Breastfeeding and Feminism, Day 2 (...2 weeks later)

My Lent resolution has apparently not yet translated into more posting! A few factors have contributed to that, among them my new full-time job(!) I have gone from per diem at the hospital working 24ish hours a week, to full-time working 36 hours a week (three 12-hour night shifts). Going from working 8-hour shifts to 12-hour shifts is a surprisingly big adjustment (although fortunately not as big an adjustment as beginning to work nights was.) There are drawbacks to my new schedule (less flexibility, losing several evenings, etc.) but the benefits are, well, the benefits! Apart from my grad school assistantships, I haven't had a job with health insurance since I was in AmeriCorps. I am looking forward to having good health insurance, along with retirement benefits. One of my goals in going to grad school was to finally get a "real" job with salary + benefits, and while it didn't happen in exactly the field I expected it to, I couldn't be more pleased (except for the part where I work nights. Hopefully someday I'll work days again!)

Now that I've made my excuses, long-delayed highlights from the second day of the Breastfeeding & Feminism conference:

* Possibly my favorite presentation of the day was Robbie Davis-Floyd's report on the International MotherBaby Childbirth Initiative. Based on the Baby-Friendly initiative, the IMBCI has outlined 10 Steps to optimal motherbaby maternity services, developed with the input of organizations around the world. Steps include treating every woman with respect and dignity, offering continuous labor support, providing evidence-based practices, and providing access to emergency OB care. Three sites have applied and been accepted to become demonstration sites, one each in Austria, Brazil, and Quebec, Canada. You can read more about the (very diverse!) demonstration sites here. She discussed more about the sites and more details of their applications. She also talked about sites that will be added soon, in South Africa, Mozambique, India, and - amazingly - the largest maternity hospital in the Philippines, which does 22,000 births a year (I cannot even imagine). It's inspirational to see institutions from countries with different levels of development and each with their own unique strengths and challenges, working on the aim of improving maternity care. I am so excited to see ow the demonstration projects go.

* Michelle Lauria, an OB-GYN from Dartmouth, gave a great talk on reducing late preterm birth, a project of the Northern New England Perinatal Quality Improvement Network. She also talked about eliminating elective inductions before 39 weeks, and in mothers who do not have a high enough Bishop's score. She said the key is to put power in the hands of the nursing staff with the hospital authorities backing them up; the doctors know if they send someone in for an induction who does not meet the guidelines, the charge nurse will send them right back home. She talked about the next step being setting stricter guidelines on ways that some doctors use to get around the restrictions; she gave the example of mildly elevated blood pressures without proteinuria being called pre-eclampsia and used as a reason to induce early.

She also discussed VBAC at some length. Her take on it was, in her region, it's all about the money - as in, medical malpractice insurance costs. In northern New England, which has a lot of isolated rural communities, she gave an example of a small regional hospital that wants to offer VBACs but would have to pay $120,000 more in malpractice insurance to do so. Given that they anticipate 2 VBACs a year, they would end up paying an extra $60,000 per VBAC. Her proposed solutions are both governmental: either medical malpractice reform of some kind, or for the government to coordinate regional VBAC centers. There would be one hospital in each region designated as the VBAC center, and all the other maternity hospitals would contribute towards the VBAC center's additional malpractice insurance. She considers this unrealistic without government intervention because of the nature of competition between hospitals.

* Beverly Rossman from Rush in Chicago did a very inspiring presentation on breastfeeding peer counselors in the NICU. The NICU breastfeeding peer counselors are truly peers - they are women who have personal breastfeeding experience with very low birthweight (VLBW) babies. She summarized some themes from qualitative interviews from mothers who worked with the peer counselors: instrumental support, emotional support, finding hope, empowerment, community, and emulation. Over and over again the interviewees talked about how much they identified with the peer counselors, how much hope they drew from seeing mothers who had been in their situation, and how important the emotional support was. It left me wanting a breastfeeding peer counselor program in our NICU so badly! (If you'd like to learn more and you have access to the Journal of Human Lactation, you can check out their journal article. Citation: Rossman, Meier, Engstrom, Verheed, Norr & Hill. "They've Walked in My Shoes": Mothers of Very Low Birth Weight Infants and Their Experiences with Breastfeeding Peer Counselors in the Neonatal Intensive Care Unit. JHL. 2011. 27(1):14-24.)


It was a great conferences with some great conversation! It was hard to choose between the CIMS and the BF & Feminism tracks sometimes because there was so much interesting stuff going on, but I'm glad they combined the conferences for the opportunity to pick and choose from both programs.

Sadly, I won't be able to go to the CLPP Reproductive Justice conference this year. Please, everyone who's going tell me all about it! I am determined to go next year.

Breastfeeding & Feminism: Day 1

I really need to take more notes at these things! So here are a few notes pulled out of my very scattered information overloaded brain:

- Eugene Declercq gave a great keynote on statistical trends in C-sections, VBAC, and other birth-related stuff. One of the most interesting sections was on homebirth. Still very tiny numbers, so hard to identify a definite overall upward trend, but it seems to be on the rise. He then broke the trends out by race, and that was fascinating: homebirth rates were the same or dropping for all races except for white women, who are clearly seeing an uptick. He reports that in the latest stats, 1% of all births to white women happened at home. That seemed high to me, but apparently that's what the statistics are telling us. I am not at all surprised, however, by the disparity.

- Bettina Lauf Forbes and Danielle Rigg of Best for Babes spoke about reframing breastfeeding, including how much they dislike the phrase "protect, promote, and support breastfeeding" - they want to replace it with "inspire, prepare, and empower moms". They really have a marketing mindset of helping introduce moms to breastfeeding via common consumer culture avenues like celebrity profiles, then help educate them on avoiding the "booby traps". As they pointed out, we have very high BF intention rates - we need to help moms achieve their personal goals!

- Keren Epstein-Gilboa, who came all the way from Canada, gave a really dynamic talk on breastfeeding and envy. She first had us imagine something that we really, really wanted - a job, a person, a house, whatever - and say how it made us felt. (Great!) Then we had to think about how we couldn't have it - and how that made us feel. (Well, pretty crappy.) Now how did we feel about that thing, and the person who had that thing instead of us? We often tell ourselves we didn't want it anyway, or that it really isn't that great, or we try to break it into parts. She used that introduction to discuss her research on the relationship of fathers to breastfeeding, and how different societies treat mothers and by extension how they treat breastfeeding, and also what it means for women who try to breastfeeding and aren't able to. I only wish she'd had more than 15 minutes!

That's all for now - I've got to start recharging my brain for tomorrow...

Linky goodness: to VBAC or not to VBAC, birth videos, and more!

Time to clear out the starred posts in my blog reader! Sorry, some of them are a few weeks old but of course, still great:

Robin Marty of RH Reality Check on the many reasons she's choosing an elective repeat c-section over a VBAC attempt.

Birth Sense introduces you to the handsome, charming Dr. Justin Case.

Video of baby born in the caul, via Homebirth: A Midwife Mutiny.

Video of frank breech home birth via Gloria Lemay.

Dou-la-la channels Don Draper in explaining why those nice formula companies are so darned excited about breastfeeding.

Why African Babies Don't Cry, via Blacktating.

Mom's Tinfoil Hat linked to a post on abortion and parental notification laws that, very sadly, is no longer up (the author decided to make posts about her work private - I struggle with walking the same line, and totally understand). However, you can still read an excerpt and a long comment from the author in MomTFH's post.

Not birth-related, but something that really touched me to see today: Dan Savage's It Gets Better Project: a collection of videos of adults telling gay teenagers that high school ends and their lives will improve. Read an interview with Dan Savage here, including the reason he decided to start this project.

I'm on a (posting) roll! Midwives posting their stats for the world to see

Apparently I'm on a posting roll tonight...

Did you know that CBS Midwifery in Manhattan posts all their stats for the previous year? An excerpt from 2009's:

Vaginal deliveries 80 = 88%

Normal spontaneous vaginal 76= 95%

Vacuum extraction 4 = 5%

Vaginal births after previous C/S 8 successful out of 9 attempts = 88%

Furthermore, they deliver babies at the in-hospital birth center at St. Luke's Roosevelt. A common complaint I have heard from doulas is that their clients expect to use the birth center, and are either risked out before labor ever begins, and sometimes during labor and then they are sent to L&D. Or they get there and are told the birth center is full. So I liked even more that the midwives make that piece transparent too:

Women who wanted Birth Center and were eligible at term = 68

43 - delivered Birth Center = 63%

24 - Transferred to Labor & Delivery in labor = 35%

1- Birth Center full- had to deliver on L&D = 2%


They also provide stats on degrees of perineal trauma, meds, reasons for c-sections...
Imagine if every practice did this! How amazing would it be to be able to compare this information when looking for a care provider?

What are practices out there that you know of that make some or most of their stats available to consumers?

LC Exam minus 3

ACOG lessens (kinda) restrictions on VBACS, stories are written on shackling during labor, and posts are written on the delicate balance to strike when calling out misinformation in "failed" lactation stores, and I don't have time to write about any of it because am studying for the IBCLC exam which is happening! on! Monday!

I am anxious. I am taking practice tests and reviewing flashcards. I am reviewing chapters on immunology and jaundice and developmental milestones. I am arguing with the answers on the practice tests. I am carpooling to the exam with some other test-takers and we have already plotted out our route to avoid the main highway because what if a tractor-trailer jackknifes and we are stuck in traffic and OMFG WE MISS THE TEST. As you can see, I am ready for this to be done!

So if you see me posting on this blog or anyone else's in the next few days, tell me to go back to studying! And in the meantime click the links above for some awesomeness...

Proud of my doula client

Switching care providers twice to find someone who would support a trial of labor for VBAC.

12 hours of labor at home.

24 hours of labor at the hospital.

Slowly, slowly progressing - beating nearly every deadline set, just in the nick of time.

Unbelievable strength, patience, and dedication.

Trying every position, waiting as long as possible for any pain medication, even with transition contractions and no progress.

Putting up with some not-so-nice, not-so-encouraging care providers.

Getting so, so, so close - and then looking at the situation and agreeing that a repeat cesarean section was the best choice at the time.

In the midst of exhaustion and discouragement, still negotiating what was most important to happen at the surgery - like getting to touch and stay with baby, and breastfeed as soon as possible.

As a wise midwife once said and a doula friend reminded me, labor is about the journey, not just the destination.

And I know who I'm passing my medal along to.

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!

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.

Kanye + VBACs

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

Cesarean vs. VBAC

Via The Unnecesarean, who says "Alexandra Orchard is my personal hero":

Cesarean vs. VBAC: A Dramatic Difference from Alexandra Orchard on Vimeo.

While there are a lot of things I loved about this video (the honest portrayal of cesarean surgery, for one), the letter is what really blows me away. I would love it if more women who are disappointed with their care providers and hospitals openly expressed that disappointment. Nothing is going to change without better communication and who better to speak than someone speaking from immediate personal experience? It's hard for doulas to push that too much with individual clients, but it is inspiring when women and their families take the lead.

You can VBAC in a car, you can VBAC near or far

OK, sorry about the title. But anyway: Mother VBACs in speeding car.

Not just any VBAC - a VBAC after 3 c-sections (I'm assuming - they say their older three daughters were also born via c-section, although if some - or even all - were multiples that would reduce the total number).

After the "breech baby born in speeding ambulance" this story is suggesting to me if you want a vaginal birth, the best place to get it might be in a speeding vehicle?

Traveling times

I've been packing, moving, and traveling for the past week and will be packing, moving, and traveling for the next two weeks! So little (if any) posting, and little (if any) comment moderation (so comments may take a while to show).

Once I'm settled in my summer digs, I will hopefully be posting again. In the meantime, I leave you with some of the links that have been piling up in my Google Reader "starred" section:

The Hazards of Feeding While Mothering - this is just right.

Is health an additive or multiplicative process? Could we think of birth this way too?

Initiation of breastfeeding by breast crawl - these videos are always so neat to watch!

What it takes to VBAC in Rural County, from the great Rural Doctor blog.

You know all those birth stories I link to? This one is a comic!

A short history of the cesarean rate

Why did c-section incidence - fewer than 10% of births in the 1970s - rise in the 80s, fall in the 90s, and then rise again to where 1 out of 3 women give birth by cesarean today? The more I learn about it, the more I realize it's a pretty interesting story that says a lot about what shapes maternity care (hint: it's not always the evidence). The Well-Rounded Mama has a great post about the recent history of c-sections in the U.S.. It's completely worth reading, especially if you've been reading my posts and wondering "What's the deal with VBAC?"

Happy birth story

A while back my friend e-mailed me to thank me for posting a link to a story about a pelvis that seemed too small - and wasn't.. She said, "It's nice to see that sometimes things go well!" Ever since then I've been conscious of wanting to balance the negative with the positive. It's easy to go negative - it's easy to see all the things wrong in the world and want to point them out so someone can fix them. I think I also have a feeling of wanting to warn people - "Watch out, this could happen! Or this! Or this!"

But of course I also want to inspire people with what can go right! So when I ran across this very happy (VBAC!) birth story, I thought it would be nice to share.

Questioning the elective c-section

I have a few concerns about what's presented as fact by a mother interviewed about her elective cesarean delivery. Chief among them is that she asserts that because her baby was breech she would have "ended up with an emergency C-section and that's the thing you want to avoid".

That's just not true. Leaving aside the option of vaginal breech birth (difficult to arrange in terms of finding a provider, but not some kind of anatomical impossibility and very common elsewhere in the world) a known breech is not going to end in an emergency c-section. One of two things will happen: 1) the mother has a scheduled c-section before going into labor or 2) the mother goes into labor before her scheduled surgery, goes to the hospital, and has a c-section. Neither of these scenarios involve an "emergency" c-section. (I was also puzzled by her reference to a doctor in an emergency c-section not always being able to do a low transverse ("bikini line") incision. Does anyone know about this? I've heard of doctors cutting a classical incision for other reasons, but not emergency-related.)

The reference to differentiating between risk in planned and emergency c-sections is also not really accurate. Even studies that control for whether or not the cesarean was indicated based on risk have found a difference between cesarean and vaginal births.

Finally, I was struck by comments like "You don't have these awful stitches 'down there'" (I guess "inside and outside your abdomen" is better?) as if women are guaranteed tearing and/or an episiotomy at a vaginal birth.

I'm happy that this woman had a positive outcome from her elective cesarean section, but that doesn't change that cesarean section is riskier than vaginal birth. At the end they ask if she would have another elective c-section for future children, and she says "Absolutely!" While you could argue that the absolute difference in risk between c-section and vaginal delivery at the first birth is small, it is undeniably true that the gap grows with every subsequent c-section. Women planning to have multiple children should in particular think hard about choosing a cesarean.

Time Magazine covers VBAC

Via The Unnecessarean, Time Magazine covers the disappearing VBAC. Even more amazingly, they do a pretty good job of it! My favorite quote is this: "How can a hospital say it can handle an emergency C-section due to fetal distress yet not be able to do a VBAC?"

Yeah, how can they? "It's so much safer to be in a hospital where they can do a crash c-section!" So why do hundreds and hundreds of hospitals deny women VBACs on the grounds that they couldn't do a c-section quickly enough in an emergency?

I do wish the article had discussed how avoiding common interventions like pitocin can decrease the (tiny) risk for uterine rupture even more.

When is something not elective? When you don't choose it

Jennifer Block (author of "Pushed") has a great piece over on RHRealityCheck called "Can We Please Stop Blaming Women for C-Sections?". Amen.

I know someone who had a c-section for transverse lie, scheduled well before her due date; her baby was less than six pounds. She actually had to resist pressure to take the baby earlier. Was that elective? Let's point the fingers at the right people.