Monday, September 28, 2009

Becoming Alice

So, I have my first gig as a postpartum doula this week. I'm so excited, and also really anxious about it! We spoke on the phone tonight. She just had her fourth baby on Friday - talk about fresh out of the chute! I'll be doing about 7-8 hours Tuesday-Thursday this week (and we'll re-evaluate then to see if she wants one additional week).

I was going to have to limit it to 3 or MAYBE 4 hours due to Lily being brand new to day care (sob) . . . but then my client asked if I would be okay with bringing Lily with me, which pretty much solves everything! I wouldn't have presumed to suggest it myself, especially my first time out, with a brand-new client, during our first week of service to boot, but she just needs the help so much that it's worth it to her. I'm reducing my rate a tiny bit as a result of that (knowing my attention will be slightly more divided), and it was already very low due to the fact that I'm currently in the midst of the training process, so I feel this is a fair tradeoff.

As she already has 3 other kids, all boys, a lot of it will be helping care for the other kids and doing household chores. That's all good. Here's what I'm most anxious about, along with generally being sure that I'm really being of value to her: she said that she really needs a lot of support with breastfeeding. When I first learned about her, I assumed she'd have it down pat since this was her 4th kid. But she has inverted nipples, and thus needs a lot of help. Yes, she's experienced, but part of that experience includes knowing that she needs extra help. Goes to show what assuming will do . . .

I know what you're thinking - but Anne, you know tons about breastfeeding. And I do, yeah, but having gone through such a trial myself, and knowing just how absolutely BAFFLING, not to mention emotionally charged, nursing difficulties can really be when you're in the midst of it . . . I'm just so afraid I won't be able to help her enough. My own nipples were a little flat, so I do have some experience with it, but inverted is even harder. I'm of course going to look up everything I can on inverted nipples on kellymom and in Jack Newman's book, which I'm going to do here in just a minute.

Anyway, wish me luck! Any advice you have for dealing with inverted nipples would be most welcome, too.

(She told her husband "I need an 'Alice'," which is kind of a great description of what postpartum doulas offer, if The Brady Bunch featured lactation information and help with care for a tender perineum.)

Sunday, September 27, 2009

Much, much kinder.

Weekend Movie: "We Can Be Much Kinder", a short film on delayed cord clamping.


We Can Be Much Kinder - Birth Matters Video Contest - More amazing video clips are a click away

This will be old hat to many of y'all, but for those who haven't seen it, it's a must! Bonus: a lovely appearance by one of the grand dames of the birthbloggin' community, Barbara Herrera, a.k.a. the Navelgazing Midwife.

Saturday, September 26, 2009

Choices in Childbirth challenges the Today Show


Birth peeps: Were you outraged by the Today Show smear job? Choices in Childbirth has created a petition in response. Their goal is 5,000 signatures, to be delivered in person.

http://www.thepetitionsite.com/1/accurate-reporting-in-birth-options

Please sign this and forward it to anyone else you know who cares about birth choices in America! I think we can do a lot better than 5,000. Don't you?

Wednesday, September 23, 2009

From the File Marked 'Duh'

I have a feeling this will be an ongoing series.

The topic for today, a succinct, to-the-point article from the BBC: "[D]rugs used during labor, such as those given to prevent hemorrhaging after birth, could lower the rate of breastfeeding." The specific culprits identified in this study, examining over 48,000 women, included drugs used to treat hemorrhaging, like our good old buddy synthetic oxytocin as well as ergometrine. Pain medication was also a factor: "The Swansea University team also confirmed high doses of painkilling drugs have a similar effect." The impact of these effects on mothers and children in Great Britain:

They found use of the drugs oxytocin or ergometrine to cut the risk of haemorrhage was associated with an overall 7% decline in the proportion who started breastfeeding within 48 hours of giving birth. Among women who were not given the drugs, two-thirds (65.5%) started breastfeeding within 48 hours of giving birth. But among those given a shot of oxytocin the breastfeeding rate was 59.1%, and among those who were given an additional injection of ergometrine the rate fell to just 56.4%.

This could mean that their initial attempts to breastfeed may end in frustration, and that many give up rather than persevering. The link between painkilling drugs and lower rates of breastfeeding has already been established, and has led to revised NHS guidance on the use of epidurals in labour. Lead researcher Dr Sue Jordan said more research was required, but based on the study's findings use of the clotting drugs could lead to up to 50,000 fewer British babies being breastfed every year. She calculated that this could mean an extra 1,000 children becoming clinically obese, and 3,000 developing childhood asthma . . .

Rosemary Dodds, policy research officer for the National Childbirth Trust, said women needed more support to start breastfeeding. She said: "A lot of women are not given enough information about the medications that might be given to them during childbirth, and women at low risk of bleeding may not need to take these drugs. It is important that women understand the risks and can give their informed consent before they go into labour."

Don't get me wrong, I'm glad this study came out. But is it really all that surprising, given everything we now know about the intricate hormonal process that is normal physiological labor, one component affecting the next, and in turn the next, and then the next, all in an incredible biofeedback system. Dr Michel Odent in particular has waxed positively rhapsodical about these miraculous mechanisms and the resulting "love cocktail" of hormones we are meant to be born into, and rightly so. From pain to endorphin to oxytocin to prolactin, it's all interconnected. How can we possibly think that interfering with even one of these could NOT have an impact on everything else that follows?

I again quote my favorite onscreen heroine of all time:



"Does the word 'duh' mean anything to you?"

Brainstorming

I almost titled this "Brianstorming". Sorry "Brian", whoever you might be.

Okay, I seriously need to come up with a name for my practice so I can at least get started with some flyers and business cards, perhaps set up a separate website where services and fees are explained, etc. Sooo, after some initial brainstorming, I have a few finalists.

AfterBirth (again, either great or horrifying, right?)

Postpartum Pampering and/or
Postpartum Pantry (too wordy?)

Birth to Babymoon (overdone, I fear)

Mamarama (a little sass could be a good thing)

I'm kind of leaning towards Mamarama because it's catchy and open-ended - I could keep the same name once I add labor support into the mix in a year or two. Or . . . I could just go with Dou-la-la? And for either one of those two, maybe have a more descriptive "tagline" after the name in printed materials, like "Postpartum Pampering & Pantry Provider"? (I'm a sucker for alliteration.)

I dunno. Maybe I should just be straightforward: Anne Tegtmeier, Postpartum Doula, LLC? But, pretty darned blah.

Your thoughts? Any and all are appreciated!

Monday, September 21, 2009

AfterBirth

(Okay, so, is that a great or a HORRIBLE name for a postpartum doula service? I've been brainstorming on it so long that I've lost all perspective. You can level with me!)

Anyhow. I had to write up a brief account of my own birth and postpartum experiences for my DONA registration, and I thought it apropos to include it here. I've already shared both my birth story and our extended breastfeeding adventure, but there's something about the immediate postpartum period that amounts to its own distinct experience for moms. It also discusses some details from my pregnancy that I haven't gone into here -yet; I do want to write about my experience with "parallel care" in a future post.
My first and so far only daughter, Lily, was born in April 2008 at home, under the care of two midwives and my best friend, who acted as informal doula. It was a water birth and a wonderful experience all around, especially after a somewhat difficult pregnancy which was shadowed by a complete, then partial, then marginal placenta previa that persisted all the way up to the 34th week. A vaginal birth was no guarantee, up until that final ultrasound, let alone a home birth. Due to the previa, I had been on pelvic rest and forbidden exercise from week 18 on, and partly as a result of that, I gained far too much weight.

On top of that, for the first 20 weeks, the threat of an ‘incompetent cervix’ has hanging over my head due to a cone biopsy I underwent 16 years ago, since the medical practice I sought parallel care from insisted upon digital exams every other week to determine whether a cerclage would be recommended. I also had some sciatic issues that were resolved by chiropractic care, some nasty carpal tunnel, which B vitamins helped, and finally the dreaded rash known as PUPPP, which nothing really relieved much at all. So the birth was a huge relief in every way, and will always be remembered as the most incredible day of my life.


My postpartum experience has much to do with wanting to do work as a postpartum doula; I saw firsthand how much support means to a mom, especially a new one, and even more especially in those crucial first days. The stress, the assorted fears, the physical healing, the engorgement, and the sleep deprivation alone affected me much more dramatically than I had anticipated. Add into that the formidable hormonal wallop that results by shifting from pregnant to not-pregnant, and then from not-lactating to lactating.

I don’t think there are more dramatic hormonal transitions in a woman’s life except for puberty and menopause, and both of those processes take place over years and years; these postnatal changes happen within days, or a handful of hours, even. And then add into it the most devastating part: extreme difficulty nursing. You’ve got yourself a recipe for some considerable feelings of despair and helplessness. Day three-into-four was the day of reckoning for me, where I truly felt I was staring into the abyss.

The story of Lily’s nursing struggles is far, FAR too complicated to go into here; I will summarize by saying that it took 5 months of constant work with an IBCLC plus regular craniosacral therapy for her to be able to latch on. We’re still going strong at 17 months, so it’s quite a happy ending, but those early days were nothing short of terrifying. I was very short on support at that time, which I absolutely will make sure changes for the next child (if there is one). The postpartum visits that I did get were so incredibly important to me. I could have used a lot more of it, for sure, but that was simply our situation at the time, and I’m grateful to have experienced it at all.

I saw firsthand just how valuable postpartum care can be, not just from my midwives' three visits and through my best friend, who came by about every three days for a while, but from the first in-home lactation consultant who visited me twice and checked in multiple times by phone. This was not the genius IBCLC that I later saw, and who truly got us breastfeeding after a very long struggle, but she was helpful in her own way; getting me started with finger feeding and the breast pump, advising on other postpartum issues, and even helping to change the sorely-overdue sheets. More than anything, the kindness and the simple human contact (mother to mother, too) made a difference, in itself. She was filling a bit of the role that a postpartum doula does. I consider it only right to return that service to others.
That's what I sent to DONA; all completely true, but without some of the messy details.

That third day. I still shudder to think about it. I had probably slept a total of 4 or 5 hours since the birth. A foreshadowing of the breastfeeding difficulty to come was a growing concern, as Lily showed no rooting reflex and seemed totally uninterested in nursing, and had not yet effectively latched on, so I was desperately pumping to ensure that my supply would still come in without Lily stimulating me, and to produce a few drops of colostrum which then would be cupfed to her. My hemorrhoids were positively frightening, making every position uncomfortable. I needed to take both my and Lily's temperature regularly, I needed to massage my fundus gently but regularly to help it shrink back down, keep replenishing my witch hazel and comfrey pads in the freezer to soothe my bottom, all tasks I could never seem to keep up with enough. I also had to put in the sun for a few minutes periodically to help with her mild jaundice, and at one point I was CONVINCED I had given my newborn a sunburn and was despondent.

I could never decide whether it was better to swaddle her or keep her skin-to-skin with me - whichever one I chose, I'd feel guilty that I wasn't doing the other. I had a gorgeous Maya Wrap ring sling* given to me at my shower, but for the life of my I couldn't figure out how to use it thanks to the incredibly confusing instructions on the DVD that came with it. I watched over and over and over again, and couldn't even get beyond the intro part of threading the damned thing.** Then her umbilical cord started to look seriously funky***, possibly gangrenous in my increasingly paranoid mind, and I had no idea what was normal.

More than anything, the sheer responsibility of it all was starting to really hit me. At one point I had her wrapped up and lying on a heating pad, and her diaper leaked, wetting the pad (I hadn't gotten the hang of using the waterproof covers yet). I decided that I had almost electrocuted my own daughter in my carelessness and itwasallmyfault and proceeded to sob hysterically, and I mean hysterically, over it for about a half an hour. My milk then came in and left me freakishly engorged with what felt like rocks in my boobs and armpits. Again, I had no clue what was normal, and rather than resting when Lily slept, I took to scouring the web for advice. I remember sitting at the computer on the MDC boards at 6 am with cabbage leaves stuffed into my bra, weeping and feeling like the most pitiful mother ever to barely-qualify for the title.

. . . Yeah, you could say I was a little overwhelmed.

Later that day, seeing how unhinged I was becoming, Aaron insisted that I take a walk, as I literally had not once set foot outside the house since I was about 6 hours into my labor. Lily was asleep, my list of tasks would wait for 5 minutes. I protested a bit and finally reluctantly agreed to walk out to the mailbox, at least. I put down my checklist and I ambled out the front door in a daze, and got about three steps before suddenly realizing I had walked out there with my shirt COMPLETELY unbuttoned and hanging open, the state I'd been walking around the house in. Thank goodness no neighbors were around to see, and it did give me the first laugh I'd had.

Hopefully, I'll be able to help mothers through the labyrinth with a little more grace than I.

*Wonderful product, but check out the videos on this page rather than the product's DVD.
** We love and use it constantly these days, as per below.
*** It was completely fine.


Saturday, September 19, 2009

Laboring Under an Illusion

Weekend Movie:

This past week's episode of Mad Men, titled "The Fog", included an extended plotline about the main character's wife giving birth to their third child. This series is set on the cusp between the fifties and sixties, and thus very much in the grip of the Twilight Sleep era.

Sure enough, Betty Draper was wheeled away from her husband (left to drink and smoke in the father's waiting room, both cliched and authentic), and injected with scopalamine in short order, and in no time, her mind drifts off, free-associating, while the restrained body left behind writhes in pain and snarls at the staff, freed from the inhibitions of consciousness. Asked later how it was by another mother, she replies distantly, "Oh, you know. It's a fog."

I thought this treatment was a bit more historically honest than many other shows and films set in the same time period, which was refreshing in a way (appalling as the treatment actually was). We've all been influenced by the media's portrayal of childbirth - asked to think of the earliest impression of birth I have, Little House on the Prairie comes to mind, followed by a medley of sitcoms.

Think about the stereotypical sitcom scenario - how many times have we seen a woman "go into labor" by falling instantly to the ground and writhing and screaming like she's being attacked by invisible panthers? And of course, the baby is arriving immediately, and she has to be rescued from this by the nearest male. Another cliche is the naive woman who foolishly think she's going to labor naturally, and initially refuses medication - and is later shown begging for it, only to be told it's TOO LATE! Ha ha, joke's on her. Message clear: don't be one of these silly feminists, just get the drugs ASAP like we told you.

And don't even get me started on the reality "birth drama" shows like A Baby Story, Maternity Ward, Birth Day, and the like. "Reality"moniker aside, they're about as helpful to birth as The Bachelor is to actual dating. I yell at the TV like a disgruntled soccer hooligan. (You can probably picture this.) I was thinking that if I ever worked as a childbirth educator (springing out of doula work), I would show some clips of these shows to my clients and we could discuss them critically. But with this new film, I might just be able to loan out this DVD!

So without further ado, enjoy this peek at Laboring Under An Illusion, which looks both insightful and entertaining:



Looks like it's slated to be shown at the upcoming Lamaze conference, as well as some other dates some of you might want to check out.

Friday, September 18, 2009

Freestanding Birth Center vs. Home

Just one thought, a follow-up tangent from my previous post critiquing the film Orgasmic Birth: One specific thing I did really appreciate from the film was how they made the distinct point that many qualified midwives bring everything TO the home that is available in a freestanding birth center*. I wish more people knew that. So many people who want to be in a birthing center seem to want to be there because of the perception that it’s safer than a home birth, but I think that’s basically an illusion. Not that I have anything AGAINST birth centers, I just think people sometimes want it to be a compromise between home and hospital, and I feel that this logic is a little bit off. The great, prolific Navelgazing Midwife makes this point very well:
When a dad/partner/relative tells me s/he/they would have no problem having a baby in a birth center, but wouldn't be comfortable at home, I let him/them know that I carry the same equipment that is at the NACC-certified birth center downtown (minus the sedatives). The difference is *I* carry the equipment into their house instead of them getting up, in labor, and heading out into the elements, driving to the birth center. It often comforts them to know this. I have even gone so far as to open my kit up to show a skeptical nursing relative. It is very important for everyone (who will be at the birth) to feel 100% comfortable with the parent's choice to have their baby at home.
I've already had one home birth, as you probably know, and would absolutely do it again, so long as my risk level is appropriate. I definitely prefer this to a birth center, even a really wonderful one. But still, I could see myself choosing a birth center for one of two reasons: if it were closer than my home to a good hospital; or if my home at that moment were not a good setting for whatever reason - recent move leaving the place in a shambles, tiny apartment with thin walls, something along those lines.

There's more to discuss on this topic, of course, but I thought it was a salient point to put out there, and it was a positive thing that sprang from seeing the film despite my having a few criticisms of it, so I though it only fair to mention it. Here endeth the tangent.

*Not to be confused with hospital "birth centers", which are typically the same old maternity wards with the same old policies - but sometimes new wallpaper! And maybe a manicurist! Because those are women's top priorities, dont'cha know.

UPDATE 2/05/10: The midwife writing at Birth Sense recently weighed in on this as well, confirming all the key points listed here:

For some of my clients, I did feel the birth center was a safer location. I worked in an area where a number of my clients lived a long distance from the hospital–up to three hours away. If a woman did not have rapid access to a hospital, I would recommend the birth center because of its location only a block from the nearest hospital. Some women did not have a home setting they felt comfortable in–for example, a client who lived with her in-laws and wanted more privacy for birth. But in terms of safety, a birth center birth or a home birth with easy access to a hospital, are equivalent.

I had all of my emergency equipment and birthing supplies in portable bags which I used at either the birth center or at a home birth. I had the same trained support people helping at a birth, regardless of location. There simply is no difference in what happens in a birth center or a home birth. For any serious complication, both settings will require transfer to the hospital. There was nothing I could do for a woman in the birth center that I could not do for her in her own home.

Monday, September 14, 2009

Anticlimactic?


After a lot of buildup (don't say 'foreplay', Anne, don't do it, resist the temptation, resist . . .), having heard about it for many months with many rapturous reviews, I finally got to see "Orgasmic Birth" over the weekend.

If you haven't heard of it, it's a documentary on natural, or to be even more specific, undisturbed birth, going into the potential for ecstatic experiences during childbirth. Yes, you read that right, some women actually do have orgasms while giving birth. A small percentage, true, but it really can happen, and is more likely to happen when optimal support and minimal intervention take place. A lot of the physiological processes that take place during normal childbirth ARE similar to the processes that take place during sex, in fact. And encouraging the parents to engage in affectionate intimacy can, unsurprisingly, help the labor along. What gets the baby in, gets the baby out, as the great Ina Mae has noted.

The timing may have been off, though; throughout the film, I couldn't help thinking about the very recent Today Show piece and the wake of outrage it left in the birth advocate community (see the previous post for my own letter to the Today Show). Anyway, as a result, I found myself watching it through a skeptic's eye. One of the remarks in the Today piece that has inspired the most chagrin was the comment from a doctor, quoted by Andrew Goldman, that home birthers were seeking a "hedonistic experience". It seemed, to so many of us who made the decision based on research and much self-reflection, the most completely outlandish thing we had ever heard. Excuse me? HEDONISTIC? Are we on the same planet?

But there I was, watching a movie titled "Orgasmic Birth".

And I couldn't help thinking that maybe, just maybe, this is where the anonymous doctor got the idea. Now, it's not a BAD film, don't get me wrong, and contrary to the title, is hardly some birth fetish porno filled with scene after scene of women having orgasms. There's good information in there, and some really excellent commentary by experts. Christiane Northrup was absolutely wonderful, and Elizabeth Davis and Sarah Buckley were great too, along with many of the doctors and other professionals included in "The Business of Being Born".

But side by side with "The Business of Being Born", I think "Orgasmic Birth" is just not as strong a film. Mainly, I found it much less organized than "Business", and lacking the drive and flow that a narrative arc provides, and, more nitpickingly, lacking in humor and variety. I am most definitely part of the choir they're preaching to, no question. *I* get the point they're making. The fact that birth can be pleasurable in a way is a valid point, and one of the ways it is most relevant is in how the things that encourage pleasure are the very things that allow labor to function optimally. Yes yes yes. But I wonder what kind of an impression this film would give to a skeptic, an undecided mother, or even to someone opposed to home/natural/undisturbed birth altogether, to get back to my main point.

And I’m going to say it: One of my least favorite things about it is the title itself. A very common accusation from such opposing people is that women who are seeking an out-of-hospital birth are putting the birth "experience" above the safety of their child. Now, again, I get that they're trying to explain that the two do not have to be mutually exclusive, and that an ecstatic experience may be a by-product of such a supported, intimate birth, but through the skeptic's eye, I can see how the impression of "hedonism" might be given by the film.

Like I said, there are far fewer orgasms on display than you might think, and the emphasis isn't nearly as strong as the title suggests. If you already have a library of birth films going, this is definitely worth adding - especially for the "Birth By the Numbers" segment included in the special features. And, again, the contributions by Northrup and several others are worth the entire film - I particularly liked her comments on epidurals.

Scout's honor, when I first saw "The Business of Being Born", I remember saying (or at least thinking), "Now, if only Christiane Northrup had been included in the interviews, it would have been just about perfect." I wish I could edit my own pirated version of "The Business of Being Born", with Northrup's segments from "Orgasmic Birth" spliced in. Maybe a bit of Elizabeth Davis and Sarah Buckley's parts, too. Best of both worlds!


***

Two other notes on the Today Show piece: Ricki Lake and Abby Epstein have since weighed in with their own response. It's worth reading for their words alone, but in the comments I found a very interesting post by a woman who claims to know the couple whose tragic stillbirth was featured in the piece. She says:

The main reason that Riccardo and Catherine McKenzie decided to do that story was not to become anti-homebirth advocates, but to become pro-regulated out of hospital provider advocates . . . I will defend anyone who is worthy of defense but have to note that Catherine and I met as mothers who are in the slim majority- we lost our babies at home birth with , ahem, credentialed providers present . . .

They came forward in an attempt to continue to protect every mother and their partner that chooses home birth. Many perinatal organizations seems to be back peddling now- this organization is flinging mud on that one- is flinging mud and on and on it goes. Never forget please that on that day home birth did not lose a baby. A young couple lost a baby and that is what the story was supposed to be about- how if an out of hospital provider (any for that matter) is not practicing in compliance with the standards held by their peers, held by their profession, and as a matter bound by regulation that tragedy can strike. This was a tragic outcome on a day that was supposed to be joyful for this young couple.


Rather a different picture than the one painted by the Today Show, don't you think? I have mixed feelings about speculating on much beyond this, knowing that we're debating about a very real loss in an incredibly impersonal way, but I thought it was worth considering. If true, this does lend credence to the opinion that the couple's story was very much manipulated to fit the story's anti-homebirth agenda.

Sunday, September 13, 2009

The Perils of Lazy, Sensationalistic Journalism

Yup, the Today Show piece. In case you haven't logged into your reader the last two days, the nutshell version is that the Today Show just aired a laughably biased shock piece on "The Perils of Home Birth", linked under Latest Health Features here. Yes, they actually called it that, though only after they changed it online from the original title, "The Perils of Midwifery". Frankly, I think they're both equally bad.

This has been so handily covered by the Birth Blogs already, I hardly know where to start. But here's Stand and Deliver has a great roundup of everything that's been written so far. Check them all out. I wasn't even going to write about it myself, others had done such a righteous job of it. But I decided I at least had to write to the producers of the Today Show, which I did, and once that was done, I figured I might as well share it here. A few bits were lifted from my prior comments on some of the aforementioned fabulous blog posts, so if you feel like you have deja vu in a couple spots, that's probably why. )Mucho props to the other bloggers, especially Your Birth Right, who first pointed out the sneaky semantics they slip in by using the word "allege" selectively.)

I didn't even go into the melodramatic flourishes like showing the mother folding baby clothes in the empty nursery, or the intentionally dead-end questions our intrepid reporter Peter Alexander says doctors recommend parents ask midwives at the end of the piece; I was already running long. Anyway, here's my longwinded letter, for what it's worth.

Dear Today Show Producers,

As soon as Matt Lauer said the words "Extreme Birth" in the intro, I knew what kind of a piece we were in for.

I was astonished to see the one-sided, sensationalist, fear-mongering piece you first called "The Perils of Midwifery" and then changed to "The Perils of Home Birth". It would take pages and pages to point out all the gaping holes that riddle this "report", but I'll limit it to a few main points. Let it be said right off the bat that, of course, I feel terrible for the couple that lost their baby. It is a tragedy no matter where it took place. But I feel strongly that this couple is being completely exploited and manipulated into blaming home birth for their loss - without knowing the details of the case, we don't know if it is one of the situations that could have happened anywhere, sadly.

I can't help wishing Cara Mulhahn had been able to say more about the situation, but it's obvious to me that her hands were likely legally tied - which you made seem like an admission of guilt, which is preposterous. But putting that aside - did it ever occur to you to talk to, oh, say, another midwife? Ms. Muhlhahn is actually not the only one in New York City, believe it or not. You could have called MANA, which is the professional organization for certified professional midwives, the ones that most often attend home births, or you could have contacted ACNM, which is the equivalent for nurse-midwives who largely practice in the hospital, but still have an understanding of the goals of home birth and the midwifery model of care.

But you allowed the ACOG to be the mouthpiece for this story. When you mentioned the CDC study that demonstrated home birth outcomes being equal to or better than hospital outcomes, it's just immediately dismissed by the claim that it's because of higher risk women, with no further discussion. End of story. No mention of the recent Canadian study (among others) which specifically compares equivalent risk level! It completely refutes the previous claim about higher risk women, and has, frankly, been widely circulated, so I cannot imagine how a decent reporter could have missed it, so I can only assume it was deliberately left out in order to amp up the scary shock factors.

You also use transparent semantic tactics that insult our intelligence: statements by home birth advocates are "alleged", but anything coming out of a doctor's mouth, or from a doctor's organization, is treated as if it were handed down on a stone tablet, whether the research supports it or not. A few seconds of Marsden Wagner (who is only one among many doctors who also support alternatives to hospital birth) and a clip of one successful home birth do not journalistic balance achieve.

Insinuating that celebrities have anything to do with the rise in home birth is just plain foolish. For every home birthing celebrity, there are celebrities on the opposite end of the spectrum choosing elective, scheduled, non-medically-indicated cesareans. There are plenty of examples on both sides. What is really ridiculous is the ACOG's admonishment that women should not base their birth choices on what is "fashionable and trendy". Do they not realize that birthing in the hospital is the newest "trend" of all, historically speaking? It has been less than a century since this "trend" took hold. So, frankly, if we take their words literally, I actually agree. Women should not birth in hospitals just because everyone else is doing it. They should make that choice based on their risk level, how comfortable they are with their care provider's practices, and most importantly, the real research.

And where do I even begin with the asinine statement about home birth being like a "spa experience"? And "hedonistic"? Yeah, I totally chose a home birth because it would be, like, the ultimate bacchanalian orgy. Who cares if it's supported by research and is the best choice for me and my baby, as a low-risk pregnancy? There was no discussion about the fact that women are really choosing home birth because they want to avoid the cascade of unnecessary interventions that are NOT evidence-based, yet are standard in the vast majority of hospitals, and because of the fact that so many OBs are practicing defensive medicine and thus making choices that hurt their patients, as they themselves admitted just yesterday (what a convenient coincidence). "Cover thy ass" now comes before "First do no harm" for many physicians. Is it all that surprising some families have decided to find another way as a result?

I do not have anything against women choosing to birth in hospitals, as long as it is a truly informed choice. Some women, even low-risk ones, are simply going to feel safer there, and this is fine. The bottom line is that there are risks in both the home AND the hospital (and in birthing centers too, a third option your piece, of course, never even touched). It is up to every family to look at the real evidence, not sensationalism, and weigh those risks for themselves.

Sincerely,

Anne C. Tegtmeier


Saturday, September 12, 2009

The First Step


ACOG has taken a commendable first step in releasing the results of their survey this week: the changes OBs have been making to their practices due to fear of litigation are harming their patients.
"By publicizing the widely known fact that defensive medicine is aggressive and harmful to women seeking maternity care, ACOG has taken a profound step in openly admitting and sharing data that women’s options are being severely restricted and iatrogenic injuries are occurring on a large scale due to physician fears."
And you know what? I applaud them, as have some other birthing advocates in their response to the news. A common response is "It's a start," and "At least it's a first step." I agree, and would add that admitting you have a problem is the hardest part.

I look forward to the rest of their recovery, especially the "examining past errors with the help of a sponsor", "making amends for these errors", "learning to live a new life with a new code of behavior" and "helping others that suffer from the same addictions or compulsions". And I definitely know a few OBs who could benefit from the Serenity Prayer now and again.

Keep coming back. It works if you work it.

Race, Class, and the Pregnant/Nursing Mom

Weekend Movie: How Racism Impacts Pregnancy Outcomes



I recently had a brief but thought-provoking conversation with one of my best friends, who works as a manager of a clinic that serves homeless people (quite an amazing, admirable place, by the way). We weren't taking about her work specifically, just chatting about parenting, as moms tend to, and the topic of nursing came up, as it tends to, and turned to my particular unusually challenging experience. I mentioned how helpful chiropractic care and craniosacral therapy had been to us, and while not discounting that kind of care (her clinic employs naturopaths as well as allopaths, so she certainly recognizes the importance of offering choices in care), she observed that it's impossible for her to see these kinds of circumstances without seeing the class issues that accompany them.

She does have a point, of course. I was able to seek out this care, at least in part, because of the resources that were available to me; due, again, at least in part to my class level, my education level, the type of community my peers are based in, and any number of other socioeconomic factors. We are by NO means rich, and frankly, we still have quite a bit of debt left from the whole ordeal, but still, we were able to some of the funds together, no matter how strapped it left us. Put an impoverished woman in my same position: would she be able to pay for a lactation consultant even once, let alone multiple visits? Would she have had information about what her options were? Would anything beyond visits to a pediatrician that are covered by Medicaid be considered frivolous by her family and other members of her peer group?

It's a complex issue, to say the least, and I thought of this conversation when I saw this brief video this week. Please check it out, and give some thought to how race and class might affect access to the care that has been important to you, and the services you believe are important for others. How can we help this to change?

Thursday, September 10, 2009

And while we're on it . . .

. . . if medical students are being trained using this:


Is it any wonder things like the Labor Pro and the Birth Track are making their way into the delivery room?

I came across this "SIMone Birthing Simulator" while reading the latest comments from Nursing Birth's aforementioned post on the Labor Pro.
Simulate high stress situations with the SIMone™ birthing simulator!

Using patented haptic response technology, SIMone™ gives you a unique training experience. The level of realism is additionally heightened though a specially developed visual and audio interface . . . SIMone™ gives the opportunity to practice an instrumental delivery in a realistic manner - over and over again with little or no set up time! In fact it takes less than 60 seconds to commence a new birthing scenario.

Accessories included:
  • 1 Vacuum extractor Menox 60mm
  • 1 Vacuum hand pump
  • 1 Naegele forceps

So, basically a Real Doll for OB students. Tell me, what's the first thing you notice about the picture above? But of course "Simone" is poised cooperatively in lithotomy position. How else are they going to learn? Their whole catalog could be seen as disturbing by some, but I actually find a lot of these models interesting, and useful in a classroom situation (and not so different in spirit than Madame Coudray's creations). The SIMone Simulator just takes it to a whole new level, revealing a clear - and quite revealing - set of assumptions and beliefs.

But. There's a big but. It's tempting to just react emotionally and recoil in understandable, outraged horror at this dehumanized, computerized, amputated facsimile of the miracle of birth - after all, that was my first response - but: This is something that is being marketed, if one believes the sentiment expressed in the video (there's no separate link, just look for it in the left column on the main page by the top paragraph), specifically to help avoid cesareans. I think it's true that situations that used to call for forceps or vacuum extractors (in the obstetric mindset, of course) are now more frequently just skipping that step and going straight for the c-section, due in part to the fact that these skills aren't being taught as much anymore, from what I understand (like breech birth, which has all but been lost and is only now starting to make its way back into the hospital in Canada; we can only hope the US comes to its senses and follows suit).

Now, the question that's NOT being asked by Simone and her attendants: were the factors that led to the situation that calls for forceps or vacuums often created by hospital practices in the first place? I would say so. Are there other ways of handling these situations, ways practiced by midwives? Ways that, incidentally, usually don't involve being supine with your legs conveniently hoisted and splayed? I would also say yes. But if the mother insists on buying the hospital ticket, and going for the hospital ride, would it not be better to have some of these tools and more importantly, skills in handling these tools, available if the mother wants to avoid a cesarean? I think that's a fair question.

Oh, it's all so complicated. What IF the rate of c-sections were to drop (instead of continuously rising as it has been) as a result of increased vaginal intervention in the form of vacuums and forceps? Would American women - if I can make such a sweeping generalization - be happy with this development? If we were to say that, okay, this is the lesser of two evils, but it's still not great, it's still not addressing the dysfunction of "active management" in the obstetric standard of practice - I could see doctors everywhere throwing up their hands and saying "See? It's impossible to please them! First they complained about forceps and vacuums, and we started doing more c-sections in those circumstances. We did that. Then they wanted the c-section rate to be lowered. We did that. Now they want fewer instrumental deliveries again! WOMEN! Impossible. Whatever."

So maybe Simone isn't all bad, if she/it helps lead to an increase in the lesser of two evils, and a decrease in the greater. But is this really all women should get to choose between?

Wednesday, September 9, 2009

Brave New Birth



This is one of those DANG, she beat me to it posts, but she did it so well I can hardly begrudge her. I had been plotting a post comparing recent birth innovations I liked . . . and ones I most definitely don't like. A few years ago, when I first read "Pushed" by Jennifer Block, I was horrified to read about the a new technology she said was actually under development, which would track dilation by way of sensors placed on a woman's cervix, adding yet another branch to the tangle of wires hooked up to virtually every woman who labors in a hospital (external fetal monitors, IVs, epidurals, catheters, pulse oximeters, blood pressure cuffs, and if you're extra-lucky, maybe an intrauterine pressure gauge and an internal monitor - the last of which is a nice way of saying an electrode screwed into your baby's scalp).

All the better to distance ourselves even more from unpredictable, messy contact with a woman in labor. We already monitor her contractions from a screen at the nurses' station, but what a burden it's been to have to check her cervix ourselves. Now we can view both from a comfortable, remote distance! (By the way, yes, I do think that internal exams can be way overdone, but that's another issue; the point to me is the augmented loss of actual human contact.)

I had a hard time believing that such a product could ever exist - it seemed as chauvinistically, fancifully implausible as the Blonsky device mentioned in the same book. But then . . . it came true. The Birth Track. Stand and Deliver inveighed powerfully upon it, and Hathor made satirical light of it, but still, it came to be. I don't know how many hospitals and doctors are currently using it, and I'm a little afraid to find out, but if anyone has that info, I'd still like to know . . . I think.

Then, mere days ago, labor & delivery nurse-turned-blogger-extraordinaire Nursing Birth made it known, with her usual aplomb, that a competing, almost identical device had actually been developed. The Labor Pro, video demo here, currently trying to make it into the US. Her post here is a must-read: The WORST Idea Since Routine Continuous Fetal Monitoring for Low Risk Mothers. Her every point completely covers my own thoughts on this, though this is my absolute favorite part:
I’m telling you right now, I will UP AND QUIT my job and never look back if either LaborPro or BirthTrack EVER appears in even just one, JUST ONE of my hospital’s labor rooms. QUIT ON THE SPOT! And I will make a Hollywood exit too! A HUGE scene!!! Hooting and hollering! You just wait!! LOL! As if our moms aren’t already strapped down enough with the often unnecessary and sometimes downright harmful technology we already have. This is just TOO MUCH TO BEAR!
I commented there that we need to start spreading the word about this insanity, and let it be known that women are not going to stand for this, so here I am, doing my part. Most of you reading this no doubt completely grok why this is so crazy-making, but in case you're not sure what the fuss is all about, please read the links above. (I would go through it all here myself, but honestly, it would be redundant, as Nursing Birth and Stand and Deliver have done it all already.)

As for my originally planned post on innovations I like and innovations I don't, well, the latter has been well-covered above. Of the former, I think the Contraction Master site is pretty innocuous and potentially handy, since it's something you can use on your own right at home. I could see myself doing this for some period of time, maybe moving my laptop around with me as I changed position, or having a partner or doula click the timer at my cue, instead of writing each of the start times on a piece of paper (which has been lovingly saved for a scrapbook someday) and trying to guess at the duration. This is available in the online version linked above or as as an iPhone app.

Speaking of, I also think some of the iPhone apps for birth - in the right hands - could be helpful. Check these 5 out. I like the "OB" Patient Tracker the most. Obviously, it doesn't have to be used by an OB - it was a midwifery student on MDC who first pointed this out to me, actually; her preceptor was using it. (See above re: right hands.) The DueDateCalc seems fine, if just a tricked out version of the simple due date wheels everyone has been using since the dawn of, well, at least the 70's. And the Weight Converter, well, being severely math-challenged, I could see myself using this. At least while in school. (Yeah, I know, I should really learn to do it in my head, it's good for me, but still.) Nothing spooky about using it. The Bishop's Score calculator is more problematic. Not the calculator itself - again, it could be used appropriately, but click here and look at the conclusion that is drawn for the example on the right. Now excuse me while I retrieve my eyeballs that are rolling across the floor. Overall, though, I could totally see making use of one or two of these, especially the patient tracker, once I had a lively enough clientele.

Also in the category of technology that is actually helping birth: YouTube videos. Think about what a huge impact that has had already, and how it continues to be a vital resource for championing natural birth. It used to be that if you wanted to see something resembling normal, low-intervention vaginal birth, you had to know someone who had a relatively obscure and coveted VHS tape - and I don't know what they did before the advent of video, short of a disturbing film they showed us in 8th grade health ed. And now, the whole smorgasbord of birth is available right there: home births, birth center births, hospital births, twins, water births, unassisted births, you name it. Women who are curious about what "natural" means, and looks like, can connect with example after example after example. It's really remarkable, and we owe a huge debt of gratitude to the women who are willing to share their most intimate triumphs with us this way.

Which leads me to what's possibly the best technological boost to empowered normal birth of all, the one that connects you and I right here and now: the internet. From message boards to websites like ICAN and My Best Birth spreading the word to the whole birthing blog community, just to name a few of many stellar examples, where would birth be today without it?

I fear it might look a lot more like the picture above.

Monday, September 7, 2009

What better way to celebrate Labor Day . . .

. . . than by slicing off a nice big piece of a c-section cake? Complete with sterile draping, courtesy Cake Wrecks:

I've seen some (bizarre and unappetizing) belly and baby cakes for baby showers and the like before, pretty much all of them at Cake Wrecks as well . . .










. . . but this one takes the, well, you know. As one of the commenters observed, what's left but an episiotomy cake, with licorice stitching?

Apologies if anyone's lunch was totally ruined by this. But how could I not share?

Bon appetit.

Saturday, September 5, 2009

The road less traveled

What poem is more overused and abused than this one? It's misquoted right from the get-go, being commonly referred to not by its proper name, "The Road Not Taken", but by the partially-excerpted line used in the title above. More to the point, its very meaning has been twisted into an inspirational cliche for cheering pioneering action on, which is all well and good - it's just not what was intended by the poem at all. Before the final lines, Frost says plainly that "As for that the passing there had worn them really about the same," and then states that he will be saying that he took the road less traveled, and that that has made all the difference . . . but it's obviously not really true. Both experiences would have been equally valuable.

What in the world am I getting at? Eventually I want to comment about a few things that were recently all abuzz in the birthblogosphere, but first a little on what's been on my mind re: my own life and the whole raison d'etre of this blog.

As I mentioned, I just returned from the promised land. For me, this is Portland, Oregon. It's hard to think of a more ideally suited place for people like me to raise a family. In addition to amazing choices in education, tons of family-friendly activities and resources like OMSI, a thriving arts and music scene, fantabulous restaurants, a very green mindset, including tons of farmer's markets and an urban chickens movement, and its proximity to both mountains and ocean with rivers and abundant waterfalls in between; it's also a place where midwifery thrives and doulas are everywhere.

I got to visit Birthingway while I was there, a MEAC accredited midwifery college. I have no idea how my life gets from here to there, but this is the place I want to eventually enroll for midwifery. It's just an incredible program. I love that it's accredited, I love that you can transfer in a year of general education and come out with a Bachelor of Science in Midwifery. I love that the program revolves around a core day that remains the same day throughout your schooling (which will be so helpful when juggling child care and other jobs - I LOATHE scheduling conflicts and all the tension that results from them); this is in addition to other supplemental classes during the week. I love that on your core day, the entire class cooks and eats lunch together - this and some other attributes of the atmosphere reminds me a lot of my education at Connecticut Center for Massage Therapy (only much longer and much more rigorous, of course). I love that so many midwives in the area go to Birthingway to get their apprentices.

I've looked at some other programs, and liked some of them, but this is my first choice. The Midwives College of Utah also looks really good, but from what I understand, isn't eligible for federal aid, and thus is pretty much out the window for me. Plus, much as I love Utah, there's the greatness of Portland weighing heavily in the 'pro' column. Some have recommended doing a distance learning program, like Frontier, and while I don't doubt that many, many people can thrive on a distance program, and are great self-directed learners, I know myself pretty well by this point in my life, and I know that this just isn't for me. I honestly thrive on a classroom environment. I need to have the lecture in person, and to be able to ask questions as we go; I love the supplementation provided by class discussion; and I especially need to have the positive pressure and directness of assignments and projects. Call me a big ol' nerd, you wouldn't be the first, but there you have it.

So where does this leave me now? I won't be able to commit to this kind of a program for several years. Lily is only about 17 months old now, and still nursing at that. We're nowhere near ready to commit to this kind of intense program, much less the rigors of midwifery itself. This is where doula work comes in. It's actually great experience for future midwives - the more births (of all kinds) you see, the better! And with my massage therapy background, I think I'd be appealing to a lot of mamas - it's a nice confluence of skills there. Moost importantly, I really believe in doula work - you can hardly turn around on the internet without bumping into an article about the benefits of employing a doula. It certainly gives you the best odds of getting a natural or low-intervention birth in a hospital setting, and, let's face it, even though home birth and birth centers are becoming more common and available, the majority of American babies are still going to be born in hospitals for the foreseeable future. So, good way to make an impact, while preparing for the future.

There are quite a few reputable organizations for doula training now. The big behemoth of them all is DONA, of course. CAPPA, Birth Arts International, Childbirth International and ALACE have all gotten good reviews from various attendees. I am most drawn to ALACE (recently changed to "Tolabor", kind of oddly if you ask me), because it is specifically based on the Midwifery Model of Care, which behooves me for the future - though they are clear that they know most of their clients will be giving birth in the hospital, and prepare their trainees accordingly. Their training even includes the option of giving and receiving a pelvic exam - NOT to be performed as a doula, but as an educational experience. How incredibly cool is that? I love this and am totally down for participating.

Unfortunately, one disadvantage of theirs is the relative infrequency of their trainings, in far fewer locations than the large organizations like DONA and CAPPA. On the plus side, in seeming compensation for this, there is the possibility of becoming a sponsor for a training in your area, in which case you not only bring the training near you, but get to do it for free. I'd sound a little more excited about this, but I filled out the application for sponsorship several months ago and have yet to hear anything back. It's iffy whether my current locale is a desirable place for them, which I understand, but I still hope that I can do the birth doula training through them

But wait, you say. Being on call for births as a doula isn't so different from being on call for births as a midwife, and you just said you and Lily weren't even remotely in a position to start doing that. What gives? Well, here's where I'm going to start: I'm actually going to work as a postpartum doula first. This is something much more flexible in terms of hours and somewhat more predictable in terms of planning. Yes, it will still all depend on when the baby decides to arrive, but postpartum doulas get a bit more advance notice.

I think this will be valuable experience, seemingly backing into the whole birth spectrum from the last page of the perinatal process. I saw firsthand just how valuable postpartum care can be, not just from my midwives, but from the first in-home lactation consultant who visited me twice and checked in multiple times by phone. This was not the genius IBCLC that I later saw, and who truly got us breastfeeding after a very long struggle, but she was helpful in her own way, advised on other postpartum issues, and even helped change the sheets. More than anything, the kindness and the human contact itself (mother to mother, too) made a big difference. She was filling a bit of the role that a postpartum doula does.

Another part of the appeal as a postpartum doula is the very fact that it's largely quite humble work. Yes, breastfeeding counseling is important, and teaching women to swaddle their newborns and care for their stitches, and offering herbal support, but it's also a lot of doing dishes, scrubbing the bathtub, throwing some laundry in the wash and folding what's in the dryer, preparing food, and so on. And to me, this feels like a good place to start. It feels like paying my dues, in a way. When you consider that I'm going to be asking women to share their deepest miracle with me someday, and eventually to entrust me with acting as the safeguard for that miracle, paying dues upfront seems like exactly the right thing.

Lo and behold, through a midwife I met at last month's ICAN meeting, there is a DONA postpartum training going on just about an hour and a half from here, coming up in early October. It's even being taught by a past president of theirs, so it's sure to be a great experience. I still hope to do labor support training with ALACE, but there's no real urgency - it could even wait another year or two. I like the idea of doing the birth portion with a different organization regardless. Meanwhile, starting out, I think it will be advantageous to be connected to the larger organization, just from a logistical standpoint.

So at last, I can finally take the first concrete step on this slightly backasswards road less traveled, as I shall someday tell with a sigh, ages and ages hence - whether it's really less traveled or not. Either way, it's my road, and I'm stoked to be getting on with it.

Sociable