tag:blogger.com,1999:blog-92219849768320502072024-03-13T11:58:41.209-04:00Anthro DoulaThoughts on Birth and Culture by a New DoulaEmilyhttp://www.blogger.com/profile/02738440647498422230noreply@blogger.comBlogger507125tag:blogger.com,1999:blog-9221984976832050207.post-88687856110373143522016-12-14T15:39:00.000-05:002017-03-27T15:41:10.694-04:00Nutritional Epigenetics and Prenatal DietsNutritional Epigenetics and Prenatal Diets: “I’ve been eating this way for years”<br />
<br />
by Natali Valdez<br />
<br />
Between 2012 and 2014 I completed participant observations and interviews at two clinical<br />
trials, one in the United States and one in the United Kingdom. These trials tested nutritional<br />
interventions on ethnically diverse pregnant women who were deemed obese. The recent trend to<br />
test nutritional interventions on pregnant populations is related to the emergence of postgenomic<br />
science. Scientists believe that a woman’s weight and diet during pregnancy can influence the<br />
health risks of her developing fetus, and of future generations. Moreover, theories in nutritional<br />
epigenetics claim that food can act as an environmental factor, which can modify genetic regulation<br />
and expression. Therefore, the nutritional interventions targeting obese pregnant women are<br />
intended to provide a healthy nutritional environment for the developing fetus.<br />
<br />
In my ethnographic work at the clinical trials I found that food or nutrition came to mean<br />
many different things to the scientists designing the intervention and the participants receiving the<br />
intervention. For instance, based on the design manuals I read and interviews I had with the<br />
principal investigators and collaborators at the StandUP trial, nutrition was framed through the notion of glycemic control. Glycemic control aims at minimizing foods that are high on the glycemic index. The glycemic index is a tool that categorizes foods based on how they will affect blood sugar levels. Therefore, the intervention focused on controlling or limiting foods that are high in sugar, saturated fats, and carbohydrates. At the trial the women in the experimental group would receive the nutritional intervention, which consisted of meeting with a health trainer at least eight times to learn how to change their diet through glycemic control.<br />
<br />
The justification of the nutritional intervention based on glycemic control was explained to me in the following way: if a pregnant woman eats a donut, she will experience a spike in her blood<br />
sugar levels, which will cause a cascade of reactions related to glucose metabolism. Eating a donut<br />
will also expose the fetus to metabolic and hormonal reactions. In this case, the donut is an<br />
environmental factor that stimulates metabolic and hormonal reactions that affect the fetus. In the<br />
trials that I examined, pregnant women are not explicitly told that their diet is an environmental<br />
factor. However, the scientists at the StandUP trial drew from nutritional epigenetics to justify the<br />
significance of nutritional interventions during pregnancy precisely because food can act as an environmental factor. From my observations, the explicit framing of food as environment remained<br />
in the realm of the scientists and not necessarily in common conversations among pregnant<br />
participants in the trial.<br />
<br />
From the perspective of pregnant participants enrolled in the experimental group, nutritional<br />
epigenetics disappeared from view and what came into focus were the women’s cultural and<br />
emotional entanglements with food. On a sunny afternoon in April Mary came in for her last<br />
intervention visit with Diana, the health trainer for the StandUP trial. Mary was the first generation<br />
born in England whose parents and family were all from Senegal. She self identified as African and<br />
was studying for her masters in computer engineering in the UK. Diana identified as Afro-Caribbean since her parents migrated to England from Jamaica. Diana was one of the few women of color working on the StandUP trial.<br />
<br />
During the session, Diana asked Mary, “what are the main staple foods in Senegal?” Mary<br />
replied, rice, okra, and palm oil. Diana then reminded her that some of those foods were high on the<br />
glycemic index. She then proposed that when Mary goes back to Senegal to visit her family, she<br />
will need to focus on portion control. Mary responds, “portion, portion, portion, I do not want to<br />
share a house with you [Diana], too much portion, I just put a plate of food down and as long as you<br />
want to eat you just mix, eat, tummy is full.” Mary states this with a huge smile and both women<br />
started laughing. The session continues and Diana walks Mary through a few different<br />
questionnaires. Diana then asked Mary, “what’s been your biggest achievement and challenge?”<br />
<br />
Mary responds by stating that her biggest achievement was how the intervention had “changed the<br />
way I eat, the way I think about food – I behave myself more,” she says this again with a big cheeky<br />
smile. To address the second part of the question, Mary goes on to say that one of her biggest challenges was having to always be “aware of everything, like portions and liquid beverages, I’m<br />
not used to it, it will be hard because I’ve been eating this way for years.”<br />
<br />
Although Diana and Mary have a warm jovial dynamic during the intervention delivery,<br />
Mary was sincere in expressing how the intervention affected her. Take the example of portion<br />
control. Controlling one’s portion was at first a foreign concept to Mary. The idea that one would<br />
measure a “serving” of food calculated by grams of sugar, carbohydrates, and fat is a different<br />
epistemological approach to food, eating, and sharing. As Mary mentioned here and in other conversations she usually just put a big plate of different kinds of food in the middle of the table and<br />
everyone would take what they wanted. In this way encouraging the idea of portion control<br />
intervenes not strictly in the nutritional aspect, but it also intervenes in a cultural and social way of<br />
relating and sharing foods with others. Mary also recognizes that the intervention has “made her<br />
behave more,” which indexes how the nutritional intervention intended to change her existing<br />
eating habits. In addition, the idea that the intervention makes her “behave more” reflects the<br />
underlying notion that prior to the intervention she was not “behaving” when it came to her food<br />
and diet choices.<br />
<br />
This snap shot of a nutritional intervention during pregnancy illustrates how different<br />
approaches to food and nutrition are conceptualized at different levels and spaces within the same<br />
clinical trial. On the one hand the scientific discourse and approach to the intervention focused on<br />
nutrition as an environmental factor affecting fetal development, and glycemic control – a method<br />
to intervene spikes in blood sugar levels. On the other hand nutrition or diet from the intervention<br />
delivery was seen as a fundamental change in Mary’s life. A change in how she eats, shares, and<br />
thinks about food. The juxtaposition of both these narratives exposes how a scientific tool like a<br />
nutritional intervention is not a neutral object, but one that is rendered meaningful in different ways<br />
based on how people engage with it.<br />
<br />
Since returning from the field, it is clearer to me why a critical feminist perspective within<br />
science studies and reproductive anthropology is fundamental in the examination of epigenetics.<br />
Reproduction and pregnancy are at the center of epigenetic knowledge production, and as Rayna<br />
Rapp reminds us, reproduction is also at the center of social theory. I appreciated the opportunity to<br />
write this short reflection for CAR newsletter because it pushed me to think through material I have<br />
not examined since completing the dissertation.<br />
<br />
<br />
<em>Natali Valdez completed her PhD in June 2016 in the Department of Anthropology at the University</em><br />
<em>of California, Irvine. She is currently a Postdoctoral Fellow in the Center for the Study of Women,</em><br />
<em>Gender, and Sexuality at Rice University. At Rice she will be working on her book manuscript titled</em><br />
<em>“Weighing the Future: An Ethnographic Examination of Epigenetics and Prenatal Interventions.”</em>Emilyhttp://www.blogger.com/profile/02738440647498422230noreply@blogger.com0tag:blogger.com,1999:blog-9221984976832050207.post-72730120949740354232016-08-03T15:41:00.000-04:002016-08-03T15:43:06.867-04:00UnBreaking BirthI recently watched this video "UnBreaking Birth" - a lecture by Ryan McAllister. It is basically a version of the lecture I have given a couple of times as a guest lecturer undergraduate women's/sexual health classes.<br />
<br />
<blockquote class="tr_bq">
<b>"How you're born affects the rest of your life, and can affect the rest of your mother's life, too"</b></blockquote>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://1.bp.blogspot.com/-PdliGeZbjEQ/V6I-sU9ij1I/AAAAAAAAB1g/bxjH8wK-3XYj3xHP8zs9GrocP6eYbI0eQCLcB/s1600/slide.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="225" src="https://1.bp.blogspot.com/-PdliGeZbjEQ/V6I-sU9ij1I/AAAAAAAAB1g/bxjH8wK-3XYj3xHP8zs9GrocP6eYbI0eQCLcB/s400/slide.png" width="400" /></a></div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<blockquote class="tr_bq" style="clear: both; text-align: left;">
<b>"There are a host of values at play beyond safety"</b></blockquote>
<div class="separator" style="clear: both; text-align: left;">
<br /></div>
<div class="separator" style="clear: both; text-align: left;">
He says our birth care system is broken for at least 4 reasons:</div>
<div class="separator" style="clear: both; text-align: left;">
</div>
<ol>
<li>There isn't a sufficient amount of space and time to build an adequate relationship between the mother and the caregivers</li>
<li>Our interventions have become routine, instead of based on the mom and baby's best interests</li>
<li>Those interventions are often opinion-based</li>
<li>There are conflicts of obligation within the hospital that systematically cause behavior that is out of alignment with the mom and baby's best needs</li>
</ol>
<div>
<br /></div>
<div>
<blockquote class="tr_bq">
<b>"Even when they know that practicing a different way would be better for their clients, they have some reason to practice differently. That means that there are conflicts of obligation in the hospital. At times, when the hospital's best interest is over here, and the patient's best interest would mean you behave this way, the hospital's best interest wins."</b></blockquote>
</div>
<blockquote class="tr_bq">
<br /></blockquote>
<iframe allowfullscreen="" frameborder="0" height="315" src="https://www.youtube.com/embed/gs6KkTUzyh4" width="560"></iframe><br />
<br />
<blockquote class="tr_bq">
<b>"Obstetrics has been organized around handling high-risk, emergency surgical births. and they may do this well. But treating all births this way actually derails well-birth, which is the vast majority of births. So I think we need to keep the good of this system and pair it with another approach that doesn't break well-birth."</b></blockquote>
<blockquote class="tr_bq">
<b>"How could we possibly find or create highly trained experienced professionals who have evidence based practices, who work within a strong relationship wit h the mother, compassion for newborns, and don't experience conflicts of obligation with a large institution?... Those practitioners already exist. They are independent midwives."</b></blockquote>
<br />
The video does not have ALL of the information on the topic, but is a nice overview for consumers. It covers:<br />
<ul>
<li>Why birth is broken (evidence that we spend more on maternity care in the U.S. but have worse outcomes; evidence that c-sections are too high and it is not caused by women being in worse health)</li>
<li>The 4 reasons he believes our maternity care system is broken </li>
<li>A system that would work better for well-birth (certified professional midwives, birth centers)</li>
<li>What YOU can do to help improve the system</li>
</ul>
<div>
This would be a great video to share in a class, because it is only 32 minutes long.<br />
<br />
<blockquote class="tr_bq">
<b>"Being aware of and making available these other options, especially independent midwives, but also including other birth assistants such as doulas, is key to unbreaking birth in the U.S."</b></blockquote>
<br />
<br /></div>
<div>
I like the way the <a href="http://unbreakingbirth.org/" target="_blank">UnBreaking Birth</a> says about the indicators that we have a serious problem. It is basically a run-down of why I do what I do as a public health professional and a doula/childbirth educator:</div>
<li style="line-height: 20px; margin: 0.3em 0px 0.3em 1.6em; padding: 0px;"><i>there are terrible health disparities by race and socioeconomic status</i></li>
<li style="line-height: 20px; margin: 0.3em 0px 0.3em 1.6em; padding: 0px;"><i>infant and maternal mortality rates are higher than in 45 other nations</i></li>
<li style="line-height: 20px; margin: 0.3em 0px 0.3em 1.6em; padding: 0px;"><i>the maternal mortality rate has risen every year since 1995 while in most other countries it has decreased</i></li>
<li style="line-height: 20px; margin: 0.3em 0px 0.3em 1.6em; padding: 0px;"><i>only 25% of obstetric practice guidelines are based on good scientific evidence, many are overtly contra-indicated</i></li>
<li style="line-height: 20px; margin: 0.3em 0px 0.3em 1.6em; padding: 0px;"><i>common hospital policies are not in the best interest of moms and babies</i></li>
<li style="line-height: 20px; margin: 0.3em 0px 0.3em 1.6em; padding: 0px;"><i>and we spend more than any other nation on healthcare</i></li>
Emilyhttp://www.blogger.com/profile/02738440647498422230noreply@blogger.com0tag:blogger.com,1999:blog-9221984976832050207.post-34481816737440726732016-07-29T10:10:00.001-04:002016-07-29T10:10:35.904-04:00We Make Plans and Babies Don't Follow ThemThat moment when you're headed to your first doula prenatal visit with a first time mom who is 35 weeks, and she calls you and says "So, it has been an interesting day... My water broke and I'm being admitted. Do you want to make your way to the hospital instead of my house?"<br />
<br />
....WHAT!?<br />
<br />
Luckily, despite our not having spent much time together, this mama was very calm and collected. And funny. I explained that she should do nipple stimulation to get contractions going (and avoid pitocin), I said "I know it feels weird to get sexy right now, but as they say, sometimes 'what gets baby in gets baby out'!" And she replied, "Maybe we shouldn't have had sex this morning!" And we both laughed.<br />
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://3.bp.blogspot.com/-QKH4DKMe-lg/V5tjp5r2MGI/AAAAAAAAB1Q/4TnR_DQXNVs7MyJ_rUgVzCbSjKWidmMlwCLcB/s1600/sexposition_spooning_4x3.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://3.bp.blogspot.com/-QKH4DKMe-lg/V5tjp5r2MGI/AAAAAAAAB1Q/4TnR_DQXNVs7MyJ_rUgVzCbSjKWidmMlwCLcB/s320/sexposition_spooning_4x3.png" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Did you know BabyCentre UK has a bunch of safe sex positions for pregnancy images? Now I do!</td></tr>
</tbody></table>
<br />
<br />
I was nervous about a preterm baby, and any changes this might cause to the labor management plan, but everything turned out great. We did end up with pitocin to start contractions but mom labored with no pain meds and pushed her baby out in 6 quick hours.<br />
<br />
It was one of those labors where I left work, doula-ed all night, and then returned to work in the morning, with no one realizing that while they slept and went about their routine, I was having an extraordinary night!<br />
<br />
<br />
<br />
<i>You learn something new every birth:</i><br />
<br />
<ul>
<li>The doctor told the mom that she couldn't start with cervidil instead of pitocin because her membranes had ruptured. </li>
<li>The nurse said the mom could use nitrous oxide during pushing if she wanted it (which she didn't). I've never seen it used during pushing. I feel like that would be hard to do both!</li>
<li>I've never heard a nurse so insistent on the use of drugs for stitch repair on a non-epidural mom. She said mom could use the nitrous during stitch repair, but she couldn't hold her baby. Mom declined. She then told her she could give her stadol in her IV, and didn't even tell her the pros and cons. I said "that will make her loopy, right?" the nurse finally said, "yes." Mom agreed and regretted her decision when she felt totally out of it and couldn't do anything about it for an hour. </li>
</ul>
Emilyhttp://www.blogger.com/profile/02738440647498422230noreply@blogger.com0tag:blogger.com,1999:blog-9221984976832050207.post-42949342944555002632016-01-19T10:32:00.001-05:002016-02-02T09:36:05.557-05:00Disposable Vs. Reusable Diapers<b>Did you know?</b><br />
<br />
In the U.S. nearly four million babies are born every year. Each of those babies is likely to use up to 8,000 throwaway diapers before they are potty trained.<br />
<br />
By 2012 the number of disposable diapers disposed of in landfills soared to a staggering 3,590,000 tons. It will take 500 years for these diapers to biodegrade.<br />
<br />
This environmental argument doesn't always impact us when we're thinking of whether we should use disposable or reusable (e.g. cloth) diapers on our babies. Most likely we think, "what will be the most efficient for me?" Time, cost, and convenience all come into play when we make decisions, <i>especially</i> as stressed new parents!<br />
<br />
Check out these informative infographics below, which cover the pros and cons, as well as some tips if you're considering giving cloth diapers a try.<br />
<br />
<br />
<div style="text-align: center;">
(click to enlarge)</div>
<div style="text-align: center;">
<span id="goog_247193465"></span><span id="goog_247193466"></span></div>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="http://1.bp.blogspot.com/-wn_bKiswIY0/Vp5SV75RzWI/AAAAAAAABzw/oGrGuAHnHPQ/s1600/deets-disposable-diapers-001.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="640" src="http://1.bp.blogspot.com/-wn_bKiswIY0/Vp5SV75RzWI/AAAAAAAABzw/oGrGuAHnHPQ/s640/deets-disposable-diapers-001.jpg" width="416" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><a href="https://www.fix.com/blog/green-diaper-guide/" style="background-color: white; color: #1155cc; font-family: arial, sans-serif; font-size: 12.8px; text-align: start;" target="_blank">https://www.fix.com/blog/<wbr></wbr>green-diaper-guide/</a></td></tr>
</tbody></table>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="http://4.bp.blogspot.com/-TrNWT5gYrns/Vp5Shww0gEI/AAAAAAAAB0U/FlVdMNelJMc/s1600/benefits-pitfalls-disposable-diapers-002.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="640" src="http://4.bp.blogspot.com/-TrNWT5gYrns/Vp5Shww0gEI/AAAAAAAAB0U/FlVdMNelJMc/s640/benefits-pitfalls-disposable-diapers-002.png" width="252" /></a></div>
<div style="text-align: center;">
<a href="http://1.bp.blogspot.com/-iSma68QA8iE/Vp5SV_-dbvI/AAAAAAAABz8/XQ9AFueo4oc/s1600/benefits-pitfalls-disposable-diapers-002.png" imageanchor="1"></a>(click to enlarge)</div>
<span style="text-align: center;"><br /></span>
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="http://4.bp.blogspot.com/-HxcCZ1X5Qv8/Vp5SV6yI1VI/AAAAAAAAB0A/En4xUNYvRpM/s1600/tips-buying-using-disposable-diapers-003.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="640" src="http://4.bp.blogspot.com/-HxcCZ1X5Qv8/Vp5SV6yI1VI/AAAAAAAAB0A/En4xUNYvRpM/s640/tips-buying-using-disposable-diapers-003.png" width="313" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><a href="https://www.fix.com/blog/green-diaper-guide/" style="background-color: white; color: #1155cc; font-family: arial, sans-serif; font-size: 12.8px; text-align: start;" target="_blank">https://www.fix.com/blog/<wbr></wbr>green-diaper-guide/</a></td></tr>
</tbody></table>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
The environmental impact is just one factor, but one we should consider. For the children we are diapering are going to grow up into a world where there are millions of diapers not quickly biodegrading around them.<br />
<br />
<br />
<br />Emilyhttp://www.blogger.com/profile/02738440647498422230noreply@blogger.com0tag:blogger.com,1999:blog-9221984976832050207.post-2256755947522814612015-11-04T18:02:00.001-05:002015-11-04T18:03:57.014-05:00A Very Informative Video on CircumcisionSo, I've just recently discovered Ryan McAllister, PhD and his videos on birth and circumcision, and I highly recommend you view his video on Child Circumcision (aka genital cutting). It is a lecture to a room of anthropology students, and he comes at the topic from an accessible academic perspective.<br />
<br />
If you're ever wanted to know more about why you should think about or question circumcision or no, this is a <i>great</i> overview video (with a brief hard-to-watch clip of male genital cutting near the beginning).<br />
<br />
He makes a number of <b>excellent</b> points. He covers culture, medicalization, the biology of the penis and the procedure, informed consent issues, ethics, the science behind common reasons for removing the foreskin, and more.<br />
<br />
I love the comedic clip's quote... "so you can have this chopped off or you could wash it?"<br />
<br />
<b>The whole video really makes you question, do the supposed pros outweigh the known cons?</b><br />
<br />
<br />
<br />
<iframe allowfullscreen="" frameborder="0" height="315" src="https://www.youtube.com/embed/Ceht-3xu84I" width="560"></iframe>
<br />
Note that this presentation includes graphic material to convey more complete information about the topic.<br />
<br />
One thing he doesn't really touch on is the fact that the obstetricians who perform this procedure are also keen to have parents circumcise because it is a relatively quick and easy surgery that they make money from.<br />
<br />
Ryan is the director of <a href="http://notjustskin.org/">NotJustSkin.org</a>.<br />
<br />
One of NotJustSkin's primary missions is to educate the public about violations of informed consent or bodily integrity. In the U.S., male genital cutting, more often called circumcision, is commonly practiced even though parents rarely receive the information that would be required to give informed consent to any other procedure. Circumcision is the only procedure where a doctor can legally amputate part of a non-consenting child without any medical reason.<br />
<br />
<br />
<b>I was not an intactivist before viewing this video, but I may be one now...</b><br />
<br />
<br />
To add, being a feminist from a Jewish background, I also encourage a perusal of an article called "<a href="http://www.noharmm.org/pollack.htm" target="_blank">Circumcision: a Jewish Feminist Perspective</a>."<br />
<br />
This is the first of Ryan's videos that I came across, but I plan to post on his other content, as well.Emilyhttp://www.blogger.com/profile/02738440647498422230noreply@blogger.com0tag:blogger.com,1999:blog-9221984976832050207.post-40180535583796733822015-10-14T13:58:00.000-04:002015-10-14T15:08:20.507-04:00New National Recommendations for Safe Reduction of Primary Cesarean Births<br />
In recent years, several national partners including ACOG, AWHONN, SMFM, CDC, HRSA and others came together as the National Partnership for Maternal Safety and have worked with the <a href="http://www.safehealthcareforeverywoman.org/default.php" target="_blank">Council on Patient Safety in Women’s Health</a> to create several “bundles” of recommendations to improve the outcomes and safety of pregnant women.<br />
<div>
<br /></div>
<div>
A bundle is a checklist of specific changes that, if followed, will lead to improvement.<br />
<br />
Bundles are a collection of succinct evidence-based components that when implemented together should have a positive impact on outcomes and safety for pregnant women. The bundles have four domains, Readiness, Recognition and Prevention, Response, and Reporting/Systems Learning. The bundles provide the core elements that every hospital can implement for every woman, every time. Birth facilities are encouraged to expand on the core component by developing policies, protocols and standardized practices that best meet local needs and are evidence based.<br />
<br />
The first bundle that was released by this partnership focused on obstetric hemorrhage, one of the leading causes of maternal mortality. It has since been followed by other bundles focusing on high impact, high volume health and safety issues such as hypertension in pregnancy and safe reduction of primary cesarean births.</div>
<div>
<div>
<br /></div>
<div>
Below, I share with you the new national patient safety bundle recommendations for supporting intended vaginal births. You may click the image to enlarge. Lowering the primary cesarean section will increase maternal safety by decreasing morbidity from unnecessary surgeries and the consequences of prior cesarean delivery in future pregnancies.</div>
<div>
<br />
<div>
<br /></div>
<div>
<b>Safe Reduction of Primary Cesarean Births: Supporting Intended Vaginal Births</b></div>
</div>
<div>
<b><br /></b></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="http://2.bp.blogspot.com/-rQlHc7SnWws/Vh6FfZoZjoI/AAAAAAAABys/_aQY3X3DEaI/s1600/Safe-Reduction-of-Primary-Cesarean-Births-Bundle-Final-10-8-15_Page_1.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="320" src="http://2.bp.blogspot.com/-rQlHc7SnWws/Vh6FfZoZjoI/AAAAAAAABys/_aQY3X3DEaI/s320/Safe-Reduction-of-Primary-Cesarean-Births-Bundle-Final-10-8-15_Page_1.jpg" width="246" /></a></div>
READINESS:<br />
Every patient, provider, and facility<br />
<br />
<ul>
<li>Build a provider and maternity unit culture that values, promotes, and support spontaneous onset and progress of labor and vaginal birth and understands the risks for current and future pregnancies of cesarean birth without medical indication.</li>
<li>Optimize patient and family engagement in education, informed consent, and shared decision making about normal healthy labor and birth throughout the maternity care cycle.</li>
<li>Adopt provider education and training techniques that develop knowledge and skills on approaches which maximize the likelihood of vaginal birth, including assessment of labor, methods to promote labor progress, labor support, pain management (both pharmacologic and non-pharmacologic), and shared decision making.</li>
</ul>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://2.bp.blogspot.com/-163yRTTa1d8/Vh6FgyO04kI/AAAAAAAABy0/wfjO0Eh5K3Q/s1600/Safe-Reduction-of-Primary-Cesarean-Births-Bundle-Final-10-8-15_Page_2.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="320" src="http://2.bp.blogspot.com/-163yRTTa1d8/Vh6FgyO04kI/AAAAAAAABy0/wfjO0Eh5K3Q/s320/Safe-Reduction-of-Primary-Cesarean-Births-Bundle-Final-10-8-15_Page_2.jpg" width="246" /></a></div>
RECOGNITION AND PREVENTION<br />
Every patient<br />
<br />
<ul>
<li>Implement standardized admission criteria, triage management, education, and support for women presenting in spontaneous labor.</li>
<li>Offer standardized techniques of pain management and comfort measures that promote labor progress and prevent dysfunctional labor.</li>
<li>Use standardized methods in the assessment of the fetal heart rate status, including interpretation, documentation using NICHD terminology, and encourage methods that promote freedom of movement.</li>
<li>Adopt protocols for timely identification of specific problems, such as herpes and breech presentation, for patients who can benefit from proactive intervention before labor to reduce the risk for cesarean birth.</li>
</ul>
<div>
RESPONSE</div>
<div>
to every labor challenge</div>
<div>
<ul>
<li>Have available an in-house maternity care provider or alternative coverage which guarantees timely and effective responses to labor problems.</li>
<li>Uphold standardized induction scheduling to ensure proper selection and preparation of women undergoing induction.</li>
<li>Utilize standardized evidence-based labor algorithms, policies, and techniques, which allow for prompt recognition and treatment of dystocia.</li>
<li>Adopt policies that outline standard responses to abnormal fetal heart rate patterns and uterine activity.</li>
<li>Make available special expertise and techniques to lessen the need for abdominal delivery, such as breech version, instrumented delivery, and twin delivery protocols.</li>
</ul>
<div>
REPORTING/SYSTEMS LEARNING</div>
</div>
<div>
Every birth facility</div>
<div>
<ul>
<li>Track and report labor and cesarean measures in sufficient detail to: 1) compare to similar institutions, 2) conduct case review and system analysis to drive care improvement, and 3) assess individual provider performance.</li>
<li>Track appropriate metrics and balancing measures, which assess maternal and newborn outcomes resulting from changes in labor management strategies to ensure safety.</li>
</ul>
</div>
<br />
<br />
I listened to the organization's conference call presentation on this new bundle. Chair of the workgroup. David Lagrew, noted:<br />
- that 53% of disparity in cesarean section rates is related to <u>labor induction</u> and <u>early admission</u>.<br />
- rates vary from provider to provider, so individual provider data tracking is helpful to make change<br />
- He also emphasized creating a <b>Culture of Supporting Intended Vaginal Delivery:</b><br />
<blockquote class="tr_bq">
To be successful, one must achieve development of a culture in which the clinical providers, administrative support and public: 1) appreciate the true value of achieving a vaginal delivery; 2) respectfully acknowledges the desires of the patient and 3) maintains educational processes, facilities, equipment and staff expertise which can maximize the chance of successfully obtaining vaginal delivery which is safe for mother and infant(s).</blockquote>
Co-presenter Lisa Kane Low noted these recommendations:<br />
- don't admit women prior to 6 cm (especially first time moms) for active labor<br />
-in-house persons, e.g. laborists, available without other demands, are associated with an increase in spontaneous vaginal deliveries<br />
- make doulas part of the team<br />
- look at Bishop score to schedule inductions and reduce inductions prior to 41 weeks.<br />
- have specialized providers available for breech version, instrumental delivery, and twin delivery<br />
<br />
Keep an eye out on the <a href="http://www.safehealthcareforeverywoman.org/safety-action-series.php" target="_blank">Safety Actions Series website</a> if you'd like the slides and recording from this call. Listen especially to the Q&A and discussion at the end!<br />
<br />
The California Maternal Quality Care Collaborative will be coming out with a toolkit for this topic, as they have in the past for previous topics, so I will be excitedly waiting for that!<br />
<br />
<br />
<br />
Additionally, here is the list of <b>resources </b>that the Council includes as part of this safety bundle:<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://1.bp.blogspot.com/-3oRPyiOOBHo/Vh6Fg-AhsZI/AAAAAAAABy8/CR4D_tfIRys/s1600/Safe-Reduction-of-Primary-Cesarean-Births-Complete-Bundle-Resource-Listing-10-9-15_Page_1.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="http://1.bp.blogspot.com/-3oRPyiOOBHo/Vh6Fg-AhsZI/AAAAAAAABy8/CR4D_tfIRys/s320/Safe-Reduction-of-Primary-Cesarean-Births-Complete-Bundle-Resource-Listing-10-9-15_Page_1.jpg" width="247" /></a></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://4.bp.blogspot.com/-eD-d7XhoR3Q/Vh6Fgw-vXzI/AAAAAAAABy4/8tgkQfP28-g/s1600/Safe-Reduction-of-Primary-Cesarean-Births-Complete-Bundle-Resource-Listing-10-9-15_Page_2.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="http://4.bp.blogspot.com/-eD-d7XhoR3Q/Vh6Fgw-vXzI/AAAAAAAABy4/8tgkQfP28-g/s320/Safe-Reduction-of-Primary-Cesarean-Births-Complete-Bundle-Resource-Listing-10-9-15_Page_2.jpg" width="247" /></a></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://3.bp.blogspot.com/-nzGIS2Uc8EI/Vh6Fh3tXTOI/AAAAAAAABzA/d2AcOc7BHaU/s1600/Safe-Reduction-of-Primary-Cesarean-Births-Complete-Bundle-Resource-Listing-10-9-15_Page_3.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="http://3.bp.blogspot.com/-nzGIS2Uc8EI/Vh6Fh3tXTOI/AAAAAAAABzA/d2AcOc7BHaU/s320/Safe-Reduction-of-Primary-Cesarean-Births-Complete-Bundle-Resource-Listing-10-9-15_Page_3.jpg" width="247" /></a></div>
<div>
<b><br /></b></div>
</div>
Emilyhttp://www.blogger.com/profile/02738440647498422230noreply@blogger.com0tag:blogger.com,1999:blog-9221984976832050207.post-7708351715067557382015-09-30T13:33:00.000-04:002015-09-30T13:33:07.746-04:00Healthy Pregnancy Spacing<div class="separator" style="clear: both; text-align: center;">
<a href="http://4.bp.blogspot.com/-uZsCyUWuxwA/Vgwauicm2bI/AAAAAAAAByY/9waIEwtqG5M/s1600/breastfeeding-birth-control-baby-spacing.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="173" src="http://4.bp.blogspot.com/-uZsCyUWuxwA/Vgwauicm2bI/AAAAAAAAByY/9waIEwtqG5M/s320/breastfeeding-birth-control-baby-spacing.png" width="320" /></a></div>
<b><br /></b>
<b><br /></b>
<b>What is the "ideal" spacing of pregnancies?</b><br />
<br />
Socially, there may be a wide range of opinions on the subject of how far apart your children should be. Theories abound as to the ideal spacing for the parents' sanity (condense the amount of time you're in diapers), the mental health of the children (will they get along if they're too close/too far apart?), and so on.<br />
<br />
We know that many women "plan" to have their kids a certain number of years apart, others try to rely on natural family planning methods which sometimes lead to close pregnancies, and some women actively try to have several children within a limited time period.<br />
<br />
Some couples decide to have or end up having several children close together, either because they had trouble conceiving at first, because they don't use a highly effective form of birth control, because they are reaching the end of their reproductive years, or because it is the norm in their social or religious community.<br />
<br />
Often it is social/parenting reasons that dictate pregnancy spacing, and many women do not take into account the health impacts of pregnancy spacing. I believe it is my public health duty to tell you that the healthiest thing you can do is to wait <u>at least 18 months to 2 years before conceiving the next baby</u>. <br />
<br />
Here's why:<br />
<br />
<b>Benefits of Spacing of 18+ months</b><br />
<br />
It has been repeatedly demonstrated that adequate birth spacing reduces adverse events for both mothers and infants. Research on several populations found that the risk for adverse birth outcomes is lowest when the interpregnancy interval was 18-23 months. These studies controlled for maternal reproductive risk factors.<br />
<br />
Adverse birth outcomes for the infant included low birth weight, preterm birth, and small for gestational age. There is also limited evidence that risk of autism increases.<br />
<br />
Adverse outcomes for the mother include increased risk of uterine rupture in women attempting a vaginal birth after previous cesarean delivery and uteroplacental bleeding disorders (placental abruption, where the placenta detaches from the uterine wall, and placenta previa, where the placenta covers the cervical opening).<br />
<br />
The benefits of waiting at least 2 years between births also extend beyond the pregnancy and birth outcomes. Closely spaced pregnancies often don't give the mothers body enough time to recover from the physical and metabolic stress of pregnancy and breastfeeding, which can deplete some nutrients. Furthermore (and this may not be relevant to your situation), for resource-poor families, two young children very close in age often leads to a time, energy, and resource disparity where one child suffers the consequences. There are some studies that show short interpregnancy interval length is associated with increased child mortality.<br />
<br />
While you can tandem nurse an older and younger child, your milk does change during pregnancy and it may be best to finish you are prepared to possibly finish your breastfeeding relationship with your elder child before becoming pregnant.<br />
<br />
If you had an adverse birth outcome with your previous birth (for example, low birth weight or premature baby), it is even more important to actively plan for your next baby, rather than leaving it to chance and potentially having a short birth interval. (The buzz word in public health is Interconception Care)<br />
<br />
<br />
<b>Consequences of (Too) Long Birth Intervals (5 years)</b><br />
<br />
It is worth noting, however, that long birth intervals (~5 years) are associated with an increase with of preeclampsia (hypertension in pregnancy). Limited evidence shows an association with preterm birth and low birth weight, as well.<br />
<br />
There are also hypotheses that waiting too long between pregnancies puts your body back into a state of a first time pregnancy, and the physiological changes caused by pregnancy that may help with pregnancy and labor may disappear.<br />
<br />
<br />
I hope this helps you think about your pregnancy spacing and family planning! With all that in mind, I'll let you figure out where in that 2-5 year window is the best time for your family to deal with the practical demands of a growing family.<br />
<br />
<br />
Resources:<br />
http://www.ncbi.nlm.nih.gov/pubmed/15820365<br />
http://www.physicianclassroom.org/uploads/1/8/9/5/1895381/effects_of_birth_spacing_on_birth_outcomes.pdf<br />
http://www.sciencedirect.com/science/article/pii/S0002937806010064<br />
http://www.mayoclinic.org/healthy-living/getting-pregnant/in-depth/family-planning/art-20044072<br />
http://www.parents.com/pregnancy/considering-baby/another/best-time-to-have-2-or-3-babies/<br />
<br />Emilyhttp://www.blogger.com/profile/02738440647498422230noreply@blogger.com0tag:blogger.com,1999:blog-9221984976832050207.post-37336390469984773122015-08-12T14:53:00.004-04:002015-08-12T15:06:45.753-04:00Teaching Feminism to Teenage Boys<a href="http://3.bp.blogspot.com/-SVoQt0TVywg/VcuJWMDFb4I/AAAAAAAABxM/4LbUJj_9wVQ/s1600/I-need-feminism.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="214" src="http://3.bp.blogspot.com/-SVoQt0TVywg/VcuJWMDFb4I/AAAAAAAABxM/4LbUJj_9wVQ/s320/I-need-feminism.jpg" width="320" /></a>I have had a desire bubbling inside me for some time now to sit my male teenage relatives down and give them a crash course on feminism and racism.<br />
<br />
My cousin does not recognize white privilege and racism, and the relatives on that side of his family have not been good examples.<br />
<br />
My brother-in-law told me he would not identify himself as a feminist because people (read: girls) would laugh at him.<br />
<br />
But how do you teach the course? This blog post is as much an exercise in figuring this out myself as it is sharing the information with you. I am open to your suggestions!<br />
<br />
<br />
<b>Teaching Privilege</b><br />
<br />
My first idea was to walk them through "<a href="http://www.deanza.edu/faculty/lewisjulie/White%20Priviledge%20Unpacking%20the%20Invisible%20Knapsack.pdf">Unpacking the Invisible Knapsack</a>" of white privilege. This can be done in worksheet form or out loud, where each person looks at a statement and decides whether they can identify with that statement. This exercise allows the individual to identify their own privilege, and perhaps have their eyes opened to the oppression of others.<br />
<br />
Some items from the exercise (slightly modified to work for teens):<br />
<ul>
<li>I can swear, or dress in second hand clothes, or not answer letters, without having people attribute these choices to the bad morals, the poverty or the illiteracy of my race.</li>
<li>I can do well in a challenging situation without being called a credit to my race.</li>
<li>I am never asked to speak for all the people of my racial group.</li>
<li>I can easily buy posters, post-cards, picture books,
greeting cards, dolls, toys and children’s magazines
featuring people of my race.</li>
<li>My parents did not have to educate me to be aware of systemic racism for my own daily physical protection.</li>
</ul>
It would be better accomplished if a discussion could be had with a friend of theirs in the room who was not white who could answer the questions, too, and perhaps surprise my cousin with their non-white responses to the questions.<br />
<br />
I actually just recently discovered that Buzzfeed has an online quiz "How Privileged Are You?" where you check off all the boxes that pertain to you. It goes a bit further than just racism, incorporating religious, sexual orientation, gender privilege, and more.<br />
<br />
<div>
Another idea is to start by appealing to the ways in which they don't have privilege. Perhaps they are left-handed, or low-income, or have mental health issues. Just because we benefit from one form of privilege doesn’t mean that we benefit from all forms of privilege. Explain that just because an individual may feel oppressed, whites and men as a group are not systematically oppressed the way other groups are.<br />
<br />
Specifically related to male privilege, I found <a href="http://amptoons.com/blog/the-male-privilege-checklist/" target="_blank">several</a> <a href="http://itspronouncedmetrosexual.com/2012/11/30-examples-of-male-privilege/" target="_blank">lists </a>online that could be used. Here are some examples:</div>
<ul>
<li>You can expect to be paid equitably for the work you do, and not paid less because of your sex </li>
<li>A decision to hire you won’t be based on whether or not the employer assumes you will be having children in the near future </li>
<li>Work comfortably (or walk down a public street) without the fear of sexual harassment </li>
<li>Go on a date with a stranger without the fear of being raped </li>
<li>You can seek political office without having your sex be a part of your platform</li>
</ul>
And here are some great <a href="http://www.upworthy.com/annoyed-when-people-talk-about-white-male-privilege-or-whatever-think-theyre-trying-to-guilt-you" target="_blank">posters from out of San Francisco</a> about privilege.<br />
<br />
<br />
<b>Teaching Feminism</b><br />
<div class="separator" style="clear: both; text-align: center;">
<b><a href="http://3.bp.blogspot.com/-eS6rmM9PbXk/VcuNarp6q8I/AAAAAAAABxs/mLX14ystFug/s1600/feminist-male-joseph-gordon-levitt.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="180" src="http://3.bp.blogspot.com/-eS6rmM9PbXk/VcuNarp6q8I/AAAAAAAABxs/mLX14ystFug/s320/feminist-male-joseph-gordon-levitt.jpg" width="320" /></a></b></div>
<br />
<b><br /></b>
As far as teaching teenage boys feminism, I think a good place to start would be to relate it to them, personally, and to stress how the system hurts us all.<br />
<div>
<br /></div>
How does the patriarchy limit their own expression as boys and men? How does it hold them back?<br />
<br />
Men are often pressured to fit into a "Act like a Man" or "Man up" world where men can't be sensitive, or have certain interests. It damages men's emotional literacy. It limits them. They are pressured to always appear strong and not ask for help. It encourages promiscuity. It encourages aggression and violence. It perpetuates one-dimensional stereotypes that not all men identify with.<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://4.bp.blogspot.com/-4G66QqqevhE/VcuI5Zbq-iI/AAAAAAAABxI/Zy9CUO3pYr8/s1600/article-0-1D6D0AFA00000578-994_634x904.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="http://4.bp.blogspot.com/-4G66QqqevhE/VcuI5Zbq-iI/AAAAAAAABxI/Zy9CUO3pYr8/s320/article-0-1D6D0AFA00000578-994_634x904.jpg" width="224" /></a><a href="http://3.bp.blogspot.com/-hDNNDBJyNnM/VcuI5U7w3pI/AAAAAAAABxE/sn4dwyixydo/s1600/enhanced-11806-1398316757-5.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="http://3.bp.blogspot.com/-hDNNDBJyNnM/VcuI5U7w3pI/AAAAAAAABxE/sn4dwyixydo/s320/enhanced-11806-1398316757-5.jpg" width="212" /></a></div>
<br />
<br />
If this is what is expected of men, then we can see how it also limits women. Namely, that women must be sensitive, weak, ask for help, less promiscuous, and less aggressive. That if a man is not a man, he is a woman, who are then inferred to be "less" or "worse". Thus, men are taught that women are inferior.<br />
<br />
Some <a href="http://www.thefrisky.com/2011-09-25/teaching-boys-to-be-feminists/" target="_blank">great suggestions</a> for talking to young men about feminism:<br />
<br />
<ul>
<li>by taking a role in feminism they will be helping <i>everyone</i>, not just women.</li>
<li>because they are at the top of society’s hierarchy, they have a responsibility and an ability to be part of social change and justice for everyone.</li>
</ul>
<br />
If the boys you are teaching are young, you still have the opportunity to change the things they've learned about women. For example, that women can be rocket scientists and doctors, are not merely ornamental, may not want children, etc.<br />
<br />
Another important part of the lesson for young men would be to talk about how every woman they have ever known has felt unsafe at some point - walking to their car, walking down the street, etc.<br />
<br />
Ileana Jimenez is a feminist teacher and has a whole segment about <a href="http://feministteacher.com/2011/03/29/teaching-boys-feminism/">teaching boys to be feminists</a>. She has a quote from a boy in her class whose eyes were opened to women's experiences with street harassment: "It’s scary to think that a man can completely get away with making a woman feel uncomfortable or unsafe on the street or subway.”<br />
<br />
She notes that "the boys in my classes are curious about how feminism might connect to their lives. They want to know if feminism can help them become better versions of themselves in a world that tells them only one version is acceptable."<br />
<div>
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="http://4.bp.blogspot.com/-CkrJBPQxPY0/VcuNat5PbgI/AAAAAAAABx4/OHzoBjw750E/s1600/tumblr_ncsrbayZxt1rnnxcfo1_1280.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="206" src="http://4.bp.blogspot.com/-CkrJBPQxPY0/VcuNat5PbgI/AAAAAAAABx4/OHzoBjw750E/s320/tumblr_ncsrbayZxt1rnnxcfo1_1280.jpg" width="320" /></a></div>
<div>
<br />
<div>
Remind them that the patriarchy oppresses all of the people in their lives, but especially their mothers, sisters, aunts, grandmothers, cousins, and female friends that they care about.<br />
<div>
<br />
<div class="separator" style="clear: both; text-align: center;">
</div>
<br />
<b>The Definition of Feminism </b><br />
<b><br /></b>
One of the most important elements of the lesson has to be the definition of feminism:<br />
<div>
<div>
<blockquote class="tr_bq">
<span style="font-size: large;">"the social, political and economic equality of the sexes"</span></blockquote>
<br />
The term "feminist" is a loaded term with a lot of misrepresentation. Being a feminist does not mean women hate men or that women think men are the enemy.</div>
<div>
<br /></div>
<div class="separator" style="clear: both; text-align: left;">
</div>
<div>
<a href="http://3.bp.blogspot.com/-s5d3H_dT5d4/VcuG8B5jqRI/AAAAAAAABwg/_nyKxbI4bAc/s1600/481468039aziz.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="213" src="http://3.bp.blogspot.com/-s5d3H_dT5d4/VcuG8B5jqRI/AAAAAAAABwg/_nyKxbI4bAc/s320/481468039aziz.jpg" width="320" /></a>There are a number of videos where reporters or comedians ask people on the street if they believe men and women should be paid the same for the same work, whether men and women should have equal rights, and they all say yes. But when asked if they are feminists, they say no. Then when they're given the definition, they realize, "oh, maybe I am a feminist, then." Though they still seem hesitant to identify with the term. </div>
<div>
<br /></div>
<div>
<br /></div>
<div>
Further, as <a href="http://blog.patrickrothfuss.com/2012/10/fanmail-faq-the-f-word/" target="_blank">Patrick Rothfuss </a>so eloquently explained:</div>
<div>
<blockquote class="tr_bq" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; border: 0px; margin-bottom: 22px; outline: 0px; padding: 0px 0px 0px 30px; vertical-align: baseline;">
1. Feminism is the belief that women are as worth as much as men.<br />
1a. (Corollary) This means women should be treated as fairly as men.<br />
1b. (Corollary) This means women should be respected as much as men.<br />
1c. (Corollary) This means women should have the same rights as men.<br />
1d. (Corollary) Etc etc.<br />
2. Feminism is the belief that women shouldn’t have to do things just because they’re women.<br />
2a. (Corollary) Men shouldn’t have to do things just because they’re men.<br />
3. Feminism is the belief that women shouldn’t have to *avoid* doing things just because they’re women.<br />
3a. (Corollary) Men shouldn’t have to *avoid* doing things just because they’re men.</blockquote>
</div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<div>
<b>Fighting Guilt, Fighting Back</b><br />
<br />
Many people feel guilt for having privilege because they did not earn it. This will be a common reaction to any discussion of this type. </div>
<div>
<br /></div>
<div>
As Birth Anarchy explains, </div>
<div>
<blockquote class="tr_bq">
"It doesn’t make you a bad person, and it doesn’t mean you are a bigot when you exist and benefit from systems and institutions with odds stacked more in your favor. Owning our privilege doesn’t mean that we hang our heads in shame."</blockquote>
<br />
“If we inherit injustice, we should never feel guilty. We are not responsible for that past. However, if we choose to do nothing about it going forward, then we have plenty to feel guilty about.” </div>
<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://1.bp.blogspot.com/-JmH8rh9bXTU/VcuLAmBv-II/AAAAAAAABxk/475AL9lDQX0/s1600/becomingaware-6e4b61c7273a0d275036fae6b9164847.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="http://1.bp.blogspot.com/-JmH8rh9bXTU/VcuLAmBv-II/AAAAAAAABxk/475AL9lDQX0/s320/becomingaware-6e4b61c7273a0d275036fae6b9164847.png" width="207" /></a></div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
And of course the #1 best thing to do is to lead by example. Make sure you "shut down" sexist arguments when they happen in front of you and your teen boys, do not essentialize, do not use racist or homophobic terms, and so on. Don't say "Man Up"!</div>
<div>
<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div>
Offer some ideas on how to not contribute to the patriarchy and fight back (AKA "check their privilege"). For example:<br />
<br />
<ol>
<li>Really listen to how being underprivileged affects women.</li>
<li>Take responsibility for addressing feminist issues with other men. Don't be a bystander - call people out. Don't be a "bro".</li>
<li>Don't rape, don't catcall, don't objectify women, don't tell sexist jokes.</li>
<li>Don't judge someone on the basis of their gender, sexual orientation, skin color, religion, etc. </li>
<li>When a woman tells you something is sexist, believe her.</li>
<li>Do not think you need to take over and "save" women from the patriarchy. Affirm the capable leadership of women.</li>
<li>Be responsible for contraception, housework, emotional work, and other things typically thought to be "women's role".</li>
<li>Help women feel safer, and be aware of the amount of space you take up (physically and in a conversation).</li>
<li>Self identify as feminist and help educate others! </li>
</ol>
</div>
<div>
<br /></div>
<div>
<b><i><span style="font-size: large;">I truly want to know, readers: What would you add to this if you were to teach teen boys about feminism? </span></i></b></div>
<div>
<b><i><span style="font-size: large;"><br /></span></i></b></div>
<div>
<br /></div>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="http://3.bp.blogspot.com/-65fDI2zaxgg/VcuHEFoqojI/AAAAAAAABwo/GyE4OEs8_80/s1600/feminismmoments2.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="320" src="http://3.bp.blogspot.com/-65fDI2zaxgg/VcuHEFoqojI/AAAAAAAABwo/GyE4OEs8_80/s320/feminismmoments2.jpg" width="214" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-size: xx-small; text-align: start;">Plenty</span><span style="font-family: Georgia, serif; font-size: 14px; line-height: 1.5; text-align: start;"> of men are feminists!</span></td></tr>
</tbody></table>
<br />
<br /></div>
</div>
</div>
</div>
Emilyhttp://www.blogger.com/profile/02738440647498422230noreply@blogger.com1tag:blogger.com,1999:blog-9221984976832050207.post-81871268119290972672015-07-02T16:28:00.001-04:002015-07-07T11:51:47.926-04:00New Ricki Lake & Abby Epstein Documentary on Birth ControlRicki Lake and Abby Epstein, the duo who brought us the ever popular Business of Being Born, are back together. They are planning a new documentary called Sweetening the Pill (based on a <a href="http://amzn.to/1JCYCcX" target="_blank">book </a>of the same name) which aims to open our eyes the way that BoBB did, but this time, about birth control.<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://4.bp.blogspot.com/-yTsBje3eiyY/VZWd3hTdt5I/AAAAAAAABv4/xBSMalapdC0/s1600/randa_slider.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="159" src="http://4.bp.blogspot.com/-yTsBje3eiyY/VZWd3hTdt5I/AAAAAAAABv4/xBSMalapdC0/s320/randa_slider.jpg" width="320" /></a></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
</div>
BoBB questioned the "one size fits all" and over-medicalized approach to childbirth, showing women that there are more options out there for birth. Sweetening the Pill hopes to do exactly the same thing, questioning the ubiquity of hormonal contraceptives (including the pill and hormonal IUDs, rings, implants).<br />
<br />
They are probably assuming that the same audience who cheered at their questioning of the assumption that hospital birth or cesareans are right for everyone would also cheer at their questioning of the assumption that hormonal birth control is right for everyone.<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://2.bp.blogspot.com/-sDqb4zAyk9Y/VZWd4TxednI/AAAAAAAABwA/qlu_a76Aobs/s1600/book_cover.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="320" src="http://2.bp.blogspot.com/-sDqb4zAyk9Y/VZWd4TxednI/AAAAAAAABwA/qlu_a76Aobs/s320/book_cover.jpg" width="207" /></a></div>
<br />
I find the concept of this film fascinating from a medical anthropology perspective. Reproductive anthropologists examine phenomena like menstruation, menopause, and birth control from a cross-cultural and biological perspective, often finding that ideas we hold true are not always universal.<br />
<br />
If you look at a the history of medicine, you find that men's bodies were considered the ideal, while women's bodies were thought to be defective machines. Men's bodies were the basis for a normal, healthy functioning body, without the confusing aspects of menstruation, pregnancy, and menopause. Female bodies were seen as problems that needed to be solved.<br />
<br />
Controlling our bodies' menstrual cycles allows the female body to be more like a man's, as we can control our "out-of-whack" hormones, keep from getting pregnant at any unknown time, and even cease bleeding. It created a freedom for women who were somewhat enslaved by their bodies making decisions for them, consequences that kept some from living a life they wanted or working outside of the home.<br />
<br />
These days, the white Western body is seen as the norm, while women of color or women from other nations are to us what women used to be to men. Hormonal birth control was developed based on what would be appropriate for the European/American body, not for the Asian, African, or Latina body. Standard hormone dosages, or any hormones at all, may not be right in all bodies, similar to how not everyone's body can process lactose.<br />
<br />
Many women find they have side effects from taking The Pill that they do not like, like feeling sick or uncomfortable, and often stop taking the pill. There has been some research on biological side effects, and we know that the pill does increase your risk of blood clots. Unfortunately, so does being pregnant! Other serious issues are rare, and it is up to women to make the right choice for themselves. Many think that choosing when to be pregnant (or never being pregnant) is the right choice for them, so taking the pill is worth the small medical risks.<br />
<br />
There is research that has found that hormonal birth control can affect sexual desire. We know that it affects hormones, and studies have found that it might affect who we find attractive. Women might wonder "Would I be different if I wasn't on this birth control?" It is a valid question to ask.<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://4.bp.blogspot.com/-nExLrWYqVcg/VZWBd6fN2LI/AAAAAAAABvQ/1b-nAnXYoow/s1600/d42191ed21f92023a64ae8d0332db73a_original.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="http://4.bp.blogspot.com/-nExLrWYqVcg/VZWBd6fN2LI/AAAAAAAABvQ/1b-nAnXYoow/s640/d42191ed21f92023a64ae8d0332db73a_original.jpg" width="640" /></a></div>
<br />
Sweetening the Pill doesn't say that hormonal birth control isn't great, they just wonder why its the only one that is usually recommended to women when they talk to their doctors about birth control. Are there other options? What's right for me? Maybe a lot of women don't even know there are non-hormonal birth control options, other than condoms. Maybe their doctors don't even tell them the side effects.<br />
<br />
I think that this is a valid perspective. I think that women deserve to know that there are non-hormonal options, such as the diaphragm and a non-hormonal copper IUD (<a href="http://www.paragard.com/" target="_blank">Paragard</a>). Other examples include cervical caps, spermicide and sponges, the pull-out method (withdrawal), and natural family planning (also called fertility awareness).<br />
<br />
The main method that the film seems to focus in on is Fertility Awareness (Natural Family Planning). They argue that though we felt empowered by The Pill, being aware of your own body's processes is even more empowering. You don't need a medication or "unnatural" hormones messing up your own natural processes, you just need to get in tune with your body.<br />
<br />
<blockquote class="tr_bq">
<b>Fertility Awareness Method</b>: a mathematical calculation of a woman’s cycle in order to determine periods of fertility and is only effective if a woman has regular 28-day periods. Fertility Awareness requires that the woman daily monitor cervical fluid, temperature and other factors to determine fertile days. In either case, either abstinence or use of a barrier method during fertile times is required in order to prevent pregnancy. </blockquote>
<br />
Fertility Awareness is a great thing to learn to do, especially if you're trying to get pregnant, but it is not a highly reliable form of birth control if you are really super trying NOT to get pregnant. If people used it perfectly, it would be as effective as people perfectly using the pill or the patch, but people don't use these things perfectly. In typical use, you take the pill at different times each day, and you might mess up or forget your tracking.<br />
<br />
Typical use of Fertility Awareness methods (including cervical mucus methods, body temperature, methods and periodic abstinence) has a 24% "failure rate," which means it is about 76% effective. That is quite close to the effectiveness of Withdrawal (pulling out), which people often refer to as a ridiculous method to use to prevent pregnancy. The success rate for withdrawal is 78% (surprisingly effective, all things considered)! I've seen other website cite Fertility Awareness as 80% effective and pulling out as 73% effective, but I trust the data from the Guttmacher Institute, a highly respected reproductive health research organization:<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://4.bp.blogspot.com/-PxlCe1tW3Ho/VZWSft74HNI/AAAAAAAABvo/3S4mm9absO4/s1600/ContraceptiveEffectiveness%2528Chart%2529.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="640" src="http://4.bp.blogspot.com/-PxlCe1tW3Ho/VZWSft74HNI/AAAAAAAABvo/3S4mm9absO4/s640/ContraceptiveEffectiveness%2528Chart%2529.png" width="444" /></a></div>
<br />
<br />
So, the public health side of me thinks that it is not wise for Sweetening the Pill to get too many people moving away from their hormonal birth control, which has quite a few benefits for women, especially low income women and marginalized women and women of color. Birth control that is highly effective, like the pill (91% effective with typical use) and the hormonal IUD (99% effective), is not something we should step away from lightly. It allows women control over their lives, it helps women who truly shouldn't (medical reasons, youth, or otherwise) get pregnant, and it avoids abortions. The Natural Family Planning method really doesn't have the efficacy that these methods do.<br />
<br />
I'm not vehemently against starting the conversation that this documentary is starting, the way some articles on the internet have been -- see the infamous Amy Tuteur's post on <a href="http://time.com/3938652/how-ricki-lakes-proposed-birth-control-documentary-is-anti-woman/" target="_blank">Time.com</a> and <a href="http://www.slate.com/blogs/xx_factor/2015/06/25/ricki_lake_christian_right_hero_she_s_making_a_documentary_against_hormonal.html" target="_blank">Slate.com's</a> articles to hear some outrageously unbalanced reviews. I think that this is a valuable conversation to have. I recognize that I am of a class privileged enough to be able to afford all types of birth control and have the time to track fertility, if we want to. Not everyone actually has the financial and temporal freedom to actually choose what is right for them, so we need true open and honest information on all of the options.<br />
<br />
<b>You can find more information on the film Sweetening the Pill at the <a href="https://www.kickstarter.com/projects/92756815/sweetening-the-pill-a-documentary?ref=video" target="_blank">Kickstarter site</a> (which has been fully backed).</b><br />
<b><br /></b>
<b><iframe allowfullscreen="" frameborder="0" height="381" mozallowfullscreen="" src="https://player.vimeo.com/video/129738582" webkitallowfullscreen="" width="600"></iframe> </b><br />
<br />
<b><br /></b>
I think a great part of this conversation, from an academic viewpoint, is whether the Pill or Natural Family Planning is more empowering, more feminist. The film's preview implies that though the Pill was the ultimate female empowerment 55 years ago, being one with your body's processes and not relying on pharmaceuticals is more empowering. Others might think that by rejecting the pill, we are undoing the work that was done to become less enslaved by our biology.<br />
<br />
<a href="http://www.bestdaily.co.uk/your-life/news/a656034/sweetening-the-pill-are-we-asking-enough-questions-about-birth-control.html" target="_blank">Best Daily'</a>s post quotes Ricki Lake/Abby Epstein:<br />
<blockquote class="tr_bq">
"The progression of mainstream feminism is founded in part on women overcoming and controlling their biology", they explained. "This is because for a long time women's biology or difference has been used against us as justification for our mistreatment and oppression. Women have come to feel that they must overcome their biology in order to have equality and freedom."</blockquote>
<blockquote class="tr_bq">
To enjoy the same privileges as men, do we feel we must we be more like them, not just in our attitudes, but in our biology? Lake and Epstein think so: "The male body is held up as the "ideal" in the medical industry and the female body is seen as inherently faulty and problematic. Women have had to make sacrifices to be allowed to work alongside men in a patriarchal society. The fear is that if we stop making those sacrifices we will lose that ground."</blockquote>
I don't think Ricki Lake and Abby Epstein are "anti-choice" or "anti-feminist" as the Time and Slate articles call them, but I do hope that they present their information in a balanced way. I do hope they talk about the pros of hormonal birth control for so many women, and the potential cons of fertility awareness methods. I hope they talk about other methods that aren't usually talked about in the mainstream.<br />
<br />
We will have to wait for its release to find out!<br />
<br />
<br />
<br />
<br />
<br />
<br />Emilyhttp://www.blogger.com/profile/02738440647498422230noreply@blogger.com2tag:blogger.com,1999:blog-9221984976832050207.post-74160934600480648952015-06-01T16:15:00.000-04:002015-06-01T16:26:43.688-04:00Officially a Lamaze Certified Childbirth EducatorIt is official - I passed my Lamaze exam and am now a certified childbirth educator!<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://4.bp.blogspot.com/-Wi4pfwYIhSU/VWypKUNE2DI/AAAAAAAABu4/uPymqd6Fjr0/s1600/LCCE.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="http://4.bp.blogspot.com/-Wi4pfwYIhSU/VWypKUNE2DI/AAAAAAAABu4/uPymqd6Fjr0/s320/LCCE.jpg" width="209" /></a></div>
<br />
<div>
I wrote a couple of months ago about <a href="http://anthrodoula.blogspot.com/2015/01/i-am-lamaze-childbirth-educator.html" target="_blank">why I did my training in Lamaze</a>, before I had completed my requirements. Because I had to wait from my training course in October to my exam in April (the exam is only offered twice a year), the process took me exactly that length of time (plus waiting for exam results)! I was able to teach a childbirth education course to be "signed" off on and register and take the exam in the time in between. If you are interested in becoming an LCCE and are already in the birth world, I think you could also do it in this time frame. I will point out, however, that if you do not "keep up" with at least the last couple of years' worth of birth/breastfeeding research and recommendations, you might have trouble. </div>
<div>
<br /></div>
<div>
<br /></div>
<div>
<u>The Exam</u></div>
<div>
<br /></div>
<div>
To prepare for the exam I read the enormous study guide, which I did not think was a very user-friendly review source. It spends much of the time referring you to outside sources. This is great as far as providing resources goes, but when I want to sit down and study for something, I don't want to have to go searching all around. I appreciated that each section had a "Review Questions" page, which I think actually helped me understand the Lamaze thought-process better than reading the study guide. I like the articles that were actually included in the study guide document, but skipped most of them unless they were Lamaze-specific and I wanted to get an idea for what their angle was. This turned out to be a good idea, because most of the questions on the exam asked extremely vague questions (e.g. "choose the <i>best</i> answer") rather than clear-cut fact-based questions. It is a good idea to get a feel for how Lamaze would like you to answer.</div>
<div>
<br /></div>
<div>
<br /></div>
<div>
<u>Teaching</u></div>
<div>
One of the up-sides, or down-sides, of Lamaze is that I get to create my own curriculum. I do not have to follow a particular work book or a set of rules. I am encouraged to base the curriculum on the 6 healthy birth practices, which I would do anyway (because they are great!), but other than that, I can choose my own books, worksheets, posters, and other teaching tools/resources. This is a pro because I am not limited, but a con because that means I have to come up with what I want to use! I am still experimenting, and haven't fully decided on what tools I think most essential. I am doing it on the cheap, at the moment, before I decide to invest in expensive DVDs, posters, pelvises, dolls, etc. Any recommendations or product reviews would be greatly appreciated!</div>
<div>
<br /></div>
<div>
Lamaze does offer the purchase of a pre-made slide set, but I don't see myself teaching with slides, and I know that it is a product I could probably make on my own (minus some shiny photos). For someone who is starting from scratch, though, I bet this would be a really useful tool. </div>
<div>
<br /></div>
<div>
<br /></div>
<div>
<br /></div>
<div>
I am excited to join the a community that I feel is respected, focused on evidence-based medicine, and well-known. </div>
Emilyhttp://www.blogger.com/profile/02738440647498422230noreply@blogger.com0tag:blogger.com,1999:blog-9221984976832050207.post-79906476779180974972015-04-15T15:38:00.000-04:002015-04-15T15:38:00.126-04:00Notes from the Field: Learning with Indigenous Midwives in Chiapas, Mexico<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="http://4.bp.blogspot.com/-J6NigYdqWz4/VRxHXlfl0II/AAAAAAAABt0/E-uOD1FLIK4/s1600/Picture%2B2.JPG" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="http://4.bp.blogspot.com/-J6NigYdqWz4/VRxHXlfl0II/AAAAAAAABt0/E-uOD1FLIK4/s1600/Picture%2B2.JPG" height="200" width="190" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Mounia during the Day of the Dead fiesta<br />
November 2014</td></tr>
</tbody></table>
<i>Today's post is a guest article from anthropologist Mounia El Kotni. Mounia's "Notes from the Field" appeared in the most recent Council on Anthropology and Reproduction newsletter, and she has kindly allowed its reproduction here. In this post, she describes her participant-observation experience with midwives in Chiapas.</i><br />
<i><br /></i>
<br />
<b>Learning with Indigenous Midwives in Chiapas, Mexico</b><br />
<br />
“Oh, I see, so you want to be a partera (midwife)” is the typical response I hear after explaining the purpose of my visit; that I am doing dissertation research to document how midwives live and work. Although I try to explain my research goal in terms of “helping raise awareness on the difficulties parteras are facing,” I am always met with this same response “so you want to learn how to become a midwife?” And as I have gotten to meet parteras and aspiring midwives, I must admit that there is not always a clear difference between what I do and how I act and what they do and how they act: asking questions about pregnancy care, sitting in on prenatal consults, taking notes on almost everything the partera says... There is a thin line between participant-observation and midwives’ apprenticeship model. And indeed, I have been learning a lot about how parteras work and live, but also a hell of a lot about plants given in pregnancy care and massage techniques.<br />
<br />
Since October 2014, I have been in San Cristóbal de Las Casas, Chiapas, conducting dissertation fieldwork and volunteering for the Women and Midwives’ Section of the Organization of Indigenous Doctors of Chiapas (OMIECH). As a volunteer, my work consists mainly of two tasks: administrative tasks (aka looking for funding) and logistical support during events and workshops. Since 1985, OMIECH has been strengthening Mayan medical knowledge and organizing health workshops in indigenous Tseltal and Tsotsil communities of Chiapas. Even though I am in Chiapas, some of my notes echo those of Kara E. Miller (Fall 2014 Newsletter). Here too, the parteras - who are referred to as Traditional Birth Attendants in international documents - are frustrated with the lack of possibilities to transfer their skills to the next generation. This is why the Women and Midwives’ section organizes workshops focused on reproductive health, and care during pregnancy, birth, and postpartum. These workshops are open to all members of the community where they take place, and aim to perpetuate botanical and medical knowledge by transmitting it to younger generations.<br />
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="http://1.bp.blogspot.com/-bn-dXJPz4q4/VRxHuHnNXAI/AAAAAAAABuA/pe4UanTAEkg/s1600/Picture%2B3.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="http://1.bp.blogspot.com/-bn-dXJPz4q4/VRxHuHnNXAI/AAAAAAAABuA/pe4UanTAEkg/s1600/Picture%2B3.JPG" height="213" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Micaela <span style="font-size: 12.8000001907349px;">giving a workshop at the meeting of OMIECH parteras</span><br />
February 2014. credit: OMIECH</td></tr>
</tbody></table>
The loss of knowledge is accelerated by various factors: young people’s migration, midwifery not being an attractive profession economically, and also the increasing medicalization of birth. The push to send women to birth in hospitals comes with a delegitimation of indigenous parteras’ knowledge as “not-modern”. Through conditional cash-transfer programs (documented by Vania Smith-Oka in the state of Veracruz), women are pushed to have their prenatal visits and give birth in hospitals. Parteras, on their end, have to attend trainings given by the Health Secretary. These trainings emerged in the 1980s, and intensified in Chiapas under the pressure of reducing maternal mortality rate to comply with the Millennium Development Goal (Chiapas has one of the highest maternal mortality rates in Mexico). Indigenous traditional midwives either have to follow the trainings or stop practicing. This can have dramatic consequences in places where they are often the only health care provider in their communities.<br />
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="http://4.bp.blogspot.com/-EYGs3o7mREM/VRxHXb2PXkI/AAAAAAAABtw/BvGKIZLb2KU/s1600/Picture%2B1.jpeg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="http://4.bp.blogspot.com/-EYGs3o7mREM/VRxHXb2PXkI/AAAAAAAABtw/BvGKIZLb2KU/s1600/Picture%2B1.jpeg" height="213" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Micaela during a community workshop with parteras.<br />
May 2014. credit:Alice Bafoin</td></tr>
</tbody></table>
As I jot down notes during an interview or observation within these different settings, I feel a thrill of delight when their words echo one another. But then I realize this means that these state policies are really achieving great changes for parteras. And like Sisyphus, tirelessly, my colleagues at OMIECH reweave what is being unwoven: traditional medical knowledge, but also, and as important, pride in it and trust within the community.<br />
<br />
While “in the field”, my notes are scribbly at times, crystal clear at others, but rarely absent. I try to type them regularly, as a good apprentice-anthropologist, but have stopped feeling guilty when I could not do so. It took me a few months to be able to “let go” and admit there will always be an event I will miss, a trip I cannot make... At my mid-point in the field (already), I have just started to take drawing classes, which helps me expand the range of my notes, when words fail to describe a hand gesture, or when I do not know the terminology for this exact point on the belly that needs to be massaged. These classes have made the familiar look different, and made me look at people in a new way, which in turns adds more depth to my notes. Life in the field intertwines professional, political and personal spheres. The friendships I have built through this research promise to impact both my career and personal life. As we were searching for plants in the garden of the organization for an upcoming booklet publication, my colleague Micaela corrected me as I got the name of the plant wrong, once again. I could sense, for the first time, an impatient tone in her voice. I pause and I suddenly realized that although I am not studying to become a midwife, every one of the parteras I have met has been a teacher to me, training me a little bit, sharing their story, their tortilla and their endless knowledge. I am looking forward to learning a lot more in the next five months I will be spending with them and I hope my dissertation will bring them knowledge they can use in their struggle.<br />
<br />
<i>Mounia El Kotni is a French-Moroccan doctoral candidate at the State University of New York at Albany. Her dissertation documents the impact of Mexican health laws on the practice of indigenous midwives. She is currently conducting fieldwork with the <a href="https://www.facebook.com/areademujeresomiech" target="_blank">Women and Midwives Section of the Organization of Indigenous Doctors of Chiapas (OMIECH)</a>. Since 2012, Mounia is also a member of the French organization <a href="http://blogdelassociationma.blogspot.mx/" target="_blank">Association Mâ</a>, which promotes respected childbirth. She can be reached at <a href="mailto:melkotni@albany.edu" target="_blank">melkotni@albany.edu</a></i>Emilyhttp://www.blogger.com/profile/02738440647498422230noreply@blogger.com0tag:blogger.com,1999:blog-9221984976832050207.post-89598449318912167272015-04-01T15:13:00.001-04:002015-04-01T15:27:24.291-04:00Notes from the Field: When Breastmilk Isn’t Enough<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="http://2.bp.blogspot.com/-uVOLXybAX28/VRrh150G1DI/AAAAAAAABtg/9mTJL7d0dRc/s1600/Veronica%2Band%2B4%2Bmonth%2Bold%2BPaulo.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="http://2.bp.blogspot.com/-uVOLXybAX28/VRrh150G1DI/AAAAAAAABtg/9mTJL7d0dRc/s1600/Veronica%2Band%2B4%2Bmonth%2Bold%2BPaulo.jpg" height="200" width="133" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Veronica and 4 month old Paulo</td></tr>
</tbody></table>
<i>Today's post is a guest article from anthropologist Veronica Miranda. Veronica's "Notes from the Field" appeared in the most recent Council on Anthropology and Reproduction newsletter, and she has kindly allowed its reproduction here. In this post, she reflects on her time spent in the Yucatan while she was breastfeeding and conducting field research.</i><br />
<i><br /></i>
<i><br /></i>
<b>When Breastmilk Isn’t Enough</b><br />
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;">
It was a hot and
humid late July afternoon when I decided to pay a visit to one of the village
midwives. I gathered my already-packed research bag and on the way out I said
good-bye to my husband (a.k.a. field assistant and nanny) and kissed our three
month old son. It was around three o’clock when I left. The heat was still
unbearable as I walked through the rural Yucatec Maya pueblo of Saban, located
in the southern interior of the peninsula.<br />
<br /></div>
When I arrived to the midwife’s house I was hot,
sweaty, and thirsty. I was escorted by the midwife’s daughter to the large
newly built thatched roof kitchen located behind the house. Elda, the midwife,
was cooking lunch when I got there. She invited me to sit down and eat with her
family. We had a simple but delicious lunch.<br />
<br />
Elda served a thin soup of boiled Chaya (a dark leafy
green high in calcium and folic acid) that was mixed with ground-up pumpkin
seeds, sea salt, and a generous squeeze of fresh lemon juice. Her son had
picked some avocados from the tree outside and made a big bowl of guacamole.
And like all meals in the pueblo, our lunch was accompanied by fresh, handmade
corn tortillas. It was one of my favorite meals. I ate two servings and savored
every bite.<br />
<br />
Elda was happy that I liked her cooking and she said I must always be hungry because I am breastfeeding. She told me she ate often
when she breastfed her children many years ago. I asked her if she exclusively
breastfed her three children—two girls and a boy. She said yes. In fact her
son, the youngest, was the largest of all her babies. He was so big that many
people thought he was a year old when he was only six months. We had already
had many conversations in the past about the importance of breastfeeding for
both baby and mother. Yet at that moment, I had to ask her a question that had
been bothering me for some time. I asked, “Elda if I am exclusively
breastfeeding my infant son and he is visibly a large and healthy baby, why are
so many people in the community telling me I needed to supplement with formula?
Why are they saying he needs more than breastmilk”?
<br />
<br />
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify; text-indent: .5in;">
<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;">
Elda
took a moment to think about what I had just said and then asked if my son
cried a lot. As a young first-time mother away from my own familial support
system, I was not really sure the average amount a baby cried. My son did cry
often throughout the day and night but I was usually able to sooth him by
breastfeeding. From the day he was born I nursed my son on demand—even at eight
months he was still adamant about having breastmilk every two to four hours. In
the end, I answered Elda’s question by saying “Yes, he does cry a little”. Her
teenage son was intrigued by our conversation and asked me if my son had air in
his belly? Assuming this was similar to colic I explained that this used to be
an issue, but not anymore. Elda suggested that he could have <i>mal de ojo</i>. But she was leaning more to
the idea that maybe I was not producing enough milk. She asked if my milk was
soft or hard when it leaked through my shirt. I paused for a moment—I had never
been asked this question before. Was she referring to my milk flow or the
thickness of my milk? I probably will never know since I did not ask her to
explain. Not completely understanding the question I said I think it comes out
soft. </div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;">
<span style="text-indent: 0.5in;"><br /></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;">
<span style="text-indent: 0.5in;">She said that was it. My son cried a lot because he
was hungry, she explained. My milk was too thin and he was not getting his
fill. I asked her what I could do to fix this, and she responded by saying, “Usually
if the mother has thin milk, about a month after the baby is born, she is told
to drink a lot of agua de Chaya and follow a local remedy of placing boiled
orange leaves over the her breast and taking a warm bath with the tea water.
The mother must stay inside for three days, especially if it is cloudy outside.
This will help increase the milk supply and make it thicker”. Unfortunately, I
had missed my chance. My son was almost four months old and my best option now was
to supplement with formula.</span><br />
<span style="text-indent: 0.5in;"><br /></span></div>
I thought about this conversation with Elda the rest
of the time I was in the field. Just a generation ago, women in the community
exclusively breastfed. The older and middle aged women who told me I needed to
supplement with formula had exclusively breastfed their own children. Women
have always breastfed. Breastfeeding continues to be widely practiced
throughout the community. As Elda pointed out, local healers and midwives have
used traditional remedies passed down from older generations to help a mother
increase her milk supply and sooth a crying baby. But times have changed;
today, breastmilk is no longer seen as enough. Many women firmly believe that infants
need to be supplemented with formula. The idea that traditional medicine is no
longer able to help women produce enough milk to feed their babies is
relatively new. Formula, for many women, provides the necessary nutrients infants
need to thrive. These beliefs are instilled through the advice of local doctors
and nurses, and reinforced by widespread media and public health campaigns. Today
the majority of new mothers believed that their infants would be healthier and
happier if they had both breastmilk <i style="text-indent: 0.5in;">and </i><span style="text-indent: 0.5in;">formula.
</span><span style="text-indent: 0.5in;"> </span>
<br />
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify; text-indent: .5in;">
<o:p></o:p></div>
<br />
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;">
There is a wide array
of literature that explains why indigenous and/or poor women choose to use
infant formula. Some reasons include 1) the belief in corporate media messages
proclaiming the superior health benefits of formula; 2) indigenous women’s
internalization of the idea that their bodies are inadequate; 3) a rise in
social status with the use of expensive formula; and 4) the adoption of the
idea by indigenous and/or poor women that they are <i>better mothers</i> by offering formula to their children. I knew all of
this going into my fieldwork. I have read the literature, and studied the
political economic histories that have affected and shaped rural women’s
choices. Yet, it was not until I personally experienced in the field the issue
of supplementing with formula that I had a greater appreciation for the many
ways in which women address on a daily basis the health of their children. As a
young researcher eager to apply the scholarly knowledge I had gained I chose to
focus heavily on the issue of breastmilk verses infant formula. But I was
wrong. After many conversations with women in the community I was finally able
to listen to them and understand that they did not see the two as a binary. It
was until much later that I realized the women suggesting I supplement with
formula were trying to help me deal with a situation and address a specific
symptom—a crying baby. These rural Yucatec Maya women are bombarded with
constant messages by doctors and from the media that their bodies are
insufficient at meeting the needs of their unborn and infant children. As with
childbirth, these women have not addressed their health and that of their
children through an either/or dichotomy. Women are trying to make the most of
all the resources they have and mixing practices allows them to ensure the
wellbeing of their children. It was shocking to see how strong the outside
messages of the inadequacy of women’s bodies had affected their beliefs, yes,
but even within that these women are trying to find the best ways to raise
healthy and happy children.<br />
<br />
<br />
<i>Veronica Miranda is a doctoral candidate in medical anthropology at the University of Kentucky. Her dissertation research focuses on how rural Yucatec Maya women, midwives, and state health care workers participate in the production of childbirth practices in relation to federal health policies and programs.</i></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;">
<o:p></o:p></div>
Emilyhttp://www.blogger.com/profile/02738440647498422230noreply@blogger.com2tag:blogger.com,1999:blog-9221984976832050207.post-3065432415419164532015-02-25T15:25:00.003-05:002015-02-25T15:56:47.622-05:00Reducing Primary Cesareans (Part 2)<i><a href="http://anthrodoula.blogspot.com/2014/12/the-primary-cesarean-reduction-movement.html" target="_blank">Click here to read Part 1: The Primary Cesarean Reduction Movement</a></i><br />
<br />
<br />
I just listened to an interesting <a href="http://www.npic.org/Services/Continuing_Education.php" target="_blank">webinar on Preventing Primary Cesareans</a>! The presenter explored much of the research and data supporting the recommendations behind the SMFM and ACOG Statement <a href="http://www.acog.org/Resources-And-Publications/Obstetric-Care-Consensus-Series/Safe-Prevention-of-the-Primary-Cesarean-Delivery" target="_blank">Safe Prevention of the Primary Cesarean Delivery.</a> I found a few of the points interesting enough to share them here.<br />
<br />
Ideally the primary cesarean reduction issue would be addressed through a systems approach, where hospitals, payors, patients, and OB providers are all working to improve primary cesarean rates. This presentation mainly focused on the obstetrics areas that can be influenced to make change.<br />
<br />
The presenter noted that the Healthy People 2020 target cesarean rate for low risk, full term, singleton, vertex pregnancies is 23.9%, BUT that the goal in 2010 was 15%. Clearly, the government had to lower its expectations.<br />
<br />
<br />
<div>
Malpresentation contributes to 17% of pre-labor cesareans, and is a highly modifiable obstetric indication for preventing the first cesarean. For example, research shows that an external cephalic version at greater than 36 weeks has a success rate ranging from 35-86%. Care providers and hospitals should be offering and encouraging this procedure. Furthermore, more clinicians need to be trained in how to vaginally deliver breech babies. The presenter only recommended this when the second twin is breech. Vaginal breech delivery of the second twin does not increase morbidity when done by an experienced provider.</div>
<div>
<br />
Failure to progress (or CPD) accounts for about 34 - 47% of intrapartum cesareans (the majority first stage arrest), and nonreassuring fetal status (heart rate tracing interpretation) accounts for about 10 - 27% of intrapartum cesareans. These are additional modifiable areas to prevent cesareans. </div>
<div>
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="http://2.bp.blogspot.com/-k5c_9dPuo10/VO4mzvb_1BI/AAAAAAAABsI/utF-4mE6Sck/s1600/oc001c.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://2.bp.blogspot.com/-k5c_9dPuo10/VO4mzvb_1BI/AAAAAAAABsI/utF-4mE6Sck/s1600/oc001c.jpg" height="396" width="640" /></a></div>
<div>
<br /></div>
<div>
A big one is Failure to Progress, aka labor arrest, aka cephalopelvic disproportion. This can be diagnosed during either first stage or second stage (pushing). We joke in the doula world that this is often "failure to wait." Many OB's are taught that labor progresses according to the Friedman's Curve. This curve is one of my biggest birth pet peeves. This curve basically says that during active labor, a primiparous woman should dilate about 1 centimeter per hour, and that (on average) the entire first stage should last about 13 hours. This is based on a 1955 study with a sample size of 500 primips. It looks like this:</div>
<div>
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="http://2.bp.blogspot.com/-qoqMoShCRp8/VO4nwXFqhVI/AAAAAAAABsQ/slOZptI0h_I/s1600/001f.gif" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://2.bp.blogspot.com/-qoqMoShCRp8/VO4nwXFqhVI/AAAAAAAABsQ/slOZptI0h_I/s1600/001f.gif" height="302" width="400" /></a></div>
<div>
<br /></div>
<div>
A 2010 multicenter study of more than 200,000 deliveries looked at primips and multips. This study found that the 95th% was about 20 hours for the first stage, with a mean of 8.4. (Keep in mind that half of the women received pitocin and 80% of the women had an epidural). Here is the curve from this study. It shows that multiparous mothers generally have shorter labors and that active labor may not really get going for them until about 6 cm dilation. Then, the curve is quick. For first time moms, however, there is no definite "turning point," and the curve is more gradual. </div>
<div>
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="http://3.bp.blogspot.com/-9zzwkHtNA4s/VO4pY9Z9vbI/AAAAAAAABsc/eAOYRm4wLGA/s1600/average%2Blabor%2Bcurve.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://3.bp.blogspot.com/-9zzwkHtNA4s/VO4pY9Z9vbI/AAAAAAAABsc/eAOYRm4wLGA/s1600/average%2Blabor%2Bcurve.jpg" height="321" width="400" /></a></div>
<div>
<br /></div>
<div>
This is a reason for the big change to starting "Active Labor" at about 6 centimeters dilation and not diagnosing labor arrest unless the mother is not having cervical change for 4 or more hours after they are at least 6 cm dilated. Moreover, diagnosis of labor arrest in the second stage has also changed due to this study, which found longer pushing stages for first time mothers as well as for mothers who had an epidural. Much research has shown that no neonatal morbidities were (statistically) significantly increased as length of second stage increased. Some maternal morbidities were found to increase (statistically) significantly as pushing time increased (e.g. uterine atony).</div>
<div>
<br /></div>
<div>
Another important point is that we need to give women who are induced more time to labor! There are few adverse outcomes associated with increased patience for inductions. The recommendation is at least 24 hours of pitocin + no regular contractions + no cervical change = arrest. </div>
<div>
<br /></div>
<div>
The presenter suggested that to addressing variation in diagnosis of nonreassuring fetal heart tones, we should really emphasize that moderate fetal heart rate variability is reassuring, as is FHR acceleration after fetal scalp stimulation.</div>
<div>
<br /></div>
<div>
I'm going to share her slide here so you can see what she lists as the non-medical factors in the hospital and among care providers that influence cesarean rates.</div>
<div>
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="http://1.bp.blogspot.com/-7BHa40hZMoA/VO4sYjy3raI/AAAAAAAABso/YYZ-8qGSbuI/s1600/slide.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://1.bp.blogspot.com/-7BHa40hZMoA/VO4sYjy3raI/AAAAAAAABso/YYZ-8qGSbuI/s1600/slide.png" height="250" width="400" /></a></div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: left;">
<br /></div>
<div class="separator" style="clear: both; text-align: left;">
I liked that she addressed that the hospital has trouble with allowing women to labor longer on L&D, that OR staff often go home at about 8pm so many Cesareans are scheduled before then so no one has to come back to the hospital at night, and that nurses are very busy and have competing priorities. Physicians of course have their own personal reasons for "diagnosing" a cesarean, among them financial incentives to deliver the child themselves so they will get paid and not someone else! Research shows that hospitals that have salaried MDs (e.g. laborists; can also be midwives) have less variability in the time of day when diagnoses of fetal distress are made. </div>
<div class="separator" style="clear: both; text-align: left;">
<br /></div>
<div class="separator" style="clear: both; text-align: left;">
She touches on myths among patients (labor is bad for the baby, long labor is bad, induced labor is the same as spontaneous labor, operative vaginal delivery is worse than cesareans, etc). This is something that childbirth educators and doulas try to impress on the public, but physicians need to be doing this education, too. </div>
<div class="separator" style="clear: both; text-align: left;">
<br /></div>
<div class="separator" style="clear: both; text-align: left;">
She did not cover medical legal issues due to time constraint (understandable - it is a major topic)! I would have liked to hear, though, ways that nurses can be involved in preventing the first cesarean. I work with a hospital that shared that they are getting their nurses educated and involved in educating and working with patients on how position changes can help the baby descend, pelvis open, and reduce first and second stage labor time (and nonreassuring fetal heart rates). I think this is a great initiative!</div>
<div class="separator" style="clear: both; text-align: left;">
<br /></div>
<div class="separator" style="clear: both; text-align: left;">
The presenter did mention doulas when prompted, praising their involvement, and the involvement of midwives, but did not touch on how they can make a difference in reducing primary cesareans. </div>
<div class="separator" style="clear: both; text-align: left;">
<br /></div>
<div class="separator" style="clear: both; text-align: left;">
<br /></div>
<div class="separator" style="clear: both; text-align: left;">
If you'd like to see the entire slide set or check the references, you can download the slide set from the <a href="http://www.npic.org/Services/Continuing_Education.php" target="_blank">National Perinatal Information Center website</a> when they become available.</div>
<div>
<br /></div>
Emilyhttp://www.blogger.com/profile/02738440647498422230noreply@blogger.com0tag:blogger.com,1999:blog-9221984976832050207.post-42200703181348589002015-02-02T08:30:00.000-05:002015-02-02T10:29:57.448-05:00Social Media Tips for Birth Pros<div>
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="http://3.bp.blogspot.com/-s-U8dtShMEE/VMqRo6E-otI/AAAAAAAABr0/qUHUOC7-ATc/s1600/social%2Bmedia%2Btips%2Bfor%2Bbirth%2Bpros.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://3.bp.blogspot.com/-s-U8dtShMEE/VMqRo6E-otI/AAAAAAAABr0/qUHUOC7-ATc/s1600/social%2Bmedia%2Btips%2Bfor%2Bbirth%2Bpros.jpg" height="215" width="320" /></a></div>
<div style="text-align: center;">
<br /></div>
<div>
<br /></div>
<div>
My first tip for Birth Professionals is to <b>Use Social Media</b>!</div>
<div>
<br /></div>
<div>
Social media is used by a growing number of men and women of reproductive age, so it very helpful for birth professionals! Social media can only increase your exposure. It helps you provide frequent, updated business information to an audience without having to constantly figure out how to refresh your website. It drives people to your website and contact information. </div>
<div>
<br /></div>
<div>
My second tip is to <b>use social media wisely.</b> Many professional organizations recommend that you avoid mentioning your clients on social media. You especially want to avoid reflecting on a negative experience, or share a photo of someone without their permission. Get permission from your clients if you'd like to use their images on the internet.</div>
<div>
<br /></div>
<div>
My third tip is to <b>follow other birth professional social media accounts</b>. How are you going to know what is going on in the world of birth/breastfeeding/babies if you don't follow along? This is the best way to find articles and information to share with your own audience. Don't just plan on making an account and only looking at your own page; make sure you are engaging with other birth pros so you can stay up-to-date for your clients!</div>
<div>
<br /></div>
<div>
<br /></div>
<div>
Here are some site-specific tips:</div>
<div>
<br /></div>
<div>
<br /></div>
<div>
<b>Facebook</b></div>
<div>
<br /></div>
<div>
Everyone tries to figure out how to work with the unknown algorithm that Facebook uses to decide whose posts show up on News Feeds and why. It is a fact that not all of your posts will be "served" to all of the people who "Like" you. Here are some of my tips to optimize use of Facebook.</div>
<div>
<ol>
<li><b>Fill our your Page completely. </b>Make sure you have your logo as your profile photo, and use your cover photo to provide more information through an image, text, or upcoming event. Fill in your contact information and your business information, and make sure you include your website link. </li>
<li><b>Do not post more than two posts to a business page per day.</b> More than two posts per day (or 10 total per week) will result in A) An annoyed/jaded FB fan audience, and/or B) Facebook's algorithm will stop showing your posts to your whole page audience. And when you do post your two posts, make sure they are spread out (to catch morning and afternoon crowds, or lunch and evening crowds). If you discover more than one interesting post at once, you can "schedule" posts for future times to ensure your posts are spread out, and continue to engage an audience even if you decide to disconnect for a day. (note: Scheduling doesn't work through clicking the "share" button on a photo or post from another FB page).</li>
<li><b>Interact with other Pages as Your Page</b>. Did you know that you can "use Facebook as" your page? I highly recommend that you switch over sometimes and use this feature to Like other local businesses, like other page's posts, and comment on other page's posts. You can't do everything that you can with your individual Facebook page (for instance, join groups or like an individual's posts). </li>
<li><b>Engage people in conversation. </b>Ask a question, share your own personal story, take a poll. The more people who are engaged in your posts, the better your Facebook page will do!</li>
</ol>
<div>
<br /></div>
<div>
<br /></div>
</div>
<div>
<b>Blog</b></div>
<div>
<b><br /></b></div>
<div>
If you are hoping to increase your business, I recommend that you add a blog to your business website. </div>
<div>
<ol>
<li><b>Update your blog regularly. </b>Write about content that you are hoping will draw-in business. This can be specific to your business, or can be interesting information related to your business area. For instance, you can blog about the safety of water birth, and anyone interested in that topic may stumble on your blog. Or, you can write specifically about the services you offer. You can even video blog (Vlog) and post those on YouTube!</li>
<li><b>Use at least one image on every blog post. </b>Photos drive attention and traffic when posts are shared on Facebook and Pinterest, and for some reason make it more likely that your post will be read! Making your own informative text-based image to describe what the post is about is often sufficient.</li>
<li><b>Post your blog posts on other social media sites.</b> Now that you've written a post, make sure you share it far and wide (and add social media buttons so others can share, too)! Post to your Facebook page, Twitter account, pin it to Pinterest, post an image from it on Instagram.</li>
</ol>
</div>
<div>
Any website that refreshes content often will lead to increased exposure in search engines (part of Search Engine Optimization, or SEO, techniques). This is why a blog will drive people to your website, and why a web search will often find a Facebook, Twitter, or Pinterest post. </div>
<div>
<b><br /></b></div>
<div>
<b><br /></b></div>
<div>
<b>Twitter</b></div>
<div>
<b><br /></b></div>
<div>
My Facebook Page posts auto-tweet, which makes sharing across platforms really easy. I haven't figured out how to best use Twitter for business, yet, though Twitter offers information on how to make this useful for you. I mainly use twitter for this blog account - to share interesting articles. It makes a great depository for articles that I want to be able to find again later, or just to try to spread information and get conversations moving on certain topics. </div>
<div>
<ol>
<li><b>Use hashtags. </b>The best advice I have for using Twitter is to use hashtags. This is the most convenient way to join a conversation with others who are interested in the same things you are. If you write a post or share an article about doulas, use the hashtag #doulas. Then, anyone who is interested in doula stuff, too, can search #doulas and your article will pop up. It helps drive followers to you and gets the info out to a larger audience. </li>
<li><b>Make it Re-tweetable</b>. Make sure you write posts in a way that is easy for people to simply click "retweet" and share with their followers. My advice here is just to say to make it relatable, and don't include anything that someone might have to take out if they want to share. </li>
</ol>
<div>
Sharing on Twitter in addition to Facebook increases your audience - someone might see your post on Twitter but miss it on Facebook (or vice versa). </div>
</div>
<div>
<br /></div>
<div>
<br /></div>
<div>
<b>Pinterest</b></div>
<div>
<b><br /></b></div>
<div>
Pinterest is great for birth businesses for two reasons: 1) The majority of users are young women, and 2) It is often an indication of things that people want in the future. Women pin merchandise they are interested in or ideas they want to come back to in the future. It is a great place not only for you to save ideas and links on a virtual cork board, but for your clients to save your business' ideas and links! </div>
<div>
<ol>
<li><b>Create topic-specific boards. </b>You may love all things birthy, but if you're using Pinterest for business, you want to make what you share easily accessible for your followers who may only be interested in certain topics. For instance, make a "breastfeeding" board, a "labor support" board, a "newborn" board, etc! Users can choose to follow some or all of your boards. </li>
<li><b>Auto-share on Twitter. </b>If you have both a Twitter and a Pinterest account, you can set your Pins to automatically tweet (make sure the pin's description is included). This drives those who may be on Twitter to the content you find on Pinterest. </li>
</ol>
</div>
<div>
<br /></div>
<div>
<b>Instagram</b></div>
<div>
<b><br /></b></div>
<div>
Instagram is a great idea for a business that plans to have a lot of visual items to share. Where twitter is text, Instagram is photos. For a birth business I envision two uses: </div>
<div>
<br /></div>
<div>
1) To keep your fans, community, clients, etc. interested in what is going on with your life (keeps things personal, which people like, but you have to be willing to be a public sharer). An example might be a picture of you getting coffee after being up all night with a laboring woman, you wearing your own baby, etc. and,<br />
2) For sharing what is going on with your business, for instance, a picture of a newly decorated room in your birth center, childbirth education supplies you have ready for the next class you're going to teach, or (with permission) your clients' newborn photos!<br />
<br />
Here are some tips:</div>
<div>
<ol>
<li><b>Make a business page, not a personal page. </b>And use it like a business. Make all of your posts relate to your business, not your personal life. Your clients probably don't care what you ate for dinner every night last week. </li>
<li><b>Use hashtags</b> is my advice, again, for the same reason as above. If your business Instagram account is public, people can find it by searching the hashtags. </li>
</ol>
</div>
<div>
<br /></div>
<div>
<br /></div>
<div>
If you get really into using social media for your business, you can analyze your analytics! You can set up analytics on your blog to see where your traffic is coming from, including referral sites or search words. Twitter and Facebook also support analytics (on FB it is called "insights"). You can see what day of the week or what time of day you are getting the most engagement on your posts, and how many new page likes you have this week compared to last week. </div>
<div>
<br /></div>
<div>
<br /></div>
<div>
There are other great resources out there for more tips on using social media; I suggest starting with Your Doula Bag's Pinterest Board "<a href="https://www.pinterest.com/yourdoulabag/social-media-for-doulas/" target="_blank">Social Media for Doulas</a>"! </div>
Emilyhttp://www.blogger.com/profile/02738440647498422230noreply@blogger.com0tag:blogger.com,1999:blog-9221984976832050207.post-6064156043207187022015-01-17T14:35:00.000-05:002015-01-17T14:35:00.328-05:00Weekend Movie: From Womb to WombBiological Anthropologist <a href="http://www.nursing.uic.edu/faculty-staff/julienne-rutherford-phd" target="_blank">Julienne Rutherford </a>has a fascinating talk available online that is a short but nice overview of the effect of epigenetics from womb to womb. Essentially she discusses the effects on the intrauterine environment, and whether the womb that we develop in affects the womb that our female offspring produce when they reproduce. The purpose is to understand how we pass down, generation to generation, the effects of our socio-ecological environment. Put another way, how our grandmother's life affects our life, and the lives of ensuing generations.<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://3.bp.blogspot.com/-v2sH7O5nwHY/VLgUAuT8ZCI/AAAAAAAABrM/vmhTplPXT6E/s1600/womb%2Bto%2Bwomb.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://3.bp.blogspot.com/-v2sH7O5nwHY/VLgUAuT8ZCI/AAAAAAAABrM/vmhTplPXT6E/s1600/womb%2Bto%2Bwomb.jpg" height="214" width="320" /></a></div>
<br />
Her talk covers how placentas play a role, how Life Course Theory is part of it, but isn't the whole picture, and how studying primates can help us get an idea of the impact of intrauterine environments on the health and lives of future offspring.<br />
<blockquote class="tr_bq">
"We are more than our genes. Genes get switched on and off constantly. All the DNA in our bodies in all the cells is essentially identical, but some get turned on, some get turned off... </blockquote>
<blockquote class="tr_bq">
But even more subtley, gene expression can be affected by our environment in the now, in the lived experience. Molecules attach to the DNA, which sort of locks it down, so its inexpressible - can't get turned on. This phenomenon is called epigenetics. Epi = beyond, above. Something beyond just the molecule themselves. How are the molecules regulated. </blockquote>
<blockquote class="tr_bq">
We know from a variety of experiments and observations in humans and other animals that the lived experience of an organism can have enormous impacts on how the genes are regulated. We also know that some of these molecular locks can be inherited along with the DNA itself. So, for ex, some genes in the stress pathway of maternal ,fetal, and placental tissues are regulated differently in people who have experienced poor nutrition, poor rearing behavior... high levels of psychosocial stress, institutional racism and discrimination, and the experience of war..."</blockquote>
<br />
It's one more argument for improving social and economic environments in order to improve a population's health and future potential. People often think that a poor or unhealthy person can just "do better" to make themselves healthier or more wealthy, but so much depends on our socio-ecological environments, and that of our ancestors.<br />
<blockquote class="tr_bq">
"The placenta contains the mysteries of the past and predictions for the future..."</blockquote>
<br />
You can <a href="https://www.cuspconference.com/videos/julienne-rutherford-2014/" target="_blank">view Dr. Rutherford's 23 minute presentation on the website for the Cusp Conference 2014</a>.<br />
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://www.cuspconference.com/videos/julienne-rutherford-2014/" style="margin-left: auto; margin-right: auto;" target="_blank"><img border="0" src="http://3.bp.blogspot.com/-Puyhq3jJFSM/VLgVWwZCe6I/AAAAAAAABrY/yZY8P40ScBc/s1600/image.png" height="226" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">https://www.cuspconference.com/videos/julienne-rutherford-2014/</td></tr>
</tbody></table>
<br />Emilyhttp://www.blogger.com/profile/02738440647498422230noreply@blogger.com0tag:blogger.com,1999:blog-9221984976832050207.post-80621673727202030452015-01-07T16:57:00.002-05:002015-01-08T11:37:49.928-05:00I am a Lamaze Childbirth EducatorIt's been 5 years since I did my doula training and attended my first birth, and I am finally officially adding a new service to my birth professional repertoire -- childbirth education!<br />
<br />
I attended a Lamaze childbirth educator training a few months ago so that I can work toward becoming Lamaze certified. I have been wanting to become a childbirth educator for some time, but knew I wanted to do certify with Lamaze. Why Lamaze? Because I consider them the most in touch with birth-related research and evidence-based recommendations. I love their blog Science and Sensibility and that they have their own peer-reviewed Journal of Perinatal Education.<br />
<br />
Lamaze isn't "all about the breathing," which is what many people who knew of Lamaze in the 20th century think of. It has come a long way to be a leading International professional organization.<br />
<br />
<br />
Tonight I officially teach my first course as a childbirth educator (rather than "just" a doula)! The responsibility is almost greater, in a way, than my usual doula prenatal visits. At those visits we can talk about anything - what I think of, what the client thinks of - and I don't have the responsibility of being the font of all their knowledge. I can assume or hope that they have read books or been to a childbirth education class already and I can just fill in the gaps or reassure. But, as childbirth educator, I am presumably the first point of contact and information with the birth world. I have the responsibility to not forget to tell them something, and to tell them everything in the right way (don't want to freak anyone out)!<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://1.bp.blogspot.com/-N_1Q_-BGQCM/VK2sV-GnbtI/AAAAAAAABq8/sTTE3J3s6Yw/s1600/lamazenewlogo.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://1.bp.blogspot.com/-N_1Q_-BGQCM/VK2sV-GnbtI/AAAAAAAABq8/sTTE3J3s6Yw/s1600/lamazenewlogo.png" /></a></div>
<br />
My favorite aspect of the Lamaze approach are the 6 Healthy Birth Practices. If you visit their website, you can watch easy-to-digest videos on each birth practice, or read each practice's paper, which includes the research-based for every recommendation. All of this is available here: http://www.lamazeinternational.org/HealthyBirthPractices<br />
<br />
My scholarly heart rejoices at how evidence-based it all is!<br />
<br />
They recently created an infographic and accompanying infographic video that outlines the Healthy Birth Practices in a simple way. They are also slowly releasing infographics for each of the individual steps. Learn more below!<br />
<br />
<h1 class="yt" id="watch-headline-title" style="background: rgb(255, 255, 255); border: 0px; color: #222222; font-family: arial, sans-serif; font-size: 24px; font-weight: normal; margin: 0px 0px 10px; overflow: hidden; padding: 0px;">
<span class="watch-title " dir="ltr" id="eow-title" style="background: transparent; border: 0px; font-size: small; margin: 0px; padding: 0px;" title="6 Simple Steps to a Safe and Healthy Birth">6 Simple Steps to a Safe and Healthy Birth</span></h1>
<div style="text-align: center;">
<iframe allowfullscreen="" frameborder="0" height="315" src="//www.youtube.com/embed/243cnpOLKxk" width="560"></iframe><br /></div>
<br />
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="http://2.bp.blogspot.com/-L9nm_l72fiQ/VD7ERmUchOI/AAAAAAAABnA/_K8yh1NCSAc/s1600/Lamaze_6HealthyBirthPractices_Infographic_FINAL.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="http://2.bp.blogspot.com/-L9nm_l72fiQ/VD7ERmUchOI/AAAAAAAABnA/_K8yh1NCSAc/s1600/Lamaze_6HealthyBirthPractices_Infographic_FINAL.jpg" height="640" width="206" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">click to enlarge</td></tr>
</tbody></table>
<br />
<b>Anyone else out there Lamaze certified? </b><br />
<div>
<br /></div>
<div>
Turns out there is only one other Lamaze-certified childbirth educator (LCCE) in my area. ONE! I hope that I can fill a need. I wasn't able to attend a training as soon as I had wanted, because there are no Lamaze trainers in my state. I'm not sure why they aren't as popular here. </div>
<div>
<br /></div>
<div>
Just as an aside, I actually thought that my Lamaze seminar was kind of a waste of time. I already knew all of the content, and was hoping to learn more about teaching methods than I dd (since I'm new to teaching). It was a requirement for those of us who haven't taught childbirth education before and want to take the certification exam sooner than we can teach 60 hours of CBE. You can get around it if you are a CBE that has taught 60 hours in in the 3 years prior to taking the Lamaze exam. The seminar would be valuable for someone very new to birth stuff. I think it was valuable for the L&D nurses who were in the training with me, too. But I learned nothing new. (But I keep up with things more than most!)</div>
<div>
<br /></div>
<div>
Wish me luck! :)<br />
<br /></div>
Emilyhttp://www.blogger.com/profile/02738440647498422230noreply@blogger.com1tag:blogger.com,1999:blog-9221984976832050207.post-88153607740700442232014-12-18T14:23:00.000-05:002015-02-25T15:52:20.777-05:00The Primary Cesarean Reduction Movement<b>There is good news to report: Health Care Professionals are paying attention!</b><br />
<br />
When we work on our grass roots advocacy we think that our issues are so important, and everyone we talk to cares, that we must be making change. Sometimes, however, we come to the sad realization that people are not paying attention. But we plug along and keep on hoping that because our issue is important, eventually society and culture will catch up and begin listening to what we have to say.<br />
<br />
Well, this is starting to happen. Birth advocates who have been fighting for years to get hospitals, obstetricians, departments of health, the federal government, ANYONE to pay attention to the increasingly harmful Cesarean epidemic are finally making a difference.<br />
<br />
<b>How do I know?</b><br />
<br />
<a href="http://3.bp.blogspot.com/-CZkdjmgEE7M/VJMm9Veq86I/AAAAAAAABqc/hn59PusBnwc/s1600/cesarean.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="http://3.bp.blogspot.com/-CZkdjmgEE7M/VJMm9Veq86I/AAAAAAAABqc/hn59PusBnwc/s1600/cesarean.jpg" height="240" width="320" /></a>I work for an organization that works to improve the quality of health care for mothers and babies in the state. We work in collaboration with ACOG, ACNM, AWHONN, March of Dimes, the hospital association, private and public health insurance agencies, hospitals networks, and individuals willing to be part of maternal and neonatal quality improvement. We network with State Perinatal Quality Collaboratives and members of the Council on Patient Safety in Women's Health. We hear what is developing nationally and discuss issues with organization representatives in our state. We hear directly from nurses, midwives, and physicians about what the environment is like in their hospitals. And I can tell you, people are talking about this issue!<br />
<br />
Furthermore, the Society for Maternal and Fetal Medicine (SMFM) and the American Congress of Obstetricians and Gynecologists (ACOG) recently released their Consensus Statement <a href="http://www.acog.org/Resources-And-Publications/Obstetric-Care-Consensus-Series/Safe-Prevention-of-the-Primary-Cesarean-Delivery" target="_blank">Safe Prevention of the Primary Cesarean Delivery</a>.<br />
<br />
The movement to reduce unnecessary Cesarean sections is picking up speed.<br />
<br />
<b>Cost-Savings</b><br />
<b><br /></b>One reason folks are starting to pay attention is the cost. Insurance companies generally pay quite a bit for a cesarean delivery, which is more costly than a vaginal delivery. <span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 18.3999996185303px;">In 2013, on average, the total cost for maternal and newborn care associated with a cesarean was $51,125, compared to $32,093 for a vaginal birth.</span><br />
<span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 18.3999996185303px;"><br /></span><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 18.3999996185303px;">Additionally, because cesareans are associated with increased risk of blood clots, bleeding, infection, complications in future pregnancies, hysterectomies, and even death, it would save the health care system a great deal of money to reduce these primary cesarean deliveries. </span><br />
<span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 18.3999996185303px;"><br /></span><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 18.3999996185303px;">Researchers from the California Maternal Quality Care Collaborative <a href="http://journals.lww.com/greenjournal/Fulltext/2012/11000/Creating_a_Public_Agenda_for_Maternity_Safety_and.27.aspx" target="_blank">make the suggestion</a> that financial incentives be put into place, for example, reforming payment for cesarean deliveries: </span><br />
<blockquote class="tr_bq">
Payment reform could create the proverbial “burning platform” that spurs change more quickly than other strategies. The first step is to remove the perverse financial incentives that currently help drive the rising rate.</blockquote>
This move would have to be made by payers (insurance companies) and/or policymakers. Movements like this are slow to occur, but are one direction that we can move toward.<br />
<br />
<b>NTSV Cesareans</b><br />
<br />
The emphasis is on reducing Cesareans among low-risk first-time mothers. The rationale for this is that repeat Cesareans would be reduced if we reduced primary C-sections (makes sense, since VBAC rates are so low), and of course comparing a low risk group makes for an easy comparison group and leaves less room for argument for "medical indication." Nationally, the data and the proposed initiatives focus on nulliparous, term, singleton, vertex Cesareans (NTSV). An NTSV is a pregnant woman who has never had a baby before, delivers at term, there is only one baby (no multiples), and the baby is head-down.<br />
<br />
Though this removes some indications for a Cesarean, others could still exist: preeclampsia, fetal distress, failure to progress, cord prolapse, elective delivery, and so on.<br />
<br />
Epidemiological data analysis has found extremely wide variation in primary cesarean rates in different parts of the country and across hospitals. What this means is that hospital primary cesarean rates range from 2% to 36%. That means that where you give birth determines whether or not you have a cesarean, not necessarily your personal or medical situation. Wide variation in hospital NTSV cesarean rates suggests that clinical practice patterns and patient preferences are affecting these rates.<br />
<br />
National research has shown that it is not individual factors (e.g. mother's age, race/ethnicity) nor pre-existing medical conditions (e.g. gestational diabetes) that account for this variation. We know that maternal request for cesareans, while highly visible among celebrities or in Brazil, is actually quite low in the U.S. What this leaves is physician practice patterns.<br />
<br />
<b>Changing Practice Patterns</b><br />
<b><br /></b>
If you've watched Eugene Declerq's <a href="http://www.birthbythenumbers.org/">Birth by the Numbers</a> videos, you have heard him examine the rising cesarean rates. He shows us that rates and patterns of diagnoses/cesareans for maternal complications such as placenta abruptio, cord prolapse, fetal distress, dysfunctional labor, and so on <i>all </i>decreased until 1996, and then <i>all </i>have increased since then. His data shows that it is not mothers changing, it is a change in medical practice. He notes an article that came out decades ago called "The rise in the cesarean rate: same indications but a lower threshold."<br />
<br />
Even the ACOG/SMFM Statement notes<br />
<blockquote class="tr_bq">
Variation in the rates of nulliparous, term, singleton, vertex cesarean births also indicates that clinical practice patterns affect the number of cesarean births performed.</blockquote>
<br />
<a href="http://4.bp.blogspot.com/-sPAecY2Vy7s/VJMpZNPZFoI/AAAAAAAABqo/uf1AZ7EY3PI/s1600/plan_template_image_1.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="http://4.bp.blogspot.com/-sPAecY2Vy7s/VJMpZNPZFoI/AAAAAAAABqo/uf1AZ7EY3PI/s1600/plan_template_image_1.jpg" /></a><b>Quality Improvement Initiative</b><br />
<br />
I envision the creation of a quality improvement (QI) initiative for hospitals to work to reduce primary cesarean sections through a focus on. A few fantastic places to start are the recommendations that ACOG and SMFM came up with themselves. I will also go beyond their recommendations to offer some of my own.<br />
<br />
Here are some changes that need to be made:<br />
<ol>
<li><b>Labor Curve</b>. Physicians need to alter the "definition of labor dystocia because recent data show that contemporary labor progresses at a rate substantially slower than what was historically taught." This also goes for the pushing phase (second stage).</li>
<ul>
<li>"A prolonged latent phase (eg, greater than 20 hours in nulliparous women and greater than 14 hours in multiparous women) should not be an indication for cesarean delivery.</li>
<li>Slow but progressive labor in the first stage of labor should not be an indication for cesarean delivery.</li>
<li>Cervical dilation of 6 cm should be considered the threshold for the active phase of most women in labor. Thus, before 6 cm of dilation is achieved, standards of active phase progress should not be applied.</li>
<li>Cesarean delivery for active phase arrest in the first stage of labor should be reserved for women at or beyond 6 cm of dilation with ruptured membranes who fail to progress despite 4 hours of adequate uterine activity, or at least 6 hours of oxytocin administration with inadequate uterine activity and no cervical change.</li>
<li>A specific absolute maximum length of time spent in the second stage of labor beyond which all women should undergo operative delivery has not been identified.</li>
<li>Before diagnosing arrest of labor in the second stage, if the maternal and fetal conditions permit, allow for the following: At least 2 hours of pushing in multiparous women, and At least 3 hours of pushing in nulliparous women (1B)
Longer durations may be appropriate on an individualized basis (eg, with the use of epidural analgesia or with fetal malposition) as long as progress is being documented."</li>
</ul>
<li><b>Fetal Monitoring.</b> "Improved and standardized fetal heart rate interpretation and management" are certainly needed. Because providers differ so greatly on how they read the electronic fetal monitoring output, there needs to be some increased training on this. More importantly, however, I would suggest following the evidence, which concludes that the continuous EFM is completely worthless at reducing infant morbidity and mortality. I don't think low risk women should be on it at all. However, I don't think that in our highly litigious society it will ever go away. </li>
<ul>
<li>"Intermittent monitoring has been shown by the research to be just as good at identifying possible fetal distress as continuous EFM. It has a quite a few benefits, too: Does not increase cesarean deliveries like continuous EFM does, and does not limit women's movement in labor."</li>
</ul>
<li><b>Doulas</b>. "Increasing women’s access to nonmedical interventions during labor, such as continuous labor and delivery support, also has been shown to reduce cesarean birth rates". It should be no surprise to anyone reading this blog that the evidence supports the use of doulas to reduce cesareans.</li>
<ul>
<li>"Given that there are no associated measurable harms, this resource is probably underutilized."</li>
</ul>
<li><b>Deliveries for Medical Reasons. </b>Stop inducing for non-medical reasons, at any gestation, but particularly before 41 weeks. Stop inducing with a non-favorable cervix. Stop scheduling cesareans for non-medically indicated reasons, particularly suspected macrosomia (big baby).</li>
<ul>
<li>"Cesarean delivery to avoid potential birth trauma should be limited to estimated fetal weights of at least 5,000 g in women without diabetes and at least 4,500 g in women with diabetes. The prevalence of birth weight of 5,000 g or more is rare, and patients should be counseled that estimates of fetal weight, particularly late in gestation, are imprecise."</li>
</ul>
<li><b>Operative Vaginal Delivery. </b>Many obstetricians are quick to jump to a cesarean section rather than deliver with forceps or a vacuum. This is most likely because they are not well-trained to use these methods, while they get plenty of experience doing cesarean sections. While these procedures have pros and cons, cesareans certainly do as well, and comparably, these have much fewer associated injuries and morbidities. </li>
<ul>
<li>"Operative vaginal delivery in the second stage of labor by experienced and well trained physicians should be considered a safe, acceptable alternative to cesarean delivery. Training in, and ongoing maintenance of, practical skills related to operative vaginal delivery should be encouraged."</li>
<li>Manual rotation of the fetal occiput in the setting of fetal malposition in the second stage of labor is a reasonable intervention to consider before moving to operative vaginal delivery or cesarean delivery. In order to safely prevent cesarean deliveries in the setting of malposition, it is important to assess the fetal position in the second stage of labor, particularly in the setting of abnormal fetal descent."</li>
</ul>
<li><b>Variations.</b> Many obstetricians are not taught how to attend a vaginal breech birth or a twin birth, and go straight to delivering by surgery. Increasing the availability of care providers trained in safely delivering these variations vaginally would greatly reduce the primary cesarean rate. "External cephalic version for breech presentation and a trial of labor for women with twin gestations when the first twin is in cephalic presentation are other of several examples of interventions that can contribute to the safe lowering of the primary cesarean delivery rate."</li>
<ul>
<li>"Fetal presentation should be assessed and documented beginning at 36 0/7 weeks of gestation to allow for external cephalic version to be offered."</li>
</ul>
</ol>
<div>
<br /></div>
<b>Barriers</b><br />
<b><br /></b>
No one is quite sure how to remove fears of malpractice litigation, which "leads many physicians to have a lower tolerance for any perceived labor abnormality."<br />
<span style="background-color: white; font-family: Arial, Verdana, Tahoma, sans-serif; font-size: 13px;"><br /></span>
Another issue is time efficiency. Greater patience is needed on the part of the care providers. One possible solution to this might be increasing the use of midwives to handle low-risk labors and births in hospitals. This has yet to be supported by research.<br />
<br />
Out-of-hospital births should also be promoted for women with low-risk pregnancies, as cesarean rates are much lower for planned home and birth center births. More states need to legally recognize and license out-of-hospital midwives.<br />
<br />
<br />
<br />
As <a href="http://journals.lww.com/greenjournal/Fulltext/2012/11000/Creating_a_Public_Agenda_for_Maternity_Safety_and.27.aspx" target="_blank">Main et al</a> of the California paper write,<br />
<blockquote class="tr_bq">
The most promising mix includes clinical quality improvement strategies with careful examination of labor management practices to reduce those that lead to the development of indications for cesarean deliveries; payment reform to eliminate negative or perverse incentives; health care provider and consumer education to recognize the value of normal vaginal birth; and full transparency through public reporting and continued public engagement.</blockquote>
I agree with the authors of the <a href="http://journals.lww.com/greenjournal/Fulltext/2012/11000/Creating_a_Public_Agenda_for_Maternity_Safety_and.27.aspx" target="_blank">California paper</a> that we can't focus on just the clinical aspect of this issue (as outline in my QI Initiative recommendations, above), but it is an excellent place to start.<br />
<br />
<br />
<b>What do you think? Do you have additional ideas?</b><br />
<b><br /></b>
<br />
<b><br /></b>
<b><i><a href="http://anthrodoula.blogspot.com/2015/02/reducing-primary-cesareans-part-2.html" target="_blank">Click here to read Part 2.</a></i></b><br />
<br />Emilyhttp://www.blogger.com/profile/02738440647498422230noreply@blogger.com0tag:blogger.com,1999:blog-9221984976832050207.post-40769754054463291542014-11-20T16:21:00.000-05:002014-11-21T13:42:22.445-05:00Breastfeeding Problems Linked to Mom's Post-Birth Meds?<blockquote class="tr_bq">
<span style="background-color: white; color: #141823; font-family: Helvetica, Arial, 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 14px; line-height: 19.3199996948242px;">"Evidence-based care acknowledges that, sometimes, having no interventio</span><span class="text_exposed_show" style="background-color: white; color: #141823; display: inline; font-family: Helvetica, Arial, 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 14px; line-height: 19.3199996948242px;">n is safest, and, sometimes, having interventions is safest.... </span><span style="background-color: white; color: #141823; font-family: Helvetica, Arial, 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 14px; line-height: 19.3199996948242px;">Advocating for evidence-based practices and interventions is not an ideology that interventions are bad. It's taking an objective look at scientific research and actually applying it to individuals, rather than basing care on outdated traditions, fear, and the ridiculous idea that women shouldn't be involved in their own health care." - ImprovingBirth.Org</span></blockquote>
<br />
A <a href="http://online.liebertpub.com/doi/abs/10.1089/bfm.2014.0048">new study</a> is out that takes a look at the effect of intramuscular injections mothers receive immediately after birth and their effect on breastfeeding. These are injections that occur during the third stage of labor (before or after delivery of the placenta) that are intended to help the uterus begin to contract down to normal size. This helps prevent postpartum hemorrhage.<br />
<br />
The <a href="http://www.internationalbreastfeedingjournal.com/content/1/1/25/comments">International Breastfeeding Journal notes</a>:<br />
<blockquote class="tr_bq">
Existing RCTs found no links between uterotonics administered in third stage of labour and breastfeeding. These trials were published ten and twenty years ago, and, to our knowledge, more recent trials have not examined the impact of uterotonics on breastfeeding. In the absence of trial data, observation studies and biological mechanisms assume greater importance.</blockquote>
This Brown and Jordan article notes the background information on the literature:<br />
<blockquote class="tr_bq">
Analysis of a large birth cohort (n=48,366) indicated that intramuscular injection of oxytocin, with or without ergometrine, in the third stage of labor reduced breastfeeding rates at 48 hours by 6-8% (adjusted odds ratio [OR]= 0.75, 95% confidence interval [CI] = 0.61-0.9 1; adjusted OR=0.77, 95% CI=0.65- 0.9 1), consistent with other observational studies. A randomized controlled trial (n = 132) of active management of the third stage with intravenous ergometrine indicated an increase in supplementation and cessation of breastfeeding by 1 and 4 weeks postpartum, mainly because lactation was inadequate for the infants' needs.</blockquote>
The medications this 2014 Brown and Jordan study looked at included oxytocin and ergometrine. The study gave mothers who had a vaginal birth within the past 6 months a questionnaire that asked about whether they received uterotonic injections, breastfeeding at birth, breastfeeding duration, and, where applicable, reasons for breastfeeding cessation, whether physical, social, or psychological. 82% of the mothers had received active management of the third stage, and 17% received physiological management.<br />
<br />
<div>
Here are the study results:<br />
<blockquote class="tr_bq">
No significant association was found between infant feeding mode at birth (breast/formula) and injection of uterotonics. However, <u>mothers who had received uterotonics were significantly less likely to be breastfeeding at all at 2 and 6 weeks.</u> Among mothers who had stopped breastfeeding, those who had received parenteral prophylactic uterotonics were significantly more likely to report stopping breastfeeding for physical reasons such as pain or difficulty.</blockquote>
<div>
What this means is that their study might imply that uterotonic injections during the third stage of labor do not affect breastfeeding initiation, but may affect breastfeeding duration.<br />
<br />
As with all research, we can say that this study showed an association between the injections and the cessation of breastfeeding due to physical reasons, but we cannot necessarily say it is causation. It is an important point to keep in mind when reading about research.<br />
<br />
There is a great deal of evidence for the benefits of uterotonics for prevention of postpartum hemorrhage. Randomized control trials and metasyntheses of research by organizations such as the World Health Organization and the Cochrane Library have found that administration of oxytocin or other uterotonic are highly effective at reducing postpartum bleeding and prolonged third stage, with no apparent side effects for the baby. Ergometrine is associated with nausea for the mother.<br />
<br />
The data for this study was collected by self-report on a questionnaire filled out by the mothers. Of course there are data collection errors, like selection bias and recall bias, involved in this type of study. It is not secondary data analysis (e.g. they did not look at medical charts to determine if an injection was received and then link it to data for the mother showing whether she stopped breastfeeding at a certain point in time). It is not a prospective randomized control trial (the gold standard of research, though not always possible).<br />
<br />
Interestingly, they removed mothers who had intravenous oxytocin from their statistical analyses, as they were likely to have been receiving it during labor for induction, and also more likely to have an epidural. However, when they did analyze this small sample, they found that the finding was still significant: <b>women who had the intramuscular <i>injection </i>compared to those receiving it intravenously were less likely to be breastfeeding at 2 and 6 weeks</b>. So what is it about the injection, then?<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://1.bp.blogspot.com/-K2CzM8QiTDE/VG5aToLxYQI/AAAAAAAABqI/e--0qgSLyrM/s1600/clip_image006.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://1.bp.blogspot.com/-K2CzM8QiTDE/VG5aToLxYQI/AAAAAAAABqI/e--0qgSLyrM/s1600/clip_image006.jpg" /></a></div>
<br />
<br />
Also, their psychological questions on reasons for stopping found that mothers who had an active third stage were significantly more likely to say they stopped breastfeeding for reasons of pain and/or embarrassment. Why would receiving uterotonics after labor contribute to difficulty latching or embarrassment? Perhaps they are correlated but not causational. Or perhaps the medication affects the baby's ability to latch. The authors suppose the two are related: mothers who have trouble latching will be more embarrassed to nurse in front of others. This is all conjecture.<br />
<br />
Brown and Jordan note in their discussion section that active management may not reduce postpartum hemorrhage for women at low risk of hemorrhage. This is a good argument for more risk assessment antenatally and upon birth admission. Many obstetric hemorrhage initiatives in the U.S. include this as a recommendation for hospitals. There is always the argument, however, that even low risk women sometimes hemorrhage after birth (there are instances of low risk home birth mothers transferring due to excessive bleeding). In rural or resource-poor settings, it may be beneficial to standardize receipt of prophylactic uterotonics when transfer could be life-threatening.<br />
<br />
Furthermore, when care is not standardized, more health care mistakes are made. This is what the field of quality improvement in healthcare has found, and the reason standards of care are emphasized. It also means that everyone is doing the same thing, which reduces the receipt of poor care one place and better care at another. Standardization of care has been shown to reduce life-threatening errors in healthcare. There are times when we have to weigh the pros and cons (e.g. prophylatic uterotonics can reduce morbidity and mortality associated with hemorrhage, but may decrease breastfeeding success and duration). I work with a lot of doctors and nurses in my job in healthcare quality improvement, and I've learned a lot about the capabilities of the providers in our healthcare system. I've seen how changes are made in a system.<br />
<br />
As a doula and a social researcher, I am also a strong proponent of patient-centered care. I think that care should also focus on what is right for each individual. Sometimes that means asking the patient what they want, though they may defer to the care provider to make the decision. The care provider may then decide that the pros outweigh the cons.<br />
<br />
Another point is that women are more and more high risk for OB hemorrhage in industrialized countries. With the increase in medical conditions, inductions, cesarean sections, pitocin augmentation, use of pain medication and analgesia, advanced maternal age, etc., more women are going to be high risk and therefore more will receive active management of the third stage. So a great intervention would be to recognize that more women need assistance with breastfeeding in the first 2 - 6 weeks so that they can overcome latch issues, embarrassment, perceived low milk supply, and so on.<br />
<br />
Moreover, how do we know that the women who have physiologic third stages are somehow different than the women who do not? Since active management is, at the moment, is the norm, and is in the population in this study, the women who "choose" to have no uterotonic injections may already be better informed on breastfeeding, better linked-into breastfeeding help networks, etc.<br />
<br />
I did find their explanation of the interaction and possible mechanism behind uterotonics and breastfeeding. The authors speculate:<br />
<blockquote class="tr_bq">
It is possible that disruption of neuroendocrine/paracrine pathways may lead to suboptimal latching, nipple trauma, pain, and feeding difficulty.</blockquote>
They explain a bit more in the discussion how ergometrine and oxytocin may disrupt hormone balance.<br />
<br />
<b>More research is needed on active management of the third stage and its effect on breastfeeding!</b><br />
<b><br /></b>
I definitely think this article contributes to what a lot of lactation professionals have been noticing, however: Interventions during labor have an effect on breastfeeding success, and we know that epidurals and pitocin augmentation during labor are associated with breastfeeding issues. But does the post-delivery dose have a large enough effect to change practice?</div>
</div>
<div>
<div>
<br />
I don't think this particular research article should lead to full-scale changes in recommendations or standards of care at this time. I was inspired to write this article for just that reason - those who may think this is definitive evidence that we should stop promoting prophylactic uterotonics. We do a lot of things prophylactically in our lives. A prophylactic is something that is designed to prevent something from occurring. I think that a lot of birth and breastfeeding advocates are quick to judge all medical interventions as bad, and also to believe research that reinforces their beliefs, and not believe research that does not (well, most people do that). I have taught to be critical of research and to examine it from all sides.<br />
<br />
I also think its unfair to blanket statement that all physicians and hospital medical professionals are the only ones to use interventions that may be harmful. Sometimes medical professionals close their eyes to the evidence of harm from routine interventions, but sometimes natural birth advocates (doulas, midwives) do to. </div>
<div>
<br /></div>
<div>
"Midwives are often quick to criticize medical birth attendants for unwise interventions that disrupt normal birth and may cause harm. But how many of us are guilty of the same thing?" - Gail Hart</div>
<div>
<br /></div>
<div>
Even home birth midwives sometimes use supplements, herbs, etc that have not been tested or approved for effectiveness and safety. Doulas, too, make suggestions for some interventions for pregnant women and babies that we don't know are entirely safe or efficacious. We all have to pay close attention to good, solid evidence, and keep in mind that sometimes things are true even if they contradict what we believe. </div>
</div>
<div>
<br />
<b>If you're interested in learning more on how to be a critical reviewer of research, I suggest you peruse Science and Sensibility's series of posts on "<a href="http://www.scienceandsensibility.org/?tag=understanding-research">Understanding Research</a>."</b><br />
<b><br /></b>
<b><br /></b>
Brown, Amy and Sue Jordan (2014) Breastfeeding Medicine. Vol 9, No 10. DOl: 10.1 089/bfm.2014.0048<br />
<b><br /></b></div>
<div>
<br /></div>
Emilyhttp://www.blogger.com/profile/02738440647498422230noreply@blogger.com0tag:blogger.com,1999:blog-9221984976832050207.post-13759002803607308152014-10-24T12:08:00.000-04:002014-10-24T12:08:00.024-04:00Halloween, Pregnancy and Birth Style<b>I LOVE Halloween!</b> It is my very favorite holiday. I love all of the creativity that goes into becoming someone else, and that we all love to see and be seen. I love that people decorate and go all out to create haunted houses. I am not even all that into the candy, but I think a holiday that is big about giving out free stuff is pretty cool. And there are so many fantastic birth-related halloween fun things to do and make when you're pregnant!<br />
<br />
Do you have your costume yet? There are a wide variety of costume possibilities that work best when you are pregnant.<br />
<br />
I'm a big fan of the creepy ones...<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://3.bp.blogspot.com/-cWEjnvoNzOM/VEE6jSrpKcI/AAAAAAAABpA/uOm-zWUT-gM/s1600/slide_320260_2989969_free.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://3.bp.blogspot.com/-cWEjnvoNzOM/VEE6jSrpKcI/AAAAAAAABpA/uOm-zWUT-gM/s1600/slide_320260_2989969_free.jpg" height="320" width="258" /></a></div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="http://4.bp.blogspot.com/-NhU2C8m3kkQ/VEE7To4_odI/AAAAAAAABpY/fpfKc33w1Xk/s1600/tumblr_ltg2b9oe4g1qenpbbo1_500.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://4.bp.blogspot.com/-NhU2C8m3kkQ/VEE7To4_odI/AAAAAAAABpY/fpfKc33w1Xk/s1600/tumblr_ltg2b9oe4g1qenpbbo1_500.jpg" height="320" width="239" /></a></div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="http://2.bp.blogspot.com/-SId7bhrP7VU/VEE7Tn_3JDI/AAAAAAAABpc/M4ujLM0Es0s/s1600/c04b5f4962ec06b192965fdfeba645b3.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://2.bp.blogspot.com/-SId7bhrP7VU/VEE7Tn_3JDI/AAAAAAAABpc/M4ujLM0Es0s/s1600/c04b5f4962ec06b192965fdfeba645b3.jpg" /></a></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<br />
<br />
But you can just go funny, especially with couples costumes. Here are just a few:<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://2.bp.blogspot.com/-Dw3b5MVQ8dc/VEE6jeItmeI/AAAAAAAABpE/TpjSK6tJ5iM/s1600/7_12_months_pregnant_makes_for_a_great_man_gut.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://2.bp.blogspot.com/-Dw3b5MVQ8dc/VEE6jeItmeI/AAAAAAAABpE/TpjSK6tJ5iM/s1600/7_12_months_pregnant_makes_for_a_great_man_gut.jpg" height="320" width="240" /></a></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://2.bp.blogspot.com/-RMNCi2jOGQw/VEE82pRf9mI/AAAAAAAABps/H2SzkKZLy0g/s1600/48f12531ef9e0a302879a9b38afe9e23.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://2.bp.blogspot.com/-RMNCi2jOGQw/VEE82pRf9mI/AAAAAAAABps/H2SzkKZLy0g/s1600/48f12531ef9e0a302879a9b38afe9e23.jpg" height="320" width="236" /></a></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://4.bp.blogspot.com/-LrGmh6uhaTc/VEE82qY-7dI/AAAAAAAABpw/guWRoTMusnM/s1600/static.squarespace.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://4.bp.blogspot.com/-LrGmh6uhaTc/VEE82qY-7dI/AAAAAAAABpw/guWRoTMusnM/s1600/static.squarespace.jpg" height="320" width="240" /></a></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://3.bp.blogspot.com/-5SRKIXra6wA/VEE2q6XrGPI/AAAAAAAABoU/53sy6M8JcCU/s1600/milkman.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://3.bp.blogspot.com/-5SRKIXra6wA/VEE2q6XrGPI/AAAAAAAABoU/53sy6M8JcCU/s1600/milkman.jpg" height="320" width="194" /></a></div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="http://1.bp.blogspot.com/-G8K0CBqEBdo/VEE62PH4ttI/AAAAAAAABpQ/8nLha443dec/s1600/juno_and_bleeker.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://1.bp.blogspot.com/-G8K0CBqEBdo/VEE62PH4ttI/AAAAAAAABpQ/8nLha443dec/s1600/juno_and_bleeker.jpg" height="320" width="213" /></a></div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="http://4.bp.blogspot.com/-tPgqDFztPoY/VEE2q4MHoKI/AAAAAAAABno/60Yy2_3Gseg/s1600/pregnant-halloween-costumes-6.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://4.bp.blogspot.com/-tPgqDFztPoY/VEE2q4MHoKI/AAAAAAAABno/60Yy2_3Gseg/s1600/pregnant-halloween-costumes-6.jpg" height="320" width="213" /></a></div>
<br />
<br />
Or just super cute on the days leading up to Halloween!<br />
<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://4.bp.blogspot.com/-xHV7at52DO0/VEE2qE7me0I/AAAAAAAABnQ/qWO_sNqS9PA/s1600/71ee07fc29782e0993d788deaf36b5d9.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://4.bp.blogspot.com/-xHV7at52DO0/VEE2qE7me0I/AAAAAAAABnQ/qWO_sNqS9PA/s1600/71ee07fc29782e0993d788deaf36b5d9.jpg" /></a></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://1.bp.blogspot.com/-R9hRnn_sL3E/VEE2qaJEMbI/AAAAAAAABnY/AnMsFLnnszE/s1600/il_340x270.654343840_9q3s.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://1.bp.blogspot.com/-R9hRnn_sL3E/VEE2qaJEMbI/AAAAAAAABnY/AnMsFLnnszE/s1600/il_340x270.654343840_9q3s.jpg" height="254" width="320" /></a></div>
<br />
<br />
I really hope that I have a baby bump during Halloween sometime in the future!<br />
<br />
<br />
I also love carving pumpkins this time of year, and working on my creativity. Here are some beautiful pregnancy ones:<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://1.bp.blogspot.com/-rLSw-4RCzoM/VEE4oeXyr9I/AAAAAAAABow/ufI6PWTBTw8/s1600/01-21.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://1.bp.blogspot.com/-rLSw-4RCzoM/VEE4oeXyr9I/AAAAAAAABow/ufI6PWTBTw8/s1600/01-21.jpg" height="319" width="320" /></a></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://3.bp.blogspot.com/-W3gyv_vh3D4/VEE4ocozQ7I/AAAAAAAABos/OnQJ6Jdposs/s1600/pregnant-silhouette.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://3.bp.blogspot.com/-W3gyv_vh3D4/VEE4ocozQ7I/AAAAAAAABos/OnQJ6Jdposs/s1600/pregnant-silhouette.jpg" height="320" width="320" /></a></div>
<br />
<br />
<br />
Here are a few (of many) birth-related pumpkins that have brought many a happy tear to my eye:<br />
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="http://2.bp.blogspot.com/-sjT37HdSLJQ/VEE3JBdnEsI/AAAAAAAABog/4hFLEmqmmCY/s1600/pumpkin-hospital-birth.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="http://2.bp.blogspot.com/-sjT37HdSLJQ/VEE3JBdnEsI/AAAAAAAABog/4hFLEmqmmCY/s1600/pumpkin-hospital-birth.jpg" height="239" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><br /></td></tr>
</tbody></table>
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="http://4.bp.blogspot.com/-TNcDzkpD_-4/VEE2rpEA73I/AAAAAAAABoE/v7_WSO8RtrU/s1600/pumpkin-giving-birth.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="http://4.bp.blogspot.com/-TNcDzkpD_-4/VEE2rpEA73I/AAAAAAAABoE/v7_WSO8RtrU/s1600/pumpkin-giving-birth.jpg" height="240" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">home birth</td></tr>
</tbody></table>
<br /><br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://3.bp.blogspot.com/-aXOL7mXgoZk/VEE2qIDErKI/AAAAAAAABnU/OyK4ApgXtfU/s1600/dr-hoque1.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://3.bp.blogspot.com/-aXOL7mXgoZk/VEE2qIDErKI/AAAAAAAABnU/OyK4ApgXtfU/s1600/dr-hoque1.jpg" height="240" width="320" /></a></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://4.bp.blogspot.com/-kMIdlSVTWLw/VEE2qHwp8BI/AAAAAAAABnk/ydzGISrf6Gk/s1600/7747c5264122c3349bab5415604dc3ef.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://4.bp.blogspot.com/-kMIdlSVTWLw/VEE2qHwp8BI/AAAAAAAABnk/ydzGISrf6Gk/s1600/7747c5264122c3349bab5415604dc3ef.jpg" height="320" width="240" /></a></div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="http://1.bp.blogspot.com/-pPym4NY1KN8/VEE2rIWB4aI/AAAAAAAABns/Ykcj4oN0W48/s1600/pulp-fiction-477.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://1.bp.blogspot.com/-pPym4NY1KN8/VEE2rIWB4aI/AAAAAAAABns/Ykcj4oN0W48/s1600/pulp-fiction-477.jpg" height="320" width="240" /></a></div>
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="http://1.bp.blogspot.com/-zNLaVDY88g4/VEE2rTHZnkI/AAAAAAAABn0/MmUJ6d9C3-w/s1600/pumpkin-crowning.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="http://1.bp.blogspot.com/-zNLaVDY88g4/VEE2rTHZnkI/AAAAAAAABn0/MmUJ6d9C3-w/s1600/pumpkin-crowning.jpg" height="214" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">water birth</td></tr>
</tbody></table>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://2.bp.blogspot.com/-a6yascMhJUM/VEE2rxITa3I/AAAAAAAABn8/GMbOeO-C2Q4/s1600/pumpkin-giving-birth1.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://2.bp.blogspot.com/-a6yascMhJUM/VEE2rxITa3I/AAAAAAAABn8/GMbOeO-C2Q4/s1600/pumpkin-giving-birth1.jpg" height="320" width="240" /></a></div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<span style="color: #b45f06; font-size: x-large;"><br /></span></div>
<div class="separator" style="clear: both; text-align: center;">
<span style="color: #b45f06; font-size: x-large;">HAPPY HALLOWEEN!</span></div>
<br />
<br />Emilyhttp://www.blogger.com/profile/02738440647498422230noreply@blogger.com0tag:blogger.com,1999:blog-9221984976832050207.post-69247134964968182682014-10-16T14:50:00.000-04:002014-10-17T11:21:10.939-04:00I Am Not the Doula For EveryoneAt the beginning of our doula-in-training journeys, I think we all want to be the world's doula. We say yes to every potential client who comes our way -<br />
<blockquote class="tr_bq">
"Yes! I WILL be your doula!"</blockquote>
- No matter who she is. We want those experiences so badly! And we know or recognize everything that we will come to know and recognize.<br />
<br />
I am grateful when I interview with someone who asks me numerous questions that are only going to lead her to be disappointed in what I say, and she does not hire me.<br />
<br />
I am grateful when I interview with someone who says they want an intervention-free birth and a doula because their friends did it or they saw it on TV, but don't really know what a doula is and just do everything their doctor says, doesn't hire me.<br />
<br />
I would be grateful to not be hired by the woman who wants a cesarean section for convenience (though, thankfully, I've never encountered this), or a woman who has no interest in breastfeeding, or something else I believe in.<br />
<br />
I am getting better at recognizing a doula client who will not be a good match for me. Luckily, I've had to say "I don't think I'm the right doula for you," only once. Sometimes I say I am unavailable (often true) and refer her to other doulas. Sometimes the client simply hires someone else (I assume)...<br />
<br />
When a woman who I would like to hire me doesn't hire me for any number of reasons -<br />
<ul>
<li>I'm too young and don't remind her of her mother </li>
<li>I have not birthed a child of my own</li>
<li>Because I don't do aromatherapy/TENS/etc. </li>
</ul>
<div>
She is grateful that she has not hired a doula that is not right for her. </div>
<div>
<br /></div>
<div>
And I recognize that it is OK, because I do not want to be hired by a client that is not right for me, and am grateful. It comes from both sides...</div>
<div>
<br /></div>
<div style="text-align: center;">
I am not the doula for everyone.</div>
<br />Emilyhttp://www.blogger.com/profile/02738440647498422230noreply@blogger.com1tag:blogger.com,1999:blog-9221984976832050207.post-30716470603520521362014-10-03T15:36:00.000-04:002014-10-03T15:36:01.336-04:00Doula Re-CertificationThis month marks 5 years since my DONA International doula training workshop, where I began my doula journey. Just a couple of months ago I renewed my CD(DONA) certification!<br />
<br />
There are many doulas who choose not to re-certify, or to certify in the first place, for that matter. Certification is the effort to professionalize and legitimize the doula profession, to have it be recognized by health care providers and consumers as a trained role backed by a regulating body and a code of ethics.<br />
<br />
There are some who say that doula work does not need to be professionalized or legitimized. Many doulas say they have no issues finding clients or doing their work as non-certified doulas, so it is not worth the cumbersome paperwork and cost of staying affiliated with the organization. I completely understand this perspective.<br />
<br />
Others say that DONA's code of ethics and scope of practice are too narrow - they do not allow you to speak for the client, do not allow you to contradict the medical advice given by the provider, do not allow you to say that you are providing aromatherapy/other therapeutic techniques as a <i>doula </i>(you can do so as a trained aromatherapy practitioner, though). I personally think it is right that there be some boundaries that you do not cross in the role of a doula. The doula training is not medical training (if you have medical training, that's a different situation) and it does not make a professional with essential oils. I strongly believe that in order for doulas to remain allowed to come into the delivery room, we do have to play nice with the doctors and nurses (its common courtesy, anyway - just be friendly not combative)! Also, we shouldn't ever presume to put words in someone's mouth, especially someone who is about to become a mother (one who we hope will be a strong and confident mother, which often starts with birth).<br />
<br />
<blockquote class="tr_bq">
DONA is ensuring that no doula ever oversteps her bounds, for the safety of the woman and her family.</blockquote>
I respect any doulas choice for certifying or not certifying. I will not judge you for doing so or not, as I hope whether or not you spend the time and money for the credentials that you still follow a scope of practice and a code of ethics that only helps women and other doulas, and does not hurt them. Doulas need to make sure that we build a positive reputation and never make any bad press for one another.<br />
<br />
I chose to re-certify, and it really was not too rigorous. I started very soon after I became certified initially - I brought some papers to clients for them to sign to prove that I was at their birth, or had them fill out evaluations on me. I took my CLC training, and that knocked all of my continuing education credits out in one fell swoop. As my re-certification date neared, I did realize that I was missing a signature from one more mom, and asked a recent client to sign a form for me. Piece of cake! Submission wasn't too hard, and a couple of months later I received my new certificate.<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://4.bp.blogspot.com/-ygI-J6zlSaE/VC755_AfB8I/AAAAAAAABmw/hzCFHum6yy4/s1600/DONA%2BCertificate.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://4.bp.blogspot.com/-ygI-J6zlSaE/VC755_AfB8I/AAAAAAAABmw/hzCFHum6yy4/s1600/DONA%2BCertificate.png" height="248" width="320" /></a></div>
<br />
<br />
I have clients ask me if myself and my back-up doulas are certified. I've had clients say they don't want a back-up doula that isn't yet certified. I've had clients specifically ask me about DONA. Being certified proves that you <i>are </i>trained (not just calling yourself a doula), and therefore can associate yourself with all of the <a href="http://evidencebasedbirth.com/the-evidence-for-doulas/">research-proven benefits</a> of having a doula!<br />
<br />
I am thankful for DONA International because the organization has:<br />
<ol>
<li>Legitimized the profession of the doula, leading many childbirth educators to refer parents to DONA's website to find a doula, and hospitals to allow doulas in the labor room,</li>
<li>Worked hard to get doulas the ability to have an NPI number so we can help clients submit for insurance reimbursement,</li>
<li>Spoken and written (Penny Simkin and colleagues) on numerous topics that are now growing in evidence-base and popularity for the good of the mother and baby (e.g. the positive impact of the doula on labor experiences, delayed cord clamping, etc), </li>
<li>Celebrated doulas and provides resources for both parents and doulas all over the world.</li>
</ol>
<div class="separator" style="clear: both; text-align: center;">
<a href="http://1.bp.blogspot.com/-8WIpe4dXJqk/VC74TV-2DaI/AAAAAAAABmk/P6lz7AIe9tU/s1600/dona_international-1.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://1.bp.blogspot.com/-8WIpe4dXJqk/VC74TV-2DaI/AAAAAAAABmk/P6lz7AIe9tU/s1600/dona_international-1.jpg" height="168" width="320" /></a></div>
<div>
<br /></div>
Emilyhttp://www.blogger.com/profile/02738440647498422230noreply@blogger.com0tag:blogger.com,1999:blog-9221984976832050207.post-37510504697380229022014-09-24T13:59:00.000-04:002014-09-24T13:59:47.820-04:00Birth by the Numbers Update<div class="tr_bq">
Eugene Declerq and the team at Birth by the Numbers have very recently updated their statistics and their video!</div>
<br />
Two years ago I posted the video <a href="http://anthrodoula.blogspot.com/2012/09/birth-by-numbers.html">Birth by the Numbers</a>, a fantastic resource for mothers, public health professionals, students, and teachers. If you haven't seen it yet, I highly recommend you<a href="http://anthrodoula.blogspot.com/2012/09/birth-by-numbers.html"> check it out</a>.<br />
<br />
This brand new updated Birth by the Numbers covers several maternal and infant health indicators, including maternal mortality and neonatal mortality, compared to other countries. This may sound dry, but he makes some jokes to start you off.<br />
<br />
Dr. Declerq then covers Cesarean sections, with a great overview of trends in primary cesarean section rates. He even discusses cost savings of reducing these rates.<br />
<br />
Are we doing better? Worse? Tune in to find out this answer and more!<br />
<br />
<iframe allowfullscreen="" frameborder="0" height="315" src="//www.youtube.com/embed/a_GeKoCjUQM" width="520"></iframe><br />
<br />
<br />
<br />
I really like this slide:<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://1.bp.blogspot.com/-m7YL2cihEBo/VCMGJAM-aLI/AAAAAAAABmQ/QFxgD-mVSm0/s1600/birthbythenumbers2014.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://1.bp.blogspot.com/-m7YL2cihEBo/VCMGJAM-aLI/AAAAAAAABmQ/QFxgD-mVSm0/s1600/birthbythenumbers2014.png" height="217" width="400" /></a></div>
<br />
I also recently saw a graph elsewhere showing the c-section rate rise with the introduction and push of the electronic fetal monitor. And of course, the decrease in the rate during the period in the 90's when Trial of Labor after Cesarean was promoted.<br />
<br />
<br />
For further information, I highly recommend the <a href="http://www.birthbythenumbers.org/">Birth by the Numbers website</a>, or any of the sites he references at the end of the video.<br />
<br />
Also, if you're into the research on c-sections, here is an article on the variation in cesarean section rates across the country and in each hospital, and some analysis of why:<br />
<blockquote>
<a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3615450/">Cesarean Delivery Rates Vary 10-Fold Among US Hospitals; Reducing Variation May Address Quality, Cost Issues</a><br />
"We found that cesarean rates varied tenfold across hospitals, from 7.1 percent to 69.9 percent. Even for women with lower-risk pregnancies, in which more limited variation might be expected, cesarean rates varied fifteen-fold, from 2.4 percent to 36.5 percent. Thus, vast differences in practice patterns are likely to be driving the costly overuse of cesarean delivery in many US hospitals."</blockquote>
<br />Emilyhttp://www.blogger.com/profile/02738440647498422230noreply@blogger.com0tag:blogger.com,1999:blog-9221984976832050207.post-86025917718808196382014-09-18T12:29:00.001-04:002014-09-18T12:31:40.327-04:00Keeping My Doula Mouth ShutRecently I feel as if everyone around me is getting pregnant. It started a few years ago and was just a trickle on my facebook page. Now it is more and more frequent, back-to-back newborn photos on my newsfeed, and more immediate, with more people I actually know in person getting pregnant!<br />
<br />
And it has become a problem.<br />
<br />
Why would this be a problem for a doula and maternal and child health professional?<br />
<br />
Well, it is not a problem if it is someone seeking me out for doula services! Then it is great. I can feel free to help them to my fullest extent - send them articles, answer questions, give them advice, etc. They came to me for information and wisdom, and I share it.<br />
<br />
The issue occurs is when it is a friend or colleague.<br />
<br />
It is very hard to talk to an acquaintance about their pregnancy. Do they want me to give them more information, knowing I'm a doula? Do they want me to keep my mouth shut, as they have not indicated any interest in hiring me? Should I discreetly post things on facebook and <i>hope </i>that they see it?<br />
<br />
If I ask the questions I ask doula clients about their pregnancy and birth wishes, if I give advice that has not been solicited, will they pull away? Will they not want to be around me anymore? Will they actually choose something opposite of what I've recommended because I've turned them off? Is it more information than they want to hear (often the case, where most women put all their trust in their OB and rarely take childbirth education)?<br />
<br />
It can be so hard to want to tell them how wonderful birth can be! But I know that pregnant women hear a lot of unsolicited advice, and I don't want to be part of the annoying crowd. I want them to know that I am here as an option if they feel comfortable approaching me. I never want to come across too strong (it is like dating)!<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://4.bp.blogspot.com/-2O_U57B21KI/VBsG6aYyl0I/AAAAAAAABlg/f7tDX6FTeX0/s1600/hand%2Bover%2Bmouth2.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://4.bp.blogspot.com/-2O_U57B21KI/VBsG6aYyl0I/AAAAAAAABlg/f7tDX6FTeX0/s1600/hand%2Bover%2Bmouth2.jpg" height="212" width="320" /></a></div>
<br />
If I tell them that the hospital they are going to has the highest intervention and cesarean section rates in town, they will most likely feel judged and angry at me, rather than thinking they should switch providers. I struggle with this with my doula clients, as well.<br />
<br />
Do I want my friends and acquaintances to hire me as their doula? Absolutely. I want all my friends to hire me as their doula. I want them to be with someone they feel comfortable talking with, and to receive the benefit of a doula. I would not even be bitter if a colleague hired another doula and not me (I know I'm not the exact perfect fit for every woman!), because I would be glad that they'd have a great source of support and information.<br />
<br />
Even though I am approaching the 5th anniversary of my doula training, I still cannot say that I've figured this aspect of being a doula out.<br />
<br />
I actually wrote about this 3 years ago in a post called <a href="http://anthrodoula.blogspot.com/2011/10/banned-from-baby-showers.html">Banned from Baby Showers</a> (inspired by another blogger). In this post I wrote,<br />
<blockquote class="tr_bq">
I find it difficult not to share everything I've learned with everyone I encounter! I want to shout it all from the rooftops!</blockquote>
But I try to follow the wise advice that I quoted:<br />
<blockquote class="tr_bq">
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.</blockquote>
So for now I wiggle and squirm internally, watching friends post on facebook that they are reaching their due date and "why isn't baby born yet?!" Or listen to people say that their baby is too big. And I can't send them the information that pregnancy is not postterm until 42 weeks (especially in first-time moms), and that suspected macrosomia is not a medical indication for induction. And I feel sad when an acquaintance is induced with a healthy first time pregnancy and ends up with a C-section for failure to progress, as can be expected.<br />
<br />
The activist part of me wants to say to everyone that they need to know this, because it will affect every future pregnancy, but I don't want people to shut me out. So I continue to share everything on my Anthro Doula facebook page and my doula services page where those who want to see it, can.<br />
<br />
I know some birth professionals who would not cover their mouths - they would still talk to everyone and anyone about what they think. The thing is, I've seen people recoil from them. I don't want to lose potential people to help. Sometimes people ask for help in their own time and we have to let them. Others are more independent. Research has shown that women do not think that there is an issue with modern maternity care. I might talk like there obviously is and turn someone I am trying to help away, thinking I'm crazy.<br />
<br />
I won't keep quiet in my professional life. I will still continue to be a birth activist and work towards improved maternity care and better births for all women. But around friends, I have to let them live their lives as they will. Friends who I don't want to unfollow or avoid me will continue to not be hit with unsolicited information or advice. I am here if they need me.<br />
<br />
<br />
<i>Has anyone else figured this out in their lives? Do you have any advice for birth professionals who struggle with this issue? </i><br />
<i><br /></i>
<i><br /></i>
<i><br /></i>
Emilyhttp://www.blogger.com/profile/02738440647498422230noreply@blogger.com1tag:blogger.com,1999:blog-9221984976832050207.post-11332075444141167672014-07-23T13:28:00.004-04:002014-07-23T13:50:07.731-04:00Choosing Your Pregnancy Care Provider and Birth LocationYou're Pregnant? Congratulations! You're full of excitement and love, and your family is already planning your nursery and picking names and buying toys and clothes.<br />
<br />
You know you need to see a health care provider. You think, "I guess I'll just go to my regular gynecologist."<br />
<br />
WAIT! There's a lot more that goes into your pregnancy and birth care provider choice than what goes into your gynecologist choice. You have a lot of options when it comes to your pregnancy care that most women don't know about before they are pregnant.<br />
<br />
Why is this important?<br />
<br />
1. Because <b>women remember how they were treated during their birth for the rest of their lives.</b> Choose someone who will make you feel respected.<br />
2. Because it will affect the amount of information you receive, what options you have during birth, and the degree to which you are involved in decisions about your care.<br />
<br />
So, here is a guide to finding and picking a care provider and birth location.<br />
<br />
<br />
<b><u>Your Options: Hospital, Birth Center, or Home</u></b><br />
<b><u><br /></u></b>
Most of us assume that birth will be done in a hospital, and that's that. Truly, everyone feels safer in different environments. Find the best match for you:<br />
<br />
<u>Hospital</u>: A great option for high risk care for you or your baby; No need to transfer to a different location if something goes wrong in labor; Medical pain relief and other medication is immediately available; Care is standardized ("cookie cutter") rather than individualized; Interventions are used routinely whether or not there is a clear medical need; Technology is relied on to make decisions rather than a woman's body or intuition; Staff are not always available to provide continuous emotional, informational, and physical support; Requires transfer from home to hospital during labor.<br />
<br />
<u>Free-standing Birth Center:</u> Greater emphasis on individualized care; Rely on your body's physiology rather than technology; Staff are available to provide psycho-social support; Requires the need to transfer from home to the birth center while in labor; Requires transfer to the hospital in an emergency; Some birth centers do not have medications available for labor; Avoid routine interventions and rely on medical need.<br />
<br />
<u>Home Birth:</u> Highly tailored to your individual needs and preferences; Completely avoids use of routine interventions during labor and delivery; Continuous psycho-social support is available; Does not require transfer from home to a different birth setting during labor; Does require transfer to hospital in the case of emergency.<br />
<br />
<b><u><br /></u></b>
<br />
<b><u>Your Options: Obstetrician or Midwife</u></b><br />
<br />
The typical American woman has an obstetrician as her care provider. It is the doctor that we are used to, and it is all we have seen on TV, in movies, and our relatives do. Obstetricians are the default option for women who want to give birth in a hospital.<br />
<br />
A midwife, to the general populace, is what our great grandparents used for birth, or what they use in primitive tribes. The thought is that they are for people who don't have doctors. Or, maybe they're just for the hippie types who don't use health care.<br />
<br />
In reality, a midwife is a great option for your pregnancy care provider. They are highly trained and licensed, come in all shapes, sizes, ages, and from all political backgrounds. You can be with a midwife for hospital birth, a birth center, or at home. I like to share more information on midwives because many people don't realize it is an option. There are a few types of midwives:<br />
<br />
<ul>
<li>Certified Nurse Midwife (CNM): Trained in both nursing and midwifery, and work in hospitals, birth centers, or sometimes attend home births.</li>
<li>Certified Professional Midwife (CPM): Certified by the North American Registry of Midwives. Requires knowledge of out-of-hospital birth settings. </li>
<li>Licensed Midwife (LM): A direct-entry midwife who is licensed in her state to attend out-of-hospital births.</li>
</ul>
<div>
The number of deliveries attended by midwives in the United States is growing. Numerous research studies show that midwives provide equal or sometimes better care to patients with low-risk pregnancies. To learn more about midwives, <a href="https://www.youtube.com/user/iamamidwife">check out this great video series</a>.</div>
<div>
<br /></div>
<div>
An obstetrician is a physician and trained as a surgeon. They are great for pregnancies that require a bit more medical care, and they generally supervise or "back" midwives in the hospital. Because midwives do not perform emergency surgical procedures, midwives always "risk out" a patient who may need additional care. An obstetrician is a medical doctor.</div>
<div>
<br /></div>
<div>
<u>Differences in models of care</u></div>
<div>
The medical model of care that a physician provides focuses more on a hierarchical system of care where the woman is a patient, birth is meant to be managed by experts because it is potentially pathological. Some obstetricians are great and spend personal time with patients, but many are authoritarian, depersonalized, and do not provide emotional support. The midwives' model of care respects birth as a normal part of a woman's life and involves her more in the relationship. Decision making is ideally shared, and information is shared during more in-depth prenatal visits. Some midwives are more medical model, and some obstetricians are more midwife model. It all depends, and that's why its a good idea to interview your provider.</div>
<div>
<br /></div>
<div>
<u>Other care providers</u></div>
<div>
You can also have a MFM (maternal fetal medicine specialist) as your care provider for high risk pregnancies, a family physician, or ARNP, but these are generally less common than OB or midwife.<br />
<br />
<br />
<br />
<b><u>Choosing a Care Provider</u></b></div>
<br />
One way to start choosing a care provider is to see which providers your health insurance covers. Another is to pick based on where you want to give birth - home, birth center, or hospital. A great way is to ask around among birth professionals in your area, including doulas and childbirth educators, who know the local "birth scene."<br />
<br />
If you've started reading books, blogs, or signed up for a childbirth education course, you'll learn what your options are for birth and decide what is important to you. Is it the freedom to move around during labor? To avoid medication during labor? To have a VBAC?<br />
<br />
Once you make an appointment with a care provider, it is important to take a tour of where they deliver. Find out what the birth experience will be like. Does the hospital have a certain reputation (e.g. high c-section rates)? Interview moms who have worked with that particular home birth midwife. Call and ask what hospital or care provider statistics are on intervention rates that you might like to avoid (e.g. induction).<br />
<br />
<u>Questions about the Birth Location</u><br />
<br />
<ul>
<li>Are there restrictions on who is allowed in the room?</li>
<li>Do they allow intermittent monitoring, birth balls, laboring in the bath tub, walking around during labor, etc?</li>
<li>Can I eat and drink during labor?</li>
<li>Are they supportive of doulas attending labors? (if your provider says no, it may be that they do not have your best interests in mind. Doulas are evidence-based!)</li>
<li>What are the hospitals c-section, induction, epidural rates?</li>
<li>Are mom and baby kept together after birth? Does the hospital support immediate skin-to-skin? </li>
<li>How does the hospital support breastfeeding? </li>
<li>What if I choose to decline a certain intervention for myself or my baby?</li>
<li>(If at birth center or at home): Under what scenarios am I risked out of your care?</li>
<li>Do I feel comfortable here?</li>
</ul>
<br />
<u>Questions for the Care Provider:</u><br />
When you have a chance to sit down with your care provider, here are some questions to ask to gauge whether they are a right fit for your desires:<br />
<br />
<ul>
<li>What is your birth philosophy? How do you feel about natural birth?</li>
<li>What do you consider "full term" or "past due"?</li>
<li>How much time will be spent with me during each appointment?</li>
<li>What routine tests are there during pregnancy?</li>
<li>What are your intervention rates? (induction, artificial rupture of membranes, episiotomy, epidural, c-section, etc)</li>
<li>How do you feel about my hiring a doula?</li>
<li>Can I push and deliver in different positions, including hands and knees, squatting, side lying, etc?</li>
<li>Is there an on call rotation?</li>
<li>What if I want to refuse a procedure for myself or my baby? Are there any procedures that are non-negotiable?</li>
<li>How do you feel about my birth plan to avoid [continuous fetal monitoring, an episiotomy, pain medication, pitocin augmentation, etc].</li>
<li>Do I feel respected by this care provider, and like my wishes will be granted?</li>
<li>Are his/her practices consistent with evidence-based medicine?</li>
<li>How much responsibility do I want to take for my pregnancy and birth?</li>
</ul>
<div>
Here are more <a href="http://www.childbirthconnection.org/article.asp?ck=10161">questions to ask a midwife,</a> and <a href="http://www.childbirthconnection.org/article.asp?ck=10149">questions to ask a doctor</a>.</div>
<div>
<br /></div>
<div>
<br /></div>
<div>
<br /></div>
<div>
<b><u>Switching Care Providers</u></b></div>
<div>
<b><br /></b></div>
<div>
After you've begun to receive prenatal care from a provider, you may notice that he or she is not as supportive of your wishes as you'd like them to be. Or, you've learned that the hospital they deliver at has the highest cesarean section rate in the region! Everyone deserves respect in health care. Ideally, you should have shared decision making and be able to ask them anything. They should respect your plan for your ideal birth. If you find you might like to switch, it is a great time to get feedback and advice on providers from others in your childbirth education course, or do some research and call up a new doctors office, birth center, or home birth midwife. You need to make sure that you "click" with the person providing your care during this very emotional time. </div>
<div>
<br /></div>
<div>
I've heard switching stories lots of times. It seems difficult (you're already invested in your current provider, they have your health records, you think its too late to switch, you don't want to hurt their feelings, etc). but it is generally an easy thing to do. If you are very near the end of your pregnancy, you may have to call a few people to find someone who is willing to take on a new client so late. Again, ask your local birth community on advice on how to ask to switch (they can help you say the "right things" to get you in)!</div>
<div>
<br /></div>
<div>
<br /></div>
<div>
For more great information and resources from an excellent national resource, check out <a href="http://www.childbirthconnection.org/article.asp?ck=10158">Choosing a Caregiver</a> and <a href="http://www.childbirthconnection.org/article.asp?ClickedLink=252&ck=10145&area=27">Choosing A Place of Birth</a> from Childbirth Connection.</div>
<div>
</div>
<div style="text-align: center;">
<a href="http://birthwithoutfearblog.com/2010/11/12/your-body-your-birth-your-baby/">And remember, it is <i>your </i>body, <i>your </i>baby, <i>your </i>birth!</a></div>
<div style="text-align: center;">
<br /></div>
<div style="text-align: center;">
<br /></div>
<div>
<b><br /></b></div>
Emilyhttp://www.blogger.com/profile/02738440647498422230noreply@blogger.com2tag:blogger.com,1999:blog-9221984976832050207.post-14195424685585423962014-05-23T11:29:00.000-04:002014-05-23T11:29:00.110-04:00What Pregnant Women Google WorldwideI encountered a post on the <a href="http://www.nytimes.com/interactive/2014/05/18/sunday-review/googling-while-expecting.html?smid=tw-nytimes">New York Times</a> of a Google word analysis of things people search about pregnancy in different parts of the world. I found this fascinating from a cultural perspective. In our globalized world, many of the (male or female) googlers inquiring about pregnancy are concerned with much of the same things.<br />
<br />
For instance, the top five keywords searched, in several countries, for "How to ___ during pregnancy" brings up, as the NYT notes, issues of vanity and sex.<br />
<br />
Pregnant women (and their family members) are seemingly preoccupied with how to not gain too much weight, not have too many stretch marks, and how to have sex. Even in non-"Western" countries (the ones represented here by the NYT, at least), pregnancy Googlers focus on the same issues. This reflects a desire for the mother to maintain normalcy while pregnant: The typical appearance of ones body (not as the large, stretch-marked person pregnancy often creates), a good amount of sleep, and their regular sex life. A few "stay healthy/fit" items are thrown in, as well, which brings the focus back to the baby.<br />
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="http://1.bp.blogspot.com/-GzzJEbel2Jo/U39Kx8JdTMI/AAAAAAAABkI/c0qKB4erYx4/s1600/How+to+_+during+pregnancy.jpg" imageanchor="1" style="clear: left; display: inline !important; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img alt="http://www.nytimes.com/interactive/2014/05/18/sunday-review/googling-while-expecting.html?smid=tw-nytimes" border="0" src="http://1.bp.blogspot.com/-GzzJEbel2Jo/U39Kx8JdTMI/AAAAAAAABkI/c0qKB4erYx4/s1600/How+to+_+during+pregnancy.jpg" height="161" title="" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Click to enlarge</td></tr>
</tbody></table>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: left;">
<br /></div>
<div class="separator" style="clear: both; text-align: left;">
When it comes to pregnancy worries, there a lot. No surprise there, with doctors, family members, and strangers alike telling us what we can and cannot do with our bodies while pregnant. But the number one question about what pregnant women can do has to do with... FOOD!</div>
<div class="separator" style="clear: both; text-align: left;">
<br /></div>
<div class="separator" style="clear: both; text-align: left;">
This could reflect 1. The high level of importance of food in our lives (on an hourly basis, in some cases, but at least daily); 2. A high level of rumor and confusion related to whether certain food items are "ok" while others aren't (stemming either from bioscience "rules" or from cultural taboos); 3. Lack of dialogue with care providers not providing enough information about what is safe/unsafe or what might have side effects. </div>
<div class="separator" style="clear: both; text-align: left;">
<br /></div>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="http://2.bp.blogspot.com/-TLMRBQlptvQ/U39KxyifvnI/AAAAAAAABkE/e0r2bJBOTgE/s1600/Can+pregnant+women+__.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img alt="http://www.nytimes.com/interactive/2014/05/18/sunday-review/googling-while-expecting.html?smid=tw-nytimes" border="0" src="http://2.bp.blogspot.com/-TLMRBQlptvQ/U39KxyifvnI/AAAAAAAABkE/e0r2bJBOTgE/s1600/Can+pregnant+women+__.jpg" height="277" title="" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Click to enlarge</td></tr>
</tbody></table>
<br />
Interestingly, though, are the ones that stand out -- Brazil's has nothing about food, but wonders at riding a bike, and Spain's women don't know if it is all right to sunbathe.<br />
<br />
Important to keep in mind that it may not be the pregnant women themselves who are googling (could be the dads or grandparents-to-be)!<br />
<br />
<br />
<br />
NYT interprets "Can pregnant women <u>_Fly_</u>?" as flying in an airplane, but if that was really the Google search, I'm thinking:<br />
<br />
<div style="text-align: center;">
CAN PREGNANT WOMEN FLY?!</div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://3.bp.blogspot.com/-Mx-83JGnq8s/U39oYJndS7I/AAAAAAAABkg/f7gxGec_Ojs/s1600/pregnant+wings.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://3.bp.blogspot.com/-Mx-83JGnq8s/U39oYJndS7I/AAAAAAAABkg/f7gxGec_Ojs/s1600/pregnant+wings.jpg" height="320" width="187" /></a><a href="http://2.bp.blogspot.com/-mQq6Pte2jsg/U39oX5pSzcI/AAAAAAAABkc/4zNLJL1RvjQ/s1600/super+pregnant.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://2.bp.blogspot.com/-mQq6Pte2jsg/U39oX5pSzcI/AAAAAAAABkc/4zNLJL1RvjQ/s1600/super+pregnant.jpg" height="234" width="320" /></a></div>
<br />
<br />
Now that would be a neat superpower to obtain while pregnant! ;)<br />
<br />Emilyhttp://www.blogger.com/profile/02738440647498422230noreply@blogger.com0