Thursday, October 29, 2009

Getting the flu vaccine

I've gotten the flu vaccine every year for a while now (my mother calls me every fall to make sure.) I've already gotten the seasonal flu vaccine this year, and as a health student with direct patient contact I'm being offered the H1N1 vaccine as well. (I'm glad that as a research assistant at my school, I'm considered a university employee and am offered both vaccines through Employee Health, because H1N1 vaccine is tough to find right now.)

I know that there are questions about vaccine safety, particularly for children, and I know that some health care workers are refusing the H1N1 vaccine. Personally, I get the flu vaccine for 3 reasons:

1) I don't want to get the flu. It sucks. I've only had it once as an adult, and it was so much worse than I remembered. I had a fever, was very achy, could barely sleep because I couldn't breathe through my nose, was coughing terribly, missed days of work, and could only lie on the couch and stare at the TV. (I watched the same episode of "The Ashlee Simpson Show" three times. 'Nuff said.)

2) Whatever risks the vaccine has, I believe them to be very small for me. Whatever else one's feelings about vaccines for children, I feel comfortable getting vaccines as an adult. I've never had an allergic reaction to a vaccine, and I've done all my growing and developing. Beyond that, it's just an achy arm.

3) Since I think any risks are small, I'm willing to take them on, both to protect myself and also to reduce my chances of passing on the flu to the pregnant/postpartum women and infants I work with. If I can't get the flu, then I can't transmit it either.

To me, vaccines for parents/caretakers/health care workers are a no-brainer. One thing I learned this summer is that new parents are now recommended to update their whooping cough (pertussis) vaccine, as immunity can fade over time and whooping cough is back on the rise. Re-upping this vaccine helps "cocoon" infants until they can be fully vaccinated, and I think it's all the more important if you're not planning to vaccinate, or use an adjusted schedule. I get the concerns of parents who resist vaccinating their children, but it can't hurt to at least vaccinate yourself and offer them protection through your immunity. Why pass it on if you don't have to?

Nestle-free week, Oct 26-Nov 1

Angela at Breastfeeding 1-2-3 posts about how you can join the Nestle boycott this Halloween season. She has some excellent links including why you should consider boycotting Nestle, and what products are Nestle products (short answer: a lot).

Even if you're not able or prepared to boycott Nestle 52 weeks a year, consider joining the boycott for this week...especially when considering candy purchases. Which can't be that hard, because they don't sell Snickers or Milky Way or 3 Musketeers or Almond Joy or...mmm, I'm getting distracted just thinking about Halloween!

(Side note: Speaking of Halloween, my department is doing group costumes again this year. Last year we were all different forms of contraception (I went as the Pill). This year we are flu-related costumes - Spanish flu, swine flu, etc. I'm going as the flu vaccine, which could be scary depending on your take on vaccines and/or giant syringes. Is anyone else out there doing a health-related costume/theme?)

I haven't been great about avoiding Nestle products in the past, but looking at Crunchy Domestic Goddess' list, I actually think it wouldn't be so hard to cut out the Nestle products I do sometimes purchase: PowerBars (I stick them in my doula bag, but there are lots of other brands), certain cosmetics (since I probably buy make-up once every two years), and bottled water (again not often, but sometimes when I'm traveling or at an outdoor event). So I think I can go all Nestle-free long-term if I keep an eye out! I'll admit shopping at Trader Joe's makes this easier because they have so many of their own store brands.

Let me know if you're boycotting Nestle this week! And enjoy all those mini-Snickers! Mmmmm...

Wednesday, October 28, 2009

Links - how important is birth? problems with research, VBAC questions, and more

Enjoy Birth and Stand and Deliver and Talk Birth all meditate on the importance of birth - how it shapes women, how it shaped them - and whether or not it is important in shaping women as mothers. All provoked by this post at Sweet Salty. Excellent food for thought.

No Fat Talk Week - I personally celebrate this 52 weeks a year, and invite you to join!

Winning entries from the National Advocates for Pregnant Women writing contest. How's this for a title: “In the Manner Prescribed By the State”: Potential Challenges to State-Enforced Hospital Limitations on Childbirth Options. I like!

Melissa lists questions to ask a VBAC provider.

Amy at Science & Sensibility asks Do We Need a Cochrane Review to Tell Us That Women Should Move in Labor?. She says, "Somehow, things have gotten turned around, and the normal condition is now the “experiment” and the intervention is the “control”. In addition to being irrational, this is a set-up to perpetuate conventional obstetric care, which imposes unhealthy and unfounded restrictions on women in labor. This is because in “intervention versus control” research, you have to show that the intervention performs significantly better, otherwise the control condition remains standard practice." Read the rest on how this is a bass-ackwards way to go about things. It's alerted my eyes to look for the same issues in breastfeeding research.

Aaaand a new favorite (via, as so often, The Unnecesarean), Arwyn explores the analogy between athletics and childbirth:

"Everyone has heard of and no one doubts the existence of “runner’s high”, so why do we start plugging our ears and rolling our eyes and flapping our tongues when we speak of “birthing high”? ... Even discounting that, or in its absence, there is potential for pride and a sense of accomplishment: something we value so much in athletics, yet scoff at in childbirth, where our effort benefits both us and another. We deny women that pride in accomplishment (for which support of athletics is so vital to girls’ sense of self and women’s equality), that boost in self-esteem and feeling of competency, right when we need it most: at the start of parenting, one of the most demanding journeys a person can undertake."

And that's enough for tonight!

Tuesday, October 20, 2009

Reply turned post, on the comments sections of feminist blogs

I posted a week or so ago about the comments on Joy Szabo's case over at Feministing. Dou-la-la noted that the same story, and similar comments, have gone up at Jezebel. I wrote a comment that started turning it into its own post, and Anne said it should just become its own post, so here it is! (slightly revised.)

It seems like so much birth guilt/trauma/processing comes up in those discussions by women who had c-sections. I feel like I see a lot of "My c-section was NECESSARY and I have decided to STOP FEELING GUILTY about it." Hooray! What does that have to do with this case? "My c-section was NOT A BIG DEAL so stop equating it with RAPE!" So glad to hear you were happy with it! And yet your consented c-section has nothing to do with this other woman's situation. So why are we talking about it?

I browsed by (as I occasionally do when I forget my better judgment) Dr. Amy's site and she had reposted from a piece about breastfeeding written by a mother who had supply issues and decided that terrible mean people were making mothers feel guilty about not breastfeeding. Cue dozens of comments like "Thank you, I had to feed my baby formula and then I felt guilty! Shut up, breastfeeding promotion!"

I feel like our culture gets women juuuust far enough ("vaginal birth good", "breastfeeding good") and then dumps them at the gate. "Good luck with your vaginal birth in a country of 30% c-sections and breastfeeding in a country with low breastfeeding rates and no paid maternity leave!" No further education, no support, nothing. And then when those things don't happen, they feel guilty and like failures (because why we encourage women to blame the system when they could blame themselves/each other?) And then to feel like less of a failure, they have to hate on the things that make them feel guilty (see above re: blaming each other). And they process all those feelings in the comments sections of these posts.

If I had a c-section and couldn't breastfeed for some reason, I'd be upset and pissed. But I accept that c-sections and formula feeding (OK, I would probably search out all the donor milk I could, so mixed feeding) are reasonably safe things, and were the best options available to me. That doesn't mean they are a universal good and it doesn't mean they're equal to the alternatives. Nor does it mean that other people need to STFU and do what I did without complaint so that I can feel better.

Just today in class we had a guest lecture by my breastfeeding/LC professor. She does a fantastic job of showing nothing but the evidence and demonstrating that formula kills, in this country and around the world. She showed a slide saying that our attitude in this country is "Breastmilk is best, but there's nothing bad about formula." One of the regular professors said something to the effect of, "Well, that seems reasonable - I mean, is formula poison or something?" You could see the breastfeeding advocate stiffen and then she looked around and said, "What do other people think?"

And me, because I have a big ol' mouth, I raised my hand and said (I paraphrase), "First of all, there have been cases of formula poisoning. The melamine case in China, other instances of formula recalls and formula poisonings. So no artificial feeding method is without risk. However, I would say that I and a lot of people in this room were raised on formula and feel perfectly fine. We are healthy. But as public health professionals, we cannot ignore the evidence. At an individual level, formula feeding may be fine. But we have a responsibility to admit that lack of breastfeeding contributes to infant mortality and that we have to work to promote breastfeeding. You can find someone who smoked every day of their life and never had a health problem, but as a public health professional you know and see that tobacco use is harmful. Similarly, at a population level, YES, formula IS dangerous."

Guilt and mothering and feminism are all tangled up in these issues and I don't want to deny them or say they are not important - they are important and obviously need more outlets for reasoned, informed discussion. But we can't deny the evidence either. We don't ignore the evidence about smoking because someone is addicted to nicotine. We don't ignore the evidence about exercise because someone doesn't like to get off the couch. We shouldn't ignore the evidence about breastfeeding, or c-sections, or anything else just because we do a piss-poor job of supporting women to be as healthy as possible and then make them feel guilty about it.

And that's my rant for the day!

EDITED TO ADD: I read this over and it was appropriately rant-y for a rant, but I failed to say that while I do get frustrated with women who process their guilt by blaming others, I sympathize with them, hugely. They were the ones who got taken just far enough and then dumped. Their pain and regret and anxiety are real, and like I said above I'd feel similarly if the same thing happened to me.

I would also NEVER, EVER tell a formula-feeding mother that artificial feeding kills or any of the other crazy crap people say to formula-feeding moms because they think they know what's going on in another person's life. Like I said in my little rant in class, I was raised mostly on formula and so were a lot of people. It's not a death sentence. It's just a risk, and I am speaking from a public health standpoint, not an OMGZ UR BABY WILL DIE crazy person standpoint.

Vaginal breech birth: yes it is possible!

I was talking with a woman recently who had a c-section for her first baby, who was breech. I said something like, "Yeah, almost all breeches are c-sections now, although in Canada they're starting to do them vaginally again." She looked surprised and said, "Really? I thought they COULDN'T be born vaginally. I thought they would be strangled or something."

This woman was totally happy with her c-section, and it seemed like that was the right choice for her. She said she'd even consider a repeat c-section with her next baby, breech or not, so my guess is that given a choice between a vaginal breech and c-section for her first baby, she'd have chosen c-section.

But she didn't choose; what's more she didn't even know she had a choice. She thought her baby could never have come out safely vaginally. I worked with a client last year who found out at 36 weeks that her baby was breech. A doula friend had e-mailed me a series of photos of her friend giving birth to a breech baby, and I pulled them up on my computer just so my client could see with her own eyes: Yes, a baby can be born breech. Before she could investigate vaginal breech more fully (including whether there was anyone who would be willing to deliver her breech in the area), she ended up having a c-section for a combination of issues. Again, it was the right choice in her situation, but in my heart I thought "At least she saw what was possible, and she knew her options". I don't think it's OK for a woman who has a breech baby not to be informed that it is possible for her baby to be born vaginally, and to refer her to more information about that option. Would/could most women travel to find a breech-friendly provider? Probably not, but they can't if they don't even know about it. That's not informed consent.

Rixa at Stand and Deliver has just posted about her first day at the International Breech Conference. It is so wonderful to read about midwives and doctors talking about how to provide safe, skilled breech birth services to their patients. But it doesn't do much if women don't even know those options exist. Spread the word: vaginal breech is possible.

Monday, October 19, 2009

Which is more important: your birth plan or your provider's?

The Unnecesarean has a new post up, reposting a mother's copy of her OB's birth plan. (He handed it to her husband at the 26-week visit.) Here are some choice excerpts:

* Continuous monitoring of your baby’s heart rate during the active phase (usually when your cervix is dilated 4cm) is mandatory. This may be done using external belts or if not adequate, by using internal monitors at my discretion. This is the only way I can be sure that your baby is tolerating every contraction. Labor positions that hinder my ability to continuously monitor your baby’s heart rate are not allowed.

* Rupture of membranes may become helpful or necessary during your labor. The decision as whether and when to perform this procedure is made at my discretion.

* I perform all vaginal deliveries on a standard labor and delivery bed. Your legs will be positioned in the standard delivery stirrups. This is the most comfortable position for you. It also provides maximum space in your pelvis, minimizing the risk of trauma to you and your baby during delivery.

So much of what this guy has written is distorted or just plain wrong, it's incredibly paternalistic, and violates basic legal rights (the decision to perform a c-section is at his discretion? Um, actually it requires signed consent forms. Signed BY THE PATIENT.)

And I kind of love it. Why? Because it's honest and lays it all out. In the end, your care provider's birth plan carries a lot more weight in the hospital than yours does. This guy isn't kidding about rupturing your membranes at his discretion; at the extreme end of things, he can tell you he's "just going to do a vaginal exam" and then rupture them without ever asking you, and that piece of paper in the corner saying you want to wait until your water breaks spontaneously isn't going to protect you. Even a doula, your partner, or a committed nurse can only do so much ("Whoops! I guess they just ruptured by accident!") And that's why I would say it's more important to get your care provider's birth plan than it is to give them yours. I've said before that if you find the right care provider and birthplace, you don't need a birth plan, and that's because you have found a care provider and learned enough about THEIR birth plan to know that it matches what YOU want.

The mom who posted her OB's birth plan ended up running so far in the opposite direction that she ended up at a birth center with a midwife and was delighted with her choice. But let me say - as some of the commenters on the Unnecesarean were pointing out - that this isn't an argument for women just needing to choose different care providers. This guy is an honest jerk with non-evidence based practices, but he's still a jerk with non-evidence based practices (say that 10 times fast!), there are more out there, and many women don't have the choice to find a new provider. At the individual level yes, PLEASE, find out your care provider's birth plan and make a switch if you need to. But on a bigger level, we need to stamp this stuff out.

Because, seriously, "Delaying [cord clamping] is not beneficial and can potentially be harmful to your baby" - as one of the commenters to the original posting said, this birth plan would be modern obstetrics only if it were written in 1975.

Sunday, October 18, 2009

Notes from the NICU

The last three weeks of my LC shadowing have been with LCs who cover the NICU. It's been very different from my previous experience with breastfeeding support; the work I observe in the NICU involves very little direct breastfeeding, more counseling on pumping, and a lot of logistics. Some recent experiences:

1) Conferring with the NICU head nurse on flu policies. This has been a constantly evolving discussion since I have started observing at the hospital. Right now the policy is that no one with flu symptoms, including the mom, is allowed to visit the NICU until they have been afebrile (without a fever) for 10 days. But moms are encouraged to continue pumping and send pumped milk for their infants with a family member or friend. The LC and the NICU head discussed what to tell flu-infected moms about pumping hygiene, how to clean the bottles once they arrive at the hospital, and where to store the milk. Interesting to see policy being worked out, and so nice to see the NICU valuing and encouraging pumping!

2) Boxing and moving left-behind milk. The overflow freezer for storing pumped milk was itself overflowing, so I helped the LC transfer some of the milk to yet another freezer. We used Enfamil boxes to store the milk - they're made to fit very similar size bottles - and joked about "redeeming" the boxes. I asked about the milk we were transferring and the LC said it belonged to a mom whose baby had died after several months in the NICU. The LCs are waiting to hear back from her about what she wants to do with the milk. The LC was crossing her fingers that the mom would be willing and able to donate it. After seeing it, I hoped so too - there were some bottles of beautiful golden colostrum, and bottles and bottles of mature milk - after moving it all I'd estimate there were over 300 ounces! What amazing dedication. I can't imagine how hard it would be for this mom to think about what to do with this milk she hoped to give to her own baby.

3) Seeing how breastfeeding/pumping can come in dead last on a list of priorities for any NICU mom. So, you've had a c-section in a hospital a hundred miles away, your baby was transferred emergently to this hospital with serious health problems, you've been trying to coordinate the care of your older children while trying to recover and hoping to be discharged ASAP, 4 days after the birth you've finally managed to get over to visit your baby, which someone had to drive you to because you're not allowed to drive, you have to understand what's happening medically with the baby and possibly make decisions with the doctors about care, and in the midst of this is this sick tiny infant who is hooked up to ten different machines who you can't hold. And then this lady comes in and asks you if you want to pump milk for your baby. Who can't even eat right now. Sometimes I think it's a miracle any mother says yes.

4) And then seeing how much pumping can mean to a NICU mom. It obviously meant a lot to the mom who pumped over 300 ounces. Sometimes, it is the only thing a mother can do for her baby. I learned last week about oral care, done to keep the baby's mouth healthy and hydrated even if they're NPO (nothing by mouth). The LC counseled a mother that even if she was just pumping drops of colostrum at the beginning, she could soak up the drops with a Q-tip and use the Q-tips for oral care. Then the baby could smell her and know that she's close by. The mom started to cry. She couldn't touch her baby, didn't know if her baby would live, but she could do this one thing.

I think I'm lucky to have this opportunity to see NICU LCs in action, although it seems unlikely that I would ever end up in that role given that I don't have a nursing degree (most of the NICU LCs are former NICU RNs). I am looking forward to getting back to some more hands-on breastfeeding support, but this has been a real window into what babies and families going through the NICU experience.

Tuesday, October 13, 2009

Breastfeed: be a star

I heard about the British Be a Star Internet breastfeeding campaign through my IBCLC class. I get the concept of it - reframe breastfeeding as glamorous (easier now that there are so many breastfeeding celebrities) - and target it at younger women (at least that's what I'm guessing by the age of the moms picked to profile).

Above is Clare, 20, from Morecambe:

Please explain why you’ve chosen to breastfeed.
Well, it’s convenient, it’s good for baby, helped me get my figure back quickly – there are lots of health benefits for both of us. To be honest I didn’t ‘choose to breastfeed my eldest son, in fact I planned to bottle feed him and I’d bought all the bottles and the steriliser too, but after he was born the midwife in hospital brought him over to me and asked if I’d like to try feeding him myself, and we just went from there: once I’d got going with breastfeeding I realised how easy it was, and that’s when I realised all the good things about breastfeeding! With my second son there was no other way I would have chosen to feed but breastfeeding, for me it was the natural choice.

The text is no-nonsense, simple, and hopefully accessible. Personally, I love the photos and the concept, but I wonder whether the photos are as accessible as the message. If teens moms actually click over to this site, are they weirded out by these pictures of women wearing sometimes weird get-ups and breastfeeding? Are they insulted by the implication that they need to be marketed to with shiny photos and fabulous make-up? Finally, does this just further the impression that to breastfeed you need to be a rich, glamorous woman? Would it have been better to show these moms breastfeeding in their regular lives - at family parties, at the bus stop, before they go out in the evening?

What do you think?

Monday, October 12, 2009

How to make a doula feel loved

I loved this interview with Dr. John Kennell - I had never heard of him before, but apparently he is a big doula supporter and a founding member of DONA (Doulas of North America):

NLJ: Dr. Kennell, you are an adamant supporter of doulas, and much of your research has focused on the benefits of having a doula present during the birth process. You are often quoted, having stated: “If a doulas were a drug, it would be malpractice not to use it.” That’s a pretty, strong statement.

Dr. Kennell: Yes it is.

NLJ: Why do you feel doulas are so important?

Dr. Kennell: When providing the mother with a doula, which is really bringing back an old, old practice, we found that it just made a remarkable difference in the obstetric outcomes. So that’s one reason. There are strong suggestions that mothers who have a doula feel much better about themselves and how they did during labor. ... So, something that makes mothers enthusiastic about their baby and about what they did themselves, that’s great.

Read the rest here - I only wish it were longer.

I will say, nothing warms my heart like medical staff who appreciate doulas. Attention supportive midwives, nurses, and doctors: give the doulas you see a quick welcome if you can. In the best hospitals I've been in, people say "Oh, you're the doula! We LOVE doulas here!" It will make your patient happier, her doula more comfortable, and everything can run more smoothly when everyone knows they're a welcome part of the team. Reading Dr. Kennell's interview made me think of all the wonderful hospital staff I've met who were excited to see a doula in the room and let everyone know it!

Sowing the seeds of distrust

I have been working on a post lately about why you shouldn't count on being able to advocate for yourself in labor. I worked on it a lot and then started rereading it and thought it, "This is too negative. It is based on fear. I don't want to write posts based on such deep suspicion of all care providers. Many of them are great, and since I want people to be confident and trust in their birth, why should I write a post based in distrust and fear?"

Then I read At Your Cervix's post on delivering babies early because of inaccurate fetal lung maturity testing. I thought, Oh my god. What if those doctors were taking care of my friends or my relatives? And this happened to someone I know? As one of the commenters suggested in that post, there's absolutely a role for staff/public health people to play in establishing systems and safety checks so that no one can practice this way. But in the meantime, am I wrong for not wanting to go to everyone I know who will ever have a baby and say, "Please, please, please! Do your research and choose someone who will treat you with evidence-based care, with respect for you and your baby! And they may be the sweetest, nicest person you have ever met, beloved by everyone you know, and you may want to trust them - but please educate yourself and make sure you are FULLY informed before you consent to medical intervention."

When I was working as a bra fitter, women would come in during their last month of pregnancy to get nursing bras they could use right after birth. I probably worked with hundreds of them over the course of a year. They were beautiful, healthy, round, and looked whole to me in a way that made me sad. In a quiet moment at the store, I once asked the other doula who worked there, "Do you ever look at all these happy pregnant women and feel sad at what's likely to happen to them during birth?" She thought about it for a moment and said yes. We both felt sad, because one out of every three women was going to undergo surgery, perhaps without a good reason but still believing it was necessary. And even if they avoided surgery, most of these women were going to be tied to the bed with catheters and IVs, monitored, pumped full of drugs... and I sensed that even the ones who didn't particularly mind a medicalized birth, didn't fully realize the extent to which it was going to happen.

It is such a relief to me to meet someone who is planning a birth in a setting I know is trustworthy, if only because then I don't have to think about all the things I want to warn them about (but am not going to because they didn't ask). ("Don't agree to an induction unless it's absolutely necessary, drink lots of water before ultrasounds to avoid a diagnosis of low amniotic fluid, don't go to the hospital too early in labor," etc. etc. etc.) And now I've read the above post and I am adding to that mental litany, "Be cautious about an elective early delivery based on fetal lung maturity testing".

Since I usually don't say anything anyway, I can't just use that convenient X-Files line of "Trust No One". But if I was going to say something, and if I am ever going to finish that post, what should I say? "Trust someone, and make sure it's a good one"? "Trust yourself, and hire a doula"?

Wednesday, October 7, 2009

Descriptive studies & routine fetal monitoring

Sometimes the birth-related stuff shows up where I don't expect it. From an article for my research methods class tomorrow:

"...Another sad example in which misinterpretation of descriptive studies* hurt public health is routine electronic fetal monitoring in labour. A quarter of a century ago, temporal associations between the introduction of electronic fetal monitoring and falling perinatal mortality rates led to the conclusion that continuous fetal heart rate monitoring was a good thing. Moreover, authorities of the day predicted a 50% reduction in perinatal morbidity and mortality from its use.

Based on this rosy assessment from prominent obstetricians, this expensive and intrusive technology took obstetrics by storm. However, the initial upbeat
assessment did not survive scientific scrutiny. Years later, a meta-analysis of the randomised controlled trials showed that, by comparison with routine intermittent auscultation, routine electronic fetal monitoring confers no lasting benefit to infants, whereas it significantly increases operative deliveries; thus harming women.

Based on objective reviews, both the Canadian Task Force on the Periodic Health Examination and the US Preventive Services Task Force have given routine electronic fetal monitoring a D recommendation (fair evidence against its routine use). Despite this advice, about three-fourths of all births in the USA include electronic fetal monitoring. Failure to appreciate the limitations of descriptive studies has caused lasting harm and squandered billions of dollars."

*The authors define a descriptive study as "concerned with and designed only to describe the existing distribution of variables, without regard to causal or other hypotheses." An example of descriptive studies is early reports of AIDS, describing clusters of unusual cases and generating hypotheses as to their cause(s).

Citation: Grimes DA, Schulz KF. "Descriptive studies: what they can and cannot do". Lancet. 2002. 359:145-49.

(H/t to my roommate and classmate Katie, who found this passage and suggested I might want to get on that class reading!)

Monday, October 5, 2009

Feminists, reproductive rights, and VBAC

So Feministing also posted a link to the article on Joy Szabo's VBAC challenge, and the comments section has gotten - interesting. I don't want to say that every Feministing commenter is in fact a card-carrying feminist (what, you don't have a card? I keep mine in my wallet, it's laminated and everything!) but the reactions of some of the commenters really surprised me.

Despite my better judgment and a pile of other tasks I need to do today, I have gotten into the fray. It just raises my hackles when women who in many other contexts would aggressively question medical/legal authority and advocate for a woman's right to make choices about her own body go off on the "Well, if her DOCTOR says it why would she put HERSELF and everyone else at RISK" line. As if your reproductive autonomy ends when you choose to continue a pregnancy, and you must willingly hand your body over to the medicolegal system. As if VBAC access in no way equates to abortion access. As if it's OK for a hospital to threaten to get a court order for unnecessary surgery, because "She's the one who decided to get pregnant and decided to have a VBAC, so she's got to live with the consequences. The hospital has to protect themselves". I'm glad there are other commenters who see the irony here, but shocked that there are those who do not.

I have so much more to say about the relationship of feminists/the reproductive rights movement to birth, but that post would take longer than I have at the moment. Suffice it to say, I think reading the comments on that post is educational, if nothing else, and offers food for thought about how to appropriately illustrate to those in the movement that birth issues are not related to reproductive rights - they ARE part of reproductive rights and just as important as any other.

Arizona woman fights VBAC ban

Joy Szabo had a normal vaginal delivery for her first child, then an emergency c-section for her second, followed by a successful VBAC for her third. By the time she was pregnant with her fourth, the hospital in her town had banned VBACs. Yes, the same hospital where she had just had a successful VBAC two years earlier. So she decided to go out and make some noise about it.

Her local newspaper wrote an article about her situation. The Unnecesarean posted excerpts from her story and contact info for the hospital, prompting a Twitter response from the hospital's PR person (read all the way down the entry). Now the ICAN blog has Joy's story in her own words. Here's a bit from her second meeting with the hospital CEO:

...I asked why they are doing labor and delivery if they cannot offer a timely cesarean. She defended the hospital, saying that they can do emergency cesaereans, but did not want to accept the risk of VBAC. I asked what the hospital policy is if I show up and just refuse to consent to a cesarean. She said they would seek a court order. She repeated to me that Page Hospital does not have the facilities nessasary to handle an emergency.

(My translation: "Can Page Hospital handle an emergency c-section?" "Yes! No! Depends on who's asking! Go away or I'll get a court order!")

The newspaper article features a photo of the kick-ass message she's painted on her minivan, equating her hospital's threat to get a court order for a cesarean with rape. Because of the VBAC ban not only in her hometown, but on multiple hospitals closer to where she lives, as of now Joy Szabo has decided to try to find an OB/hospital in Phoenix - a 5 hour drive from her home - that will work with her VBAC.

The ICAN blog has links for "mom-sized" activism (or really, any busy-person-sized). Tell Page Hospital and the Banner hospital system that forcing a mom with 3 children to travel hundreds of miles just to give birth as her body intended, and threatening her with a court order for unwanted surgery...well, that's just Not Cool. And yes, that last part does sound a lot like rape.

Sunday, October 4, 2009

The best birth plan

Tiffany at the Midwives of Bethany Women's Healthcare blog posted one of the best birth plans I have ever read. I was giggling the whole time I read it.

I was asked to give feedback on a birth plan the other day, and spent some time crossing out things that didn't really need to be on there, explaining that other things should really be discussed in advance, etc. etc. Maybe I could have just suggested they xerox this plan and use it. If nothing else, I think it would put the staff in a great mood!

Saturday, October 3, 2009

Physiologic birth and breastfeeding

I went to a very fast birth recently! Mom called me to tell me she was in labor, an hour later to say they were going to the hospital. I didn't believe from the tone of her voice that she was really so far along (although I just said, "Sounds good, see you there.")

I arrived at the hospital thinking she might be 4-5 cms, max. But when I walked into her room they said "You're just in time!" I said, "Just in time for what?" "For her to have the baby!" Yep, she walked in at 10 centimeters and pushed the baby out about 45 minutes later. Until she was checked she fooled just about everybody about how far along she was, including her husband and the midwife - everyone was shocked by how far along she was. Fortunately mom tuned into her own body and ignored the rest of us!

Because she walked in ready to go, and didn't want drugs anyway, mom really got absolutely nothing - no IV, no injections, nada. She just sat down on the bed and pushed her baby out. And after days of rounding with the LCs on a floor full of post-epidural babies, it was so striking to see a baby from a totally unmedicated labor! This baby was so alert from the beginning - eyes open, looking around - and latched on and nursed beautifully within half an hour. When I went in the next day it was the same story - awake, perfect latch, nursing frequently and effectively. This on a floor full of babies with bad latches, breast refusal, ineffective suck.

Birth practices affect breastfeeding. It just gets brought home to me over and over. The LCs all know it. They dislike epidurals and other interventions not in any holier-than-thou, you're-a-worse-mom way. One LC needed to have all her babies by c-section. But just like the others, she sighs in frustration over how all those meds are affecting the babies that she's trying to get onto the breast.

We so rarely see a baby who has experienced a physiologic birth, we forget what it looks like. This mom went into labor on her own, got zero meds, followed her body's urges to push (very minimal coaching), and when baby emerged it went straight to mom. Her placenta came out quickly, her uterus firmed up nicely, she began nursing, the end. Nobody did anything to speed her up or slow her down, and she moved and positioned herself however she wanted. Her body just did its thing. That's a physiologic birth! As a doula, I'm fortunate to attend more than my share. As an LC-in-training, I'm lucky to see them at all. All these nursing problems begin to seem normal...but they're not, or at least they don't have to be.

I don't want to sound all super crunchy, "Sure you can have your precious epidural...IF YOU NEVER WANT YOUR BABY TO BREASTFEED." Can you have an epidural and breastfeed successfully? OF COURSE! Can you have an physiologic birth and have feeding issues? Sadly, yes! I'm not talking here about individual choices - many birth-related feeding problems are transient and a determined mom can easily surmount them. But I'm speaking here from a public health standpoint. Not all moms are determined, or have the resources to draw on to overcome those problems. By messing with breastfeeding in any way, we tip more and more of those moms-on-the-edge right over it. And we're messing with breastfeeding big time via birth. Too many women see the fussy sleepy baby and/or the latch issues, and they just decide "This is not for me". Either we have to do something about how we provide pain relief for those who want it, or how we prepare and support moms who have high-intervention births.

A good first start, from what I've seen, is to make sure moms get two full days in the hospital with lots of LC (or other trained staff) assistance - instead of the hospital hustling them out the door. It's hard to fix or even wait out birth-related breastfeeding problems in just 24-36 hours. Yet all these moms are being whisked out the door because hospitals get paid the same for your postpartum care, whether you stay 1 day or 2 days. And of course there aren't enough LCs to give the intensive support some moms need. Sigh.

Friday, October 2, 2009

Beautiful breastfeeding PSA from Puerto Rico!

Breastfeeding public information broadcast from Puerto Rico, "Dar la teta es dar vida" ("To 'give the breast' (breastfeed) is to give life"):

I love how this shows moms nursing toddlers and older children, not just babies. So many women seem to have this idea that breastfeeding should end as soon as baby turns a year (or even less). This is a lovely way to show that the breastfeeding relationship can continue as long as both participants are enjoying it. If we can normalize toddler nursing, we've got it made!

Puerto Rico may be part of the U.S., but it's clearly a long way ahead of us when it comes to breastfeeding PSAs (although their breastfeeding rates are not very different, according to the scant statistics I could find.) I wonder what the reaction was there when it was broadcast?

The video was originally posted by the makers here here, and the notes at the right side of the screen give more information about the song, the production team, toddler nursing, and more. Unfortunately it's been flagged as "inappropriate" (puh-lease!) so you have to sign in to get to it. (I linked to a repost that has fortunately not been flagged, let's hope it stays that way.)