Thursday, March 24, 2011

Breastfeeding and Feminism, Day 2 (...2 weeks later)

My Lent resolution has apparently not yet translated into more posting! A few factors have contributed to that, among them my new full-time job(!) I have gone from per diem at the hospital working 24ish hours a week, to full-time working 36 hours a week (three 12-hour night shifts). Going from working 8-hour shifts to 12-hour shifts is a surprisingly big adjustment (although fortunately not as big an adjustment as beginning to work nights was.) There are drawbacks to my new schedule (less flexibility, losing several evenings, etc.) but the benefits are, well, the benefits! Apart from my grad school assistantships, I haven't had a job with health insurance since I was in AmeriCorps. I am looking forward to having good health insurance, along with retirement benefits. One of my goals in going to grad school was to finally get a "real" job with salary + benefits, and while it didn't happen in exactly the field I expected it to, I couldn't be more pleased (except for the part where I work nights. Hopefully someday I'll work days again!)

Now that I've made my excuses, long-delayed highlights from the second day of the Breastfeeding & Feminism conference:

* Possibly my favorite presentation of the day was Robbie Davis-Floyd's report on the International MotherBaby Childbirth Initiative. Based on the Baby-Friendly initiative, the IMBCI has outlined 10 Steps to optimal motherbaby maternity services, developed with the input of organizations around the world. Steps include treating every woman with respect and dignity, offering continuous labor support, providing evidence-based practices, and providing access to emergency OB care. Three sites have applied and been accepted to become demonstration sites, one each in Austria, Brazil, and Quebec, Canada. You can read more about the (very diverse!) demonstration sites here. She discussed more about the sites and more details of their applications. She also talked about sites that will be added soon, in South Africa, Mozambique, India, and - amazingly - the largest maternity hospital in the Philippines, which does 22,000 births a year (I cannot even imagine). It's inspirational to see institutions from countries with different levels of development and each with their own unique strengths and challenges, working on the aim of improving maternity care. I am so excited to see ow the demonstration projects go.

* Michelle Lauria, an OB-GYN from Dartmouth, gave a great talk on reducing late preterm birth, a project of the Northern New England Perinatal Quality Improvement Network. She also talked about eliminating elective inductions before 39 weeks, and in mothers who do not have a high enough Bishop's score. She said the key is to put power in the hands of the nursing staff with the hospital authorities backing them up; the doctors know if they send someone in for an induction who does not meet the guidelines, the charge nurse will send them right back home. She talked about the next step being setting stricter guidelines on ways that some doctors use to get around the restrictions; she gave the example of mildly elevated blood pressures without proteinuria being called pre-eclampsia and used as a reason to induce early.

She also discussed VBAC at some length. Her take on it was, in her region, it's all about the money - as in, medical malpractice insurance costs. In northern New England, which has a lot of isolated rural communities, she gave an example of a small regional hospital that wants to offer VBACs but would have to pay $120,000 more in malpractice insurance to do so. Given that they anticipate 2 VBACs a year, they would end up paying an extra $60,000 per VBAC. Her proposed solutions are both governmental: either medical malpractice reform of some kind, or for the government to coordinate regional VBAC centers. There would be one hospital in each region designated as the VBAC center, and all the other maternity hospitals would contribute towards the VBAC center's additional malpractice insurance. She considers this unrealistic without government intervention because of the nature of competition between hospitals.

* Beverly Rossman from Rush in Chicago did a very inspiring presentation on breastfeeding peer counselors in the NICU. The NICU breastfeeding peer counselors are truly peers - they are women who have personal breastfeeding experience with very low birthweight (VLBW) babies. She summarized some themes from qualitative interviews from mothers who worked with the peer counselors: instrumental support, emotional support, finding hope, empowerment, community, and emulation. Over and over again the interviewees talked about how much they identified with the peer counselors, how much hope they drew from seeing mothers who had been in their situation, and how important the emotional support was. It left me wanting a breastfeeding peer counselor program in our NICU so badly! (If you'd like to learn more and you have access to the Journal of Human Lactation, you can check out their journal article. Citation: Rossman, Meier, Engstrom, Verheed, Norr & Hill. "They've Walked in My Shoes": Mothers of Very Low Birth Weight Infants and Their Experiences with Breastfeeding Peer Counselors in the Neonatal Intensive Care Unit. JHL. 2011. 27(1):14-24.)

It was a great conferences with some great conversation! It was hard to choose between the CIMS and the BF & Feminism tracks sometimes because there was so much interesting stuff going on, but I'm glad they combined the conferences for the opportunity to pick and choose from both programs.

Sadly, I won't be able to go to the CLPP Reproductive Justice conference this year. Please, everyone who's going tell me all about it! I am determined to go next year.

Friday, March 11, 2011

Breastfeeding & Feminism: Day 1

I really need to take more notes at these things! So here are a few notes pulled out of my very scattered information overloaded brain:

- Eugene Declercq gave a great keynote on statistical trends in C-sections, VBAC, and other birth-related stuff. One of the most interesting sections was on homebirth. Still very tiny numbers, so hard to identify a definite overall upward trend, but it seems to be on the rise. He then broke the trends out by race, and that was fascinating: homebirth rates were the same or dropping for all races except for white women, who are clearly seeing an uptick. He reports that in the latest stats, 1% of all births to white women happened at home. That seemed high to me, but apparently that's what the statistics are telling us. I am not at all surprised, however, by the disparity.

- Bettina Lauf Forbes and Danielle Rigg of Best for Babes spoke about reframing breastfeeding, including how much they dislike the phrase "protect, promote, and support breastfeeding" - they want to replace it with "inspire, prepare, and empower moms". They really have a marketing mindset of helping introduce moms to breastfeeding via common consumer culture avenues like celebrity profiles, then help educate them on avoiding the "booby traps". As they pointed out, we have very high BF intention rates - we need to help moms achieve their personal goals!

- Keren Epstein-Gilboa, who came all the way from Canada, gave a really dynamic talk on breastfeeding and envy. She first had us imagine something that we really, really wanted - a job, a person, a house, whatever - and say how it made us felt. (Great!) Then we had to think about how we couldn't have it - and how that made us feel. (Well, pretty crappy.) Now how did we feel about that thing, and the person who had that thing instead of us? We often tell ourselves we didn't want it anyway, or that it really isn't that great, or we try to break it into parts. She used that introduction to discuss her research on the relationship of fathers to breastfeeding, and how different societies treat mothers and by extension how they treat breastfeeding, and also what it means for women who try to breastfeeding and aren't able to. I only wish she'd had more than 15 minutes!

That's all for now - I've got to start recharging my brain for tomorrow...

Wednesday, March 9, 2011

Upcoming plans

So last year, I gave up Facebook for Lent, deciding I was letting it suck too much of my time. It was a surprisingly scary thing to do at the beginning! I really, honestly found myself getting kind of anxious when the time came to log out for the last time. And then...yeah, it was totally fine. I kind of forgot it existed, and when the time came for me to get back on I would go days before remembering to log in again. It was nice!

Of course, since then my usage has crept up again and realizing Lent was coming up, I thought about it and decided to take another Facebook break this year. Along with an even scarier one... blog reading. I do love Google Reader... maybe a little too much. I find myself spending hours consuming and clicking and reading and thinking, which is all well and good, but can spiral into way too much time, and in the meantime I'll "star" a dozen more to go back and read in more depth, or as inspiration for a post of my own, etcetera and those just pile up. The productivity scale goes way down the farther I get sucked in. You all know how it is, right? This just seemed like a good opportunity to give it a break and see what else I can do with that time.

So if I'm a regular commenter on your blog and am quiet for the next, oh, 40 days or so - you have your explanation! And while I am giving up blog reading, I'm not giving up blog writing and in fact hoping that this break gives me more time to work on posts I've been letting sit for a long time. Hopefully you'll see a little more content here!

In non-Internet-related news (although hopefully a post-generating activity) I will be going to the Breastfeeding and Feminism/CIMS conference this Friday and Saturday. Very excited! Anyone else planning to go?

I am still thinking about attending the CLPP Reproductive Justice conference in April. I am really hoping to be able to go. I can't say enough good things about this conference - each time I've gone has been a fantastic experience. If I make it, I'll definitely be posting here about it!

That's all for tonight...just posted my Facebook farewell and am ready to begin my Internet fast!

Saturday, March 5, 2011

"I would juggle speculums if they asked"

Do yourself a favor and read this long, funny, and compelling article by an abortion-provider-in-training. Some of my favorite excerpts:

It all breaks down to this: no one is immune to mistakes, whether it’s a mistake of their own making or (more likely) an end effect of the system, especially our fucked-up broken medical system I hate representing. (Sorry, system! Had to say it.) If you think I am making too many excuses for my patients, I will let you know that I am often one of the first people to make excuses for them in their lives and am happy to do so for no fee whatsoever. I would juggle speculums if they asked. I have not yet been asked to do this.


Up until recently I’d come out of any closet I found myself in — queer, non-monogamous, I fucking love Tool still, whatever — not that I live to hear the drink-choking sound, but because, to me, coming out was just one of the ways I could pay back the privileges that had been arbitrarily bestowed upon me (educated! white-appearing! “normal!”). My responsibility to normalize as much as I could. But training as an abortion provider is the first thing in my life that I hold back on spilling about. At the core of it, there’s a huge gap between saying “I had one” and saying “I do them.” I don’t want to alienate people. And nothing else I’ve ever done or been has felt like a direct invitation to a motivated someone out there to kill me and get away with it.


I speak of my abortion as a positive experience, not to secure the “most awesome abortion” prize (hello judges…?) but to save a seat for the possibility that this doesn’t have to be the worst thing that ever happened to you in your whole life. I don’t want it to in any way represent anyone else’s experience or make them feel disavowed of their own. So let me say: this is my personal experience with abortion! It was positive in every respect. It made me want to help other people also have as positive an experience as possible, so I went into the business. If you think that’s a bullshit line, or it makes you uncomfortable to think about abortion as something that could possibly be positive for a person, think of why you're a person who doesn't want someone to do the best that they can under the circumstances they're in.

If you read the whole thing, you'll learn about how she handles pro-life patients who come for abortions, her interaction with a female soldier who had to fly back from Afghanistan for an abortion, and her reflections on the distinction the law makes between MDs and advanced nurse-practitioners, just for this one fairly simple procedure. I am blown away by her compassion and courage. Please read it!

I found this post through my friend Melissa's new blog in the Feministing community. Melissa comments:

Approaching reproductive justice from a position of love and respect for women means that we recognize the varied experiences women have. Certainly, abortion is a difficult and even harrowing choice for some. But for others, abortion is a positive move forward on their journey to being the person, the partner, or the mother they want to become. If we ignore the positive experiences of those women, we’re adding to the stigma of abortion. To put it simply, although no woman wants an abortion, not every abortion is a tragedy.

Keep an eye out for more posts by Melissa! She is awesome.

Choosing and getting into MPH programs: Part 5: Getting funded

At long last, the conclusion to my MPH series! I hope it has been helpful to people out there. Here's the full list of the series:

Part 1: Should you even get an MPH?
Part 2: What is a Master's in Public Health, anyway?
Part 3: Which MPH program(s) should you apply to?
Part 4: Getting in

So! Getting funded.

There are, as far as I can tell, the following ways to get funded for your MPH:
1) Loans (federal or private). Obviously, these are the least preferable as you will have to pay them back!
2) Grants: the school pays part of your tuition, and you are not obliged to pay them back.
3) Assistantships/fellowships/etc.: these come under several different names, but you are generally employed by the university - doing something like working on a research project, assisting professors, TAing classes - and in return get some or all of your tuition paid for. Sometimes these also come with a monthly stipend.
4) Outside fellowships/scholarships: Funding you apply for completely independently of the university
5) Tuition assistance as an employee of the university: Many schools will let employees take one free course a semester, and/or offer a discount for classes
6) Tuition assistance as an employee of a lovely, generous outside company: Some companies/organizations will pay for their employees to take classes or pursue a particular degree that is relevant to their workplace

(Does anyone have other sources to add to this list?)

So how do you sort this all out and figure out how YOU will pay for school?

Again, I'll tell you a little story to start. When I applied to schools, I basically figured nobody would offer me a full ride, and nobody would offer me zero aid at all - they would all offer me some variable amount of aid. I also figured I had relatively little control over whether or not I got said aid.

Come decision-time, I discovered that what I thought was my first choice was offering me basically nothing. They just deducted the expected family contribution from their tuition, and offered me the rest in loans. That really dampened my enthusiasm, along with a campus visit that made me realize this wasn't really the ideal program I'd thought it would be. On the heels of that realization I got an offer from another school for a full fellowship my first year, with the possibility of finding more funding my second. I then visited the school that had been my second choice, had great interactions with some faculty there, told them about my full-funding offer from the other school, and they offered me what amounted to a third of their tuition in grants - the rest I would still need to cover or take out loans for.

So, so much for my ideas that I would get all the same funding offers and had no control over the process! I basically lucked my way into a great situation, despite having started the process with a lot of misconceptions. (If you're wondering what the end of the story is - I weighed my options with no small amount of agonizing, and ended up taking the fellowship. And I've never regretted it!) So let's talk about a few things I learned:

You do have control in some situations - and if you don't, you should find out.

At What-I-Thought-Was-My-First-Choice, I talked with a faculty member, with the administrative director of the program I was applying to, and with a financial aid officer. I also talked to a student there I happened to know. Everyone told me the same thing: you can only avoid paying full price if you find a position as a full-time employee, and go to school part-time using your employee tuition remission. There were literally hundreds of applications for every posted position. I had very little control in that situation! I was not one of the people at their accepted students day still asking about how to get funding - I already knew the score.

Talk with students, administrators, and faculty realistically to get an honest assessment of whether this program could be affordable for you. Even if you don't have control, at least you'll know about it.

At Second-Choice, I had more control than I realized. By meeting with faculty and expressing my enthusiasm for their program and talking to them about my other offer, I was able to get an offer of more grants - although still not what I would have liked.

If you get competing offers, let the other schools know diplomatically, while letting them know how much you'd like to be able to attend their program.

At Where-I-Ended-Up-Going, I had way more control than I realized until I got to campus. I had a fellowship that gave me tuition remission + a stipend, but other students had assistantships that gave them the same thing, and they had come to campus to meet with faculty and network for assistantships before they were even accepted. Knowing I would need something for my second year, I did the same and my fantastic advisor helped me find an assistantship for my second year.

At our school, not everyone was promised an assistantship, and the positions weren't generally posted - your advisor might talk to somebody who had one to offer, or you might hear from a friend that she was quitting hers for a different position. Networking was a necessity! At a couple other schools I applied to, they more or less said upfront that they would help anyone who wanted an assistantship find one.

Again, talk to faculty, students, and administrators to find out how you can get funding, and network, network, network! I told everyone I talked to at the end of my first year that I was looking for funding. Don't be shy!

Continuing in the networking theme, look for funding sources outside your department. If you speak German, a TAship in the German department could get you just as much tuition remission as one in the MPH program. If your school offers employee tuition assistance, working for the admissions office full-time won't get you through school as quickly, but it could mean a lot of $$ saved.

If you'd like to try to get funding from an outside source, many schools have a listserv that lists opportunities for outside fellowships and funding you can apply for. Also keep an eye out for programs that the university administers, but come from outside sources: I could kick myself for not applying to the Foreign Language Area Studies Program.

Important consideration for public universities: It's important to find out who can be considered a resident for tuition purposes, and how to establish your residency. Some states are huge sticklers - you have to be living there for many years before you can be a resident and provide signed proof from your landlord, your great-grandmother, and God. Some are much more relaxed, with shorter terms and less proof needed. The difference between in-state and out-of-state can be huge, so investigate this carefully. (Also check to see if the new state has an education compact with your home state, where the states agree to offer in-state tuition reciprocally to each other's residents.)

Finally, be realistic about where this program will get you financially and what you're able to pay back if you'll need to take out loans. I found the NY Times article Is Law School a Losing Game?, to be great reading for anyone considering any type of graduate school. Here's an excerpt:

Compared with the life he left four years ago, he has lost ground. That research position in Newark, he figures, would pay him $60,000 a year now, with benefits. Instead, he’s vying with a crowd for jobs that pay at rates just a little higher, but that last only a few weeks at a time, with no benefits. And he’s a quarter-million dollars in the hole.

At least no MPH will put you a quarter-million dollars in debt! But let's be real: we're not in a good economy right now. Think carefully about whether graduate school will put you in a better situation - financially, career-wise, health-and-happiness-wise - before you commit to the debt it can entail. Don't just ignore a lower-cost program that you love less. I loved What-I-Thought-Was-My-First-Choice; then I loved Second-Choice; I was really unsure about Where-I-Ended-Up-Going. I finally made the decision by saying to myself, "Any school you go to, some parts of it are going to make you pissed off or seem useless or that you just hate. You might as well hate them for free." Like I said, I've never regretted that choice! (Just to clarify, I ended up liking my program just fine, but there were of course parts that drove me nuts.)

This concludes my extremely long-drawn-out series! I hope it's been helpful to people out there (and continues to be). (If you're thinking about e-mailing me with questions, please read through the whole series to see if I've already answered them.)

Best of luck with your MPH journey!

Wednesday, March 2, 2011

Happy IBCLC Day!

Happy IBCLC Day! Since I didn't get around to be preparing a post, I'm throwing another breastfeeding-theme link party:

* Dou-la-la on loving her IBCLC, finding a good one, and why we need them.

* More about telling the real IBCLCs from the not-so-real.

* ILCA has an appreciation certificate to give to your favorite IBCLC.

* An IBCLC shares her personal story of overcoming challenges breastfeeding a baby with Kabuki syndrome.

Many mothers are talking today about how grateful they are for the IBCLCs who helped them feed their babies. I have a bit of a different take: I want to reiterate my gratitude for the IBCLCs who are stepping up to help train the next generation -- especially the ones who inspired and trained me, and continue to teach me every time I work with them. Without them, I could never have achieved my dream and I am so grateful!