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.