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Interviewing A Doula Who Isn't Certified

I've read several "interviewing doulas" guides today and I noticed the 1st question invariably centers on certification. Well what of the uncertified doula?

Many questions will actually remain the same but there are a few things you'll want to ask a doula who hasn't certified with a doula organization. The 1st question is "Why?" There are several reasons a doula may choose not to certify.

It may be that the cost of certification is prohibitive. She may be planning to certify down the road when it is affordable for her. It may be that the doula in question hasn't found a certifying organization in line with her philosophy of birth work. Some doulas may not want to be limited to just doula work if they have other training say as an herbalist, lpn,etc. Or she may have been doula-ing for years already and sees no need to pay for a piece of paper.

Depending on her reasons for not certifying you'll want to ask other questions.

If certification is not financially feasible right now, is she passing the savings on to you? Is she completing the portions of the certification process (such as reading, observing, building her network) that don't require a financial commitment? Is she spending money on marketing, building a lending library or other learning opportunities?

What if she hasn't found the right organization to certify with yet? You'll want to find out what it is she likes or dislikes about the different organizations. What is her philosophy?

What if she objects to the scope of practice of a particular certifying agency? Find out what skill set she has and how she aquired the knowledge that she feels is outside the scope of practice. Ask what her personal scope of practice is and why she practices that way. Ask yourself if you want/need her skill set.

Suppose she has been a doula for years. Ask for references. If she's been around for that long she should have references not only from other clients but from other birthworkers.

I'm sure there are other good questions. I'd love to hear from you if you are uncertified or if you have interviewed or hired an uncertified doula.


Book Review - "So That's What They're For"

Just wanted to pass along my review of the book "So That's What They're For" by Janet Tamaro.

This is the best breastfeeding book I have read yet. It's so down to earth while presenting clinically accurate info. Was a bit heavy handed regarding alcohol/drug intake while nursing but other than that, GREAT! Everybody who works with mothers and mothers-to-be should have several copies for lending.

I was pleased to see two new books at my local library also. They've aquired a copy of "Adventures in Tandem Nursing"

I haven't read this one but I think its great the Library has recognized how common it is to find yourself contemplating the idea anyway.

They also have a new edition of "Hypnobirthing: The Monegan Method"


dads, doulas and birth

Been thinking about dads and birth lately. Started with this article where Orlando Bloom joked that he wanted an epidural during his wife's recent birth.

Then @nashvillebirth tweeted a link to her article about doulas and dads .

And who can forget Childbirth Ed .


"I don't know nothin' 'bout birthin" no babies"

The LA times recently spotlighted a study led by Dr Michael Klein which shows most women don't know much about childbirth.

In particular over 15% of the 1,318 women who were part of the study answered "I don't know" to 8 questions about the risks and benefits of 3 common interventions: epidural anethesia, cesarean section, and episiotomy. While much of the commentary I read seems to point the blame for this ignorance on the women themselves I believe Doctors must bear a large portion of blame. Doctors practice with an obligation to provide informed consent and informed refusal to their patients.

It is interesting to note that fewer women under the care of midwives gave "I don't know" as a response.

In a follow up piece I'll shed some light on the interventions that recieved IDK responses.


college campuses cover cesarean rise

This post from The Eagle, the student paper of Florida Gulf Coast University, is the second article I've seen this week about birth issues in a college publication. I wonder if this is a new trend?

I think it's a great idea to give students who are just entering into their childbearing years this kind of information BEFORE they even concieve.


Rules of Engagement for Lactivists

I read this post from Free Childhood! a while back and I immediately incorporated "hater search" into my twitterfeed. As I tweet I constantly have one tab open to a search for "breastfeeding". If somebody tweets misinformation or misplaced disgust about breastfeeding then I (and hundreds of other lactivists) will retweet and reply.

As the screen shot from just a few minutes ago shows, the discussion is neverending. Too often it goes like this: someone posts a disdainful tweet about a mom breastfeeding in public, lactivists reply in an effort to educate and retweet in an effort to create awareness of the preponderance of negativism regarding breastfeeding, tweetwars ensue. Retractions, apologies, learning? Well, sometimes.

Then I read this post over at momotics and all the posts she linked to (most of which are discussed below) and I got to thinking about tactics. And goals.

The post at momotics was written in response to a post on stir wherein a mom blogs about her pride in her decision to formula feed and then calls breastfeeders who responded "mean." Those 2 posts reminded me of this from phdinparenting.

Recently Paige at Paigeworthy posted a tweet when she saw a mom breastfeeding at a Starbucks in Chicago. Fatal flaw? She used the hashtag #gross. She talks about the experience here. Claire responds here on her blog, Life in Chicago.

As the MinnPost shows here, the establishments themselves sometimes get into the mix. In this instance Brian Franklin, owner of The Doubleshot Coffee Co. in Tulsa OK tweeted this:

A few hours later the "policy" was rescinded.

So what's the take-away?

When someone tweets something about breastfeeding that's either offensive (i.e. calling it #gross, telling women they should use the bathroom, implying that it's in some way sexual etc.) or just plain wrong (imposing arbitrary age limits, downplaying the risks of formula, equating nursing in public with public exposure etc.) I feel a responsibility to correct wrong information. I feel a responsibility to call people out for not supporting breastfeeding moms. I feel a resonsibility to make business owners aware of breastfeeding mom's legal protections.

But, when I certified as a lactation counselor we learned that it's not our job to convince anyone to breastfeed. From reading the comments on Annie's post about how proud she is to be formula feeding I can tell you lactivists will not change anybody's mind if they've already made their decision.

So does searching out the haters do any good. I think it depends on our goals in doing so. What exactly is the goal? My goal is mainly to correct misinformation so it doesn't linger in the internet ether for some unsuspecting person to find and believe.

Tactically speaking, no one is going to learn anything if they feel like they are being attacked. I think we lactivists have got to validate formula feeding moms somehow.

Reconcillitory statements like "some moms may need or choose to formula feed" or "the decision to use formula can be hard" need to become a part of the conversation. Calling formula feeding mothers "selfish", "lazy", "ignorant" or any other derisive term doesn't make them feel any better than calling breastfeeding mothers "immodest", "hippies" or "nipple-nazis" makes them feel. Formula is "the lowest ranked method for infant feeding", "inferior to breastmilk" and "risky". But at least in the developed world, where we can be reasonably sure the water supply is safe and that minimum manufacturing and storage conditions have been met formula is not "poison."

I love these posts from Natural Mama NZ with factual responses to so many breastfeeding myths.

I guess what it boils down to is: No Name-calling! And "Just the FACTS, ma'am!"


Healthcare providers and Domestic Violence

October is Domestic Violence Awareness Month.

I've been involved with Domestic Violence Awareness Month for quite a while. I was a victim of domestic violence at the hands of my oldest daughter's father what feels like a lifetime ago. Even though it was about 12 years ago, I have never forgotten that awful feeling of both never wanting anyone to find out the predicament I was in and also desperately wishing someone would discover my secret and help me out. After I was able to leave I did an internship with my local women's shelter. I am committed to ending domestic violence.

With that in mind and considering that the childbearing year is a particularly vulnerable time for victims I've put together a few links specifically for health care providers. These address both screening and prevention.

First up all health care providers should be aware of the National Domestic Violence Hotline. Victims, perpetrators and professionals can all make use of the hotline for information, support and referrals to local programs.

Health care providers can not only use the hotline they can easily post it in private areas such as the restrooms, exam rooms or other areas.

Violence against women often begins or escalates during pregnancy so routine screening as a part of prenatal care may be something you would like to integrate into your practice. If a patient does disclose an incident of domestic violence to you the way you document it can either help or hurt her if she goes to court. Find out about best practices in documentation. You will also want to know where you can refer her locally.

Finally there is a wealth of pamphlets and brochures you can make available to patients and their partners.

This page from the National Online Resource Center on Violence Against Women has links to many more tools for a wide range of healthcare settings.


Surprising Sustainable Solution to Diaper Need

Huggies has commissioned a study which suprisingly shows a previously undiscovered "diaper need" problem. The Every Little Bottom study found that 1 in 3 mothers in America and 2 in 10 mothers in Canada report ever running out of diapers for their children. And running out of clean diapers constitutes "diaper need".

What I found most interesting about this study is the section on beliefs about cloth diapers. A majority of mothers (65% in both Canada and the US) believe cloth is cheaper yet most (95% US and 91% Canada) still use disposables. Yet the whole point of this study seems to be based on the economy of diapers.

I think the more telling statistics are the beliefs about the convenience and acceptance of sposies vs. cloth. A large majority believe that cloth is less convenient and difficult to use if there is not an in-home washer/dryer. A small number of moms also believe that daycare and laundrymats will not accept cloth diapers.

I'm here to say that cloth is much more convenient for me. I never have to make an emergency run to the store. We have not always had a washer/dryer at home so I've washed my diapers in laundrymats many times over the 5ish years that I've been using cloth. Theres not generally an attendant and I've never seen a sign to indicate that I was breaking any rules anyway.

Neither of my two cloth diapered babies have been to daycare so I can't speak personally to that issue but here is a great resource for anyone who needs it. The Real Diaper Association has put together a list of cloth friendly daycare providers and a tip sheet for introducing cloth if your provider is new to the concept.

A lot of people point out the initial investment required with cloth. I was lucky enough to be gifted 12 prefolds and 3 covers when I started. And then someone else gave me 3 fitted dipes. You can always request cloth for baby gifts. I added to my stash little by little. I bought mostly used diapers. Altogether I've spent $300-$400 spread out over 5 years, to diaper two kids.

I'd love to hear your thoughts about a cloth solution to diaper need :)


Birth: the Adventure

So this was all over my facebook this week

Parents Magazine has created a Choose Your Own Adventure for labor and delivery. Which could be great because envisioning different scenarios can be really helpful. But let's take a looksee, shall we?

I'm only going to give a few highlights because I don't want to do a complete spoiler.

"You're 37.5 weeks pregnant and while making breakfast one morning you feel something that comes on gradually and reminds you of a mild menstrual cramp. Just like a menstrual cramp it fades away. You....

A. Wonder if it might be a contraction then decide its probably not-it's just wishful thinking. You still have two weeks to go. Hello Braxton-Hicks! You continue making breakfast and getting ready for work.

B. Think oh my god it's a contraction! Its almost time, it's getting close, it must be the Baby! You go lie down for a few minutes to see if you feel another one."

OK why are we starting our labor visualization at 37.5 weeks? I know, I know labor can start 2 weeks either side of the EDD. Due dates are just a guess anyway. BUT average gestation for a first time mom is 41 weeks 1 day and for mother having their 2nd or later child 40 weeks 3 days.

In a later scenario after arriving at the hospital dilated at 1cm and with broken waters you are given the option to wait and see what happens or to be induced immediately. Even the American Congress of Obstetricians and Gynecologists(ACOG)reccomends AGAINST an elective (non-medically indicated) induction before 39 weeks. This medscape article indicates a wait and see approach is clinically appropriate for at least the 1st 24 hours after your water have broken. (After 24 hrs the main risk is intrauterine infection. This is one reason to avoid vaginal exams if your waters have broken, avoiding vaginal exams may help reduce the risk of infection.) Most women (90%) will go into spontaneous labor within that time.

In the Parents Birth Adventure if you choose to wait then you walk the halls till midnight at which time you're 3cm and your OB is apparently ready to go home. At this point your waters have only been broken for 13hrs! But the OB says you need a cesarean because "you're just not progressing" and he thinks the baby will be "8 pounds plus."

As this article from the American Academy of Family Physicians shows, cesarean section for suspected big baby is NOT Recommended. Estimates of fetal weight are often off by up to two pounds. And 8lbs isn't actually a big baby anyway. Fetal macromsomia is defined as a baby who is over either 8lbs13oz or over 9lbs15oz.

There are a few good things in this scripted adventure though. At one point you are bouncing on a birthing ball and you seem to have freedom of movement throughout labor.

Birthing Naturally has a similar tool on their site.

What I like best about the Birthing Naturally tool is the emphasis given to reflection. After you complete your virtual labor you are asked to answer some questions about the experience.

I think the thoughtful examination of choices can make an imagined labor and delivery a much more significant help for an expectant mother.

Some other ways to prepare for the different courses your labor might take include reading birth stories both online (here's my most recent birth story) and in print and talking to your friends and family. And the most important factor determining how your labor will go is choosing carefully when you choose your care providers.

Here is the page from about choosing your care provider. The way your provider typically practices will probably be the way s/he cares for you too. So it's important to find out up front how s/he deals with situations like going "overdue", breech presentations, labor progress that falls outside the Friedman's Curve and anything else you can think of. You want to know ahead of time what his or her stance is on induction, episiotomy, etc. What is his or her cesarean rate? How do they monitor baby during labor?(continously or intermittently? doppler or fetoscope?)

In addition to your choice of provider you have a choice in where you birth your baby. Each location will have its own section and induction rates. Different hospitals or birthcenters may have different options. One may be set up for waterbirth for instance and the one down the street is not. One may restrict the number of people who can be in the room with you and amother may not?

The only way to find this information out is to ask. Ask providers when you interview. Ask them continously during your prenatal care. Ask friends and family who've used the same care provider. Ask the hospital or birth center staff. Ask childbirth educators and doulas in your area.

(more to come)


Bloggin' Bloggin'

Many gracious thanks to THE RAMONES for inspiration on this. See original "Touring" lyrics here.

We ll we've blogged about bellies ,breasts ,babies and birth ,
vaccines and circumcisionin and midwifery legislation too

The hits all come from miles around
The tweeps meet up anytime they're around
My recliner's the only place I go
I know I know I know

Cyberspace is alive mommybloggers got the power baby
Cruise the information highway at 500 gigs an hour baby
Got wi-fi and a latte man this post is sublime
about letting the kids go up the down slide

Lets go! MommyBlog, everybody c'mon
Lets go! Mommy Blog, everybody c'mon now

Blogging, Blogging is never boring
Blogging, Blogging is never boring
Blogging, Blogging is never boring
Blogging, Blogging, oh baby, Blogging
Especially with your sisters on the journey
Blogging, Blogging about it all

Well we've blogged about the issues we hold dear
And we've met those for and against
No its not hard not far to reach
You can advocate for any cause you please
Feminism, Lactivism, Intactivism,Birth Activism those are my deal
I hope you find yours and blog with zeal

My laptop is my soapbox I know I know I know

So lets go! Lets go! Lets go! 500 miles to Mexico
Lets go! Lets go! Lets go! 200 miles to Tokyo
Lets go! Lets go! Lets go! Lets go!

Type, type, type the night away
straight on through to the break of day
type, type type the night away
Well it's in your blood, it's in your blood

Bloggin' Bloggin'...
Bloggin' Bloggin', all around the world
Bloggin' Bloggin', all aroung the world
Bloggin' Bloggin' all around the world