Emily at Anthro Doula just completed her Certified Lactation Counselor (CLC) course (congratulations!) and in her post on what she learned, she pointed to a link to a position paper 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.
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 arguing that CLCs can be just as qualified as IBCLCs to help breastfeeding moms. There are 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. 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.
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.
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?
(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.)
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. As this post points out, there are some really bad IBCLCs out there, and great CLCs. 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 this post claims - 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.
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. I've written about how financially and logistically impossible IBCLC training is for many people to attain. 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?
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.
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.
Thoughts? Any IBCLCs and/or CLCs out there want to give their perspectives?
Friday, May 25, 2012
Thursday, April 12, 2012
Baby-Friendly rap
Words cannot express how much I love this video!
Via Kellymom's Facebook page, which is basically a neverending stream of greatness.
Via Kellymom's Facebook page, which is basically a neverending stream of greatness.
Tuesday, April 3, 2012
Guest post: A doula's path through pregnancy/birth (Part 1: Prenatal Care and Education)
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, here. 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!
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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.
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.
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.
After I had already gone to my first prenatal visit, I read Rebecca’s post on "what every first time mom should know" (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!
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.
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 recommended over individual prenatal care by the American College of Nurse Midwives. Science and Sensibility has a useful post 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.
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.
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.
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! Rebecca’s friend Mollie sure did, 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.
----
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.
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.
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.
After I had already gone to my first prenatal visit, I read Rebecca’s post on "what every first time mom should know" (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!
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.
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 recommended over individual prenatal care by the American College of Nurse Midwives. Science and Sensibility has a useful post 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.
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.
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.
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! Rebecca’s friend Mollie sure did, 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.
Thursday, March 22, 2012
Guest post: All you have to do is be there
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.
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.
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.
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.
Some details have been changed to protect the client's privacy.
----
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.
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.
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.
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.
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."
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.
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.
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.
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.
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.
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.
Some details have been changed to protect the client's privacy.
----
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.
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.
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.
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.
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."
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.
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.
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.
Friday, March 16, 2012
Everyone 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. This piece really, really stood out to me. It isn't the first account like this I've read, but it's so timely and I think it is so important:
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.
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.
“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.
“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.
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.
“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.
Read the full article here
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.
Check out the new cesareanrates.com
While I've been busy being a blog-derelict, Jill over at the Unnecesarean 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 ICAN). 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!
Click here to check it out:
Click here to check it out:
Friday, March 2, 2012
Guest post: Midwife vs. OBGYN
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.
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.
Guest post: Midwife vs. OBGYN
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.”
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.
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.
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.
I thought the best way to really portray the difference is to give you some examples of my care at both places.
Example 1: Birth Plan
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.
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.
Example 2: Extras
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.)
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.
Example 3: Induction
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!
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!
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!
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.
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.
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.
Guest post: Midwife vs. OBGYN
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.”
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.
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.
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.
I thought the best way to really portray the difference is to give you some examples of my care at both places.
Example 1: Birth Plan
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.
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.
Example 2: Extras
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.)
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.
Example 3: Induction
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!
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!
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!
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.
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.
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