I used to work as a bra fitter. Not just any bras - nursing bras. That's right - just in case being a doula, going through a breastfeeding educator course, and then doing dozens of breastfeeding consults during my AmeriCorps stint hadn't provided me with more than my lifetime quota of boob-viewing. Still, it was a good set-up for doula work because they were flexible if I, or the other doula working there, needed to call in "birth". (You would think we'd have also gotten clients from there but it wasn't as great a networking spot as you'd think.)
Anyway, I had never really understood how bra sizing worked before I got hired there. I had, when I was about 14, tried on bras in a JC Penney's dressing room until I found a size that seemed to work, and stuck with that size for well over the next decade. Sometimes I'd try slightly different sizes, because Oprah said that 80% of women were wearing the wrong bra size, but the ones I picked seemed too small or too big. I got measured at a Victoria's Secret one time and tried on their recommended size - that was a joke. I stuck to my old size.
A month into working at the store, I realized how I had been wearing a laughably wrong bra size for years. After a few more months, I realized how EVERYbody (or at least 80% - just like Oprah said!) else had been too.
One day during that time, I saw a picture of Dolly Parton and it got me wondering - what was her bra size? I had fit people resembling her, so I thought I had a pretty good guess. Googling around, however, I got mostly the same figure - one that I just could not believe. If a woman who looked like her walked into the store I used to work in and said she was a 40DD, every fitter in the room would turn around and raise their eyebrows.
But yet this "40DD" was repeated over and over on different websites with absolutely no questions asked. And it got me thinking about the fact that most of the world doesn't understand how bra size works - heck, I didn't until I started working as a fitter. I feel like bra sizing is this secret that's not hard to understand, but somehow concealed from women worldwide (possibly so we won't demand any sizes outside of 32-34-36 A-B-C). So I want to do a little explanation, because understanding this has changed my bras (and my life - really) for the better. I wrote a version of this a while ago for my my personal blog and had a lot of friends ask me questions and go for fittings. After this post, I'll do another one specifically on what I've learned about buying bras for pregnancy and nursing.
Your band size
The first part of your bra size - the number, aka the "band size" - has nothing to do with your breast size. Nothing. It has to do with your ribcage size. Wrap a measuring tape around your body just under your armpits, and pull tight (actually, have someone else do this for you). That's the number you're looking for. It's likely to be smaller than what you're wearing now.
"But I'm a 36! I've worn a 36 my whole life! It fits!" Take a look in the mirror. Do your bras ride up in the back? The back should be exactly level with the front of the bra. If they're riding up, they are TOO BIG. Period. "But I put on a 34 and it felt soooo tight!" Of course it will. You've been wearing 36s for your whole life. Wear the right size for 3 days and after 3 days it will no longer feel tight. Then put on your old bras and see how uncomfortable they really are - how they don't lie flat against your ribs, how they ride up underneath your breasts, how the straps are always falling down. (Right? You thought it was because you didn't tighten the straps enough. But since I started wearing the right band size, I can count on one hand the number of times my straps have fallen.) They don't give you any support underneath, so all the weight is hanging from your shoulders. They're Bad. You'll throw them out (just like I did) and be happier for it.
"But my band size is less than 32. So I'm a 32, right?" While a store like Wal-Mart will carry up to about a 44 band size, and a lot of plus-size stores will carry larger band sizes, finding very small band sizes is harder. That does not, however, mean that you should wear the wrong size. 30s and 28s are out there - mostly online, in specialty stores, and at Nordstroms. "But that will be expensive!" It is hard when you're used to buying $15 bras and discover that they weren't really doing you any favors and you have to shell out some more. But think about this: unless you have a smaller cup size and don't need it all the time, you probably wear your bra all day, every day. (Cost it out over total hours worn and you may see things differently.) It is what makes your clothes look good, makes you feel comfortable, and can help relieve back and neck pain. Treat your bras nicely and they will last longer, but regardless of lifespan they are worth the investment!
How important is the exact right band size?
If you're an A or B cup, do you really need to wear a nice tight band? Probably not, because you don't need as much support. If you're "supposed to be" a 32 but you like 34s better - not such a big deal. If you DO need the support, however, you want a tight, supportive band. It's a nice secure shelf under your breasts.
Can we talk about cup size now, please?
OK, we've got the band size taken care of. Now for the cup size. The cup size is the letter. It is the difference between your band size (around your ribcage) and your bust size (around the fullest part of your breasts). A few things about cup size: it is not absolute. Because it's about the DIFFERENCE between sizes, someone who is a 32C will have smaller breasts than a 40C. Cup size is all about proportion. This is why if you have a small band size, you are more likely to have a big cup size: the breasts that are a C on your sister who has a 38 ribcage will be a DD on your 34 ribcage.
"I'm a DD, that's so huge!" No, it's not. It's just a different proportion. When you start being realistic about your band size, you will inevitably go up in cup size (I have never met anyone who was wearing a band that was too small - most people are wearing a band that is too big).
I don't hold with measuring for cup size except as a general guide. Use it to get you in the right zone, but one measurement shouldn't be taken as gospel. Once you have a band size that you know works, just keep trying on larger cup sizes until you get one that fits you smoothly (no wrinkles) and doesn't create a double-boob on top by cutting into you. Ignore the letters - no really, ignore them! They will only distract you with preconceived notions of what that particular letter looks like on someone's body.
"But I CAN'T be a DD!" Why not? "Because that's so HUGE! I mean, Dolly Parton is a DD!" No, she's not. She obviously doesn't want to freak people out, but looking at her I would guess she's a 34H, minimum (and she's so tiny - she has to be a 32 or less). If she's making up for it by wearing 40DD, no wonder she has back problems.
"I've never heard of an H!" In German sizing (we carried a lot of bras from Germany in the store where I worked) they don't screw around with all these double letters. Americans seem to have a mental block about the letter "D" - we can't go beyond it. People will be DDDD's, but they won't just go ahead and be a G, whereas in Germany they just march inexorably down the alphabet. (In England they seem to split the difference by doubling every letter once - D, DD, E, EE and so on - but at least only once.) No one seems to want to hear these letters. Because so many women are wearing the wrong size, we have attached letters like "DD" to Dolly Parton and can't see ourselves realistically.
"But if I'm more than a DD then where do I find my bras?" See above re: small band sizes. They will be harder to find, and more expensive, and yet you will be glad. My recommended bra-shopping websites: Figleaves.com, Barenecessities.com, and Bravissimo.com (the last is UK-only store although they will ship to the US. I have never ordered from them, but I hear great reviews and they have a good explanation of how to visually assess whether your bra is the right fit.)
One more thing - bra fitters
With all this explanation about how to fit yourself, I can't emphasize enough how helpful a good, experienced fitter can be. And that's why you can't go to Victoria's Secret. A bra store can only put you in sizes they have. Vicky's doesn't have much. Nordstrom's has a much wider range, and in this country is a lot of people's only nearby bricks-and-mortar resource. Local specialty stores are also a good bet if you have one - but check to see if they have the size range you think you're looking in. Always bring your own judgment - it's normal for a smaller band to feel tight, but it shouldn't require a crowbar to fasten, and if something is just not working then say so.
Once you have bras that fit, spread the gospel! I've talked to a lot of women who feel so frustrated and demoralized by bra shopping. It makes them feel bad about their bodies and insecure about what they "should" look like or what size "normal" people wear. I wish more women understood sizing and accepted their bodies and breasts as they are - normal and fabulous - and useful for feeding babies if you get the chance :-)
Friday, June 19, 2009
Where do our ideas about breastfeeding come from?
What does a mother tend to hear if she smokes? Has food poisoning? Has a beer? Is taking anti-depressants or even anti-virals or antibiotics? "You should stop breastfeeding – just to be on the safe side."
Now see what the WHO says are contraindications (opens a PDF). Note how very, very short it is. (Could we print this out and hang it up in every medical office? It wouldn’t take much space.)
What is the underlying message when mothers hear the stop-to-be-safe line? That breastmilk is best – but it is also very easy to ruin in which case it is DANGEROUS! Formula, on the other hand, is basically as good as breastmilk, and always, always safe (Har.)
This message undermines breastfeeding. It gets into people’s heads and stays there. I did a focus group with med students about breastfeeding promotion and one aspiring pediatrician said, “Of course, lots of women can’t breastfeed, because they’re on medication.” The others all nodded and agreed. (This is one of the reasons I want to start a breastfeeding workshop for med students at my school, but I digress.)
This message works because we have internalized another message, that formula is normal and breastfeeding is “special” in that it confers “extra” benefits. If breastfeeding is normal, then instead of breastfeeding’s benefits (lower risk of allergy, diabetes, etc.) we would talk about formula’s risks (increased risk of allergy, diabetes, etc.) So when any risk, even minor, is introduced into breastfeeding (ooh, you had a glass of wine? Better pump and dump), it’s better to go with something that you know is totally safe. Right?
Where did THAT message come from? Why do we see breastmilk as so fundamentally untrustworthy? Jacqueline Wolf is a professor of the history of medicine and has done some fabulous research on the history of breastfeeding and artificial feeding in the U.S. Her article, “The Social and Medical Construction of Lactation Pathology” (Women & Health, 2000. 30:3,93-110) explores how and why we started constructing this idea of breastmilk as easily spoiled and dangerous:
Note: She has also done research on why there was a growing epidemic of “bad” or insufficient milk starting in the 1880s, and concludes that it was due to the rising popularity of regimented feeding schedules (often feeding every 4 hours) which lead to low milk supply.
So now, even when we understand the principles of milk production and how to ensure a healthy milk supply, we’re still left with the idea of breastmilk as a touchy, easily spoiled substance and mothers’ bodies as unreliable. (If you want to read more about this I highly recommend Jacqueline Wolf’s book, Don’t Kill Your Baby: Public Health and the Decline of Breastfeeding in the 19th and 20th Centuries. She also has a new book out about the history of obstetrical anesthesia, which I am really excited to read.)
We need to get a new mindset in – from “if there’s anything potentially wrong, stop breastfeeding” to “there’s very little so bad that it can outweigh all the good things breastfeeding provides”. Otherwise, we’ll keep getting women advised to stop breastfeeding because they have food poisoning, have had a beer, smoke, is taking anti-virals, or because the “baby is gaining weight too quickly” – all reasons I have heard personally from medical professionals or the mothers the advice was given to. And that's just not helping.
Oh, and when I did a google search for “reasons to stop breastfeeding”, what was the first ad to come up?
Stop Breastfeeding
Get a Free breastfeeding support
kit w/ important DHA supplement.
www.enfamil.com
Now see what the WHO says are contraindications (opens a PDF). Note how very, very short it is. (Could we print this out and hang it up in every medical office? It wouldn’t take much space.)
What is the underlying message when mothers hear the stop-to-be-safe line? That breastmilk is best – but it is also very easy to ruin in which case it is DANGEROUS! Formula, on the other hand, is basically as good as breastmilk, and always, always safe (Har.)
This message undermines breastfeeding. It gets into people’s heads and stays there. I did a focus group with med students about breastfeeding promotion and one aspiring pediatrician said, “Of course, lots of women can’t breastfeed, because they’re on medication.” The others all nodded and agreed. (This is one of the reasons I want to start a breastfeeding workshop for med students at my school, but I digress.)
This message works because we have internalized another message, that formula is normal and breastfeeding is “special” in that it confers “extra” benefits. If breastfeeding is normal, then instead of breastfeeding’s benefits (lower risk of allergy, diabetes, etc.) we would talk about formula’s risks (increased risk of allergy, diabetes, etc.) So when any risk, even minor, is introduced into breastfeeding (ooh, you had a glass of wine? Better pump and dump), it’s better to go with something that you know is totally safe. Right?
Where did THAT message come from? Why do we see breastmilk as so fundamentally untrustworthy? Jacqueline Wolf is a professor of the history of medicine and has done some fabulous research on the history of breastfeeding and artificial feeding in the U.S. Her article, “The Social and Medical Construction of Lactation Pathology” (Women & Health, 2000. 30:3,93-110) explores how and why we started constructing this idea of breastmilk as easily spoiled and dangerous:
Women’s accounts of their breastfeeding travails and their consequent need for galactagogues and human milk substitutes engaged early twentieth century pediatricians like no other medical crisis. Despite doctors’ universal support of breastfeeding--and their consistent condemnation of artificial feeding--they began to corroborate mothers’ frequent reports of too-little, or bad, breast, milk.
Note: She has also done research on why there was a growing epidemic of “bad” or insufficient milk starting in the 1880s, and concludes that it was due to the rising popularity of regimented feeding schedules (often feeding every 4 hours) which lead to low milk supply.
Physicians publicly advised women of the dangerous propensity of human milk to metamorphose within women’s bodies. When F. W. Reilly, the Chicago Assistant Commissioner of Health, urged mothers in 1895 to nurse their babies in order to keep them healthy, he coupled the decree with an equally stern caveat. Under certain conditions, Reilly warned, "even breast milk" caused babies severe digestive distress. If a mother is overheated, he explained, she should express and discard a teaspoon of milk before breastfeeding, implying that the milk nearest the surface of mothers’ bodies could easily sour--like cow’s milk left on a porch during the summer. …
Although the medical community continued to declare breastfeeding the optimum practice after a birth in principle, doctors now counseled mothers and each other that human milk was best only if a mother supplied her baby with, not just any breast milk, but an "average" breast milk (Churchill, 1896). "Below-average" or "too-rich" human milk, they contended, posed as great a peril to babies as breast milk substitutes. An editor of an infant-care magazine reminded mothers, "Remember that to-day the best artificial food is quite as safe as a poor quality of human milk" (Nursery Problems, October 1887).
So now, even when we understand the principles of milk production and how to ensure a healthy milk supply, we’re still left with the idea of breastmilk as a touchy, easily spoiled substance and mothers’ bodies as unreliable. (If you want to read more about this I highly recommend Jacqueline Wolf’s book, Don’t Kill Your Baby: Public Health and the Decline of Breastfeeding in the 19th and 20th Centuries. She also has a new book out about the history of obstetrical anesthesia, which I am really excited to read.)
We need to get a new mindset in – from “if there’s anything potentially wrong, stop breastfeeding” to “there’s very little so bad that it can outweigh all the good things breastfeeding provides”. Otherwise, we’ll keep getting women advised to stop breastfeeding because they have food poisoning, have had a beer, smoke, is taking anti-virals, or because the “baby is gaining weight too quickly” – all reasons I have heard personally from medical professionals or the mothers the advice was given to. And that's just not helping.
Oh, and when I did a google search for “reasons to stop breastfeeding”, what was the first ad to come up?
Stop Breastfeeding
Get a Free breastfeeding support
kit w/ important DHA supplement.
www.enfamil.com
Wednesday, June 17, 2009
New breech guidelines from Canada
The Society of Obstetricians and Gynecologists of Canada has come out with new guidelines for breech birth, saying that the automatic c-section is not an evidence-based practice and that all breeches should be evaluated and offered vaginal delivery if appropriate. New guidelines are here. I was curious to read through the guidelines, but as I read them I thought “What doctor is going to be willing to go through this checklist when they could just schedule another c-section and be done with it?” That’s why I liked an article that accompanies the published guidelines, by Dr. Andrew Kotaska, called titled, “Breech Birth Can Be Safe, But Is It Worth the Effort?”: (all the emphasis is mine)
Whether term vaginal breech birth is safe is no longer a question. The PREMODA study has clearly shown that with careful selection and management by average maternity units, breech birth can be safe. …
In the PREMODA study, the overall vaginal birth rate was only 23%. Is it important to mount the significant effort required to offer women breech birth if only one quarter will thereby avoid Caesarean section? … In North America, over 100 000 women have pregnancies that remain breech at term annually. With a success rate similar to that of the PREMODA study, some 25 000 could safely avoid Caesarean section.
…[T]he current practice of “not offering” women a trial of labour while providing ready access to Caesarean section is coercive, especially given the equivalency of long-term neonatal outcome. Now, with a more comprehensive understanding of the components required to make short-term outcomes of vaginal breech birth equivalent as well, it would be unethical not to provide this information to women. Although it may be difficult in some settings to offer vaginal breech birth routinely, its availability elsewhere should be disclosed and assistance offered to obtain it if requested. To offer only Caesarean section is ethically and legally difficult to justify if a reasonable alternative is available.
This is really the crux of it, and the guidelines even state that women who refuse a c-section recommendation must still be given care (why does this even need to be said?) Why is it OK to providers to offer one option and not the other? What if no c-sections were offered and all women were required to deliver breech vaginally, regardless of the risks – would anyone be ethically down with that?
I think the next big step is to change the attitude that offering women one choice (to be accurate, no choice at all) is acceptable. After some new evidence came out about Term Breech Trial and other breech trials in 2006, ACOG did a weak “we guess maybe you could try vaginal breech if you REALLY REALLY want to” policy change, and I think everyone would agree it didn’t change much here. The Canadian guidelines, on the other hand, are actual guidelines with specific recommendations on how to safely offer and assist breech deliveries, along with a recommendation to train more providers in breech skills. But without strong advocacy the status quo seems likely to persist there as it does here. Will there be loud enough voices in Canada demanding that those guidelines be applied?
Whether term vaginal breech birth is safe is no longer a question. The PREMODA study has clearly shown that with careful selection and management by average maternity units, breech birth can be safe. …
In the PREMODA study, the overall vaginal birth rate was only 23%. Is it important to mount the significant effort required to offer women breech birth if only one quarter will thereby avoid Caesarean section? … In North America, over 100 000 women have pregnancies that remain breech at term annually. With a success rate similar to that of the PREMODA study, some 25 000 could safely avoid Caesarean section.
…[T]he current practice of “not offering” women a trial of labour while providing ready access to Caesarean section is coercive, especially given the equivalency of long-term neonatal outcome. Now, with a more comprehensive understanding of the components required to make short-term outcomes of vaginal breech birth equivalent as well, it would be unethical not to provide this information to women. Although it may be difficult in some settings to offer vaginal breech birth routinely, its availability elsewhere should be disclosed and assistance offered to obtain it if requested. To offer only Caesarean section is ethically and legally difficult to justify if a reasonable alternative is available.
This is really the crux of it, and the guidelines even state that women who refuse a c-section recommendation must still be given care (why does this even need to be said?) Why is it OK to providers to offer one option and not the other? What if no c-sections were offered and all women were required to deliver breech vaginally, regardless of the risks – would anyone be ethically down with that?
I think the next big step is to change the attitude that offering women one choice (to be accurate, no choice at all) is acceptable. After some new evidence came out about Term Breech Trial and other breech trials in 2006, ACOG did a weak “we guess maybe you could try vaginal breech if you REALLY REALLY want to” policy change, and I think everyone would agree it didn’t change much here. The Canadian guidelines, on the other hand, are actual guidelines with specific recommendations on how to safely offer and assist breech deliveries, along with a recommendation to train more providers in breech skills. But without strong advocacy the status quo seems likely to persist there as it does here. Will there be loud enough voices in Canada demanding that those guidelines be applied?
Monday, June 15, 2009
'Birth Beyond Belief' - Homebirth on TV
I got this through a doula listserv. Here's the press release:
We are excited to announce the premiere of Births Beyond Belief, a reality program which airs on Discovery Health June 16th at 7pm CST. The show, created and produced by Video Arts, explores the ups and downs of homebirth by following three separate mothers in Hawaii, Los Angeles, and New Jersey. Rarely is homebirth highlighted on such a large stage in mass media like Discovery Health, which is broadcast in over 68 million households.
Demi Moore and Ashton Kutcher's full time chef, Grace GlennAnthony, pursued a home birth with their support. The Video Arts crew documented Grace working in the celebrities' Beverly Hills home. Grace's baby was in the breech position making homebirth an illegal option according to California law. She was forced to choose between sacrificing her dream birth and breaking the law.
Hawaii couple, Jason and Kollette Stith, gave birth on their organic coffee bean farm deep in the mountains in a Mongolian tent known as a yurt. The delivery was complicated by the fact that their remote location is only accessible by four-wheel drive vehicles and does not have running water or electricity.
A New Jersey couple, Soyini and Esu Ma'at, were expecting their second child. The Video Arts crew documented Soyini in a temple in Brooklyn using sacred Egyptian meditations to prepare for birth. The birth took a dramatic turn when Soyini requested to move from the floor of her bedroom to a birthing tub to deliver after the baby's head had crowned.
Don't miss this engaging documentary produced right here in Fargo, ND by Video Arts Studios on Tuesday, June 16th at 8pm (EST/PST), 7pm (CST).
Do I smell a little sensationalization here? A breech birth, a remote location, and obviously a stretch for the third one - "Oh no! She wanted to move! You can't MOVE!" It's frustrating because the press release makes it sound like it's so great that they're showing homebirths, and then goes on to spin all three births as only something only those crazy, "beyond the pale" types do. Why does home birth have to be "beyond belief" or "dramatic"?
Someday I'm going to make a documentary about hospital birth called "Sadly, Births That Are All Too Common". Instead of dramatizing un-dramatic things, it will do the opposite. When someone yells in a mom's face to push, the camera will zoom in on reassuring FHTs and a pop-up will offer the factoid that purple pushing is not evidence-based. When a mother is told her labor is progressing too slowly and she requires an "emergency" c-section, we'll cut to a review of the research on labor dystocia. Fun!
I am currently cable-less, but given that Discovery Health re-airs things often, I'm hoping to catch this show again in the future. If anyone out there watches it first, I'd like to hear a review!
We are excited to announce the premiere of Births Beyond Belief, a reality program which airs on Discovery Health June 16th at 7pm CST. The show, created and produced by Video Arts, explores the ups and downs of homebirth by following three separate mothers in Hawaii, Los Angeles, and New Jersey. Rarely is homebirth highlighted on such a large stage in mass media like Discovery Health, which is broadcast in over 68 million households.
Demi Moore and Ashton Kutcher's full time chef, Grace GlennAnthony, pursued a home birth with their support. The Video Arts crew documented Grace working in the celebrities' Beverly Hills home. Grace's baby was in the breech position making homebirth an illegal option according to California law. She was forced to choose between sacrificing her dream birth and breaking the law.
Hawaii couple, Jason and Kollette Stith, gave birth on their organic coffee bean farm deep in the mountains in a Mongolian tent known as a yurt. The delivery was complicated by the fact that their remote location is only accessible by four-wheel drive vehicles and does not have running water or electricity.
A New Jersey couple, Soyini and Esu Ma'at, were expecting their second child. The Video Arts crew documented Soyini in a temple in Brooklyn using sacred Egyptian meditations to prepare for birth. The birth took a dramatic turn when Soyini requested to move from the floor of her bedroom to a birthing tub to deliver after the baby's head had crowned.
Don't miss this engaging documentary produced right here in Fargo, ND by Video Arts Studios on Tuesday, June 16th at 8pm (EST/PST), 7pm (CST).
Do I smell a little sensationalization here? A breech birth, a remote location, and obviously a stretch for the third one - "Oh no! She wanted to move! You can't MOVE!" It's frustrating because the press release makes it sound like it's so great that they're showing homebirths, and then goes on to spin all three births as only something only those crazy, "beyond the pale" types do. Why does home birth have to be "beyond belief" or "dramatic"?
Someday I'm going to make a documentary about hospital birth called "Sadly, Births That Are All Too Common". Instead of dramatizing un-dramatic things, it will do the opposite. When someone yells in a mom's face to push, the camera will zoom in on reassuring FHTs and a pop-up will offer the factoid that purple pushing is not evidence-based. When a mother is told her labor is progressing too slowly and she requires an "emergency" c-section, we'll cut to a review of the research on labor dystocia. Fun!
I am currently cable-less, but given that Discovery Health re-airs things often, I'm hoping to catch this show again in the future. If anyone out there watches it first, I'd like to hear a review!
Sunday, June 14, 2009
Maternal mortality in NY state under review
The Poughkeepsie Journal notes efforts in NY state to investigate rising maternal death rates and notes that they have risen along with cesarean rates.
A few thoughts about this: it's easy to say "more women have cesarean sections because more women are high risk" (this is essentially what one OB in the article says). Very true - sing it with me, "Correlation does not imply causation". (By far the most important thing you learn in epidemiology.) High-risk women are more likely to have c-sections, and also more likely to suffer serious complications. But research also shows that cesarean section rates have risen for ALL women in ALL risk categories. So yes - it's not just that there are more high risk women, it's that there are more c-sections done on them.
I also wish the article had been willing to make it clear - c-sections DO carry a higher risk of maternal mortality. Maternal mortality is very rare - that's why it's measured per 100,000 (vs. infant mortality, which is measured per 1,000), so an increase may not be quickly visible because the rise in absolute numbers is very small. But if we get to a 40% cesarean rate, or 70% cesarean rate, or 100% like in some places in Brazil - we may not be able to say for sure which deaths were caused by cesarean, and which would have happened anyway, but it will be statistically guaranteed that some women will die from unnecessary cesarean surgeries. It doesn't really seem debatable.
Finally, as a caveat to all this and the entire article - I was curious to know whether New York state maternal mortality reporting has changed in the decade in question. Many states have adopted new death certificates and new reporting rules that have really upped the number of pregnancy-related deaths reported. The changes in reporting have made it really challenging to say anything reliable about national trends, and I wonder if the same holds true for NY.
A few thoughts about this: it's easy to say "more women have cesarean sections because more women are high risk" (this is essentially what one OB in the article says). Very true - sing it with me, "Correlation does not imply causation". (By far the most important thing you learn in epidemiology.) High-risk women are more likely to have c-sections, and also more likely to suffer serious complications. But research also shows that cesarean section rates have risen for ALL women in ALL risk categories. So yes - it's not just that there are more high risk women, it's that there are more c-sections done on them.
I also wish the article had been willing to make it clear - c-sections DO carry a higher risk of maternal mortality. Maternal mortality is very rare - that's why it's measured per 100,000 (vs. infant mortality, which is measured per 1,000), so an increase may not be quickly visible because the rise in absolute numbers is very small. But if we get to a 40% cesarean rate, or 70% cesarean rate, or 100% like in some places in Brazil - we may not be able to say for sure which deaths were caused by cesarean, and which would have happened anyway, but it will be statistically guaranteed that some women will die from unnecessary cesarean surgeries. It doesn't really seem debatable.
Finally, as a caveat to all this and the entire article - I was curious to know whether New York state maternal mortality reporting has changed in the decade in question. Many states have adopted new death certificates and new reporting rules that have really upped the number of pregnancy-related deaths reported. The changes in reporting have made it really challenging to say anything reliable about national trends, and I wonder if the same holds true for NY.
Friday, June 12, 2009
OK, that wasn't quite all for today
Thanks to Jill's link giving the Times Online three dramatic chipmunks for their misleading homebirth headline, I was reminded that I wanted to post this:
The Science News Cycle. Oh yeah, this definitely applies to birth!
The Science News Cycle. Oh yeah, this definitely applies to birth!
Public health doula is BACK!
This has been quite the radio silence! There's been a lot going on - moving, traveling, settling into my new city and my summer internship...and then my computer died. More accurately, my hard drive. So after getting it replaced, trying to get the data off the old one (note: back up your hard drive, or you will regret it), and formatting and installing everything on the new one...I am back.
I have a crazy backlog of posts in mind and will probably never ever catch up on all of them. So for now I'll just share a little bit about my work this summer. My internship is in a large metro-area county health department - keep in mind that this is a county that has more population than most states, so it's not a typical county health department! I'm working with the data people - that means a lot of taking big datasets and running the numbers to generate reports and answer information requests from outside. The data that we're working with is MCH-related, so that's been very interesting for me to work with - playing around with breastfeeding stats is always fun. It's also educational to see how the sausage is made, statistically - for example, how information from birth certificates is transformed into usable data. My co-workers are very helpful and I'm already learning a huge amount about statistical analysis software, how large surveys are run, the ins and outs of survey design and data collection - all things I know I didn't have experience with, and wanted to add to my skill set.
Still and all, after a few weeks in front of the computer crunching numbers, I can tell that this work isn't about to jump out and seize my interest. It's challenging and interesting to figure out how to get the data someone needs, and it's incredibly important and useful, but I'm not a big one for abstractions. I like people. As a doula, that's a helpful asset. I hope to locate my public health career somewhere in between the one-to-one of direct service as a doula, and sitting in an office cubicle analyzing hundreds of thousands of births. The next step is to figure out exactly where in that in-between space I'd like to be.
As I left off with a link dump, I'll do another one to clear out some of the (many great) posts that have been getting starred and stored in my Google Reader. Mixed in here a couple of really lovely birth stories/videos/photos - I am renewing my vow to post the good and not just the bad!
Jive Turkey tells her birth story:
Part One and Part Two. She has a pretty funny take on the experience. She's also posted a "what you need to have a baby" and suggests that to the hospital, you bring "YOUR BALLS". Amen.
Guestblog on Radical Doula about ICTC Doula Training. It makes me wish I'd taken my doula training with them! If you're interested in doula-ing with a social justice/community focus, check this out.
Birth Faith talks about why giving birth without medications doesn't make her a hero. The "don't be a martyr" line sets my teeth on edge because no woman has ever said to me, "I'd like to give birth unmedicated because I've always dreamed of being a martyr."
Preggy Blonde's birth story with a couple of really lovely photos.
Amazing birth story in photos via Birth at Home in Arizona, who also posts a link to a a beautiful home birth video.
That's all for today!
I have a crazy backlog of posts in mind and will probably never ever catch up on all of them. So for now I'll just share a little bit about my work this summer. My internship is in a large metro-area county health department - keep in mind that this is a county that has more population than most states, so it's not a typical county health department! I'm working with the data people - that means a lot of taking big datasets and running the numbers to generate reports and answer information requests from outside. The data that we're working with is MCH-related, so that's been very interesting for me to work with - playing around with breastfeeding stats is always fun. It's also educational to see how the sausage is made, statistically - for example, how information from birth certificates is transformed into usable data. My co-workers are very helpful and I'm already learning a huge amount about statistical analysis software, how large surveys are run, the ins and outs of survey design and data collection - all things I know I didn't have experience with, and wanted to add to my skill set.
Still and all, after a few weeks in front of the computer crunching numbers, I can tell that this work isn't about to jump out and seize my interest. It's challenging and interesting to figure out how to get the data someone needs, and it's incredibly important and useful, but I'm not a big one for abstractions. I like people. As a doula, that's a helpful asset. I hope to locate my public health career somewhere in between the one-to-one of direct service as a doula, and sitting in an office cubicle analyzing hundreds of thousands of births. The next step is to figure out exactly where in that in-between space I'd like to be.
As I left off with a link dump, I'll do another one to clear out some of the (many great) posts that have been getting starred and stored in my Google Reader. Mixed in here a couple of really lovely birth stories/videos/photos - I am renewing my vow to post the good and not just the bad!
Jive Turkey tells her birth story:
Part One and Part Two. She has a pretty funny take on the experience. She's also posted a "what you need to have a baby" and suggests that to the hospital, you bring "YOUR BALLS". Amen.
Guestblog on Radical Doula about ICTC Doula Training. It makes me wish I'd taken my doula training with them! If you're interested in doula-ing with a social justice/community focus, check this out.
Birth Faith talks about why giving birth without medications doesn't make her a hero. The "don't be a martyr" line sets my teeth on edge because no woman has ever said to me, "I'd like to give birth unmedicated because I've always dreamed of being a martyr."
Preggy Blonde's birth story with a couple of really lovely photos.
Amazing birth story in photos via Birth at Home in Arizona, who also posts a link to a a beautiful home birth video.
That's all for today!
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