One more note

Here is a link to the original complaint filed by the plaintiff in the abusive OB case.

When doctors take it out on patients

Via Feministing comes the story of a woman who is suing the OB who cared for her in labor over abusing her verbally and refusing pain medication, saying "Pain is the best teacher". I believe that when he saw her, he could have legitimately considered her too far progressed for any pain meds (every doctor seems to have a very different rule of thumb about how late is too late), but you don't have to be a jerk about it. More troubling is the allegations that he deliberately gave her a vaginal exam in the middle of a contraction (already painful and during a contraction even more so), stitched her up with a too-large needle, and had her start pushing when she was not fully dilated, telling her to "Shut up and push". And of course there's the "you'll hemorrhage and die" card.

These incidents are not as rare as we would like to think. I've seen very disrespectful treatment myself and heard far, far worse stories from other doulas. There are doulas who refuse to practice in hospitals anymore because they can't stand to see treatment like this. In the doula listserve I'm on, doulas often write in with these stories asking for advice - what can we do to change this treatment? How can we encourage patients to complain, without having them dwell on the negative aspects of their birth experience? It's the rare family who will actually bring suit.

My own personal and unscientifically formed perspective is that this treatment seems to be more common when it's not the patient's regular care provider (in the suit above, her OB was out of town) or is someone in the practice the patient hasn't seen very often. I wonder what all the reasons are that this could be...

Home On the Breast (a breastfeeding song)

At a singalong, my mother ran into a guy who had written a breastfeeding song. Given my interest, she asked him to send along the lyrics. I enjoyed it - I especially love the chorus - so here it is:

Home On The Breast (sung to the tune of Home On The Range)
written by Steve Baggish as "channelled" by 8 month old son, Eli

Oh give me some food,
I don't mean to sound rude,
But I'm hungry and cranky and tired.
You've got what I want,
You're a fine restaurant,
And there's no reservations required!

CHORUS:
Home, home on the breast,
Where the love and the milk are expressed,
On the left or the right,
In the day or the night,
That's the place I like hanging out best.

I must think somehow
You're a magical cow,
You've been there since the time of my birth.
So give me one sip,
Or just one little nip,
And I'll milk you for all that you're worth! (CHORUS)

Someday I'll grow up,
And I'll drink with a cup,
And I'll eat with a fork and a knife.
But please don't be sad,
I'll be just like my dad,
And love breasts for the rest of my life! (CHORUS)

Why don't women trust hospitals?

Gloria Lemay writes a response to a Canadian obstetrician who asks "When did we become the enemy?" I took an Advanced Doula training course online with Gloria and think she has some valuable perspectives to share. I like that she calls out the attitudes he demonstrates in his own op-ed to show the reasons that women who want normal birth do not trust the hospital. I particularly noticed his statement, "I have attended about 7,000 pregnant women and have a good idea how the complicated collection of things that must come together in just the right way for there to be a good outcome actually come together." This is how so much of the generic hospital attitude is towards birth: everything has to be just right - just perfect - for you to have a baby normally. You must have just the right strength of contractions, just the right amount apart, or you'll get Pitocin to make them right. You must have just the right amount of progress - not too slow, now! - to avoid Pitocin or artificial membrane rupture. Prolonged pushing? A little concern about the heart rate? Oxygen monitor, oxygen, fetal scalp electrode, vacuum extraction, etcetera. Ask a doctor whether you can avoid interventions - IV, continuous monitoring, and so forth - and he or she will often say, "As long as everything is proceeding normally." But normal is defined so narrowly that almost no one gets to fall in this range. (And then women who get these interventions say, "My birth wasn't normal - something was wrong with the heart rate - I had to get oxygen - birth is so dangerous.") This isn't to say I don't think nothing can go wrong at birth or that interventions are never necessary, but an OB who already thinks that birth is so complicated and will need lots of management to come together "right" is not one I'd pick.

The evidence base against induction

Why do I discourage women I talk to from being induced?

Many reasons. But most importantly:

Induction greatly increases your risk for a cesarean.

"Elective induction of labor is associated with a significantly increased risk of cesarean delivery in nulliparous women. Avoiding labor induction in settings of unproved benefit may aid efforts to reduce the primary cesarean delivery rate." Abstract here.


Induction greatly increases your risk for a cesarean.

"Elective induction significantly increased the risk of cesarean delivery for nulliparas, and increased inhospital predelivery time and costs."
Abstract here.


If you body is not ready to give birth, induction greatly increases your risk for a cesarean.

"Compared with spontaneous onset of labor, medical and elective induction of labor in nulliparous women at term with a single fetus in cephalic presentation is associated with an increased risk of cesarean delivery, predominantly related to an unfavorable Bishop score at admission."
Abstract here.


Unless you have a very pressing medical indication, induction is not indicated, because induction greatly increases your risk for a cesarean.

"While these interventions often are medically indicated for the well-being of mothers and infants, the evidence supporting their benefits when used electively is controversial."
Abstract here.


There is no benefit to induction because "the baby looks big". Be skeptical of offers to induce because "the amniotic fluid looks a little low".

If a doctor says that there is no difference in risk between an induction and a naturally occurring labor, that person has not read their own professional literature, or is lying.

Because induction greatly increases your risk for a cesarean.

And the answer is...

D! Maybe I made it too obvious, although people have asked me about tattoos and breastfeeding in the past. I guess I have smart readers! Just to note: it is perfectly safe, and I've seen heavily tattooed women happily breastfeeding with no change in milk color. I did win the prize for best fun fact with the fact that "Wet nurses in medieval France were allowed to nurse up to four babies at a time". Other great fun facts were that a nursing woman produces up to a gallon of milk a day, and women begin producing milk up to four months before birth. I like to go with the historical trivia because I think often we don't appreciate how very flexible and varied breastfeeding has been historically. The lines we've drawn in our culture around what breastfeeding outline only a very small part of what it can be (thus the shock over women nursing four year olds, when in fact we've just made up the rule that children should stop nursing in toddlerhood.*) My prize was - of course - a calendar of babies dressed up as different animals. I told my classmates I'd hang it up in our department's computer lab so we can all enjoy it.

Speaking of breastfeeding multiple babies, this is a great story that made the rounds after the earthquake in China about a Chinese policewoman who was nursing EIGHT babies who had been orphaned or for some other reason did not have access to milk.

*This is not to say that only our culture makes rules around breastfeeding, or that only Western cultures do so. I would say that probably almost every culture has some rules about breastfeeding; my point is that what can be normally and harmlessly practiced in one culture is sometimes forbidden in another.

Breastfeeding Today

Thanksgiving was wonderful but very busy - not much time for posting, although I have several new posts to get up soon including some thoughts about being a public health doula (vs. any other kind).

Right now I'm busy writing a paper due on Friday; we're allowed to pick our on topics, and I cycled through a bunch. I settled on one finally by picking a topic that's very current on campus right now. A rep from a student group got up in front of our Biostatistics class the other day and announced that they were raising money to provide formula (and a pot for sterilizing water to prepare it) to HIV-infected mothers in Uganda. Of course, the heads of every maternal child health student in the auditorium popped right up, and while that wasn't the moment for confrontation, someone from our department is trying to get a meeting with them to find out more about the organization they're fundraising for. While avoidance of breastfeeding does prevent some mother-to-child transmission of HIV, done in resource-poor settings it can pose a greater risk to children than HIV infection (because it increases the risk of other diseases). I decided to write my paper on the most recent research and recommendations around HIV and breastfeeding, and discuss how organizations can determine whether or not they should support formula provision in a particular setting. It's really interesting! I'll post a summary when I'm done.

After our papers are turned in on Friday, my class is having a celebration in the form of an evening cocktail party. The hostess has decided to offer door prizes for several categories, including "Best Dressed" and "Best Fun Lactation Fact". I'm hoping to win both, of course - I may have the best shot at the latter. While trying to decide which lactation fact is the most fun, I thought I'd try to spark some comments on this blog, by using my ideas to make a little quiz:

Which fun fact about lactation is NOT true (documented):

A. A woman can breastfeed up to four babies exclusively at one time.

B. Women in some cultures nurse piglets, puppies, and other domestic animals.

C. Newborn babies placed on their mothers' stomachs need no assistance in crawling to, locating, and latching onto the nipple

D. Ink from tattoos on a nursing mother's breasts can change the color of her milk.

E. Milk made by mothers whose infants were born early is different from that made by mothers of infants born at term.

I'll post the answer in a few days...