Guest post: A doula's path through pregnancy/birth (Part 2: Preparation - physical, mental, and more)

My friend and fellow AmeriCorps doula Chris wrote her first post in this guest series, "A doula's path through pregnancy and birth", way back in April: Part 1: Prenatal care and education. As she notes at the beginning of this next post, time flies (for me, too!) so this next installment is a little delayed. But I think it's very well worth the wait - there's so much great advice and experience in here (check out the birth plan, for example.) Big thanks to Chris for working so hard on it!

Birth story is coming very soon!

(And if you haven't already, don't forget to check out Chris's intro post, one of my favorite doula stories from our year in AmeriCorps.)

----

So I had big plans of writing about how we were preparing for birth as we were actually preparing. Then life got away from me, and all of a sudden here I am writing about preparing for birth while my 6-month old baby girl is asleep.  The upside is that I’ve had a chance to reflect on how our preparations affected our experience of birth, and I can comment on the parts that (in hindsight) seem particularly important.  Here’s what we did, and soon you can read about how it worked out.  

Luckily my pregnancy proceeded without complication, and Kevin and I started preparing for birth pretty early.  Rebecca has a post about why you shouldn't "try" to have an unmedicated birth--you have to prepare to have one (like you prepare for running a marathon; you don't just get up and try it).  I think the comparison between endurance running and giving birth is apt.  Both require preparation in many different ways--physically, mentally, and emotionally.  Here's how we got ready.

Physical Preparation:
I started going to a prenatal yoga class quite early in the pregnancy, at maybe 12 weeks.  I felt a little silly at first, sitting in the room with all these women sporting huge bellies and due dates only weeks away, but my fantastic teacher Cundy says there is no such thing as too early or too late to start prenatal yoga--the important thing is just to get there.  I went to yoga once or twice a week almost every week for the rest of the pregnancy.  It was excellent physical preparation for labor--lots of pelvic strengthening work, lots of squatting, and lots of practice with deep relaxing breathing.  I think it was also an excellent mental break every week, and a chance to absorb positive messages about giving birth.

I did my best to stay active with cardiovascular exercise while pregnant.  I ran pretty regularly prior to getting pregnant, though that ended with the first trimester (I ran/walked the Athens half marathon at 13 weeks pregnant, and after that set my running shoes aside).  I walked all day every day for work as a high school teacher, and also made long walks part of my weekly routine.  As my belly grew my walks got shorter.  :)  Interestingly, when I was newly pregnant walking was about the only way I got any relief from the near-constant nausea.  I think it had to do with the breathing.

Looking back after the delivery, I can say that I am glad I stayed relatively active and I'm particularly glad I stuck with the yoga so regularly.  Though I remember feeling exhausted while in labor, it was more of the I've-been-up-all-night-can't-I-have-just-a-few-minutes-to-sleep tired, not the type of fatigue one feels from reaching the limits of what your muscles can do.  I felt strong even as I felt exhausted.

Mental Preparation
Pretty soon after realizing we were pregnant, I sat Kevin down and we watched The Business of Being Born.  (FYI: you can stream this movie via Netflix).  If you're on the fence about what kind of birth you want to have or if you're looking for encouragement to have a natural, normal birth, this movie is a must-watch.  You see a little more of Ricki Lake than you ever thought you would, but I know every time I watch that movie I come out of it thinking Ricki is pretty much a rock star.  It's also a great one to watch if you are trying to get a loved one on board with your ideas about birth, midwifery care, or how to avoid getting sucked into the medical monster.  Put it on your list!  We also watched the movie Babies (the one that follows infants in different parts of the world through their first year).  That baby in Mongolia is VERY cute.

My mama taught me that there’s no such thing as too much reading, and my doula experience exposed me to some titles that everyone planning for a non-medicated birth should know about.  So upon getting a positive pregnancy test, I busted out my copy of the trusty Pregnancy, Childbirth, and the Newborn by Penny Simkin and ordered The Pregnancy Book and The Baby Book (both by Dr. Sears), which I read in chunks here and there. I ordered my wonderful husband a copy of Simkin’s The Birth Partner.  He worked his way through it over the course of the pregnancy, starting with his biggest concern--how to deliver the baby in an emergency.  :)  I also enjoyed Ina May’s Guide to Childbirth, which was wonderful--I’m an especially big fan of her chapter on Sphincter Law.  It gave me lots to think about.  As the pregnancy progressed, the question “How on earth do you take care of a baby?!” occupied more and more of my brain, and I read the ubiquitous Happiest Baby on the Block by Harvey Garp, which backs up a lot of what the Sears book teaches.  One book that I thought would at least be funny but turned out to not work for me at all was The Girlfriend’s Guide to Pregnancy, which was recommended to me by pretty much everybody I know who has had a baby in the last 10 years.  I read some of it and wound up feeling fat and neurotic--two adjectives that I don’t think generally apply to me, pregnant or not.  I quit reading it about halfway through, and wouldn’t recommend it.  Later in the pregnancy I read a book on the Bradley method for childbirth.  Most of it didn't really suit me--I found it to be way too structured--but I did like the parts about visualization and relaxation during contractions.

After we hit 20 weeks, we started the most important mental preparation we did--our prenatal Centering program.  Centering is basically group prenatal care for the second half of the pregnancy.  Every other week, Kevin and I met with a midwife and a group of 3 other couples due at roughly the same time we were.  The meetings (which happened in the evening, to accommodate work schedules) started with individual check-ins with the midwife to listen to the fetal heart tones and discuss any private concerns.  We also checked our own blood pressure and weight and peed in the obligatory cup.  After that we sat down as a group to discuss anything that was going on with our pregnancies.  It was a great time to get ideas for dealing with discomfort, to see what other people were reading, and to get some reassurance about what was happening with our bodies and our lives.  We also did potluck dinners, which was really fun.  Finally, we would discuss a topic relevant to pregnancy and birth, and in that respect it was a lot like a childbirth class.  We covered the progress of labor and birth, options for pain management, breastfeeding basics, and how to take care of a newborn.  Our centering group really connected, and we've stayed in touch even now that all the babies are on the outside.

Because I had a very solid background in childbirth education through my doula work, and since we were already covering lots of relevant topics in Centering, we decided that a full-scale multi-week childbirth class was not for us.  But when the opportunity arose to take an independent one-day childbirth course taught by a very well-respected member of the Athens pregnancy/early-parenting community, we decided to go for it.   It turned out to be a good review for me and a great way for Kevin to run through everything we learned in Centering again.  We practiced with birth balls and rebozos, worked on breathing and relaxation, and focused on the principles that set you up for a normal birth.  We are very lucky to live in a community with excellent resources for prenatal support and education.  Between Centering, midwifery care, prenatal yoga, and our childbirth class, we both felt confident as I approached the end of the pregnancy.

In the last few weeks of the pregnancy, we created our birth plan.  At first I started with a list of things that I did NOT want, but after a little bit of writing I realized that type of birth plan was probably not the most useful approach.  I think I needed to work through some of the baggage I had from the difficult, medicalized births I had seen as a doula.  But through writing down what I was worried about, I came to the understanding that by making smart choices about my prenatal care, a lot of my concerns would not be an issue.  I didn’t need to write “no episiotomy” on my birth plan because not one of the midwives in our practice would ever dream of doing a routine episiotomy.  We'd had a chance to discuss a lot of potential hospital pitfalls during Centering, and I came away feeling confident that these midwives were for real.  Their very low c-section and induction numbers backed me up.  So I rewrote the birth plan and talked it through with our doula.  This is what we came up with:

Labor:
We have been preparing for a normal, unmedicated birth.  Any suggestion or assistance that supports that goal is welcome.  Christine is aware of all medical pain management options and will ask for them if wanted.  We are working with a doula and her support is important to us.

Delivery:
Immediate skin to skin contact is a priority, as is early breastfeeding. We would like all newborn exams performed while we hold the baby. Kevin would like to cut the cord once it has stopped pulsing.

Newborn Care Preferences:

• Christine intends to breastfeed--please no bottles or pacifiers.
• We plan to use Dr. M as our pediatrician.  We will begin the baby’s Hepatitis B vaccinations through Dr. M’s office.  
• We would like the vitamin K injection and eye ointment to be delayed until we have had some time to spend with our new baby.  
• We would like the baby to stay in the room with us for as much of the time as possible. If it is necessary for the baby to stay in the nursery, Kevin would like to stay with her.
• We would like to help give the baby her first bath.  

In case of cesarean:
We ask that as many of our preferences regarding delivery and newborn care as possible be respected (family-centered cesarean).  Kevin would like to be in the operating room, and we request to be included in all decisions related to the care of our baby.  

In case of baby in the NICU:
Just as with a cesarean, we request that as many of our above preferences as possible be respected, and we ask for any support available to promote breastfeeding.  We would also like to spend as much time as possible giving skin-to-skin contact.

Thank you!
Kevin & Christine

I think it's also worth noting what we did NOT do prior to the birth.  We did not spend one minute watching nonsense "reality" childbirth shows on TV. While this choice could most directly be attributed to not having cable, I wouldn't have wanted to watch that stuff anyways.  They present a sensationalized version of childbirth that makes having a baby look like a scary emergency every time.  If you want to have a normal, unmedicated birth, the last thing you need is a bunch of stories emphasizing worst-case scenarios and medical-model labor.  It's totally normal to be thinking about birth and the baby all the time, but if you want to immerse yourself in learning about birth, spend some time reading or go whole-hog and get MORE Business of Being Born, good old Ricki's new project that is an even more in-depth treatment of natural birth than the original BofBB.

People Preparation
One aspect of birth that I think can be easy to overlook is figuring out exactly who you want to be with you when it’s actually baby time.  Your caregiver and your partner are obviously very important, but it’s worth considering who else you want with you when you’re in labor.  It’s also worth it to start talking to the people who are important to you ahead of time and find out what their expectations are for the day of the birth.

Kevin and I were planning to have a doula and we eventually found one, but we waited probably a little too long to actually go about our search.  I think I got the impression that in a town like Athens, doulas were practically coming out of the woodwork.  That turned out not to be the case, and about 2 months before I was due, when we finally started getting serious about the doula search, we discovered that 1) it was hard to find a doula that wasn’t booked, and 2) doulas cost more than we anticipated.  In the end we found an apprentice doula who was available and within our budget.  We almost didn’t hire her (based on the idea that my prior doula experiences had left me better prepared than the average first time mom), but in the end, I came down firmly in favor of having a doula.  Here was my reasoning:  maybe we’d be fine by ourselves if everything went perfectly smoothly, but what if something came up?  If I had a 60 hour labor, I wanted a doula.  If I had to be induced, I wanted a doula.  If we had to decide about a c-section, I wanted a doula. And you can’t just call a random doula when you’re 6cm dilated and ask her if she can hop over to the hospital.

The other people we took into consideration when planning for the birth were our parents.  All four parents live within 2 hours of us, and this being the first grandchild on either side, we knew they would want to be involved.  However, I didn’t want a bunch of people camping out in Athens, waiting for me to go into labor.  I also wasn’t sure I wanted lots of people there for every nitty-gritty moment of the labor.  I was OK with the idea of both the moms being in the room at least part of the time because I knew they wouldn’t try to pressure me to do anything I didn’t want to.  My mother had 2 unmedicated births, and Kevin’s mom had 6 babies in 6 different ways.  I was lucky that they were on board with the idea of normal birth and that I never had to explain or defend our birth plan. But even though I have a very good relationship with both my mother and my mother-in-law and had no reservation about them being present at the birth, in my head, we would wait to call them until we were admitted to the hospital and knew that I was well into active labor.

Amazingly, that’s more or less how things worked out, and everybody seemed to feel good about it in the end. My relentlessly prompt parents did arrive on my due date, before any signs of imminent labor, and they literally camped out about 20 minutes away and waited on me to have a baby (which they assumed would happen fairly soon, given the genetic tendency towards promptness).  However, since I went into labor at night, we didn’t let them know what was going on until about 5:30 the next morning, when the delivery looked pretty close.  So my mom got to be there for part of the labor and for the birth but not for so much of it that I felt like I had an audience waiting on things to move along.  We called Kevin’s parents at the same time we called my parents.  But just to prove that you can never predict birth, when they arrived after their 2 hour drive I was still laboring.  Kevin’s mom chose to stay in the waiting area, but all four grandparents were close by when it was time to meet the baby.

We are lucky to have a very low stress family situation and to live in a community where it is possible to find doulas.  But for anybody preparing for birth, I think it’s really worth it to give some thought to who will be with you on the big day and to have those conversations early.  When it’s time to have a baby, you want to feel surrounded by support and encouragement.

Emotional Preparation
I wonder if perhaps the most important preparation we did for the birth wasn't the emotional work.  It's certainly important to be fit and educated when the time comes, but I think all of that work is for naught if you don't have confidence that you can have a normal birth.  For me, a lot of that confidence came from surrounding myself with people who shared that goal.  Our Centering group provided an important emotional connection to pregnancy and birth.  Kevin and I looked forward to the social aspect of Centering--we ate together, discussed progress and difficulties, and shared the process of beginning to imagine ourselves as parents.  I also found pregnant friends through yoga class, which was another powerful affirmation of the process of growing a baby and giving birth.  I think that if I only had one piece of advice for a newly pregnant woman, it would be to surround yourself with positive people who will help you stay confident in yourself and your body.  Find pregnant friends (and friends with young children) who share your goals and priorities.

Kevin and I are not usually huge fans of what we call "barfy baby stuff"--going to someplace like Babies ‘R’ Us to make a registry was so low on our list that it never got done. (Way better registry for people who hate shopping:  do one online through BabyList).  But the one thing we did that sounds like it's straight out of TheBump.com is take a babymoon.  If you can swing it, I totally recommend it.

My school's spring break fell when I was about 36 weeks pregnant--about our last chance to take a relaxing trip prior to baby go-time.  We drove down to a cottage in Florida belonging to some friends of Kevin's family and spent a very relaxing few days swimming, enjoying the beach, and just hanging out.  It was a really nice time spent just being together, getting ready emotionally for how our lives were changing.  I think pregnancy lasts 9 months not just to give the baby time to develop but also to give the parents time to prepare themselves.  A lot of that work is emotional.  Kevin and I had been together for a decade before getting pregnant, and I think we needed a minute to say goodbye to our exclusive little club and get ready to add a new member.

One of the sweetest memories I have of Kevin and I getting ready for the birth together happened at the end, when I was right at 40 weeks pregnant.  I was feeling stressed for all kinds of reasons, and I'm sure he was too.  But instead of escalating my little freak out, Kevin sat me down, rubbed my neck, and talked me through some relaxation.  He helped me breathe, and we practiced how I would relax when the actual labor began.  I'm not sure I managed to relax physically that same way during labor, but I know I went back to that emotional space when I felt overwhelmed by the experience of giving birth.  It was a really nice place to be.

In sum, I think the ideal preparation for birth (for anybody, not just me) puts you in a place where you feel confident in your knowledge, in your caregivers, in your support system, and in your body.  If you're getting ready for birth, take inventory of how you feel about each of those areas.  If you find that any one of them doesn't make you feel good about giving birth, make the changes you need to right now.  You will thank yourself later, and so will your baby.

Can we and should we measure "lactastrophe" rates?

This started as a links post, but my commentary on the first link got long enough to qualify it as a post in and of itself! It turns out I have a little more to say about this topic than I realized. First, please go read "How often does breastfeeding just not work?" from the Academy of Breastfeeding Medicine blog:

From a health and wellbeing perspective, however, I’m not sure that it matters whether we “count” both “biological” and “perceived” insufficient lactation together. The total burden of this problem is enormous, and mothers are suffering, whether they lack glandular tissue and or they lack self-efficacy and support. We need mothers for whom lactation doesn’t work to know that they are not alone. And we need to demand research to develop the tools that will identify the underlying problems and allow us to implement the appropriate treatment.

We also need to step back from assertions that every mother can breastfeed, if she just tries hard enough. As Neifert has written, “The bold claims made about the infallibility of lactation are not cited about any other physiologic processes. A health care professional would never tell a diabetic woman that ‘every pancreas can make insulin’ or insist to a devastated infertility patient that ‘every woman can get pregnant.’ The fact is that lactation, like all physiologic functions, sometimes fails because of various medical causes.”

It's a great post and great comments. The one thing I would add is that while it does us no good to bicker about whether this person or that person "truly" had a low milk supply, on a public health/policy level I believe having these statistics could help push for change. It's also not useful to spend time picking apart an individual's c-section as "necessary" or "unnecessary" - but when we look at two hospitals, select out their low-risk populations, and compare their c-section rates, we can start to see what might be attributable to environment and what might be unavoidable. It provides a basis for us to say to the hospital with a 40% rate, "Hey, all these surgeries might seem necessary to you, but let's see what might be some underlying causes."

I have been talking with a colleague about the idea of a prospective survey tracking a population of women who are getting "ideal" breastfeeding support - women delivering at a mother- and baby-friendly facility, who have good prenatal education and postpartum support for breastfeeding, and are generally very committed to making breastfeeding work. What is the rate of "unplanned undesired weaning"/"lactation dysfunction"/"lactastrophe" among women with near-ideal circumstances? (Or as ideal as you can get in a country with no mandated paid maternity leave...) I think the results would help guide us, not toward a way to pick apart whether an individual woman "could have made it work if she tried harder" or "didn't really have a low milk supply", but towards an understanding of what is possible. Sometimes I get tired of hearing "lots of mothers don't make enough milk" and "some people just can't breastfeed". I get tired of hearing these statements not because I don't believe they are true - they are depressingly true - but because they are recited as if they are unpreventable, unmodifiable facts. If the data is used carefully and correctly, it could serve as a benchmark for measuring how much farther we can go towards preventing "lactastrophes" for all mothers.

Still, I want to inscribe that last paragraph on a freaking 10-foot-tall stone tablet somewhere and make every parent-to-be, support person, doula, and health care professional read it out loud before they receive their first education on breastfeeding. Why do so many people imbue breastfeeding with a magical evolutionary resiliency that nothing else possesses? (Is it just an overreaction to the opposite problem, the attitude that breastfeeding is fragile and usually destined to fail?) Real people suffer when those around them adopt the attitude that "every woman can breastfeed." Nuance often gets lost in the rah-rah atmosphere we use to try to shore up most women's (dismal) expectations for their breastfeeding success, but it is so necessary right now when more women than ever are trying to breastfeed and more are confronting medical conditions that make it challenging or impossible.

Reply turned post: The nightmarish vision of a baby-friendly hospital

Feministe, along with a few other things I've seen around the interwebs, has a hand-wringing post about New York City encouraging hospitals to adopt baby-friendly practices such as limiting staff access to formula, not advertise formula, not give free formula samples, etc. Caperton at Feministe describes this state-controlled gulag:

Starting September 3, baby formula will be a controlled substance at some New York City hospitals. Under the health department’s voluntary Latch On NYC program, 27 hospitals are literally hiding the baby formula under lock and key, tucking it away in distant storerooms and locked dispensaries like legitimate medications that need to be tracked. Nurses will be expected to document a medical reason for every bottle a newborn receives, and mothers will get a breastfeeding lecture every time they ask for a bottle of formula.

Cue lots of upset in the comments about how babies will go hungry.

My first response:

So many of these comments are ridiculously overdramatizing an already overdramatized issue. “Babies will be forced to wait an hour for a bottle!” No. I work as an LC at a hospital with these policies so let’s clear some things up:
1) You don’t want to breastfeed, you don’t. You get your bottles on admission and that’s the end. The LC doesn’t see you unless you ask to be seen for some reason, like engorgement.
2) You want to breastfeed, you breastfeed. Nurses can’t sneak formula behind your back. Before we started documenting the mother’s consent, there was a lot of “she said/she said” after the night shift left. The nurse claimed the mom asked for a bottle, the mom claimed the nurse gave it without permission. Now if there’s a bottle, everything is documented and no one can say they didn’t know.
3) You need a bottle, the nurse or NA brings it to you. There’s no “queue” and no one is waiting for an hour. The formula is in the cabinet with all the other supplies. (That is totally staff-facing by the way – it’s not like the parents ever know it’s locked up. So is the Tylenol and that’s not shaming people with headaches.) We limit the amount of formula we give per feeding in part because people will give insanely inappropriate amounts. A newborn has a stomach made to hold about a third of an ounce at birth. I have seen people give over two ounces at one feeding!! It’s considered an accomplishment by grandma that she got the baby to eat so much, but it is not good for the baby.
4) If you are asking for formula for personal reasons, we document the reason. If the baby needs it for medical reasons, we document that too. Again, this is not to shame anybody or demand they give us a good excuse, it is to push the medical/nursing staff to acknowledge that “the baby cried some” is not a reason to tell the mother “you need to formula feed or your baby will starve”. (You think people don’t do that? You are wrong.) Medical reasons to supplement include excessive weight loss, jaundice associated with poor feeding, etc.
5) No one gets lectured. The consent they sign does say that giving bottles may interfere with their STATED plan to breastfeed. That is the truth, so I don’t think there’s a big problem with it. I work with a lot of moms who choose to formula feed for various reasons, usually because they believe they don’t have enough milk. I disagree, and I explain why I don’t think that there is a medical need for supplementation. I say that while there is no medical need, it is their baby and they can decide whatever they want. Some parents hear my explanation, feel reassured, and keep breastfeeding exclusively. Some decide they want to go ahead and supplement. Their baby, their choice. So much for the heavy-handed police state – sorry if real life disappoints. I feel like so many of these comments are like a Tea Party vision of Obamacare.


My second comment:

@Caperton: “On top of that, we have arguments of Nurses are good and supportive and helpful and so this policy won’t have negative side effects vs. Nurses sneak formula and bottle-feed your baby behind your back and don’t honor your wishes, so they need extra rules. Whether it’s either or both…” It is both, and also Nurses can be pushy jerks about both breast and formula feeding (and a million other topics as well “stop picking up the baby when it cries!”) They do need extra rules. These are some of the rules.

 “…Whether it’s either or both, we still have a policy that’s based on locking up baby formula and dispensing it bit by bit like feeding a baby bird, rather than on treating new mothers like adults: educating them about breastfeeding, letting them know that support is available, and then trusting them to make their own choice. And then honoring that choice.” But see this is where I don’t get it. How does the status quo honor people’s choices? We DO have breastfeeding moms getting the runaround and staff disrespecting them. This policy is meant to address that. In the meantime, everyone still gets what they want. This obsession about the locking up is still so puzzling to me. No mother could ever go and help herself to the formula cabinet. She always had to call the nurse to get formula brought to her. The lock is for the STAFF. And actually, feeding a baby human IS like feeding a baby bird (except for the worms part). They only need very small amounts. And they are OK if you bring them one meal at a time; they don’t know or care where the next meal is stored.

Finally, I am ALL FOR maternity leave. This is a HUGE and important component of breastfeeding support. And you better believe breastfeeding advocates know it and talk about it A LOT. It doesn’t mean that the hospital isn’t important too, and is a place where public health officials can actually make a concrete, immediate difference. People who are sabotaged in the hospital don’t ever make it to 2-3 months out as it is. I did some number-crunching for a WIC office and 50% of their moms who initiated breastfeeding stopped in the first two weeks. There is a huge drop-off after the much-vaunted 90% initiation, and that actually starts in the hospital for many people.


In response to continued upset about the locked formula: 

@Lauren: “That’s a staff education issue, not a mother education issue. It’s not resolvable by locking up baby food.” Again, locking up the formula is PART of what they are doing for staff. When you call for a bottle, do you know if the nurse has to deal with a lock or not? Nope. But she can’t be snagging bottles left and right for moms who don’t want them. Staff education is also part of that; it’s still just so puzzling to me that people are acting like the baby itself will have to open a bank vault to get fed.

Now this evening an update to the original post: 

*Update 8/1, 6:30 p.m. According to Samantha Levine, deputy press secretary in Mayor Bloomberg’s office, the information on the Latch On NYC site was wrong, and hospitals will not be expected to keep formula locked away (although they’re free to do so). She says they’re correcting the FAQs to reflect that. It seems like a rather a strange thing to get so diametrically incorrect, but removing the lock-and-key element of the Latch On NYC initiative does help things immeasurably.

---

 ??? I do not get it. This is what our scary locked formula storage looks like. It's in the nursery.

You type your login, hit a few buttons, and open the door. FYI, the breast pump kits, nipple shields, etc. are in this too. It helps the people who restock track the par levels so they can keep any supplies from running out. No one is upset that because those things are locked up, they're discouraging breastfeeding.

Can anyone help me understand all the drama over the locked cabinet requirement, which once removed has "helped things immeasurably"? I'd say out of all the things commenters were concerned about (shaming, lecturing) it is the least relevant. Ask any of our patients who use formula whether we keep it behind a lock (besides the lock on the nursery door) and I guarantee not a single one will know. Is it just some kind of gut feeling?

GE ad shows NICU baby's first breastfeeding

I'm an Olympics junkie, so when I went out with some friends this evening we still had our eyes on NBC. This ad caught my eye, of course, because it showed babies in a NICU; when I saw the end I started hitting the friend sitting next to me with excitement (not hard. I think.) How wonderful that the happy ending to this commercial is...breastfeeding!


(If the embed doesn't work, click here for the direct link.)

How a pro-life, homebirthing, staunchly conservative mom lost her fear of universal healthcare

By living in Canada, where she is at first concerned and disturbed by having to participate in a universal health care system:

When I moved to Canada in 2008, I was a die-hard conservative Republican. So when I found out that we were going to be covered by Canada’s Universal Health Care, I was somewhat disgusted. This meant we couldn’t choose our own health coverage, or even opt out if we wanted too. It also meant that abortion was covered by our taxes, something I had always believed was horrible. I believed based on my politics that government mandated health care was a violation of my freedom. When I got pregnant shortly after moving, I was apprehensive. Would I even be able to have a home birth like I had experienced with my first 2 babies? Universal Health Care meant less choice right? So I would be forced to do whatever the medical system dictated regardless of my feelings, because of the government mandate. I even talked some of having my baby across the border in the US, where I could pay out of pocket for whatever birth I wanted.

Read more here about her experiences with the health care system, maternity care, and her feelings on abortions in a universal care system. I only hope we can move closer to living this reality in the U.S. quickly enough for others to lose their fears as well.

ACA upheld!

I am happy and relieved that the Affordable Care Act was upheld today - for both public health and doula-related reasons! To illustrate just a few of the reasons why, I point you to this article from the American College of Nurse-Midwives:

Before implementation of the new health care reform provisions, many uninsured young women have not been eligible for Medicaid or other insurance coverage until becoming pregnant. For example, a nine-state study found that from 17 to 41 percent of childbearing women lacked insurance prior to pregnancy, with 13 to 35 percent transitioning to Medicaid at some point during pregnancy (3). Lack of insurance before pregnancy has limited the ability of a large segment of childbearing women to use health services to plan a successful pregnancy. ...Three PPACA provisions will dramatically change this situation.

Preconception care is a huge issue. Many pregnant women end up getting access to coverage via Medicaid, but there is only so much prenatal care do when you already had poorly controlled diabetes and high blood pressure prior to pregnancy.

In the past, uninsured pregnant women have largely been ineligible to purchase private insurance or, if they could purchase insurance during their pregnancies, the coverage generally did not include maternity care for the present pregnancy. More recently, some insurers have deemed women who had a previous cesarean birth to be ineligible for maternity care coverage (6), and there are anecdotes of similar practices, such as excluding coverage of pelvic floor problems among women who have had an episiotomy. Such practices will be illegal in 2014.

This is huge! It is essentially impossible for pregnant women to buy health insurance; if you don't qualify for Medicaid, you are totally out of luck. The denial of coverage to women who have had prior c-sections is hugely problematic, and will be banned along with other "pre-existing conditions".

In recent years, Medicaid beneficiaries in some states have lost access to birth center coverage, and many freestanding birth centers have been threatened with closure due to loss of Medicaid reimbursement. Although birth centers have traditionally been reimbursed within Medicaid programs, some state Medicaid programs had recently begun to deny birth center claims and legislation had not mandated such coverage for Medicaid beneficiaries. A PPACA provision requires coverage of care in freestanding birth centers that meet state regulatory requirements, beginning in 2010.

Straightforward and much-needed. Birth centers are part of making care more effective and affordable!

Beginning in 2010, all new health plans are required to offer, at no extra cost to the patient, all services and screenings recommended by the U.S. Preventive Services Task Force. For childbearing women, the recommended services include folic acid supplementation, breastfeeding counseling before and after birth, tobacco use counseling, and screening for several conditions

This includes reimbursement for lactation consultants!

The act directs employers to provide new mothers with a reasonable break time to express milk for a nursing infant for 1 year after the birth and a private place that is not a bathroom for doing so.

This is one of the provisions that very few people outside the breastfeeding advocacy community paid a lot of attention to, but one of the things that will make a HUGE difference for pumping moms in the workplace. People I know who work with universities who are building out their campuses say that they are hearing more and more about making sure that every building has a mother's room. There is so much more - some that not even I was aware of. Read it here!"

"The only good abortion is my abortion"

I may not be writing much, but I can link! And I really wanted to share a post from BoingBoing. The posts there range from technology, science, art, and culture to unicorns and funny cats, and occasionally more personal posts from the group of authors who contribute.

This post is very personal, and that's why I think we should be grateful that it's being made very public: "The only good abortion is my abortion":

The heart hasn’t sped up. The fetus hasn’t grown. The egg yolk is now bigger than the fetus, which usually indicates a chromosomal abnormality. Basically, this fetus is going to die. I am going to have a miscarriage. It’s just a matter of when.

Because of these facts—all these facts—I get special privileges, compared to other women seeking abortion in the state of Minnesota.

Nobody has to tell my parents. I am not subject to a 24-hour waiting period. I do not have to sit passively while someone describes the gestational stage that my fetus is at, presents me with a laundry list of possible side-effects (some medically legit, some not), lectures me on all the other options that must have just slipped my mind, or forces me to look at enlarged, color photographs of healthy fetuses.

Because I have health insurance, I can afford a very nice OB/GYN whom I chose and who does not exercise her right to deny me this option. Thankfully, I don't live in a state where she can legally lie to me about the status of my fetus, to dissuade me from having an abortion.

Most importantly, from my perspective, I have the privilege of a private abortion in a nondescript medical office. I will not have to go to an abortion clinic. I will not have to walk by any protesters—not even Charlie, the one guy who is paid to protest every day outside Minneapolis’ abortion clinic, where I have volunteered as an escort in the past.

Most of these privileges boil down to the fact that, as far as my doctor and my medical billing are concerned, this is not an elective procedure.

But here’s the thing. It is elective.

The comments, from both men and women who have experienced a pregnancy loss of their own or of their partners, are almost universally compassionate and often share very difficult stories of their own. I think it's important reading.