Monday, February 28, 2011

Congresswomen speak out

In the debate over defunding Planned Parenthood, two Congresswomen have taken the floor to share personal experiences in a way I found very moving.

First there was Rep. Jackie Speier. Rep. Chris Smith, a Republic from New Jersey, took the floor to read aloud a description of a second-trimester abortion procedure. Rep. Speier stood up immediately after he spoke.

"I really planned to speak about something else. But the gentleman from New Jersey just put my stomach in knots. Because I'm one of those women he spoke about just now."

Rep. Speier:

Brave, honest, amazing.

Then there was Rep. Gwen Moore. From Salon's summary:

[L]ate Thursday night, Georgia Republican Rep. Paul Broun had trotted out the old canard about Planned Parenthood being a bunch of eugenically motivated abortion enthusiasts, pointing out that "there are more black babies killed through abortion proportionally than there are white babies or any other colored babies."

Responding to Broun's deep concern for the well-being of black babies (a concern that apparently ends when those black babies grow up to need breast exams or cervical screenings) Wisconsin Democrat Gwen Moore said, "I know a lot about having black babies. I’ve had three of them. And I had my first one ... at the ripe old age of 18.
An unplanned pregnancy."

Rep. Moore:

These are not men talking about lives, decisions, and responsibilities that will never ever be theirs. These are women baring difficult parts of their lives to bring some honesty and reality to the discussion. Thank you Congresswomen - for being our voices of women's real, lived experiences in the U.S. Congress, and for standing up for everyone's access to affordable care.

I still hate directed pushing

Navelgazing Midwife has a great post up about doula-ing the birth of a woman with epilepsy. I think it's a very educational post for doulas, touching on aspects of working with women with chronic medical conditions, women who are not opposed to intervention, and women with very interesting ways of coping with their contractions!

My attention was caught by another illustration of one of my pet peeves, directed pushing:

Now it was time to push. Now that the stage was set for everyone else. Never mind she’d been pushing for a few minutes already. And the head had come down fantastically without any coaching whatsoever. No, now she needed direction and education. Really? Let the cheerleading begin.

When I talked to my client afterwards, she said she was only focused on the doctor, her husband and me, so she was protected from the chaotic yelling at her to push. The woman had a ten minute second stage. And it took three minutes for the baby to be born from the time we first saw her head. Yet, every nurse there, as well as the doctor kept trying to tell her how to push. I’m serious.

“Take a deep breath. Let it out. Take a deep breath. And push, counting to ten.”

Are you kidding me? The woman coughs and a quarter of the head gooshes out!

“No, not like that. You’re wasting your energy.”

I couldn’t believe the surreality of the situation; it was so absurd I really could barely accept they were instructing her this way. I kept whispering to her, “You’re doing great. Exactly like that. Yes… you’re doing great.” She told me that’s all she heard. Thank goodness the cacophony of shrieking nurses remained in the background of this mama’s perception.

I wrote about this in my post on how much I hate directed pushing:

Everything goes great until pushing and then BAM, all of a sudden we're back to the worst of the medicalized model. The second a woman is judged to be "complete", everyone in the room suddenly gets license to, quite frankly, be a total jerk to her. Before she has pushed even once, there is the presumption that she is going to push "wrong". She is never even given a chance to try pushing in different positions or for a few contractions to get the hang of it. Instead, the nurse spells out the position she should assume (chin to chest, pulling back on her thighs, on her back? but of course!), support people are given her legs to hold, and she gets the 3-pushes-per-contraction speech. Then from the first push she is loudly coached, counted off, and urged on MORE MORE MORE KEEP GOING PUSH HARDER HARDER HARDER and that's about when I start grinding my teeth.

In comparison, what happened at the homebirth I attended this month?

As the mom hit transition, she started to make sounds that the midwives and I recognized as "pushiness". The midwife just talked quietly to the mom about how she was moving through transition, acknowledged this was a very intense time, and reassured her. Once mom finished transition and instinctively began to push (there was one cervical check not long before she hit 10 centimeters to check progress, but there was no check to ritually declare her complete) the midwife again quietly spoke to her and encouraged her to let the baby push down with contractions, and let her body be the guide about when she should begin to actively push. That's exactly what she did, pushing in short bursts at first, and then longer as she felt increasing pressure. She started on her side in bed, then got up on her hands and knees. The midwives watched her and would let her know when they saw a very effective push, giving her nothing but gentle praise and encouragement. As the baby began to crown, the midwife again quietly told her to listen carefully as the head emerged, because the midwife might tell her to slow down or breathe through a contraction (although baby came barreling out so quickly I'm not sure the midwife got a chance to get a word in edgewise!)

End result: a good-sized baby born to a first-time mom in almost exactly an hour of pushing. This result achieved with no need for yelling, cheerleading, counting, special magical pushing positions, or other forms of, as NGM so aptly puts it, this "odd ritual".

Just say no to the pushing police!

Thursday, February 24, 2011

Tips on studying for the IBCLC exam

I wrote down all my studying methods and resources just after I took the LC exam, but was superstitiously unwilling to post anything until I knew I passed. (Plus, who knew if it was good study advice or not??)

It's now a long time since I found out that I had passed, but I'm trying to work through my backlog of half-finished posts and realized that this one has just been sitting forgotten for months! I did my best to finish it up with what I still remember about my studying. So if you're preparing for the IBCLC exam, here are my study suggestions...

Edit, 2018: The rest of this post, freshly updated, is now here on a new blog I'm contributing to. Please click through to read the rest!

Saturday, February 19, 2011

Please stand with Planned Parenthood

I am sickened by the nakedly ideological attack by the Republican party on Planned Parenthood.

I cannot count the number of friends I know who have used Planned Parenthood as their ONLY affordable, accessible resource for gynecological care, birth control, STI testing, emergency contraception, and yes, also abortion. Those are services that save women's lives, and allow them to protect their current health and protect their future fertility. Regardless of what anyone may think of Planned Parenthood's provision of abortion services (a LEGAL service for which they use NO federal money, and to which all of 3% of their total funds go) the Republicans are attempting to defund a major source of Americans' access to primary health care. Not just reproductive health care - primary health care, period. For many people - especially women - Planned Parenthood is their primary care provider: they have nowhere else to go.

There is a conception by conservatives I have spoken to that Planned Parenthood pushes abortions and promiscuous sex (via "pushing" birth control?) and relies on somehow manipulating their consumers into these choices, all to make a profit (I guess the fact that they are a non-profit organization is just a minor detail.)

I knew someone exposed to this propaganda who was shocked - shocked - when she met a nurse who worked at Planned Parenthood and found out that this nurse was a normal, nice person who cared about mothers and babies. It was so completely different from the idea of Planned Parenthood that had been marketed to her by conservative religious organizations. It is an idea that is so ludicrous and at odds with my experiences and those of everyone I know who has used Planned Parenthood's services, or worked for their organization.

It's disgusting and disturbing, a ridiculous foundation for legislation, and I cannot imagine where millions of Americans will turn for these services if Planned Parenthood loses their federal funding.

Please stand with me in standing with Planned Parenthood and sign this petition now. Please share it with your friends on your blog, on Facebook, and/or via e-mail.

And please watch this video of a brave and honest woman sharing her personal experience, on the House floor:

Thursday, February 10, 2011

How much are spending cuts really cutting, and what would we lose?

Sociological Images has a nice breakdown of Republicans' proposed spending cuts. Check out the post for a full discussion, but here is a helpful graphic:

So, in cutting 4/10s of 1 percent from the budget, what do we lose? Proposed cuts of over $1 billion to community health centers and the National Institutes of Health, among others. Oh, and let's not forget cutting the entire Title X family planning program. And $758 million from WIC.

I am so sick of the hypocrisy. This money spent on health and prevention prevents us from needing to spend much bigger sums elsewhere in the budget. Slash it, and watch other expenses rise. Or refuse to pay those expenses either, and let a huge swath of America suffer. Just to score political points ("we're not funding that horrible Planned Parenthood anymore!") for what amounts to a miniscule amount of total expenditures and doing very little towards deficit reduction.

Wednesday, February 9, 2011

My first homebirth as a doula

Yesterday I was privileged to attend my first homebirth as a doula! I've been to so many births, and none outside of the hospital - until now. It was such a lovely experience for me and, I think, for the family - although, like any birth, a lot of hard work for the laboring woman! And she was a rockstar!! It ended with a perfect healthy happy baby (born in the caul - another first for me!) and an amazing healthy happy new mother - the best outcomes possible.

The family and woman-centered-ness I saw in the midwives' care was so exceptional. What the midwives needed to do, they did as quietly and unobtrusively as you could imagine. Most conversation between the birth team took place in hand signals or sub-whispers. Every question and transition was explained simply, quietly, and calmly. And being a healthy, progressing labor they didn't need to do much - so they didn't. There wasn't constant pressure to monitor progress (except by observing and listening), no restrictions on movement or food or with cords and wires, and there wasn't a constant battle to fight those things off either. It was just labor, unique to that particular person, but a familiar sight.

I can't express how different in tone and attitude it felt from a hospital birth. Having experienced it, I see why some doulas have a hard time going back to hospital births after attending home births. (The only hospital birth I've been to that has ever come close is this one, which had a fortuitous constellation of a fast labor, great nurse, two doulas, and one of my favorite midwives ever, at the most mother-friendly hospital I've ever seen. And even then - just not the same.) The respect, the privacy, the autonomy, the gentle guidance, the comfort and calm and normalcy, I have never seen replicated in any hospital (although I so deeply wish they were). It was a powerful experience.

In case you can't tell, I'm still riding the lovely wave of good feeling and harmony that comes with seeing a new life come into the world. Thank you to my friends for inviting me to be present. I was honored to be there. Your new family is great and I can't wait to see this baby grow up!

Monday, February 7, 2011

Lovely Blessingway!

I posted a while back about how I was planning a baby shower/Blessingway (thank you so much to readers who had suggestions or rituals of their own to share). I'm happy to report that it went off fantastically! We decided to make Blessingway portion of the shower very simple but hopefully meaningful. In the Evite we sent out to the invitees, I explained the plan (bring a bead and think of a wish/hope/thought to say for the new mom/parents) and I sent several reminders to people to bring a bead. Since the shower was for one of my fellow MCHers, we put a lot of far-flung alums on the guest list and suggested that people who couldn't attend still send a bead and a note.

Despite all the reminders, for some reason I couldn't really believe that people would actually bring a bead or take the ceremony too seriously. As the organizer, I myself ended up running over to the bead store the morning of (where I found a big lovely rainbow-striped bead). We brought some extras assuming most people would forget or not have time.

It turned out we had about 21 people attending and I think almost every one of them brought their own bead! Not only that, but we had several long-distance contributions including an MCH alum who mailed us her bead and then Skyped in live from the country of Mali to speak. As we went around and each person placed her bead on the string, I was so pleasantly amazed and touched by the heartfelt thought and wishes each one put into their little speech. Some people talked about the treasured friendship they had with the parents-to-be, others had wishes for health and happiness, others talked about why they knew the couple would be wonderful parents. There was a lot of laughter and some tears too. Each bead was so beautiful and when it was over, the necklace was so lovely with all of them placed together.

One of the things I most enjoyed about it, which I didn't really think about in advance, was the chance for a non-material focus as part of the shower. While there were many great gifts, the part that felt really special was the part where people talked about their love and hopes for the new family. It was a good reminder that while swaddling blankets and slings are needed and great, a caring community of friends is at least as important. It was really just a wonderful experience, and multiple people said it was their favorite part.

I don't think a ritual like this would work at every shower, but I hope to incorporate it into future baby-celebrations that I plan!

Sunday, February 6, 2011

100% real life, as seen by doulas

Gina at the Feminist Breeder posted a most excellent angry rant about the Lifetime TV show L&D reality show, "One Born Every Minute". She had some issues with the way a couple planning an unmedicated birth was portrayed in the documentary, but this is what she had to say about the medical staff's attitude towards them:

And now thankfully the show is over, and I never have to see that nonsense again. Except that I do — in real life — every time I attend a birth at a hospital with a high rate of unnecessary interventions. As a doula, I can tell you that Lifetime’s “One Born Every Minute” is 100% REAL LIFE, and the things happening on that show are absolutely representative of what’s going on in EVERY labor and delivery unit where the staff and providers do not practice evidence-based medicine or the midwifery model of care.


You can read the post for a blow-by-blow of each interaction these parents have with the nurse Gina terms "Nurse Dread". In a follow-up post, Gina has a clip of one of their interactions with said nurse - or more accurately, their doula's interactions with the nurse. If you are planning to give birth in a hospital setting you suspect or know will be hostile to an unmedicated, low-intervention labor, you need to watch this:

This is what doulas want you to understand: as Gina puts it, this is 100% REAL LIFE. The nurse's tone, attitude, demeanor, were so intensely familiar to me.

This is how it is. Bleeding from a thousand passive-aggressive cuts. "I'm trying to take care of ALL of you, especially your BABY, and I can't do my job! Haha, I'm laughing, YOU'RE RISKING YOUR BABY'S LIFE. Here's the monitors laid out nicely [those are the belts she's messing with], why don't you get back in the bed now." And I guarantee you she'll be back every 10 minutes with a variation of the same speech. "You know, when you're making such slow progress, we just get very worried about the baby. We want what's best for both of you, you know that. Right?? Mommy and baby, we care about you both so much! We just really need to be able to know what's going on in order to do that." And on. And on. And ON.

This is not because the nurses are evil horrible people bent on ruining birth. I bet this nurse is a wonderful person and takes excellent care of her patients. But she is made so profoundly uncomfortable by a labor that goes off her standard script that she cannot handle the situation respectfully or gracefully. She is constantly trying to nudge it back to what she's used to seeing, so she can get back on-script and go on with her life.

And this is why you need a doula. In this clip, the the parents aren't even seen; the doula's the one to deal with the aggro, then go in to communicate the situation to the parents (and probably discuss with them how to negotiate the next steps). Listen to how the doula is working to defuse the situation, acknowledging the nurse's concerns, reminding her the parents' priority is a healthy baby, and offering her some alternative ways to think about the situation ("people have different pathways"). The mother portrayed talks in an interview with Gina about how the doula was, in fact, the person handling most of the stressful interactions with the nurse:

[talking about her disappointment with the way the show handled things]:

I wish two things: 1. that they’d portrayed our doula in a better light. She was incredibly supportive, and had to field the majority of our conflict with Pam. AND, she did everything on zero sleep, since she came directly from another long birth, and 2. that they hadn’t insinuated that Eleanor was in trouble, and that we were putting her at risk. Every time we were on the monitor (which was 20 minutes of every hour), she was tolerating perfectly well, and even when we were pushing, her heartrate stayed up. There was never any danger.

From now on, whenever I'm trying to explain to someone why it's important to have a doula when you're planning an unmedicated and/or low-intervention birth, I'm going to point them to this show. You need someone between you and those negative attitudes to absorb as much as possible for you, and to keep the comments that do hit home from sapping you of your confidence and energy. Please, please, don't try to do it alone - find someone who can help protect you, and keep you feeling in control and confident, no matter how things go.

Thursday, February 3, 2011

The doula's first-time mama advice kit

Just about everyone who knows me knows I like to talk. Very quickly they generally find out that I am especially talkative on some of my favorite subjects of birth and breastfeeding. (I am so proud of myself last month that I went to a New Year's Eve party and only ended up talking about breastfeeding once, and very briefly at that!)

So when friends and acquaintances get pregnant, they often come to me for advice. (Sometimes I hear in their voice a kind of loving "OK, know-it-all, NOW you can tell me" tone!)

While I always try to tailor my advice to their specific questions (in part so as not to overwhelm them!) I do find myself answering similar questions and requests more than once. I've been thinking about putting together a set of the links, books, and resources I recommend to the newly pregnant woman (as opposed to the packets of info and resources I put together for my doula clients). That way I won't forget anything and will have it all conveniently in one place, so I can answer specific questions and then say "If you want more information, here's the link".

Here's a preliminary set of the info I'd give to a newly pregnant woman:

Suggested for everyone before they do anything else

The very first thing to do - before ANYTHING else - is read my post on What I Want My Friends to Know.

Next, unless said friend has put up with a lot of my rants or been following my blog for a long time (hi guys! hope you have been!), it's time to start researching options for birth.

So secondly, watch The Business of Being Born (also available on instant view from Netflix). Seriously, this is the first thing I think any pregnant woman and her family can do to help them understand the lay of the land in the U.S. right now, birth-wise.

(Reading "Pushed" by Jennifer Block is also great but not as easy as sitting down to a (very well-made) movie for a couple hours.)

Choosing a care provider and birth setting:

Often the first care provider someone goes to after finding out about the pregnancy (or to confirm pregnancy) is the person's regular GYN provider. That may be a gynecologist, an ob/gyn, a nurse practitioner, a family practice doc, a midwife, etc. If that provider offers obstetric services, the woman may begin her prenatal care with that provider, but wonder if she should investigate other options. If that provider does not offer obstetric care, she'll definitely be looking for a place to get prenatal care and deliver (since the two generally go hand in hand). So people frequently talk to me about how to go about researching and choosing a provider and birth setting.

What I say is that when looking for a care provider and birth setting, it's important that they match YOUR philosophy and what YOU want out of your birth experience... which can be hard to formulate when you're all of 5 weeks pregnant and have never thought about this before! So it's OK to establish care with someone knowing you might switch later.

In the meantime, gather your information and investigate your options carefully.

Why it's important to investigate and choose carefully

The First Birth - No Do-Overs Currently Available - just found this via Birth at Home in Arizona and love it. Make sure to read the comments as well.

You buy the hospital ticket, you go for the hospital ride by Navelgazing Midwife is an honest assessment of why it's so important to look very closely and be realistic about whether a particular birth setting will be right for you.

Information to gather and questions to ask about a care provider/setting

Their state's hospitals' c-section rates if available, from The Unnecesarean.

From Childbirth Connection:
Choosing a caregiver
Questions to ask a health care provider
Choosing a place of birth
Tips and tools for choosing a place of birth

From Birth Sense:
In Search of Dr. Right: 11 Questions to Ask and One More Question to Ask

Considering a home birth? Here are some links for thought specifically to help you interview potential homebirth midwives:

A short discussion and links about the fact that all midwives practice differently, and you will still need to find someone who has the right practice style for you.

From Navelgazing Midwife, advice on interviewing homebirth midwives: Part 1, Part 2, Part 3, Part 4, Part 5, and the finale. A commentary she wrote while posting the series is here. This is another post she wrote about interview questions, critiquing a list of suggested questions. Please read them all if you are planning to interview homebirth midwives!

My biggest piece of advice is to find experienced local doulas and talk to them about your options. They will know not just what local maternity care providers say they will do, but also what they actually do, which can help avoid the problem of the doctor or midwife who seems lovely and then becomes a totally different personality in the delivery room, or claims they practice one way and end up doing something very different. If you aren't ready to commit to hiring a doula or a specific doula, I think most doulas would be open to meeting with you for an hour or two, with the offer of compensation for their time based on the understanding that you may not hire them for the birth. (Doulas understandably feel poorly used when people act like they're going to hire them, spend a long time "interviewing" them while getting lots of advice/information/resources with no compensation, then never call again.)

If I know you personally, I'll usually get on a doula forum or two and ask for local suggestions from the doulas there - so hit me up!

Finally, go into this keeping an open mind. You may think you've found Dr. Right and then when you finish your birthing class at 32 weeks, realize that person is not the right fit for you. That's OK; there is still time to switch. Please don't fall into the trap of thinking that you can't switch after some magic number of weeks! Every doula can tell you the story of the client who switched at [34 weeks, 37 weeks, 41 weeks, in early labor, in active labor, etc.] It's only too late to switch after you've had the baby... and are regretting not switching before.

Here are the instructions for how to switch if you need them.

I'm not done talking about switching care providers, because I can hear people saying "I know I COULD switch, but it just seems too complicated/confusing/difficult/scary... I don't love this person, so I think maybe for my NEXT birth I will choose someone different/a home birth/a new hospital/etc." Do you hear yourself saying that? Stop and go back and read The First Birth - No Do-Overs Currently Available.

Now read the Unnecesarean's post of mothers who did (and didn't) make the switch.

Have you done those two things? Go and do them right now. Okay, REALLY done them now?

Then one more thing to remember: you may never have as many options as you do now - carrying scars, emotional or physical, from your first birth may impact your second in ways you may find hard to think about right now. Do not make excuses for care that does not live up to what you know you want and need! Do not put yourself and your needs off into the future - address them now in whatever ways you deserve.


Along with advice about bras, probably the most frequently asked question - what to read?

Standard warning: NOT "What to Expect When You're Expecting". 'Nuff said.

My favorite suggestion lists for books: What Not to Read, from Bellies and Babies. Along with each book she thinks women should avoid, she has 3 suggestions for better books on that topic.

Childbirth classes

I can't emphasize enough not taking the hospital classes. No matter how great the teacher is or how much freedom she seems to have - she is limited by hospital policy and you cannot be sure exactly what those limitations are.

An independent childbirth class with at least 5-6 sessions is a far better choice. Research a little bit about the philosophy of instructor and the class before signing up - there are many options (e.g. Bradley, Hypnobirthing, Hypnobabies, Lamaze, etc.) This post at Bellies and Babieshas a nice overview of the most common/popular childbirth ed programs.

If you live in an isolated area and can't find local classes, some independent instructors offer DVDs of their classes, and Hypnobabies has a full home study kit.

I have heard several childbirth educators recently saying plaintively that parents are looking for a small number of sessions, or preferring weekend workshops with a lot of information packed into 1-2 long days. I agree with them that it's very challenging to get all the information you need AND (more important) absorb and process it with these kinds of classes. If that's all you can do, go for it - but really try to make the time for something with a slower, calmer pace.

If you have trouble finding affordable birthing classes, ask around for childbirth educators in training, and talk to your local health department and/or community health center - they sometimes offer low-cost options.


By far one of my most frequently asked questions. Fortunately I wrote a series on this!


I recommend, if the mom feels comfortable, going to a couple La Leche League meetings while pregnant. They are a great place to see other women breastfeeding, hearing their questions, and getting advice. And they're free!

You might also think about taking a breastfeeding class. Oftentimes local maternity stores, hospitals, private lactation consultants, etc. will offer them. I currently teach one at a local yoga/wellness studio. No matter who teaches it, you can almost always look forward to practicing latch and position with baby dolls!

Rixa at Stand and Deliver has some excellent suggestions on A Proactive Approach to Breastfeeding.

You'll see a note from me in the comments encouraging confidence. Many of my friends ask me tentatively "How often do women have problems nursing?" or "What percentage of women can't make enough milk?" These are normal concerns coming from a culture where so many women seem to struggle with latch and supply. These are real issues, many stemming from institutional and systemic factors like birthing practices and hospital policies (see more at Rixa's post). But the biggest predictor of breastfeeding success is confidence, and the perseverance to overcome whatever challenges arise.

(And again, if we know each other you know you can call me any time about any breastfeeding question! Seriously. Any time. I have a bizarre sleep schedule anyway.)


Phew! That's all I have for now. Readers, what would you add to this list? What are your first recommendations for a newly pregnant mom?