Back from another trip and about to work...a lot. I know my latest posts have been sporadic and all link parties. I am sorry! More actual content is coming!
While traveling, my lovely smartphone (got it in February and just seem to find more and more uses for it!) has helped me keep updated on reading. Here are some links while I'm catching up with the rest of life:
- Erykah Badu is a doula and wants to become a midwife. I read this one flipping through People magazine in an airport kiosk. Just seeing the word DOULA printed huge in a headline in People magazine made me all excited! The article itself, unfortunately, did not do the greatest job of accurately representing what a doula is/does. Someone reading it would come away with the distinct impression that doulas are 1) definitely only for mothers who want unmedicated births, 2) possibly only for mothers who use midwives, and 3) deliver babies (people are ALWAYS saying "oh, you deliver babies!" No, I do not! The midwife or doctor does! I just support the family.) But hopefully this will get more people aware of doulas and more accurate education can follow. And - Erykah Badoula? How great is that?
- JAMA publishes an article on "Lesbian, Gay, Bisexual, and Transgender–Related Content in Undergraduate Medical Education", and I am proud to say I know one of the authors!
Via Bellies and Babies, some waterbirth videos for the birth video addict!
- PhD in Parenting on Evenflo's quick transition from Code supporter, to a marketer that emphasizes pumping and bottle feeding as superior (and less icky and embarrassing, of course!) than direct breastfeeding. Depressing, but Evenflo's Facebook update today shows that the attention has gotten them to take one of the offending videos down.
Wednesday, September 7, 2011
Wednesday, August 24, 2011
Link party, August blogcation
I guess my blogging is on an August hiatus? Between traveling and bracketing the traveling with long shifts at work, I am not doing much blogging (also, my e-mail inbox hates me - at least, I assume the feeling is mutual. So if you've e-mailed me and not heard back, that may be a factor.) Early September may not be much better, but I promise to post again soon!
In the meantime, some links:
* Jessica Valenti on learning to love her baby through a harrowing delivery and long NICU stay
* From Birthing Beautiful Ideas, these are many of the reasons that I too love being a doula!
* Elita at Blacktating ponders the idea of the "relief bottle".
* A doula's birth story that highlights some of the ways a doula can play an important role in a planned cesarean
* The Unnecesarean links to this excellent piece on the co-opting of "pregnancy is not a disease" by anti-contraception organizations, and then breaks it down:
* And for the lighter side of things... I've just discovered the webcomic Married to the Sea, and in celebration they clearly did a comic just for me:
There are lots more!
In the meantime, some links:
* Jessica Valenti on learning to love her baby through a harrowing delivery and long NICU stay
* From Birthing Beautiful Ideas, these are many of the reasons that I too love being a doula!
* Elita at Blacktating ponders the idea of the "relief bottle".
* A doula's birth story that highlights some of the ways a doula can play an important role in a planned cesarean
* The Unnecesarean links to this excellent piece on the co-opting of "pregnancy is not a disease" by anti-contraception organizations, and then breaks it down:
...this whole conversation is ridiculous. We are only having it because somebody, somewhere, is upset that women are having sexy non-babymaking funtimes they don’t approve of, and they’re determined to make us all pay for their inability to deal with not everybody agreeing with them that this is bad.Go on, read the whole thing!
* And for the lighter side of things... I've just discovered the webcomic Married to the Sea, and in celebration they clearly did a comic just for me:
There are lots more!
Wednesday, August 10, 2011
Link party! CBACs, Fulbrights, and bras
I am on the road! Excited to be traveling to a favorite city to help with and attend the wedding of a great friend. I have several posts in the "What every doula should know about breastfeeding" series in progress, but I don't know how much work I'll get done on them in the next week. So in the meantime, a few links!
A planned, empowered, and enjoyable CBAC story (by a mother who had already had one c-section and a VBAC). "I will never forget these moments. Ever. They were beyond perfect. At last a very beautiful, calm and positive birth experience. I felt fully supported, I felt my son and I were in good hands. My husband and I were respected, and the birth truly was a celebration."
A step-by-step guide for applying for a Fulbright. I am so proud of my sister who has a Fulbright next year to study sustainable agriculture in west Africa! Have you ever thought about wanting to research issues related to reproductive health or other related issues in another country? A Fulbright can fund you for a year, on huge range of research topics!
I've been getting into some different bra blogs lately! They are written by women who have "unusual" sizes (in quotes because it's not unusual for women to BE these sizes, it's just unusual for them to KNOW they are these sizes). This is a great post on how many women are fitted poorly into bras and how the many different shapes and sizes that we come in are not respected:"The War on Plus Four": "...for some women, the fact that they might need a 30 or even 28 band and a significantly larger cup might seem like an alien concept as we generally have it drummed into us that a 32 is the smallest band available, and anything below this should be considered a ‘specialist’ size. Or an ‘awkward’/'odd’ size (I’ve heard it described as such and everything in-between). Even the idea that going down a band size (or even multiple sizes) makes people shudder. "
That's all for now!
A planned, empowered, and enjoyable CBAC story (by a mother who had already had one c-section and a VBAC). "I will never forget these moments. Ever. They were beyond perfect. At last a very beautiful, calm and positive birth experience. I felt fully supported, I felt my son and I were in good hands. My husband and I were respected, and the birth truly was a celebration."
A step-by-step guide for applying for a Fulbright. I am so proud of my sister who has a Fulbright next year to study sustainable agriculture in west Africa! Have you ever thought about wanting to research issues related to reproductive health or other related issues in another country? A Fulbright can fund you for a year, on huge range of research topics!
I've been getting into some different bra blogs lately! They are written by women who have "unusual" sizes (in quotes because it's not unusual for women to BE these sizes, it's just unusual for them to KNOW they are these sizes). This is a great post on how many women are fitted poorly into bras and how the many different shapes and sizes that we come in are not respected:"The War on Plus Four": "...for some women, the fact that they might need a 30 or even 28 band and a significantly larger cup might seem like an alien concept as we generally have it drummed into us that a 32 is the smallest band available, and anything below this should be considered a ‘specialist’ size. Or an ‘awkward’/'odd’ size (I’ve heard it described as such and everything in-between). Even the idea that going down a band size (or even multiple sizes) makes people shudder. "
That's all for now!
Tuesday, August 2, 2011
What every doula should know about breastfeeding: Tip #3: A few must-knows for pumping
Preface: Often as a doula, before I became an LC, I would encounter situations in the hours after the baby was born, or at postpartum visits, where I wasn't quite sure what to suggest; or looking back, I realize I could have done something differently. I've decided to share some tips with other doulas about things that I wish I had known long ago! Today is Tip #3: A few must-knows for pumping.
There are a number of reasons your doula client may want or need to pump, including increasing her milk supply/getting additional stimulation to bring in a good supply, and pumping for a baby who can't latch and/or is in the NICU. Some mothers will end up (short- or long-term) exclusively pumping, aka EPing. If your client is EPing because of latch issues including difficulty getting the baby to latch or pain with nursing, make sure she sees a good LC fast!
Like some other topics in this series, I am bummed to have to give many of these pumping tips to doulas, not because I don't think doulas should know this stuff, but because EVERYONE involved in caring for new moms/babies should know this stuff! Moms often do not get the support they need to make pumping successful. But knowing that doulas are there to fill in the gap, these are important things that you may be the only one to discuss.
These tips are by no means all anyone needs to know about pumping, but they are opportunities for the doula to fill in gaps in knowledge:
With that thought in mind, I am putting two very simple, very important tips first:
#1: Cleaning: On a Medela, the valve and flange come preassembled, like this:
With that thought in mind, I am putting two very simple, very important tips first:
#1: Cleaning: On a Medela, the valve and flange come preassembled, like this:
So nobody realizes that the yellow valve and white membrane come off and come apart, like this:
On an Ameda, the valve and flange also come preassembled; their valve looks like this:
Every time the mother uses the pump, those parts should be completely taken apart, washed, and dried separately. If those pieces are not taken apart, milk and moisture can accumulate between them and cause problems like poor pump suction and mold growth (EW, I know.)
People just do not know this; I know people who pump for months or YEARS and do not know this. Tell your doula clients! Tell all your friends! Rent out a billboard! Pump valves come OFF THE PUMP!
#2) Flange fit.
***ATTENTION: PUMP FLANGES COME IN DIFFERENT SIZES.***
Look at this picture:
GOOD FIT
Now look at this one:
TIGHT FIT
(Both images taken from this simple, lovely page by Ameda.)
I carry a copy of these two pictures around with me at work (I know, I know... my job is so cool!) Any pumping mother, when asked, can tell you whether her pumping sessions look more like the first photo or the second photo (occasionally they'll say "well, kind of halfway between the two" which still suggests a tight fit.)
The wrong size flange can cause pain and low supply. Once again, mothers pump for YEARS with the wrong flange and say "The pump never worked very well for me" or "Pumping always hurt for me", never knowing there was any size flange but the one that came with the pump!
If you know a mother will be pumping a lot, show her these pictures and tell her in advance to keep an eye on flange fit (consider printing the pictures out and keeping them in your doula bag). Mothers may start out a pumping session with what looks like a good fit, and end it with a tight fit; those women should get a bigger flange. They may also be OK on one size for a while, then start to need a bigger size after a few days or weeks of pumping; those women should also get a bigger flange.
The "standard" size in the box is the 24mm flange. Both Medela and Ameda manufacture various sizes up to a 36mm flange, and Medela also makes a 40mm flange. They can be purchased at stores like Buy Buy Baby, Babies R Us, Target, local lactation consultants, or baby boutiques; or they can be ordered online.
Many mothers find that the Pumpin Pals brand shields are more comfortable for long-term use than the standard flange that comes with their pump kit; Pumpin Pals flanges can be used with a number of different pump brands. They're angled and more curved than standard flanges, so many mothers report they feel gentler on the breast, and they also allow the mother to lean farther back when she's pumping.
#3) Early pumping: As I noted in my hand expression post, pumps are usually NOT very effective at removing milk in the early days. Mothers of a fussy baby may sometimes ask to pump to see "if there's anything there". The pump will not help her with that! Counsel the mother who wants or needs to pump in the first 1-3 days that she may not see much with the pump, and help her learn hand expression to maximize the amount she can get out. Mothers who are totally pump-dependent are understandably discouraged by pumping and pumping and getting a single drop. Give them lots of cheerleading and support, and reassure them that they will see more milk within a few days.
#4) She needs a great pump, aka not all pumps are created equal: If your doula client needs to or decides to EP, DO NOT let her buy a crappy, low-power pump. I usually don't talk in such absolutes, but it has to be said. There are some women who can get and maintain a great supply on those $70 pumps; they are in the tiny minority. Usually women buy one of those pumps because they see the price of a Medela or Ameda as prohibitive, but once they've bought a crap pump they've now sunk $70 into something that causes supply issues, and quite possibly nipple trauma (I'm looking at you here, Early First Years pump) AND they're looking at spending again on a high-quality pump. These situations just about break my heart. If the mother wants to provide exclusive breast milk, she needs a better pump.
She should also NOT get a single-sided pump, or anything with a little motor like the Medela Freestyle. These pumps are OK for the occasional pumper, not for the EPer. Once again, some women can maintain a supply on these pumps, but if they can't they've just wasted a lot of money and are going to have to spend even more. If she chooses to rent a pump instead of buy, you are on safer ground as she will be renting a hospital-grade pump which are all double electrics and have good suction/motors. (If she is struggling with supply and using a good consumer-grade pump like a Medela Pump in Style, she should also consider upgrading to a hospital-grade rental. Moms with supply issues need the best stimulation possible!) When thinking about pump prices, help her think about the value of the milk she will be pumping out. Good pumps are expensive - but so is formula.
If your doula client has difficulty affording a pump, check to see if she is enrolled in WIC, and if not encourage her to try to enroll. Any mother on Medicaid will be eligible for WIC, but even if she is not on Medicaid her income may still qualify her. (She does NOT need to be a US citizen or resident to enroll in WIC; after all, her baby, the one who will be getting the milk, is a citizen.) Many WIC offices have loaner pumps available for mothers who need to pump for medical reasons. If she tells the WIC office she is enrolling because she needs a pump, they may expedite her enrollment to make sure she gets the pump quickly.
#5: Support! EPing is not easy (even though to some moms it may seem like a quicker fix for latch issues in the beginning.) These moms often struggle with low supply, and with the extra time and work it takes to clean pump parts, bottles, carry the pump everywhere, etc. Suggest EPing moms join an online support group - they can really use the support and camaraderie, and it is easy for them to feel like they are all alone when they don't know other pumping moms nearby.
Mothers who have issues with supply or pain issues while EPing should of course be referred to your favorite local lactation consultant! LCs are not just for direct breastfeeding; they can have excellent resources and advice on pumping comfort, ways to build supply, and may even be able to help get the baby back to the breast if that's possible.
---
I bet there are some long-term pumpers out there - what do you wish doulas (or birth professionals in general) knew about pumping?
Monday, August 1, 2011
Conferences, everywhere!
With a number of my work colleagues just returned from the International Lactation Consultant Association (ILCA) conference, I've started pondering about how to use the education $$ available from our department to go to a conference myself.
The APHA conference is coming up...ooh, the chance to check out lots of breastfeeding and MCH-related public health workshops/connections! (And let's just say, that conference is not cheap. I would love for my work to cover it!) That is late Oct/early Nov.
Then there's the Academy of Breastfeeding Medicine conference, also in early Nov. They have a track for non-physicians that I would love to attend. So much fascinating stuff on international issues!
If Health Connect One has another conference, I would be so excited to attend...hoping they announce one soon.
Let's not forget the next ILCA conference is a year from now in Orlando!
The APHA conference is coming up...ooh, the chance to check out lots of breastfeeding and MCH-related public health workshops/connections! (And let's just say, that conference is not cheap. I would love for my work to cover it!) That is late Oct/early Nov.
Then there's the Academy of Breastfeeding Medicine conference, also in early Nov. They have a track for non-physicians that I would love to attend. So much fascinating stuff on international issues!
If Health Connect One has another conference, I would be so excited to attend...hoping they announce one soon.
Let's not forget the next ILCA conference is a year from now in Orlando!
And although it wouldn't be connected directly enough with my job (so I'd have to pay my own way) - having missed this year's, I am really determined to attend next year's CLPP conference (and I'd like to do a workshop - I am brainstorming ideas at the intersection of birth/breastfeeding/reproductive justice if anyone would like to collaborate!)
Any other conferences out there you'd suggest, or planning on going to?
Sunday, July 31, 2011
What every doula should know about breastfeeding: Tip #2: When to refer, how to refer
Preface: Often as a doula, before I became an LC, I would encounter situations in the hours after the baby was born, or at postpartum visits, where I wasn't quite sure what to suggest; or looking back, I realize I could have done something differently. I've decided to share some tips with other doulas about things that I wish I had known long ago! Today is Tip #2: Referring to advanced support.
Knowing when to refer and how to refer mothers to advanced breastfeeding support is a vital part of a doula's role in supporting breastfeeding.
WHY to refer:
As doulas, we spend hours, sometimes days with our clients through one of the most intense experiences of their lives. You often end up very bonded and very invested, and when breastfeeding issues arise you're ready to jump in and do everything to make it work.
Resist the temptation to solve everything for your client!
On doula listservs I sometimes see questions like, "My client's baby's weight is down 12% and she's having to supplement with formula. What can I do to help her?" or "My client's baby just won't latch, should I suggest she do a lot of skin-to-skin?" You can give so much to a client in this situation: compassion, practical support, a listening ear at 2 a.m.; but the most important thing you can give her is a referral to a lactation consultant and the encouragement to call ASAP. She has a problem that needs quick professional help; it will probably not be helpful to her for you to come back in a couple days with tips from people who have never met her.
A 3-5 day CLC/CLE/CBE etc. course is wonderful (as is years of experience breastfeeding your own babies, helping friends, etc.) but KNOW YOUR SCOPE and be careful about venturing slowly into deeper and deeper waters where suddenly you discover you're in way over your head. It is so easy to get drawn into helping beyond your expertise. I speak from experience! I have written about how the more I learn, the more I realized I didn't know. I say this knowing that I, myself, would sometimes get in over my head when helping clients in AmeriCorps; our supervisor was a midwife who could help out when we were stuck, but she wasn't always available and I was trying to fix things knowing the patients might not be able to come back for a follow-up visit. I honestly cringe at some of the advice I used to give! It wasn't terrible or harmful, but it was probably really unhelpful.
In general, think of yourself as a "breastfeeding emergency first responder". You should provide the same services as any emergency first responder - do what you can at the moment to help the patient, offer them comfort and support, and then get them to advanced care. So absolutely suggest that the mom whose baby isn't latching do lots of skin-to-skin - and then help her find an LC who can assess why this is happening and how to fix it.
In the meantime, support the mother and remember the rules:
Rule 1) FEED THE BABY (in whatever way is necessary; sometimes bottles and formula ARE necessary);
Rule 2) Protect the milk supply (through pumping and/or hand expression if the baby is not feeding effectively at the breast).
WHEN to refer:
Not sure if your client is having just some normal latch pain and things are going to get better? Not sure if the weight is a real concern or just a temporary dip?
Here's a (partial) list of situations in which your client should DEFINITELY be referred to an LC (do not pass Go, do not collect $200):
HOW to refer:
To refer your clients, you need to know about the lay of the land in your community. Who are the lactation consultants? Where are they based - pediatric offices, hospitals, private practice? Does the mother have to go to them, or do they do home visits? What do they charge and how do they bill the mother's insurance? (For example, at our hospitals outpatients' insurance is billed for a nurse visit and the mother has a small co-pay; a private practice LC will generally be paid up front and the mother must apply for reimbursement.) For lower-income mothers, is there a WIC breastfeeding support program that has an IBCLC?
As you're getting to know the lactation support resources in your community, please read Best for Babes' Is Your Lactation Specialist an Imposter? Not all lactation "helpers" are lactation consultants; and sad to say, not all lactation consultants are supporting moms the way they should. This is true of every profession; hopefully, you would not refer your doula clients to a midwife just because she had "CNM" or "CPM" after her name, assuming she provided optimal midwifery care, because not all midwives practice in ways that are consistent with a compassionate, evidence-based midwifery model of care. You would want to talk with other doulas, mothers, and providers - or work with the midwife directly - to know that she provided the kind of care you were comfortable recommending. I have worked with midwives I would refer my clients to, and midwives I would warn them away from; the same goes for LCs. You help your clients by finding trusted people you can refer to.
Ask local La Leche League leaders, mothers, doulas, midwives, doctors, and other community resources who they trust and recommend. Listen for specifics of how they deal with different issues, and whether the mothers who use them found them to be sympathetic and helpful. And, while this is a little delicate, keep your ear to the ground for the people who are not recommended or who you hear about giving questionable advice. Of course, even the best provider will have some dissatisfied patients (again, you may have an absolute favorite midwife and meet someone who had a bad experience with her - maybe it just wasn't a good personality fit, or a bad day.) But when you hear the same poor feedback over and over about somebody, it could be a sign to have your ears perked if your client mentions working with that person. (And if you know a hospital doesn't have LCs on staff, and the mother says "But the lactation consultant in the hospital said her latch was perfect!"...be skeptical.)
Knowing when to refer and how to refer mothers to advanced breastfeeding support is a vital part of a doula's role in supporting breastfeeding.
WHY to refer:
As doulas, we spend hours, sometimes days with our clients through one of the most intense experiences of their lives. You often end up very bonded and very invested, and when breastfeeding issues arise you're ready to jump in and do everything to make it work.
Resist the temptation to solve everything for your client!
On doula listservs I sometimes see questions like, "My client's baby's weight is down 12% and she's having to supplement with formula. What can I do to help her?" or "My client's baby just won't latch, should I suggest she do a lot of skin-to-skin?" You can give so much to a client in this situation: compassion, practical support, a listening ear at 2 a.m.; but the most important thing you can give her is a referral to a lactation consultant and the encouragement to call ASAP. She has a problem that needs quick professional help; it will probably not be helpful to her for you to come back in a couple days with tips from people who have never met her.
A 3-5 day CLC/CLE/CBE etc. course is wonderful (as is years of experience breastfeeding your own babies, helping friends, etc.) but KNOW YOUR SCOPE and be careful about venturing slowly into deeper and deeper waters where suddenly you discover you're in way over your head. It is so easy to get drawn into helping beyond your expertise. I speak from experience! I have written about how the more I learn, the more I realized I didn't know. I say this knowing that I, myself, would sometimes get in over my head when helping clients in AmeriCorps; our supervisor was a midwife who could help out when we were stuck, but she wasn't always available and I was trying to fix things knowing the patients might not be able to come back for a follow-up visit. I honestly cringe at some of the advice I used to give! It wasn't terrible or harmful, but it was probably really unhelpful.
In general, think of yourself as a "breastfeeding emergency first responder". You should provide the same services as any emergency first responder - do what you can at the moment to help the patient, offer them comfort and support, and then get them to advanced care. So absolutely suggest that the mom whose baby isn't latching do lots of skin-to-skin - and then help her find an LC who can assess why this is happening and how to fix it.
In the meantime, support the mother and remember the rules:
Rule 1) FEED THE BABY (in whatever way is necessary; sometimes bottles and formula ARE necessary);
Rule 2) Protect the milk supply (through pumping and/or hand expression if the baby is not feeding effectively at the breast).
WHEN to refer:
Not sure if your client is having just some normal latch pain and things are going to get better? Not sure if the weight is a real concern or just a temporary dip?
Here's a (partial) list of situations in which your client should DEFINITELY be referred to an LC (do not pass Go, do not collect $200):
- Painful nipples throughout the feeding...
- ....especially with any signs of nipple trauma (cracking, bleeding, blisters)
- ....especially if the mother tells you she "dreads" feedings, that she cries from pain during the feeding, that she puts off feedings or limits their length because of pain, or that she is exclusively pumping because of latch pain
- Excessive weight loss or poor weight gain in the baby, or any concern for weight that leads the baby's doctor to recommend supplementation
- A mother who was sent home from the hospital supplementing the baby (via any method, not just bottles) without clear further instructions about when/how to stop supplementing
- A baby who refuses to latch or does not latch consistently; the mother may describe feedings as "battles" or "fights" that drag out, sometimes for over an hour
HOW to refer:
To refer your clients, you need to know about the lay of the land in your community. Who are the lactation consultants? Where are they based - pediatric offices, hospitals, private practice? Does the mother have to go to them, or do they do home visits? What do they charge and how do they bill the mother's insurance? (For example, at our hospitals outpatients' insurance is billed for a nurse visit and the mother has a small co-pay; a private practice LC will generally be paid up front and the mother must apply for reimbursement.) For lower-income mothers, is there a WIC breastfeeding support program that has an IBCLC?
As you're getting to know the lactation support resources in your community, please read Best for Babes' Is Your Lactation Specialist an Imposter? Not all lactation "helpers" are lactation consultants; and sad to say, not all lactation consultants are supporting moms the way they should. This is true of every profession; hopefully, you would not refer your doula clients to a midwife just because she had "CNM" or "CPM" after her name, assuming she provided optimal midwifery care, because not all midwives practice in ways that are consistent with a compassionate, evidence-based midwifery model of care. You would want to talk with other doulas, mothers, and providers - or work with the midwife directly - to know that she provided the kind of care you were comfortable recommending. I have worked with midwives I would refer my clients to, and midwives I would warn them away from; the same goes for LCs. You help your clients by finding trusted people you can refer to.
Ask local La Leche League leaders, mothers, doulas, midwives, doctors, and other community resources who they trust and recommend. Listen for specifics of how they deal with different issues, and whether the mothers who use them found them to be sympathetic and helpful. And, while this is a little delicate, keep your ear to the ground for the people who are not recommended or who you hear about giving questionable advice. Of course, even the best provider will have some dissatisfied patients (again, you may have an absolute favorite midwife and meet someone who had a bad experience with her - maybe it just wasn't a good personality fit, or a bad day.) But when you hear the same poor feedback over and over about somebody, it could be a sign to have your ears perked if your client mentions working with that person. (And if you know a hospital doesn't have LCs on staff, and the mother says "But the lactation consultant in the hospital said her latch was perfect!"...be skeptical.)
If you develop a relationship with an LC, or a few LCs, that you consistently refer to, you may also develop a referral system. Many LCs will welcome a phone message or e-mail from a doula or other professional working with the mother, who can offer an outside perspective on what has been happening and why the mother is being referred. Talk to the LCs you work with about whether this would be helpful.
Even when you've helped your client find a great LC, your client may be hesitant to pay for a lactation consultant - especially since with a private practice LC they will need to pay up front. Help her think through the cost of formula, or even of exclusive pumping (which some women seem to regard as a quick solution for any breastfeeding problem, without understanding that it brings its own distinct challenges.) Talk to her about how she saw the value in hiring a trained labor support person; hopefully she will see the same value in finding professional breastfeeding support.
A lot of women seem to feel guilt or frustration for needing to turn to someone for help at what is supposed to be "natural" (I say "it might be natural, but it doesn't always come naturally!") You can discuss some women's need for lactation support with your client at prenatal visits, so your clients who need LCs know in advance that they're not "failing" or somehow strange for needing an LC. You can include information about LCs you recommend in your prenatal information packets.
If you can, follow up with the mother about the LC visit, how it went, and how things are progressing; or encourage her to call you if things are still not going well. If the mother did not feel helped by the first LC she sees, offer to help her find someone else, especially if you are not sure about that LC's qualifications. And of course, support and empower her in whatever challenges she is facing, and listen to and validate her concerns.
Even when you've helped your client find a great LC, your client may be hesitant to pay for a lactation consultant - especially since with a private practice LC they will need to pay up front. Help her think through the cost of formula, or even of exclusive pumping (which some women seem to regard as a quick solution for any breastfeeding problem, without understanding that it brings its own distinct challenges.) Talk to her about how she saw the value in hiring a trained labor support person; hopefully she will see the same value in finding professional breastfeeding support.
A lot of women seem to feel guilt or frustration for needing to turn to someone for help at what is supposed to be "natural" (I say "it might be natural, but it doesn't always come naturally!") You can discuss some women's need for lactation support with your client at prenatal visits, so your clients who need LCs know in advance that they're not "failing" or somehow strange for needing an LC. You can include information about LCs you recommend in your prenatal information packets.
If you can, follow up with the mother about the LC visit, how it went, and how things are progressing; or encourage her to call you if things are still not going well. If the mother did not feel helped by the first LC she sees, offer to help her find someone else, especially if you are not sure about that LC's qualifications. And of course, support and empower her in whatever challenges she is facing, and listen to and validate her concerns.
Note for community-based and/or volunteer doulas:
If you are working with low-income women, they may be in a very difficult situation. We confronted this issue a lot when I was working in AmeriCorps. Ask around for low-cost resources like WIC, LCs who are willing to do pro bono work (especially if it is referred by a doula who knows the mother's financial situation), LCs working at hospital-based clinics that may take Medicaid, and free mother-to-mother support groups that the mother would be comfortable attending (keep in mind some women may feel out of place in settings like La Leche League meetings). Be proactive about helping the mother get in touch with these resources.
If you are the only help available to a mom, ask around for LCs/LLLLs/other resources who might be willing to talk you through problems or offer suggestions, and again be very careful about not overstepping your boundaries. While it's hard to see a situation go down the tubes, and you want to throw every idea you have at the problem to fix it, it is actually better for a mother to give up breastfeeding than for her or her baby to be harmed by poor advice... and it's hard to know what's poor advice if you're stepping outside your scope of practice.
If you are working with low-income women, they may be in a very difficult situation. We confronted this issue a lot when I was working in AmeriCorps. Ask around for low-cost resources like WIC, LCs who are willing to do pro bono work (especially if it is referred by a doula who knows the mother's financial situation), LCs working at hospital-based clinics that may take Medicaid, and free mother-to-mother support groups that the mother would be comfortable attending (keep in mind some women may feel out of place in settings like La Leche League meetings). Be proactive about helping the mother get in touch with these resources.
If you are the only help available to a mom, ask around for LCs/LLLLs/other resources who might be willing to talk you through problems or offer suggestions, and again be very careful about not overstepping your boundaries. While it's hard to see a situation go down the tubes, and you want to throw every idea you have at the problem to fix it, it is actually better for a mother to give up breastfeeding than for her or her baby to be harmed by poor advice... and it's hard to know what's poor advice if you're stepping outside your scope of practice.
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I loved the feedback on the last post, and welcome comments on this one! More tips to come!
Wednesday, July 20, 2011
The IUD comeback
When I was in college, I remember IUDs being completely dismissed as a form of contraception - they were barely even discussed, but I got the impression that they were some quasi-medieval little device that was only used by women who had already had at least 4 children.
Come grad school, IUDs were a hot topic in my MCH class, both academically and personally. For the personal side, at least a third of our cohort got IUDs, and academically they came up in almost every class discussion of family planning as an increasingly popular and very effective method of long-term contraception.
This Wired article does a nice job of summarizing the history behind the rise, fall, and rise again of the IUD.
There is plenty of reason to believe that more American women will be adopting the IUD when you compare our IUD use prevalence to that of other European countries, including Norway which tops out at 27% prevalence IUD use!
One interesting note is the price of getting an IUD in the U.S.
Most people I know had insurance that did cover a pretty decent amount for the IUD and the appointment to get it inserted. But if you're paying out-of-pocket, it is a big investment even knowing that in the end it will probably be cheaper than other methods. Compare the prices we are paying in the U.S. with this: I have a friend working on an IUD project in West Africa. They offer only the Paragard (copper) IUDs. Price for the IUD + insertion? $3. Her expat friends get their IUDs before they come back to the U.S.
Come grad school, IUDs were a hot topic in my MCH class, both academically and personally. For the personal side, at least a third of our cohort got IUDs, and academically they came up in almost every class discussion of family planning as an increasingly popular and very effective method of long-term contraception.
This Wired article does a nice job of summarizing the history behind the rise, fall, and rise again of the IUD.
By the early 1970s, 17 IUDs were under development by 15 different companies. The problems started with the fourth one to actually hit the market: the Dalkon Shield. AH Robins (which also made ChapStick and Robitussin) marketed one version of it as a smaller option for women who didn’t have children. Like all medical devices at the time, the Shield wasn’t vetted by the FDA. While drugs got careful screening, safety and efficacy claims on device labels did not. The FDA stepped in only if people started reporting problems. And report they did. ...
The new research [in the 90s] and thinking on IUDs had important implications for the future of the device. For one thing, it’s clear that doctors should not put it into women who have an active STD infection. (And even then, it’s only bacterial infections like chlamydia and gonorrhea that are problems; infection with the widespread human papillomavirus doesn’t disqualify anyone.) For another, inserting it under sterile conditions is paramount. To the people running these studies—and the doctors who read them in medical journals—the results were reassuring. There was nothing wrong with IUDs as a technology. ...
IUDs are on the verge of a remarkable return to popularity. Nationally, 5.5 percent of women using contraception choose them. That sounds unimpressive, but it’s the first time in more than 20 years that the number has risen above 2 percent; in 1995, it was 1.3 percent. By that baseline, 5.5 percent represents a sea change. And a few pharmaceutical companies believe that number is poised to grow.
There is plenty of reason to believe that more American women will be adopting the IUD when you compare our IUD use prevalence to that of other European countries, including Norway which tops out at 27% prevalence IUD use!
One interesting note is the price of getting an IUD in the U.S.
Also, the devices are expensive—the ParaGard costs $500, the Mirena $850. “It’s absolute highway robbery that these companies charge so much,” Espey says. “If you went to Home Depot and got the raw materials for a copper IUD, it would cost less than 5 cents.” And the hormones don’t contribute much more to the cost, she adds.
In fact, amortized over years of use—10 for the ParaGard and five for the Mirena—an IUD is far cheaper than birth control pills, which can cost $30 or more a month. But the initial outlay is difficult for some women to manage, and it’s not always covered by insurance. Schnuriger, who comes from a working-class St. Louis family, split the $450 cost of her IUD with her boyfriend. She used money earned from a work-study job to pay her half. If she keeps the ParaGard the full 10 years, it will end up having cost $3.75 a month.
Most people I know had insurance that did cover a pretty decent amount for the IUD and the appointment to get it inserted. But if you're paying out-of-pocket, it is a big investment even knowing that in the end it will probably be cheaper than other methods. Compare the prices we are paying in the U.S. with this: I have a friend working on an IUD project in West Africa. They offer only the Paragard (copper) IUDs. Price for the IUD + insertion? $3. Her expat friends get their IUDs before they come back to the U.S.
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