I'm on a (posting) roll! Midwives posting their stats for the world to see

Apparently I'm on a posting roll tonight...

Did you know that CBS Midwifery in Manhattan posts all their stats for the previous year? An excerpt from 2009's:

Vaginal deliveries 80 = 88%

Normal spontaneous vaginal 76= 95%

Vacuum extraction 4 = 5%

Vaginal births after previous C/S 8 successful out of 9 attempts = 88%

Furthermore, they deliver babies at the in-hospital birth center at St. Luke's Roosevelt. A common complaint I have heard from doulas is that their clients expect to use the birth center, and are either risked out before labor ever begins, and sometimes during labor and then they are sent to L&D. Or they get there and are told the birth center is full. So I liked even more that the midwives make that piece transparent too:

Women who wanted Birth Center and were eligible at term = 68

43 - delivered Birth Center = 63%

24 - Transferred to Labor & Delivery in labor = 35%

1- Birth Center full- had to deliver on L&D = 2%


They also provide stats on degrees of perineal trauma, meds, reasons for c-sections...
Imagine if every practice did this! How amazing would it be to be able to compare this information when looking for a care provider?

What are practices out there that you know of that make some or most of their stats available to consumers?

Doula memories

I've been puttering around today, catching up on some of the things I put off while getting ready for the exam. Some of my friends have been talking birth stories/birth plans lately and we talked a bit about wanting positive hospital birth stories since there are so many scary ones out there and yet there CAN be such lovely births at the hospital.

I started thinking about a birth I attended back when I was in AmeriCorps and went searching through my old birth stories (we wrote one up for each birth we attended, and when I left I kept a copy of all of mine and am SO glad I did - they are wonderful to look back through) to find what I wrote about it at the time. And I cannot for the life of me find it. I must have missed it when I was making my copies.

So, without that sheet of paper I can't remember all the information about the birth, like whether mom had an epidural or not, what # baby this was for her, even whether baby was a boy or girl! But I do remember that the family had a few older children, some of whom were present, and that they were very positive, friendly people - I really enjoyed being at the birth with them. There was a recently hired (but experienced) midwife at this hospital that I hadn't worked with before* and she was the midwife on all day as mom labored and I worked with her.

As the birth grew nearer, and mom was working hard and pushing, the midwife beckoned the dad over to where she was keeping an eye on the perineum. Baby began to crown and she said to dad, "Come here. Give me your hands." As the baby's head emerged, she laid his hands on the baby's head and guided him in catching his own baby - the first person ever to lay hands on his child. I watched his eyes widen, his face about to split apart with a smile as he did it. Together they handed baby to mom and she cuddled her new baby as they got baby cleaned off.

Afterwards, dad was just glowing, literally bouncing around the room, still unable to wipe that huge grin off his face. "Did you see that?" he kept asking everyone there. "Did you see what I did? That was amazing! It was AMAZING!"

It was even neater - to me - because these were not people who had sought out midwives to get greater control over the birth process. They were community health center patients who just needed quality affordable prenatal care, and ended up working with midwives because that's who did the births for the CHC at that hospital. And they were handed this really amazing gift of participating more fully in their child's birth.

Later the midwife told me that she had been watching me work with the mom all day, and had been going to offer ME the chance to help catch the baby, but could tell how excited the dad would be to do it. I was bowled over by that! I told her I was so glad she had the dad catch. I was just there for one day, but I hope that every year on this baby's birthday, that dad is still telling his child the story of how he helped catch him/her, and how proud he was to do it.

So that's your wonderful hospital birth story of the day, courtesy of my free association skills!

*Do any other doulas have the experience with new-to-the-system midwives that they're such a breath of fresh air? They haven't gotten trampled down by the system yet, they're not looking over their shoulders at the nurse who might "turn them in", they're just practicing how they want to practice. That's not to say that experienced midwives who know how to work the system aren't fabulous and valuable and just as subversive in their own ways - if not more - but being with a new midwife can be so...liberating.

IBCLC exam over!

DONE!! It was so hard to get to sleep the night before last. I kept thinking "I just wish I could take the test RIGHT NOW and get it over with." I woke up at 5 am and couldn't get back to sleep (which beats my classmate who woke up at 4 am and a study partner who claimed she didn't sleep all night). But once we were at the test center, in line waiting to show our IDs to register for the test, I wanted to slow down and let it all sink in for a moment. My dream, getting to sit for the IBCLC exam, coming true - it's still a little hard to believe.

Now it's all over but the waiting...for the results. I understand in principle why it takes IBLCE sooo long to get the test results back to us. But the end of October? In practice, this is very hard. (It's obviously payback for all my whining and moaning about the GRE being on a computer, and set up so you couldn't skip questions you weren't sure about and go back to them later. While I am VERY glad I could go back on the IBCLC exam - I think I went through both morning and afternoon test booklets at least 3 times each re-reading every question - I have to admit it was pretty nice to get the GRE results instantly.)

And while I think I did reasonably well on the exam, it's so easy to doubt. What if I fail it by a question? What if all the questions I challenged were the ones I got RIGHT? What am I going to tell people November 1st if I fail? I pingpong back and forth between guarded optimism and the prospect of having to actually admit to people that it didn't turn out the way I'd hoped. If you all could do me a favor and forget that I ever took this exam, and not ever ask me about it again, just in case - thanks!

LC Exam minus 3

ACOG lessens (kinda) restrictions on VBACS, stories are written on shackling during labor, and posts are written on the delicate balance to strike when calling out misinformation in "failed" lactation stores, and I don't have time to write about any of it because am studying for the IBCLC exam which is happening! on! Monday!

I am anxious. I am taking practice tests and reviewing flashcards. I am reviewing chapters on immunology and jaundice and developmental milestones. I am arguing with the answers on the practice tests. I am carpooling to the exam with some other test-takers and we have already plotted out our route to avoid the main highway because what if a tractor-trailer jackknifes and we are stuck in traffic and OMFG WE MISS THE TEST. As you can see, I am ready for this to be done!

So if you see me posting on this blog or anyone else's in the next few days, tell me to go back to studying! And in the meantime click the links above for some awesomeness...

Michelle Obama on the importance of breastfeeding

From Michelle Obama's speech at the NAACP National Convention, July 12:

And finally, it’s one thing we can think about, is working to make sure that our kids get a healthy start from the beginning, by promoting breastfeeding in our communities. (Applause.) One thing we do know is that babies that are breastfed are less likely to be obese as children, but 40 percent of African American babies are never breastfed at all, not even during the first weeks of their lives.

And we know this isn’t possible or practical for some moms, but we’ve got a WIC program that’s providing new support to low-income moms who want to try so that they get the support they need.

And under the new health care legislation, businesses will now have to accommodate mothers who want to continue breastfeeding once they get back to work. (Applause.) Now, the men, you may not understand how important that is. (Laughter.) But trust me, it’s important to have a place to go.

I also heard recently that Michelle Obama's office has been talking to national breastfeeding organizations about incorporating breastfeeding support/advocacy into their "Let's Move" campaign. So exciting that she is finally talking about this!

Via Blacktating.

Alert, someone is wrong on the Internet!

Some discussion going on in the comments at Science and Sensibility's post on the new meta-analysis of home birth in AJOG. Aaaand I let myself get drawn in. Funny how that happens when I have about six other projects I could be working on. I trace it to a moment of intrigue when one of the commenters stated that the Netherlands has poorer perinatal outcomes than the rest of Europe both at home and in the hospital because there are so many midwives that there isn't enough emergency OB care/neonatal services even in the hospital. All those midwives, taking up space, and just no room for OBs or pediatricians! So I went and looked around for some published evidence on that, and all I found was a BMJ summary of a Dutch government report that recommended, among other things, better emergency OB availability in small community hospitals. I responded pointing out that the U.S. also lacks immediate emergency OB care in many small community hospitals and we can't really attribute that to a surplus of midwives. But heck, maybe this commenter knew something I didn't? Maybe they spent years as a maternity nurse in the Netherlands! Maybe they speak fluent Dutch and this is all over the Dutch perinatal literature! Who knows!

Sadly, the reply to that was basically a lot of name-calling accusing, apparently, all midwives everywhere of being shameful liars. I know, I know. Having (hopefully) extricated myself, I'll slink back to studying for the IBCLC exam. Eleven more days, ack!

In the meantime, if anyone has any actual insights over this whole Dutch emergency OB care thing, I'd be curious to know.

Breastfeeding support for women in the military

Just came across this site: Breastfeeding in Combat Boots. The website and the associated book answer questions like:

o How do I get breastfeeding off to a good start in only six short weeks?

o Can I pump while in the desert for training exercises?

o Is my pump allowed onboard ship?

o Do I need to pump and dump if I’ve been exposed to JP-8?

Questions like "Can I breastfeed while I'm in uniform?" might never occur to someone who's never been associated with the military and even those who are probably don't have a ready answer! If you are a mom on active duty in the military, or someone who works near a base or in a military hospital, take a look - you can even join the discussion on the forums.

Looking back at Centering Pregnancy

Donna at Banned from Baby Showers writes about her excitement that CenteringPregnancy is coming to her area. (You can read a description of Centering in her post, and learn more about the model at the Centering website.) That reminded me that I just finished the last visit for the Centering group I have been co-faciitating and have been wanting to write a post about the experience.

The group I worked with was led by a CNM, and co-facilitated with me and one other volunteer. (Like Donna mentioned, Centering was started by, and is most often facilitated by midwives, and is a great example of a midwifery model of care. However, I do know of family practice docs and OBs in our area who do Centering!) She was fabulous, an experienced Centering facilitator. My first vision of Centering was that a woman would ask a question, and the midwife would answer it so everyone could hear it and learn together. Instead, a woman would ask a question, and the midwife would turn it right around. "Oh, what helps with leg cramps? What's good for leg cramps, everyone? What do you do?" Oftentimes she never even gave her own answer to a question - the group did, finding their own answers and gaining confidence in the process.

She was also a real midwife, not shy about bringing up potentially delicate topics. "I have trouble sleeping," someone would say. She would turn the question back around to the group, and then at the end of all the suggestions she would say "And...sex?" (It was actually a Spanish-speaking group so she would say "Y...el sexo?" which somehow was even funnier). I thought all these shy Hispanic ladies would just turn beet red and clam up - especially in the presence of their boyfriends/husbands - but instead everyone started talking. "But what if you don't want it? What if you do - how much is too much? What if you don't want him to even TOUCH you?" It was pretty funny and great to watch.

I kept wondering, in my didactic mindset, "When are we going to teach about birth?" I was all ready to break out the Childbirth Graphics posters. Instead, the midwife took the group on a hospital tour. She walked them through the halls and we took over a birthing room. We fetched birth balls and had the women try sitting on them. We got a squat bar and the midwife got up on the bed and got one of the women to pretend to catch her baby in different positions. She told us that the nurses know when a Centering mom is checking in because "She asks for a lot of stuff!" We had a reunion visit with another group whose babies were several months old, and they talked about requesting birth balls and how nice they were to labor on. I also discovered that the women in our group didn't know that they could decline to have students in their room, and we talked about the power they had to make decisions over what happened to them in their health care.

The women in the group were lovely. It was a fairly quiet group, but we had some nice discussions (not just about sex!) I did the reminder phone calls for each visit, and they started to recognize my number and answer the phone with "Bueno, Rebecca?" They had a lot of struggles - partners working far away, one deported while the group was happening, trouble finding work, difficulty navigating a new country and an unfamiliar language. But they were always so gracious and appreciative.

At the end of the last visit, we all stood in a circle. The midwife took a ball of yarn and wrapped the end around her wrist. She tossed it to the next person, who had to wrap the yarn around their wrist twice and say an appreciation for the group, or wish for the group. One of the women thanked the facilitators for taking the time to help them, because she felt like most people in the U.S. didn't. Another thanked the midwife for the personal care and attention, and said she was only sorry that this was the first time she was experiencing it, during her last pregnancy. At the end we were all linked by overlapping strings of yarn. We each cut the yarn close to our wrists and tied it up, a little blessing-bracelet from the group.

It was sad to say good-bye! There were a lot of hugs. I'm so excited for each person to have their babies, and to see them at the reunion visit in a couple of months. It really has been such a great experience. I'm already looking for another group to join. (Although another co-faciliator told me "Watch out, Centering can be habit-forming.")

If you can choose Centering care for your pregnancy, I highly encourage it! If you're interested in working with Centering groups, see if there are any in the area that need assistance. The Centering program I've been volunteering with depends hugely on volunteers as co-facilitators - it is based out of a community health center with minimal resources.

And just in case you don't catch this on the Centering website, Centering decreases preterm birth rates and increases breastfeeding rates. All this touchy-feely stuff isn't just touchy-feely - it is evidence-based and improving outcomes. And I really believe based on what I've seen that Centering helps women take control of their health care and be better self-advocates. I hope to write more soon about the Centering module I've been developing on health disparities - but that's another project for another day...

Edited to add: Amy Romano of Science and Sensibility mentioned in the comments that she recently wrote an article for RH Reality Check on how Centering can reduce our infant mortality disparities. Check it out!

Tip of the day

Calculating weight loss of newborns? You can get reaaaally good at doing it on your own: (Birth weight - Current weight) / Birth weight * 100 = % lost. Or you can find a website to do it for you.

The first way can solidify your admittedly weak arithmetic skills. But the second way is so easy!

And that's your tip of the day, and possibly of the week since I have been too busy with work + Fourth of July + life to be posting much. I promise the next installments of my MPH series are in the works!

BBC doesn't believe lack of breastfeeding kills babies in developing countries

Morgan Gallagher, breastfeeding advocate in the UK, writes about how she was kicked off an interview on the BBC world service for saying that formula feeding kills babies in Africa.

Here's an excerpt, when the producer tells her she needs to stop criticizing formula:

...she cut me off and said she understood I was against formula, and pro-breastfeeding, but formula wasn't the issue. I was biased, and they couldn't have that bias on air. I said they had the bias, not me, and this was the World Service, and they had a duty to act globally, and not act as if the whole discussion was taking place in West London. How could they ask a women in KENYA if she would support formula feeding?

It consistently blows my mind how the media is able to cast health effects breastfeeding vs. formula feeding as a matter of opinion even when the discussion is happening re: the developed world. It's beyond belief that the BBC World Service would try to apply this already false construct to the developing world, and would throw off a participant for being willing to say that babies die in the developing world because they are not breastfed. Because, you know, she's "biased". I guess I'm "biased" towards breastfeeding too, particularly for children in the developing world. I am also "biased" towards those children getting food aid, vaccines, and clean water, as those also improve survival rates. Oh, wait - those are considered facts. Strange.

Ugh. Working nights is making me cranky, and this is not helping!