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.
Monday, October 5, 2009
Sunday, October 4, 2009
The best birth plan
Tiffany at the Midwives of Bethany Women's Healthcare blog posted one of the best birth plans I have ever read. I was giggling the whole time I read it.
I was asked to give feedback on a birth plan the other day, and spent some time crossing out things that didn't really need to be on there, explaining that other things should really be discussed in advance, etc. etc. Maybe I could have just suggested they xerox this plan and use it. If nothing else, I think it would put the staff in a great mood!
I was asked to give feedback on a birth plan the other day, and spent some time crossing out things that didn't really need to be on there, explaining that other things should really be discussed in advance, etc. etc. Maybe I could have just suggested they xerox this plan and use it. If nothing else, I think it would put the staff in a great mood!
Saturday, October 3, 2009
Physiologic birth and breastfeeding
I went to a very fast birth recently! Mom called me to tell me she was in labor, an hour later to say they were going to the hospital. I didn't believe from the tone of her voice that she was really so far along (although I just said, "Sounds good, see you there.")
I arrived at the hospital thinking she might be 4-5 cms, max. But when I walked into her room they said "You're just in time!" I said, "Just in time for what?" "For her to have the baby!" Yep, she walked in at 10 centimeters and pushed the baby out about 45 minutes later. Until she was checked she fooled just about everybody about how far along she was, including her husband and the midwife - everyone was shocked by how far along she was. Fortunately mom tuned into her own body and ignored the rest of us!
Because she walked in ready to go, and didn't want drugs anyway, mom really got absolutely nothing - no IV, no injections, nada. She just sat down on the bed and pushed her baby out. And after days of rounding with the LCs on a floor full of post-epidural babies, it was so striking to see a baby from a totally unmedicated labor! This baby was so alert from the beginning - eyes open, looking around - and latched on and nursed beautifully within half an hour. When I went in the next day it was the same story - awake, perfect latch, nursing frequently and effectively. This on a floor full of babies with bad latches, breast refusal, ineffective suck.
Birth practices affect breastfeeding. It just gets brought home to me over and over. The LCs all know it. They dislike epidurals and other interventions not in any holier-than-thou, you're-a-worse-mom way. One LC needed to have all her babies by c-section. But just like the others, she sighs in frustration over how all those meds are affecting the babies that she's trying to get onto the breast.
We so rarely see a baby who has experienced a physiologic birth, we forget what it looks like. This mom went into labor on her own, got zero meds, followed her body's urges to push (very minimal coaching), and when baby emerged it went straight to mom. Her placenta came out quickly, her uterus firmed up nicely, she began nursing, the end. Nobody did anything to speed her up or slow her down, and she moved and positioned herself however she wanted. Her body just did its thing. That's a physiologic birth! As a doula, I'm fortunate to attend more than my share. As an LC-in-training, I'm lucky to see them at all. All these nursing problems begin to seem normal...but they're not, or at least they don't have to be.
I don't want to sound all super crunchy, "Sure you can have your precious epidural...IF YOU NEVER WANT YOUR BABY TO BREASTFEED." Can you have an epidural and breastfeed successfully? OF COURSE! Can you have an physiologic birth and have feeding issues? Sadly, yes! I'm not talking here about individual choices - many birth-related feeding problems are transient and a determined mom can easily surmount them. But I'm speaking here from a public health standpoint. Not all moms are determined, or have the resources to draw on to overcome those problems. By messing with breastfeeding in any way, we tip more and more of those moms-on-the-edge right over it. And we're messing with breastfeeding big time via birth. Too many women see the fussy sleepy baby and/or the latch issues, and they just decide "This is not for me". Either we have to do something about how we provide pain relief for those who want it, or how we prepare and support moms who have high-intervention births.
A good first start, from what I've seen, is to make sure moms get two full days in the hospital with lots of LC (or other trained staff) assistance - instead of the hospital hustling them out the door. It's hard to fix or even wait out birth-related breastfeeding problems in just 24-36 hours. Yet all these moms are being whisked out the door because hospitals get paid the same for your postpartum care, whether you stay 1 day or 2 days. And of course there aren't enough LCs to give the intensive support some moms need. Sigh.
I arrived at the hospital thinking she might be 4-5 cms, max. But when I walked into her room they said "You're just in time!" I said, "Just in time for what?" "For her to have the baby!" Yep, she walked in at 10 centimeters and pushed the baby out about 45 minutes later. Until she was checked she fooled just about everybody about how far along she was, including her husband and the midwife - everyone was shocked by how far along she was. Fortunately mom tuned into her own body and ignored the rest of us!
Because she walked in ready to go, and didn't want drugs anyway, mom really got absolutely nothing - no IV, no injections, nada. She just sat down on the bed and pushed her baby out. And after days of rounding with the LCs on a floor full of post-epidural babies, it was so striking to see a baby from a totally unmedicated labor! This baby was so alert from the beginning - eyes open, looking around - and latched on and nursed beautifully within half an hour. When I went in the next day it was the same story - awake, perfect latch, nursing frequently and effectively. This on a floor full of babies with bad latches, breast refusal, ineffective suck.
Birth practices affect breastfeeding. It just gets brought home to me over and over. The LCs all know it. They dislike epidurals and other interventions not in any holier-than-thou, you're-a-worse-mom way. One LC needed to have all her babies by c-section. But just like the others, she sighs in frustration over how all those meds are affecting the babies that she's trying to get onto the breast.
We so rarely see a baby who has experienced a physiologic birth, we forget what it looks like. This mom went into labor on her own, got zero meds, followed her body's urges to push (very minimal coaching), and when baby emerged it went straight to mom. Her placenta came out quickly, her uterus firmed up nicely, she began nursing, the end. Nobody did anything to speed her up or slow her down, and she moved and positioned herself however she wanted. Her body just did its thing. That's a physiologic birth! As a doula, I'm fortunate to attend more than my share. As an LC-in-training, I'm lucky to see them at all. All these nursing problems begin to seem normal...but they're not, or at least they don't have to be.
I don't want to sound all super crunchy, "Sure you can have your precious epidural...IF YOU NEVER WANT YOUR BABY TO BREASTFEED." Can you have an epidural and breastfeed successfully? OF COURSE! Can you have an physiologic birth and have feeding issues? Sadly, yes! I'm not talking here about individual choices - many birth-related feeding problems are transient and a determined mom can easily surmount them. But I'm speaking here from a public health standpoint. Not all moms are determined, or have the resources to draw on to overcome those problems. By messing with breastfeeding in any way, we tip more and more of those moms-on-the-edge right over it. And we're messing with breastfeeding big time via birth. Too many women see the fussy sleepy baby and/or the latch issues, and they just decide "This is not for me". Either we have to do something about how we provide pain relief for those who want it, or how we prepare and support moms who have high-intervention births.
A good first start, from what I've seen, is to make sure moms get two full days in the hospital with lots of LC (or other trained staff) assistance - instead of the hospital hustling them out the door. It's hard to fix or even wait out birth-related breastfeeding problems in just 24-36 hours. Yet all these moms are being whisked out the door because hospitals get paid the same for your postpartum care, whether you stay 1 day or 2 days. And of course there aren't enough LCs to give the intensive support some moms need. Sigh.
Friday, October 2, 2009
Beautiful breastfeeding PSA from Puerto Rico!
Breastfeeding public information broadcast from Puerto Rico, "Dar la teta es dar vida" ("To 'give the breast' (breastfeed) is to give life"):
I love how this shows moms nursing toddlers and older children, not just babies. So many women seem to have this idea that breastfeeding should end as soon as baby turns a year (or even less). This is a lovely way to show that the breastfeeding relationship can continue as long as both participants are enjoying it. If we can normalize toddler nursing, we've got it made!
Puerto Rico may be part of the U.S., but it's clearly a long way ahead of us when it comes to breastfeeding PSAs (although their breastfeeding rates are not very different, according to the scant statistics I could find.) I wonder what the reaction was there when it was broadcast?
The video was originally posted by the makers here here, and the notes at the right side of the screen give more information about the song, the production team, toddler nursing, and more. Unfortunately it's been flagged as "inappropriate" (puh-lease!) so you have to sign in to get to it. (I linked to a repost that has fortunately not been flagged, let's hope it stays that way.)
I love how this shows moms nursing toddlers and older children, not just babies. So many women seem to have this idea that breastfeeding should end as soon as baby turns a year (or even less). This is a lovely way to show that the breastfeeding relationship can continue as long as both participants are enjoying it. If we can normalize toddler nursing, we've got it made!
Puerto Rico may be part of the U.S., but it's clearly a long way ahead of us when it comes to breastfeeding PSAs (although their breastfeeding rates are not very different, according to the scant statistics I could find.) I wonder what the reaction was there when it was broadcast?
The video was originally posted by the makers here here, and the notes at the right side of the screen give more information about the song, the production team, toddler nursing, and more. Unfortunately it's been flagged as "inappropriate" (puh-lease!) so you have to sign in to get to it. (I linked to a repost that has fortunately not been flagged, let's hope it stays that way.)
Monday, September 28, 2009
Mass media birth vs. reality
How many times have I said, "Birth is nothing like it is in the movies" or complained about how "A Baby Story" or "Maternity Ward" portray labor and delivery? (I just can't watch those shows any longer. I start yelling at the TV and then I have to turn it off.)
That's why the movie "Laboring Under an Illusion" looks both educational and fun. From the press release:
"There are more pregnant women watching TV birth scenes than attending childbirth classes. So when labor starts, they may be surprised by the real thing. ... A new documentary film, “Laboring Under An Illusion: Mass Media Childbirth vs. The Real Thing,” contrasts actual birth footage with the fictionalized commercial version. In over 100 video clips, anthropologist Vicki Elson explores media-generated myths about childbirth."
Here's the trailer:
This looks like a nice way - perhaps even a little more gentle than "Business of Being Born" - to introduce people to the difference between the way they perceive labor & birth and the way it actually is.
The website lists some events. I'm thinking about whether it's worth me investing in a copy (or better yet, finding some way for our breastfeeding student group to pay for it and screen it!) Has anyone seen this yet?
(h/t to Dou-la-la!)
That's why the movie "Laboring Under an Illusion" looks both educational and fun. From the press release:
"There are more pregnant women watching TV birth scenes than attending childbirth classes. So when labor starts, they may be surprised by the real thing. ... A new documentary film, “Laboring Under An Illusion: Mass Media Childbirth vs. The Real Thing,” contrasts actual birth footage with the fictionalized commercial version. In over 100 video clips, anthropologist Vicki Elson explores media-generated myths about childbirth."
Here's the trailer:
This looks like a nice way - perhaps even a little more gentle than "Business of Being Born" - to introduce people to the difference between the way they perceive labor & birth and the way it actually is.
The website lists some events. I'm thinking about whether it's worth me investing in a copy (or better yet, finding some way for our breastfeeding student group to pay for it and screen it!) Has anyone seen this yet?
(h/t to Dou-la-la!)
Friday, September 25, 2009
Sen. Stabenow to Sen. Kyl: Oh SNAP!
United States Senator John Kyl (R. - Ariz) said in health care reform hearings: "I don't need maternity care", so health care reform should not require insurance companies to provide it.
Senator Debbie Stabenow (D. - Mich) fires back: "I think your mom probably did."
(Via Feministing.)
Sen. Kyl then snorts "Yeah, about 60 years ago." Perhaps someone should also show him the evidence that prenatal (AND preconception) health of the mother have impacts on the health of her baby, decades into the future. Or is that just an "I got mine" statement?
If we pass health care reform that does not mandate maternity coverage, we're not getting true health care reform.
Senator Debbie Stabenow (D. - Mich) fires back: "I think your mom probably did."
(Via Feministing.)
Sen. Kyl then snorts "Yeah, about 60 years ago." Perhaps someone should also show him the evidence that prenatal (AND preconception) health of the mother have impacts on the health of her baby, decades into the future. Or is that just an "I got mine" statement?
If we pass health care reform that does not mandate maternity coverage, we're not getting true health care reform.
Wednesday, September 23, 2009
IBCLC training update
This semester, it is busy. As usual, there are a million things I have sitting around waiting to be linked to. I haven't even talked about the Today show home birth ridiculousness yet! (But when so many other people have done it so well, now it seems repetitive).
Today is Wednesday, which is my lactation consultant observation day at the hospital, which is one of the things that is making me so busy: I'm there all day, and by the time I get home I am zapped and don't get a lot of schoolwork done (OK, any schoolwork done). If it wasn't for that I'd have the whole day free to do all the other things I have to do, which then get shoved into the precious open time in the rest of the week. But would I trade my LC observation days for more free time? Of course not. So, I am figuring out the semester as I go along. And I thought I would shake off my Wednesday evening sluggishness long enough to update a little on my LC observation so far:
The hospital I'm observing at is the same place I work as a volunteer doula, and in general I have found them to be a fairly mother- and baby-friendly hospital (they are actually working on getting their baby-friendly certification). The nurses and the pediatricians I have seen so far are very supportive of breastfeeding, even if they aren't always fully informed.
Lactation services is, unfortunately (maybe fortunately for me) not adequately staffed and in this era of budget cuts, unlikely to be increased any time soon. The LCs I work with are on their feet every minute of their workday, and usually can't even see everyone they're supposed to. Today the LC I worked with was supposed to see something like 11 patients, and made it to 6 - and that includes going to see all of those 6 multiple times - for some of them, we went to every feeding they did during the day. If you can't see everyone, this leads to some tough choices - prioritize the mom with inverted nipples, sleepy baby, and poor family support? Or see she doesn't seem that motivated, and think you should spend your time on someone who has a greater chance of succeeding? Much as these are unpleasant choices that shouldn't have to be made, they are real.
I say that the fact it's not adequately staffed is fortunate for me, only because I get to see so much in a day. There is zero downtime, unless you count when the LC dashes to the computer to chart, and I sit next to her trying to remember what I saw and record it in my observation notebook. I am getting to see so much - just a wide range of situations, anatomies, and medical conditions. I haven't done any days in the NICU yet, but I am really looking forward to my first experiences working with preterm babies & their moms.
One thing I've noticed is that my observation days seem to run in themes. For example, last week I was with an LC who was seeing a lot of outpatients, where overfeeding was the theme. This week, we were seeing all inpatients (most less than 24 hours) and the theme was sleepiness and breast refusal. I started to get a little leery as I saw the LC put on nipple shield after nipple shield. Was this her solution to everything? Then she told me, "I usually use one a week." She said she has been seeing more and more sleepy, fussy babies in the past few weeks and is getting concerned about it. Her concern is that they have apparently changed either the epidural dose and/or the medication; this being a typical American hospital, nearly everyone has had an epidural, and if it's seriously affecting the feeding behavior of the babies it's a big problem. I still don't know how I feel about the nipple shields for every problem she applied (heh) them to, but I am curious to know what she learns about the epidural meds.
In terms of the LCs I'm observing, I am learning a lot from observing different practice styles and different approaches. I try hard to check my judgment when I see something I don't want to emulate. It's so easy as an observer to think "I wouldn't do that" or "I wouldn't use that word the family probably doesn't understand" but I know how extremely hard it is to do in practice. And seeing how extremely rushed the LCs are, I can't entertain too many fantasies of long, empowering chats once my turn comes to do the consults. (Another good reason to find some LCs to shadow who are able to have a slower pace, for balance.) Still, I am trying to stay sensitive to places where I see overmedicalization, or creating dependence on the "expert". I am glad our class and professor give us space to discuss those issues.
So far, I love my LC observation days - I love working with families, having a new challenge every 20 minutes, keeping busy, and learning. And I love all those cute little babies! I know not every doula/midwife/other perinatal professional goes into the field from loving babies - sometimes they just love to work with women and don't find babies that interesting. But I have always loved babies, and I really love these tiny little newborns. It's amazing how they are simultaneously so dependent and helpless, and yet so capable. I haven't seen any true self-latching, but when a baby is hungry but not latching, the LCs will encourage the mom to put the baby upright between her breasts, skin-to-skin. The baby will right away start bobbing its head and throwing itself to the side, then move down her breast, and root for the nipple. And when they're done nursing, they'll just relax into a little pink ball on her skin and fall into the deepest sleep. It never fails to make me go "Awwww." So that's my mission these days: more empowered babies!
Today is Wednesday, which is my lactation consultant observation day at the hospital, which is one of the things that is making me so busy: I'm there all day, and by the time I get home I am zapped and don't get a lot of schoolwork done (OK, any schoolwork done). If it wasn't for that I'd have the whole day free to do all the other things I have to do, which then get shoved into the precious open time in the rest of the week. But would I trade my LC observation days for more free time? Of course not. So, I am figuring out the semester as I go along. And I thought I would shake off my Wednesday evening sluggishness long enough to update a little on my LC observation so far:
The hospital I'm observing at is the same place I work as a volunteer doula, and in general I have found them to be a fairly mother- and baby-friendly hospital (they are actually working on getting their baby-friendly certification). The nurses and the pediatricians I have seen so far are very supportive of breastfeeding, even if they aren't always fully informed.
Lactation services is, unfortunately (maybe fortunately for me) not adequately staffed and in this era of budget cuts, unlikely to be increased any time soon. The LCs I work with are on their feet every minute of their workday, and usually can't even see everyone they're supposed to. Today the LC I worked with was supposed to see something like 11 patients, and made it to 6 - and that includes going to see all of those 6 multiple times - for some of them, we went to every feeding they did during the day. If you can't see everyone, this leads to some tough choices - prioritize the mom with inverted nipples, sleepy baby, and poor family support? Or see she doesn't seem that motivated, and think you should spend your time on someone who has a greater chance of succeeding? Much as these are unpleasant choices that shouldn't have to be made, they are real.
I say that the fact it's not adequately staffed is fortunate for me, only because I get to see so much in a day. There is zero downtime, unless you count when the LC dashes to the computer to chart, and I sit next to her trying to remember what I saw and record it in my observation notebook. I am getting to see so much - just a wide range of situations, anatomies, and medical conditions. I haven't done any days in the NICU yet, but I am really looking forward to my first experiences working with preterm babies & their moms.
One thing I've noticed is that my observation days seem to run in themes. For example, last week I was with an LC who was seeing a lot of outpatients, where overfeeding was the theme. This week, we were seeing all inpatients (most less than 24 hours) and the theme was sleepiness and breast refusal. I started to get a little leery as I saw the LC put on nipple shield after nipple shield. Was this her solution to everything? Then she told me, "I usually use one a week." She said she has been seeing more and more sleepy, fussy babies in the past few weeks and is getting concerned about it. Her concern is that they have apparently changed either the epidural dose and/or the medication; this being a typical American hospital, nearly everyone has had an epidural, and if it's seriously affecting the feeding behavior of the babies it's a big problem. I still don't know how I feel about the nipple shields for every problem she applied (heh) them to, but I am curious to know what she learns about the epidural meds.
In terms of the LCs I'm observing, I am learning a lot from observing different practice styles and different approaches. I try hard to check my judgment when I see something I don't want to emulate. It's so easy as an observer to think "I wouldn't do that" or "I wouldn't use that word the family probably doesn't understand" but I know how extremely hard it is to do in practice. And seeing how extremely rushed the LCs are, I can't entertain too many fantasies of long, empowering chats once my turn comes to do the consults. (Another good reason to find some LCs to shadow who are able to have a slower pace, for balance.) Still, I am trying to stay sensitive to places where I see overmedicalization, or creating dependence on the "expert". I am glad our class and professor give us space to discuss those issues.
So far, I love my LC observation days - I love working with families, having a new challenge every 20 minutes, keeping busy, and learning. And I love all those cute little babies! I know not every doula/midwife/other perinatal professional goes into the field from loving babies - sometimes they just love to work with women and don't find babies that interesting. But I have always loved babies, and I really love these tiny little newborns. It's amazing how they are simultaneously so dependent and helpless, and yet so capable. I haven't seen any true self-latching, but when a baby is hungry but not latching, the LCs will encourage the mom to put the baby upright between her breasts, skin-to-skin. The baby will right away start bobbing its head and throwing itself to the side, then move down her breast, and root for the nipple. And when they're done nursing, they'll just relax into a little pink ball on her skin and fall into the deepest sleep. It never fails to make me go "Awwww." So that's my mission these days: more empowered babies!
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