Saturday, January 30, 2010

Two resources: cervixes and menstrual cups

Last night, I was at a potluck/Tu B'Shevat celebration with a bunch of people including one other Maternal/Child Health student from my program. That is a 99% guarantee that at least one of the following will come up in conversation: 1) breastfeeding 2) birth 3) birth control in general 4) IUDs in particular. There was a little cluster in the corner of myself, a social work student, my fellow MCHer, and her roommate (a med anthro student) and we managed to hit 3 and 4 (and 1 came up later, prompted by a reading from the seder that likened growing your own food to breastfeeding).

We also discussed two websites: One was a website that I was showing to everyone in my class last year (in case you're wondering, yes, I do have a bit of a reputation), but which I'm not sure I ever posted here: the Beautiful Cervix project. This began with a project undertaken by a student midwife to photograph her own cervix each day throughout one menstrual cycle. I found it completely fascinating, especially since I had just read "Taking Charge of Your Fertility" and thought it was neat to actually be able to SEE the changes the cervix goes through. Since then she's added photos of other cervixes (cervices? according to the Internet either is acceptable), including a women who are pregnant, have IUDs, have gone through menopause, etc.

The other website is a LiveJournal community forum on menstrual cups. I've had the Keeper for a little over a year now, but I didn't know about this website until my fellow MCHer told me about it last night. All I can say is, I wish I'd found that site a year ago! The Keeper has worked great for me when it's in - no leaking and comfortable. But I've found myself avoiding using it sometimes because it's been so hard for me to insert and remove; I was contemplating switching to a DivaCup to see if that would make things easier, or just giving up altogether and investing in a whole lot of LunaPads. Things I could have learned sooner if I'd known about that forum: 1) there are many choices of menstrual cup, above and beyond just the Keeper or the DivaCup; 2) there are many ways to fold a cup for insertion, which I think is about to make my life so much more comfortable, and 3) there are multiple ways to size cups (among other "myths propagated by the cup companies"). I'm willing to give some new techniques a try to see if I can stick with the Keeper, but if not I'm reassured I have many more options!

This concludes your Very Hippie Post of the week ("Visualize your cervixes, ladies! And catch your moon flow with a non-disposable product! Bliss and peace!")

Monday, January 25, 2010

HMBANA collects mothers' milk to go to Haiti

I learned this evening that the Human Milk Banking Association of North America is now partnering with the Red Cross and the U.S. Navy to provide human milk from U.S. donors to Haitian babies. It will be used in the NICU of the U.S.S. Comfort, a Navy hospital ship that is providing emergency medical care to Haitians. HMBANA's supplies are low right now (much like many blood banks around the country, having seen a drop in donations over the holidays), so by becoming a donor to HMBANA you can help supply both U.S. and Haitian infants with mothers' milk! Guidelines for donors, and info for who to contact, are here.

(Note: To my understanding, HMBANA is partnering with the International Breast Milk Project for this effort. If you know anything about IBMP, this may not matter to you, or may make you hesitate. My feelings on IBMP are complex, and complicated by recent unverified info that they are no longer working with ProLacta at all. To me, this alliance with HMBANA is a good sign and if nothing else, means that anything that's not sent to Haiti will at least be processed and distributed by a non-profit milk bank in the U.S.)

Here's a story about aid efforts from the Dominican Republic:

Inside the station, volunteers huddle around a table and make a human assembly line packaging rice into smaller, manageable bags.

“These people have nothing and literally are donating the clothes off their backs,” Sylvie says, pointing to the boxes of clothing, non-perishable food and medicine.

At the hospital, nursing mothers who had no money donated bottles of their own breast milk. And by Saturday, 25,000 Dominican Republic pesos (about $725 Canadian) had been collected for medication and for gasoline for the caravan.

And the Oscar goes to...

This was a hard one! I was just about ready to do eeny-meenie-miny with my favorites, it was so hard to pick. But the winner is...Olyglotpay! For capturing that special patronizing WTEWYE tone with deft writing and a plot that's true to the spirit of this pregnancy classic - even incorporating an especially lovely quote from the original:

Our protagonist is a woman who thinks of herself as a non-conformist. She's been married for a few years, doesn't work, and is antsy staying at home. Her husband is getting kind of freaked out because she seems different than he remembers her as a new bride. She goes for long drives and returns late at night, wide-eyed and silent.

On her birthday, he surprises her at a nice dinner with his gift - the announcement that they can start trying for a baby. She acts ecstatic, although we see some signs that she's privately ambivalent.

Fast forward a few weeks and we see her starting to deal with some morning sickness. She's not happy about the pregnancy - just pissed off about the inconvenience. Unsurprisingly, the dad-to-be is alarmed that getting knocked up hasn't knocked her out of what he thinks is a long-lived funk.

In desperation he goes to the university library and browses until he stumbles on an old, ratty copy of WTEWYE. He jots down a note and leaves. Cut to him handing his wife a nicely wrapped package, containing a bright new copy of WTEWYE (you didn't think he was actually going to hand her that germy old copy, did you?!).

That night, our little mother starts reading. We see dark turn to light as she sits up overnight, reading in a rocking chair (in a muumuu). When dawn breaks, we zoom in for a close up of her face. She has found her focus. Her pregnancy will give meaning to her life! She has something to spend her time on!

The next montage shows her raiding every room in the house, throwing out all plastics, sanitizing, getting rid of all her old unhealty/evil foods, then making trip after trip to Babymart for gizmos and gadgets of all sorts. She curses herself for being over 30 but starts wearing flats and support hose. She puts away her China so that she can "keep her clumsy paws" away from it [that's a real quote!]. She buys the WTE Journal. Bravely, she peruses some pregnancy websites, but of course trusts her OB to know best.

When her husband tells her he's anxious about the birth, she comes up with her own surprise for him: a C-section, scheduled during week 38 on his birthday! As he pulls her into his arms, he sheds a single tear of happiness for how involvement in her pregnancy has changed his stagnant wife's ways. No longer does she mope around, thinking about herSELF. And the baby itself? Why, that's just the icing on the cake.

As they day draws near, she gets happier and happier, counting down. On the actual day of the birth, we see her wheeled into surgery (doors swing closed), then being wheeled back out (doors swing open) ... down the hall to the nursery, where her lovely baby lies fussing. The credits roll as she gives the baby its first bottle.

Please go and read through all the entries - there are some great zombie horror, "your baby will DIE", mass world domination, and Stepford robot plots cooked up by all the awesome participants.

Olyglotpay, please e-mail me with your address so you can get your copy of Our Bodies, Ourselves: Pregnancy and Birth!

Thanks to everyone for participating! This contest has been fun, I'll have to do another one sometime!

And for my last word (for now) on the subject of WTEWYE, I leave you with a passage from a recently published novel (that I otherwise enjoyed): "Commencement" by J. Courtney Smith. (Note: SPOILERS if you plan to read the book):

"Sally, we're having a little trouble getting the baby's shoulders out," the doctor said. "We're going to have to do a small episiotomy." ...

"No," Sally said, shaking her head. "I don't want it done."

Celia was about to speak up, about to say that these damn people needed to listen to Sally, and really, hadn't the poor girl been through enough without slicing her open?

"Babe," Jake said gently. "I know you didn't want one, but it will heal so much better than a jagged tear."

Bree's eyes nearly popped out of her head.

The doctor grinned. "I see Daddy here has been reading
What to Expect When You're Expecting. He's right, I'm afraid."

"Oh okay," Sally said. "Just get this thing out of me." She put her head back, resigned.

Sunday, January 24, 2010

Contest extended through this evening at 5 p.m.

I can tell it's going to be a pattern. All week I'll think about how I should do the assignment for my (stupid*) online Environmental Health course (due Sunday evenings). And every Sunday I'll roll out of bed and confront the fact that sometime today I just have to buckle down and do it.

So since I'll be a little busy this afternoon, I am extending the contest through 5 p.m. today. That's a deadline for both me and for you! Once I'm done with this assignment, reading through all the great entries and picking a winner will be my reward.

*It's not that environmental health is stupid. It's that this is a pretty stupid course. Students complained about it so much that they had to add a residential course taught by a different professor. Apparently the residential one isn't much better, though, so I've decided to stick with the online one since at least it doesn't require me to show up for any lectures. It's frustrating for 2 reasons: 1) Environmental health is an important topic, about which I'm learning almost nothing, and 2) We all have to take an Envr course but nobody has to take an MCH course. Where's the justice?

Saturday, January 23, 2010

Contest closes tonight! And 2 more questions: baby books and rockers

Don't forget that you have but a few more hours to post your WTEWYE movie plot! You too could win a fantastic prize (that is, ahem, currently at the bottom of a pile of books on my desk, but otherwise in excellent condition and hopefully inspiring me to tidy up this weekend.)

My last post didn't come up with any suggestions for a mom-oriented breastfeeding newsletter (but I'm with Dou-la-la that gosh darn it, somebody should do one! Another project for the spring?)

In the meantime, I have one more question to pose: my cousin is expecting her first baby in the spring (yay!) and asked me two questions as she prepares:

1) Is a rocker/ottoman combo worth it for the baby's room? They can get pricey but they are pretty comfy! I tend to err on the side of suggesting to people that they wait on most baby gear (expensive cribs in particular, who needs a $600 laundry hamper for a baby that ends up in the Pack & Play or in the grown-up bed every night?) But that's just my opinion; did other people find those rockers helpful for getting baby to sleep and/or nursing?

2) What are good baby books? I own the Sears & Sears Baby Book - one thing I think is great about the Sears books is that you can trust them to have good, accurate breastfeeding advice, and not to give suggestions that interfere with breastfeeding. I've also worked with families that loved this book. But besides that, I have little experience with the baby book world - other suggestions?

Thursday, January 21, 2010

Contest closing in two days! And a question.

Don't forget to submit your ideas for the What to Expect When They're Making a Movie Contest! I've decided to close the contest on Saturday evening, and name a winner by Monday. So if you've been brainstorming, or letting your subconscious work on it, get your idea(s) into a comment soon - you could win a copy of Our Bodies, Ourselves: Pregnancy and Birth!

In the meantime, a question: some pregnant women sign up to get regular "pregnancy update" e-mails from services like this from American Pregnancy, or this from Lamaze. They have information about the baby's growth, tips for discomforts of pregnancy at that stage, links to more information, etc. Does anyone know of anything similar for breastfeeding, with regular updates and links to common concerns/info for that age? (Like why a 4-month-old might want to nurse all night, or tips for starting solids at 6 months). Anything out there?

Sunday, January 17, 2010

The What To Expect When They're Making a Movie Contest

Because these days you can make "movies" out of board games and self-help books, surely scary pregnancy advice books were next: A U.S. film version of the pregnancy bible "What to Expect When You're Expecting" is in the works.

No, seriously.

This has inspired me to host my first contest! I can only imagine that the WTEWYE plot will have as much to do with its source material as "He's Just Not That Into You" or the upcoming "Monopoly" movie. Still, you never know! In a comment, post your plot idea for the movie plot that would best represent that timeless classic, "What to Expect When You're Expecting".

Helpful reference materials include What to Expect When You're Not Expecting to Be Sued By Your Doctor (Unnecesarean), and What to Expect When You Didn't Expect to Read The Worst Pregnancy Book Ever (Strollerderby), and their accompanying comments. You can also consult the source - available on every thrift store bookshelf for a buck or so.

The author of the best movie plot, selected by me and my Ouija board (OK, actually just me), will receive a copy of "Our Bodies, Ourselves: Pregnancy and Birth" which definitely ranks above WTEWYE on the helpfulness scale and includes this gem from a mom contributor:

"I mean, must they [pregnancy books] be so alarmist? 'You didn't paint your toenails before you knew you were pregnant, did you? Don't worry - if you're lucky, at least one hemisphere of your baby's brain should still develop normally.' ... And the whole 'best bite' pregnancy diet? Please. 'Is that the very best bite for the baby?' Michael likes to tease when I'm hunched like a criminal over a pack of gummy bears. 'Be sure to indulge yourself at least once a week,' the book advises. 'A fruit yogurt makes a nice treat'. A fruit yogurt! As if. A pound of cookie dough washed down with a quart of half and half - now that makes a nice treat."

Let your imaginations run wild!

Hooray for a happy birth!

This week has seen a lot of loss - hearing about Haiti's devastation, loss, and mourning. In addition, one of the original professors for my lactation course, who has been ill for a while, is likely in her final days.

In the midst of all that, it's wonderful to hear about new life. I was hanging around my hometown till the very last minute of winter break, hoping to be the doula for a friend of mine. While I didn't manage to be there I was delighted to get the baby news today! He was born at home this morning, attended by midwives; speedy labor and healthy mommy and baby. (Quote: "He nurses, he sleeps, he peed!") I've seen a few pictures already and he's a cute one too! Congratulations to the newly expanded family!

Saturday, January 16, 2010

Infant feeding and disaster relief

Like everyone else, I've been reading/listening/watching the news reports from Haiti and it is just heart-wrenching to see so much need and be able to do so little. The impulse, of course, is to do something, not just donate - but the message seems to be getting through that what Haitians need right now is MONEY, given directly to the aid agencies that are on the ground. (Or as one story I saw put it, "Nobody needs your old shoes." At the very least, they might not mind your old shoes if you could teleport them there, but nobody wants to collect, sort, pack, ship, and distribute your old shoes when for a fraction of the time and the money they could just buy shoes and hand them out.)

With that in mind, Elita at Blacktating talks about how to help Haiti - especially why NOT to take part in any efforts that donate infant formula. While there may be some babies in Haiti who need infant formula, that should be provided in a systematic way by relief organizations that follow protocols around infant nutrition and help ensure that formula goes only to infants who truly cannot survive otherwise - not to breastfeeding infants who will be placed at greater risk.

The Emergency Nutrition Network has information about the dangers of infant formula provision in emergencies, and a list of Core Group members who are collaborating to improve infant and young child nutrition emergency response. From that list, I'm contributing to CARE, an organization which was already in Haiti at the time of the earthquake and is working to deliver immediate and long-term relief. I'm also contributing to Partners in Health, which was founded to target health problems in Haiti and has deep roots there (and yes, because I read "Mountains Beyond Mountains" and, like every public health student I know, idolize Paul Farmer/Partners in Health).

Thinking of all the people in Haiti and wishing fervently for the international outpouring of aid to make a difference for them.

Wednesday, January 6, 2010

10 social determinants tips to a healthier pregnancy

Via The Fat Nutritionist (and originally, I gather, grabbed from a Wikipedia entry):

"Don’t be poor (and other New Year’s resolutions.)"

The traditional 10 Tips for Better Health

* 1. Don’t smoke. If you can, stop. If you can’t, cut down.
* 2. Follow a balanced diet with plenty of fruit and vegetables.
* 3. Keep physically active.
* 4. Manage stress by, for example, talking things through and making time to relax.
* 5. If you drink alcohol, do so in moderation.
* 6. Cover up in the sun, and protect children from sunburn.
* 7. Practice safer sex.
* 8. Take up cancer-screening opportunities.
* 9. Be safe on the roads: follow the Highway Code.
* 10. Learn the First Aid ABCs: airways, breathing, circulation.

The social determinants 10 Tips for Better Health

* 1. Don’t be poor. If you can, stop. If you can’t, try not to be poor for long.
* 2. Don’t have poor parents.
* 3. Own a car.
* 4. Don’t work in a stressful, low-paid manual job.
* 5. Don’t live in damp, low-quality housing.
* 6. Be able to afford to go on a foreign holiday and sunbathe.
* 7. Practice not losing your job and don’t become unemployed.
* 8. Take up all benefits you are entitled to, if you are unemployed, retired or sick or disabled.
* 9. Don’t live next to a busy major road or near a polluting factory.
* 10. Learn how to fill in the complex housing benefit/asylum application forms before you become homeless and destitute.

I loved this, and it got me thinking how these could be applied to pregnancy outcomes, which are rife with social determinants. I started coming up with my own list, and while I wandered off the social determinants course on a couple, they're all structural.

My (kind of) social determinants 10 Tips for a Healthier Pregnancy:

1. See all of the above social determinants; and if those aren't possible, then:
2. Don't go to a busy impersonal OB clinic, and don't choose at a high-volume public teaching hospital with high c-section rates. Instead, get a midwife and/or attend group prenatal care, which are shown to improve outcomes for socially high-risk women.
3. Don't be on Medicaid or other public insurance program that may or may not cover alternative care options.
4. Don't be uninsured yet have too much money to qualify for Medicaid, because then you won't be able to buy health insurance at all due to your "pre-existing condition" of pregnancy.
5. Don't be a victim of domestic violence, which is statistically more likely to occur during pregnancy.
6. If things get really desperate, for god's sake just make sure you're don't end up in jail, where you can be denied basic care and then shackled to the hospital bed when it's time for you to have your baby.
7. Practice not having to go back to work immediately postpartum to survive financially. Also, practice having a job that allows flexibility and breastfeeding/pumping breaks. Breastfeeding mitigates many of the infant mortality risks associated with being low-income.
8. Don't be African-American; if you have to be African-American, be a recent immigrant or make sure your ancestors have immigrated very recently, so that lifetimes of stress have as minimal an impact as possible on your childbearing.
9. Don't be isolated and experiencing a lot of stress. Just don't!
10. Practice having access to family planning. Sure, you may have trouble affording birth control because emergency Medicaid cuts you off after 6 weeks, but do your best.

I could go on (of course) but we don't want people to feel overwhelmed by all the things they have to not do. Happy New Year!

Sunday, January 3, 2010

Induction and perception

You all know how I feel about induction. Pinky has just posted about how tough inductions can be:

Like most L&D nurses, I hate to induce a primip with a long thick and closed cervix. Especially when she is not 42 weeks. Some babies go 42 weeks. We hate to see the 3 day induction. Which goes like this: 1st evening you get cervadil. Next morning we start pitocin even if you are still not ripe. Repeat cervadil in evening or maybe put in misoprostal next morning repeat pitocin. We might turn the pitocin off a few times if the floor gets busy during the day so you get set back a few times. By the 3rd day the woman and her partner are begging for a C-section. We hate to do this. Sometimes she pops into labor and delivers a baby no problem. But that is usually if she has a ripe cervix in the 1st place or by the end of 12 hours of cervadil. ...

Funny thing is no matter how much you tell folks about how the 3 day induction will suck, most will sign up for it. They must think, "Oh I won't be the 3 day induction and if I am I will get a c-section." I think most people down play the risk of c-section. Either they down play it or the catastrophize it. In my book a c-section is to be avoided if possible. It really is a big surgery but not a catastrophe. Most abdominal surgeries can be done by laproscopy. We have not figured out the laproscopic c-section.

It got me thinking about a blog I was following recently. Sometimes my google alerts kick up blogs of expecting moms and I end up scanning through them. This woman decided on an induction at 41+2 and wrote "I know I know, there are a lot of people out there that are against inducing, but [husband] and I are not." There are many ways the story could unspool, but the way it ended up was an induction beginning Sunday night, lasting through Monday night, and ending with a c-section on Tuesday morning due to exhaustion and slow progress. So, pretty consistent with Pinky's description.

This woman seemed OK with having ended up with a c-section, and I think it's great that she felt happy about her experience. But to me, it was illustrative of how choices with real consequences can start being treated as philosophic differences. I'm sure I would be placed into the class of one of the "lot of people out there" against inducing, but I am not "for" or "against" induction. Rather, I think that induction, particularly used electively and/or when the body is not ready (as measured by a Bishop's score), carries risks and that individuals should be aware of these risks.

Making the choice to use or not use an intervention involves a set of risks and benefits that every individual has to weigh for themselves. And one of the risks of induction is that it will be long, exhausting, slow, and result in a c-section which, as Pinky points out, carries real risk of its own. That's easy to ignore, though, when the discourse becomes whether people are "for" or "against" epidurals, inductions, c-sections, etc. That obscures the reality that these are not "chocolate or vanilla" choices of personal preference. It makes it easy to ignore the 3-day inductions and c-section complications, or at least to perceive them as common outcomes of labor (and so not consequences of the induction) vs. common outcomes of induced labor. It's hard because I think many people are trying to spread the word about the risks of induction. But if it's coming across as another "pick your flavor" choice, it's obviously not coming across correctly.