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.

Clipped from: twitter.com (share this clip)

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A few hours later the "policy" was rescinded.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.

1-800-799-SAFE(7233) or 1-800-787-3224(tty)

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.

Clipped from: new.vawnet.org (share this clip)

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

Clipped from: http://clply.com/11jfs (share this clip)

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.

Clipped from: www.birthingnaturally.net (share this clip)

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.

Clipped from: www.birthingnaturally.net (share this clip)

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.com 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

my breastfeeding story

In honor of National Breastfeeding Month I'm sharing my own breastfeeding story. I'm mother to 3 kids and each one has been a totally different feeding experience.

With my first I never gave a thought to how I would feed her. I planned to breastfeed but didn't really research it or do any advance planning. Despite an epidural delivery, Olivia latched on just fine. They gave me demerol right after she was born while they stitched up my episiotomy so my memory of the first few hours is a little foggy but I believe she was with me from right after birth until several hours later. I did send her to the nursery that night so I could sleep and I don't know if she was supplemented with formula at that time or not. Back then I wouldn't have known to ask them not too. But once she came back to my room the next morning she stayed with me and didn't go back to the nursery. We left the hospital exclusively breastfeeding but were never visited by a lactation counselor nor given any referals for breastfeeding support should issues come up. We were given the ubiquitous bag however.

The first few days were actually pretty easy. But it didn't take long for my daughter's poor latch to begin damaging my nipples. It's been so long ago, over 10 years, that I can't look back and diagnose her latch problems, but I wish someone back then had just asked how breastfeeding was going. Her pediatrician or someone at the wic office, or anybody. I wish the hospital, pediatrician or wic office had at least offered a handout with some basic breastfeeding support and information. By 6 weeks I was in so much pain with each feeding that I dreaded her cries for milk. Both nipples were cracked and blistered. I hate telling this part of my breastfeeding story because knowing what I now know I feel like I shouldn't have given up so soon. I always qualify my story with examples of the stress I was under. (To be fair, I was under extreme stress dealing with my child's father, an abusive alcoholic, and dealing with health issues related to my ulcerative colitis)

During her sixth week of life I started giving her formula from the bag we took home from the hospital for some feedings. Just so I wouldn't hurt. Just to give my nipples some rest. I had no idea I was sabatoging my breastfeeding relationship. I had no idea something like a lactation consultant even existed much less where to find one. I didn't know there was good latch vs. bad latch. I didn't know how easy a bad latch can be to fix. I didn't even know I could get relief just by changing the way I held her for her feeds. I didn't know how much better it gets once mama and baby learn to breastfeed comfortably.

And the one thing I wish I had know more than any other That NO ONE EVER MENTIONED was the utter infiriority of formula compared to breastmilk. If I had known the full extent of the detriment of formula feeding I might have stuck it out.

We left her father when she was three months old. Once I got my health issues under control my stress levels went way down. That would have been a great time to try relactation but once again no one ever mentioned it.

My next child was born six years later and his breastfeeding story is so different. While pregnant with Kellen I took a childbirth class from a former La Leche League leader who used to be a certified Bradley instructor. I switched to midwifery care around 28 weeks. I also did a whole lot more during my second pregnancy. I even read a few breastfeeding books beforehand. Additionally I had actually seen other mothers breastfeeding a few times. My sister breastfed her son. I saw a cousin breastfeed her daughter a few times. And perhaps most important I knew where to go for help if I got stuck.

I chose to birth Kellen without an epidural or other pain medications so neither of us was groggy during "the golden hour". We delayed giving eye drops and bathing the baby. We used a different hospital for the birth and they sent a lactation counselor to see us twice before discharge. The hospital didn't give us bag packed with formula samples. Once again we went home exclusively breastfeeding.

With my son the atmosphere at home was so much better. His daddy was so supportive of my breastfeeding. My childbirth instructor had coached my fiance on some practical ways to help me succeed. He was always ready with a snack and a glass of water and did at least twice as many diaper changes as I did. When I developed sore, cracked nipples, I knew where to go for help. I saw a local lactation consultant, attended a breastfeeding support meeting, and searched online for support and information. ( I spent a lot of time on mothering.com, kind of woo but a great source of support and info )

I was able to breastfeed my son for 2 and 1/2 years.

Later when I had the opportunity I took a course to become a certified lactation counselor myself. So by the time I had my 3rd child I felt well prepared to nurse her.

She too, took to nursing right away. We didn't take but a few days to learn to breastfeed together. I did have a few really painful days with her but by the time she came along I had enough techniques under my belt to launch a full fledged attack on the pain and the root cause. What helped me most with her was rotating her round the breast from each feeding to the next and applying breastmilk to the nipples.

She's a year old now and still nursing. I don't know how long it will last. I'm working full time and I've weaned from the pump. (although in place of pumping I come home from work for some breaks) She's actually lost weight so her pediatrician reccomended pushing more solids. Weaning is a process, not a day so we could conceivable continue to nurse for another year or two. I would love that but she's never been the boob-a-holic my son was so who knows.

If you've read this far I hope it has been an informational, supportive and encouraging post. If you have any questions or comments please let me know. I'll answer anything I can and help you find the answer to anything I can't.

Holy (UN)COW its the last day of World Breastfeeding Week

As World Breastfeeding Week draws to a close I'm just sharing some of my favorite posts from the week. The theme this year is Just Ten Steps.

Ten Steps to Successful Breastfeeding

1. Have a written breastfeeding policy that is routinely communicated to
all healthcare staff

2. Train all healthcare staff in the skills necessary to implement this
policy

3. Inform all pregnat women about the benefits and management of
breastfeeding

4. Help mothers initiate breastfeeding within 1 hour of birth

5. Show mothers how to breastfeed and how to maintain lactation even if
they are separated from their infants

6. Give newborn infants no food or drink other than breastmilk unless
medically indicated

7. Practice "rooming in"- allow mothers and infants to remain together 24
hrs a day

8. Encourage breastfeeding on demand

9. Give no pacifiers or artificial nipples to breastfeeding infants

10. Foster the establishment of breastfeeding support groups and refer
mothers to them on discharge from the hospital or clinic

Here Teresadoula vows to include everyone. Breastfeeding rates are calculated by several organizations and in several ways but I have to agree with Teresa: the more women we include as "breastfeeding mothers", the more women who have a vested interest in improving breastfeeding protection and support.

Anne at Doula-la-la has a really nice round up that brought Why I won't ask you why you aren't breastfeeding from Phdinparenting to my attention. An older post from the same blog, Does breastfeeding hurt? one of my favorite brestfeeding posts ever, reflects on the common quote "It's not supposed to hurt."

And Dani over at Informed Parenting has several great posts up including a repost of the 1st few paragraphs of From Bottle to Drive-thru, a commentary on the impact of food marketing. Dani got some great comments and conversation on her repost.

Katie Granju posts here about being unable to breastfeed and the emotional fallout that can have on a self identified lactivist. That post was even discussed in the New York Times. The comments range from people who are angry at lactivists creating an atmosphere of guilt and blame when breastfeeding doesn't go as planned to people offering advice of things to try to simple support and sympathy.

The comments on these types of high profile breastfeeding stories offer a really good look at the culture mothers face when making the crucial infant feeding decision. I really think we lactivists, lactation professionals, and anyone involved in infant/maternal care should make it a point to read the comment sections in these kinds of posts more often. I know my eyes tend to sort of glaze over by page 2 most of the time because I know exactly what I'm going to read. But to occasionally step back and read it again with fresh eyes, might give a better apprectiation of what mothers are already subjected to and give us some insight into how best to advocate for breastfeeding without alientating women who either haven't decided yet or can't or won't breastfeed.

And heres another wrap up from Elita over at Blacktating writing for Best for Babes. Among other topics, Elita touched on the controversy surrounding comments made by model Gisele regarding breastfeeding and the law and points out some laws we could all get behind.

Annie Newman over at Reproductive Health Reality Check expands on that theme and ties it to the WBW theme for this year by examining how society can be "Baby Friendly" outside the bounds of hospital walls. My favorite link from her piece is this article which discusses breastfeeding in the context of women's rights.

"2. Why is breastfeeding considered a woman’s right?

Breastfeeding is an area where one might perceive
a potential for conflict between the woman’s and
the child’s rights [46]. As confirmed by the
Convention on the Rights of the Child, children
have a right to the best start in life with the best
chance for health [47], as well as for intelligence,
proper growth, protection against immediate and
chronic diseases, etc. But why is this is also a
woman’s right? In countries throughout the world,
women’s autonomy frequently has been limited in
the name of ensuring children’s well-being, subordinating
women’s rights to children’s rights. However,
by framing the issue as a woman’s right to
choose and succeed with breastfeeding makes it a
responsibility for the family, society and workplace
to recognize and support this right. In addition,
clear biological considerations indicate that, indeed,
the right to breastfeed is a woman’s right for
her own health. Thus, women who breastfeed have
improved postpartum recovery, less iron loss,
delayed fertility return, lowered incidence of
breast, ovarian and uterine cancers, and apparently
better bone status in older age. Two international
conventions, the Convention on the Rights of the
Child and the Convention on the Elimination of All
Forms of Discrimination against Women (CEDAW)
[48] support this right for both the child and
mother. Both Conventions place substantial obligations
on the state to enable accommodation of
childbearing and childrearing roles, among other
roles."

Here is a post from Marie Clements an RN and IBCLC at Concientious Breastfeeding Connections. She criticizes what she sees as too many hospitals reliance on pumping as a first line of breastfeeding support.

There is a lot of great coverage out but I'm going to wrap up my wrap up with the Surgeon General's Statement

AIDS news

New reports spotlight the AIDS crisis.

The Centers for Disease Control released a study entitled Communities in Crisis: Is there a Generalized HIV Epidemic in Impoverished Urban Areas of the U.S.? Researchers found that AIDS rates in impoverished areas are alarmingly high. They also found that most people living in impoverished areas are Black. According to Phil Wilson, founder and CEO of The Black AIDS Institute, this only confirms what many AIDS activists have been saying for years: "...a generalized epidemic exists within many Black communities."

One interesting finding from the report involves the few Whites and Latinos living in these areas. All participants experienced elevated rates of HIV infection. In fact, the researchers found the differences between races to be statistically insignificant. So we find that when other races live in the same areas their infection rates rise to the same levels.

Phil goes on to say "To engage in a meaningful dialogue about whether or race drives the differences in HIV rates, researchers need to ask some other very important questions. What are the differences in HIV rates in poor urban communities which are overwhelmingly Black, and poor white rural communities? How do middle class and wealthy Blacks fare compared to middle class and wealthy whites?"

We do know that health outcomes for other conditions or disease states tend to be more negative for African-Americans across the income spectrum. For example, infant mortality is 3 times higher for Black babies regardless of income level. Asthma is similarly more prevalent in african americans. One study even links higher rates of asthma to poorer housing conditions. Some researchers have speculated that a greater number of negative health outcomes among African-Americans can be partially attributed to the stress of living under systemic racism.




I'm not sure what the best approach is in adressing health disparities in the U.S. I think the first step is to acknowledge them. Perhaps the next step is more research.


On a related note UNIFEM, the women's fund of UNICEF has released a report entiltled Transforming the National AIDS Response: Advancing Women's Leadership and Participation. The report essentially says that despite comprising a rising percentage of new diagnoses of HIV/AIDS, women are under represented in AIDS leadership. Salon summarizes here.


Perhaps Annie Lennox's appearance at Idol Gives Back was a good start. She spearheaded the organization SING specifically to empower women and children in the fight against AIDS.

And on the topic of women and children The World Health Organization has released updated guidelines regarding anti-retroviral treatment to prevent mother to child transmission of the virus.


Just a small slice of what's going on in the AIDS arena but 3 slices of hope I think.

maternity clothes for teens?

So Forever 21 has launched a new line. A maternity line. Big controversy ensues.

Fueling the controversy? Of the 5 (California, Alaska, Utah, Texas and Arizona) states chosen to open the launch, 3 (California, Arizona and Texas) have some of the highest rates of teen pregnancy in the U.S.

The company claims the they are not specifically targeting teens. They do after all carry women's, men's, teens and tweens clothing and shoes.

So what do yout think? Is it irresponsible to design a maternity line when your company apeals to the young? I read several posts on the subject and I think I like this one from Jaime the best.

Hobo Mama: Tips to help parents assume the best intentions

Hobo Mama: Tips to help parents assume the best intentions

Just read this great blog post. LOVE it!

breastfeeding advice on the interwebz

Came across this question about induced lactation and this about breastfeeding as a smoker. I was really pleased to see that both women did get good advice but sorry to see so many answers that were flat out wrong too.

Thought this was great opportunity to point out my favorite sites for good breastfeeding advice, info and support on the web.

kellymom
the breastfeeding threads on mdc
lactmed (a great site where you can look up medications to see if they are compatible with breastfeeding)
The Academy of Breastfeeding Medecine
US Breastfeeding Committee
La Leche League

Also don't overlook the possibility of in person support via La Leche League or other breastfeeding support group meetings, Lactation Consultants or Lactation Counselors (did you know if you get WIC they have peer counselors?)

cesareans and "choice"

I read this letter of the day in the StarTribune out of Minneapolis-St. Paul Minnesota and it really got me to thinking. In the letter a mom who had a cesarean birth defends her "choice." She says "I "chose" a Caesarean because medical complications made it necessary, but the OB made it clear that this was still my choice."

Now if a cesarean is medically necessary, is it really a choice?

And then I got to thinking more and I remembered something I read in The Birth Book by William and Martha Sears. In the book they talked about hard and soft indicators for cesarean. Hard indicators include complete placenta previa , a breech in a transverse position,
prolapsed cord , and a very few others.

Soft indicators would be "failure to progress" or "prolonged labour", changes in fetal heart tones, and suspected big baby. These and other soft indicators are covered here at childbirth connection and here at unnecesarean

In the case of a hard indicator, cesarean isn't a choice. It's a medically indicated major abdominal surgery. Like all surgery cesarean carries risks but in these few cases the benefits (i.e. baby born quickly before s/he loses too much oxygen from a compressed cord) outweigh the risks (delayed breastfeeding initiation, wound infection, iatrogenic prematurity, etc) to such an extent that the "choice" doesn't exist.

But I'm going to assume the best. I'm going to assume the woman who wrote the letter had a soft indicator for cesarean, was presented with evidence that examined the risks, benefits and alternatives of both vaginal and cesarean birth for her specific situation and then made the decision that she knew was best for her and her baby.

fyi because this blog is focused on natural birth options I conciously chose to use a link that shows some of the risks of cesarean, I don't intend to imply that there are no risks in a vaginal delivery, but the risks of cesarean are often downplayed at the time a decision is to be made. As to the link for alternatives i chose to link to a site describing an alternative to cesarean that is specific to cesarean for cephalopelvic disproportion, It is not the only alternative and is not a useful alternative to cesarean for other reasons, just one example.

This is why I blog about birth and breastfeeding. This is why I'm taking doula training in the fall. Because I want women to know their options. If there is a choice to be made, if a midwife or ob suggests a cesarean for a non-emergent reason, I hope that women will have the knowledge (and hopefully a doula by her side) to make a choice she is confident in.

edited to add this link to a post from Anne @ Doula-la-la. After I wrote my post I read hers and I think we are talking on very similar points. Then I read Michelle's comment and totally second guessed myself.

Am I assuming other moms would choose as I do if they just knew what I know?

womens health news

just wanted to point out a great blog i've found: Women's Health News

It's written by a medical librarian and chock full of info from the full spectrum of health care.

A Decision and A Date

My husband says I'll be able to go to school in 2012. I know that's a ways a way but it's a date. An actual time has been set when I can get on with my formal schooling. (Although I'll be gaining a new certification in the Fall....the doula grant has been approved so I'll be getting some training in that)

And I've decided. I'll be going to nursing school. Don't know yet if I'll start at the tech school with my LPN (liscensed practical nurse) or if I'll go directly back to college for my BSN(bachelor of science in nursing). My longterm goal is to become a CNM(certified nurse-midwife). I just don't know which route is going to be the best.

At first I wasn't sure if I wanted to become a CPM(certified professional midwife) or a CNM but I decided I really do want to go for the CNM. I figure even though not many CNM's attend homebirth being a CNM isn't a big a barrier to attending homebirth as being a CPM is to attending hospital birth. And let's face it most births in this country take place in the hospital.

It was actually this post from Public Health Doula that helped me decide.

In the post she's talking about the pros and cons of getting a masters in public health as opposed to well anyhting else. ANd she talks about the thought process involved.

As I reflected I realized I will have more opportunity to be "with woman" WHEREVER SHE CHOOSES TO BIRTH as a CNM.

Iwould love to hear from anyone else on the journey though and hear your thought process....

australia, male hormonal contraception, oxytocin

I came across this blog all about the situation in Australia. While some of the posts are specific to the situation there some are applicable to midwifery everywhere. Hope ya'll enjoy!

Birth control may soon be shared more equally between men and women. This article from USA Today details research efforts underway to develop hormonal contraception for men. Researchers are most interested in investigating testosterone as a sperm production blocker though some studies have involved progestin. Likely routes of delivery include injections or topical gels. But Dr. John Armory an associate professor of medecine at The University of Washington says "Everybody's been saying 'in the next 5 years' for the past 30 years."

New research on everybody's favorite hormone, oxytocin. This article from The Telegraph discussesnew findings regarding the effects of oxytocin on soldiers in battle. According to the article "The results indicated that oxytocin drives a “tend and defend” response, promoting in-group trust and co-operation and defensive, but not offensive, aggression toward competing out-groups."

ella

From the Washington Post Next week the FDA convenes to consider the approval of a new emergency contaceptive. Ella (ulipristal acetate) works for up to 5 days after contraceptive failure or unprotected sex. It is already available in at least 22 countries. The usual suspect are trotting out the same arguments, against the new pill that were used against Plan B . Because of a chemical similarity they are also linking the new contraceptive to the abortion pill RU-486 (Mifeprex)

biting my tongue: when is it appropriate?

When to share our knowledge and when to bite our tongues: I think this is something many of us involved in birth or breastfeeding issues struggle with. I had one of those opportunities at work yesterday. (FYI my paid employment doesn't really have anything to do with birth)



Actually 2 different birth related scenarios played out. The 1st was one of the times I think its usually best to refrain from sharing. A customer came in and was talking about her elective repeat cesarean, scheduled for tommorrow. No need to share VBAC knowledge there. Her mind was already made up. Besides, she wasn't even talking to me. (You fellow birth advocates know how you can hear the words "cesarean", "VBAC", "induction" and the like from way across the room :lol)



At least no need for me to share with her. Talking later with my co-workers I was able to say that VBAC is a reasonable option for most women. Not alot of sharing because, well, nobody asked for further info.



Which is a part of deciding what if anything to say in those kinds of situations. How much interest is there? How much chance is there that anything you say will make any difference? Not that the reasons to discuss birth solely involve changing people's minds. Because quite frankly theres very little mind changing going on in a casual discussion at work. Informing women of their options might happen though if you watch what you say.



Later at work as I mentioned that birth is my thing. A co-worker shared her family history of cesarean. As much as I wanted to go on a spiel about pelvic adequacy and the rarity of cephalopelvic disproportion. I didn't. Why didn't I speak up that time and why did my silence nag at me so I felt compelled to post on the topic?

Well for one I don't like to contradict people. I couldn't figure out how to share information w/o contradicting. Maybe I could have said something about the capacity for even a small pelvis to expand?

btw here is a great link to an article from the great Gloria Lemay about pelvis's (pelvi? :lol how about pelvic variety?) http://www.midwiferytoday.com/articles/pelvis.asp

homebirth in australia: legal but not supported

Homebirth has been a contentious issue in Australia for a long time. A big country with vast stretches of sparsely populated area, the homebirth debate is perhaps less philosophical and more practicle than it is in more densely urban countries. And the woman and babies who face long travel times if they are forced into hospital births are caught in the middle.

The Minister of Health recently required professional midwives to carry indemnity insurance. They are being required to pay a minimum of $5000 for hospital services. Indemnity insurance for homebirth services is not available at this time. http://bit.ly/9JH0gv The Health Minister released a statement praising the new insurance requirements and detailing the benefits for mothers and babies. http://bit.ly/cc2n0l

Homebirth is still an option a woman may legally choose for herself and her baby. However there is the concern that midwives will be forced to pass on the cost of the new insurance to home and hospital birthers alike. Despite loft ideals, for many women place of birth is choice often defined at least in part by cost considerations.

Even women who have read the research on homebirth option and determined that it is a safe choice for their situation (as it is for most mother/baby dyads) must balance that knowledge with their financial particulars.

Additionally it is being reported that some homebirth mothers are being denied medical care when they do seek a physicians consult. http://bit.ly/9t1jEc

thoughts on contraception

I've been thinking about various issues surrounding contraception lately.

I've had some fatigue and lightheadedness lately which has one of my bosses convinced I'm preggers again.... thankfully my chart says "no!" http://www.tcoyf.com/charts/pdf/bc_fahr.pdf

I use over-the-counter birth control. Depending on where I am in my cycle we use either film http://www.vcf-contraceptive.com/whatisvcf.html or condoms. For the past 2 years we've use flexible spending to pay for it. But my flex spending just changed the rules about otc items being eligible. So I've been thinking about if I want to change methods. (decided we're actually pretty happy with what we're using. gonna see if I can get an rx for it. it'll be covered with an rx)

I recently read this article http://bit.ly/aWDABa in The Nation regarding contraceptive sabatoge (thanks momstinfoilhat http://momstinfoilhat.wordpress.com/2010/05/28/accepting-responsibility/ for alerting me to this btw)

And then today this article shows up on my google alerts http://www.rhrealitycheck.org/node/13599 As part of the Patient Protection and Affordable Care Act enacted in March "preventative care and screenings for women" will be required to be covered by insurance. This will go into effect 6 months from March 23, 2010. So sometime before September 23 it must be determined exactly what services will be covered under that umbrella.

In light of goals set by the Department of Health and Human Services (Healthy People 2020 http://www.healthypeople.gov/hp2020/Objectives/TopicArea.aspx?id=32&TopicArea=Maternal%2c+Infant+and+Child+Health and http://www.healthypeople.gov/hp2020/Objectives/TopicArea.aspx?id=21&TopicArea=Family+Planning family planning, including contraceptive services, as part of preventive care makes sense. Even though unintended pregnancy is not a disease state, its prevention has important health considerations for both mother and child. Women are fertile from the age of roughly 13-50. Tha's almost 40 years. We spend most of that time actively avoiding pregnancy. So some kind of contraception is going to be necessary for most women for a large portion of their lives.

what is a partogram?

Thanks to moms tinfoil hat http://momstinfoilhat.wordpress.com/I found this great piece of research http://download.journals.elsevierhealth.com/pdfs/journals/0002-9378/PIIS0002937808007758.pdf

The authors take a look at a large number of common interventions during labor and delivery and determine if they are supported by evidence or not.

One of the things they looked was using a partogram. Now this is a term I had never heard before. Naturally I had to google it. I don't know if this is the best page to define the term http://staff.um.edu.mt/csav1/lectures/partogram.pdf but it sure has a lot of charts. As best as i understand a partogram is basically a chart with an "action line" and anything that falls into the range of the "action line" requires some kind of action. Something like the Friedman's Curve.

Barbara over at NavalGazingMidwife http://navelgazingmidwife.squarespace.com/ kindly posted this link to an article that gives a good explaination of that http://emedicine.medscape.com/article/273053-overview

Something I'm going to have to learn more about for sure.

If you're interested they concled that the evidence is insufficient to recommend routine use of the partogram.

International Doula Month

Happy International Doula Month

With all the excitement over international day of the midwife I'm a bit late celebrating the doulas. But now that I'm on it:

Just in case you aren't familiar with the word "DOULA", from the homepage of DONA International

The word "doula" comes from the ancient Greek meaning "a woman who serves" and is now used to refer to a trained and experienced professional who provides continuous physical, emotional and informational support to the mother before, during and just after birth; or who provides emotional and practical support during the postpartum period.

Did you know the benefits of having a doula present at birth is proven by research?

DONA (doulas of north america) goes over the research here http://www.dona.org/resources/research.php and sage birth gives a neat little summary of some of the specific figures here http://sagebirth.com/Doulabenefits.htm

and here are more links:
from the american pregnancy association http://www.americanpregnancy.org/labornbirth/havingadoula.html
from midwife ronnie falcos archives http://www.gentlebirth.org/archives/doulnots.html
from one of my doula friends on facebook
http://dou-la-la.blogspot.com/

I'm really excited to be reminded of Doula Month. I'm still hoping to do some training in that area as soon as the grant money comes through.

trying to start good habits

Once again I am cleaning my in-box of old e-mails. This has been a huge problem for me so I'm posting even though this isn't especially birthy.

I changed my settings on face book so i don't get a new e-mail everytime anybody sneezes ( :lol)

I unsubscribed to a few newsletters i'm not really interested in anymore.

Hopefully these small steps will help keep it from getting to the point its at now ever again.

Also while going through whats left. i'm doing by the page. I just click "select all" then QUICKLY skim the titles/senders. Very little is making the cut to even be read. Much of what I bother to read can be deleted. And that which I really want to keep I'm labeling into folders so I can find it later.

BABY STEPS BABY STEPS.....

(although i admit i just did a huge step tonight. i have halved my inbox. down from 4000+)

thoughts on international day of the midwife 2010

This past Wednesday we celebrated International Day of The Midwife 2010. http://internationaldayofthemidwife.wikispaces.com/International+Day+of+the+Midwife+2010

I took the day off work so as to attend as many online discussions/presentations as possible. As an aspiring midwife it was a tremendous opportunity to hear perspectives from midwives who've been at it far longer than I.

I caught a discussion regarding midwives perceptions of working in a birth center. While it wasn't terribly relevant to me now it did reinforce my notion that the hospital birth culture is not currently woman center-ed.

I'm not sure how I feel about having that notion reinforced though. I do feel that midwives are needed as much or more for hospital birth as for home birth. I feel strongly that every woman deserves midwifery model care http://cfmidwifery.org/mmoc/define.aspx

The Midwives Model of Care is
based on the fact that pregnancy and birth are normal life processes.


The Midwives Model of Care includes:

Monitoring the physical, psychological, and social well-being of the
mother throughout the childbearing cycle

Providing the mother with individualized education, counseling, and
prenatal care, continuous hands-on assistance during labor and delivery, and
postpartum support

Minimizing technological interventions

Identifying and referring women who require obstetrical attention

The application of this woman-centered model of care has been proven to
reduce the incidence of birth injury, trauma, and cesarean section.


Copyright (c) 1996-2008, Midwifery Task Force, Inc., All Rights
Reserved

I can't see how I can take the many years of schooling required to become a CNM (certified nurse-midwife) just to be able to attend hospital births, though. Taking the direct entry route to midwifery and then providing out of hospital birth AND in hospital doula services, childbirth education or other non-medical forms of support for women who prefer to birth in a hospital would allow me to work towards changing hospital birth culture. But it would be quicker and a lot less expensive. I also think i could work "with woman" as a labour and delivery nurse.

So who knows what i'll end up doing?

After that i watched a presentation entitled "Cesarean Delivery on Maternal Request" http://www.slideshare.net/VirtualIDM/cesarean-delivery-on-maternal-request while I listened to The Feminist Breeder's http://thefeministbreeder.com/ podcast interview w/ Amy Romano, Mary Murray and Amie Newman and simultaneously joined the twitterfest @ #idm2010. The feminist breeder's show was dedicated to midwives online presence and tied in nicely to the next presentation "Online Presence for Midwives".


Next up was a session from Gloria Lemay on "Nutrition for Two". Iloved simply Gloria presented the task of eating healthfully. In fact I'm trying to incorporate some of her suggestions into my own eating even though i'm not pregnant.

The presentation on "Fetal Monitoring for Low-Risk Women" went a little over my head at some points but was fascinating nonetheless. I think the important thing I took away was how inportant it is for midwives to learn "high touch/low tech" means of monitoring the mama-baby dyad. These skills are being lost and its up to midwives not to let that happen. If skills like ascultation, palpation, and simple observation are lost what will happen to women when the power goes out? or women who have unplanned out of hospital births?

The drop in sessions for student midwives was a bust but i did enjoy the story telling that took place in its stead.

One session that I missed that I really wanted to participate in was the one about midwifery in South Carolina. That's so close to my location!


Even though these session were mostly targeted towards midwives I came out feeling highly motivationed to get back out in the birth related relms of the internet. (Look, ma! I'm Blogging again!) I'm not a midwife yet but that doesn't mean I don't have a voice to contribute. I have a desire to share what I know and to learn MORE MORE MORE.... and then pass that on.

Additionally I feel motivated to take a few baby steps towards midwifery . I've earned one credential that relates to my midwfery aspirations. Last year I earned my CLC (certified lactation counselor) which I see being really beneficial in postpartum doula work and in childbirth education. Next on my list is to earn my CPR certification and my NRP certification. Beyond that I plan to take advantage of some local networking opportunities. I'm involved in a local Healthy Start group http://www.heartofgeorgiahealthystart.org/ http://www.healthystartassoc.org/ so I want to become more active in that group and make inroads into other groups as well.

Why I Want to be a Midwife (or why does midwifery attract so many wannabes?)

This is a post in reply to a comment on a post from Barbara over at Navelgazing Midwife

I've muddled around with this post for a long time and I think I'm finally happy with it.


Like a lot of us in the birthy blogosphere I am an aspiring midwife.


I have a few reasons for wanting to be a midwife. In the main I see a need in my community for midwifery, perhaps homebirth midwifery in particular. There is no midwife in my immediate community. There is one freestanding birthcenter in my state. It's about 2 and a half hours away and is staffed by Certified Nurse-Midwives. Thats the only out of hospital birth option besides unassisted that is legally available. Certified Professional Midwives (CPMs) are the only birth assistants mandated by their certifying body to receive training in out of hospital birth but CPMs are not legally authorized to attend any birth in my state. I can choose to birth in a hospital assisted by a Certified Nurse-Midwife (CNM) if I'm willing and able to travel an hour or more. There is a CNM in my area who has recently graduated from The Frontier School of Nurse-Midwifery but as far as I know she has not yet set up practice. There is (or at least was, 5 years ago) a CNM in practice about an hour away. About 2 hours away either north or east there are clusters of both CNMs and CPMs.

I find the body of knowlege encompassed in midwifery to be fascinating. As a woman and as a feminist I enjoy the demystification of my own bodily processes. Just as a birthing woman, gaining resources and information about the normal and the abnormal, techniques and treatment involved in managing either is incredibly empowering. I have learned a lot just researching my own births and reading as much as I can about birth and midwifery. One of the most important things i have learned is just how much more there is to learn. Going into a formal training program to earn the title of Midwife would give me some structure to my studies and hands-on experience with clinical skills.

I think of midwifery as both a teaching and a caring profession.I want to share the empowerment I have found. I love helping other women find the things they need to know for their own births. As a midwife I would have the opportunity and obligation to pass on the things I learn.

I also believe I would be a good midwife. Who doesn't want to find something they love to do, and can do well? Some of the things i think I already have that might be the beginnnings of a good midwife? I listen.At my current job I have recieved compliments from my customers for my empathetic nature. I'm not tied to "being right", so I think I'd be good with mama's who choose to birth differently than I would. Communication is a two way street and I think I'm good at telling too. I can already envision myself conveying information to new parents on controversial topics like vaccination, or circumcision, or VBAC. I think I have the emotional/ mental stability and stamina to handle midwifery.

And moving beyond my personal reasons and qualifications I think midwifery serves the greater good. Its an honorable and simple profession that doesn't seek fame and fortune. Midwives are not accountable to many beyond each mother-baby dyad. No corporate adgenda to bow to (though I do realize midwifery politics can draw one into dogmatic allegiences if you let it ;>) They say "peace on earth begins with birth." and I think theres some truth to that. I think midwifery model care for the majority would be more economically and perhaps environmentally sustainable.