tag:blogger.com,1999:blog-51865977471410681052024-03-05T07:57:59.845-05:00Public Health DoulaDoula, master's of public health graduate, new IBCLC, and feminist. I'm reflecting on my studies, reflecting on other people's studies, posting news, telling stories, and inviting discussion on reproductive health from birth control to birth to bra fitting.Rebeccahttp://www.blogger.com/profile/02589949170980959443noreply@blogger.comBlogger378125tag:blogger.com,1999:blog-5186597747141068105.post-31933122631401364152013-04-29T19:36:00.001-04:002013-06-19T03:43:35.187-04:00The nursery: DON'T forget to ask these important questionsAttending more births at various hospitals, and working in a postpartum hospital setting for several years now, has gotten me fired up lately on the topic of the nursery (and postpartum floor in general) as pretty darn important in terms of your "birth" experience. Postpartum recovery and breastfeeding are important parts of birth (and the reproductive life cycle in general), and the policies and practices at hospitals can vary as widely in the postpartum setting as they do in labor & delivery. Most people will spend more time - sometimes 2-4 times as long - on the postpartum floor, yet most lists of questions patients are encouraged to ask are largely limited to the portion of their time in L&D.<br />
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That includes, I admit, the resources in <a href="http://phdoula.blogspot.com/2011/01/doulas-first-time-mama-advice-kit.html">my own advice kit</a>. Even the questions that are suggested - "are babies given formula routinely?" - your obstetrician and even your midwife are very unlikely to have a clue about. Doulas are aware of, and often frustrated by, differences between nurseries, but I think even we don't see the full impact because we usually leave a few hours after birth. But I am starting to really bring it up when I talk to prospective doula clients or anyone who is thinking about where to give birth. When two hospitals seem equal on the L&D side, what happens after birth can really tip the balance.<br />
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DO NOT assume that a touchy-feely, midwife-friendly, natural birth-heaven L&D floor translates into great postpartum and breastfeeding support. They are usually totally different floors with different managers, policies, doctors, and cultures. A hospital in a city where I used to work has one of the absolute best reputations for L&D in the doula community - but a negative reputation for the postpartum floors. Among other issues, this hospital refused to hire lactation consultants because "all of our nurses are trained in breastfeeding support". People would come out of there complaining "everyone told me something different" and end up with really difficult breastfeeding experiences. Especially sad because so many of those moms had gone in so committed!<br />
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Why is this so important? How different can postpartum policies be, really? Here are some questions that suggest how nursery routines can have a real impact on the postpartum experience and breastfeeding. They are too detailed to be useful questions for everyone to ask - don't worry, I'll go over more practical questions later - instead, they are here to illustrate things that can make a big difference, but which few parents contemplate:<br />
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1) <b>Admission: </b>How quickly do the nursery nurses come to do the admissions? Within 20 minutes? Within an hour? How good are they about keeping the baby skin-to-skin AFTER the initial meet-and-greet with mom, or how pushy are they about getting their tasks done? How much stuff do they pack into the first session (are we seriously getting footprints before the baby has eaten?)<br />
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2) <b>Routine separation: </b>Is there routine separation of mother and infant for any reason? Car seat test, hearing test, circumcision, blood draws, exams? What about after a c-section? What about after a planned c-section?<br />
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3) <b>Late preterm infants: </b>What is the routine for a baby that comes between 34-37 weeks, also known as late preterm? Especially for the 36 weekers - are they routinely taken to the special care nursery even if they are doing well? On the other hand, are the babies that stay in regular postpartum given extra care and support, and are they held long enough before discharge to ensure they are feeding well?<br />
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4) <b>Blood sugar testing: </b>What is the protocol for testing babies' blood sugar? Is it tested routinely for all infants? Is it tested only for babies considered at higher risk, and if so, which babies are those (large for gestational age, small for gestational age, infants of diabetic mothers, etc. - what about a mother who is not diabetic who just happens to have a large baby?) What is the "cut-off" where the blood sugar is considered to be low - 45? 40? 35? Are babies allowed to breastfeed before being supplemented for low blood sugar? Does the hospital have donor milk available for supplementation?<br />
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5) <b>Baths:</b> When is the baby bathed? Within an hour of birth? After a delay of 6 or 12 hours? What about unstable babies - those with blood sugar issues, or late preterm babies, or breathing troubles - are their baths delayed until they are more stable?<br />
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6) <b>Lactation:</b> When are lactation consultants available? Days, evenings, nights? Weekends, holidays? Are they International Board-Certified Lactation Consultants (IBCLCs), the gold standard for lactation support, or are they RNs with other certifications? Are they dedicated to providing lactation support, or are they also RNs with their own assigned patient loads? What is the ratio of IBCLCs to patients - can you expect to see one every day, or only the day of discharge, or only if you verbalize to your nurse that you are having trouble? Are you guaranteed to see one? What training do the nurses have in providing lactation support?<br />
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Do these questions make a big difference? Let's draw an illustration of two nurseries:<br />
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<b>Hospital A:</b> Hospital A does not allow babies to stay with the parents after a planned c-section. They may greet and hold the baby for a few minutes, then it is taken for observation in the nursery. Stable late preterm babies are also held in the NICU for 12 hours before being allowed to room-in, but may be discharged after 24 hours if they are still stable. Babies do 20-30 minutes of skin-to-skin with mom after vaginal deliveries, then all babies are bathed within an hour of birth, whether or not they are in distress, and they are also weighed, measured, and footprinted. Their blood sugar is tested. Any baby with a blood sugar of 45 or lower is supplemented with formula to bring their sugar up. Hospital A trains all of its nurses in lactation, but only has lactation consultants available in the mornings, on weekdays - the nurses are expected to take care of most of their patients' breastfeeding support needs (while also taking care of 4-8 patients a shift). All tests and the pediatricians' exams are done in the nursery, so babies generally spend 2-4 hours a day in the nursery, where they are bottle fed formula if they get hungry.<br />
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Have you given birth in a hospital like this? I'm pretty sure thousands of people have!<br />
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<b>Hospital B: </b>Hospital B does skin-to-skin routinely in the OR after a c-section as long as the baby is stable, and the baby stays with the parents throughout recovery. All rooms are "LDRP" where the family stays in the same room throughout labor, delivery, recovery, and postpartum, so they do not have to move. Stable late preterm babies may stay with the parents, but are held an extra day past normal discharge to ensure they are doing well. Babies do unrestricted skin-to-skin after all vaginal deliveries, are are only moved after they have at least attempted to breastfeed, or if mom requests it. Admission procedures are done 1-2 hours after birth. Baths are done after a minimum of 12 hours to allow the baby to stabilize its temperature, and are held longer if the baby is unstable. Only babies at high risk have blood sugar tests. There is no nursery - parents room-in with babies 24 hours a day, and all tests and exams are done in the room. Lactation consultants are available every day until 7 p.m. and see every patient at least once before discharge. Hospital B is also training all of its nurses in lactation, with the goal of becoming Baby-Friendly.<br />
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Not many people get to give birth in a hospital like this - but I think almost all my doula clients, given the choice between the two nurseries, would like to be at Hospital B.<br />
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However, while you can start to get information and clues about how your OB or midwife practices, and by extension what the L&D may be like, all throughout prenatal care, you DON'T get the same experience of what postpartum will be like. It can be hard/impossible to find a pediatrician who you like with privileges at the hospital where you want to give birth; even then your pediatrician can only do so much to modify standard procedures based on your wishes, and can't wave their magic wand to make lactation consultants appear when you need them.<br />
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How CAN you get a feel for what the nursery is like? If your pediatrician does work at a hospital you want to know about, they are a good place to start. Even if they don't know about or can't control all the issues you bring up, it's useful for them to know what is influencing their patients' choices about where to go.<br />
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The next place to ask questions is the hospital tour. This is most informative if it's given by a member of the hospital staff, less likely to have much detail if it's given by volunteers who don't work there - but again, it's good for them to hear what matters to patients.<br />
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Next, and possibly most useful, is of course - your friendly local doulas. Doulas see some and hear more about what our clients experience in the postpartum setting. We will not be shy about telling you what we think - but you need to ask, and let us know that you want an honest answer.<br />
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So what questions SHOULD you be asking all these people? Here are my suggestions - additions and revisions gladly accepted:<br />
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<b>For all parents</b><br />
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<b>1) </b>What is your policy on skin-to-skin after birth? If the baby and I are stable, is there any time limit on how long we can stay that way before they have to be checked?<br />
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<b>2) </b>When do you do the first bath? What if my baby is breathing a little fast or has low blood sugar, do they still get their bath then? Can we decline a bath? (you can always decline a bath - but if they say "no" you know you're working with less-than-flexible people)<br />
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<b>3) </b>What are the reasons you take babies to the nursery? Which tests and exams are done there, and which are done in my room?<br />
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<b>4) </b>Do you ever give breastfed babies formula for any reason? What about water or sugar water? Would you ask my permission before doing this?<br />
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<b>5) </b>Are there lactation consultants available? How many times can I expect to see one? What about if it's the weekend? What kind of training do nurses have to help with breastfeeding? Is the hospital Baby-Friendly or planning to become Baby-Friendly?<br />
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<b>6) </b>Do all babies have their blood sugar tested routinely? <br />
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<b>For diabetic mothers, or women with a history of large babies</b><br />
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<b>1) </b>How often will you test my baby's blood sugar after birth (or will you test it if my baby is above a certain weight)? How long will it continue to be tested?<br />
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<b>2) </b>What is the cut-off for when blood sugar is considered to be low? Can I breastfeed to try to bring it up before deciding to supplement?<br />
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<b>3) </b>If the baby needs supplementation, do you have donor milk available? Can you help me spoon or cup feed or use a supplemental nursing system at the breast so the baby does not get confused between breast and bottle?<br />
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<b>4) </b>Can I pump or hand express colostrum before my baby's birth, freeze it, and bring it in to use in case my baby needs to be supplemented?<br />
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What to do with this information?<br />
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First of all, use the information you gather to inform your decisions about where to give birth. You might be considering two hospitals that both have L&D environments you like, but when you add the postpartum piece to the balance it really swings the decision one way. If possible, write a letter to the hospital you are leaving or deciding against and let them know what swayed your decision. If you can, definitely write a letter of praise to the hospital you chose and let you know what made you happy about your care!<br />
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Second, prepare. This lets you know what you may be up against in terms of routines at whatever hospital you choose. If the hospital routinely supplements babies in the nursery, keep your baby with you as much as possible and make a sign for the crib that says "No bottles!" for the times that you are apart. Or maybe you'll find out that you need to be extra-pushy about getting your skin-to-skin time - you can ask your support people to try to head off the nurse for you and protect your space.<br />
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If you have really important and pressing issues with the answers to these questions, the place to go is the nurse manager. You can't sit down and ask them your list of questions, or take up small issues with them. But if you know you will be having a c-section, and everyone you talk to shrugs and says "It's our policy to take the baby straight to the nursery for 6 hours even if you want the baby to stay with you" - you need to speak with the person who signs off on the policies. Ask to speak with the nurse manager of L&D and/or the nursery. Take your concerns to them as an informed consumer and someone with options - especially for a planned c-section, you can easily take your business elsewhere.<br />
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What about your birth plan? The postpartum experience generally does not get covered in most birth plans. A good, simple birth plan usually says something like "We plan to exclusively breastfeed, and we do not want to be separated from the baby; if the baby is separated from us for any reason [partner/family member name] would like to accompany the baby at all times". This is fine.<br />
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If you have very specific desires/needs, you can write out something VERY brief for your postpartum nurse. For example (for a diabetic mom): "Thank you for taking care of us! We appreciate your support while we are learning to take care of our baby. We are planning to exclusively breastfeed - please no bottles or pacifiers for any reason without discussing with us first. We know that our baby's blood sugar will be checked for the first 24 hours and have discussed it with pediatrician Dr. _____. If breastfeeding does not bring up a low blood sugar, we are OK with using formula but would like to give it in a cup."<br />
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Finally, remember as you are asking these questions and making these requests that you are doing it NOT just for yourself and your baby - but for the people who come after you. When hospitals see that these issues are becoming important to their consumers - their patients - they start to shift, however slowly it may happen. Just by asking, you make a difference!Rebeccahttp://www.blogger.com/profile/02589949170980959443noreply@blogger.com5tag:blogger.com,1999:blog-5186597747141068105.post-42031243956933851592013-01-05T08:00:00.000-05:002013-01-05T08:00:08.121-05:00Happy New Year & links party! ...of randomnessCulled at will from my starred posts in Google Reader...there are so many. So, so many.<br />
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* I loved this post about <a href="http://lactationmatters.org/2012/11/01/a-day-in-the-life-of-breastfeeding-support-and-promotion-in-public-health-3/">A day in the life of breastfeeding support and promotion in public health</a>. Pretty much exactly what I would love to end up doing someday (maybe with a little bit more clinical work mixed in). <br />
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* This was a lovely reflection on <a href="http://bfmed.wordpress.com/2012/10/16/how-a-surgeon-ended-up-in-abm/" style="-webkit-touch-callout: none;">how a surgeon ended up in the Academy of Breastfeeding Medicine.</a></div>
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* Interested in going for a career in international health or international development? Here are <a href="http://bloodandmilk.org/2009/04/18/the-bare-bones-of-prepping-for-an-international-career/">the bare bones of prepping for an international career.</a> (Office work - who'd have thunk?)<br />
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* My friend Mollie (<a href="http://phdoula.blogspot.com/2011/05/guest-post-mollies-path-to_25.html">remember her</a>?) did a great and long round-up of <a href="http://littleredrowan.blogspot.com/2012/06/breastfeedingpumping-in-mainstream.html" style="-webkit-touch-callout: none;">breastfeeding on TV and in the media.</a> Love that pop culture knowledge!</div>
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* How about a <a href="http://birthingbeautifulideas.com/?p=4682">beautiful homebirth transfer and CBAC story.</a><br />
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* The Well-Rounded Mama has been doing an awesome <a href="http://wellroundedmama.blogspot.com/2012/10/plus-sized-breastfeeding-photo-gallery.html" style="-webkit-touch-callout: none;">Plus-sized breastfeeding photo gallery.</a> Please view, and submit a photo if you can! What a great resource when so many of the breastfeeding photos we see do not show the full spectrum of real moms' bodies.</div>
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* Rixa at Stand and Deliver posted an amazing series of recaps from the <a href="http://rixarixa.blogspot.com/search/label/international%20breech%20conference">International Breech Conference</a>. (Am I the only doula who reads these with the thought in the back of my mind that you never know when a mom is going to deliver precipitously at home, and surprise breeches do happen? I would never, ever, EVER try to deliver a breech baby, or think I knew anything substantive about doing it from reading a series of blog posts. But in an emergency with a baby emerging feet-first and no first responders there yet, I would want to be able to communicate effectively with the emergency responders on the phone, and understand what was happening and what could make things better or worse.)<br />
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* If you work in public health/development you quickly learn from people who are up close to these issues that orphanages in developing countries are problematic, and orphanage tourism? Really, really problematic. <a href="http://www.huffingtonpost.com/daniela-papi/cambodia-orphanages-_b_2164385.html">Don't do it. </a></div>
Rebeccahttp://www.blogger.com/profile/02589949170980959443noreply@blogger.com0tag:blogger.com,1999:blog-5186597747141068105.post-17867622102861496222012-11-19T08:00:00.000-05:002012-11-19T08:00:05.587-05:00Five things I'll kick myself if I don't tell you about breastfeedingThis is kind of a companion piece to my <a href="http://phdoula.blogspot.com/2011/01/doulas-first-time-mama-advice-kit.html">"first time mama's advice kit"</a>, but breastfeeding-specific. I get questions from lots of people in my life about breastfeeding, and I notice them falling over time into similar themes. I also hear after-the-fact stories of what I consider not-so-good (or terrible) advice and I kick myself, mentally, for not having somehow headed this off before it ever became an issue. So here are five things I want you to know, in no particular order:<br />
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1) <b>Babies want to eat. They eat a lot. Let them eat. I know it can be hard.</b> If I hear "he's just using you as a pacifier" one more time, I might scream. Do not listen to people who tell you that, or listen to them while smiling, nodding, and ignoring. Yes, some babies suck for comfort past when they are hungry. That's not bad for them. The worst thing that happens for them is that they get more food and they increase your milk supply so they have even more food available in the future. And most babies, especially very young ones, are nursing frequently for...food! I hear "I think he's just nursing for comfort" all the time during the second-night cluster feeding period, and from moms whose milk supply is a little delayed. I try to gently explain that while they are making enough milk for their babies, it's not coming very quickly. The baby acts like he's hungry and wants to nurse because, well... he's hungry and wants to nurse: he needs to eat pretty often to get enough food.<br />
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Do you feel like you can never put your baby down and are tethered to breastfeeding 24/7? My personal opinion is that it is not the end of the world to introduce a pacifier to your baby <i>once your milk supply is established, and you have a good read on when your baby has fed well and is satisfied. </i><a href="http://kellymom.com/ages/newborn/newborn-concerns/pacifier/"><span class="s1">Kellymom recommends 4-6 weeks before introducing a pacifier</span></a> and I tend to agree (of course there are exceptions to every rule.) Until then, try to <a href="http://kellymom.com/bf/normal/frequent-nursing/"><span class="s1">just let feeding frequently be the norm and let go of stresses or people who guilt you about "nursing him all the time"</span></a>. Trust yourself, and your baby - it is okay to feed often.<br />
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Do you feel frustrated and unsure about whether all this frequent feeding=healthy and normal or frequent feeding=starving because not enough milk? See point #2, which is...<br />
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2) <b>Please, please, see a good lactation consultant if you have any problems. </b>Yes - it costs money, sometimes a lot of money, and you have just spent a lot of money on, you know... having a baby. But it will be worth it. If you really, really can't afford an LC, talk to WIC to see if they have someone available, call your hospital and see what the co-pay is to see their LCs (often they will take insurance when your local private practice LCs won't), call La Leche League for referrals, and talk to the private practice people about what insurance reimbursement looks like and whether they could work out a payment plan with you. But IT IS WORTH IT to have good, hands-on help.</div>
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You might be hesitant to see an LC because "I don't know if I really have a problem". If you feel like there is a breastfeeding problem - that in itself is a problem! If the LC watches the baby nurse, checks the intake, answers your questions, and then tells you it looks like everything is okay - awesome. For example, maybe she reassures you that your baby who "eats all the time" is just a normally frequent feeder and is eating and growing beautifully. You get some ideas for coping with this and are reassured that your baby is normal and healthy.<br />
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On the other hand, if the LC finds something you can fix - now you have a way to address your issues, and you can keep working on them together if needed. You might feel like a baby who can't be removed from the breast without becoming completely frantic "shouldn't be" a problem because isn't it normal for babies to "eat all the time"? But when you go to the LC because you're completely exhausted and never sleep, you might find that the baby has difficulty transferring enough milk . Now you can work on strategies for improving the baby's milk transfer, and have a follow up visit in a few days to see if they're working. <br />
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If the person you see does not help you/listen to you/really pisses you off, find someone else. This is just like OB/midwife shopping - some people are going to be a good match, some not so much. Note: the "lactation specialist", "lactation counselor", or "lactation educator" at your pediatrician's office may be very nice, but they are not IBCLCs, and neither is your pediatrician. They may be great - they may even be better than some IBCLCs - but I have seen patients really get burned thinking they saw an LC when they didn't.<br />
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I know I sound like a broken record on the topic of seeing an LC. But sometimes it's the difference between stumbling through a dark forest with your hands outstretched, and walking through with a flashlight and a map.</div>
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3) <b>It's not thrush. </b>OK, OK - it's <i>probably</i> not thrush. But it's really, really probably not thrush. We used to think almost all chronic nipple pain was due to yeast infection of the nipples and/or the baby's mouth. A lot of IBCLCs and other health care providers are now very wedded to the idea that nipple pain without any glaringly obvious latch issues = thrush. And yet when we actually culture the nipples and milk...no yeast. Yet moms with chronic pain will go through multiple courses of antifungal treatment for "thrush", and then "resistant thrush" and then "chronic thrush". While most nipple pain is <i>typically </i>not thrush, if you have treated for thrush and it has not responded, it's almost <i>definitely</i> not thrush.<br />
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What could it <i>actually </i>be? Bacterial infection, vasospasm, blebs, oversupply, dermatitis, tongue or lip tie... the list goes on and on. How can you figure out which one it is? See point #2.<br />
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If you really think it might be thrush - and fine, sometimes it is! - then go ahead and treat for it. But consider the symptoms before going with that diagnosis, and don't go through multiple rounds of treatment for thrush without considering other diagnoses.</div>
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4) <b>Measure baby's weight on the right charts. </b><a href="http://phdoula.blogspot.com/2010/10/what-growth-chart-to-use.html">This post kind of says it all.</a> If your pediatrician isn't using the WHO charts, you can encourage them to follow the CDC recommendations and switch to these charts for all their infants. At least bring in a copy for them to use for your baby. If you don't do this, you may start getting worried looks at some point about how "she's falling off the growth curve a little" and "maybe you should start solids early". Measure breastfed babies on breastfed baby charts!</div>
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5) <strong>Most medications are safe for breastfeeding. Most healthcare providers do not know this. </strong>I have lost count of the patients and friends who have been told by doctors, nurses, and pharmacists "you have to pump and dump while taking ____". It has been true exactly twice. I have worked with people in the intensive care unit, people who are having major health crises, multiple surgeries, etc. - and all their meds were fine. And then I meet someone who got told to pump and dump for her mastitis antibiotics! NEVER pump and dump until you have independently verified that you need to - instead, pump, label the milk with the meds you are on, and save it. Then look up your meds on <a href="http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT">Lactmed</a> and/or call Dr. Thomas Hale's <a href="http://www.infantrisk.com/">Infantrisk hotline </a>(Mon-Fri) and discuss what you learn with your doctor/midwife/pharmacist before making the final call (nb: most health care professionals are very reassured to hear that Lactmed is run by the NIH.) Jack Newman notes that the standard warnings on the label and in the Physicians Drug Reference are <a href="http://www.nbci.ca/index.php?option=com_content&view=article&id=26:breastfeeding-and-medications&catid=5:information&Itemid=17">about legal liability, and not about the available research and understanding of med safety.</a> PUMP AND SAVE! And educate your health care providers, if possible, to use Lactmed and Dr. Hale's hotline and book as references, not the PDR or ePocrates.<br />
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What have I forgotten? Anyone have things to add to this list that they wish they'd known?</div>
Rebeccahttp://www.blogger.com/profile/02589949170980959443noreply@blogger.com5tag:blogger.com,1999:blog-5186597747141068105.post-10201254661312025932012-11-12T08:00:00.000-05:002013-01-05T14:25:00.272-05:00Guest post: A doula's path through pregnancy/birth (Part 3: Birth story)<span style="white-space: pre-wrap;"><i><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">This is the last in my friend and fellow doula Chris's series on a doula's path through pregnancy and birth. Other installments are here:</span></i></span><br />
<span style="white-space: pre-wrap;"><i><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Intro: <a href="http://phdoula.blogspot.com/2012/03/guest-post-all-you-have-to-do-is-be.html">All you have to do is be there</a></span></i></span><br />
<i><a href="http://phdoula.blogspot.com/2012/04/guest-post-part-1-doulas-path-through.html"><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Part 1: Prenatal care and education</span></a></i><br />
<span style="white-space: pre-wrap;"><i><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><a href="http://phdoula.blogspot.com/2012/11/guest-post-doulas-path-through.html">Part 2: Preparation - physical, mental, and more</a></span></i></span><br />
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<span style="white-space: pre-wrap;"><i><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">I think this is a pretty amazing birth story - Chris has suggested, and I am planning, to do a follow-up post on one of the topics raised in it. Thanks again to Chris for working so hard on this series to share her experiences and knowledge, and thanks to Kevin for writing the birth story in such detail! They are great friends, great parents, and they have just about the cutest baby in the world.</span></i></span><br />
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<b id="internal-source-marker_0.5600394059438258" style="font-weight: normal;"><span style="font-family: Arial; font-size: 15px; font-weight: bold; vertical-align: baseline; white-space: pre-wrap;">Part 3: The Birth</span><br /><span style="font-family: Arial; font-size: 15px; font-weight: bold; vertical-align: baseline; white-space: pre-wrap;"></span><br /><span style="font-family: Arial; font-size: 15px; font-weight: bold; vertical-align: baseline; white-space: pre-wrap;">In the days right after you give birth, you think you will never forget a minute of it. It turns out that’s not the case, and life with a baby (and probably some really awesome hormonal processes specially designed to help you forget pain) makes things get fuzzy very quickly. Luckily, in the days following delivery while I was dozing with the baby, my awesome rock star amazing birth partner and husband Kevin took the time to write down a very detailed description of the birth from his perspective. This is the birth story according to Kevin, with my notes added in italics. </span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;"></span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;">Christine’s contractions started about dinner time on the 9th of May, one day after the baby’s estimated due date. Her parents were in town and came to the house to make us dinner. It’s funny now to think back on the unintentional good decisions we made that evening. For example, I decided to take a nap and then took a short run to perk up before eating a large pasta dinner. I guess I subconsciously knew I would be working hard that night, so I needed to be in top form. (I also enjoyed a glass of good whiskey and reflected on our pre-kid years). </span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;"></span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;">Around 8:45PM, after her parents had left, Christine told me she had a strong contraction that felt different from the Braxton-Hicks contractions she’d been having since the week before. She hopped in the shower to see if that would soothe them. When it didn’t, we figured this was the real deal. Nothing left to do but wait patiently at the house until contractions were 4 minutes apart, drive calmly to the hospital, and push out a baby....easy, right?</span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;"></span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;">By 10:45PM Christine was having trouble focusing on things other than the contractions. We were halfway through a movie when she decided to move into the bedroom where it was quieter and she could concentrate on breathing through contractions. She told me I could keep watching, but I knew better than that. My main focus for the previous 40+ weeks was supporting her, and I wasn’t about to start labor by neglecting her to finish watching a movie.</span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;"></span><br /><span style="font-family: Arial; font-size: 15px; font-style: italic; vertical-align: baseline; white-space: pre-wrap;">I remember that conversation. I also remember walking away and thinking “I really should have told him to turn off the TV and just come with me.” I also remember that he almost immediately showed up in the bedroom with his Birth Partner Game Face on. </span><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;"> </span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;"></span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;">So we moved into the bedroom and started timing and working through the contractions. Around 11:30PM we called Caroline, our doula, and asked her to come to the house. While we were waiting for Caroline, I started packing the car. I also made the mistake of making Chris laugh just before a contraction started. The combination of the two was pretty intense, and she started to 1) laugh harder, 2) cry, 3) shake, and 4) cry some more. That freaked me out a little; I was worried she was progressing faster than we thought (that she had somehow hit transition) and that we would have to hurry to the hospital or call an ambulance. Turns out, laughing and contracting were just not a good combination!</span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;"></span><br /><span style="font-family: Arial; font-size: 15px; font-style: italic; vertical-align: baseline; white-space: pre-wrap;">I was surprised at what happened when I laughed and contracted (I read a lot of Ina May Gaskin, and she is all about laughing through contractions). But for me, when I laughed, everything just got all out of control. I guess I needed to focus on the matter at hand. </span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;"></span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;">Caroline arrived a bit before midnight and confirmed that we were definitely in labor. We didn’t actually need her to confirm it for us, but it made Christine feel better to know we weren’t overreacting. </span><span style="font-family: Arial; font-size: 15px; font-style: italic; vertical-align: baseline; white-space: pre-wrap;">(I was very concerned about going to the hospital too early).</span><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;"> By now the contractions were about 4 minutes apart, and Christine was working hard to get through them. She was doing a great job focusing on her breathing and staying relaxed through and between contractions. Then everything slowed down. It was a little before 1am when the contractions spread out--first to 8 minutes apart (I thought I had missed one), then a couple at 10 minutes apart. I figured maybe the baby was just being considerate and wanted us to sleep (I pictured us going to the hospital at 9am alert and totally well rested). But she faked us out! I had just made up the futon for Caroline when Christine’s contractions started again--right back to 4 minutes apart. They were a little stronger, so Caroline suggested the tub. Caroline helped Christine get situated and started pouring water over her belly as I packed up the last few items for the hospital. This was the moment I remember thinking “I’m so glad we got a doula.” </span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;"></span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;">From 2:10 to 2:30 the contractions were 3 minutes apart and gaining intensity, so we decided to go to the hospital. We hopped in the car and took what seemed like the slowest possible route to the hospital. I felt particularly bad about the route selection while we were crossing through a neighborhood that had speed humps. Of course, the contractions seemed to find every bump in the road. Anyways, we got to the hospital at 3am and entered through the ER. Caroline and Christine headed up to Labor & Delivery while I grabbed the ridiculous number of bags we packed and took care of check-in at the ER registration desk. By the time I got up to L&D Christine and Caroline were getting settled into Room 3, which has a tub and is HUGE. That’s why the staff call it the “Taj Mahal”. It also faces east, which made for a beautiful ambience in the room a little later that morning. </span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;"></span><br /><span style="font-family: Arial; font-size: 15px; font-style: italic; vertical-align: baseline; white-space: pre-wrap;">It’s important to note what DIDN’T happen when we checked into the hospital. No IV was inserted, and I was not permanently connected to the monitors. (They hooked me up for the first 15 minutes or so, and after that only monitored me intermittently). I didn’t have to get into a hospital gown, and there was no prohibition on food or drink. No one made dreadful statements about my last chance to get an epidural or IV pain meds. Full credit goes to the midwifery practice for making sure their practices truly support normal and unmedicated birth. </span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;"></span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;">Our arrival at the hospital marked the point where the labor turned into as much (or more) of a psychological challenge as physical. When I got up to L&D, The charge nurse escorted me back to the room and asked for the details of the labor so far, and we showed her a copy of the birth plan. Tanya, the midwife on call, came in to check Christine’s dilation and assess her progress. We had met Tanya at an earlier office visit and really liked her. She confirmed with Christine that at her last checkup (at 40 weeks on the dot), her cervix had been 90% effaced and in a good forward position but not dilated at all. We had all assumed that 8 hours of contractions would have opened her cervix to at least 2-3 cm (Christine was hoping for more like 4-5). Tanya could see the frequency of contractions from the monitors, and I think she expected to find Christine to be pretty far along as well. That turned out not to be the case--Christine’s cervix was still completely closed. </span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;"></span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;">I’d been consistently impressed by the midwives during the pregnancy, so it’s hard to identify one caregiver who stands apart--but I think Tanya (and later Diana) were exactly the people we needed for this delivery. Tanya immediately recognized that something was off with the progression of labor. The contractions should have been producing more progress. It turns out that about 10 years ago, Christine had cryotherapy to remove abnormal cells on her cervix that turned up on a pap smear. Evidently the procedure left scar tissue on her cervix that was now preventing it from opening. I’m still impressed that Tanya had the presence of mind at 4am to ask about this right off the bat. She said she could clear the scar tissue with her fingers, and Christine gave the go-ahead to do so. It was pretty intense and looked pretty painful, but Christine dilated to 2cm immediately, and her water also broke. </span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;"></span><br /><span style="font-family: Arial; font-size: 15px; font-style: italic; vertical-align: baseline; white-space: pre-wrap;">This is where everything got very fuzzy. I remember saying “yes, do it” when Tanya asked about clearing the scar tissue. She did it while I was in the middle of a contraction, and I remember intense pain and a gush that turned out to be my bag of waters breaking. After that, labor felt like something I could just barely hang onto instead of something I was in control of. It was almost like starting a second, entirely different labor. It took a while to wrap my head around what had happened and what was happening, and I remember feeling very needy--like I really truly needed everybody in that room to be constantly telling me I was doing well and that it was going to be OK. That emotion wasn’t one I had anticipated. </span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;"></span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;">The baby was now on the way for real, but Christine was pretty deflated to find out she wasn’t further along. It’s also important to point out that dilating 2cm instantly is physically demanding. Christine’s body was playing catch-up at this point, and the contractions became much more intense. She got shaky and started shivering, and asked to get in the tub. </span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;"></span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;">We had talked through a lot of labor and delivery scenarios to try to be prepared for a curveball--what if labor stalls? What if we needed an emergency c-section? What if the baby needs to go to the NICU? But this situation never crossed our minds. In some ways it was harder than some of the other things we discussed. Rather than presenting us with a concrete decision, it placed Christine on a different trajectory, and she dilated faster and delivered sooner than she would have if she had truly been at 0cm at 3am. The labor went from feeling manageable for Chris to feeling like something that she could just barely hang on for. </span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;"></span><br /><span style="font-family: Arial; font-size: 15px; font-style: italic; vertical-align: baseline; white-space: pre-wrap;">The contractions before and after my water broke were very different. Before, I could stay in control and breathe through even the most intense contractions. After, I remember feeling pushed to my absolute limit with every contraction. I lost all composure and really needed Kevin and Caroline to help me refocus after each one. I remember feeling restless or almost trapped, and having that back-of-the-throat almost-scream feeling. They would talk me down and get me to breathe and relax and make productive noises. </span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;"></span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;">I’ve been able to provide pretty good detail so far, but things sort of blend together from this point onwards. Christine stayed in the tub, and Caroline and I stayed next to her and did our best to help through contractions. I would remind her to breathe and relax, and Caroline would provide comfort measures (hand holding, water on the belly). Unfortunately, the hospital only has regular-sized bathtubs, so it’s difficult to get the belly all the way in the water. Christine had great support, but she was doing all the work. One thing I told her repeatedly was “No one is more prepared for this than you”. It’s true--she was as ready physically and mentally as any first-time mom could be. Some women would have caved under the mental strain and physical pain, but my wife is TOUGH.</span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;"></span><br /><span style="font-family: Arial; font-size: 15px; font-style: italic; vertical-align: baseline; white-space: pre-wrap;">One thing that didn’t cross my mind during labor but I have thought about a lot since then is the fact that, in accordance with our birth plan, no one offered me pain medication. In the end, I think this made all the difference in my ability to have an unmedicated birth. I really believe that if someone had asked me when I was at about 7 or 8cm if I wanted an epidural, I would have said yes in a heartbeat. But as it was, I was so far into the labor zone that I didn’t even think about medication. And since no one brought it up, I just kept doing what I was doing and it turned out exactly how I hoped. When I was a doula, I don’t think I understood how important the not-asking was. I thought “Well, if they ask, you just say no.” Now I get it. Having an unmedicated birth depends on a lot more than just previous intention and willpower. </span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;"></span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;">One thing Chris needed a lot of was reassurance. She really needed to hear “Yes, you’re making progress” and “Yes, it’s moving quickly”. She asked Tanya to check her a couple of times while she was in the tub, and each time she had made progress. By the time she was dilated to 6cm, I was standing in the tub to help support her through contractions and to give counterpressure. Before I knew it we were at 8cm, we had moved back to the bed, the delivery instruments had been prepared, and we all thought Chris would be pushing at any moment. It was about 6:30am, and Christine had dilated from 0-8cm in 3 and a half hours. Christine’s mom arrived sometime around then, and I remember Chris asking “Mama, how did you do this twice?”.</span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;"></span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;">We tried a number of positions on the bed, but Chris was most comfortable on her knees, leaning over the back of the bed (which we had put in the full-upright position). By 7AM she was having a LOT of back pain. I was applying counterpressure with each contraction, and LeeAnn (our nurse) and Caroline were pushing against Christine’s hips. I was also massaging her back with raquetballs between contractions (I had lots of tricks in my gypsy bags). It took almost two hours to get through transition, which was slower than anticipated given how fast she had gotten to 8cm. The baby had been anterior all through the pregnancy and had been low in the pelvis for some time. It seemed unlikley she would have rotated to a posterior position during labor, but the nurses and midwives started to wonder about it since things had slowed down and Chris was having so much back labor. I was concerned because she had worked so hard all night long, and I was worried she would start to run out of steam if pushing was very difficult. When she finally began to push (around 8AM), it wasn’t an overwhelming need. She would push a little but then stop halfway through contractions, saying it was all she could do. </span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;"></span><br /><span style="font-family: Arial; font-size: 15px; font-style: italic; vertical-align: baseline; white-space: pre-wrap;">I had lost all concept of time by this point. I remember being upright on the bed, leaning over the back and moving my hips constantly. I couldn’t stop it, even though I was so tired. I remember Caroline standing by the head of the bed feeding me Craisins between contractions. I remember that eventually, the pain never went away, even when I wasn’t contracting. I think I said “the baby is going to come out of my back”. And I remember that I did not like to push. I never had an overwhelming urge, and when I did push, I could only do it for about half of a contraction. After that the pain was too much and I just had to breathe. But nobody was rushing me or counting or telling me to hold my breath and push for longer. They let me figure it out on my own.</span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;"></span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;">Around this time the midwives had a shift change, and Tanya handed the reins to Diana and Angela. (Since Diana is new to the practice, Angela was there to back her up). I took shift change as an opportunity to consider our options for getting Christine some rest or pain relief. We wanted an unmedicated birth, and the nurses and midwives were great about not offering epidurals or other meds after the very first time (I think they were required to have her do the pain scale and confirm that she was aware of medical pain management options upon admission). But I wanted to talk through our options in case we didn’t get things moving again, or if Christine turned out to be too exhausted to push. Christine was SO tired, and I thought that if we got something to cut the pain, she may be able to rest a bit and come back at it with more energy. </span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;"></span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;">Pushing was a struggle at first. Christine had a hard time finding a comfortable pushing position on the bed and was struggling to activate the right muscles. LeeAnn reminded her that you need the same muscles you use for a bowel movement, which may have been what got Chris thinking about the toilet, so we headed to the bathroom.</span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;"></span><br /><span style="font-family: Arial; font-size: 15px; font-style: italic; vertical-align: baseline; white-space: pre-wrap;">I also remember LeeAnn being really hands on. She took my hands and looked right in my eyes and told me that I had to find the exact place where it hurt the most and push straight into it, even though that felt like the last thing I’d ever want to do. And she was right. She pretty much taught me to push. </span><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;"> </span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;"></span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;">While Christine labored in the bathroom, I stepped out into the hall with several of the midwives to discuss what might come next if Christine was too tired to push. We were all hoping no intervention would be necessary, but it seemed wise to have the discussion before things got urgent. There was talk of Nubain to cut the pain and provide some time to rest, asking the MD on call to scrub in and see if the baby's head could be rotated into a more favorable position, and vacuum extraction as a last resort</span><span style="font-family: Arial; font-size: 15px; font-style: italic; vertical-align: baseline; white-space: pre-wrap;">. (I remember having the feeling that if I didn't start making some good progress with the pushing, people were going to start suggesting things that I didn't want to hear. I was already pushing, but at that point I started pushing like never before.)</span><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;"> While we were talking, Diana (the new midwife on call) was with Christine while she pushed. When she joined us in the hall, I asked for her thoughts on how things were going. She replied that she wasn't sure whether the baby was posterior or not, but she felt like Christine was making progress with pushing and the best thing to do would be to give her some more time to work before suggesting anything else. That's what we did.</span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;"></span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;">Diana and I went back into the bathroom, and before too long the baby was crowning. Diana told Christine that if she wanted to move to the bed, now would be the time, but staying put would be OK too. Chris made an attempt to get off the toilet but could barely stand, and she promptly decided that moving was out of the question. Diana said, "No problem. We can deliver here." So Diana settled in cross-legged on the floor, and the nurses brought the instruments into the bathroom (which, by the way, was huge). As Diana was prepping for the delivery, a contraction started. I was squeezed up next to the wall still giving counterpressure, and LeeAnn and Caroline were right next to me holding Christine's hands. Christine needed to get further forward on the seat so that Diana could have a better angle to protect the perineum and deliver the baby, so I got behind Christine and held her up by the arms. Diana kept asking me to move her forward more and more until before I knew it I was sitting on the toilet and Christine was on the ends of my knees and I was supporting her with my forearms. I'm honestly not sure how long we pushed that way, but my legs were numb. With one contraction Christine got very loud, and I thought "this must be it!" Diana looked up and said "Christine, get control of yourself, you're almost there, keep breathing." I could tell a difference in the next push--Chris was squeezing my hands and I could feel her core muscles working. With the next push, I think we were both screaming, and then I actually felt the baby come out--I could feel all of Christine's power while she was sitting on my lap. There was a little tug, and then Chris relaxed, and moments later Diana lifted our baby Annie onto Christine's chest, and I was sobbing as hard as the baby was crying (she had powerful lungs from the get-go). It was just after 9:00AM. After a few minutes LeeAnn took over my position behind Christine so I could cut the cord, and then we helped Christine walk back to the bed and lie down. </span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;"></span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;">Annie was the most incredible beautiful thing I had ever seen, and I was completely overwhelmed by the delivery. Christine had been so strong and worked so hard to grow our daughter and bring her into the world. Experiencing her birth that way was more powerful than I could have prepared for. It is (and will remain) the most amazing experience of my life. Our Annie girl was finally with us after so many months, and I fell in love with her in an instant.</span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;"></span><br /><span style="font-family: Arial; font-size: 15px; font-style: italic; vertical-align: baseline; white-space: pre-wrap;">I have snatches of very clear memories of the delivery--of squeezing Kevin's hands harder than I had ever squeezed anything, of bellowing louder than I ever expected to, of Diana's face asking me with intensity to get control and breathe, and of this huge feeling of relief when I held the baby for the first time. I still don't know how I walked to the bed, because an hour later I couldn't stand. I had second degree perineal tears that Diana stitched up, and the entire time nobody even suggested moving Annie off my chest. We just rested together. </span><br /><span style="font-family: Arial; font-size: 15px; font-style: italic; vertical-align: baseline; white-space: pre-wrap;"></span><br /><span style="font-family: Arial; font-size: 15px; font-style: italic; vertical-align: baseline; white-space: pre-wrap;">It turned out that the reason labor had slowed so significantly during transition (and the reason I had so much back labor) was that Annie was born with a nuchal arm--she had one arm extended by her head upon delivery, so she came out Superman-style. (Interestingly, she had an arm up by her head as early as the 20-week anatomy check ultrasound, and I wonder if she didn't just keep it up there!) She was 7lbs 5oz, born perfectly healthy after around 12 or 13 hours of labor (though all the cervical dilation happened in the last 6 hours). There was a lactation nurse beside the bed before I even realized it, and she helped Annie and I nurse for the first time maybe a half hour after delivery. When we were ready, Kevin went with the nurses to do the rest of the newborn exams and give Annie her first bath while I ate some breakfast and moved to our room in the Mother-Baby unit.</span><br /><span style="font-family: Arial; font-size: 15px; font-style: italic; vertical-align: baseline; white-space: pre-wrap;"></span><br /><span style="font-family: Arial; font-size: 15px; font-style: italic; vertical-align: baseline; white-space: pre-wrap;">If you ask most women who have given birth what they remember about the experience, they'll tell you that it's hard to remember much. While preparing for Annie's birth, I had a hard time fathoming how one forgets such an important experience. Now, nearly 6 months after the fact, I can tell you that the forgetting is the absolute truth--it faded a little bit every time I held the baby or nursed her or napped with her. All those fuzzy details just got fuzzier (I'm so glad Kevin wrote everything down so soon after the delivery!), and what I'm left with is an overall impression of the experience. I am very lucky that it's such a positive and empowering impression. When I think back on the birth, I feel proud of myself, but more than anything I feel grateful--grateful for the support I had, grateful to have medical care that truly supported normal birth, grateful for the physical and mental strength to give birth the way I wanted to. And most of all, I'm grateful for our beautiful daughter, who made such a memorable entrance and has been making life more exciting ever since. </span></b>Rebeccahttp://www.blogger.com/profile/02589949170980959443noreply@blogger.com2tag:blogger.com,1999:blog-5186597747141068105.post-17978592949800882922012-11-10T08:00:00.000-05:002012-11-10T08:00:09.751-05:00Guest post: A doula's path through pregnancy/birth (Part 2: Preparation - physical, mental, and more)<i>My friend and fellow AmeriCorps doula Chris wrote her first post in this guest series, "A doula's path through pregnancy and birth", way back in April: <a href="http://phdoula.blogspot.com/2012/04/guest-post-part-1-doulas-path-through.html">Part 1: Prenatal care and education</a>. As she notes at the beginning of this next post, time flies (for me, too!) so this next installment is a little delayed. But I think it's very well worth the wait - there's so much great advice and experience in here (check out the birth plan, for example.) Big thanks to Chris for working so hard on it!</i><br />
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<i>Birth story is coming very soon!</i><br />
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<i>(And if you haven't already, don't forget to check out Chris's intro post, <a href="http://phdoula.blogspot.com/2012/03/guest-post-all-you-have-to-do-is-be.html">one of my favorite doula stories</a> from our year in AmeriCorps.)</i><br />
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<b id="internal-source-marker_0.5600394059438258" style="font-weight: normal;"><span style="font-family: Arial; font-size: 15px; font-weight: bold; vertical-align: baseline; white-space: pre-wrap;">So I had big plans of writing about how we were preparing for birth as we were actually preparing. Then life got away from me, and all of a sudden here I am writing about preparing for birth while my 6-month old baby girl is asleep. The upside is that I’ve had a chance to reflect on how our preparations affected our experience of birth, and I can comment on the parts that (in hindsight) seem particularly important. Here’s what we did, and soon you can read about how it worked out. </span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;"></span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;">Luckily my pregnancy proceeded without complication, and Kevin and I started preparing for birth pretty early. Rebecca has a post about why you shouldn't "try" to have an unmedicated birth--you have to prepare to have one (like you prepare for running a marathon; you don't just get up and try it). I think the comparison between endurance running and giving birth is apt. Both require preparation in many different ways--physically, mentally, and emotionally. Here's how we got ready.</span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;"></span><br /><span style="font-family: Arial; font-size: 15px; font-weight: bold; vertical-align: baseline; white-space: pre-wrap;">Physical Preparation:</span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;">I started going to a prenatal yoga class quite early in the pregnancy, at maybe 12 weeks. I felt a little silly at first, sitting in the room with all these women sporting huge bellies and due dates only weeks away, but my fantastic teacher Cundy says there is no such thing as too early or too late to start prenatal yoga--the important thing is just to get there. I went to yoga once or twice a week almost every week for the rest of the pregnancy. It was excellent physical preparation for labor--lots of pelvic strengthening work, lots of squatting, and lots of practice with deep relaxing breathing. I think it was also an excellent mental break every week, and a chance to absorb positive messages about giving birth.</span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;"></span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;">I did my best to stay active with cardiovascular exercise while pregnant. I ran pretty regularly prior to getting pregnant, though that ended with the first trimester (I ran/walked the Athens half marathon at 13 weeks pregnant, and after that set my running shoes aside). I walked all day every day for work as a high school teacher, and also made long walks part of my weekly routine. As my belly grew my walks got shorter. :) Interestingly, when I was newly pregnant walking was about the only way I got any relief from the near-constant nausea. I think it had to do with the breathing.</span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;"></span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;">Looking back after the delivery, I can say that I am glad I stayed relatively active and I'm particularly glad I stuck with the yoga so regularly. Though I remember feeling exhausted while in labor, it was more of the I've-been-up-all-night-can't-I-have-just-a-few-minutes-to-sleep tired, not the type of fatigue one feels from reaching the limits of what your muscles can do. I felt strong even as I felt exhausted.</span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;"></span><br /><span style="font-family: Arial; font-size: 15px; font-weight: bold; vertical-align: baseline; white-space: pre-wrap;">Mental Preparation</span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;">Pretty soon after realizing we were pregnant, I sat Kevin down and we watched </span><span style="font-family: Arial; font-size: 15px; font-style: italic; vertical-align: baseline; white-space: pre-wrap;">The Business of Being Born</span><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;">. (FYI: you can stream this movie via Netflix). If you're on the fence about what kind of birth you want to have or if you're looking for encouragement to have a natural, normal birth, this movie is a must-watch. You see a little more of Ricki Lake than you ever thought you would, but I know every time I watch that movie I come out of it thinking Ricki is pretty much a rock star. It's also a great one to watch if you are trying to get a loved one on board with your ideas about birth, midwifery care, or how to avoid getting sucked into the medical monster. Put it on your list! We also watched the movie </span><span style="font-family: Arial; font-size: 15px; font-style: italic; vertical-align: baseline; white-space: pre-wrap;">Babies</span><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;"> (the one that follows infants in different parts of the world through their first year). That baby in Mongolia is VERY cute.</span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;"></span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;">My mama taught me that there’s no such thing as too much reading, and my doula experience exposed me to some titles that everyone planning for a non-medicated birth should know about. So upon getting a positive pregnancy test, I busted out my copy of the trusty </span><span style="font-family: Arial; font-size: 15px; font-style: italic; vertical-align: baseline; white-space: pre-wrap;">Pregnancy, Childbirth, and the Newborn</span><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;"> by Penny Simkin and ordered </span><span style="font-family: Arial; font-size: 15px; font-style: italic; vertical-align: baseline; white-space: pre-wrap;">The Pregnancy Book</span><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;"> and </span><span style="font-family: Arial; font-size: 15px; font-style: italic; vertical-align: baseline; white-space: pre-wrap;">The Baby Book</span><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;"> (both by Dr. Sears), which I read in chunks here and there. I ordered my wonderful husband a copy of Simkin’s </span><span style="font-family: Arial; font-size: 15px; font-style: italic; vertical-align: baseline; white-space: pre-wrap;">The Birth Partner</span><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;">. He worked his way through it over the course of the pregnancy, starting with his biggest concern--how to deliver the baby in an emergency. :) I also enjoyed Ina </span><span style="font-family: Arial; font-size: 15px; font-style: italic; vertical-align: baseline; white-space: pre-wrap;">May’s Guide to Childbirth</span><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;">, which was wonderful--I’m an especially big fan of her chapter on Sphincter Law. It gave me lots to think about. As the pregnancy progressed, the question “How on earth do you take care of a baby?!” occupied more and more of my brain, and I read the ubiquitous </span><span style="font-family: Arial; font-size: 15px; font-style: italic; vertical-align: baseline; white-space: pre-wrap;">Happiest Baby on the Block</span><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;"> by Harvey Garp, which backs up a lot of what the Sears book teaches. One book that I thought would at least be funny but turned out to not work for me at all was </span><span style="font-family: Arial; font-size: 15px; font-style: italic; vertical-align: baseline; white-space: pre-wrap;">The Girlfriend’s Guide to Pregnancy</span><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;">, which was recommended to me by pretty much everybody I know who has had a baby in the last 10 years. I read some of it and wound up feeling fat and neurotic--two adjectives that I don’t think generally apply to me, pregnant or not. I quit reading it about halfway through, and wouldn’t recommend it. Later in the pregnancy I read a book on the Bradley method for childbirth. Most of it didn't really suit me--I found it to be way too structured--but I did like the parts about visualization and relaxation during contractions.</span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;"></span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;">After we hit 20 weeks, we started the most important mental preparation we did--our prenatal Centering program. Centering is basically group prenatal care for the second half of the pregnancy. Every other week, Kevin and I met with a midwife and a group of 3 other couples due at roughly the same time we were. The meetings (which happened in the evening, to accommodate work schedules) started with individual check-ins with the midwife to listen to the fetal heart tones and discuss any private concerns. We also checked our own blood pressure and weight and peed in the obligatory cup. After that we sat down as a group to discuss anything that was going on with our pregnancies. It was a great time to get ideas for dealing with discomfort, to see what other people were reading, and to get some reassurance about what was happening with our bodies and our lives. We also did potluck dinners, which was really fun. Finally, we would discuss a topic relevant to pregnancy and birth, and in that respect it was a lot like a childbirth class. We covered the progress of labor and birth, options for pain management, breastfeeding basics, and how to take care of a newborn. Our centering group really connected, and we've stayed in touch even now that all the babies are on the outside. </span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;"></span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;">Because I had a very solid background in childbirth education through my doula work, and since we were already covering lots of relevant topics in Centering, we decided that a full-scale multi-week childbirth class was not for us. But when the opportunity arose to take an independent one-day childbirth course taught by a very well-respected member of the Athens pregnancy/early-parenting community, we decided to go for it. It turned out to be a good review for me and a great way for Kevin to run through everything we learned in Centering again. We practiced with birth balls and rebozos, worked on breathing and relaxation, and focused on the principles that set you up for a normal birth. We are very lucky to live in a community with excellent resources for prenatal support and education. Between Centering, midwifery care, prenatal yoga, and our childbirth class, we both felt confident as I approached the end of the pregnancy.</span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;"></span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;">In the last few weeks of the pregnancy, we created our birth plan. At first I started with a list of things that I did NOT want, but after a little bit of writing I realized that type of birth plan was probably not the most useful approach. I think I needed to work through some of the baggage I had from the difficult, medicalized births I had seen as a doula. But through writing down what I was worried about, I came to the understanding that by making smart choices about my prenatal care, a lot of my concerns would not be an issue. I didn’t need to write “no episiotomy” on my birth plan because not one of the midwives in our practice would ever dream of doing a routine episiotomy. We'd had a chance to discuss a lot of potential hospital pitfalls during Centering, and I came away feeling confident that these midwives were for real. Their very low c-section and induction numbers backed me up. So I rewrote the birth plan and talked it through with our doula. This is what we came up with:</span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;"></span><br /><span style="font-family: Arial; font-size: 12px; font-style: italic; vertical-align: baseline; white-space: pre-wrap;">Labor:</span><br /><span style="font-family: Arial; font-size: 12px; font-style: italic; vertical-align: baseline; white-space: pre-wrap;">We have been preparing for a normal, unmedicated birth. Any suggestion or assistance that supports that goal is welcome. Christine is aware of all medical pain management options and will ask for them if wanted. We are working with a doula and her support is important to us.</span><br /><span style="font-family: Arial; font-size: 12px; font-style: italic; vertical-align: baseline; white-space: pre-wrap;"></span><br /><span style="font-family: Arial; font-size: 12px; font-style: italic; vertical-align: baseline; white-space: pre-wrap;">Delivery:</span><br /><span style="font-family: Arial; font-size: 12px; font-style: italic; vertical-align: baseline; white-space: pre-wrap;">Immediate skin to skin contact is a priority, as is early breastfeeding. We would like all newborn exams performed while we hold the baby. Kevin would like to cut the cord once it has stopped pulsing.</span><br /><span style="font-family: Arial; font-size: 12px; font-style: italic; vertical-align: baseline; white-space: pre-wrap;"></span><br /><span style="font-family: Arial; font-size: 12px; font-style: italic; vertical-align: baseline; white-space: pre-wrap;">Newborn Care Preferences:</span></b><br />
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li style="font-family: Arial; font-size: 13px; list-style-type: disc; vertical-align: baseline;"><b id="internal-source-marker_0.5600394059438258" style="font-weight: normal;"><span style="font-size: 12px; font-style: italic; vertical-align: baseline; white-space: pre-wrap;">Christine intends to breastfeed--please no bottles or pacifiers.</span></b></li>
<li style="font-family: Arial; font-size: 13px; list-style-type: disc; vertical-align: baseline;"><b id="internal-source-marker_0.5600394059438258" style="font-weight: normal;"><span style="font-size: 12px; font-style: italic; vertical-align: baseline; white-space: pre-wrap;">We plan to use Dr. M as our pediatrician. We will begin the baby’s Hepatitis B vaccinations through Dr. M’s office. </span></b></li>
<li style="font-family: Arial; font-size: 13px; list-style-type: disc; vertical-align: baseline;"><b id="internal-source-marker_0.5600394059438258" style="font-weight: normal;"><span style="font-size: 12px; font-style: italic; vertical-align: baseline; white-space: pre-wrap;">We would like the vitamin K injection and eye ointment to be delayed until we have had some time to spend with our new baby. </span></b></li>
<li style="font-family: Arial; font-size: 13px; list-style-type: disc; vertical-align: baseline;"><b id="internal-source-marker_0.5600394059438258" style="font-weight: normal;"><span style="font-size: 12px; font-style: italic; vertical-align: baseline; white-space: pre-wrap;">We would like the baby to stay in the room with us for as much of the time as possible. If it is necessary for the baby to stay in the nursery, Kevin would like to stay with her.</span></b></li>
<li style="font-family: Arial; font-size: 13px; list-style-type: disc; vertical-align: baseline;"><b id="internal-source-marker_0.5600394059438258" style="font-weight: normal;"><span style="font-size: 12px; font-style: italic; vertical-align: baseline; white-space: pre-wrap;">We would like to help give the baby her first bath. </span></b></li>
</ul>
<b id="internal-source-marker_0.5600394059438258" style="font-weight: normal;"><span style="font-family: Arial; font-size: 12px; font-style: italic; vertical-align: baseline; white-space: pre-wrap;"></span><br /><span style="font-family: Arial; font-size: 12px; font-style: italic; vertical-align: baseline; white-space: pre-wrap;">In case of cesarean:</span><br /><span style="font-family: Arial; font-size: 12px; font-style: italic; vertical-align: baseline; white-space: pre-wrap;">We ask that as many of our preferences regarding delivery and newborn care as possible be respected (family-centered cesarean). Kevin would like to be in the operating room, and we request to be included in all decisions related to the care of our baby. </span><br /><span style="font-family: Arial; font-size: 12px; font-style: italic; vertical-align: baseline; white-space: pre-wrap;"></span><br /><span style="font-family: Arial; font-size: 12px; font-style: italic; vertical-align: baseline; white-space: pre-wrap;">In case of baby in the NICU:</span><br /><span style="font-family: Arial; font-size: 12px; font-style: italic; vertical-align: baseline; white-space: pre-wrap;">Just as with a cesarean, we request that as many of our above preferences as possible be respected, and we ask for any support available to promote breastfeeding. We would also like to spend as much time as possible giving skin-to-skin contact.</span><br /><span style="font-family: Arial; font-size: 12px; font-style: italic; vertical-align: baseline; white-space: pre-wrap;"></span><br /><span style="font-family: Arial; font-size: 12px; font-style: italic; vertical-align: baseline; white-space: pre-wrap;">Thank you!</span><br /><span style="font-family: Arial; font-size: 12px; font-style: italic; vertical-align: baseline; white-space: pre-wrap;">Kevin & Christine</span><br /><span style="font-family: Arial; font-size: 12px; font-style: italic; vertical-align: baseline; white-space: pre-wrap;"></span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;">I think it's also worth noting what we did NOT do prior to the birth. We did not spend one minute watching nonsense "reality" childbirth shows on TV. While this choice could most directly be attributed to not having cable, I wouldn't have wanted to watch that stuff anyways. They present a sensationalized version of childbirth that makes having a baby look like a scary emergency every time. If you want to have a normal, unmedicated birth, the last thing you need is a bunch of stories emphasizing worst-case scenarios and medical-model labor. It's totally normal to be thinking about birth and the baby all the time, but if you want to immerse yourself in learning about birth, spend some time reading or go whole-hog and get MORE Business of Being Born, good old Ricki's new project that is an even more in-depth treatment of natural birth than the original BofBB. </span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;"></span><br /><span style="font-family: Arial; font-size: 15px; font-weight: bold; vertical-align: baseline; white-space: pre-wrap;">People Preparation</span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;">One aspect of birth that I think can be easy to overlook is figuring out exactly who you want to be with you when it’s actually baby time. Your caregiver and your partner are obviously very important, but it’s worth considering who else you want with you when you’re in labor. It’s also worth it to start talking to the people who are important to you ahead of time and find out what their expectations are for the day of the birth.</span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;"></span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;">Kevin and I were planning to have a doula and we eventually found one, but we waited probably a little too long to actually go about our search. I think I got the impression that in a town like Athens, doulas were practically coming out of the woodwork. That turned out not to be the case, and about 2 months before I was due, when we finally started getting serious about the doula search, we discovered that 1) it was hard to find a doula that wasn’t booked, and 2) doulas cost more than we anticipated. In the end we found an apprentice doula who was available and within our budget. We almost didn’t hire her (based on the idea that my prior doula experiences had left me better prepared than the average first time mom), but in the end, I came down firmly in favor of having a doula. Here was my reasoning: maybe we’d be fine by ourselves if everything went perfectly smoothly, but what if something came up? If I had a 60 hour labor, I wanted a doula. If I had to be induced, I wanted a doula. If we had to decide about a c-section, I wanted a doula. And you can’t just call a random doula when you’re 6cm dilated and ask her if she can hop over to the hospital. </span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;"></span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;">The other people we took into consideration when planning for the birth were our parents. All four parents live within 2 hours of us, and this being the first grandchild on either side, we knew they would want to be involved. However, I didn’t want a bunch of people camping out in Athens, waiting for me to go into labor. I also wasn’t sure I wanted lots of people there for every nitty-gritty moment of the labor. I was OK with the idea of both the moms being in the room at least part of the time because I knew they wouldn’t try to pressure me to do anything I didn’t want to. My mother had 2 unmedicated births, and Kevin’s mom had 6 babies in 6 different ways. I was lucky that they were on board with the idea of normal birth and that I never had to explain or defend our birth plan. But even though I have a very good relationship with both my mother and my mother-in-law and had no reservation about them being present at the birth, in my head, we would wait to call them until we were admitted to the hospital and knew that I was well into active labor.</span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;"></span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;">Amazingly, that’s more or less how things worked out, and everybody seemed to feel good about it in the end. My relentlessly prompt parents did arrive on my due date, before any signs of imminent labor, and they literally camped out about 20 minutes away and waited on me to have a baby (which they assumed would happen fairly soon, given the genetic tendency towards promptness). However, since I went into labor at night, we didn’t let them know what was going on until about 5:30 the next morning, when the delivery looked pretty close. So my mom got to be there for part of the labor and for the birth but not for so much of it that I felt like I had an audience waiting on things to move along. We called Kevin’s parents at the same time we called my parents. But just to prove that you can never predict birth, when they arrived after their 2 hour drive I was still laboring. Kevin’s mom chose to stay in the waiting area, but all four grandparents were close by when it was time to meet the baby.</span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;"></span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;">We are lucky to have a very low stress family situation and to live in a community where it is possible to find doulas. But for anybody preparing for birth, I think it’s really worth it to give some thought to who will be with you on the big day and to have those conversations early. When it’s time to have a baby, you want to feel surrounded by support and encouragement.</span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;"></span><br /><span style="font-family: Arial; font-size: 15px; font-weight: bold; vertical-align: baseline; white-space: pre-wrap;">Emotional Preparation</span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;">I wonder if perhaps the most important preparation we did for the birth wasn't the emotional work. It's certainly important to be fit and educated when the time comes, but I think all of that work is for naught if you don't have confidence that you can have a normal birth. For me, a lot of that confidence came from surrounding myself with people who shared that goal. Our Centering group provided an important emotional connection to pregnancy and birth. Kevin and I looked forward to the social aspect of Centering--we ate together, discussed progress and difficulties, and shared the process of beginning to imagine ourselves as parents. I also found pregnant friends through yoga class, which was another powerful affirmation of the process of growing a baby and giving birth. I think that if I only had one piece of advice for a newly pregnant woman, it would be to surround yourself with positive people who will help you stay confident in yourself and your body. Find pregnant friends (and friends with young children) who share your goals and priorities.</span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;"></span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;">Kevin and I are not usually huge fans of what we call "barfy baby stuff"--going to someplace like Babies ‘R’ Us to make a registry was so low on our list that it never got done. (Way better registry for people who hate shopping: do one online through </span><a href="http://babyli.st/a/BL46"><span style="color: #1155cc; font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;">BabyList</span></a><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;">). But the one thing we did that sounds like it's straight out of TheBump.com is take a babymoon. If you can swing it, I totally recommend it.</span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;"></span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;">My school's spring break fell when I was about 36 weeks pregnant--about our last chance to take a relaxing trip prior to baby go-time. We drove down to a cottage in Florida belonging to some friends of Kevin's family and spent a very relaxing few days swimming, enjoying the beach, and just hanging out. It was a really nice time spent just being together, getting ready emotionally for how our lives were changing. I think pregnancy lasts 9 months not just to give the baby time to develop but also to give the parents time to prepare themselves. A lot of that work is emotional. Kevin and I had been together for a decade before getting pregnant, and I think we needed a minute to say goodbye to our exclusive little club and get ready to add a new member. </span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;"></span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;">One of the sweetest memories I have of Kevin and I getting ready for the birth together happened at the end, when I was right at 40 weeks pregnant. I was feeling stressed for all kinds of reasons, and I'm sure he was too. But instead of escalating my little freak out, Kevin sat me down, rubbed my neck, and talked me through some relaxation. He helped me breathe, and we practiced how I would relax when the actual labor began. I'm not sure I managed to relax physically that same way during labor, but I know I went back to that emotional space when I felt overwhelmed by the experience of giving birth. It was a really nice place to be. </span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;"></span><br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;">In sum, I think the ideal preparation for birth (for anybody, not just me) puts you in a place where you feel confident in your knowledge, in your caregivers, in your support system, and in your body. If you're getting ready for birth, take inventory of how you feel about each of those areas. If you find that any one of them doesn't make you feel good about giving birth, make the changes you need to right now. You will thank yourself later, and so will your baby.</span></b>Rebeccahttp://www.blogger.com/profile/02589949170980959443noreply@blogger.com0tag:blogger.com,1999:blog-5186597747141068105.post-74673463667817001652012-11-09T08:00:00.000-05:002012-11-09T08:00:15.982-05:00Can we and should we measure "lactastrophe" rates?This started as a links post, but my commentary on the first link got long enough to qualify it as a post in and of itself! It turns out I have a little more to say about this topic than I realized. First, please go read <a href="http://bfmed.wordpress.com/2012/10/15/how-often-does-breastfeeding-just-not-work/">"How often does breastfeeding just not work?"</a> from the Academy of Breastfeeding Medicine blog:<br />
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<blockquote class="tr_bq">
From a health and wellbeing perspective, however, I’m not sure that it matters whether we “count” both “biological” and “perceived” insufficient lactation together. The total burden of this problem is enormous, and mothers are suffering, whether they lack glandular tissue and or they lack self-efficacy and support. We need mothers for whom lactation doesn’t work to know that they are not alone. And we need to demand research to develop the tools that will identify the underlying problems and allow us to implement the appropriate treatment.<br />
<br />
We also need to step back from assertions that every mother can breastfeed, if she just tries hard enough. As Neifert has written, “The bold claims made about the infallibility of lactation are not cited about any other physiologic processes. A health care professional would never tell a diabetic woman that ‘every pancreas can make insulin’ or insist to a devastated infertility patient that ‘every woman can get pregnant.’ The fact is that lactation, like all physiologic functions, sometimes fails because of various medical causes.”</blockquote>
<br />
It's a great post and great comments. The one thing I would add is that while it does us no good to bicker about whether this person or that person "truly" had a low milk supply, on a public health/policy level I believe having these statistics could help push for change. It's also not useful to spend time picking apart an individual's c-section as "necessary" or "unnecessary" - but when we look at two hospitals, select out their low-risk populations, and compare their c-section rates, we can start to see what might be attributable to environment and what might be unavoidable. It provides a basis for us to say to the hospital with a 40% rate, "Hey, all these surgeries might seem necessary to you, but let's see what might be some underlying causes."<br />
<br />
I have been talking with a colleague about the idea of a prospective survey tracking a population of women who are getting "ideal" breastfeeding support - women delivering at a mother- and baby-friendly facility, who have good prenatal education and postpartum support for breastfeeding, and are generally very committed to making breastfeeding work. What is the rate of "unplanned undesired weaning"/"lactation dysfunction"/"lactastrophe" among women with near-ideal circumstances? (Or as ideal as you can get in a country with no mandated paid maternity leave...) I think the results would help guide us, not toward a way to pick apart whether an individual woman "could have made it work if she tried harder" or "didn't really have a low milk supply", but towards an understanding of what is possible. Sometimes I get tired of hearing "lots of mothers don't make enough milk" and "some people just can't breastfeed". I get tired of hearing these statements not because I don't believe they are true - they are depressingly true - but because they are recited as if they are unpreventable, unmodifiable facts. If the data is used carefully and correctly, it could serve as a benchmark for measuring how much farther we can go towards preventing "lactastrophes" for all mothers.<br />
<br />
Still, I want to inscribe that last paragraph on a freaking 10-foot-tall stone tablet somewhere and make every parent-to-be, support person, doula, and health care professional read it out loud before they receive their first education on breastfeeding. Why do so many people imbue breastfeeding with a magical evolutionary resiliency that nothing else possesses? (Is it just an overreaction to the opposite problem, the attitude that breastfeeding is fragile and usually destined to fail?) Real people suffer when those around them adopt the attitude that "every woman can breastfeed." Nuance often gets lost in the rah-rah atmosphere we use to try to shore up most women's (dismal) expectations for their breastfeeding success, but it is so necessary right now when more women than ever are trying to breastfeed and more are confronting medical conditions that make it challenging or impossible.Rebeccahttp://www.blogger.com/profile/02589949170980959443noreply@blogger.com1tag:blogger.com,1999:blog-5186597747141068105.post-78779571357208316382012-08-02T00:57:00.000-04:002012-08-02T12:22:48.901-04:00Reply turned post: The nightmarish vision of a baby-friendly hospitalFeministe, along with a few other things I've seen around the interwebs, <a href="http://www.feministe.us/blog/archives/2012/07/31/latch-on-nyc-or-else/">has a hand-wringing post about New York City encouraging hospitals to adopt baby-friendly practices</a> such as limiting staff access to formula, not advertise formula, not give free formula samples, etc. Caperton at Feministe describes this state-controlled gulag:
<br />
<blockquote>
Starting September 3, baby formula will be a controlled substance at some New York City hospitals. Under the health department’s voluntary Latch On NYC program, 27 hospitals are literally hiding the baby formula under lock and key, tucking it away in distant storerooms and locked dispensaries like legitimate medications that need to be tracked. Nurses will be expected to document a medical reason for every bottle a newborn receives, and mothers will get a breastfeeding lecture every time they ask for a bottle of formula.</blockquote>
Cue lots of upset in the comments about how babies will go hungry.<br />
<br />
<b>My first response:</b><br />
<br />
So many of these comments are ridiculously overdramatizing an already overdramatized issue. “Babies will be forced to wait an hour for a bottle!” No. I work as an LC at a hospital with these policies so let’s clear some things up:<br />
1) You don’t want to breastfeed, you don’t. You get your bottles on admission and that’s the end. The LC doesn’t see you unless you ask to be seen for some reason, like engorgement.<br />
2) You want to breastfeed, you breastfeed. Nurses can’t sneak formula behind your back. Before we started documenting the mother’s consent, there was a lot of “she said/she said” after the night shift left. The nurse claimed the mom asked for a bottle, the mom claimed the nurse gave it without permission. Now if there’s a bottle, everything is documented and no one can say they didn’t know.<br />
3) You need a bottle, the nurse or NA brings it to you. There’s no “queue” and no one is waiting for an hour. The formula is in the cabinet with all the other supplies. (That is totally staff-facing by the way – it’s not like the parents ever know it’s locked up. So is the Tylenol and that’s not shaming people with headaches.) We limit the amount of formula we give per feeding in part because people will give insanely inappropriate amounts. A newborn has a stomach made to hold about a third of an ounce at birth. I have seen people give over two ounces at one feeding!! It’s considered an accomplishment by grandma that she got the baby to eat so much, but it is not good for the baby.<br />
4) If you are asking for formula for personal reasons, we document the reason. If the baby needs it for medical reasons, we document that too. Again, this is not to shame anybody or demand they give us a good excuse, it is to push the medical/nursing staff to acknowledge that “the baby cried some” is not a reason to tell the mother “you need to formula feed or your baby will starve”. (You think people don’t do that? You are wrong.) Medical reasons to supplement include excessive weight loss, jaundice associated with poor feeding, etc.<br />
5) No one gets lectured. The consent they sign does say that giving bottles may interfere with their STATED plan to breastfeed. That is the truth, so I don’t think there’s a big problem with it. I work with a lot of moms who choose to formula feed for various reasons, usually because they believe they don’t have enough milk. I disagree, and I explain why I don’t think that there is a medical need for supplementation. I say that while there is no medical need, it is their baby and they can decide whatever they want. Some parents hear my explanation, feel reassured, and keep breastfeeding exclusively. Some decide they want to go ahead and supplement. Their baby, their choice.
So much for the heavy-handed police state – sorry if real life disappoints. I feel like so many of these comments are like a Tea Party vision of Obamacare.<br />
<br />
<br />
<b>My second comment:</b><br />
<br />
@Caperton: “On top of that, we have arguments of Nurses are good and supportive and helpful and so this policy won’t have negative side effects vs. Nurses sneak formula and bottle-feed your baby behind your back and don’t honor your wishes, so they need extra rules. Whether it’s either or both…”
It is both, and also Nurses can be pushy jerks about both breast and formula feeding (and a million other topics as well “stop picking up the baby when it cries!”) They do need extra rules. These are some of the rules.<br />
<br />
“…Whether it’s either or both, we still have a policy that’s based on locking up baby formula and dispensing it bit by bit like feeding a baby bird, rather than on treating new mothers like adults: educating them about breastfeeding, letting them know that support is available, and then trusting them to make their own choice. And then honoring that choice.”
But see this is where I don’t get it. How does the status quo honor people’s choices? We DO have breastfeeding moms getting the runaround and staff disrespecting them. This policy is meant to address that. In the meantime, everyone still gets what they want. This obsession about the locking up is still so puzzling to me. No mother could ever go and help herself to the formula cabinet. She always had to call the nurse to get formula brought to her. The lock is for the STAFF. And actually, feeding a baby human IS like feeding a baby bird (except for the worms part). They only need very small amounts. And they are OK if you bring them one meal at a time; they don’t know or care where the next meal is stored.<br />
<br />
Finally, I am ALL FOR maternity leave. This is a HUGE and important component of breastfeeding support. And you better believe breastfeeding advocates know it and talk about it A LOT. It doesn’t mean that the hospital isn’t important too, and is a place where public health officials can actually make a concrete, immediate difference. People who are sabotaged in the hospital don’t ever make it to 2-3 months out as it is. I did some number-crunching for a WIC office and 50% of their moms who initiated breastfeeding stopped in the first two weeks. There is a huge drop-off after the much-vaunted 90% initiation, and that actually starts in the hospital for many people.<br />
<br />
<br />
<b>In response to continued upset about the locked formula: </b><br />
<br />
@Lauren: “That’s a staff education issue, not a mother education issue. It’s not resolvable by locking up baby food.”
Again, locking up the formula is PART of what they are doing for staff. When you call for a bottle, do you know if the nurse has to deal with a lock or not? Nope. But she can’t be snagging bottles left and right for moms who don’t want them. Staff education is also part of that; it’s still just so puzzling to me that people are acting like the baby itself will have to open a bank vault to get fed.<br />
<br />
<b>Now this evening an update to the original post: </b><br />
<br />
*Update 8/1, 6:30 p.m. According to Samantha Levine, deputy press secretary in Mayor Bloomberg’s office, the information on the Latch On NYC site was wrong, and hospitals will not be expected to keep formula locked away (although they’re free to do so). She says they’re correcting the FAQs to reflect that. It seems like a rather a strange thing to get so diametrically incorrect, but removing the lock-and-key element of the Latch On NYC initiative does help things immeasurably.<br />
<br />
---<br />
<br />
??? I do not get it. This is what our scary locked formula storage looks like. It's in the nursery.
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://www.carefusion.com/Images/Medication_Management/medstation_DI_0609_0068_.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="550" src="http://www.carefusion.com/Images/Medication_Management/medstation_DI_0609_0068_.jpg" width="388" /></a></div>
You type your login, hit a few buttons, and open the door. FYI, the breast pump kits, nipple shields, etc. are in this too. It helps the people who restock track the par levels so they can keep any supplies from running out. No one is upset that because those things are locked up, they're discouraging breastfeeding.<br />
<br />
Can anyone help me understand all the drama over the locked cabinet requirement, which once removed has "helped things immeasurably"? I'd say out of all the things commenters were concerned about (shaming, lecturing) it is the least relevant. Ask any of our patients who use formula whether we keep it behind a lock
(besides the lock on the nursery door) and I guarantee not a single one
will know. Is it just some kind of gut feeling?Rebeccahttp://www.blogger.com/profile/02589949170980959443noreply@blogger.com39tag:blogger.com,1999:blog-5186597747141068105.post-64424894660476884722012-07-29T02:21:00.002-04:002012-07-29T02:51:11.441-04:00GE ad shows NICU baby's first breastfeedingI'm an Olympics junkie, so when I went out with some friends this evening we still had our eyes on NBC. This ad caught my eye, of course, because it showed babies in a NICU; when I saw the end I started hitting the friend sitting next to me with excitement (not hard. I think.) How wonderful that the happy ending to this commercial is...breastfeeding!<br />
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<br />
(If the embed doesn't work, <a href="http://bcove.me/1tccttd4">click here</a> for the direct link.)Rebeccahttp://www.blogger.com/profile/02589949170980959443noreply@blogger.com2tag:blogger.com,1999:blog-5186597747141068105.post-59980049084937616532012-07-21T01:19:00.002-04:002012-07-21T01:19:51.888-04:00How a pro-life, homebirthing, staunchly conservative mom lost her fear of universal healthcareBy living in Canada, where she is at first concerned and disturbed by having to participate in a universal health care system:
<blockquote>When I moved to Canada in 2008, I was a die-hard conservative Republican. So when I found out that we were going to be covered by Canada’s Universal Health Care, I was somewhat disgusted. This meant we couldn’t choose our own health coverage, or even opt out if we wanted too. It also meant that abortion was covered by our taxes, something I had always believed was horrible. I believed based on my politics that government mandated health care was a violation of my freedom.
When I got pregnant shortly after moving, I was apprehensive. Would I even be able to have a home birth like I had experienced with my first 2 babies? Universal Health Care meant less choice right? So I would be forced to do whatever the medical system dictated regardless of my feelings, because of the government mandate. I even talked some of having my baby across the border in the US, where I could pay out of pocket for whatever birth I wanted.</blockquote>
<a href="http://ayoungmomsmusings.blogspot.com/2012/07/how-i-lost-my-fear-of-universal-health.html">Read more here</a> about her experiences with the health care system, maternity care, and her feelings on abortions in a universal care system.
I only hope we can move closer to living this reality in the U.S. quickly enough for others to lose their fears as well.Rebeccahttp://www.blogger.com/profile/02589949170980959443noreply@blogger.com0tag:blogger.com,1999:blog-5186597747141068105.post-34635921055230421942012-06-28T16:34:00.002-04:002012-06-28T16:34:54.211-04:00ACA upheld!I am happy and relieved that the Affordable Care Act was upheld today - for both public health and doula-related reasons! To illustrate just a few of the reasons why, I point you to <a href="http://transform.childbirthconnection.org/progress/ppacamaternity/">this article</a> from the American College of Nurse-Midwives:
<blockquote>
Before implementation of the new health care reform provisions, many uninsured young women have not been eligible for Medicaid or other insurance coverage until becoming pregnant. For example, a nine-state study found that from 17 to 41 percent of childbearing women lacked insurance prior to pregnancy, with 13 to 35 percent transitioning to Medicaid at some point during pregnancy (3). Lack of insurance before pregnancy has limited the ability of a large segment of childbearing women to use health services to plan a successful pregnancy. ...Three PPACA provisions will dramatically change this situation. </blockquote>
Preconception care is a huge issue. Many pregnant women end up getting access to coverage via Medicaid, but there is only so much prenatal care do when you already had poorly controlled diabetes and high blood pressure prior to pregnancy.
<blockquote>In the past, uninsured pregnant women have largely been ineligible to purchase private insurance or, if they could purchase insurance during their pregnancies, the coverage generally did not include maternity care for the present pregnancy. More recently, some insurers have deemed women who had a previous cesarean birth to be ineligible for maternity care coverage (6), and there are anecdotes of similar practices, such as excluding coverage of pelvic floor problems among women who have had an episiotomy. Such practices will be illegal in 2014.</blockquote>
This is huge! It is essentially impossible for pregnant women to buy health insurance; if you don't qualify for Medicaid, you are totally out of luck. The denial of coverage to women who have had prior c-sections is hugely problematic, and will be banned along with other "pre-existing conditions".
<blockquote>In recent years, Medicaid beneficiaries in some states have lost access to birth center coverage, and many freestanding birth centers have been threatened with closure due to loss of Medicaid reimbursement. Although birth centers have traditionally been reimbursed within Medicaid programs, some state Medicaid programs had recently begun to deny birth center claims and legislation had not mandated such coverage for Medicaid beneficiaries. A PPACA provision requires coverage of care in freestanding birth centers that meet state regulatory requirements, beginning in 2010.</blockquote>
Straightforward and much-needed. Birth centers are part of making care more effective and affordable!
<blockquote>Beginning in 2010, all new health plans are required to offer, at no extra cost to the patient, all services and screenings recommended by the U.S. Preventive Services Task Force. For childbearing women, the recommended services include folic acid supplementation, breastfeeding counseling before and after birth, tobacco use counseling, and screening for several conditions</blockquote>
This includes reimbursement for lactation consultants!
<blockquote>The act directs employers to provide new mothers with a reasonable break time to express milk for a nursing infant for 1 year after the birth and a private place that is not a bathroom for doing so.</blockquote>
This is one of the provisions that very few people outside the breastfeeding advocacy community paid a lot of attention to, but one of the things that will make a HUGE difference for pumping moms in the workplace. People I know who work with universities who are building out their campuses say that they are hearing more and more about making sure that every building has a mother's room.
There is so much more - some that not even I was aware of. <a href="http://transform.childbirthconnection.org/progress/ppacamaternity/">Read it here!"</a>Rebeccahttp://www.blogger.com/profile/02589949170980959443noreply@blogger.com0tag:blogger.com,1999:blog-5186597747141068105.post-22794728771617835032012-06-23T03:16:00.001-04:002012-06-23T03:16:46.985-04:00"The only good abortion is my abortion"I may not be writing much, but I can link! And I really wanted to share a post from <a href="http://www.boingboing.net/">BoingBoing</a>. The posts there range from technology, science, art, and culture to unicorns and funny cats, and occasionally more personal posts from the group of authors who contribute.<br />
<br />
This post is very personal, and that's why I think we should be grateful that it's being made very public: <a href="http://boingboing.net/2012/06/20/the-only-good-abortion-is-my-a.html">"The only good abortion is my abortion"</a>:<br />
<br />
<blockquote>
The heart hasn’t sped up. The fetus hasn’t grown. The egg yolk is now
bigger than the fetus, which usually indicates a chromosomal
abnormality. Basically, this fetus is going to die. I am going to have a
miscarriage. It’s just a matter of when.<br />
<br />
Because of these facts—all these facts—I get special privileges,
compared to other women seeking abortion in the state of Minnesota.<br />
<br />
<span id="more-167042"></span>
Nobody has to tell my parents. I am not subject to a 24-hour waiting
period. I do not have to sit passively while someone describes the
gestational stage that my fetus is at, presents me with a laundry list
of possible side-effects (some medically legit, some not), lectures me
on all the other options that must have just slipped my mind, or forces
me to look at enlarged, color photographs of healthy fetuses.<br />
<br />
Because I have health insurance, I can afford a very nice OB/GYN whom
I chose and who does not exercise her right to deny me this option.
Thankfully, I don't live in a state where she can legally lie to me
about the status of my fetus, to dissuade me from having an abortion.<br />
<br />
Most importantly, from my perspective, I have the privilege of a
private abortion in a nondescript medical office. I will not have to go
to an abortion clinic. I will not have to walk by any protesters—not
even Charlie, the one guy who is paid to protest every day outside
Minneapolis’ abortion clinic, where I have volunteered as an escort in
the past.<br />
<br />
Most of these privileges boil down to the fact that, as far as my
doctor and my medical billing are concerned, this is not an elective
procedure.<br />
<br />
But here’s the thing. It <i>is</i> elective.</blockquote>
<br />
<br />
The comments, from both men and women who have experienced a pregnancy loss of their own or of their partners, are almost universally compassionate and often share very difficult stories of their own. I think it's important reading.Rebeccahttp://www.blogger.com/profile/02589949170980959443noreply@blogger.com1tag:blogger.com,1999:blog-5186597747141068105.post-75331326725124094062012-05-25T00:03:00.000-04:002012-05-27T00:16:32.874-04:00IBCLC vs CLC - which is better? Why are we asking?Emily at Anthro Doula just completed her Certified Lactation Counselor (CLC) course (congratulations!) and <a href="http://anthrodoula.blogspot.com/2012/05/certified-lactation-counselor-training.html">in her post on what she learned</a>, she pointed to a link to <a href="http://www.healthychildren.cc/Position%20Paper%20on%20Comp.%20Roles.pdf">a position paper</a> by the organization that runs CLC training, Healthy Children. The position paper essentially argues that the CLC and IBCLC are equal credentials and that there is no "hierarchy" in lactation credentialing. I have seen this as a hotly discussed topic among IBCLCs, CLCs, and doulas recently - online and in person - and reading the position paper made me really want to get my thoughts down on this.<br />
<br />
There are a lot of arguments about which training/exam/experience turns out better lactation professionals, or whether one is guaranteed to turn out better professionals that the other. There are CLCs out there <a href="http://www.hearthsidedoulas.com/blog/2011/06/18/Lactation-Guidance-Whats-In-A-Name-Part-II.aspx">arguing that CLCs can be just as qualified as IBCLCs to help breastfeeding moms</a>. There are <a href="http://www.second9months.com/?p=1141#more-1141%27">IBCLCs who argue that the training and credentials of IBCLCs are superior and that mothers should not count on CLCs for certain kind of breastfeeding help</a>. The comments sections of the second post engages in some debate, so read up if you want to familiarize yourself with some arguments on either side.<br />
<br />
On the question of who is the more advanced support for breastfeeding and who receives the more advanced training, my answer is unequivocally IBCLCs. I did a training very, very similar to the CLC training when I was training as a doula. It was a slightly shorter course, but otherwise it had many of the features that the CLC's position paper favorably compares to IBCLC training - competencies testing, written exam, dozens of hours of classroom teaching, etc. It was a FANTASTIC training! I learned so much, and still use some of the skills I learned there today. I went on to help a lot of mothers and babies breastfeed; I think I did about 40 hands-on consults in the following year. I had what some CLCs feel makes them comparable to IBCLCs: training and experience. I puttered along happily with that training for years, feeling capable of handling a lot of breastfeeding questions.<br />
<br />
Then I did IBCLC training. I am here to tell you that there is no comparison between a CLC-level course, and a Pathway 2 IBCLC course. How can there be, when in Pathway 2 you spend hundreds of hours hands-on with a clinical mentor? There was so much I learned from my mentors, a lot of mistakes I made that they were able to correct, and a lot of time to soak up knowledge and techniques. Could I have gotten there on my own by trial and error, via experience as a green CLC? Probably - I had to make some mistakes on my own anyway when my training was over, because making mistakes is an inevitable part of learning, in any profession. But let me point out that when we make mistakes to get experience, we are making them by working with mothers and babies who may have more difficulty breastfeeding, health issues, and emotional pain because of our mistakes. Shouldn't we do our best to minimize the number and impact of these errors by setting up mentor relationships, much as other health professions like medicine, midwifery, and nursing do for their trainees and new graduates?<br />
<br />
(The one place where the CLC might get traction with me in this argument is in the issue of Pathway 1, which I have also written about before. I think this is an area that IBLCE will need to address in the near future - the fact that individuals with another clinical degree do NOT need mentored hours - although they do have many hours of hands-on experience. I think it's problematic that someone with no other qualifications can become a CLC without ever doing hands-on clinical work and then promote their services. I think it's also very problematic that someone with clinical qualifications can become an IBCLC without ever MEETING another IBCLC. Those IBCLCs are missing out the same thing that a CLC is - mentorship and hands-on training.)<br />
<br />
So no, I don't think Healthy Children, or CLCs - especially new CLCs - should say that IBCLCs and CLCs have equal experience and training to offer to mothers. Does this mean that if I took the best CLC in the world and compared her to the worst IBCLC, that individual IBCLC would still be better? Probably not. <a href="http://www.hearthsidedoulas.com/blog/2011/07/07/Lactation-Guidance-Whats-in-a-Name-Part-IV.aspx">As this post points out, there are some really bad IBCLCs out there, and great CLCs.</a> There are likely also CPMs out there who give better, more evidence-based counseling and treatment to their clients for gestational diabetes than do some OBs, even though OBs are supposed to be the experts in high-risk pregnancy. Anybody can be good or bad at something, regardless of the letters next to their name. But I will certainly argue that the overall average experience and range of IBCLCs exceeds that of CLCs, and I base this in large part on the fact that I've done both kinds of training and lived the difference. There is no way that new CLCs can handle 95% of breastfeeding problems and that the rest require advanced, non-lactation interdisciplinary support as <a href="http://www.hearthsidedoulas.com/blog/2011/06/18/Lactation-Guidance-Whats-In-A-Name-Part-II.aspx">this post claims</a> - I can't handle every breastfeeding problem without calling on more experienced IBCLCs for help and guidance, and I've already been an IBCLC for two years (and no, it doesn't need to rise to the level of needing outside specialties to need some extra guidance.) In fact, I felt MORE confident and independent BEFORE I did the IBCLC training - because I didn't know what I didn't know.<br />
<br />
BUT - until we get IBCLC licensing in the U.S. (which I am excited about and seems to be moving forward on many fronts) the question is to some extent academic. Anyone can advertise their services, and any CLC can say she's equal to an IBCLC without legal repercussions. The debate is mostly lactation-world infighting and it's questionable whether, apart from potentially convincing CLCs not to advertise their services, it will really benefit consumers (unless there are a lot of sleep-deprived new mothers out there researching the issue on the internet before they decide whom to hire). I think the more interesting issue raised here is access. <a href="http://phdoula.blogspot.com/2010/10/thoughts-on-ibclc-training.html?showComment=1337830518243#c2701534545868334952">I've written about how financially and logistically impossible IBCLC training is for many people to attain</a>. People who get bitten by the breastfeeding bug fall hard - I know, I got bitten myself. You end up searching and searching for ways to do what you love - helping moms and babies - and all the routes to an IBCLC seem closed. I would brainstorm ways to make it work at various points in my life, before giving up again upon realizing there was no way I could get the clinical hours. The CLC, on the other hand, has brilliantly positioned itself as a way to be "like an IBCLC" without all the impossible requirements, not to mention the financial investment in IBCLC training that is so difficult to recoup. It is unleashing a group of people who so deeply want to do this work by giving them a credential they can feel is "close enough" to enable them to pursue that passion. Should we be surprised that CLCs are such vocal defenders of the certification, that Healthy Children is investing so much in legitimizing it, or that people sign up in droves?
<br />
<br />
But it is troubling to me, because what we need is not to make a lactation consulting credential that is more accessible because it's quicker and cheaper. We need to make a credential that is accessible because lactation consulting becomes a profession that will pay off in the long run through reimbursement and greater recognition, and because it is offered through formal educational programs. This would enable the credential to become more rigorous, not less, which I believe is the way the field needs to go.
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In short, I think in a better world, we wouldn't be asking which is better, IBCLC or CLC. No one would be battling to prove that they could do consults with a CLC credential, because the people who wanted to do consults would be able to become IBCLCs. The CLCs could happily go on doing basic breastfeeding support, education, etc. - which is a great role for that credential to play.
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Thoughts? Any IBCLCs and/or CLCs out there want to give their perspectives?Rebeccahttp://www.blogger.com/profile/02589949170980959443noreply@blogger.com19tag:blogger.com,1999:blog-5186597747141068105.post-16055761635632461942012-04-12T01:34:00.001-04:002012-04-12T01:36:12.387-04:00Baby-Friendly rapWords cannot express how much I love this video!<br /><br /><iframe width="560" height="315" src="http://www.youtube.com/embed/N9KptD3t110" frameborder="0" allowfullscreen></iframe><br /><br />Via <a href="https://www.facebook.com/kellymomdotcom">Kellymom's Facebook page</a>, which is basically a neverending stream of greatness.Rebeccahttp://www.blogger.com/profile/02589949170980959443noreply@blogger.com0tag:blogger.com,1999:blog-5186597747141068105.post-79551796255808151912012-04-03T08:16:00.003-04:002012-11-09T02:17:54.383-05:00Guest post: A doula's path through pregnancy/birth (Part 1: Prenatal Care and Education)<i>This post begins the series written by my friend and fellow doula, Chris. You can see the intro to the series, one of Chris' doula stories, <a href="http://phdoula.blogspot.com/2012/03/guest-post-all-you-have-to-do-is-be.html">here</a>. She's now getting to see pregnancy and birth from the other side, and is writing a series of guests posts on her experiences. Stay tuned for more!</i> <br />
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Working as a full-time doula and childbirth/breastfeeding educator for a year (straight out of college) means that I am probably one of the most over-educated first time moms ever. Not only have I read the books, I have seen firsthand what the books are talking about, and I’ve had the chance to form some pretty firm opinions about labor, delivery, and newborn care in a hospital setting. It also means that I have a lot of intuition to rely on when it comes to making choices. Having a well-considered philosophy of birth means that I can rule out a lot of the noise that surrounds birth and focus on finding local resources that can support me through a healthy pregnancy and delivery. It’s pretty exciting to have a chance to put my ideas into action in the first person, and it’s interesting to see what has changed in the years since I left doula work to be a high school teacher.<br />
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When it comes to making decisions regarding prenatal care providers and a birth setting, I was lucky to have the benefit of first-hand experience to guide me. My experience with midwives through AmeriCorps was varied and quite educational. On one end, we had our former boss Barb, who is probably the image of what everyone thinks of as a midwife--earthy, friendly, competent, easy to talk to, and a very vocal proponent of women’s ability to make the best choices for our bodies. At the other end we met CNMs who seemed to need to prove their “legitimacy” to the medical establishment at the hospital and were just as interventionist as any of their MD colleagues. Having met Barb and other similar midwives, I knew that having a wonderful midwife provide my prenatal care and attend my delivery was non-negotiable to me, but I also knew I needed to be careful--not all midwives are created equal.<br />
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I actually chose my prenatal care well before getting pregnant. My husband Kevin and I moved to Athens, GA about 4 years ago, and I had to find a new place for my annual GYN care. Though we weren’t even discussing having kids yet, it made sense to me to find a practice that I might like to stay with straight through (instead of having to find a different prenatal care provider). Since I didn’t have many Athens friends yet, I started with the Internet, where searches for “midwives Athens Georgia” turned up the same practice time and time again: the midwifery clinic associated with Athens Regional Medical Center (a hospital). I made an appointment for a Pap and met an absolutely wonderful midwife. My next three annual exams were performed by different midwives but were just as wonderful (yes, I am using that adjective to describe appointments including Pap smears and internal exams). So when I had my IUD removed last summer, I had no intention of switching practices if we were to become pregnant. I liked this place.<br />
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After I had already gone to my first prenatal visit, I read Rebecca’s post on <a href="http://phdoula.blogspot.com/2011/01/doulas-first-time-mama-advice-kit.html">"what every first time mom should know"</a> (particularly the section on “information to gather and questions to ask about a care provider/setting”), and my type-A side all of a sudden hit the panic button. I hadn’t asked any of those questions! I hadn’t even thought about it! Good moms-to-be and good feminist pregnant women who take charge of their bodies should be asking those questions!! I should have asked those questions before choosing a provider! <br />
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Then I slowed down and thought about why I hadn’t felt the need to do so (I am normally NOT the person who fails to ask questions or probe for reasons/answers), and this is what I realized: I liked the Athens Regional midwifery clinic and trusted their care because it felt familiar to me--it felt like the clinic where I worked with AmeriCorps, which had a very open-minded, forward thinking attitude towards pregnancy and birth (largely due to the aforementioned Barb). I hadn’t felt the need to quiz my midwives because they gave me “that good midwife-y feeling like Barb did.” What I love about midwifery care is that it feels like a partnership. A great midwife values your input and listens to your observations while still sharing her expertise, and you leave the appointment feeling good about your body, what it’s capable of, and what you’re built to do. A great midwife normalizes the process of pregnancy and birth and builds your confidence about what you’re experiencing. And a great midwife helps you extend those feelings to your birth by supporting your childbirth decisions and creating a mother-centered experience. A wonderful OB/GYN can give you the same feeling, but patient-centered care with an emphasis on education is a hallmark of the midwifery model. It’s also one of my favorite parts of working with a midwife.<br />
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The clinic had other signs that reassured me it was the kind of place I wanted for my prenatal care. It offers Centering Pregnancy (which I learned about through Barb and AmeriCorps, and thought was totally cool). Centering combines regular checkups with prenatal education as well as support from a group of women who are due around the same time as you. Centering is great from my perspective as a pregnant woman because I’m excited to make some pregnant friends, and it’s also <a href="https://www.centeringhealthcare.org/forms/ACNM-Position-Paper-Dec-2010.pdf">recommended over individual prenatal care</a> by the American College of Nurse Midwives. Science and Sensibility has a <a href="http://www.scienceandsensibility.org/?s=centering">useful post</a> on the structure and benefits of group care (and they do a cool WellBabies group care program that I’d love to see come to my area). Now that my centering classes have started, I like it even more than anticipated. It’s a great feeling of support and camaraderie, and the midwife who facilitates the group does a wonderful job. Even more fun is the fact that Kevin is enjoying it as much as I am. <br />
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I also like that the clinic isn’t exclusive or private-pay only, which makes for an interesting demographic mix. They accept Medicaid (and in fact were one of the only public-health prenatal practices in Athens for a long time). Also, a lot of the people who go there speak Spanish, and some of the midwives and all of the support staff speak excellent Spanish as well. To me, that feels comfortable and progressive. Because after all, a supported, educated birth should be a right for all women, not just ones with private insurance or the right immigration documents. <br />
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However, even with all of those reassuring signs, I’ve done my fair share of question-asking regarding the practice and what I can expect from a delivery at Athens Regional through the midwifery practice. I’ve asked everyone I bump into with experience with the A.R. midwives--women who have given birth with them, doulas, childbirth educators, a student nurse midwife--and the responses have been unanimously positive. I even talked to one woman who switched to this midwifery practice from an MD’s office halfway through her first pregnancy, and she described the experience as “amazing.” I feel like that’s a pretty solid endorsement. <br />
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All in all, having prior experience as a doula doesn’t exempt me from doing my research or from thinking carefully about my choices in care providers. It just means that I have a place to start from and that it’s easier to weed out the non-helpful stuff (from outdated advice to scary books to unnecessary testing), since I have a pretty clear idea of what I’m NOT looking for. I means I am already developing confidence in my choices and learning to trust that “woman’s intuition” that you hear about. But it should definitely be said that you can accomplish all that without experience as a doula! <a href="http://phdoula.blogspot.com/2011/05/guest-post-mollies-path-to.html">Rebecca’s friend Mollie sure did,</a> and she had a beautiful birth experience. I have a ton of respect for the research and effort she put into her preparation. The point is this: no matter which angle you approach from, the more you know and the more you ask, the more confident you are. The more confident you are, the better your chances for having a satisfying, positive birth experience. That kind of birth is what I wish for all women, no matter how, where, or when you deliver.Rebeccahttp://www.blogger.com/profile/02589949170980959443noreply@blogger.com0tag:blogger.com,1999:blog-5186597747141068105.post-48826011968573520442012-03-22T18:00:00.006-04:002012-03-22T19:09:08.335-04:00Guest post: All you have to do is be there<i>My next series of guest posts is from my friend and fellow doula, Chris. Chris and I became friends and doulas at the same time, on our AmeriCorps maternal and child health team. She has remained my friend and doula sister ever since - years later I still sometimes call her to process a tough birth. Chris is an awesome doula, a great friend, and a smart cookie! She's is expecting her first baby now (hooray!) and her posts for this blog are on her experiences with prenatal care, birth preparation, and (eventually) her birth story.<br /><br />Before that series begins, I asked Chris if I could introduce her with a piece she wrote at the end of our AmeriCorps service. As part of the intro for the incoming MCH team, we each wrote up one birth story to help them get an idea for what our doula work was like. <br /><br />Chris' story was really beautiful and I have found myself retelling it often recently as novice doulas have sought me out for advice about being a new doula. These newly trained doulas are expressing their worries about how they won't know how to help or what to do in the birthing room. I remember these concerns so clearly, along with the worry at births that I should always be doing and/or saying something because if I wasn't "doing something", I couldn't be doing anything, right? Yet like Chris, often the births where I felt most useless or helpless were ones where I was thanked effusively later by the mother and her support people. <br /><br />The more births I attended, the more I realized the value of presence alone. I started to let my presence be enough: if something needed to be done, I did it; the rest of the time I could just be - be positive, be calm, be present. I tell new doulas this story to help them work through those concerns about knowing what to "do" and help them feel more confident that their presence is perhaps the single most important thing they bring to the birthing room. It is also a great story about the importance of doula support for all women and how we as doulas need to work hard to make sure we support programs that offer doula support to those who need it the most.<br /><br />Some details have been changed to protect the client's privacy.</i><br /><br />----<br /><br />I was on my way out of the hospital after being a doula at a truly amazing birth when I got the call that a doula was being requested at a different hospital. Coming off such a beautiful delivery, I was still feeling great - energetic, excited, and in love with my job. By the time I drove across town to the other hospital, I was feeling the weight of the day and starting to drag.<br /><br />The birth I had just come from was wonderful - very natural, lots of labor support from family, a wonderful midwife. When I walked into the second delivery room, the atmosphere could not have been more different. Instead of a sunset coming in through the window, there was fluorescent light. Instead of soft music, there was beeping from the IV pump and thumping from the fetal monitor. The mother, Elena, was all alone, hooked up to Pitocin, receiving IV pain meds, and thrashing and moaning through contractions. Just as I walked into the room, the nurse gave her another dose of medicine.<br /><br />The thing about meeting a woman for the first time when she is in active labor is that she doesn't talk much. In fact, women in active labor without an epidural usually don't want to talk at all - they've got something much more important to focus on. I took Elena's hand, and helped her breathe through the next contraction. I didn't feel like I was helping - I figured that the reason she was calmer was the pain meds. She slept in between contractions and moaned when she was in pain, and for hours I sat next to her, holding her hand and rhythmically stroking her belly through contractions. She hardly spoke to me; the extent of our interaction included waking her up to say (in Spanish) "Elena? The nurse wants to know if you want more medicine." The nurse told me that Elena's husband was in jail, and that this was her first baby. I had no further information about the situation.<br /><br />Elena progressed steadily, and sometime after midnight she was ready to push. She pushed out a healthy baby girl she named Stefania Espiritu. As they took the baby away to be examined and cleaned, Elena burst into tears. They seemed to be more than just tears of joy over the birth of a baby, and I asked her what was going on. "It's my husband," she said, "I just wish he could have been here. He's in jail. He got caught driving without a license and they were going to deport him back to Ecuador today." Her husband was an undocumented immigrant who happened to get caught doing something many other people do. But now he was separated from his family and had no way of even knowing about his new baby girl.<br /><br />As I spent more time talking to Elena, I realized what a big moment this was for her and how important it was that I had been there. She had previously thought that she couldn't have children, though she had tried and tried. When she finally conceived, she and her husband were overjoyed. She kept repeating, "I didn't think I could ever have a child, and here she is." Her mother worked the overnight shift and couldn't be with her at the hospital, and she had no other person to support her. She looked to me and said "Thank you so much for being here! You helped me so much - with the breathing, and with the pain - I couldn't do it before you got here."<br /><br />For hours I had felt pretty useless - the whole time she was in labor I thought I wasn't helping at all. To hear her thank me and to find out that I was such important support for her was incredible. I was so glad I could be there so she could share that moment with someone, so she could show off her baby, so she could tell someone her story. The staff at the hospital, while competent and sympathetic, couldn't be there for her in the way I was as a doula. I may not have done much, but my presence made a difference.<br /><br />I spent several hours with her postpartum, just letting her talk. She had so much to share! By the end of it we had established a strong connection and I realized what a valuable service I had provided. Being a doula isn't just about breathing through contractions or changing positions or massaging through back pain--it's about being there, believing in a woman, and listening to her. A midwife once told me that doulas always help, every time. The more births I go to, the more I believe what she says.<br /><br />I will never forget Elena or her story, and I am sure Stefania Espiritu will grow up to be as strong and beautiful as her mother.Rebeccahttp://www.blogger.com/profile/02589949170980959443noreply@blogger.com0tag:blogger.com,1999:blog-5186597747141068105.post-53595709226114991012012-03-16T15:27:00.005-04:002012-03-16T15:37:23.235-04:00Everyone should read this: "The Right Not to Know"In the midst of all the war-on-women contraceptive/ultrasound/domestic violence legislative insanity that I haven't been blogging about in part because, unfortunately, there's so damn MUCH to cover, there are a few pieces that have really stood out to me. <a href="http://www.texasobserver.org/cover-story/the-right-not-to-know">This piece really, really stood out to me.</a> It isn't the first account like this I've read, but it's so timely and I think it is so important:<br /><br /><blockquote>My counselor said that the law required me to have another ultrasound that day, and that I was legally obligated to hear a doctor describe my baby. I’d then have to wait 24 hours before coming back for the procedure. She said that I could either see the sonogram or listen to the baby’s heartbeat, adding weakly that this choice was mine.<br /><br />“I don’t want to have to do this at all,” I told her. “I’m doing this to prevent my baby’s suffering. I don’t want another sonogram when I’ve already had two today. I don’t want to hear a description of the life I’m about to end. Please,” I said, “I can’t take any more pain.” I confess that I don’t know why I said that. I knew it was fait accompli. The counselor could no more change the government requirement than I could. Yet here was a superfluous layer of torment piled upon an already horrific day, and I wanted this woman to know it.<br /><br />“We have no choice but to comply with the law,” she said, adding that these requirements were not what Planned Parenthood would choose. Then, with a warmth that belied the materials in her hand, she took me through the rules. First, she told me about my rights regarding child support and adoption. Then she gave me information about the state inspection of the clinic. She offered me a pamphlet called A Woman’s Right to Know, saying that it described my baby’s development as well as how the abortion procedure works. She gave me a list of agencies that offer free sonograms, and which, by law, have no affiliation with abortion providers. Finally, after having me sign reams of paper, she led me to the doctor who’d perform the sonography, and later the termination.<br /><br />The doctor and nurse were professional and kind, and it was clear that they understood our sorrow. They too apologized for what they had to do next. For the third time that day, I exposed my stomach to an ultrasound machine, and we saw images of our sick child forming in blurred outlines on the screen.<br /><br />“I’m so sorry that I have to do this,” the doctor told us, “but if I don’t, I can lose my license.” Before he could even start to describe our baby, I began to sob until I could barely breathe. <br /><br /><a href="http://www.texasobserver.org/cover-story/the-right-not-to-know">Read the full article here</a></blockquote><br /><br />Heartbreaking, enraging, and the truth. I want the legislators who wrote that bill to read this piece and understand what it means to intrude on the most intimate decisions people can make.Rebeccahttp://www.blogger.com/profile/02589949170980959443noreply@blogger.com0tag:blogger.com,1999:blog-5186597747141068105.post-88602990762520310182012-03-16T12:26:00.004-04:002012-03-16T12:42:47.175-04:00Check out the new cesareanrates.comWhile I've been busy being a blog-derelict, Jill over at <a href="http://www.theunnecesarean.com">the Unnecesarean</a> has been busy starting an entirely new site to document and publicize cesarean rates in the U.S. It includes cesarean rates by state, and within each state by hospital (when they are available). It also has the most recent information available on VBAC bans (via <a href="http://www.ican-online.org">ICAN</a>). This is a really exciting project and I hope it will help place more pressure on states that do not make their rates regularly and publicly available. You can do your part (and learn very interesting facts about your local hospitals!) by visiting the site and - if you're not finding the information you need - use the contact info provided to let your state officials know that you would like cesarean rates documented. You can also submit pictures of your local hospitals to be included in the slide show on the first page!<br /><br />Click here to check it out:<br /><a href="http://www.cesareanrates.com" target="_blank"> <br /><img src="http://www.cesareanrates.com/storage/header.jpg" border="0"> </a>Rebeccahttp://www.blogger.com/profile/02589949170980959443noreply@blogger.com0tag:blogger.com,1999:blog-5186597747141068105.post-56278567351963173472012-03-02T18:02:00.003-05:002012-03-02T18:12:16.329-05:00Guest post: Midwife vs. OBGYN<i>I am excited to be presenting several guest posts in the upcoming weeks. While I've been feeling lately like I might have temporarily run out of things to say, a lot of the wonderful women around me are going through experiences that have given them a lot to say - and I've been shamelessly recruiting them for guest posts. <br /><br />The first comes from my cousin, Maggie. We lived far apart growing up, but were close in age and shared a lot of phone calls – mostly on the topic of American Girl dolls, if I remember correctly. Now we text about breastfeeding instead! (But yes, I do have Samantha and Felicity in a box somewhere.) Maggie is pregnant with her second baby (yay, more babies in the family!) and I asked her to share her thoughts on the difference in care between her first and second pregnancies. I was so happy to get this post and see what a more positive experience she is having this time around.</i><br /><br /><b>Guest post: Midwife vs. OBGYN</b><br /><br />I just went to my 34 week doctor appointment today and the first thing I told my husband after I left the appointment was, “The closer I get to my due date, the more I realize how glad I am that I changed to the midwife group.”<br /><br />To give you a little background, I am pregnant with my second baby and going to a midwife group that is associated with a hospital. This means they deliver at a hospital and still have to abide by hospital rules and regulations, but they are a lot different than a typical OBGYN group. <br /><br />I went to an OBGYN group during my first pregnancy. They deliver at the same hospital I am delivering at now and overall, were a nice group of women (all the docs in the group were women), but I just never felt like they cared about me. Every time I met with them I felt like I was just a number. They took my blood pressure, listened for the heartbeat and I was out the door. <br /><br />I didn’t do much research about labor, pregnancy, etc until I actually was pregnant with my first and had already started to go this practice. What I know now is that I could have switched, but then I was too nervous. I felt like it was the wrong thing to do and my care would somehow be compromised. Not that I didn’t get good care there, I did, but the biggest difference between them and the midwives is that there I felt like I was just a number. They had their way of doing things and overall, they were doing it no matter what their patients wanted. I feel like the midwives treat me like a person that has opinions and feelings about how her pregnancy and labor should go. To me, that is the most important thing you can ask for in a provider, no matter who they are. <br /><br />I thought the best way to really portray the difference is to give you some examples of my care at both places.<br /><br /><span style="font-weight:bold;">Example 1:</span> Birth Plan<br /><br />The OBGYN office did not discuss birth plans with you. The midwife office does and requires each woman to fill one out around 34 weeks. My cousin (who writes this wonderful blog) helped me put together a birth plan for my first pregnancy. I brought it to my appointment with the OB and asked her to look at it just to make sure I was on the right page. I had something in the birth plan about the hospital staff not asking me if I wanted any pain medication. The doctor’s response to this was laughing and saying, “What are the nurses supposed to do when you are lying on the floor screaming in pain?” Needless to say I left the appointment completely shaken up, crying and even more nervous about the labor. <br /><br />I discussed my birth plan today with one of the midwives at my 34 week appointment. This birth plan is a lot more simplified. One thing I learned after my last pregnancy is that everything will not go according to plan and I can’t get discouraged if it doesn’t. I basically stated that I would like to try to go naturally and use certain techniques that have always helped me relax. The midwife was wonderful when going over the plan and even gave me suggestions about things to add in. <br /><br /><span style="font-weight:bold;">Example 2:</span> Extras<br /><br />I am not sure what to call all of the additional things that happen after the labor such as cord cutting, skin to skin contact, nursing immediately etc, but I will just call them extras. These extra things were a cause of worry for me when my first was born. Waiting to cut the cord, not cleaning the baby right away, etc were not routine for the OB practice I went to. It was just one more thing I had to worry about getting included on my plan and making sure they would follow. (Luckily they did.) <br /><br />I went to a “Meet the Midwives” open house when I was first pregnant with my second and trying to decide if I should go to their practice or not. Some of the women there asked questions about cord cutting, skin to skin, etc and midwives said these are not even things that need to be included in the plan because they are all routine at their practice. In fact, the midwife I met with today even told me about a study that the hospital is doing called “Kangaroo Care” and to make sure I tell the nurses I want to be a part of it. That way I am guaranteed that all the nurses follow these procedures from birth to discharge. <br /><br /><span style="font-weight:bold;">Example 3:</span> Induction<br /><br />I ended up getting induced with my first. Yes, completely different than what the plan was. I was 41 weeks and the doctors recommended I get a non-stress test. Of course, we failed! My daughter’s heart deceled one time during the test and the doctor told me that I needed to get induced. Actually she told me we needed to go straight to the hospital, not to eat anything, and that I couldn’t go home and get my bags. I was freaking out! After 30 hours of Cervidil, Pitocin and an epidural my wonderful daughter was born. In the end, the labor didn’t matter. I had her vaginally and I was blessed with a wonderful, healthy daughter. But, do I want to go through that again - no way! <br /><br />I discussed my last labor with the midwife today and have discussed it with my new group in the past. They basically have told me that because they are associated with a hospital if a patient gets to 41 weeks they have to recommend a non-stress test for liability reasons. Would the OB docs have told me it was a liability issue, again, no way! <br /><br />They have also told me that there are more false positives than positives in a non-stress test. In fact, when I met with the midwife today I told her that I think my daughter’s heart rate never decelled. I told her that the monitor moved while I was being monitored and I believe that is when it recorded the decel. In the next 30 hours of labor my daughter’s heart rate did not drop one time. She laughed at me when I told her that. Not because she thought I was uneducated or naive, but because she could tell how strongly I felt about the whole thing. She actually went on to tell me that if I get to 41 weeks this time and get a non-stress test that I need to make sure I drink plenty of water, eat a lot before the test and “watch the monitor like a hawk.” She said if the monitor moves at all I need to pull it off, call the nurse and tell her to come put it back on. That way no false decel is being recorded. I almost grabbed her out of her chair and started kissing her when she told me that! A medical professional that is listening to me – what a novel concept! <br /><br />Overall, I have had a lot better experience at my midwife group. I feel like they listen to my concerns, answer my questions and most importantly want me to have a role in my pregnancy and labor instead of just sitting back and being a passenger. That is how I felt at the OB group. <br /><br />My recommendation to any pregnant women thinking about what type of practice to choose is to educate yourself first. Maybe you are okay with being a passenger, maybe you want to be in the driver’s seat. Either way, decide how you want to approach your pregnancy and pick a provider that offers you that. It has made my second pregnancy such a better experience.Rebeccahttp://www.blogger.com/profile/02589949170980959443noreply@blogger.com1tag:blogger.com,1999:blog-5186597747141068105.post-64418714382953036882012-03-02T01:00:00.000-05:002012-03-02T01:28:14.041-05:00Getting the most out of your MPHWhile I was writing my guide for applying and getting into MPH programs, someone suggested a "getting the most out of your MPH" kind of companion piece. I thought that was a good idea, and now I'm finally getting around to it!<br /><br /><b>Your goals</b><br /><br />So remember how I talked about knowing very clearly what your goal is before you apply to MPH programs? That's not just to decide whether you should get an MPH, and which program you should choose. Your goal(s) can carry through your entire academic experience and guide what you do to get the most out of your MPH (which isn't to say they can't change - but if you don't have any to start it will make things much more difficult.)<br /><br />Are you in an MPH program for specific skills, contacts, credentials, or work/research experience? <br /><br />If you end up in an MPH program that is very structured and by design gives you exactly what you need - great! But generally you will have a fair number of choices about how you structure your experience in school, and need to be proactive to get certain experiences that you're looking for. Think as you move through your program whether you're getting closer to your goals and whether there are still things you want to fit in. You don't want to end your experience frustrated that "my program didn't give me _____", and then realize later that you could have made it happen.<br /><br /><br /><b>Getting the most out of your academics</b><br /><br />Use your goals when thinking about structuring your academics - that includes thinking about:<br /><br />- What classes you choose for your electives - qualitative analysis? SAS programming? reproductive health policy?<br />- Topics for class papers or projects - maternal mortality in West Africa? children with special health care needs in the U.S.? global HIV/AIDS policy?<br />- How you choose to focus your efforts - is your data analysis about getting something publishable, or is it about learning the software in-depth?<br /><br />For maternal child health-minded people with highly specific interests - c-section rates, breastfeeding promotion, utilizing midwifery care, etc. - know that you will probably not find a professor/academic niche tailor-made for you, unless you have specifically sought that out. And even then, it will probably be just one person or one project working on that issue. Think broadly about how what you're learning can serve your end goal, and try to network outside of your department/school in addition to your academics to find people working on your specific issues.<br /><br />In the end, I think the most important thing about academics in grad school is to focus on the long-term goal vs. the short-term assignment. I would find myself stressing out about some artificially constructed goal like "500 words about ______" (how am I going to keep it to 500 words, will the professor dislike the way I structured this, etc. etc.) and then have to catch myself. Nobody would ever know or care what grade I on this assignment. I needed to focus on what I wanted from the experience, which was often the excuse to investigate something I wanted to learn more about anyway, and to get feedback on my academic writing so I could keep improving. My high school and undergraduate education at what I fondly refer to as my "hippie schools" definitely emphasized learning for your own sake and not for arbitrary grades, and I found that to be a very helpful lesson in graduate school. I think everyone is happier for this realization; it helps you focus on what you actually need to stress about.<br /><br /><br /><b>Getting the most out of your practicum and thesis</b><br /><br />I put these together for the same reason, which is that I found I needed to dial my expectations way down when it comes to both of these experiences. I was much more satisfied – and got more out of them! – because I did.<br /><br />Your practicum is a 2-3 month experience, often where you are parachuted into a new organization in a new location. Sadly, it won't and can't be everything you want it to be: practicing and getting every skill you want, burnishing your resume, working in exactly your chosen location and field, networking with the perfect people, AND accomplishing something concrete and meaningful to show for your time/work. I think people are happier if they pick ONE thing (max, two) they want out of the practicum and focus on that. I decided I wanted to get solid experience with data analysis and the quantitative side of public health research in general. This was both to get it on my resume/get better at it, and also to figure out if I liked it enough to take a job that was data-heavy (answer: no.) <br /><br />Financial considerations will also play a big factor, since many internships (particularly abroad) don't pay, or pay minimally. If the practicum you want is unpaid, investigate whether your school has funding for practicum experiences and apply to all the funding sources you can. Think about the cost/benefit – an unpaid internship with a really great organization may set you up enough to be worth it down the line, but it also may not – it’s up to you to decide.<br /><br />Your thesis, likewise, is not a dissertation, and (thankfully) won’t define the course of your career. It's actually just another, slightly longer, paper that you're required to write, within various guidelines established by your department. Pick a goal for this experience as well – whether it’s developing something for publication, creating a useful document for an organization, exploring a topic you want to become more familiar with, etc. I used it as an opportunity to help the Centering Pregnancy program I worked with develop a new curriculum module. <br /><br /><br /><b>Getting the most out of grad school life</b><br /><br />Don't be a stranger! Join (or start) student groups, journal clubs, etc. This can be hard for people with a lot of outside commitments like work and family; don't make commitments that add more stress, but try to find ways to connect with your classmates, even if it's just being friendly, and chatting before and after class. I have heard from people many years out of their MPH programs that they are still working with/hiring old classmates. These are your future colleagues in what sometimes feels like a very small field.<br /><br />The same goes for faculty - get involved in research if you can, reach out to faculty who are working on things you are interested in, and seek their help when networking for things like practicum placements and jobs. Again, they are your teachers, but now that you're entering this field they're also your colleagues - you may end up working for/with them in the future. Nurture those relationships!<br /><br /><br /><b>So, in summary:</b><br />- Don't expect to have people who understand your specific interests - make your own path<br />- Know your goals and be proactive about achieving them - don't expect your program to spoonfeed you or to be especially useful in the ways you want it to be without putting out significant effort on your part<br />- Your practicum, thesis etc. should be part of this plan - not envisioned as some amazing perfect all-encompassing crowning achievement, but as realistically-sized means to your ends<br />- NETWORK - don't be a stranger - this applies to both other students and the faculty<br /><br /><br />---<br /><br />This is TRULY the coda to my MPH series! I hope it's been useful to people out there. It does seem to get a fair number of hits! Again, if you're planning to e-mail me, please read through the whole series first to see if I've already answered your questions, and know that I'm not a professional grad school admissions advisor - I'm just someone who's been through the process and has some tips from the other side.Rebeccahttp://www.blogger.com/profile/02589949170980959443noreply@blogger.com3tag:blogger.com,1999:blog-5186597747141068105.post-61043225388301024792012-02-24T17:16:00.002-05:002012-02-24T17:17:16.103-05:00Crunchy moms say...So maybe instead of actual posts, I'll just do funny comics and videos for a while? How does that sound?<br /><br /><iframe width="560" height="315" src="http://www.youtube.com/embed/RVA-A0RqkhM" frameborder="0" allowfullscreen></iframe>Rebeccahttp://www.blogger.com/profile/02589949170980959443noreply@blogger.com0tag:blogger.com,1999:blog-5186597747141068105.post-25386941742110849972012-02-09T01:19:00.003-05:002012-02-09T01:26:23.770-05:00Another great breastfeeding comic from Married to the Sea!Man, I love Married to the Sea. I think this is breastfeeding comic #3 I've seen from them in the space of 6 months.<br /><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://www.marriedtothesea.com/020912/hurry-up-and-breastfeed.gif"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 600px; height: 466px;" src="http://www.marriedtothesea.com/020912/hurry-up-and-breastfeed.gif" border="0" alt="" /></a><br /><br /><a href="http://www.marriedtothesea.com/index.php?date=020912">Link to original</a>, <a href="http://www.marriedtothesea.com/">see many more great comics on various topics here</a>.Rebeccahttp://www.blogger.com/profile/02589949170980959443noreply@blogger.com0tag:blogger.com,1999:blog-5186597747141068105.post-16504786722177471682012-01-30T09:00:00.000-05:002012-01-30T09:00:00.382-05:00How college prepared me for being a doulaSometimes - often as I'm heading to or from a birth - I'll think about the skills I draw on as a doula, and how I wasn't expecting college to have prepared me so well in certain ways for the life of a doula. I think it often enough that I decided I should do a post about it. So from least to most important, here's how what I learned in college applies to doula work:<br /><br />4) <b>Epidemiology and other courses that taught me how to read and interpret scientific literature</b> <br />My master's in public health certainly built on and added to these skills, but I got a very solid foundation in college. Nearly all of my courses emphasized critically reading and analyzing primary literature. I have really enjoyed sharing the benefits of this with my doula clients - helping them understand the evidence for and against various interventions in birth or other concerns they may have.<br /><br />3) <b>Medical anthropology</b><br />Without question one of the most generally life-changing courses I've ever taken, and very applicable to doula work. So much of what we do as doulas involves negotiating the boundaries between very different cultures of birth, and understanding (and sometimes critiquing) those cultures AND our own. The most important thing I learned in my med anthro class was that "Culture is to people as water is to fish...you can't see your own culture because you're in it". It's difficult to mentally step back and try to see your own culture, but it's as important for a doula to understand her own personal mindset and cultural values as it is for her to learn more about those of her clients, the hospital staff, etc.<br /><br />2) <b>Spanish</b><br />I have a whole separate post on Spanish coming, but to summarize I will say that when I was an AmeriCorps doula this was vital. In fact, the Spanish skills of the doulas on my team got us called into a lot more births than we might have been otherwise. The nurses were NOT supposed to call us as interpreters, but they knew that having us around helped make the Spanish-speaking only patients feel more comfortable...and it did make the nurses' jobs easier. And there is a cultural preference on the part of many Hispanic women for unmedicated birth - all the harder to accomplish through language barriers - so very often a doula was especially appropriate. I haven't been to a Spanish-speaking birth in a while, but I'm pretty sure it would all come flooding back to me: "La cervix es la boca de matriz. Tiene que abrir de zero a 10 centimetros..."<br /><br />And the number one thing I learned in college...<br /><br />1) <b>All-nighters</b><br />No lie. (All you doulas know I'm not lying.) I remember the first time I tried to pull an all-nighter in college I physically could not do it. I had to quit around 3-4 am and go to bed. A few more practice nights and I was able to push that out to 5 am...then to 7 am...and then I could enable my natural procrastination with nonstop marathons to finish those final papers the night before the deadline. I learned to accept the physical effects of sleep deprivation (for me, nausea) and find remedies (protein!) And I learned to carefully assess the correct way to manage getting back on schedule (short nap in the afternoon? or just stay up and then go to bed early?) I also learned to do this all without the use of caffeine (I know, I know - I was the only freakish college student not chugging coffee.) <br /><br />All of this proved invaluable when I started attending labors that could last for 24+ hours and/or begin just as I was about to go to bed. And when I became a doula I discovered that giving counterpressure at 4:30 am is a actually easier than constructing supporting arguments for a thesis. And that while turning in those 20-25 pages is certainly a satisfying feeling, it doesn't really compare to the adrenaline rush of attending a birth. So while I still use my skills from those days, doula all-nighters compare very favorably to college all-nighters!<br /><br /><br />I guess the moral of all this is that if you're in college and an aspiring doula, take epi, med anthro, Spanish, and don't write any of your papers for those classes until the last minute! (Note: staying up all night partying is not equivalent preparation, but feel free to do some of that too.)Rebeccahttp://www.blogger.com/profile/02589949170980959443noreply@blogger.com2tag:blogger.com,1999:blog-5186597747141068105.post-62207968145416798572012-01-29T04:23:00.003-05:002012-01-29T04:34:55.662-05:00The fantasy doula leagueFantasy football is ending. Sad? You won't be after listening to this podcast which envisions...a fantasy doula league!<br /><br />These dads are obviously quite familiar with the doula trade and are fantasy doula league experts. They really pick up on the crucial skills and stats of doula practice. And, then of course, there's the placenta-kiwi foam.<br /><br /><iframe src="http://player.vimeo.com/video/30512137?title=0&byline=0&portrait=0" width="400" height="300" frameborder="0" webkitAllowFullScreen mozallowfullscreen allowFullScreen></iframe><p><a href="http://vimeo.com/30512137">Fantasy Doula Report - Comedy</a> from <a href="http://vimeo.com/user8901781">Jon Cragle</a> on <a href="http://vimeo.com">Vimeo</a>.</p><br /><br />"With Rebozo moves like this, she will not be available long!"Rebeccahttp://www.blogger.com/profile/02589949170980959443noreply@blogger.com0tag:blogger.com,1999:blog-5186597747141068105.post-36723326205391224572012-01-17T18:30:00.003-05:002012-01-17T18:35:40.659-05:00More on the UW midwifery programSeattle columnist advises you <a href="http://seattletimes.nwsource.com/html/dannywestneat/2017242298_danny15.html<br />">never to get between a midwife and a birthing baby</a>:<br /><br /><blockquote>Last month, the faculty there recommended eliminating the UW's 19-year-old midwife training program.<br /><br />That isn't surprising on its own. Just about everything is on the chopping block these days.<br /><br />It was their reasoning. It has angered midwives all over the region. Not to mention thousands of moms.<br /><br />The nurse-midwife program was judged not to meet a "societal need." In fact, maternal and newborn health were not even on the list of societal needs drawn up by a UW committee looking to cull programs.<br /><br />Surprisingly, this isn't directly about money. The students in the program pay more in fees than it costs to educate them. Plus midwives are a force that drives down birth-related health costs. ...<br /><br />The UW hooked me up with Carol Landis, a professor in the nursing school who helped draft the recommendation. She said it was not an "arbitrary devaluing of midwives." Driven by state budget cuts, the School of Nursing is reducing the number of areas in which it is teaching- and training-focused (regrettably to her), she said. The emphasis is on high-level research, the kind that brings in grant money.</blockquote><br /><br />And Shari, a midwifery student at UW, commented with the following clarification to my last post:<br /><br /><blockquote>I would like to clarify and issue with this proposal to cut our program. It is not because of the budget per se, as the Midwifery program is funded entirely from student funds. We are one of the only programs operating in the black. This is politcal decision that must be reversed! Please stand with us and sign the petition! Research dollars do not trump the health and welfare of women and children</blockquote><br /><br /><a href="http://www.change.org/petitions/save-the-uw-nurse-midwifery-education-program">The petition already has almost 2500 signatures - with a goal of 10,000!</a>Rebeccahttp://www.blogger.com/profile/02589949170980959443noreply@blogger.com0tag:blogger.com,1999:blog-5186597747141068105.post-90019644760726912292012-01-12T23:22:00.000-05:002012-01-12T23:32:19.104-05:00Sign to save the UW midwifery programThe nurse-midwifery program at the University of Washington is currently slated to be cut. I am shocked that in this day and age universities would be cutting, instead of expanding, nurse-midwifery programs. With our entire health system increasingly depending on mid-level providers, and with the excellent outcomes of nurse-midwives in caring for low-risk women, it seems like a bizarre decision. According the the ACNM website, this is one of only two midwifery education programs in Washington state.<br /><br />If you would like to support the program you can sign a <a href="http://www.change.org/petitions/the-wa-state-senate-save-the-uw-nurse-midwifery-education-program">petition urging the University and the state government to reconsider their decision</a> (you don't need to be a local).Rebeccahttp://www.blogger.com/profile/02589949170980959443noreply@blogger.com2