Monday, September 28, 2009

Mass media birth vs. reality

How many times have I said, "Birth is nothing like it is in the movies" or complained about how "A Baby Story" or "Maternity Ward" portray labor and delivery? (I just can't watch those shows any longer. I start yelling at the TV and then I have to turn it off.)

That's why the movie "Laboring Under an Illusion" looks both educational and fun. From the press release:

"There are more pregnant women watching TV birth scenes than attending childbirth classes. So when labor starts, they may be surprised by the real thing. ... A new documentary film, “Laboring Under An Illusion: Mass Media Childbirth vs. The Real Thing,” contrasts actual birth footage with the fictionalized commercial version. In over 100 video clips, anthropologist Vicki Elson explores media-generated myths about childbirth."

Here's the trailer:

This looks like a nice way - perhaps even a little more gentle than "Business of Being Born" - to introduce people to the difference between the way they perceive labor & birth and the way it actually is.

The website lists some events. I'm thinking about whether it's worth me investing in a copy (or better yet, finding some way for our breastfeeding student group to pay for it and screen it!) Has anyone seen this yet?

(h/t to Dou-la-la!)

Friday, September 25, 2009

Sen. Stabenow to Sen. Kyl: Oh SNAP!

United States Senator John Kyl (R. - Ariz) said in health care reform hearings: "I don't need maternity care", so health care reform should not require insurance companies to provide it.

Senator Debbie Stabenow (D. - Mich) fires back: "I think your mom probably did."

(Via Feministing.)

Sen. Kyl then snorts "Yeah, about 60 years ago." Perhaps someone should also show him the evidence that prenatal (AND preconception) health of the mother have impacts on the health of her baby, decades into the future. Or is that just an "I got mine" statement?

If we pass health care reform that does not mandate maternity coverage, we're not getting true health care reform.

Wednesday, September 23, 2009

IBCLC training update

This semester, it is busy. As usual, there are a million things I have sitting around waiting to be linked to. I haven't even talked about the Today show home birth ridiculousness yet! (But when so many other people have done it so well, now it seems repetitive).

Today is Wednesday, which is my lactation consultant observation day at the hospital, which is one of the things that is making me so busy: I'm there all day, and by the time I get home I am zapped and don't get a lot of schoolwork done (OK, any schoolwork done). If it wasn't for that I'd have the whole day free to do all the other things I have to do, which then get shoved into the precious open time in the rest of the week. But would I trade my LC observation days for more free time? Of course not. So, I am figuring out the semester as I go along. And I thought I would shake off my Wednesday evening sluggishness long enough to update a little on my LC observation so far:

The hospital I'm observing at is the same place I work as a volunteer doula, and in general I have found them to be a fairly mother- and baby-friendly hospital (they are actually working on getting their baby-friendly certification). The nurses and the pediatricians I have seen so far are very supportive of breastfeeding, even if they aren't always fully informed.

Lactation services is, unfortunately (maybe fortunately for me) not adequately staffed and in this era of budget cuts, unlikely to be increased any time soon. The LCs I work with are on their feet every minute of their workday, and usually can't even see everyone they're supposed to. Today the LC I worked with was supposed to see something like 11 patients, and made it to 6 - and that includes going to see all of those 6 multiple times - for some of them, we went to every feeding they did during the day. If you can't see everyone, this leads to some tough choices - prioritize the mom with inverted nipples, sleepy baby, and poor family support? Or see she doesn't seem that motivated, and think you should spend your time on someone who has a greater chance of succeeding? Much as these are unpleasant choices that shouldn't have to be made, they are real.

I say that the fact it's not adequately staffed is fortunate for me, only because I get to see so much in a day. There is zero downtime, unless you count when the LC dashes to the computer to chart, and I sit next to her trying to remember what I saw and record it in my observation notebook. I am getting to see so much - just a wide range of situations, anatomies, and medical conditions. I haven't done any days in the NICU yet, but I am really looking forward to my first experiences working with preterm babies & their moms.

One thing I've noticed is that my observation days seem to run in themes. For example, last week I was with an LC who was seeing a lot of outpatients, where overfeeding was the theme. This week, we were seeing all inpatients (most less than 24 hours) and the theme was sleepiness and breast refusal. I started to get a little leery as I saw the LC put on nipple shield after nipple shield. Was this her solution to everything? Then she told me, "I usually use one a week." She said she has been seeing more and more sleepy, fussy babies in the past few weeks and is getting concerned about it. Her concern is that they have apparently changed either the epidural dose and/or the medication; this being a typical American hospital, nearly everyone has had an epidural, and if it's seriously affecting the feeding behavior of the babies it's a big problem. I still don't know how I feel about the nipple shields for every problem she applied (heh) them to, but I am curious to know what she learns about the epidural meds.

In terms of the LCs I'm observing, I am learning a lot from observing different practice styles and different approaches. I try hard to check my judgment when I see something I don't want to emulate. It's so easy as an observer to think "I wouldn't do that" or "I wouldn't use that word the family probably doesn't understand" but I know how extremely hard it is to do in practice. And seeing how extremely rushed the LCs are, I can't entertain too many fantasies of long, empowering chats once my turn comes to do the consults. (Another good reason to find some LCs to shadow who are able to have a slower pace, for balance.) Still, I am trying to stay sensitive to places where I see overmedicalization, or creating dependence on the "expert". I am glad our class and professor give us space to discuss those issues.

So far, I love my LC observation days - I love working with families, having a new challenge every 20 minutes, keeping busy, and learning. And I love all those cute little babies! I know not every doula/midwife/other perinatal professional goes into the field from loving babies - sometimes they just love to work with women and don't find babies that interesting. But I have always loved babies, and I really love these tiny little newborns. It's amazing how they are simultaneously so dependent and helpless, and yet so capable. I haven't seen any true self-latching, but when a baby is hungry but not latching, the LCs will encourage the mom to put the baby upright between her breasts, skin-to-skin. The baby will right away start bobbing its head and throwing itself to the side, then move down her breast, and root for the nipple. And when they're done nursing, they'll just relax into a little pink ball on her skin and fall into the deepest sleep. It never fails to make me go "Awwww." So that's my mission these days: more empowered babies!

Sunday, September 20, 2009

More book recs on what to read for pregnancy, birth, and beyond

I really enjoyed this post from Bellies and Babies on what to read and what not to read when you're expecting. (Sneak peek: definitely NOT What to Expect When You're Expecting"). She also breaks her "to-read" suggestions down into 3 categories: Citizen ("for the average Joanne), "Seeker" ("for the one who is definitely looking into her options"), and "Sold" ("she knows, she has researched, she is a proactive consumer"). Her recommendations are right on, too - for example, the Sears & Sears Pregnancy Book is a good "Citizen" read but the Birth Book is more for the "Seeker".

Ultimately my goal is to have a really great "doula library" of books that I can lend out to clients, and send out to friends, who are at any of those "levels". Her recommendations have definitely added some titles to my wish list!

Thursday, September 17, 2009

Where to find conferences?

My school has some travel awards and I'd like to use one before I graduate! I've been thinking about putting together a poster of my undergraduate thesis research (lo, those many years ago!) and seeing if I can be a presenter somewhere. Does anyone know of a centralized listing of birth and/or breastfeeding-related conferences? (There would need to be at least some breastfeeding.) Wish I could go to the International Breech Birth Conference but it's too soon (and hard to find a reason to present there with a poster on WIC clients' views on breastfeeding).

Kanye + VBACs

So I try not to link to the Unnecesarean aaaaall the time, and hope and trust that my readers have it in their feeds as well. But you can't miss Kanye talks VBACs. As I noted in the posts, it is right up there with Kanye interrupts Barack Obama.

Tuesday, September 15, 2009

Another way to build your birth(/pregnancy/breastfeeding) library

I've mentioned before that the thrift store of a college town is a great place to build my "doula shelf" of books that are useful to me and to lend out to clients and others. Last weekend I was at Barnes & Noble where they were selling "Birthing From Within" for the list price of $20. A half-hour later I found it at the thrift store for 25 cents!

Finds like that don't come along all the time, though, and lately I've become enamored of PaperBackSwap. The way it works is pretty simple: you post books you have to offer. Every time someone requests one from you, you mail it, and get a credit. When you find a book you want, you request it, and use a credit. Since every book you mail costs about $3 by media mail, each credit you use has basically cost you about $3 - not 25 cents, but not bad either.

Some books are hard to come by (I think I'm something like #171 on the wish list for "Ina May's Guide to Childbirth") but others come easy - I lent out and never got back my Sears & Sears "The Birth Book", and when I looked there was already one posted for me to request (hopefully not the one I lent out originally!) And it's a good way to get rid of books you're not going to read again! The thrift store reads I don't want to keep, I just post up there and they go to a good home.

So that's my tip for the evening. Now back to homework!

What I want my friends to know

I started this blog for a few reasons. One was to take all the doula-, birth-, and breastfeeding-related stuff out of my personal blog and put it in one place, where it would be easier for me to think and write about (and expand on) separately. Another was to have a place for myself to make connections between what I was studying in my MPH and other issues that I care about. It has been a great place to do those things, as well as provided a more unexpected benefit of connecting me to an amazing community of smart, interesting, challenging bloggers who think about the same stuff I do.

But I had another motivation for starting this blog. Yes, I took a lot of my birth-related stuff out of my personal journal - but my hope was that my friends would humor me by adding Public Health Doula to their Google Reader as well, and that maybe I could draw in a few more friends/classmates/relatives. And then, THEN, I could expose those people to all the things I was learning and thinking about birth, maternity care, breastfeeding etc. I don't want to be the Obnoxious Friend bringing it up all the time...or worse, the Obnoxious Friend bringing it up while my friend is actually pregnant or parenting. Once someone is pregnant, I try to offer my services in a low-pressure way, then shut my damn mouth and only bring something up if they bring it up first. (Do I always succeed? No, but I try.) I don't want anyone to feel like I'm judging their choices, even if my intention is only to offer more information or ask questions. This blog is a way to make my thoughts available without forcing them on anyone.

But yet I've been thinking lately about how reading about my feelings on a lot of these issues could make some of you out there in real-world friend land feel judged. Or at the very least, not sure whether or not I would judge you for choices you might make. And let me say, at this stage in my life, it feels like EVeryone I know is having babies. So I am writing this post now, just to say: as a doula, I do not judge my clients for any of the decisions they make. I want them to make educated, supported decisions they feel happy about. God knows I want no less for my friends, and hope I would treat them with no less respect and consideration.

So I thought I would write down the things I do and don't care about, so I can make sure I'm clear:

Here are things I DON'T care about:

-I don't care if you give birth in a hospital
-I don't care if you hire an OB-GYN
-I don't care if you get an epidural
-I don't care if you have an elective induction
-I don't care if you have an elective c-section

Yes - I encourage working with a midwife, taking a childbirth education class, avoiding unnecessary interventions, inductions, and c-sections, breastfeeding, and using a mother- and baby-friendly birthplace.

But I encourage these things NOT because I think they make you a better woman, mother, or person. I encourage these things because I care about you, and through reading the evidence and from personal experience, I think these are your best shots at having a happy healthy birth experience and having a happy healthy baby.

If you decide something else is the best choice for you - it's your body, your baby, your choice. Do I want you to know the risks of an elective induction before you choose it? Yes, which leads me to:

What I DO care about:

- I care that you know enough about birth, and your choices (and RIGHTS) in birth, to make educated decisions and know what your priorities and values are. This is the biggie. I hope you never think "I wish I had known..." or "If only someone had told me..." If I am ever pushy with information, it is with this goal in mind.

- I care that with what you learn about pregnancy, birth, and breastfeeding, you resist the misinformation out there, and refuse to spread it yourself. If one of my friends says, "Once a child's old enough to ask for it, he's too old to breastfeed" ...well, let's just say we'll have to talk.

I also have some hopes - things I cross my fingers that my blog posts are teaching you more about:

- I hope you know that you have many options and variations in terms of maternity care. How one individual care provider practices is not necessarily the gold standard that you cannot question.

- I hope for you not to be frightened of birth, and I want to balance out the voices that might be feeding you fear.

- I hope for you to feel supported in whatever choices you need to make for your health (mental and physical) and your baby's health (mental and physical).

- I hope for you to feel happy and at peace with whatever happens at your birth, and if you don't I am there if you want to process your feelings or want help finding more information. But I never want you to feel like I am playing the "If Only" game with your birth unless you have specifically asked me how I think things could have been different.

So again: no matter what happens during your pregnancy, birth, and parenting - I want you to NEVER EVER feel judged by me for any of the choices you make and if you do, call me on it.

And I am here for you. If there is anything I can do to help you...whether it be troubleshooting breastfeeding at 2 am or just needing to talk through your feelings...I am here for you. And that's the most important thing I want you to know.

Monday, September 14, 2009

A Peace Corps volunteer in Africa

Lately I've been really enjoying the blog of a friend of mine from college, Aaron. He's now about a year into a two-year Peace Corps stint in Burkina Faso, a small country in West Africa. He's able to send out periodic e-mail updates, which another friend then posts to his blog. Aaron has had some great stories and reflections - touching, humorous, sometimes sad, often illuminating about the nature of doing development work and being a foreigner in a very different place. Some of his work focuses on reproductive and maternal/child health, which makes it extra interesting (at least for me!)

Some of my favorite posts:
On Porridge - on combating malnutrition in infants and toddlers.
Christians and Play-dough (not the actual title, but that's how I think of it) - what happens when charity efforts go a little awry.
Sort've like home - getting kids in Burkina to play American theater games.

If you're interested in Peace Corps, development, international health work, or just in some great stories and pictures I encourage you to check it out!

Sunday, September 13, 2009

Delivery room football again

Last weekend, I went to a wonderful birth. One of the things that was nice was the immediate skin-to-skin contact mom and baby had right from birth, which was very important to the family. But I didn't realize at the time exactly how it came about. When I went for my postpartum visit, the dad told me the story:

Because of a complication right at the beginning of labor, mom and baby were both being carefully monitored and baby was looking absolutely fabulous on the monitor. No problems at all. However, as things were getting closer to pushing time, the midwife said she wanted to warn them that because of the complication, the pediatric team would need to come, and would want to take the baby right away. That would mean there would be no immediate skin-to-skin or delayed cord clamping.

(I have seen this happen at that hospital before, usually because of meconium in the amniotic fluid: with any mec, the protocol is that the peds team stands hovering around the warmer, and as soon as the baby is born - no matter how healthy and vigorous - they take the baby to the other side of the room. Then they spend five or so minutes wiping, suctioning, and monitoring while mom is craning her neck trying to see. It just seems...silly. She wants the baby, the baby wants her, the baby is healthy, why go through that routine? But I digress.)

So the midwife was explaining this to the mom, who was on her way to the bathroom and going through transition and not listening very closely, and to the dad, who was listening very closely indeed. I was in the bathroom with the mom, supporting her through contractions, so I did not know about this part until the next day:

While we were in the bathroom, the midwife was explaining this to the dad, and he said, "But the baby is healthy, right? You keep telling us she's doing great."

"Yeees...but we're really supposed to have the pediatric team here, and if they come, they usually don't just want to stand around. They'll want to take the baby."

"Even if the baby is born healthy and totally fine?"

"Yes, they'll want to take her."

Skin-to-skin and delayed cord clamping were really important parts of their birth plan, and the dad hadn't really heard a reason yet for that to change. He was focused on his wife who was going through a lot at the moment, and was in the bathroom vocalizing very loudly, and he just wanted the conversation over.

He said firmly, "You can call them, and they can come. But if they try to take our healthy baby, I will tackle them. I will just...tackle them."

And the midwife looked back at him and said, "Okay. Let me give them a call and see what we can work out."

Birth time came, peds hovered around the warmer, baby was born looking good, went straight to mom, had all newborn assessments done skin-to-skin, and cord was allowed to pulse before they cut. Then baby was taken for a couple minutes for a quick check and suction, then went straight back to mom and started breastfeeding.

Go dad!!

When I heard about how he made it happen, his threat to tackle reminded me of the original Delivery Room Football". Rixa at Stand and Deliver posted about it recently again, talking about "iron in my soul".

So a note to dads, moms, and other birth partners: as a doula I can encourage you to know your rights and be assertive, but only you can actually DO it. Don't be afraid to!

Thursday, September 10, 2009

The if only game

I know that I, along with almost everyone else you will talk to about birth choices, urges you to prepare yourself, to educate yourself, to make good choices, to prepare. There's an insidious corollary to all these exhortations: when something does not work out, there is the potential for people to hear or assume it means that you DIDN'T educate yourself and/or prepare properly (aka blaming the victim). I read a blog post recently about this, by Navelgazing Midwife, and I highly recommend reading it. She talks about "birth guilt" and the "If Only" game:

As one birth traumatized mother said to me, “I also have had to hear for four years the questioning of my choices, the searching for blame that other women do. And then the ‘Well, there you go, bingo! That is the one thing you didn’t do that I did and that is why your birth sucked and mine was awesome. It’s not even subtle. I say something like, ‘Well I wanted a natural birth, but it didn’t go so well…” and they say, ‘Oh, well, did you have a doula?’ ‘Yes, I had a doula.’ ‘Did you have a midwife?’ ‘Yes, I had a midwife.’ ‘Well, did you do Bradley?’ ‘Um, no, that wasn’t really my philosophy.’ ‘Oh, yeah, well, you see, we did Bradley and it went just great. I highly recommend it.’ I truly think women want to believe that what they did had an effect, and I mean, it does have an effect, but there is also just luck, too.”

It's true that sometimes when things didn't go the way a person wanted, it's because they didn't prepare. But you can have the best preparation in the world, and things can still not work out like you hoped. (You can also do very little and get very lucky, although that is less common.) And without knowing exactly what happened, isn't it better to assume that a woman did her best to get what she wanted, and things just didn't work out?

As a doula, it's hard not to play the "If Only" game sometimes. I do it with my clients - never with them directly, unless they specifically bring it up, but I Monday-morning-quarterback in my head plenty. Particularly about what I should have done differently. I know I also do it with the stories other people tell me, although unless somebody specifically wants to know from me what I thought could have been different or affected the outcome, I try to validate whatever they experienced that was traumatic, and celebrate whatever was positive, and keep my mouth shut about the rest. I say I try...I probably don't always succeed, and this post reminds me to be mindful of that.

ACNM offers homebirth insurance for CNMs in all 50 states

So apparently ACNM has teamed up with an insurance company to offer coverage to CNMs with home birth practices in all 50 states. I don't really know enough about the ins and outs of costs, premiums, payouts, and insurance coverage to know if this is a great thing...but it can't be a bad thing, right?

Tuesday, September 8, 2009

Perinatal hospice doula

A warning, first - this post talks about infant loss and might be a difficult read for some.

I just came across an article about an amazing woman who serves as a perinatal hospice doula - she is a doula only for families who are anticipating an infant loss. I simply cannot imagine that work. If I had a doula client who found out that they had experienced, or were going to experience a fetal or infant loss, I would absolutely be there for them in every way I could (which would probably, in the end, just be - being there.) I have even thought I would like to try volunteering at adult hospices, which create such a beautiful and peaceful setting for people to leave this world - much like good birthplaces create beautiful, peaceful places for people to enter the world.

But to work only with clients experiencing perinatal losses? That takes a very special person. And it's clear from the article how much her support means to the women she works with.

Monday, September 7, 2009

Why you (yes, YOU) should become a doula

Remember when I said I didn't think I would be attending any labors this weekend? Clearly when I said that, I made it happen - I ended up attending a fabulous birth (and when I see the family again tomorrow, I'm going to ask their permission to share a great story from it on this blog.) I really had such a wonderful time - I left on that birth high that comes from being present at something so wonderful. And that feeling is what prompts me to talk about why you (yes, YOU, the person reading this) should become a doula.

I'll admit it: I am a shameless doula recruiter. When I hear someone is interested in birth, I tell them, "You should think about becoming a doula!" When I talk to someone who says they've thought about doula training, I say, "You should go for it!" When I tell someone about my work and they say, "Wow, that sounds so interesting," I say, "It's great! And YOU could do it too!"

I am always cheerleading for doula training; the doula trainer in town doesn't give me a commission, but that's not to say she shouldn't start thinking about it. Already this semester I've pitched doula training to my patient advocacy class, all the first-year MCHers in orientation, a woman who e-mailed me interested in the LC course, and a couple people who stopped by the table for our breastfeeding advocacy group at the student activities fair. A woman from my breastfeeding course last spring that I talked to about it just e-mailed to say she'd decided to do the training - could I lend her some books? And I told my classmate who took the training last spring that I would mentor her first birth this fall.

Why am I such a fan of doula training? I give the following reasons to the people I talk to in person, and now I'll tell you (yes you!) too:

1. What you learn in doula training is important knowledge that everyone should have. After being steeped in this knowledge for a while now, I am always surprised to discover that people aren't sure about the difference between the placenta and the amniotic sac, and where the cord factors into all of this. Doula training is a fascinating way to discover important facts about women's bodies and the process of birth.

2. Even if you never work as a professional doula, this knowledge can help you and people you care about. If you plan to give birth someday in the future, this is amazing knowledge to serve you. Whether or not you personally plan to give birth, this is knowledge that can serve your friends and family. You can be there for your friends when they give birth, which is an amazing resource.

3. The training is not a huge time commitment. Apart from the major component of doula training (generally 2-3 days, almost always on a weekend), most of the other requirements can be completed on your own time. Because there's an online course for everything, there are also online doula courses, although I think most people would enjoy and get more out of a class in person.

4. The training is not a huge money commitment. Around here, I'd say that the cost of the training plus the other required classes wouldn't put you much over $400. Even if you buy all the books (vs. borrowing them from the library or friends) you shouldn't go much over $500. This is certainly a significant chunk of money for most people - but if you're able to make the investment and wait for the return, even in areas where the going rate is low, doulas generally charge $200-300 per birth. By attending even two paid births you've made it back.

5. I have never heard anyone say they regretted going through doula training. Even if you never attend a single birth, it's a wonderful time spent with like-minded people who want to support women and respect birth. If you do go on to attend births, then you get to go out and work with families on one of the most important days of their lives, witness the amazingness of babies being born, and feel proud of the role that you played in helping women achieve their goals and feel good about their births. Even at the frustrating births, the ones that don't go as hoped, ones where I am struggling against a strong tide, ones I have to process later with fellow doulas, ones that leave me more down than high - I am glad I was there, because that family needed a doula.

I will also add for any public health types out there:

6. It's a good way to connect policy to action and understand the messy complexities of health care as it happens. This summer at my internship I was often surprised by coworkers who didn't seem connected to the clinical realities of care. One question from our survey asked women about their Group B Strep status. I suggested that it was pointless to ask this, since most women don't really understand the test or the condition, and don't know that the little bag of clear fluid going in during labor is antibiotics. The highest GBS rates were reported among well-educated, high-income women because, of course, they were the only ones who knew they had been diagnosed and treated for GBS. Particularly if you're in maternal and child health, it's worth seeing how maternity care looks up close.

7. If you're somewhere with a volunteer doula program (like my school) it's a great way to get experience and provide doula care to those who can't afford to pay for it. The hardest births to get can be those first certification births, even when you're offering to do them free. Our doula volunteer program offers new doulas "mentor" births with an experienced doula, and a good way to connect to clients who are seeking free doulas.

8. We need more doulas. Especially if you're interested in volunteering or providing low-cost services - so many women need doulas. Every woman should have one, really, but some women need it more than others. You can be there.


Finally, probably, my advocacy comes from a very personal place. Being a doula has changed and guided my career goals, and been one of the most fulfilling things I've done in my life. The feeling as I walk out after a birth and head home is just utter satisfaction - for a little while, all the things that are worrying me or on my to-do list fall away. I have been so in the moment at something so important that it grounds me like nothing else. Yet as I've said before, if it hadn't been for my AmeriCorps job I might never have taken the leap to actually do the training. The thought that other people might be missing out, might be thinking "I don't know, should I?" when they could be having this amazing experience...well, I don't like that thought!

So if you're thinking about it...if you're thinking "I don't know, should I?" or "Will it be worth it?" or "Is it going to be any good for me?" - my answer is YES. Find a training and just do it!

Some doula training organizations:
DONA International
Childbirth and Postpartum Professionals of America (CAPPA)
International Center for Traditional Childbearing (social justice and infant mortality reduction focus - I would love to take their training!)
Tolabor (formerly ALACE)

(A note on certification: it's not necessary. I don't have it from any major certifying organization; our AmeriCorps supervisor, an experienced birth attendant, did a training based on the DONA curriculum, and our clinic certified us. I have never had a client ask about my certification, only about my experience. I believe anyone can become a doula through experience alone, but I promote doula training because it's the easiest way to get started.)

Friday, September 4, 2009

Labor Day weekend links

School has come upon me with a vengeance! I'm hoping to keep up posting regularly but it may not be as frequent. To clear out my Google Reader "starred items" again, a link post. My apologies - some of these links are reeeeally old:

Sacrifice, Feminism, and Parenting She wades through reflections on Sears & Sears and attachment parenting, making good points, to get to what I think it a very good point: Breastfeeding and other AP practices may be a sacrifice for some women. As a parent you don't have to use any of these practices, but you are going to have to sacrifice for your children in various ways. What we really need to do is make sure that the sacrificing does not fall unequally on women, and that we form communities to alleviate it as much as possible. (Not sure how I feel about her other solution of trying to get men to lactate - not that I'm opposed to people doing research into whether it's feasible on a wide scale, just not sure that what little evidence exists supports this possibility.) (Edit: although apparently one Swedish man is giving it a go.)

The National Association for Pregnant Women responds to the American Life League's claims that no, really, "personhood" measures WON'T hurt pregnant women: "Although current law does not in fact permit courts or prosecutors to substitute their judgment for that of pregnant women, "Personhood" Measures would change that. These measures would permit courts, as a routine matter: to appoint lawyers for the unborn, to force pregnant women and their families to participate in emergency court hearings, and then to decide for them what is best for the baby."

Reality Rounds writes about why she chose midwifery care for her birth. She talks about how wonderful it was to form a relationship with her care providers that has transitioned past birth into well-woman care. In the comments, several people talked about feeling disappointed with their midwives. I replied, and say again, that you can be a jerk and still pass all the classes and clinical requirements to become a CNM, MD, RN, or really almost any career under the sun. There is no "nice" test. But I do feel that generally midwifery care attracts and promotes the type of caring that does prize good relationships and patient-centered care.

Birth is Not a Spectator Sport. Amen! How many times have I walked into a room to see the mother in bed writhing through a contraction, with her whole family lined up along the side of the room staring at her? I hate how hospital rooms are set up so that when you sit in the chairs provided, you are too far from the mom to touch her. I always grab a rolling stool if there's one around so I can scoot right up to her bedside, and try to get other people to come in closer as well. Even when I'm not needed (for a mom with an epidural, for example, who is resting) I try not to make her feel like a watched pot...or worse, a watched television (as people stare avidly at contraction monitors, ignoring the person who is having contractions).

Why routine vaginal checks at the end of pregnancy? Too many people's attitude is "Why not?" I agree with Nicole...skip this routine!

Did you know that I'm in love with Sarah Haskins? Well I am, and if you watch her "Target: Women" segments you will be too.

Off to my weekend. I have my first volunteer doula client of the semester, and while I doubt she'll go into labor over the weekend you never know! (Imagine the jokes that must fly when you arrive at the hospital on Labor Day.) In the meantime I will be trying to finish the last of my unpacking and organizing, and diving into work for my assistantship. Hopefully there will also be time for barbecue and sitting by the pool, because what's Labor Day weekend without a last taste of summer?

The truth about preconception care

Did you know women who are on Medicaid because they're pregnant get kicked off after 60 days? Yes, after you've made that cute little baby and gotten your one postpartum visit, you no longer need medical care. Even if you've just delivered a preterm baby - putting you at high risk for having another one - you're off. Even if you're still poor and now unable to afford family planning services - putting you at high risk for a short birth interval and even HIGHER risk for a repeat preterm birth - sorry! The Pump Handle discusses Preterm Births and Changing Minds, highlighting work at Emory University to reduce preterm births in high-risk mothers by (gasp!) getting them comprehensive interconception medical care!

The surprise was just how unhealthy some of these women giving birth to preterm infants really were. Nearly one-fourth of the mothers were sick when the program began. They had severe hypertension, sickle-cell disease or uncontrolled heart problems. Even though they would have automatically become eligible for Medicaid once they were pregnant, for these most at-risk women, “pregnancy is too late,” Brann says."

The point of preconception (and interconception) care is that in many ways, you're wasting your money on prenatal care. You can't fix a lot of medical problems in 7-8 months of prenatal care. If you want healthy baby and healthy mom, you need a healthy population of moms. And since 50% of pregnancies are unplanned, ALL women of childbearing age need to get adequate care to be as healthy as possible. I will admit, when I first started hearing about "preconception care", I was squicked out. Women are not potential baby vessels who only deserve health care so they'll turn out better babies. Women deserve health care because they are human, and health care is a human right. But if we can get health care for all by pointing the wasted money and waste of life, then to the barricades for preconception care.

Just don't let anyone tell you that "preconception care" is a visit to the doctor before you start trying to conceive. See above re: how long it takes to fix medical problems and the 50% unplanned pregnancies. Preconception care is, quite simply, good health care throughout a woman's reproductive life.