV than through childbirth education.

The greatest concern with the care received during birth was feeling “rushed.” In 2002 and in 2006, about half of women agreed that giving birth is a natural process that should not be interfered with unless absolutely medically necessary. One-third of women had limited understanding or none about her legal right to full information about any procedure and her right to refuse. More than one-third reported she would have liked to know about this during maternity care.

“What happens to childbearing women, infants and families matters deeply. A vast body of evidence is accumulating about lifelong implications of the medical, physical, and social environment during this crucial period. Growing evidence also supports the long-term impact on maternal well-being of conditions at this time.” (LTMII, 2006, p 8)

“Large segments of this population experiencing clearly inappropriate care that does not reflect the best evidence, as well as other undesirable circumstance and adverse outcomes.” (LTMII, p 8)

References:

Declerq, Eugene, Carol Sakala, Maureen P. Corry, Sandra Applebaum, Risher P. (2002) Listening to Mothers: Report of the First National U.S. Survey of Women’s Childbearing Experiences. New York: Maternity Center Association, 2002.

Declerq, Eugene, Carol Sakala, Maureen P. Corry, Sandra Applebaum (2006) Listening to Mothers II: Report of the Second National U.S. Survey of Women's Childbearing Experiences. New York: Childbirth Connection.

Facts on Contraceptive Use in the U.S.

2011-11-21T10:05:00.003-05:00

These fascinating facts on the use of various forms of birth control in the U.S. were presented in one of my classes, and I thought they were too good not to share.

The best part is the chart of effectiveness in perfect use vs. typical use.

Information from the Guttmacher Institute

Did you know?

There are 62 million U.S. women in their childbearing years (15–44).

Seven in 10 women of reproductive age (43 million women) are sexually active and do not want to become pregnant, but could become pregnant if they and their partners fail to use a contraceptive method.

The typical U.S. woman wants only two children. To achieve this goal, she must use contraceptives for roughly three decades.

Overall, 62% of the 62 million women aged 15–44 are currently using a method.

Almost one-third (31%) of these 62 million women do not need a method because they are infertile; are pregnant, postpartum or trying to become pregnant; have never had intercourse; or are not sexually active.

Thus, only 7% of women aged 15–44 are at risk for unintended pregnancy but are not using contraceptives.

Among the 43 million fertile, sexually active women who do not want to become pregnant, 89% are practicing contraception.

Method	No. of users (in 000s)	% of users

Pill	10,700	28
Tubal sterilization	10,400	27.1
Male condom	6,200	16.1
Vasectomy	3,800	9.9
3-month injectable	1,200	3.2
Withdrawal	2,000	5.2
IUD	2,100	5.5
Periodic abstinence (calendar)	300	.9
Implant, 1-month injectable, patch	400	1.1
Periodic abstinence(natural family planning)	100	.2
Diaphragm	N/A	N/A
Other*	200	.4
TOTAL	38,109	100.0
* Includes emergency contraception, the sponge, cervical cap, female condom and other methods.

OK now check this out - First year contraceptive failure rates (or, the woman becomes pregnant) with perfect use compared to typical use, and all contraceptive methods compared to one another.
This is such an interesting chart! Take a look at how Withdrawal method under typical use has the same effectiveness as Condoms under typical use! Amazing!

FIRST-YEAR CONTRACEPTIVE FAILURE RATES

Method	Perfect use*	Typical use
Pill (combined)	0.3	8.7
Tubal sterilization	0.5	0.7
Male condom	2.0	17.4
Vasectomy	0.1	0.2
3-month injectable	0.3	6.7
Withdrawal	4.0	18.4
IUD Copper-T	0.6	1.0
IUD Mirena	0.1	0.1
Periodic abstinence
Calendar	9.0	25.0
Ovulation method	3.0	25.0
Sympto-thermal	2.0	25.0
Post-ovulation	1.0	25.0
1-month injectable	0.05	3.0
Implant	0.05	0.05
Patch	0.3	8.0
Diaphragm	6.0	16.0
Sponge
Women who have had a child	20.0	32.0
Women who have never had a child	9.0	16.0
Cervical cap
Women who have had a child	26.0	32.0
Women who have never had a child	9.0	16.0
Female condom	5.0	27.0
Spermicides	18.0	29.0
No method	85.0	85.0

Perfect use: The ability of an intervention to produce the desired beneficial effect in expert hands and under ideal circumstances (i.e., in clinical trials). When contraception is used every time, and used according to the instructions every time.

Typical use: When contraception is not used every time, or it is not used according to instructions every time. For instance, when you don't take your pill at exactly the same time every day or you forget, or when you forget to replace your patch or get a shot at the right time, or when you don't use the condom exactly right every time.

Did you notice that the vasectomy has a failure rate under typical use? Were you surprised by some of the "failure" rates?

What do you find the most interesting, or perhaps shocking? What did you learn that you didn't know?

For more information: The Guttmacher Institute

World Prematurity Awareness Day

2011-11-16T15:52:00.000-05:00

November 17th is World Prematurity Awareness Day

In the United States, 1 in 8 babies is born prematurely.
Worldwide, 13 million babies are born too soon each year.
Prematurity is the leading killer of America's newborns. Those who survive often have lifelong health problems.

You can find your U.S. state's 2011 Prematurity Report Card here via the March of Dimes:

As you can see, Vermont is the only state with an A (what are they doing right?). Louisiana, Mississippi, Alabama and Puerto Rico all have F's.

There are now more babies born at 39 weeks than at full term.
The average time a fetus spends in the womb has fallen seven days since 1992.
In the last two decades, the number of babies born at prior to 37 weeks increased by more than 30 percent, and babies born at 37 and 38 weeks rose more than 40 percent.
In 2007, 9.6 percent of births were early – through scheduled inductions or C-sections – for non-medical reasons.
Deliveries at 37 and 38 weeks account for about 17.5 percent of total births in the United Statess.
Of the 540,000 babies born before 37 weeks gestational age each year in the United States, approximately 75 percent are born between 34 and 36 weeks.

Premature birth is a serious health problem. Premature babies are at increased risk for newborn health complications, such as breathing problems, and even death. Most premature babies require care in a newborn intensive care unit (NICU), which has specialized medical staff and equipment that can deal with the multiple problems faced by premature infants.

Premature babies also face an increased risk of lasting disabilities, such as mental retardation, learning and behavioral problems, cerebral palsy, lung problems and vision and hearing loss. Two recent studies suggest that premature babies may be at increased risk of symptoms associated with autism (social, behavioral and speech problems). Studies also suggest that babies born very prematurely may be at increased risk of certain adult health problems, such as diabetes, high blood pressure and heart disease.

Preterm birth is a serious health problem that costs the United States more than $26 billon every year, according to the Institute of Medicine.

Any woman can give birth prematurely, but some women are at greater risk than others. Researchers have identified some risk factors, but providers still can't predict which women will deliver prematurely. Three groups of women are at greatest risk for premature birth:

Women who have had a previous premature birth
Women who are pregnant with twins, triplets, or more
Women with certain uterine or cervical abnormalities

There are other risk factors as well: click here for more information.

More and more births are being scheduled early for non-medical reasons, and this is resulting in babies being born prematurely. The March of Dimes “Healthy Babies are Worth the Wait” campaign is an effort to eliminate preventable preterm births.

Babies born too early may have more health problems at birth and later in life than babies born full term. Here's why your baby needs 39 weeks:

Important organs, like his brain, lungs and liver, get all the time they need to develop.
He is less likely to have vision and hearing problems after birth.
Babies born too soon often are too small. Babies born at a healthy weight have an easier time staying warm than babies born too small.
He can suck and swallow and stay awake long enough to eat after he's born. Babies born early sometimes can't do these things.

All information is via the March of Dimes

Childbirth/Breastfeeding Day in Anthropology

2011-11-14T13:42:00.000-05:00

I apologize for the slow down in posting... Grad school and doula work is taking up all of my time this semester! But I will be able to catch up on everything during holiday time, so please stay tuned!

So that fabulous reproductive health anthropology class that I mentioned? Well we had our unit on childbirth and breastfeeding - my favorite day! Naturally, this is the day I chose to help facilitate the discussion for, so I have a little more information on this topic for you.

Our readings on Birth were:

Brunson, J. (2010). "Confronting maternal mortality, controlling birth in Nepal: The gendered politics of receiving biomedical care at birth." Social Science & Medicine 71(10): 1719-1727.

Notes:

"Universal hospital deliver also may be inappropriate given the desires and/or economic limitations of community members"

"The concept of birth preparedness, like prenatal care, is a part of a biomedical model and risk framework; when birth is considered a natural event, it does not require planning."

"this study's major contribution is a detailed description of the gendered and household politics that determine whether a woman receives biomedical care at birth."

"By using the term 'natural' I do not intend to invoke a romanticized vision of low-tech, 'traditional' birth as the ideal form. Nor do I mean to equate a 'natural' view of birth with a purely biological view of it... Rather I am referring to a worldview involving a cosmic order in which many aspects of life are seen as beyond human control (although efforts or propitiations may be made in an attempt to influence outcomes) as opposed to the mechanistic materialism of modern science that rejects an ordered cosmic totality and instead articulates the world in terms of cause and effect..."

"Women were socialized to keep quiet about their suffering, was usually men who made decisions such as determining at what point situations were dangerous or life-threatening enough to warrant taking them to the hospital."

"More research needs to be done on possible factors that discourage families from delivering in hospitals, in particular the obstacles for impoverished families such as intimidation or cost."

What are the limitations these women face in having a safe and healthy birth? What factors influence a Nepali woman to birth where she does?
Would planning for a birth, in any way, mean that birth would no longer be viewed as a natural event? Is a planned-for birth necessarily a biomedical event?
In order to reduce maternal mortality, Bruson asks, who ought to control birth? Who should be the advocate?

Miller, A. C. (2009) "Midwife to Myself": Birth Narratives among Women Choosing Unassisted Homebirth. Sociological Inquiry 79,1: 51–74.

Notes:

"Despite this clear reliance on midwifery, use of a midwife is seen as inappropriate. From the UC perspective, midwives and doctors are 'the same'... professionals who interfere with a woman's natural ability to experience completely unhindered birth. When a birth attendant is present, UC advocates argue that women cease to rely on the inner 'primal' knowledge that exists to guide them through the best, safest, and most empowering birth possible."

The authority of the biological construction of pregnancy and birth indeed reflects what Foucault described as 'bio-power.'"

These women already believe that birth isn't medical, dangerous, etc - "A fundamental rejection of the biomedical discourse on birth."

"The assumption, whether accurate or not, is that when a midwife enters the home she becomes 'in charge'"

"the natural role of husbands as decision-makers"

The professional birth attendant has been rejected, but the framework remains, gesturing to the power of the midwifery model as the primary counterdiscourse to the biomedical construction of birth.

In what way is choosing unassisted childbirth a privilege?
Where does the authoritative knowledge lie in unassisted childbirth?

Piperata, B.A. (2008) Forty days and forty nights: A biocultural perspective on postpartum practices in the Amazon. Social Science &Medicine 67: 1094–1103.

Notes:

"In the eastern Amazon the immediate postpartum period is referred to as resguardo, lasts for 40-41 days and includes food taboos and work restrictions."

"Quantitative and qualitative data on dietary intake and energy expenditure were collected on 3 consecutive days in each of three postpartum periods."

"women responded by saying 'the boy pulls more' meaning the boy places more strain on the mother... a male infant puts more pressure on a woman's body in terms of breastfeeding style and by causing greater pain an hardship during parturition. The implication is that women require more time to recuperate after the birth of a boy."

"The taboo status of foods was not unanimous... what was taboo for one may not be for another."

"The seduction of the river dolphin"

"During resguardo energy expenditure in physical activity was lower, reducing women's energy needs and allowing them to devote more time to infant care. However, energy intakes were also lower. The reduction in dietary intake was impacted more by work restrictions and the loss of women in subsistence tasks during resguardo than by adherence to food taboos."

Why is the biocultural framework useful in this study?
Thinking about the three articles on birth, what effects to gender roles have on the experiences of parturient women?

Our readings on Breastfeeding were:

Gribble, K. D., M. McGrath, et al. (2011). "Supporting breastfeeding in emergencies: protecting women's reproductive rights and maternal and infant health." Disasters 35(3):

Notes:

"Reproductive rights rest on the recognition of the basic right of all couples and individuals to decide freely and responsibly the number, spacing and timing of their children and to have the information and means to do so..."

"Mothers and infants are vulnerable groups that are disproportionately affected by emergencies and the negative ramifications of breaching these rights are enhanced in emergency conditions."

"breastfeeding reduces women's physiological responsiveness to both physical and emotional stress...artificial feeding increases the resources needed and the work associated with caring for an infant."

The undermining of breastfeeding rights in emergencies

"Supplying breast-milk substitutes to women as a precautionary measure, in the event that they produce insufficient milk, also undermines their confidence in their ability to breastfeed."

Why is breastfeeding a reproductive right?

In what ways is this right undermined in both emergency situations and non-emergency situations worldwide? What are the results?

Kukla, R. (2006) Ethics and Ideology in Breastfeeding Advocacy Campaigns. Hypatia 21(1): 157-180.

Notes:

"As a result, many of our public health initiatives specifically target mothers' choices, as though these were morally and causally self-contained units of influence; if only we could talk women into making the right choices, these initiatives presume, then children would turn out healthy"

"The fact that mothers are not behaving as they are being called upon to behave is here smoothly interpreted as empirical proof that they are no actually hearing the call. Such an interpretation closes down any interrogation of why women might not behave as they are asked to, even if they hear and understand the request."

"One might have assumed that what makes the United States saliently different from all other developed nations with better breastfeeding rates is not its lackluster advertising campaigns, but rather its abysmal maternity leave policies, privatized daycare system, complete absence of workplace regulations supporting breastfeeding, and so forth."

"It utterly fails to examine or address the reason for this gap between message and behavior, insistently keeping the focus on changing women's choices... We need to question our assumption that improper education is the cause of low breastfeeding rates."

There are many American women, especially women from the socially vulnerable groups least likely to breastfeed, for whom breastfeeding is not in fact a livable choice..."

"Breastfeeding mothers are asked to negotiate an exceptionally complicated set of codes of privacy and publicity."

"...in comparison with mobile, privileged white women whose bodies do not challenge normative conceptions of femininity"

"As a culture, we expect and demand that breastfeeding be contained within the domestic space..."

In ads, mothers are portrayed as white women, garbed in bedroom clothing, sitting in a nursery or a nonspace, the women look down at their infants, the children are never older than 1, etc.

Really interesting section on the sexual texture of breastfeeding... "position the infants as traditional male sexual conquerors"

"When we hide the real, deeply culturally embedded barriers to safe, comfortable breastfeeding, we tell mothers who face these barriers that they are unmotherly, shameful, incapable, defective, and morally inadequate/ We then combine this with the message that breastfeeding their child is the only decent choice, the only way of refraining from harming their children, and their responsibility as mothers."

The U.S. DHHS breastfeeding advocacy campaign fails to take into account societal and policy level issues related to breastfeeding barriers, focusing only on the assumed rational behavior of individual mothers. What effect does this have on breastfeeding rates?
What do the "Breast is Best" and "Babies were Born to Be Breastfed" campaigns mean for the "good/bad mother" debate?
Kukla argues that "the reasons women 'fail' to breastfeed go not only well beyond selfishness or lack of education, but even beyond physical and economic barriers such as cracked nipples and long work hours. These reasons lie buried deep within our culture..." How is breastfeeding culturally situated, and how can the cultural context be altered?

Non-normative bodies and various breastfeeding campaigns (click to enlarge):

Breastfeeding outdoors, in work clothing, not looking at baby, as a woman of color, breastfeeding twins, in an airport, in front of family, in front of strangers, with tattoos, breastfeeding toddlers, and other kinds of breastfeeding campaigns

I had been trying to find this image before class and couldn't, but now I have it so I'm sharing it:

We also touched on laws protecting breastfeeding in the U.S.:

Our professor also invited some perinatal loss doulas to come and speak about the support that they provide for women experiencing fetal loss, choosing to terminate a pregnancy, or giving birth to a stillborn baby or baby that is not expected to live past birth. This was very interesting, as I had heard of Full Spectrum Doulas before providing doula support during abortions, but hearing the accounts from these doulas about how they work with mothers and families experiencing various forms of grief was incredible. They are usually called by the hospital health care workers directly when a family finds out about their baby's condition, and they provide information and psychosocial support, as well as physical labor support, in addition to photography, footprint mementos, and so on for families that desire them. These ladies have very big hearts to work with family after family experiencing the loss of a wanted pregnancy.

Further reading/watching:

Canar, Ecuador: Birth and Indigenous Identity in the 21st Century - video preview of an anthropologist's documentary that touches on medical pluralism and birth
Breast-Milk for Haiti: Why Donations are being Discouraged, Jan 29, 2010 - an article about the difficulty of sending breast milk donations to Haiti after the earthquake
Breastfeeding Legislation and Policy, United States Breastfeeding Committee
Best for Babes Foundation - dedicated to beating the Booby Traps, the cultural and institutional barriers that prevent moms from achieving their personal breastfeeding goals
Born Free: Unassisted Childbirth in North America - Dissertation by Dr. Rixa Freeze, department of American studies (2008) - Rixa herself had a planned homebirth, a planned unassisted birth, and an unplanned unassisted birth
Birth in Four Cultures: A Cross-Cultural Investigation of Childbirth in Yucatan, Holland, Sweden and the United States by Brigitte Jordan (1992) - the mother of anthropology of reproduction, anthro of birth, and the concept of authoritative knowledge
Medical Anthropology Quarterly, June 1996 10(2) - a full issue on authoritative knowledge and birth
Monique and the Mango Rains: Two Years with a Midwife in Mali by Kris Holloway (2006) - a quick read by a young peace corps worker about her experience with reproductive health issues in Mali

It's my Second Blogoversary!

2011-11-07T18:08:00.004-05:00

HAPPY TWO YEAR BLOGOVERSARY TO ME!

It's my blog's 2nd birthday! Whoa! I can't believe it has been two years since I started my doula journey!

A year ago I was averaging an average of 170 page loads, and now I'm averaging about 200 per day. In the past week I've had 1,580 page loads. I've also added a new popular post:

Chimps Give Birth Like Humans but Don't have Midwives

I've had visitors from the United States, Canada, the UK, India, Australia, Indonesia, Latvia, Portugal, Greece, South Africa, France, Malaysia, Czech Republic, Switzerland, Norway, Hong Kong, Singapore, Croatia, Netherlands, and Mexico.

Also, in the past year, I've met Robbie Davis-Floyd, Penny Simkin, and Jill Arnold from the Unnecessarean!

If you are one of my regular readers, thank you for sticking by me! I really appreciate all comments and feedback. I'm still learning as I go!

I think Ricki Lake and Abby Epstein timed their release of More Business of Being Born DVDs perfectly with my blog's anniversary - Don't forget that MBOBB officially comes out tomorrow! And it is definitely going on my wish list :)

(And if you weren't around for last year's blogoversary, I encourage you to check out the awesome doula comic I posted a year ago!)

Writing Client Birth Stories

2011-11-01T12:08:00.001-04:00

A former client in the state I moved from a year ago, and one of my first doula moms, said: "I have been thinking of you because I know like 6 preggo people! I'd be giving you lots of business if you were here!" Awww :)

She also said that she showed some people the birth story that I wrote for her, and it made them want to hire me just from that! This is interesting, because I wrote birth stories for all my first clients, and since moving have stopped doing so. You can actually read a couple of the ones I wrote, with names removed, here: Doula Double Header Part 1 and Doula Double Header Part 2. There are many ways to write one - to the parents, to the mom, to the baby. You can say "you" or "I" or "mom."

There are differing opinions on the alldoulas.com forum about whether or not writing a birth story for your client is a good idea. Many doulas do it, but others don't think its a good idea.

The reasoning is that writing a birth story may alter the mom's perception of the birth, while it is not the doula's story to write. Many doulas say that writing it down from our perspective tells our story, not the mom's, and that's not the point.

The doula may write that the mom was powerful, or the caretakers were kind, and the mother may see it entirely differently. And what to do if it was an incredibly difficult labor and delivery? Can you write the story in a positive light, if the mother doesn't see it that way at all? Or what if you felt it was difficult, but the mother thinks everything went well? It would be terrible if we negated a mother's experience of joy or trauma based on our own perspective of it.

Many get around this by writing only simple timelines of the things that happened - when contractions began, when the doula was called, when they left for the hospital, when vaginal checks occurred, when the baby was born, etc. This removes all emotion and makes it not technically a story at all.

Since doing my certification births I have stopped writing birth stories for my client. One reason was because I read the forums and was confused about how I felt about it all. Another reason was because I liked writing the stories for my blog, but then realized that I shouldn't be posting another person's birth story with my opinions on my blog, in case the mother found it. A third reason was because I had my first birth where I felt a little bit like a failure in some aspects of my doula work - it was so different from previous births - so how should I write it down for the mom? So I just didn't. And I didn't want to write birth stories only for the births I thought were perfect, because that didn't seem fair. So now I don't write any at all.

I still talk about the births with my moms afterward, at the postpartum visit. I ask them how they felt about it, what they remember, tell them funny things people said, or what time things occurred. I tell my opinions if asked, which is hard to do sometimes. And I've learned a lot! Things that I'd feel terrible about they didn't think was a big deal, and things I thought were good choices they felt really upset about.

It's hard to not want to write birth stories for the parents, sometimes, though. Especially when my former client tells me that her husband loves reading the story I wrote for them because it makes him cry, or she shares it with all her pregnant friends. I love to be able to continue to make a happy difference in people's lives for years to come through the story, but I'm still not sure the benefits outweigh the possible risks in other situations.

Do you write birth stories for your clients? What are your thoughts on all this? Please share!

Teens: "I Have Sex"

2011-10-28T09:35:00.000-04:00

This video came up in conversation during my Reproductive Health class, and I had never seen it before. Have a look, tell me what you think!

Teens: "I Have Sex"

Links of Interest

2011-10-25T20:12:00.000-04:00

So, I've been more than a little busy lately, but here are several interesting articles that I've been keeping a list of and been meaning to share... I'm not caught up on my google reader, so you may have seen some of these may have been seen before, but if not, take a look!

I've been thinking a lot about the Certified Nurse Midwife vs. Certified Professional Midwife distinction, and here is a really great response to all the recent talk on the subject: CNM vs. CPM on Vita Mutari

Adorable Baby Halloween Costumes via Pregnant Chicken

This appeals to the sci fi nerd in me, in addition to the breastfeeding nerd in me - Evangeline Lily (from Lost) on Breastfeeding as a Hobbit (on the set for the new movie).

Kristen at Birthing Beautiful Ideas talks respect in her letter to the care provider from a pregnant woman:

All your years of training–the blood, the sweat, the tears, the money spent on education, the hours sacrificed to your profession–they give you extraordinary skills and abilities and knowledge, but they do not give you the knowledge of what it’s like to be any one of us.

A woman's hilarious birth story of her surprise unassisted birth (at home, after cesarean) - it is written in the most amusing way!

"I quickly realize, though, that either this is the biggest turd of my life, or it is the baby descending like a train through a tunnel"

"...push hard while making this super animalistic noise, very much like what Chewbacca marrying a humpback whale might have sounded like at the end of the raucous wedding reception"

Found a new blog by an MCH student. I love the way she phrases this, in her post "navelgazing":

I would say right now I am mostly trying to hash out a spot somewhere between three angles on the topic:
One. The fact that many or even most aspects of modern American birth are not optimal for healthy mothers and babies, aka the public health angle.
Two. The severe lack of information, choice, and agency most women face in their childbirth experiences, aka the feminist angle.
Three. The devious little inner know-it-all birth nerd that thinks everyone should have a non-interventive birth and breastfeed as long as possible, aka the asshole angle.

Banned from Baby Showers

2011-10-20T10:13:00.000-04:00

Haha, I'm not really banned from baby showers. But that is the title of one of the blogs I like to frequent, and the phrase sure ran through my head a lot this past week.

Last weekend I went to my first baby shower for a couple that I consider my friends. Compared to the baby showers I've attended in the past, which were for moms who weren't in my friend circle, this one was a little bit different. This was the first one where I signed a card "Auntie Em"!

So, here I am at this baby shower, as a doula, but not as the pregnant couple's doula, thinking things that would surely get me banned from baby showers if I were to express them out loud.

The whole time I was suppressing the urge to get into pregnancy, birth and baby talk with the people at the baby shower. For one thing, I wanted to keep these friends, and you never know when one piece of unwanted information or advice could really piss someone off. Secondly, a lot of the family members in the room were either from a previous generation (which comes with its own beliefs and experiences and knowledge of how things go or should go), or from a younger generation that hasn't yet been exposed to the birth world beyond the fiction portrayed on television.

I think that its a fine line to walk, and probably why the blogger, Donna, decided to name her blog "banned from baby showers" in the first place. As someone who eat, sleeps, and breathes childbirth education and has numerous, recent, firsthand experiences in a variety of settings, (not to mention that I read about birth in my free time for fun, and I study maternal and child health in graduate school), I find it difficult not to share everything I've learned with everyone I encounter! I want to shout it all from the rooftops!

Now, don't get me wrong, I do not want to force anything on anyone, and I certainly respect someone's choices, but I respect them more if they are well-researched and well-considered. I would never ever openly judge a doula client or a friend for the choices they feel are best for them. But I am passionate about spreading knowledge, and I am of the opinion that pregnant women and their partners are severely under-prepared for childbirth these days.

Donna writes on her blog:

I decided a couple of years ago that it was probably more important to have friends than to educate them about why they shouldn't believe everything their OB says.

And that's how I feel, too. So, for now, all I can do is refer them to websites that they may not go to, lend them books they may not read, but otherwise keep my mouth shut at baby showers.

I promise I will! Please still invite me to your baby showers, friends!

MORE Business of Being Born

2011-10-14T20:18:00.004-04:00

This is an absolutely amazing video!

Watch the trailer for More Business of Being Born - interviews with celebrities about their birth, Riki Lake and Abby Epstein meet Ina May Gaskin, women talk about how powerful labor and birth can be, issues related to VBAC and the rising Cesarean rate, and how incredible women are.

"It is a woman's right to make that decision of how she's going to give birth to her child, and it's also her right to have the information available so she can make a conscious decision, coming from a place of awareness and not a place of fear."

More Business of Being Born will be sold in a 4-DVD set, including:
1: Down on the Farm
2: Special Deliveries
3: Explore Your Options
4: The VBAC Dilemma
Learn more about them at www.thebusinessofbeingborn.com

One World Birth Videos

2011-10-13T19:18:00.001-04:00

Have you checked out One World Birth's library of videos yet?

September's theme was "The Big Picture" featuring some of the world's leading birth experts on the problems in birth, current trends, possible solutions and the idea of a birth revolution. Recent videos include:

The Safety Debate
The Risk Debate
The Recent History of Midwifery & Obstetrics
As well as the very popular 60 second doula & midwife slot

October's theme is "The Love Month" all about normal birth and oxytocin. Check them out!

Anthropology of Reproductive Health: Part 2

2011-10-06T11:52:00.001-04:00

This is the second part in my sharing of my Anthropology of Reproductive Health graduate course topics and readings.

This semester I am taking a fabulous anthropology course on reproductive health. With topics like state control/social control, pregnancy/prenatal care, childbirth/breastfeeding, abortion, infertility, STI's, and circumcision, what's not to love?

So, I thought I'd list the articles we've been reading so that you can read them, too, if interested. My professor has compiled an excellent reading list, and I hope she doesn't mind that I'm sharing them here. I will do this in parts, so as not to overwhelm anyone interested in seeing the full list, and I am including some notable quotes from some of the articles to give you an idea of what I found most interesting about them.

Our third class was dedicated to the topic of State Control/Social Control, and we touched on the following issues:

Medical Accuracy in Sexuality Education: Ideology and the Scientific Process. Santelli, J. (2008)

"The Waxman Report found that 11 of the 13 curricula [of commonly used abstinence programs] contained false, misleading or distorted information about reproductive health, including inaccurate information about contraceptive effectiveness and the risks of abortion, among others."

"Withholding potentially life-saving information from sexually active adolescents is ethically troubling. The principle of informed consent suggests that persons should be given all the information they need to make informed choices."

Counseling Contraception for Malian Migrants in Paris: Global, State, and Personal Politics Sargent, C. (2005)

"Sub-Saharan Africans had the highest fertility among foreigners living in France in 1999, with an estimated 4.72 children per woman, in contrast to 1.72 children born to mothers with French nationality."

"An implicit hospital policy opposes immigrant births and strongly encourages contraception."

"The prescription for the pill may be added to the stack of prescriptions a woman receives at discharge, without explanation."

"The predominant perspective among our informants was that Islam opposes contraception. In fact, Muslim jurists and theological texts demonstrate ambivalence regarding birth control."

Unintended consequences: Exploring the tensions between development programs and indigenous women in Mexico in the context of reproductive health. Smith-Oka, V. (2009). [I've read this before for another class; it seems to be an important one]

"Reproductive rights are culturally and historically located."

"I use a political economy framework to explore how seemingly innocuous programs, such as cash transfer policies, shape women's reproductive choices... My purpose includes the following: a. to examine women's perceptions of forcible interactions and the medical staff's use of insistence and a joking relationship to implement policies; b. to show how the implementation of development programs often goes awry on the ground; and c. to illustrate the intersections between medicine, economic development, and the state on women's reproductive freedom."

"Their knowledge about health and their bodies carry less weight than the knowledge of the medical personnel. In these contexts their knowledge becomes discredited and devalued in the light of the authoritative knowledge of doctors and nurses."

Sterilized in the name of public health: race, immigration and reproductive control in modern California. Stern, A. (2005)

"California defined sterilization not as a punishment but as a prophylactic measure that could simultaneously defend the public health, preserve precious fiscal resources, and mitigate the menace of the 'unfit' and 'feebleminded.'"

"foreign-born were disproportionately affected, constituting 39% of men and 31% of women sterilized."

"African Americans constituted just over 1% of California's population, they accounted for 4% of total sterilizations."

"California's sterilization program was propelled by deep-seated preoccupations about gender norms and female sexuality...the sterilization of women and young girls categorized as immoral, loose, or unfit for motherhood intensified."

"Sterilizations were particularly pushed on women with 2 or more children who underwent cesarean deliveries."

The social life of emergency contraception in the United States: disciplining pharmaceutical use, disciplining sexuality, and constructing zygotic bodies. Wynn, L and J. Trussle. (2006)

This article examines the FDA hearing on the proposal to permit nonprescription access to the Plan B emergency contraceptive pill. The arguments of those who came to testify for or against it are laid out and analyzed. Some of the reasons I highlighted in my text were "doctors would lose key opportunities to talk with their patients about contraception, sexual decision-making, and the risk of sexually transmitted disease" (which I've never had a doctor do, and would require women to pay not only for the pill, but also the doctor's office time, not to mention is an unequal power relationship), portraying Plan B, but not Viagra, as facilitating the sexual exploitation and seduction of women, contestations of zygotic personhood (not fetal personhood, but actually zygotic prior-to-implanation personhood), and more. Great article!

"Political debates over new medical technologies, especially new reproductive technologies, are not so much debates about science and technology as they are centrally concerned with interpreting these technologies within a web of (sub)culturally defined moral valuations and social interpretations."

"Because the contraceptive effect of breastfeeding may operate by preventing the implantation of the fertilized eff, should the merits of breastfeeding be rethought in the name of human (zygotic) life, or should female sexuality be avoided during lactation? Because half of fertilized eggs never implant, should more respect be given to the menstrual blood of sexually active women that most Americans dispose of unceremoniously in tampons and other sanitary protection products?"

The following fabulous articles consider issues regarding Pregnancy/Prenatal Care:

Ethics: ‘‘Life Before Birth’’ and Moral Complexity in Maternal-Fetal Surgery for Spina Bifida Bliton, M.J. (2003)

The Production of Authoritative Knowledge in American Prenatal Care Browner, C.H. and N. Press (1996)

"Patients are active interpreters of medical information. They pick and choose, using and discarding advice according to internal and external constraints and considerations. In our case of pregnant informants, embodied knowledge and everyday life exigencies proved to be pivotal in their selective designation of certain biomedical knowledge as authoritative."

"Valuing information about prenatal care derived from embodied knowledge over that of biomedical knowledge contrasts with the attitudes and behavior that characterize most American women as they give birth. During labor American women are highly acquiescent to biomedical authority at the expense of embodied knowledge."

God-sent ordeals and their discontents: Ultra-orthodox Jewish women negotiate prenatal testing. Ivry, T., E. Teman, et al. (2011).

"Ethnographies of reproduction teach us that a religion's formal attitude to a certain technology may be notably unrelated to its practical use... being religious does not always mean refusal [of prenatal diagnosis]."

"Carrying and raising an unhealthy child is a task God might assign a woman to test her faith... women in our study constantly prayed not to be she whom God chose for such an ordeal."

"Nearly all the women could recall at least one story of another woman getting rabbinic permission to terminate a pregnancy that was life-threatening or after lethal anomalies were detected."

Interrogating the dynamics between power, knowledge and pregnant bodies in amniocentesis decision making. Markens, S., C. H. Browner, et al. (2010)

"A common assumption is that women who decline prenatal testing distrust biomedicine and trust embodied/experiential knowledge sources, while women who accept testing trust biomedicine and distrust embodied/experiential sources. Another major assumption about prenatal testing utilization is that women who are open to abortion will undergo prenatal testing while those who are opposed to abortion will decline testing."

"'Should a pregnant woman do everything doctors advise?' 'No, they may be wrong too, you never know.'"

"'What is to guarantee the doctors know? They are human beings, and they make mistakes too... while pregnant you need to get as much advice from them [as possible], but also not to believe in everything.'"

"It is important not to view biomedical and other knowledge sources as inherently in opposition - many women see various source as powerful, valid and useful. In other words, accepting biomedical knowledge implies neither passivity in the face of technology not a necessary distrust of experiential knowledge sources."

"In our study, Mexican-born women were much more likely than the US-born women to both believe that they can 'tell' if the baby is fine and to believe it's important for pregnant women to do everything doctors advise."

Perils to Pregnancies:On social sorrows and strategies surrounding pregnancy loss in Cameroon. Van Der Sijpt, E. and C. Notermans (2010)

"Pregnant bodies have been predominantly homogenized, politicized, and medicalized."

"Spontaneous losses are often suspected to be provoked; induced abortions are often presented as spontaneous ones."

"Local notions of loss are thus not only more encompassing and diverse than assumed in global debates, but they also require strategic values that cannot be understood if not situated within local atmospheres."

Do these quotations spark any feelings or considerations? Have you read these articles? Please share your thoughts!

Anthropology of Reproductive Health: Part 1

2011-10-04T18:54:00.005-04:00

This semester I am taking a fabulous anthropology course on reproductive health. (I actually told my class that I have this blog, so if you are my classmate, hello!) I am enjoying this class more than any other class I've taken so far in graduate school - the discussions each week are excellent and I want them to continue all day, the reading assignments are fascinating and I enjoy every one, and the overall class theme is issues related to sexual and reproductive health from a multi-disciplinary approach! With topics like state control/social control, pregnancy/prenatal care, childbirth/breastfeeding, abortion, infertility, STI's, and circumcision, what's not to love?

The first day we talked about Reproductive Health and Human Rights, for which we read the articles listed below.

Palestinian Women’s Sexual and Reproductive Health Rights in a Longstanding Humanitarian Crisis (Bosmans, M., D. Nasser, U. Khammash, P. Claeys, and M. Temmermane 2008)

"...the complexity of the Israeli-Palestinian conflict is seriously affecting the sexual and reproductive rights of both refugee and non-refugee women in the West Bank and Gaza."

"Two international organizations mentioned keeping records of deliveries, still-births and cases of women dying during delivery at the military checkpoints because they were denied passage to reach the hospital."

"A woman's contribution to national development and survival is mainly understood in terms of her reproductive role, and persistent gender inequalities prevent her from using contraception."

Sex trafficking, sexual risk, sexually transmitted infection and reproductive health among female sex workers in Thailand (Decker, M. R., H. L. McCauley, et al. 2011)

‘Other Inhuman Acts': Forced Marriage, Girl Soldiers, and the Special Court for Sierra Leone (Park, A.J. 2006)

"Girls should not be subsumed under the category 'women' or 'children', but require specific attention."

Advancing Transgender Family Rights through Science: A Proposal for an Alternative Framework (Sabatello, M 2011)

"As not 'truly' man or woman, their right to marry was extremely curtailed. As not 'naturally' mother or father, their right to found a family could not reach the legal threshold for 'parenthood.'"

"While transgendered individuals were offered the advantage of scientific developments, exercising this option meant losing an array of other fundamental human rights."

Behind Closed Doors’: Debt-Bonded Sex Workers in Sihanoukville, Cambodia (Sandy, L. 2009)

Our second class was devoted to the topic of Anthropology and Reproduction:

Anthropology theorizes reproduction: Integrating practice, political economic, and feminist perspectives. Greenhalgh, S. (1995)

“Life Begins When They Steal Your Bicycle”: Cross-Cultural Practices of Personhood at the Beginnings and Ends of Life. (Morgan, L. 2006) [my favorite article of this week!]

"Feminist anthropologists have asked, for example, how 'fetal subjects' have come to acquire social currency, and who is able to assert of deny their moral significance."

"Wari' [people in western Amazonia] models of personhood emphasize bodies that are interconnected; each individual's body is constituted through the continual exchange and incorporation of body substances such as blood, semen, breast milk, and sweat. Furthermore, one's identity changes throughout one's life as one becomes more or less related to multiple others through the exchange (or not) of body substances. When Conklin asked the Wari' to explain how babies are made, tey told her that a newborn is built from the gradual accumulation and mixing of the father's semen and maternal blood over the course of pregnancy. If a father goes away for an extended period of time while his wife is pregnant, the baby will be born thin and weak because it was deprived of the semen it needed to make it strong. Conklin explained that for the Wari', this conceptualization implies that babies are always considered to be the product of a sustained relationship between a man and a woman...A Wari' pregnancy therefore can never be a mistake; a Wari' child can never be 'unwanted.'"

"I fear that the concept of culture has sometimes come to function as what anthropologist James Ferguson called an 'anti-politics machine,' an ideological apparatus used to divert attention away from structural inequalities that might be harder to change, or the questioning of which would threaten to destabilize the political system."

"A focus on fetal citizens diverts attention from other challenges that pregnant women face and from other threats to fetal health."

"Nor will personhood be resolved in the embryology laboratory or in the courts, for personhood is destined to be played forever on the disputatious fields of social practice."

Liminal Biopolitics: Towards a Political Anthropology of the Umbilical Cord and the Placenta. Santoro, P. (2011).

"Preserving UCB [umbilical cord blood] is offered as a form of engaging with biomedical evolution and with the whole new generation of stem cell therapies that will surely be developed in the near future."

In early Modern Europe, "the placenta simply could not be neglected: the child's future career depended on it, because the child inevitably suffered form the repercussions of any misadventure on the part of his double."

"[The placenta] was tied to the branch of a tree and left there to dry, or cooked and eaten by the mother and maybe other people (the belief being that the placenta had miraculous powers of fertility)."

"Among the Cherokee, the navel-string of a girl is buried under a corn-mortar, in order that the girl may grow up to be a good baker; but the navel-string of a boy is hung up on a tree, in order that he may be a hunter... In ancient Mexico they used to give the navel-string to soldiers, to be buried by them on a field of battle, in order that the boy might thus acquire a passion for war."

"A negligent disposal could be the source of directly disastrous events: if one burned the placenta in the fire, it was possible that the mother would suffer from fevers and inflammation of the womb..."

"The Santals of East India, for instance, do not refer to their birthplace, rather they refer to 'the village where my afterbirth is buried'"

Culture, Scarcity, and Maternal Thinking: Maternal Detachment and Infant Survival in a Brazilian Shantytown. Scheper-Hughes, N. (1998)

"Infant and childhood mortality in the Third World is a problem of political economy, not of medical technology."

"Whenever we social and behavioral scientists involve ourselves in the study of women's lives - most especially thinking and behavior surrounding reproduction and maternity - we frequently come up against psychobiological theories of human nature that have been uncritically derived from assumptions and values implicit in the structure of the modern, Western, bourgeois family. Theories of innate maternal scripts such as 'bonding,' 'maternal thinking,' or 'maternal instincts' are both culture and history bound, the reflection of the very specific and very recent reproductive strategy: to give birth to few babies and invest heavily in each one."

Feminist Anthropology Anew: Motherhood and HIV/AIDS as Sites of Action. Downe, P. J. (2011)

Check back for more soon!

Weekend Movie: Birth and Indigenous Identity in Ecuador

2011-09-24T11:44:00.000-04:00

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 :)

Weekend Movie: Delayed Cord Clamping

2011-09-18T12:07:00.016-04:00

Penny Simkin visually explains the benefits of delaying clamping of the umbilical cord after birth, with visual aids!

More information:

Meconium

2011-09-15T10:51:00.001-04:00

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/

Being a Doula is Hard

2011-09-13T11:59:00.008-04:00

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?

Weekend Movie: OB/GYN vs. Midwife

2011-09-10T07:08:00.001-04:00

A comparison of a prenatal appointment with an OB/GYN to that of a Midwife:

Doula Anthropologists

2011-09-07T12:54:00.005-04:00

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":

Courtney Everson, doula, Anth doctoral student

Nicole D’errico, Anth doctoral student and doula

Danielle Winner Koontz, doula and CBE, BA and MA in Anth

Cynthia Ingar, Peruvian medical and feminist anthropologist, trained doula and women's health educator
Rachel Vines, BA Anthropology and Certified Doula

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)

Weekend Movie: One World Birth

2011-09-04T18:23:00.000-04:00

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!

The Childless Doula

2011-08-25T11:55:00.000-04:00

...is still worth hiring.

After all, women hire male obstetricians every day! And I've definitely heard of childless midwives.

A doula who has never given birth herself, such as myself, may still be a great support person. The truth is, even if I had given birth, my birth experience is going to be nothing like your birth experience. A woman with a traumatic birth, or a cesarean birth, has her experience, thoughts and worries that she is bringing, but it may be a far cry from their doula client's birth experience. Precisely because I have never experienced a birth of my own I have no baggage to leave behind. This way, I go in with an open mind.

Another bonus to hiring a doula who doesn't have kids is that her schedule is more flexible; there is no need to find childcare at the last second!

It's also important to note that a doula without children may not be that way by choice. In her post, What Not To Ask Your Doula, Yoruba Doula notes:

A childless doula may not have children because she simply doesn’t want any. The doula you’re interviewing may not be able to conceive. The lovely woman sitting across from you at the coffee house as you feel out her qualifications may be overcoming the heartache of a miscarriage. She may be a single woman who wants children, but can’t afford artificial insemination or IVF. The woman who scores high in every area on your checklist except for whether or not she has children may have given birth to a baby that didn’t survive.

As my DONA trainer put it, "have you ever known someone who couldn't have children who would have made a great mother?"

You don't have to have been a mom to be a motherly supportive presence during birth. And you don't have to have given birth to know what a normal birth looks like, what the usual processes with a birth are, what positions would help you find comfort or change the baby's position, and so on. Many childless midwives and doulas still have a passion for birth and babies, a natural empathy, and a great pool of knowledge to draw from!

Photo from an article on Young Doulas

However, if it is personally important to you that your doula have experienced childbirth, breastfeeding and motherhood herself, then that is your priority. Yoruba Doula writes:

Does this mean you should stop caring about whether or not your doula has children? Absolutely not! Your desires are yours, and you deserve to have your needs met by all means. Do continue to ask ask, “Do you have children?,” as you interview. Please do not ask, “So, why don’t you have kids?” It may seem like a harmless question, but it’s one that could have devastating effects on a doula who planned to have a lovely afternoon chatting with you.

Opinions vary on whether or not to hire a doula who has never given birth, but it is a personal decision to make for every pregnant woman.

For many doulas, it is not an issue to be asked. I am not always asked, but I have been. I simply say I am waiting for the right time in my life to have kids. My training, testimonials, knowledge and experience speak for themselves (obviously I've been hired before despite my childlessness), and if the couple are comfortable with me, they hire me.

The most important thing is that you click well with your doula!

Preconception Health Interviews

2011-08-23T19:25:00.000-04:00

Dr. Michael Lu, associate professor of obstetrics & gynecology and public health at UCLA,was interviewed over several parts on Science and Sensibility: Preconception and Women’s Healthcare: An Interview with Dr. Michael Lu

I've included some great segments of the posts below. If you are a maternal and child health scholar, I encourage you to read the posts in-depth!

Part One: Preconception Care

Allen Rosenfield probably 30 years ago asked the question, “Where is the ‘M’ in MCH?” Where’s the “mother” in maternal and child health programs–because much of MCH has focused on children’s health and much less on maternal health. I think the question we’re asking today is where’s the ‘W’ in MCH—where’s the woman in maternal and children’s health? If we really want to improve maternal and child health in this country, we really have to start by improving women’s health.

I think it’s pretty much in alignment with what you’re saying; it’s not just about childbirth. If the natural childbirth movement is all about natural childbirth, it doesn’t have the kind of impact that it could have. The focus should really be on promoting women’s health over their life course continuum and how we would be a better society for doing that.

Part Two: Working Smarter - Prenatal Care 2.0

All of the things we’ve been learning about the fetal origins of health –the importance of nutrition, mental health, environmental exposures in developmental and fetal programming, how much of that counseling do you think is actually going on in OB’s office? And remember most of these OB’s didn’t sign up to be a health educator, to be a nutritional counselor, to be a teratogen information specialist, to do all the things that we know are important in terms of really promoting maternal and infant health.

The public health response over the last couple of decades has been if the OB’s aren’t doing all those things, then let’s create these “wrap-around services”– some kind of the enhanced prenatal care model: I call it the prenatal care 2.0 system.

Part Three: Prenatal Preparedness and Childbirth Educators

Given the current constraints I think childbirth educators could try to really expand the content of their education into, not only the immediate postpartum, but also the inter-conception. And if you think about it, for women that are going to have more babies, the postpartum care is really preconception [care] for the next. I think it would be a good first step. I think most health educators actually do a pretty good job in terms of talking about breast feeding. I don’t think they do as good a job talking about family planning, at least I think its variable. I don’t think they talk very much about postpartum weight retention, nutrition, physical activities. So we know that both gestational weight gain as well as postpartum weight retention are main drivers of the obesity epidemic that’s going on in this country. What are childbirth educators doing about that.

We’re talking about baby-friendly hospitals. What would a father-friendly hospital look like? What would father-friendly prenatal care look like? I think dads are changing. There are a lot of dads that really want to be involved but aren’t very well supported to get involved. What’s the role of the childbirth educator in terms of involving dads? There are things both during childbirth as well as after the baby’s born in which dads can play a very important role. But I think like most obstetricians, most childbirth education really doesn’t focus that much on dad’s role in all of this.

Part Four: Sacred Trust

It’s a system flaw. It’s not just about asking the individual OB to work harder, but it’s asking the system to work smarter. So this is where the teamwork approach actually comes into play. I think doulas are much better trained in terms of providing support during labor than obstetricians are. Most of us didn’t sign up to stay by the bed side. We signed up for obstetrics. You know that obstetrics is actually a surgical specialty? OBs are trained to screen for disease, to treat complications, etc. They’re not really trained to provide nurture and support.

Part Five: Racial Gaps, Future Research

What’s the impact of the Medicaid Reform going to be on infant mortality and on the racial gap of infant and maternal mortality? There’s very little discussion about that. I’m all for Health Care Reform, but it’s really just health insurance reform. Instead, let’s think through what are the components of care that really optimize women’s health, and make sure there is equal access to those components for African American women.

Weekend Movie: Consequences of a Near Term Birth

2011-08-21T18:43:00.001-04:00

RISK: Consequences of a Near Term Birth

Risk is a very human twenty minute educational film that helps patients and their providers experience potential outcomes of elective late preterm delivery through the stories of two moms.

Randoms: Things to Share

2011-08-18T19:59:00.002-04:00

Well, nothing as awesome as the news in my last post, but hopefully these randoms are still interesting!

I went to an art museum this past week, and of course I had to take a photo when I saw artwork that included women breastfeeding! I should have written down the names of the works of art, because I can't remember them now. I know at least the first is of the Christian "Charity."

In other news, my favorite section in my Time magazine is the Health&Science briefing. This past week there were several interesting briefs of note:

A noninvasive test of Mom's blood - which contains fetal DNA - can determine a baby's sex at as early as 7 weeks gestation. It performs more accurately after 20 weeks. The blood test could also help doctors identify babies at risk for sex-linked disorders like hemophilia and obviate the need for invasive procedures like amniocentesis. (Actually, Annie at PhDinParenting has an interesting post about it - check it out!)

45% of female scientists say they had fewer kids than desired because of their careers. For male scientists it was 25%.

Data show that soy supplements don't ease menopause - In this article they are referring to a study that finds that taking soy supplements, a popular alternative to hormone therapy, doesn't help relieve the symptoms of menopause or protect against bone loss (when compared to a placebo in a double blind).

A few others things I've been reading lately...

Kristen at Birthing Beautiful Ideas wrote a lovely blog post called Why I Love Being a Doula which sums up my feelings as well - Its not about the babies for me so much as its about helping the mothers!

A fascinating post called Doula Discourse: Ondaadiziike: Birth and the need for doulas in Native American communities

The Midwife at Birth Sense wrote a post about just how far off an estimated due date can be - quite chilling!

Some Robbie Davis-Floyd action on Mother's Advocate blog: Cultural Definitions of Motherhood

Donna at Banned from Baby Showers on why a fast labor may not be such a great thing.

Also, I got into a discussion with a friend this past week about whether Tangled was more feminist than other Disney "princess" movies (for more on what lessons the princesses teach, check out this link for some images, or this one for some commentary). I then found this article on the NOW blog called With Tangled, Disney Gets Closer to Embracing Feminism. Thoughts on how Disney did with Tangled?

Classes start next week - Hopefully I can keep up with blogging!

Officially Certified!

2011-08-14T20:19:00.000-04:00

Dear Readers,

It has been almost 2 years since I decided to look into becoming a birth doula, registered for a training workshop, and started my doula journey. And now, after the completion of 9 births, I am finally a DONA Certified Doula!

Despite the great debate over whether it is necessary or worthwhile to certify and disagreements about the merits of various certifying organizations, I am glad to be a certified birth doula. I am glad to have made it this far, coming from zero background in healthcare or motherhood. My interest in culture and women's rights combined with a desire to learn and improve the health and lives of women has brought me to my passion and I am grateful for all the training I have received along the way. And there is much more to learn!

I feel like myself and this blog have reached a great milestone, and I thank you for following along on my journey :) Whether you are a doula, doula-curious, a mother, a scholar, or everything wrapped into one, I hope reading my blog has been worthwhile, and that we can continue on together as I continue my lifelong learning.

Cheers,
Emily, Anthro Doula

That's Vaginal!

2011-08-11T18:16:00.001-04:00

Some things need no explanation. Just watch!

Recent Doula Happenings

2011-08-09T09:25:00.000-04:00

Whew! The summer is almost winding down for me, as my summer classes have ended and my fall classes start in a couple weeks. In grad school news, I have completed all my tedious required public health courses (hooray!) and can really get into the meat of my MCH degree. In Anth, I will be taking a biocultural medical anthropology course again this semester and I am thrilled!

In my doula world, I have had an eventful summer and a lot of "doula firsts" (the learning never stops!):

I was a doula for a friend, which was much more emotionally challenging than I ever could have imagined. I was a doula at the same hospital twice (the first time that has happened to me, believe it or not), with two very different experiences. I had my first extremely negative doctor-doula experience. I had a really excellent doctor-nurse-doula experience and a beautiful natural birth! I had my very first doula client cesarean section. I was paid full price for my doula services for the very first time. I went to a prenatal visit to the obstetrician office with a doula client for the first time. I had to return to a hospital within 8 hours of a birth to help with breastfeeding because a client still hadn't seen a lactation consultant. I was called to do back-up for another doula for the very first time. I labored at home with a VBAC mom for the very first time. I was at a hypnobirth and saw a mama walking and talking through 3.5 min apart contractions! I learned that sometimes what I would fear most is not what my client would fear most. I prepared a vegan postpartum meal for the first time.

Every woman, every labor, every birth are so different and I learn something from every one. Sometimes I mess up and I lay in bed at night dwelling on what I could have done differently. Sometimes people say really wonderful things that just stick with me and make me feel great about what I do!

I also finally heard back from DONA about my doula certification packet, which I sent in over two months ago. The reviewer finally received it, contacted me to let me know, and has already called me to discuss it. Turns out DONA is ridiculously nit-picky about their paperwork! If its required for them to be this way (and not just my luck of the draw), than I definitely do not what to be on the certifying committee! My reviewer is very nice, but she is asking me to go through my charts and make sure I write or check "no" as well as "yes," not just leave some blank, "so I know I didn't just forget to check something," and then scan and send her a new copy. Also, make sure you have every form of contact possible for everyone on your resources list, fellow certifying doulas, because I am being made to return to my list and find all such information.

I'm not worried that I will be certified (she said all my references has great things to say about me and all my essays are in order), I'm just made to wait to correct silly bits of paperwork. Sigh. They truly do a very thorough job, though - she was almost giving me an oral quiz about information I had written in my essays, i.e. "what can you do in the future so that your client feels differently?" or "why do you think she felt this way about that?" etc. Another thing I noticed when she was having some trouble pronouncing my client's last names was that all my certifying birth clients were from different ethnic backgrounds! Awesome!

Two more great things happened this summer - 1. I became involved with a breastfeeding task force in my county. It is a collaborative of public health workers, health workers, lactation consultants, researchers, and so forth who are working together to increase breastfeeding rates in our county, especially among low-income and minority groups. 2. I have also become involved with a local public health organization that received a grant from the March of Dimes focusing on their "Elimination of Non-medically Indicated (Elective) Deliveries Before 39 Weeks Gestational Age" in order to prevent premature births. I'm working on program planning and program evaluation. I'm excited to be involved!

I have a client currently, and will be on-call during the beginning of the semester, but was thinking of just being a back-up doula for most of my fall semester (which has become exceptionally busy). Unfortunately, I have been receiving inquiries for doula services! I know I should turn them down but its just so tempting... Do any of you have experience or advice about being a doula while taking a full load of graduate school courses and working? Advice would be greatly appreciated! :)

International Breastfeeding Symbol

2011-08-06T18:13:00.000-04:00

International Breastfeeding Symbol

Due to the fact that a bottle icon was used to signify baby-feeding locations in public places, Mothering magazine ran a contest in 2006 for a new symbol for breastfeeding that could be used to represent nursing mothers everywhere. This was the winning symbol - designed by a stay-at-home dad and graphic artist. These days, it can be seen all over the web and is quickly growing in popularity and use. It also has its own blog: http://www.breastfeedingsymbol.org/blog/

Wear the symbol, spread the word!

Happy World Breastfeeding Week!

The World Breastfeeding Week posts continue...

2011-08-05T22:30:00.000-04:00

hilarious and random photo I found

When my blog was new, I posted a lot about the things I was learning and seeing and hearing about breastfeeding as a new birth junkie. Unfortunately, at the time I only had about 5 followers of my blog!

So, I thought I'd do a link-up of some older posts on some great information, just in case any of my new followers are interested in any of these topics. Enjoy!

The benefits of Kangaroo Care for all babies

The only reasons a mother should stop breastfeeding

What makes a hospital Baby Friendly?

The truth about Extended Breastfeeding, aka breastfeeding into toddlerhood

Is there a Natural Age of Weaning?

Improving health by understanding culture and behavior - Colostrum as "dirty milk" in India

A History Lesson: Breastfeeding and WWII

How does breastfeeding while pregnant work?

Babies can latch on themselves! Watch the incredible Breast Crawl

Would you eat Breast Milk Cheese?

Happy World Breastfeeding Week 2011!

Links - World Breastfeeding Week style

2011-08-04T18:37:00.000-04:00

In case you didn't hear the great news, The U.S. Department of Health and Human Services adopted the recent recommendation of the Institute of Medicine, to require insurers to provide breastfeeding support and pump rentals, free of co-pays and other cost-sharing!
For information about the newly adopted Guidelines for Women’s Preventive Services, click over to read more at Birthing Beautiful Ideas.

The CDC recently released the 2011 Breastfeeding Report Card. Reuters reports:

Less than 4 percent of the country's hospitals fully support breastfeeding, said a report issued by the Centers for Disease Control and Prevention.

In nearly 80 percent of hospitals, healthy babies who are being breastfed are given formula even when there is no medical need for it, making it more difficult to continue breastfeeding at home, the report says.

Only a third of hospitals have "rooming in" policies that allow babies to stay in the hospital room with their mothers 24 hours a day, which can increase breastfeeding opportunities.

Nearly 75 percent of hospitals do not provide adequate support for mothers once they leave, including follow-up visits and phone calls, the report said.

What every doula should know about breastfeeding: Tip #2: When to refer, how to refer

and

What every doula should know about breastfeeding: Tip #3: A few must-knows for pumping

via Public Health Doula

Great tips for doulas from a doula/IBCLC!

On Saturday, August 6 at 10:30 am local time, for one minute, women nation wide will be breastfeeding! Find a local BIG LATCH ON event near you!

The World Alliance for Breastfeeding Action is has created a video to show you how have a Breastfeeding-themed flash mob using the song they developed for this year's World Breastfeeding Week:

Talking About Breastfeeding Videos - WBW 2011

2011-08-03T09:54:00.001-04:00

Happy World Breastfeeding Week 2011!

Join the Conversation on Breastfeeding - World Breastfeeding Week
by WomensHealth.Gov

Reflections of Breastfeeding - When families were asked if they could go back to before to right before they decided to breastfeed, what would they tell themselves...

Public Health Begins with Breastfeeding

2011-08-02T12:00:00.001-04:00

Happy World Breastfeeding Week 2011!

To understand more about why Public Health Begins with Breastfeeding, check out my posts on breastfeeding and public health:

The Public Health Significance of Breastfeeding

Health Disparities: Breastfeeding Among African American Women

Socio-Ecological Determinants of Breastfeeding Failure/Success and Interventions

The Economic Benefits of Breastfeeding

Breastfeeding Public Service Announcements Worldwide

Public Health and Breastfeeding

...and read The Surgeon General’s Call to Action to Support Breastfeeding fact sheet.

and if you'd like to purchase a poster, bumper sticker or tote bag with the image/slogan above, visit here!

World Breastfeeding Week 2011

2011-08-01T09:11:00.000-04:00

Happy World Breastfeeding Week 2011!

This year's theme focuses on engaging and mobilizing youth intergenerational work with the catchy slogan of: "Talk to me! Breastfeeding - a 3D Experience."

The theme deals with communication at various levels and between various sectors.

The World Alliance for Breastfeeding Action (WABA) writes:

Why 3D?

When we look at breastfeeding support, we tend to see it in two-dimensions: time (from pre-pregnancy to weaning) and place (the home, community, health care system, etc). But neither has much impact without a THIRD dimension - communication!

Communication is an essential part of protecting, promoting and supporting breastfeeding. We live in a world where individuals and global communities connect across small and great distances at an instant's notice. New lines of communication are being created every day, and we have the ability to use these information channels to broaden our horizons and spread breastfeeding information beyond our immediate time and place to activate important dialogue.

This third dimension includes cross-generation, cross-sector, cross-gender, and cross-culture communication and encourages the sharing of knowledge and experience, thus enabling wider outreach.

The winners of the WABA 2011 photo contest are up, and there are some beautiful photos, including my favorites:

Check the website for WBW celebrations near you, like local events for The Big Latch On or Latch on America!

Weekend Movie: A Walk to Beautiful

2011-07-29T11:05:00.004-04:00

A powerful story of healing and hope for women in Ethiopia devastated by childbirth injuries, A Walk to Beautiful portrays the loneliness and shame that thousands of Ethiopian women experience because of obstetric fistula. The story ends in a productive new life and hope for the future in this award-winning film.

Native American Breastfeeding Promo Video

2011-07-24T09:53:00.000-04:00

This beautiful video, which I found via Motherwear Breastfeeding Blog, is a video from the Native Breastfeeding Council.

Its so awesome that the interviewees discuss the importance of breastfeeding not only for health but also for the special relationship between mother and baby, and for keeping with native traditions.

There are some lovely clips of Native American women breastfeeding, too.

Also covered in the video are the high prevalence of diabetes among Native Americans, and pumping and nursing when you have to go back to work. Moms share their breastfeeding experiences and opinions.

Home Births and the Public Health Response Webinar

2011-07-21T09:50:00.001-04:00

Home Births and the Public Health Response: Promoting Informed Choices and Healthy Outcomes

This seminar took place Wednesday, July 20, 2011 from the John Hopkins Bloomgberg School of Public Health in Maryland and was broadcast live online. These are my notes from the webinar, along with some of Dr. Declerq's slides.

Eugene Declerq, PhD Assistant Dean, Doctoral Education Professor, Community Health Sciences
Boston University School of Public Health

We're talking very small numbers

Historical Context:

As the number of hospital beds increased, out of hospital birth decreased.
Supreme Court determines that even though midwife's (Porn) birth outcomes were as god or better than local doctors, they could not separate midwifery from medicine, so she was charged with practicing medicine without a license.
Nurse midwifery came about so midwives could work unders direct supervision of doctors
Netherlands remain the only industrialized country with a sig. portion of births at home, now at 26% of all births are at home.
Trend in England and Wales - only industrialized country other than US showing a sig. increase in home birth.
U.S. post 1989 - Decrease in out of hospital birth but a jump at around 2008... but very small numbers.
2003 live birth certificate asked "planning status" of home birth. 83% of home births in 2006 are planned home births.

Present Day

Planned home births in the U.S. are white/non-hispanic. Small numbers of other ethnic/racial groups. The increases have occurred almost completely in white/non-hispanic mothers.
Overwhelmingly married, usually over 30, full gestation. More likely to be in rural areas, well-educated, nonsmokers. 75% of cases tend to be mothers who have given birth before. The people having home birth in the U.S. are a selective group.
The primary group attending home births (planned or unplanned) are Certified Professional Midwives. CNM's have dropped off, esp. because of legal constraints (also physicians).
Gestational age distribution - the average in the U.S. is 39th week. The planned home birth distribution shows the classic distribution with the peak at 40 weeks.
Significant increases have occurred in California, MD, Vermont, Ohio, Kentucky, VA, NC,

"Other" could actually be attended by an "illegal" midwife but signed off on by a father, for example.

So many inferences can be made from this slide

Maryland

Home birth rates jumped in 1994 but declined until 1999, until a slow general increase.
Not all planned home births end up at home. The transfer rate for home births is roughly 15%.
Much higher proportion of black/non-hispanic home births in MD than in the rest of the US, but could be unplanned home births.

Mairi Breen Rothman, CNM, MSN Certified Nurse Midwife
Metro Area Midwives and Allied Services

Birth center births are like having a home birth at someone else's house. There is nothing there that a midwife wouldn't have at your home. They both involve trained midwives who know how to use medications, IV fluids, oxygen, resuscitation, acute care period, etc.
In a home birth you have no institutional bacteria, and it doesn't require a nervous woman and partner to get in a car and drive somewhere and then leave in a few days.
The safety of home birth has been established again and again (Olsen 1977, Johnson & Daviss 2005, Leslie and Romano, Janssen Saxell et al 2009), in North American and abroad.
Wax et al, recent meta analysis AJOG - deeply flawed inclusion data

included pre-term infants in hospital; includes data from birth certificates that do not differentiate between planned and unplanned home births; did not consider culture, geography, health care systems impact)

Why women choose home birth (Boucher-Bennett et al 2009)

Number one reason: SAFETY
Avoidance of unnecessary medical interventions
Previous negative hospital experience
More control
Comfortable, familiar environment

Home birth patients feel they are not listened to and respected in the hospital
Public Health: more women are choosing midwives, so how can we make this option safe.
Ideal scenario is that everyone who is qualified to attend births is licensed, operating within the system, has access to the model of care she chooses, we have enough midwives and no unattended home births, streamlined way to do hospital transfers, midwives can collaborate or consult with physicians, and that Medicaid covers all services.
Bottom line: Birth is about Women. The discussion is about the Sovereignty of Women.

Frequently we hear "Should women be allowed...?" Have you ever heard "Should men be allowed...?"
"If we take good care of the mothers, the mothers will take care of the babies" - Kitty Ernst

Notes from the Q&A Discussion:

We can't have randomized trials of birth, so they are typically retrospective and women are matched. Frequent limitation: can't distinguish planned home birth and which home births become hospital births.

Studies frequently find that low-risk pregnancy/births are comparable at home and in the hospital.

One study found that matched women being cared for by midwives prenatally other than physician care had a 19% lower infant mortality rate and 33% lower low-birth weight rate. Midwifery care is designed to optimize women's self-care during pregnancy.

Midwives are extremely selective at picking women to attend at birth at home because they don't want anything to go wrong at home. Age is generally no issue.

Problem with Medicaid - payment doesn't cover everything. Midwives get a very low payment that doesn't cover all over-head.

The Healthcare Reform Act has this impact on pregnant women - will cover all pregnant women who are not covered. Also, pay for certified professional midwives but only in a birth center. CNMs will be paid by medicaid at 100% of the physician fee schedule.

Low risk moms in any setting - 97% of babies are fine. What's important is to have emergency pathways to deal with babies that need help. The best thing to do for women choosing home births is to have those systems in place, so that women can access the medical system without being punished.

The British system is instructive - give people a real option to have home birth - they are at about 3%. The U.S. has a more antagonistic view of home birth so we might at some point get up to 1.5%. Probably no huge shift in the future. But maybe there will be a much more activist maternity movement in the U.S.

Quiet revolution - women are quietly examining their options, looking at research, making a choice. More and more true as time goes on.

Physician-attended home births data - who are these physicians? Could be a physician sign-off at a home birth transfer or an unplanned home birth on birth certificates. Highly unlikely that physicians are at home with mother while she is laboring, attending the delivery, cleaning up, and leaving.

From a historical perspective, CNMs and CPMs have has some divisions and competition. These days there is an attempt by the ACNM and MANA to work together.

____________

The presenters' slideshows are posted under "Documents" here
There will be a link online at the Johns Hopkins Bloomberg School of Public Health archiving this webcast for future viewing.
Learn more about Eugene Declerq's work (and what he looks like) in his video Birth by the Numbers

A Breastfeeding and Culture Moment

2011-07-20T09:50:00.001-04:00

I was watching a video on the growing population of elderly worldwide and a comparison of how the elderly are cared for in different countries, when I heard this quote by a young Tunisian man:

"Mothers milk creates an affection between mother and son, and by the grace of god all our mothers have breastfed us. That contact with the breast strengthens the affection."

In a video completely unrelated to breastfeeding, an interesting perspective on breast milk is presented. Let that be a lesson - if you want your sons to care for you in your old age, breastfeed them! :)

Note: The video was made in 2000, and the rate of breastfeeding has decreased in Tunisia in recent years.

Maternal and Child Health Leadership Training

2011-07-18T20:17:00.000-04:00

I've got good news to announce! I have been awarded a Maternal and Child Health Leadership Traineeship through my school of public health! These training grants are distributed by the Maternal and Child Health Bureau, part of the federal agency HRSA.

As part of my MCH leadership training I will be required to attend specialized seminars on various MCH leadership competencies, receive individualized mentoring from both a faculty member and a member of a community organization, and attend research-to-practice seminars.

This is very exciting news for me because it will help me get a foot into the MCH public health community here in my area, get involved in MCH research, and also provide a tuition waiver to help me with my education! The traineeship also provides travel support to conferences and a stipend.

If you are interested in pursuing this same traineeship at your own college of public health, visit the funded projects page on the MCHB website and search for your school!

Books: The Doula Advantage

2011-07-17T16:12:00.002-04:00

The Doula Advantage: Your Complete Guide to Having an Empowered and Positive Birth with the Help of a Professional Childbirth Assistant
by Rachel Gurevich

I just finished reading The Doula Advantage and have found it a great overview of the doula profession.

Rachel Gurevich covers why doulas are needed in our modern society, a great overview of the research on labor doulas, such as on the positive birth experience, the reduced need for pain medication, breastfeeding and bonding, and medical interventions overall. She then describes in detail each role the labor doula plays: Informational, Emotional, Physical, and more.

There is a chapter devoted especially to Dads and Doulas and commonly asked questions, especially by those who are unsure about the interplay between dads and doulas. This chapter even includes the opinions by dads who have hired doulas themselves.

There is also a chapter explaining the facts surround many myths about doulas and epidurals, for example: "Doulas are only interested in supporting women who plan on giving birth without medication," "Doulas push their opinions and philosophies onto their clients," "A doula will make me feel guilty if I 'chicken out' and choose to use medication," and "Women who use medication during childbirth do not need the services of a professional labor support person. There will be nothing for the doula to do." If you are interested in the truth behind these myths, I encourage you to pick up this book!

The book explains the different roles of the doula vs the labor nurse, the doctor, the midwife, as well as birth locations. It also explains the difference between a postpartum doula and a maid, baby nurse, lactation counselor.

Most importantly, the book is a fantastic resource for how to find a doula, how to decide what kind of doula is the right one for you, how to interview a doula, and how to hire one.

The Doula Advantage is full of quotes, testimonials, opinions, and unique experiences of women who have used a Labor Doula, Postpartum Doula, or Antepartum Doula which are extremely helpful for anyone interested in finding a doula.

The most interesting aspects of the book for me, as a labor doula, was the detailed explanation of what exactly a Postpartum doula does and doesn't do, and the information on Antepartum doulas (which are the least known type of doula). I also enjoyed the part on Becoming a Doula, which is full of great information for anyone to know to help understand what goes into training, business, and lifestyle of a doula. Most importantly, Gurevich outlines the Six Traits that all Great Doulas Must Have:
1. Self-motivation
2. A desire for lifelong learning
3. Perceptiveness
4. Passion
5. Flexibility
6. Professionalism

Even if you are a friend of a doula or a doula yourself there is something to learn from this great book!

I would recommend The Doula Advantage book to women, men, mothers, fathers, doctors, midwives, nurses, family members, etc who are:
- New to the concept of a doula,
- Unsure exactly about the role of a doula, postpartum doula or antepartum doula and the benefits the doula provides,
- Looking to hire a doula and get a better idea of how to go about doing so,
- Interested in becoming a doula themselves!

Favorite Blogs: Birth Sense

2011-07-12T10:00:00.001-04:00

While I'm on the topic, another blog I absolutely adore is Birth Sense!

Her blog is the blog that says everything I wish I could say, but 10x better than I could ever say it. It is written by an anonymous hospital midwife, who shares not only researched articles but also her observations of the hospital birth world. Her posts are fabulous discussion-starters and are very thought-provoking. She also responds to other articles, comments, or reader questions and birth stories. It is a must-read!

Some recent excellent posts on Birth Sense:

Patient Apathy or Provider Apathy?

Does it scare you that an entire generation of young obstetricians view c-section as safer than vaginal delivery? That they view epidural use as part of a normal, routine labor? That the only unmedicated, physiologic labors they may have ever seen were accidental ones, where the woman delivered too quickly for intervention?
I propose that the widespread acceptance of these attitudes is trickling down to women. Obstetricians don’t often talk about choices in childbirth, because as far as they have ever seen, childbirth is not a choice; it is a set of routines and procedures that everyone follows...

Does your provider voluntarily bring up choices with you? For example, do you hear, “It’s time for your ______ test. . .” or do you hear, “I’d like to discuss with you a test we offer to women at this stage of pregnancy. It is called _______, and the reason we offer this test is because (present evidence in favor of the test). Some women prefer not to have this test done. Some of the concerns I am aware of about this test are (present evidence against the routine use of the test, if any). Some alternatives to having this test done now would be (present alternatives, even if you don’t agree with them). What questions do you have for me, and how do you feel about having this test done?”

The #1 Reason To Choose A Midwife

Many of the incidents in the case studies related in the cited report involved situations which very likely would have been avoided had the health care provider been present with the woman throughout labor. Midwifery care ideally provides this continuity of care throughout labor....

Continuous labor support, continuous care by the decision-maker, is the number one reason to choose a midwife for your next birth.

and a follow-up post with some chilling stories: Do the “decision makers” listen?

Having been a labor nurse myself for 15 years before becoming a nurse midwife, I am well aware of the challenges facing nurses, especially when they care for a patient who is experiencing complications and cannot get the care provider to respond appropriately to their concerns. ..

Decision makers do not always listen. Nurses may communicate most excellently, and still be unable to secure good care for their patients.

I encourage you to follow Birth Sense! And on facebook!

Favorite Blogs: Science & Sensibility

2011-07-11T10:43:00.001-04:00

I'm going to make a big plug for Science and Sensibility, "A Research Blog About Health Pregnancy, Birth and Beyond" from Lamaze International.

I LOVE this blog! I've been reading it since the time I started my own blog, and it is absolutely fantastic. The contributors are wonderful, bringing in birth-related research from the entire spectrum of parturition-related topics. I love that everything is very carefully researched and thought-out, providing all sides of the argument, with references.

The blog contributors have different areas of expertise, and the topics cover understanding research, systematic reviews, conferences, becoming a critical reader, and so on. They frequently invite guest bloggers to add to the diverse topics of the blog.

Most recently I enjoyed this blog post by a recent contributor: Healthy Birth Practice #6, Keeping Mother and Baby Together – It’s Best for Mother, Baby, and Breastfeeding:

Some state Departments of Health, as that in Ohio, have got it right, and officially recommend skin-to-skin. That state prints and distributes cards for its WIC program that read, in part: “Hold me, Mom. Babies who are held skin-to-skin on their mother‘s chest right after birth are happier and less likely to cry, are more likely to latch on and [sic] breastfeeding well, have better heart rates, have better temperatures than under a warmer, have better blood sugars, burn less [sic] calories than under a warmer. So, be sure to tell your doctor and the hospital nurses that you want to hold your baby for at least the first hour after the birth, skin-to-skin (baby naked, not wrapped in a blanket). That‘s the best way to introduce your baby to the world”⁴

How can we account for the fact that a mother is advised by a government agency to “be sure” to tell her doc and staff to give her best-evidence care? Even for this well-documented and uncomplicated course of action, we cannot count on our caregivers to act reliably in the interests of mother and baby. Again, a Healthy Birth Practice can be read as a subtle warning: Do not let them take your baby from you for the first hour!

Why must women spend precious energy and focus during labor to advocate for best-evidence care for themselves when that kind of care should just be expectations met? Period.

Here, here!

Why should women have to defend themselves, hire doulas to advocate for their desires, fear the hospital experience so much that some switch to home birth? The U.S. maternity care system could be so much better if doctors, nurses, hospitals, insurance companies, etc all recognized and practiced evidence-based procedures, true informed consent, and respect for the choices of the mother. Instead, they practice defensive medicine and women must bring in reinforcements (in the form of people, scientific studies, etc)!

Anyway, I encourage you to subscribe to Science and Sensibility if you have an interest in childbirth-related research! I have especially loved their articles because it keeps me up-to-date on evidence-based practices and research to back up my answers to the questions that my doula clients have!

(or follow them on Facebook here)

Breastfeeding Doll!

2011-07-07T20:58:00.001-04:00

What a cute way to teach about breastfeeding!

The doll is called Bebé Glotón, which in my best Spanish means Gluttonous Baby... But maybe it has a different meaning for the toymakers in Spain? In English it is called "The Breast Milk Baby."

"the first breastfeeding doll"
"Takes the breast! A doll without a baby bottle"

This breastfeeding doll makes sucking noises as it nurses (just by bringing the doll closer to the nursing vest that the child wears). It even cries, hiccups and burps!

See the demonstration:

If you go to the Bebe Gloton website, there is a nice video on the home page that is similar to the one here, and it shows that they have male, female, white, black and asian versions of the doll for sale. There is also an English version of the website!

Not that you need a baby doll specifically for breastfeeding in order to mimic breastfeeding with a doll... but its still really great for children to imitate life!

A blogger at Babble wrote:

Created by the Spanish toymaker Berjuan, the doll created some controversy when it was first introduced last year. Some critics felt it was inappropriate to teach young girls how to nurse — as if it would encourage early pregnancy! Even some breastfeeding “lactivists” felt it was unnecessary.

What are your thoughts? Would you buy a breastfeeding doll?

I don't think its inappropriate or unnecessary to have a breastfeeding doll. A young child who sees their mother breastfeed a new baby will imitate the action, with or without a doll specifically designated for such a task. Growing up I had a doll that you could "feed" and then it would "pee." Was this doll "necessary"? No, but it was fun to pretend to feed my baby doll. So, breastfeeding is just another way to do it!

Did pretend bottle or spoon feeding my baby doll make me want to become pregnant? I'm pretty sure I had grown out of the baby doll phase by the time I was old enough to even want to touch a boy. Was it something I "needed" to practice? No, it was just a game! Just like playing school or pretending to cook in a play kitchen. If this doll helps emphasize the breastfeeding norm as an added bonus to child's play - AWESOME!

THEN, the Spanish toymaker takes it one step further, with the breast pump for the young girl to practice "filling a bottle" with, then handing it to her male playmate, who can now join in and feed the baby, too!

The toymaker says:

Enseñar a los niños la importancia de la leche materna es la principal misión de bebé glotón, por eso lanzamos al mercado "el sacaleches" una forma de seguir alimentando a tu bebé con leche materna y poder así de conciliar la vida laboral social y familiar. El lanzamiento del sacaleches de bebé glotón supone una gran novedad en la forma de educar a nuestros hijos.

Translation:

To teach children the importance of breast milk is the main mission of bebe gloton, for this reason we introduce to the market "the breast pump" a way to continue feeding your baby with breast milk and to be able to combine work life, social life and family life. The launch of the breast pump for baby gloton assumes a great innovation of education for our children.

The breast pump I do feel a little weird about... Maybe because of the controversial nature of breast pumps, or the fact that the child is now interacting with a piece of plastic on her non-breast instead of the baby doll... I can't really explain it.

Anyone else?

Maternal Wisdom: A doula birth story

2011-07-05T14:54:00.000-04:00

In response to my call for birth stories featuring doulas, Avital of Mamafesto shared this beautiful story about her birth and her wonderful doula, Chana Luba. Enjoy!

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!

Avital, a couple days postpartum, with Chana Luba

I was five months pregnant when we moved. We knew in our hearts that we had moved for all the right reasons, but it still felt so terrifying. We were moving further away from our family and friends, and knew less than a handful of people in our new town. My husband's work had him away for long days and sometimes nights, and while I wasn't working, I was finishing up my thesis project for my master's degree. I spent most of my days working diligently on my thesis while taking occasional walks into town as my belly expanded. I visited coffee shops and art galleries, book stores and boutiques, but still felt a lack of community.

Having already sadly shelved the notion of a home birth for a variety of reasons, I did my best to immerse myself in the various programs the local hospital offered pregnant mothers. Around my seventh month of pregnancy I started taking a prenatal yoga class, held in the community room of the hospital. It was there that I met my soon-to-be best friend. She was pregnant as well, only a couple of months ahead of me. She had lived in the area for a while, and as we got to know each other, my desire for community started being fulfilled. It was through her that I learned about the work of doulas. She was actually a doula in training at Maternal Wisdom and suggested I call the woman she studied with.

I took the information home with me and let the idea percolate in my brain for a bit. A person that would help me throughout my labor and birth? Wasn't that what my husband was for? The more I thought about it, the more unsure I was. The concept sounded interesting, but wouldn't the cost be prohibitive? I wanted to talk to my new friend about the idea of a doula more, but she ended up going into labor and was occupied with her newborn daughter.

In the end, I called up Chana Luba Ertel, the doula behind Maternal Wisdom and it was there that my community continued to solidify. The first time we met, all of my hesitations and concerns seemed to melt away. It was as if Chana Luba could sense what we needed and worked to give us that. After we had made the decision to have her attend our birth, everything seemed to be that much easier. We met frequently and she gave us a few exercises to practice while we were apart. She answered all of my phone calls and emails (some made in non-rational pregnancy induced panic) with grace, humor and kindness. Toward the end of my pregnancy, when I was having prodromal labor for what felt like a week, she helped by visiting me at home, providing me with not only alternative treatments to urge along the pregnancy, but reassurance and strength as well.

The night I went into actual full on labor, I finally relented and called Chana Luba around two in the morning, feeling bad for waking her. She of course only had words of encouragement and reminded me to hydrate, eat a little if I could, and relax. She arrived a few hours later as things began to pick up. From then on, she was the guide to our ship, allowing me to labor as I had hoped for, while allowing my husband his own space as well. When my contractions began getting more painful, she drew me a bath, and then, when my water broke in the bath and the pressure and urge to bear down became too strong, she hustled us along to the hospital.

I was able to stay at home as long as I did because she was there. Despite birthing in a hospital setting, I wanted to labor at home as long as possible and got my wish. Her support continued as we made the short, five minute trip to the hospital. I arrived between shifts and a midwife from my practice didn't see me for another twenty minutes. A nurse began taking vitals and became concerned when she noticed the baby's heart rate had decelerated. At that point, had Chana Luba not been with us, I have no idea what could have happened next. I was mid contraction and not fully present and my husband was concerned for both me and the baby. Chana Luba suggested I change positions, and that immediately helped the baby's heart rate go back up to normal. A little while later she went off to get me some juice and a banana on the sly to help keep my energy levels up. Only a couple of hours later my son was born, and some of those first few pictures we have of him include Chana Luba.

I wouldn't have wanted it any other way.

She ensured that we stuck as closely to our birth plan as possible and helped us to navigate the unfamiliar. She stepped in and helped us out when we needed it, allowing us to stay the course we were on instead of heading down the slippery slope of intervention, which was my biggest fear with a hospital birth. She already had a relationship with this particular hospital, which made many things easier for us, including allowing me to leave only a few hours later. Her help didn't stop there, however. In the days that followed, she remained in touch, checking up on me and making sure our nursing relationship was going well. She provided me with homeopathic treatments and herbs for a range of things from post-partum hormones to nursing woes. She was also there for me like nobody else eight days post birth when I needed her the most. She truly embodies the name behind her business, Maternal Wisdom.

A former teacher and lifetime learner, Avital Norman Nathman is a play-at-home mama, freelance writer, wife and feminist (and not necessarily in that order). When not gardening, cooking or dancing around the house, you can catch her musing about motherhood and feminism at The Mamafesto.

Thank you, Avital!

(Was your doula worth every penny? Share your story! anthrodoula at gmail dot com)

Excellent Links!

2011-06-30T10:45:00.006-04:00

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!)

Breast Milk: The Cure

2011-06-27T11:52:00.000-04:00

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:

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.

Weekend Movie: Reflections of Motherhood

2011-06-24T15:32:00.001-04:00

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?

A Doula's Birth Story

2011-06-22T09:30:00.002-04:00

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!

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

2011-06-15T11:18:00.002-04:00

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

By Shari Roan, Los Angeles Times

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)

Informed Choice and the BRAIN Acronym

2011-06-12T10:21:00.009-04:00

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.)

Breastfeeding and Socio-Ecological Determinants of Health: PART FOUR

2011-06-09T10:57:00.002-04:00

Click Here to View Part 3: Determinants

Interventions at each level of the Social Ecological Model:

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

Anthro Doula

Childbirth Around the World

Video: Birth in the Car

Doula for a Home Birth

Get Karen to Haiti: Help Ensure Safe Births in Times of Crisis

Weekend Movie: Waterbirth in a Hospital

Nursing in Public Advertisement

More Reproductive Anthropology Readings

Daley, E. et al. (2010) “Influences on Human Papillomavirus Vaccination Status Among Female College Students” Journal of Women's Health. 19(10): 1885-1891.

Another Semester Down

Comment Turned Post: Medical Anthropology and Midwife Rituals

Just One Bottle?

Transforming Maternity Care

All women and babies deserve maternity care that is woman-centered, safe, effective, timely, efficient, and equitable. Childbirth Connection is working towards this goal.

To donate to this movement in the season of giving, or donate in someone else's name, go here. All donations will be doubled until December 20th!

The Fourth Trimester

"Breastfeed" Song

Reimbursement for Doula Services

Baby Blues and Postpartum Depression

Listening to Mothers

Facts on Contraceptive Use in the U.S.

World Prematurity Awareness Day

Childbirth/Breastfeeding Day in Anthropology

It's my Second Blogoversary!

Writing Client Birth Stories

Teens: "I Have Sex"

Links of Interest

Banned from Baby Showers

MORE Business of Being Born

One World Birth Videos

Anthropology of Reproductive Health: Part 2

Anthropology of Reproductive Health: Part 1

Weekend Movie: Birth and Indigenous Identity in Ecuador

Weekend Movie: Delayed Cord Clamping

Meconium

Being a Doula is Hard

Weekend Movie: OB/GYN vs. Midwife

Doula Anthropologists

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!"

Weekend Movie: One World Birth

The Childless Doula

Preconception Health Interviews

Weekend Movie: Consequences of a Near Term Birth

Randoms: Things to Share

Officially Certified!

That's Vaginal!

Recent Doula Happenings

International Breastfeeding Symbol

The World Breastfeeding Week posts continue...

Links - World Breastfeeding Week style

Talking About Breastfeeding Videos - WBW 2011

Public Health Begins with Breastfeeding

World Breastfeeding Week 2011

Why 3D?

Weekend Movie: A Walk to Beautiful

Native American Breastfeeding Promo Video

Home Births and the Public Health Response Webinar

A Breastfeeding and Culture Moment

Maternal and Child Health Leadership Training

Books: The Doula Advantage

Favorite Blogs: Birth Sense

Favorite Blogs: Science & Sensibility

Breastfeeding Doll!

Maternal Wisdom: A doula birth story

Excellent Links!

Breast Milk: The Cure

Motherwear Blog recently blogged about the NY Times Piece:

Weekend Movie: Reflections of Motherhood

A Doula's Birth Story

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

Informed Choice and the BRAIN Acronym

Breastfeeding and Socio-Ecological Determinants of Health: PART FOUR