Out-of-hospital water birth

Reorienting

I've noticed that lately, my posts have tended more towards the "doula" (or lactation consultant) in "Public Health Doula". I blame it on two things: 1) My classes this semester aren't giving me a lot of excuses to go play in my literature of choice and 2) This semester, while not having reached the total fever-pitch of insanity I dreaded, has been pretty busy and my veg-out time has generally not been donated to PubMed. It's a lot easier to toss out my thoughts on someone else's post, tell a story, or pass along a link!

But I am hoping to circle back around and look at more issues from the public health/research standpoint - I have a post cooking on maternal mortality statistics in the U.S. and a couple on infant mortality. And I have some exciting plans for next semester that will hopefully tie in: I will be the "third facilitator" attending CenteringPregnancy sessions at a local health center. They're facilitated by an awesome midwife, and for my master's project I'll be working with her to develop and pilot her idea for a CenteringPregnancy module on health disparities, focused on taking ownership of knowledge about health disparities and on exploring solutions.

(Sometimes I just want to pinch myself and think "Am I really getting to do all this? How did I get so lucky?" Then I remember that not everyone would consider my copious opportunities to interact with breastmilk and amniotic fluid, and to have conversations about vaginas, birth control, and infant feeding, "lucky".)

Anyway, if anyone has requests for research topics/public health perspectives/other posts let me know, but if you missed them they will be coming back!

Doula-Man

I wrote once before about Keith Roberts, the first male doula certified by DONA. Here's another profile:

“This is the most important tool, this crock pot. It’s a towel heater,” he says. “It has been to 149 hospital births in the last 14 years.”

The soft-spoken, silver-haired 66-year-old tends to the laboring woman’s pain to free up her partner to pile on the emotional TLC. His massaging hands and hot towels lessen the need for drugs.

“I can’t take all the pain away,” he says, “but enough so it’s OK.”

It almost sounds too good to be true. Are you thinking what I’m thinking: “Where was this guy when I needed him?”

Male or female, bring a doula to your birth!!

Side note: the article makes mention that Vince Vaughan is developing a movie called "Male Doula" (not based on Roberts). No good can come of this!

Writing for Salon, Barbara Ehnrenreich does a nice job of asking whether the pink ribbon of breast cancer has replaced actual feminism and the fight for comprehensive health care.

I'm not cavalier about breast cancer; nearly all the women on one side of my family have had it. But I am icked out from a near-romanticization of breast cancer, and the "pinkwashing" corporations engage in. (I have been strongly influenced by the Think Before You Pink campaign.) And from a public health standpoint, the almost exclusive focus on breast cancer by many campaigns is a little strange: as the the American Heart Association notes: "Nearly twice as many women in the United States die of heart disease, stroke and other cardiovascular diseases as from all forms of cancer, including breast cancer." I think it's important to express to women that they need to take as least as much care with preventing heart disease as they do with breast self-exams, yearly mammograms, etc.

As Ehrenreich points out, while Hollywood stars flip out over new mammography recommendations, no one similarly high-profile is talking about Stupak, pushing for all women's preventive services to be covered in health care reform. No one is asking what kind of preventive care and public health funds in general are going to be aimed at the kind of basic public health interventions that affect not only breast cancer but almost every other disease you can think of: Exercise, healthy eating habits, social support, limiting environmental pollutants, etc. Women's health is not just breast cancer. (And that yogurt lid? You can just donate the cost of the stamp you'd have used to mail it; the breast cancer research organizations will get more money that way.)

Update - when the village nurses the baby

Early this year, I posted about a group of women in Michigan who were nursing the baby of a local family whose mother had died of an amniotic fluid embolism (a very rare complication during birth). Here's an updated story - looks like Moses is still being breastfed every day by local moms. So amazing.

Skin-to-skin vs. pushing latch-on right after delivery

"Breastfeeding initiated with in the first half hour" or "the first hour" (depending on what country you're in) is one of the important facets of the Baby-Friendly 10 Steps. While this is an admirable goal, Gloria Lemay has a very nice post up about the problems with aggressively pushing breastfeeding immediately after birth, sparked by e-mails with a lactation consultant in Israel. That LC, Leslie Wolff, writes:

I have a few of my own beliefs about breastfeeding immediately after delivery. I feel that skin to skin after birth for the first two hours is SO important -more important than making a big effort to get that baby to breastfeed.. MAINLY because I realize that it helps the diad - mother and baby - to recover from the birth experience, is a Win Win situation that requires no effort , there is nothing to “succeed” in - it is just a “being” situation that is beautiful for Mom and baby. And if the baby goes for the breast - great..and if not, or the breast is offered and the baby doesn’t GO FOR IT - that’s fine. ... I know that babies are “supposed to” “immediately” start breastfeeding beautifully - but I see so many mothers and babies that are SO content just lying there Skin to Skin, relaxing, bonding in their own special way. In the past, before I discovered the beauty of Skin to Skin ,I remember many frustrated Moms and babies doing their best to breastfeed, because Mom and Dad both knew that was the best thing to do immediately after birth...)

Gloria agreed and added:

I attend only homebirths and have the same attitude. It’s the skin to skin contact and little (or big) noises of the baby that cause the uterus to contract powerfully post partum. It is a sacred time right after birth that can never be recaptured. When the mother and baby have warmth and privacy they will “discover” each other and fall madly in love. This is the best child protection method both in the short and long term. We are mammals. We must sniff, lick, coo, cuddle, look at and hear our young. In turn, the baby does many “pre-nursing behaviours”-climbing, licking, looking, hearing, sniffing. . . who knows what they are doing because it’s dark and private, remember?

I think these are both beautiful and important reminders that the idea of initiating breastfeeding in the first hour is more about getting mom and baby close, practicing skin-to-skin care, and letting both "discover" each other. I don't think it's so important to - as some people do - make sure the baby is latched on, nursing vigorously, and has a perfect latch in the delivery room. (I have seen some very aggressive latching efforts by nurses that have made me very uncomfortable.)

But as a doula, I have often pushed breastfeeding in the delivery room, even when mom and baby could be happy just cuddling. Why? Because sometimes it seems like the only way to keep baby with mom. Now that (some) hospitals have placed importance on breastfeeding, it's considered an important (aka chartable?) activity. But skin-to-skin time, bonding, and relaxing are unfortunately not considered important, and thus are subservient to other important activities like weighing, measuring, eye gooping, bathing, newborn exam, etc. etc.

Itchy fingers are often waiting on the sidelines so that "when you're done nursing I'll take him up to the nursery to get checked out and then you can have him back". Or if mom needs a lot of stitches, itchy fingers are hovering to say "Since this is going to take a while, I'll just take him upstairs now and then when you get there, you can have him again to nurse." (What do you want to bet he's going to get hungry upstairs and be given a "just a little bit" from a bottle while waiting for mom?)

It's unfortunate that as a doula, I feel like I have to ask "do you want to breastfeed now? let's see if we can get her latched" - but when I sense itchy fingers waiting, I try to postpone them as long as possible and sometimes it feels like the only way to do it is to push breastfeeding. I will say that I try to be so careful to step back, not be very hands-on, and focus more on baby tasting, nuzzling, and "practice" latching than any measure of "success". (Unfortunately, parents sometimes have their own preconceived notions of "success" and the perfect nursing session, which can be hard to dispel.) I wish that all mothers were accorded the same sacred, private space that Gloria offers homebirth mothers, so this wouldn't be necessary.

New protections for nursing mothers in Senate health bill

From the Wall Street Journal Health Blog:

Here’s a detail in the Senate health-care bill we hadn’t noticed until now: Employers would be required to give nursing mothers “a reasonable break time” to express breast milk during work.

Employers would also have to provide “a place, other than a bathroom, that is shielded from view and free from intrusion from co-workers and the public, which may be used by an employee to express breast milk,” the bill says.

Companies with fewer than 50 workers would be exempted from the requirements if the rules imposed “an undue hardship.” You can read the provision yourself on page 1239 of the Senate health-care bill. Similar legislation has been introduced in Congress for years, but has never become law.

More than 20 states already have laws in place to protect nursing mothers in the workplace, according to a Kaiser Health News story that highlights several provisions in the Senate bill that haven’t drawn much attention.

There's plenty to say about ignoring extended maternity leaves in favor of lukewarm pumping protection, but at least this would extend some extra protections to women working in states that don't currently protect their right to express milk. It also shows there's at least one prevention-minded initiative in the health care bill!

Thanks for the link go to Adriane, my classmate and policy guru extraodinaire!

P.S. I just realized this is my 200th post to Public Health Doula. Wow! Thank you for reading, commenting, and sharing.