Friday, January 30, 2009
Octuplets and preterm birth
One of the things that is striking me, in the whole octuplets news story, is the amount of attention that is being devoted to the problem of higher-order multiples. I agree that the fertility industry is part of the preterm problem. But fertility treatments are almost exclusively used by those who have the least risk of preterm birth: people with high socioeconomic status. Class and race are huge risks for preterm birth. Black women have twice the preterm birth rate of white women, and this is a gap that is not closing. Should people spend their own money on fertility treatments, and then expect society to cover the costs of any consequences? This is an important question. But I think it's also important for us to ask how much time and energy we should devote to garment-rending over these 8 babies - who are an undeniably rare occurrence - when thousands of others die every year, having been conceived without a single fertility treatment.
Wednesday, January 28, 2009
Keep the keeper?
Hippie alert! I've been interested in more natural and reusable menstrual products for a while, for three reasons. First, going through thousands of pads and/or tampons in my life seemed like a real wear on the planet. Second, a lot of tampons and/or pads are manufactured with unpleasant things like bleach that don't seem innately friendly to the human body. Third and finally, I'm cheap and I don't like spending a lot of money where I could spend a little.
For a while, I used Lunapanties. I really like them, but they have a few downsides. They have to be washed - very well - which is easier when you have a convenient washing machine, which I don't always. Eventually they start to wear out, and they're not cheap. I was trying to decide whether to get more or try something new when I found myself in a feminist bookshop, standing in front of a shelf full of, shall we say, menstrual alternative products, including the Keeper and the Diva Cup. I squeezed 'em both and decided to give the Keeper a try. One cup, 10 years, sounds good to me.
I'm still trying it out, seeing how my body gets used to it and how well it works for me. But it got me thinking about alternative products and whether there's other companies or products out there that people like. Any other hot tips?
For a while, I used Lunapanties. I really like them, but they have a few downsides. They have to be washed - very well - which is easier when you have a convenient washing machine, which I don't always. Eventually they start to wear out, and they're not cheap. I was trying to decide whether to get more or try something new when I found myself in a feminist bookshop, standing in front of a shelf full of, shall we say, menstrual alternative products, including the Keeper and the Diva Cup. I squeezed 'em both and decided to give the Keeper a try. One cup, 10 years, sounds good to me.
I'm still trying it out, seeing how my body gets used to it and how well it works for me. But it got me thinking about alternative products and whether there's other companies or products out there that people like. Any other hot tips?
Tuesday, January 27, 2009
More fun breastfeeding ads!
Via Stand and Deliver, a breastfeeding promotion campaign that uses lifesize cut-outs of women nursing to encourage normalization of breastfeeding. It seems like a good idea; I'd be very curious to know what effect it has, if any.
When is something not elective? When you don't choose it
Jennifer Block (author of "Pushed") has a great piece over on RHRealityCheck called "Can We Please Stop Blaming Women for C-Sections?". Amen.
I know someone who had a c-section for transverse lie, scheduled well before her due date; her baby was less than six pounds. She actually had to resist pressure to take the baby earlier. Was that elective? Let's point the fingers at the right people.
I know someone who had a c-section for transverse lie, scheduled well before her due date; her baby was less than six pounds. She actually had to resist pressure to take the baby earlier. Was that elective? Let's point the fingers at the right people.
Sunday, January 25, 2009
Book recs
I've built up a reputation amongst my friends for bringing birth and/or breastfeeding into the conversation a little too often. That's one of the reasons I started this blog - to get all my ranting and did-you-know-ing and meditations out of my personal blog and into one place. I know this can be annoying; I've vowed to tamp it down. But being in a maternal and child health program has not helped. I now spend most of my time with other women who WANT to hear all about birth and breastfeeding - who constantly ask me questions about it, in fact! The other night at a fundraising dinner, we probably unnerved the only two people not in our program at the table by having a long discussion about induced lactation. My classmates peppered me with questions: can you lactate if you've never given birth? How is lactation induced? How likely is it that you can exclusively nurse a baby when lactation has been induced? I answered all their questions and I did so enthusiastically, but I swear to god, I did not introduce this line of discussion.
Even when I really, really vow to not get into the topic, it sneaks up on me anyway. I went to a basketball game last week. My friend and I were offered a chance to be down in the risers behind one of the baskets and we decided, why not? It could be fun. Little did we realize we'd have to stand the whole time, so as soon as we got there we secured spots at the back where we could lean against the bleachers. Most of the (over)enthusiastic undergraduates around us were jostling forward, so we ended up standing next to two other grad students, a man and a woman. We introduced ourselves and talked about our respective programs. They asked what kind of classes we take. We gave as an example that we were both in a class about breastfeeding this semester. That was all it took - the woman started asking a million questions about breastfeeding, and then she found out that I was a doula, and it turns out she's very interested in natural birth, and then she started asking questions about birth and birth books and doula-ing...
Mindful of my vow, I tried to change the subject - I asked her more about library science, we discussed the basketball game (to which we were paying remarkably little attention given that we had spots for the ultimate fans) - but every time we stopped for a moment to watch the players, she'd turn back to me and say something like, "I've read 'Misconceptions' by Naomi Wolf. Are there other good books I should read?"
What can I say? If you store something metal next to a magnet long enough, it will become magnetized. I have spent so much time talking and thinking about these topics, I have become a magnet for birth and breastfeeding questions. I can't say I mind (at ALL!) but it does give the appearance that I'm not living up to my good intentions.
But since this girl was a librarian and thus very intent on finding books, it got me thinking about book recommendations for people who have a lot of questions and are interested in learning more. I haven't read everything out there, some of which I'm sure is great, but I'm just going to list a few that I've read and found informative and well-written.
For a social/political background:
"Misconceptions" by Naomi Wolf is a good one, if a bit dated (I think late 1980s). She discusses birth in the context of her own experiences and has some interesting reflection on feminism and motherhood towards the end.
"Pushed" by Jennifer Block is great! It's more updated and covers a somewhat wider range than "Misconceptions". I know some doulas object to her portrayal of the role doulas play in the system, but I think she raises valid questions.
"The Business of Being Born" is not a book, it's a movie, but it would be a great primer for how and why our maternity care system is not working and what alternatives are available. Everyone I've shown this to has enjoyed it. Suffice it to say, I think everyone should see it - literally, everyone.
To learn more about birth itself, interventions and alternatives:
"The Birth Book" by Dr. William Sears and Martha Sears. Well written, comprehensive, I learn or am reminded of something new every time I open it.
"Ina May's Guide to Childbirth" by Ina May Gaskin. Ina May is in many ways the mother of the modern midwifery movement in the U.S. and this is a book written from her decades of experience.
Just for fun:
"Babycatcher", by Peggy Vincent. The adventures of a home birth midwife in San Francisco - lots of stories, great writing, and almost impossible to put down.
Hot tip: the thrift stores of college towns are a great place to build your library. I've been keeping an eye on the shelves every time I go in, and just yesterday I picked up "The Thinking Woman's Guide to a Better Birth" and a recent edition of "The Womanly Art of Breastfeeding".
Even when I really, really vow to not get into the topic, it sneaks up on me anyway. I went to a basketball game last week. My friend and I were offered a chance to be down in the risers behind one of the baskets and we decided, why not? It could be fun. Little did we realize we'd have to stand the whole time, so as soon as we got there we secured spots at the back where we could lean against the bleachers. Most of the (over)enthusiastic undergraduates around us were jostling forward, so we ended up standing next to two other grad students, a man and a woman. We introduced ourselves and talked about our respective programs. They asked what kind of classes we take. We gave as an example that we were both in a class about breastfeeding this semester. That was all it took - the woman started asking a million questions about breastfeeding, and then she found out that I was a doula, and it turns out she's very interested in natural birth, and then she started asking questions about birth and birth books and doula-ing...
Mindful of my vow, I tried to change the subject - I asked her more about library science, we discussed the basketball game (to which we were paying remarkably little attention given that we had spots for the ultimate fans) - but every time we stopped for a moment to watch the players, she'd turn back to me and say something like, "I've read 'Misconceptions' by Naomi Wolf. Are there other good books I should read?"
What can I say? If you store something metal next to a magnet long enough, it will become magnetized. I have spent so much time talking and thinking about these topics, I have become a magnet for birth and breastfeeding questions. I can't say I mind (at ALL!) but it does give the appearance that I'm not living up to my good intentions.
But since this girl was a librarian and thus very intent on finding books, it got me thinking about book recommendations for people who have a lot of questions and are interested in learning more. I haven't read everything out there, some of which I'm sure is great, but I'm just going to list a few that I've read and found informative and well-written.
For a social/political background:
"Misconceptions" by Naomi Wolf is a good one, if a bit dated (I think late 1980s). She discusses birth in the context of her own experiences and has some interesting reflection on feminism and motherhood towards the end.
"Pushed" by Jennifer Block is great! It's more updated and covers a somewhat wider range than "Misconceptions". I know some doulas object to her portrayal of the role doulas play in the system, but I think she raises valid questions.
"The Business of Being Born" is not a book, it's a movie, but it would be a great primer for how and why our maternity care system is not working and what alternatives are available. Everyone I've shown this to has enjoyed it. Suffice it to say, I think everyone should see it - literally, everyone.
To learn more about birth itself, interventions and alternatives:
"The Birth Book" by Dr. William Sears and Martha Sears. Well written, comprehensive, I learn or am reminded of something new every time I open it.
"Ina May's Guide to Childbirth" by Ina May Gaskin. Ina May is in many ways the mother of the modern midwifery movement in the U.S. and this is a book written from her decades of experience.
Just for fun:
"Babycatcher", by Peggy Vincent. The adventures of a home birth midwife in San Francisco - lots of stories, great writing, and almost impossible to put down.
Hot tip: the thrift stores of college towns are a great place to build your library. I've been keeping an eye on the shelves every time I go in, and just yesterday I picked up "The Thinking Woman's Guide to a Better Birth" and a recent edition of "The Womanly Art of Breastfeeding".
Nurse practitioner removes IUD without consent
In the oh no she DIDN'T! category, a nurse practitioner (and the community health center she works for) is being sued because she removed a patient's IUD without her consent, lectured her about how IUDs were like abortion, and refused to insert a new one. According to the plaintiff, the NP said "Everyone in the office always laughs and tells me I pull these out on purpose because I am against them, but it’s not true, they accidentally come out when I tug.” So funny! You know, everyone always laughs and tells me I eat so many cookies on purpose because I like them, but it's not true, they just accidentally fall into my mouth. Read the original complaint here.
But seriously, think about this: if this is an accurate quote, the NP has done this enough times to be "always" teased about it in the office. How many other women did this happen to before she hit on one who was angry and organized enough to sue her? Why was this a cause for humor and not for concern? Like I said about the abusive OB who was being sued, for every woman who sues there are many more who experienced the same thing and did not or could not speak up.
But seriously, think about this: if this is an accurate quote, the NP has done this enough times to be "always" teased about it in the office. How many other women did this happen to before she hit on one who was angry and organized enough to sue her? Why was this a cause for humor and not for concern? Like I said about the abusive OB who was being sued, for every woman who sues there are many more who experienced the same thing and did not or could not speak up.
Friday, January 23, 2009
Unassisted birth
My last year in college, I went to the Reproductive Rights Conference organized by the Civil Liberties and Public Policy program at Hampshire College. I love this conference - it is impossible to go and not leave energized, inspired, and ready to take on the world. I also love it because they have expanded their focus over time with the recognition that "reproductive rights" is a broad spectrum, and that we cannot fight for abortion rights without addressing the many other social injustices in society. This means that you could spend almost every session, for example, going to a workshop that deals with birth, midwifery, child care and/or other issues around motherhood.
My senior year was the first time I'd attended, and I had just started to get more deeply involved in this whole maternal and child health thing. I was writing my senior thesis on breastfeeding, and via that I was being exposed to a lot of writing about the medicalization of breastfeeding and birth. I don't even remember the exact name or theme of one workshop I attended, but it had to do with birth and one of the women there was a direct-entry midwife. It was my first exposure to some very radical (to me) ideas (the conference is a great place for being exposed to radical new ideas, which is one of the reasons it's so exhilirating. You come out feeling like you've just been through a vigorous stretching workout.)
One was the idea that not all midwives are created equal, and that if you are not careful you can end up with a midwife who practices like the most intervention-happy OB. I was very surprised by this, although my following year as a an AmeriCorps doula, being exposed to many practitioners, taught me the truth of it.
The other idea was that of unassisted birth. The direct-entry midwife there very matter-of-factly said that she considered all her options for birth and when it came down to it, she felt the safest place to deliver her baby was at home with only her husband present. I remember a ruffle of surprise in the room. I know I was surprised; I had never even contemplated the possibility that someone might choose to give birth alone, or only with family present. I thought to myself, "Well, she is a midwife. Maybe it made sense to her that she could take care of herself," but it still seemed...weird. Risky, and definitely inexplicable. Why would you choose to give birth alone when you could have other trained people present? How could it possibly seem safer that way?
Over the years since then, I've become more familiar with the unassisted childbirth (UC) idea (I don't think the woman at the workshop even used the phrase, but I later realized that the term applied.) There have been debates about it on the doula listserv I'm on (is it a good idea? should doulas be willing to attend those births?), I've occasionally skimmed forums for UCers out of curiosity, and I've read accounts and seen videos of UCs. I recently saw an interesting documentary on the Discovery Health channel, "Freebirth" (a term also sometimes used for UC) that followed three women through their choice to UC, process of preparation, and births. I've heard people say that UCers are irresponsible or taking the ultimate responsibility, that they are childish and rebellious, or very brave. I learned that someone I've known for a long time in my hometown, a nurse, gave birth to her first at home with a midwife and her second two at home assisted by only her husband. At the "Orgasmic Birth" screening I went to, there was a woman there who had very recently had a UC. During question-and-answer time, she went on for several challenging minutes about her experience of UCing and the lack of support she felt from the natural/homebirth and midwifery community.
All of those experiences have given me a lot of pieces of the puzzle. But I don't know that anything has given me better insight into the UC phenomenon than this dissertation. Rixa over at Stand and Deliver (formerly The True Face of Birth) has just completed and posted her PhD dissertation on why women choose unassisted birth. Warning: it's a PhD dissertation, so it's long! I stayed up far too late reading it the day she posted it, and was only able to skim the areas I was most interested in. So far I've read a lot of chapters 3, 5, and 6, being very interested in how and why women choose UC, how they conceive of the questions of responsibility, and how medical professionals perceive UC and how it has affected their care practices. If you're curious about what UC is and why it happens, this is a great place to start.
My senior year was the first time I'd attended, and I had just started to get more deeply involved in this whole maternal and child health thing. I was writing my senior thesis on breastfeeding, and via that I was being exposed to a lot of writing about the medicalization of breastfeeding and birth. I don't even remember the exact name or theme of one workshop I attended, but it had to do with birth and one of the women there was a direct-entry midwife. It was my first exposure to some very radical (to me) ideas (the conference is a great place for being exposed to radical new ideas, which is one of the reasons it's so exhilirating. You come out feeling like you've just been through a vigorous stretching workout.)
One was the idea that not all midwives are created equal, and that if you are not careful you can end up with a midwife who practices like the most intervention-happy OB. I was very surprised by this, although my following year as a an AmeriCorps doula, being exposed to many practitioners, taught me the truth of it.
The other idea was that of unassisted birth. The direct-entry midwife there very matter-of-factly said that she considered all her options for birth and when it came down to it, she felt the safest place to deliver her baby was at home with only her husband present. I remember a ruffle of surprise in the room. I know I was surprised; I had never even contemplated the possibility that someone might choose to give birth alone, or only with family present. I thought to myself, "Well, she is a midwife. Maybe it made sense to her that she could take care of herself," but it still seemed...weird. Risky, and definitely inexplicable. Why would you choose to give birth alone when you could have other trained people present? How could it possibly seem safer that way?
Over the years since then, I've become more familiar with the unassisted childbirth (UC) idea (I don't think the woman at the workshop even used the phrase, but I later realized that the term applied.) There have been debates about it on the doula listserv I'm on (is it a good idea? should doulas be willing to attend those births?), I've occasionally skimmed forums for UCers out of curiosity, and I've read accounts and seen videos of UCs. I recently saw an interesting documentary on the Discovery Health channel, "Freebirth" (a term also sometimes used for UC) that followed three women through their choice to UC, process of preparation, and births. I've heard people say that UCers are irresponsible or taking the ultimate responsibility, that they are childish and rebellious, or very brave. I learned that someone I've known for a long time in my hometown, a nurse, gave birth to her first at home with a midwife and her second two at home assisted by only her husband. At the "Orgasmic Birth" screening I went to, there was a woman there who had very recently had a UC. During question-and-answer time, she went on for several challenging minutes about her experience of UCing and the lack of support she felt from the natural/homebirth and midwifery community.
All of those experiences have given me a lot of pieces of the puzzle. But I don't know that anything has given me better insight into the UC phenomenon than this dissertation. Rixa over at Stand and Deliver (formerly The True Face of Birth) has just completed and posted her PhD dissertation on why women choose unassisted birth. Warning: it's a PhD dissertation, so it's long! I stayed up far too late reading it the day she posted it, and was only able to skim the areas I was most interested in. So far I've read a lot of chapters 3, 5, and 6, being very interested in how and why women choose UC, how they conceive of the questions of responsibility, and how medical professionals perceive UC and how it has affected their care practices. If you're curious about what UC is and why it happens, this is a great place to start.
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