Saturday, September 25, 2010

Take the challenge!

Are you familiar with the Quintessence Breastfeeding Challenge? Organized by the Quintessence Foundation of Canada, this is an international event held every year on the first Saturday in October.

From their website:

Join us to celebrate breastfeeding in a fun “competition” where every child “wins” because they are breastfed!

... This fun event is a challenge for which geographic area (province, state or territory) has the most breastfeeding babies, as a percentage of the birthrate, “latched on” at 11am local time.

Why: To celebrate breastfeeding and milk-banking, and demonstrate promotion, protection and support for breastfeeding women and their families. It’s a chance for education and peer support done in a fun social way.

I have helped coordinate one of these in the past and it was very fun! Our group included one woman who drove several hours from her small, rural town to participate. She was still breastfeeding her toddler and didn't have any friends or social support for breastfeeding locally, much less continuing to nurse her baby long-term. She was so excited to come meet other breastfeeding moms, and we were so excited to meet her. It reinforced for me that these events are a great form of peer support.

If you're interested in participating, think creatively - maybe this could be used as a chance to celebrate WIC participants who are breastfeeding, or as a special occasion for a La Leche League group, or even be done on a hospital postpartum floor (encouraging all the moms to get their babies latched on in their rooms and sharing the final number with them so that they feel part of a shared experience). Or if you're in a small town or don't have the resources to coordinate a big event, you can invite as many nursing women as you know to a smaller get-together at someone's home - it still counts!

If it's a public event, you consider inviting the media to help spread awareness of breastfeeding support programs in your community. To help make it a fun, family-centered event, you can ask local birth/breastfeeding/etc. stores for donations for a raffle/door prizes, and local grocery stores for donations for snacks. Some activities for older kids help too - they can be simple like macaroni necklaces, coloring stations, or bubbles.

Let me know if you or a group you're involved with is doing Quintessence! I'd love to hear about it.

The NY Times on direct-entry midwifery legislation in Illinois

Use of Midwives Rises, Challenging the State to Respond:

Each year, 700 to 1,000 babies are born at home in Illinois, many of them in rural locations, according to the Illinois Department of Vital Health Statistics. Licensed home-birth practitioners work in just 7 of the state’s 102 counties, and most are concentrated in Lake and Cook Counties, leaving the majority of Illinois home births unattended, or attended illegally by someone whose education and licensing are unregulated.

That could change as early as November. After 30 years of trying to get the legislature to license direct-entry midwives, Illinois’s midwifery organizations are guardedly optimistic. In May, the State Senate passed the Home Birth Safety Act. A House vote is pending.

Check out the rest of the article, including their allusion to the fact that not all DEMs want licensure, and a choice quote from the OB/GYN on "natural birth plans". Hey, he's tellin' it like it is!

Wednesday, September 22, 2010

Linky goodness: to VBAC or not to VBAC, birth videos, and more!

Time to clear out the starred posts in my blog reader! Sorry, some of them are a few weeks old but of course, still great:

Robin Marty of RH Reality Check on the many reasons she's choosing an elective repeat c-section over a VBAC attempt.

Birth Sense introduces you to the handsome, charming Dr. Justin Case.

Video of baby born in the caul, via Homebirth: A Midwife Mutiny.

Video of frank breech home birth via Gloria Lemay.

Dou-la-la channels Don Draper in explaining why those nice formula companies are so darned excited about breastfeeding.

Why African Babies Don't Cry, via Blacktating.

Mom's Tinfoil Hat linked to a post on abortion and parental notification laws that, very sadly, is no longer up (the author decided to make posts about her work private - I struggle with walking the same line, and totally understand). However, you can still read an excerpt and a long comment from the author in MomTFH's post.

Not birth-related, but something that really touched me to see today: Dan Savage's It Gets Better Project: a collection of videos of adults telling gay teenagers that high school ends and their lives will improve. Read an interview with Dan Savage here, including the reason he decided to start this project.

Sunday, September 19, 2010

Feminist reading group on pregnancy, birth, and parenting

Molly at First the Egg is starting up a Goodreads-based reading group on pregnancy, birth, and parenting from a feminist perspective. Books she suggests (click through for the full list) are a nice mix including memoirs, social/cultural criticism and academic texts, and a variety of different topics.

I am really excited about this (as you can see from my overenthusiastic suggestion of new titles for the list at every opportunity) and encourage others to join! As I said in my intro post to the group, I don't get a lot of opportunities to talk about this stuff with people in my offline life right now. That's not to say I don't have access to smart people who think critically about these issues, but we tend to be talking more about "how do we get more people to enroll in our study" vs. "hey, let's have a cup of tea and talk about gendered bodies in reproductive spaces". So having an online group for that is something I'm very much looking forward to.

To go directly to the Goodreads group, join, and introduce yourself, just click here.

One man's take on breastfeeding in public

One man objects to public breastfeeding, but not for the reasons you might expect.

Wednesday, September 15, 2010

Take action to support federal funding for community-based doula programs

From Health Connect One (formerly the Chicago Health Connection, which piloted some of the most prominent and impressive models for community-based doula programs!):

"Help ensure continued funding for community-based doulas!
Email your elected officials today

We have received confirmation from staff with Senator Richard J. Durbin and Congressman Jesse L. Jackson Jr. that both Senate and House Appropriation Committee FY11 U.S. DHHS reports include funding for the community-based doula program at its current level of $1.5 million. The Senate Appropriations Committee specific language is as follows: “$93,999,263 for the Special Projects of Regional and National Significance [SPRANS]. Within that total, the Committee recommendation includes sufficient funding to continue the set-asides for oral health, epilepsy, sickle cell, doula programs, and fetal alcohol syndrome at no less than last year's level.” In addition, although the House Appropriations Committee has not released its report, we know the House bill includes funding for doulas.

It is anticipated that after the November elections, a Conference Committee, made up of members of the House and Senate Appropriations Committees, will create a final bill. We need you to contact your Senators and Representatives and encourage them to keep the doula funding in the final bill."

Click here to easily contact all of your reps + the president - it takes all of 3 minutes to write an e-mail and send it along!

"Help! My husband/partner/family doesn't want a doula"

If I had a nickel for every time I heard a mom say, "I would love to have a doula, but my husband [or partner, or mom, or whoever is going to be the primary support person] is against it" - well, I would be a much richer doula! In these situations, unfortunately, their support person's opposition usually wins out over mom's desire for a doula - and more unfortunately, I sometimes hear mom saying later that she regrets letting herself be overruled.

Much of the resistance seems to be based in the idea that the doula will take over the family's role. I think they envision the doula hovering around mom - getting her everything she needs, rubbing her back, talking with her - while her family sits in the corner watching, excluded from being hands-on.

What I try to express to people who envision that is that this is almost NEVER the picture you truly see at a doula-assisted birth - instead, it's what I see happening when I first walk in the room! Mom is often lying in bed, and her family/friends are lined up on the couch watching her like a TV show, wanting to help but not sure what to do; or slightly better, standing next to her as she vocalizes through a contraction but not sure what to say or how to help.

My goal is to change that picture, but not in the way the family is envisioning. In fact, my ideal picture is for the people who love the laboring woman the most to be the ones who are massaging her lower back, who are whispering encouragement in her ear, who she leans on during a contraction; if there's anyone sitting on the couch watching, it's me!

To get to this picture, there are a few key things I do as a doula that I think are so important: first, I help the support people understand what's normal. They may be very anxious about noises mom is making, or the length of labor, or baby's heartrate. I can help them understand that things are going normally, which gives them the space and confidence to reassure the laboring woman and keep her going. It sounds simple, but I think it's absolutely one of the most important things I do. You can watch a dozen birth videos and still find the actual process and presence of labor intimidating; it takes a little while to get comfortable with its rhythms and sounds and, ahem, bodily fluids. Just having a calm, confident presence frees up so much energy that is otherwise in anxiety and helps everyone enjoy the birth experience without fear.

Second, I know the ins and outs of the labor room. I know where the volume control is on the fetal monitor (and that it's perfectly fine to turn it down), where to find the birth balls (and how to get mom onto one without disturbing the monitors and IVs if she can't get them disconnected), how long that fetal monitor really needs to run before she can take it off and start intermittent monitoring (and I'll happily be the one to push the call button and ask the nurse to come in and take mom off).

Third, I remind and reinforce what they may already know. For example, I find more and more that there's some point in labor where I sense that mom needs to get in the tub or shower. She's starting to get totally overwhelmed and I can see incipient panic in the eyes of her support team. Sure, they learned that water can be helpful in labor; it's probably on their birth plan. But in the moment, they just don't think of it. Often, mom is reluctant to try it (remember, she's totally overwhelmed and even walking one step seems impossible), but I encourage her, get the tub all set up, she decides to give it a shot, and... aaaah. She relaxes into the water and gets her second wind. The bathroom is tiny, so her partner kneels by the tub to coach her through contractions and I retreat into the L&D room to just listen in case they need anything. This is often when mom is going through transition and I love getting to facilitate those last intimate moments between the parents before she starts to push and they get ready to meet their baby.

Finally, while I'm happy to sit on the couch and hang out if that's all that's needed, I should add I don't need to be hands-on to be busy as a doula! I can be running down the hall for more ice or to heat up the rice pack or getting snacks for mom/support people; bringing fresh washcloths for mom's forehead; catching medical staff at the door so if they've just come to "check in" I can update them without them having to interrupt the laboring woman's space; searching out birth balls, rocking chairs, squat bars, etc.; plugging and unplugging portable IVs, fetal monitors, etc. if mom is moving around/headed to the bathroom; and on and on. Again, these are things that the other support people might be hesitant to do or not know their way around well enough to do confidently; I can take care of that stuff and free the family up for focusing on mom and baby.

In short, a doula does not and cannot replace a woman's own family and friends - and doesn't want to! She is there to make everyone's experience better. Once your support team understands this, they're usually much more open to having a doula at the birth.

You could also try this quote on them, from an OB-GYN who had a doula at her first birth: "I can't say if having a doula shortened my labor, but it definitely lengthened my marriage!"

Do you have family and/or friends who are planning to be at your birth, but are resistant to the idea of a doula? Here are a few things for them to read to get educated about a doula's role at a birth:

From DONA:

From Penny Simkin, doula extraordinaire: Myths about Dads and Doulas

Written by a dad: 5 Reasons Dads Should Demand a Doula

Do Doulas Replace Dads? includes a nice chart on what kind of support each person in the birthing room provides, and where doulas do and don't overlap.

(I apologize for the heteronormativity of all these links! I have tried in this post to use language that's inclusive of different types of family structures. Hopefully regardless of what label your support people fall under, they can find this information helpful.)

In the end, remind yourself and your support people - this is YOUR birth. Just as you have the right to say that no, your mother-in-law and all your second cousins are NOT welcome in the delivery room - you have the right to say that you WOULD like a doula there. If this is truly important to you, your support people should respect that and work with you to find a doula they feel confident will empower them, and you, during the birth.

Sunday, September 12, 2010

Technically birth-related

I just thought this was so cool:

Evolution in Action: Lizard Moving From Eggs to Live Birth

Evolution has been caught in the act, according to scientists who are decoding how a species of Australian lizard is abandoning egg-laying in favor of live birth.

Along the warm coastal lowlands of New South Wales, the yellow-bellied three-toed skink lays eggs to reproduce. But individuals of the same species living in the state's higher, colder mountains are almost all giving birth to live young.

Only two other modern reptiles—another skink species and a European lizard—use both types of reproduction.

Evolutionary records shows that nearly a hundred reptile lineages have independently made the transition from egg-laying to live birth in the past, and today about 20 percent of all living snakes and lizards give birth to live young only.

But modern reptiles that have live young provide only a single snapshot on a long evolutionary time line, said study co-author James Stewart, a biologist at East Tennessee State University. The dual behavior of the yellow-bellied three-toed skink therefore offers scientists a rare opportunity.

"By studying differences among populations that are in different stages of this process, you can begin to put together what looks like the transition from one [birth style] to the other."

Thursday, September 9, 2010

What makes a doula "experienced"?

I was talking with someone at a party last weekend who is in the midst of interviewing doulas. (Yes, I was voted "Most likely to talk about childbirth at a party" by my MCH cohort - what of it?) She wanted someone who was "experienced" and asked me how many births I thought made someone experienced. I was brought up short - truth to tell, I wasn't really sure. I thought well, I consider myself experienced - how many births have I been to? How many did it take before I felt more "experienced"?

I had kind of been losing track of the number of births I'd been to - I had them all recorded in one place or another, but hadn't been keeping a running total like I used to. I keep saying "oh, probably around 45" so I finally sat down and totaled them all up the other day. My accounting may still not be exact, but it looks like I've attended 42 births at this point.

So, 42: not bad at all - and I'm proud that those were a very diverse group of births: high- and low-risk, women from all backgrounds, with all kinds of birth plans (or no plan at all), with a range of different providers and settings. So I feel "experienced".

And yet I know I learn something new at every birth, and almost always think of something I wish I had done different; and I also know doulas who have attended hundreds of births. So maybe I'm only medium-experienced? And so how can I say exactly when I did cross the line from "novice" to "medium-experienced"? Ten births? Fifteen? Twenty?

On top of that, did I become a "better" doula when I became more "experienced"? Certainly my comfort and confidence have increased the more I've done this work, and I hope that both my greater confidence along with my growing knowledge and skills have helped my clients. But when so much of attending births as a doula has to do with "being" instead of "doing", there may not be that big a gap between me as a novice doula and me as an experienced doula as I think.

What do you think? Is an experienced doula important to you? Doulas, what differences do you see between your novice self and your more experienced self? Do you think there are any special strengths of being a novice doula at births?

Sunday, September 5, 2010

US Dept. of Labor offers guidelines on break time for nursing mothers

The U.S. Department of Labor's Wage and Hour Division has a fact sheet out for employers and employees, explaining more about the break time for pumping mandated in the health care reform law. Here's an excerpt on the space requirements:

Employers are required to provide a reasonable amount of break time to express milk as frequently as needed by the nursing mother. The frequency of breaks needed to express milk as well as the duration of each break will likely vary.

A bathroom, even if private, is not a permissible location under the Act. The location provided must be functional as a space for expressing breast milk. If the space is not dedicated to the nursing mother's use, it must be available when needed in order to meet the statutory requirement. A space temporarily created or converted into a space for expressing milk or made available when needed by the nursing mother is sufficient provided that the space is shielded from view, and free from any intrusion from co-workers and the public.

Read the rest here.

Saturday, September 4, 2010

Score another one for the big babies!

I haven't had a lot of doula/birthy posts lately, probably not enough to justify the name of this blog! That's in part because I hadn't been to any births recently. But the past few weeks I've been waiting on two births, due about a week apart but of course delivered only about 24 hours apart. So it's been busy!

The second labor was definitely another score for the big babies. Fast labor, basically no pushing - more breathing the baby down while trying NOT to push (I was a little concerned baby might be born in the car, but I have yet to hit that doula milestone!) - and fast delivery. Well over nine pounds! The midwife said the shoulders were a little sticky but because mom was already on hands and knees (which she chose instinctively for labor and pushing), it all went very smoothly.

Let me say it again: Big babies can be born vaginally! They can be born quickly! They can be born easily! Don't trust scare tactics about a big baby - read the research, and hear the positive stories.

So now I am coming down off my post-two-births high and thankful to go off call for a little while. I know I'll start jonesing to attend another birth soon!

Wednesday, September 1, 2010

Fewer Swedish babies breastfed, still way more Swedish babies breastfed than American babies

Every so often...okay, not often, but once in a blue Swedish skills come in handy. And today I got the chance to put them to use, reading this report from the Swedish government on changes in breastfeeding rates from 2004 to 2008. While their recent decreases in breastfeeding are a problem (drops of more than 4% for some indicators) I was also struck by how insanely high most of their numbers seem to someone from the U.S.:

Exclusive breastfeeding at 1 week: 85% (down 4.3% from 2004)
Partial breastfeeding at 1 week: 12% (up 3.5% from 2004 - so there seems to be more early supplementation going on)
Adding these up, only about 3% of babies at one week are exclusively formula fed

Contrast this to the U.S. where over a quarter of infants are supplemented with formula before 2 days.

The drop becomes more pronounced the older children are (makes sense with an increase in early supplementation). At 6 months, 66.5% children are still exclusively or partially breastfed, down 6% from 2004. (But still, compare to 43% in the U.S.)

The one data point I found contradicting this pattern was breastfeeding to a year. While this report doesn't give national numbers, it notes that any breastfeeding at 12 months ranged from 11-22% in different regions of the country. That actually compares favorably in the U.S. with about 22% of babies being breastfed at 12 months here. It seems counterintuitive, given that one of the great supports Sweden gives to nursing mothers is their year of "mammaledig" - maternity leave. It makes me want to ask my Swedish friends more about how long they planned to breastfeed and when the cultural expectation is that they'll wean.

The researchers note that they don't know why breastfeeding is decreasing, because it hasn't been studied yet in relation to social and demographic factors. I've heard that "pappaledig" - paternity leave - has been increasing in popularity and fathers are increasingly taking a larger share of the time off. Could this be a contributor? Again, I'll have to investigate...