Link party, August blogcation

I guess my blogging is on an August hiatus? Between traveling and bracketing the traveling with long shifts at work, I am not doing much blogging (also, my e-mail inbox hates me - at least, I assume the feeling is mutual. So if you've e-mailed me and not heard back, that may be a factor.) Early September may not be much better, but I promise to post again soon!

In the meantime, some links:

* Jessica Valenti on learning to love her baby through a harrowing delivery and long NICU stay


* From Birthing Beautiful Ideas, these are many of the reasons that I too love being a doula!


* Elita at Blacktating ponders the idea of the "relief bottle".


* A doula's birth story that highlights some of the ways a doula can play an important role in a planned cesarean


* The Unnecesarean links to this excellent piece on the co-opting of "pregnancy is not a disease" by anti-contraception organizations, and then breaks it down:

...this whole conversation is ridiculous. We are only having it because somebody, somewhere, is upset that women are having sexy non-babymaking funtimes they don’t approve of, and they’re determined to make us all pay for their inability to deal with not everybody agreeing with them that this is bad.

Go on, read the whole thing!


* And for the lighter side of things... I've just discovered the webcomic Married to the Sea, and in celebration they clearly did a comic just for me:



There are lots more!

How people find my blog, June edition

I wasn't planning to do one of these again so soon, but looking through the list of search terms used en route to Public Health Doula just offered too many opportunities to resist. How have people been finding my blog this month? Let's see:

"public health boring"

Well, sometimes. Sorry, stroke prevention...I just can't get excited about you, as important as you are, but I'm sure the stroke prevention people find my work boring too, so I'm happy we've all found our bliss.


"documentary how do you know when a molly is about to give birth"

Is a "molly" some kind of animal? Or this just specifically for women named Molly? And there's a whole documentary about them?


"i want to breastfeed buy nicu has my baby on bottle what should i do"

This makes me sad because I see it so often. Short answer: Demand a visit with a lactation consultant, and if the hospital doesn't have any find an outside IBCLC who can help you. Join a La Leche League group for support, and stay committed - time and patience can do a lot in this situation.


"baby friendly initiative bullshit"

I'm assuming this was a search done by a bitter postpartum floor nurse. I think I might know a few of them. Sorry you're not a fan of evidence-based practices!


"how should you supplement a hypoglycemic baby"

Depends on the hypoglycemia and the baby, but in many situations the first choice should always be breastfeeding/the mother's own milk!


"hate directed pushing"

Me too!!!


"barbie doula"

Oh my god, I can't wait for Doula Barbie! Let's figure out an outfit for her. I'm thinking her accessories should definitely include a birth ball, a rice sock, and a tiny copy of "The Labor Progress Handbook".

What I missed

You know you were (are) a Google Reader addict when you get back on after giving it up for Lent, and it's stopped counting new posts after "1000+". If I was going to be really true to my Lenten vow I would have marked them all as read and started afresh. But I did skim some of my faves. So while these links are probably old to everyone else, here are a few that jumped out at me:

Navelgazing Midwife on Touring L&D suites around the country and wondering what they say about what patients want...or are supposed to wait. I commented about how often hospitals seem to advertise "private rooms"... even in pretty dingy public hospitals I have yet to work with a doula client who got anything but a private room, whether L&D or postpartum. Is this just an advertising gimmick?

The Academy of Breastfeeding Medicine on audio galactagogues for mothers of babies in the NICU. I want to hand out little MP3 players to all the pumping NICU moms I see! It made me wonder whether a Hypnobirthing/Hypnobabies type of track targeted especially to NICU moms to listen to before or during milk expression would be helpful.

Alanna at Blood and Milk on how "helpful" postpartum visitors are a lot like "helpful" aid organizations.

Via Motherwear Breastfeeding Blog, a NY Times article on the deadly consequences of cultural beliefs that deprive babies of breastmilk in developing countries.

Reply turned post: Bottle feeding, breastfeeding, and the NICU

I vent a lot (maybe too much... trying to stay open to positive possibilities for education and cooperation) about the NICU & breastfeeding.

Because of those challenges, this post on My OB Said What caught my eye today: "You’ll get him home sooner if you just bottle feed," – NICU nurse to breastfeeding mother of a NICU baby. Many commenters chimed in to rightfully assert that the mother's breastmilk is much better than a bottle of formula, especially for a NICU baby, but I think this is not quite what the nurse meant. This was my comment:

"This is sad but true... the requirements for the NICU babies to go home is to take all feeds PO (by mouth), maintain their oxygen sats on room air, and maintain their temp. The PO feeding requirement leads to a lot of bottles because they are the easiest and fastest way to declare the baby capable of all-PO feeding. I have met very few moms able to avoid any bottles in the NICU. It basically means insisting on gavage feeding for every feed at which the mother is not present, and it is hard for the mother to be present 24/7 because the NICU is not set up for that. So it absolutely can mean that the baby stays longer. It is very frustrating because direct breastfeeding is best and least taxing for these babies."

It's a real catch-22. The way to prove the baby can do OK on all PO feeds is for the mother to breastfeed him/her around the clock. But there is often nowhere for the mother to sleep after she's discharged from the hospital herself. So to be with her baby 24 hours a day to breastfeed, she has to agree to bottle feeds to "prove" her baby can effectively take all feeds by mouth. The bottle feeds can and do cause issues with breastfeeding, but even for the most motivated mom, it can be a very difficult choice between agreeing to many bottles, and waiting extra days to take her baby home.

Recently, I saw a baby born at 32 weeks go to the NICU, have nothing but breastmilk and never have a single bottle touch her lips, and eventually go home feeding exclusively at the breast. Her mother was highly educated and motivated, had excellent family and community support, and really advocated for herself and her baby. As LCs, we were all so amazed and impressed by what they did. It was truly an accomplishment in a NICU environment... and it took bucketloads of privilege. Very few people are able to accomplish that without support from the staff, which the nurse quoted above was definitely not providing. Staff support is a huge issue. I have even heard a NICU nurse say "If they don't want to bottle feed, I just tell them 'We can put a tube down your baby's nose instead' [referring to gavage/NG tube feeding] - that changes their mind!'" A really inappropriate thing to say just to scare parents, given that this way of feeding may be necessary for certain babies who aren't able to safely do PO feeds.

In my perfect fantasy world, NICU babies who are ready to do PO feeds are moved to private or semi-private rooms that have a space for mom to sleep, so she can be with the baby 24/7 and breastfeed easily. She can stay there until the baby is ready to go home. Bottles are only given with explanation and consent, used appropriately, and stopped quickly if they begin to cause breastfeeding issues. Is this really such a crazy fantasy?

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

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

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

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

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

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

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


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

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

NY Times on kangaroo care

A NY Times piece on kangaroo care, from their Fixes blog:

The babies stay warm, their own temperature regulated by the sympathetic biological responses that occur when mother and infant are in close physical contact. The mother’s breasts, in fact, heat up or cool down depending on what the baby needs. The upright position helps prevent reflux and apnea. Feeling the mother’s breathing and heartbeat helps the babies to stabilize their own heart and respiratory rates. They sleep more. They can breastfeed at will, and the constant contact encourages the mother to produce more milk. Babies breastfeed earlier and gain more weight. ...

Dr. Rey took a challenge that most people would assume requires more money, personnel and technology and solved it in a way that requires less of all three. I am not a romantic who wants to abandon modern medical care in favor of traditional solutions. People with AIDS in South Africa need antiretroviral therapy, not traditional healers’ home brews. If you are bitten by a cobra in India, you should not go to the temple. You should go to the hospital for antivenin. Modern medical care is essential and technology very often saves lives.

Kangaroo care, however, is modern medical care, by which I mean that its effectiveness is proven in randomized controlled trials — the strongest kind of evidence. And because it is powered by the human body alone, it is theoretically available to hundreds of millions of mothers who would otherwise have no hope of saving their babies.

Read the rest here.

I felt somewhat sad reading this because we had a meeting at work recently about feeding in the NICU and the nurses were saying that because of new bubble CPAP machines, it's becoming harder and harder to do any kangaroo care with many babies in our NICU. This photo illustrates why - it is difficult to position the baby in any way but with its head supported from behind. We were trying brainstorm ways to have baby facing out, although I don't think that would be as nice for the parents. Does anyone have experience with kangaroo care + bulky CPAP?