When you're a woman in your twenties, you and/or your friends are likely to be hard up for money at some point. For young women, egg donation can seem attractive. It's a lot of money for a completed cycle (the ads I've seen offered from $2500 up to $10,000) and doesn't seem like that big a deal - after all, to donate their sperm all guys have to do is a little business into a cup!
Not that the money wasn't tempting, but after reading about what it entails, I tried to sound a note of caution with my friends who were thinking about it. We already know that there are potential cancer risks linked to estrogen and phytoestrogen exposure, and egg donation requires big doses of hormones to stimulate the ovaries. I think it's one thing to undergo it if you're doing it to conceive your own children, but it's another to take on those risks for cash, without knowing for sure what your future holds in terms of future reproductive life plans. Now, learning more about the growing concern of egg donation risks, I'm wondering how we can really educate young women about what being an egg donor might entail, and how we can push research that explores what kind of risks women are exposing themselves to by donating eggs.
Do you have personal (or friends') experiences with egg donation? What do you think?
Monday, April 6, 2009
Sunday, April 5, 2009
Two great lectures! Lecture 1: OB care in the UK
Sometimes being a student is a drag. Like today - it's a beautiful day, the birds are chirping, the sun is shining, and all I should be doing is writing papers and working on group projects (well, with a little break to write a blog post). But sometimes I'm so grateful for the chance to be exposed to, and connect with, people doing amazing work in maternal and child health.
I went to two great lectures recently (I'll cover the second one in the next post). The first was by Holly Powell Kennedy, incoming president of the American College of Nurse Midwives, presenting on her recent research as a Fulbright Distinguished Scholar in the UK. Her research was an ethnographic study that included interviews and participant observation in a hospital birth center. She was interested in both how the health care practitioners defined "normal birth" and "optimal birth", as well as what the system of care looked like.
She did her research at a hospital in London considered "the best of the best" of the UK maternity care system, and I will say - it sounded incredible. Here are the things I was most impressed by:
One-to-one care: In this birth center, they used a combination of midwifery care (over 50% of births), doctors in training, and obstetricians. With the midwifery care at least, it is all one-on-one. There are no obstetric nurses - the midwife does all the nursing and midwifery care and is with the patient more or less continuously. Powell Kennedy pointed out in her pictures how empty the corridors were - because everyone's in the rooms with the patients! The two reasons she gave for this are the one-on-one care, and also...
No central monitoring, and no routine continuous monitoring: Go into a hospital and you get very familiar with the nurses' station full of people keeping their eye on 2-3 patients via computer screen. In this hospital there is no electronic fetal monitoring unless there is a clinical indication - it's intermittent auscultation using a doppler or even a fetoscope/pinard horn - and no way to watch even the continuous monitoring if you're out of the room. (There's also no strip on admission!) When it's time for the birth, the midwife only pages for help if she (or he) needs it - there's no flood of 2-5 people suddenly in the room staring at your crotch!
Hands-on, and hands-off skills: She never saw midwives or OBs doing ultrasound for position - they were confident in their skills to tell by feel, and she never saw any misses. They also had a strong belief and skills in observing external signs of labor, and did few vaginal checks.
Does any of this sound like homebirth midwives you know? It's so similar to that ideal midwifery model of care! But what struck me most was how in this hospital system, when they embraced homebirth, they were able to have such seamless and better care. Powell Kennedy highlighted one midwifery practice that cares for a very poor population but that has excellent outcomes. One of their standards is to have the 36-week visit at home, with the mom and her planned support people. They give her a home birth kit and say "Don't decide now where you want to give birth. When it's time, we'll come here and labor with you as long as you want to stay home. If you want to go to the hospital (or need to), we'll go. If you want to stay here, we'll stay." Imagine!
Powell Kennedy really remarked on some fundamental differences in belief in this sytem: they trust in women and give women the authority. Women carry their own records - bringing them to their appointments, bringing them to the hospital at birth. Let me make that clear: the office keeps no records on them. They carry their own records, lab tests, the whole thing. There's also a strong focus on spontaneous labor and birth, as a normal physiologic event, and the idea that health care providers should master the art of doing "nothing" well.
I was sitting one row in front of the midwives from the hospital practice where I've volunteered as a doula. You should have heard them whispering to each other and sighing with delight during this whole presentation! But Powell Kennedy really emphasized that this hospital was not necessarily typical of the UK system - only, it seems, what is possible within that system (and so far impossible in ours, with rare exceptions). Even within this hospital, things aren't perfect - there isn't necessarily continuity even across midwifery teams in all these practices. Still, it was so impressive - more or less like a vision of heaven! I was pleased that it was part of grand rounds for the hospital, so there were some OBs/residents/med students there able to hear that this isn't just hippie crazytalk - other health systems actually use these standards of care.
Two final notes that I don't know much about but would like to learn more: Powell Kennedy commented on the use of nitrous oxide as a pain reliever during birth. She said it was as ubiquitous as oxygen - available at the bedside, at home births, even in the labor room bathrooms! They had a very low epidural rate (10%) but almost 50% of the births she observed, the moms used nitrous oxide. I know almost nothing about it and its use for pain relief, but now I'm curious.
She also referred us to this website, Birth Choice UK, which is supposed to have statistics for every maternity care practice in the country! Not all the statistics are complete, and I haven't had much chance to investigate it, but imagine if we had that here?
I went to two great lectures recently (I'll cover the second one in the next post). The first was by Holly Powell Kennedy, incoming president of the American College of Nurse Midwives, presenting on her recent research as a Fulbright Distinguished Scholar in the UK. Her research was an ethnographic study that included interviews and participant observation in a hospital birth center. She was interested in both how the health care practitioners defined "normal birth" and "optimal birth", as well as what the system of care looked like.
She did her research at a hospital in London considered "the best of the best" of the UK maternity care system, and I will say - it sounded incredible. Here are the things I was most impressed by:
One-to-one care: In this birth center, they used a combination of midwifery care (over 50% of births), doctors in training, and obstetricians. With the midwifery care at least, it is all one-on-one. There are no obstetric nurses - the midwife does all the nursing and midwifery care and is with the patient more or less continuously. Powell Kennedy pointed out in her pictures how empty the corridors were - because everyone's in the rooms with the patients! The two reasons she gave for this are the one-on-one care, and also...
No central monitoring, and no routine continuous monitoring: Go into a hospital and you get very familiar with the nurses' station full of people keeping their eye on 2-3 patients via computer screen. In this hospital there is no electronic fetal monitoring unless there is a clinical indication - it's intermittent auscultation using a doppler or even a fetoscope/pinard horn - and no way to watch even the continuous monitoring if you're out of the room. (There's also no strip on admission!) When it's time for the birth, the midwife only pages for help if she (or he) needs it - there's no flood of 2-5 people suddenly in the room staring at your crotch!
Hands-on, and hands-off skills: She never saw midwives or OBs doing ultrasound for position - they were confident in their skills to tell by feel, and she never saw any misses. They also had a strong belief and skills in observing external signs of labor, and did few vaginal checks.
Does any of this sound like homebirth midwives you know? It's so similar to that ideal midwifery model of care! But what struck me most was how in this hospital system, when they embraced homebirth, they were able to have such seamless and better care. Powell Kennedy highlighted one midwifery practice that cares for a very poor population but that has excellent outcomes. One of their standards is to have the 36-week visit at home, with the mom and her planned support people. They give her a home birth kit and say "Don't decide now where you want to give birth. When it's time, we'll come here and labor with you as long as you want to stay home. If you want to go to the hospital (or need to), we'll go. If you want to stay here, we'll stay." Imagine!
Powell Kennedy really remarked on some fundamental differences in belief in this sytem: they trust in women and give women the authority. Women carry their own records - bringing them to their appointments, bringing them to the hospital at birth. Let me make that clear: the office keeps no records on them. They carry their own records, lab tests, the whole thing. There's also a strong focus on spontaneous labor and birth, as a normal physiologic event, and the idea that health care providers should master the art of doing "nothing" well.
I was sitting one row in front of the midwives from the hospital practice where I've volunteered as a doula. You should have heard them whispering to each other and sighing with delight during this whole presentation! But Powell Kennedy really emphasized that this hospital was not necessarily typical of the UK system - only, it seems, what is possible within that system (and so far impossible in ours, with rare exceptions). Even within this hospital, things aren't perfect - there isn't necessarily continuity even across midwifery teams in all these practices. Still, it was so impressive - more or less like a vision of heaven! I was pleased that it was part of grand rounds for the hospital, so there were some OBs/residents/med students there able to hear that this isn't just hippie crazytalk - other health systems actually use these standards of care.
Two final notes that I don't know much about but would like to learn more: Powell Kennedy commented on the use of nitrous oxide as a pain reliever during birth. She said it was as ubiquitous as oxygen - available at the bedside, at home births, even in the labor room bathrooms! They had a very low epidural rate (10%) but almost 50% of the births she observed, the moms used nitrous oxide. I know almost nothing about it and its use for pain relief, but now I'm curious.
She also referred us to this website, Birth Choice UK, which is supposed to have statistics for every maternity care practice in the country! Not all the statistics are complete, and I haven't had much chance to investigate it, but imagine if we had that here?
Wednesday, April 1, 2009
Reply turned post, on how to promote breastfeeding without coming on too strong
Over at Mom's Tinfoil Hat, she's writing about stories of "breastfeeding bullies" and wondering where those stories come from. She sees far more women being disrespected and the targets of pushy behavior from formula-advocated nurses and doctors than she sees nagging, pushy lactation consultants. This was my reply (now slightly edited and expanded):
I agree that I have never seen LCs actually do this - just heard stories from moms without getting to see/hear the other side of the story. I don’t disbelieve that there are a few bad applies out there, but I agree with Labor Nurse that some stories might come from a mother’s reluctance to say out loud “I want to quit” and the LC not picking up on whatever signals the mother thinks she is giving. Hands-on postpartum, I have seen nothing but positive support, patience and working toward’s a woman’s breastfeeding goals, whatever they are.
I will say that prenatally I could see more of a challenge, because that’s I think when people feel comfortable being a little more hardline, and it is hard to advocate breastfeeding without stepping into a minefield. Just a few weeks ago I was at a birth where the mom told me that at the last minute, she had made up her mind to formula feed. I asked her why, then let it go for a while.
But it was a long birth, and I kept sitting there and thinking, Was I letting this go too easy? Maybe she just needed someone to nudge her back in the other direction, since she had been equivocating so recently. I didn’t think her concerns (returning to work, getting baby used to the bottle) were such big barriers as she saw them. But maybe they were proxy reasons for some deeper issues. Would I be a good doula by giving her more facts? Would I be a bad doula by not supporting her decision? Might she think a year later “That dumb doula at my birth who nagged me to breastfeed” or might she think “I’m glad she sat down and talked to me, because that helped me decide to give it a try and now I enjoy it”? I think sometimes my drive, or an LC’s, to give all the facts could be seen as nagging even when we are doing our best to be nonjudgmental and supportive.
I confess I had a few other things on my mind. I realize that I softpedal my behavior when I'm talking to someone who in my mind is unlikely to breastfeed. If a fifteen-year-old says she's going to formula feed and her mother is sitting right there nodding, is there any point in me saying anything? They've made their decision. She has more on her plate to deal with at the age of fifteen than I have in my entire life. Why should I start nattering on about fewer ear infections?
What about African-American women? As a white woman, it is so easy for me to feel awkward about promoting something that far more white women do, and have the privilege of being able to do, than black women. I have only begun to understand the complex cultural dynamics behind those differences. Should that awkwardness get in the way of the discussion?
What about single mothers, poor women who have to return to work right away, women whose whole families have formula fed, women who have formula fed their other children? Am I doing them a favor or disservice by keeping my mouth shut?
You could say I'm doing them a favor by respecting their decisions. But is that what every other person they interact with in the health system thinks too? Are they going to be frustrated someday realizing that because of their race, class, culture, or other stereotypes about them, they were not given the same information as other women? For all I know as a doula, maybe that's exactly what has happened and I am the last person available to say, "Just so you have this to think about..."
So while I don’t see LCs haranguing new moms “Don’t give up! Or you’ll kill your baby!” I understand where the nagging label might come from. Because eventually I pulled up a chair next to the mom's bed (she had a very effective epidural at that point, so I wasn't trying to harass her during contractions!) and I told her I thought she might want to give it a shot, and I gave her some reasons. She said "OK, I'll think about that." I think she was just being polite. I wasn't able to stay after the birth as long as I usually do, so I wasn't there for any first feeds. When I came to do my postpartum visit, I didn't ask, much less nag or yell, about how she was feeding the baby. But I still don't know how she would label my talk to her before birth. So maybe there are some LCs out there who are doing something we could call nagging prenatally. I just hope most moms understand that it's not done in that spirit.
I agree that I have never seen LCs actually do this - just heard stories from moms without getting to see/hear the other side of the story. I don’t disbelieve that there are a few bad applies out there, but I agree with Labor Nurse that some stories might come from a mother’s reluctance to say out loud “I want to quit” and the LC not picking up on whatever signals the mother thinks she is giving. Hands-on postpartum, I have seen nothing but positive support, patience and working toward’s a woman’s breastfeeding goals, whatever they are.
I will say that prenatally I could see more of a challenge, because that’s I think when people feel comfortable being a little more hardline, and it is hard to advocate breastfeeding without stepping into a minefield. Just a few weeks ago I was at a birth where the mom told me that at the last minute, she had made up her mind to formula feed. I asked her why, then let it go for a while.
But it was a long birth, and I kept sitting there and thinking, Was I letting this go too easy? Maybe she just needed someone to nudge her back in the other direction, since she had been equivocating so recently. I didn’t think her concerns (returning to work, getting baby used to the bottle) were such big barriers as she saw them. But maybe they were proxy reasons for some deeper issues. Would I be a good doula by giving her more facts? Would I be a bad doula by not supporting her decision? Might she think a year later “That dumb doula at my birth who nagged me to breastfeed” or might she think “I’m glad she sat down and talked to me, because that helped me decide to give it a try and now I enjoy it”? I think sometimes my drive, or an LC’s, to give all the facts could be seen as nagging even when we are doing our best to be nonjudgmental and supportive.
I confess I had a few other things on my mind. I realize that I softpedal my behavior when I'm talking to someone who in my mind is unlikely to breastfeed. If a fifteen-year-old says she's going to formula feed and her mother is sitting right there nodding, is there any point in me saying anything? They've made their decision. She has more on her plate to deal with at the age of fifteen than I have in my entire life. Why should I start nattering on about fewer ear infections?
What about African-American women? As a white woman, it is so easy for me to feel awkward about promoting something that far more white women do, and have the privilege of being able to do, than black women. I have only begun to understand the complex cultural dynamics behind those differences. Should that awkwardness get in the way of the discussion?
What about single mothers, poor women who have to return to work right away, women whose whole families have formula fed, women who have formula fed their other children? Am I doing them a favor or disservice by keeping my mouth shut?
You could say I'm doing them a favor by respecting their decisions. But is that what every other person they interact with in the health system thinks too? Are they going to be frustrated someday realizing that because of their race, class, culture, or other stereotypes about them, they were not given the same information as other women? For all I know as a doula, maybe that's exactly what has happened and I am the last person available to say, "Just so you have this to think about..."
So while I don’t see LCs haranguing new moms “Don’t give up! Or you’ll kill your baby!” I understand where the nagging label might come from. Because eventually I pulled up a chair next to the mom's bed (she had a very effective epidural at that point, so I wasn't trying to harass her during contractions!) and I told her I thought she might want to give it a shot, and I gave her some reasons. She said "OK, I'll think about that." I think she was just being polite. I wasn't able to stay after the birth as long as I usually do, so I wasn't there for any first feeds. When I came to do my postpartum visit, I didn't ask, much less nag or yell, about how she was feeding the baby. But I still don't know how she would label my talk to her before birth. So maybe there are some LCs out there who are doing something we could call nagging prenatally. I just hope most moms understand that it's not done in that spirit.
Breastfeeding in a restaurant? The debate rages
One of my classmates mentioned that there's a heated discussion currently going on in the Washington Post restaurant discussion group. A reader complained about a woman openly (gasp!) breastfeeding her baby in a nice restaurant (because you should only breastfeed your baby in a not nice restaurant? Not sure about how that works.) The debate spans from "don't bring your children to nice restaurants at all" to "go do it in the bathroom" to "don't tell me what to do!" My favorite comment is that a woman breastfeeding her child in the dining room has "ruined" the dining plans of everyone else there. Oh no! Because that baby is eating now we can't eat!
Tuesday, March 31, 2009
How to make a birth plan
Notice I didn't say write a birth plan! Why? Labor Nurse has a great post up about why writing your birth plan for hospital staff should be the last step in getting your needs met. It's a long and very comprehensive post about what questions to ask your care provider and on a hospital tour, why choosing the right provider and birthplace is so important, and what parts of your birth plan you should negotiate with your provider before ever walking through the hospital door. All this ultimately informs what you need to write down for hospital staff - and it's probably going to be a lot more user-friendly and helpful than some stock plan you print off the internet.
Monday, March 30, 2009
Breastfeeding & social marketing
This week for my breastfeeding class, I'm hard at work on a social marketing project. My idea is to market to health care providers (in this case doctors) to encourage them to talk to their patients about breastfeeding. Despite good evidence that doctors' encouragement does make a difference, I think a lot of doctors don't know/believe it or don't know how to start the conversation. My goal is to give them a little evidence to nudge them forward, and the tools to do it (pocket cards with ideas for how to start the conversation).
The hardest part has been the required focus group - I wanted to focus group it with OB or family practice residents who do prenatal care, and one of my classmates is a family practice physician at a nearby university. She tried to help me think of ways I could snatch a tiny bit of the residents' time, but we came up empty. Apparently they don't even sit down to eat lunch because by then they're running behind. So I'm focus grouping it with med students, who have a more flexible schedule but not much hands-on practice experience. This just serves to illustrate another reason for not discussing breastfeeding: no time.
It is sad, though, to realize that no matter how hard I work on this project, I may never come up with a breastfeeding social marketing campaign as fantastic as this:
I forwarded it to a couple of friends who used to live in Thailand, and they assured me that this is very representative of Thai soap operas, although probably without the list of vitamins found in breastmilk.
The hardest part has been the required focus group - I wanted to focus group it with OB or family practice residents who do prenatal care, and one of my classmates is a family practice physician at a nearby university. She tried to help me think of ways I could snatch a tiny bit of the residents' time, but we came up empty. Apparently they don't even sit down to eat lunch because by then they're running behind. So I'm focus grouping it with med students, who have a more flexible schedule but not much hands-on practice experience. This just serves to illustrate another reason for not discussing breastfeeding: no time.
It is sad, though, to realize that no matter how hard I work on this project, I may never come up with a breastfeeding social marketing campaign as fantastic as this:
I forwarded it to a couple of friends who used to live in Thailand, and they assured me that this is very representative of Thai soap operas, although probably without the list of vitamins found in breastmilk.
Sunday, March 29, 2009
Oh, the induction
A Twittered induction-turned-cesarean. A cesarean for a baby who is just "too big" - at 7 lbs. 12 oz.
One more story to add another little nudge to our culture's perceptions that babies are too big, that all c-sections are necessary, that induction has nothing to do with it.
One more story to add another little nudge to our culture's perceptions that babies are too big, that all c-sections are necessary, that induction has nothing to do with it.
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