bellywisebirthsupport

Interviewing A Doula Who Isn't Certified

2011-10-08T22:45:00.003-04:00

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"

2011-07-26T13:51:00.002-04:00

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

Clipped from: www.amazon.com (share this clip)

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"

Clipped from: www.amazon.com (share this clip)

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"

Clipped from: www.amazon.com (share this clip)

dads, doulas and birth

2011-07-19T17:21:00.003-04:00

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"

2011-06-20T11:50:00.003-04:00

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

2010-11-10T13:33:00.004-05:00

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

2010-11-02T17:31:00.014-04:00

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

2010-10-26T15:46:00.007-04:00

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

2010-10-25T12:24:00.003-04:00

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

2010-09-21T15:03:00.009-04:00

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'

2010-09-04T20:33:00.002-04:00

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

2010-08-17T14:01:00.014-04:00

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

2010-08-07T18:23:00.018-04:00

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

2010-07-22T20:40:00.013-04:00

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?

2010-07-20T11:13:00.005-04:00

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

2010-07-02T20:15:00.001-04:00

Hobo Mama: Tips to help parents assume the best intentions

Just read this great blog post. LOVE it!

breastfeeding advice on the interwebz

2010-06-21T12:04:00.004-04:00

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"

2010-06-20T12:28:00.011-04:00

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

2010-06-18T11:01:00.002-04:00

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

2010-06-16T22:56:00.003-04:00

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

2010-06-14T13:58:00.007-04:00

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

2010-06-13T18:29:00.005-04:00

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?

2010-06-09T15:06:00.003-04:00

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

2010-06-09T00:54:00.002-04:00

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

2010-06-04T23:47:00.003-04:00

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?

2010-05-21T23:23:00.002-04:00

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

2010-05-13T02:46:00.003-04:00

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

2010-05-13T01:50:00.003-04:00

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

2010-05-09T22:31:00.004-04:00

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?)

2010-04-03T14:03:00.011-04:00

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.

cool contest alert

2009-11-11T00:16:00.003-05:00

woman to woman childbirth is sponsoring an awesome giveaway http://www.facebook.com/l.php?u=http%253A%252F%252Ftinyurl.com%252Fykmb8e8&h=469fb47e25f3950c5e6db49aedc1104d&ref=nf of the book breastfeeding with comfort and joy http://go2.wordpress.com/?id=725X1342&site=womantowomancbe.wordpress.com&url=http%3A%2F%2Fwww.thebreastfeedingbook.com%2F

good luck w/ your entries (this is my entry)

preview of future post

2009-11-09T00:15:00.003-05:00

so i'm currently researching the gay parenting journey. a comment i overheard the other day promted me to look into it. it was meant as a joke when one half of a lesbian couple said "you know its hard for gay folks to have a baby" but it got me to thinking.....

i can see that it would be a more difficult journey than it would for a hetero couple. so far i've found out that more than half of the homosexual population wants kids. and they have multiple routes to that goal. adoption, artificial insemination, surrogacy, etc.

but if they want a child who is biologically tied to at least one half of the couple, well how many of those procedures would be covered by insurance? how costly are they?

i learned that most children sucessful artificial insemination produces male offspring. some people really do have a preference for one sex or another so thats something to consider.

i'll be posting something on the topic soon, maybe this month if i get a chance to do enough research.

additionally the recent live streeamed birth http://www.facebook.com/l.php?u=http%253A%252F%252Fwww.theunnecesarean.com%252Fblog%252F2009%252F11%252F6%252Flynsee-is-in-labor-broadcasting-birth-live-right-now.html&h=f67aa58d7a5a5128bff33de74c36c390&ref=mf has me thinking about the nature of birth advocacy. the discussion has fallen from one end of the spectrum with complete disrespect for hospital birth to a sort of resigned "well at least it wasn't a cesarean" to total acceptance of that mamas experience epidural, hospital and all.

so i'm re-evaluating my role as a self appointed "advocate for normal birth". i mean what does that mean? canada defined "normal birth" almost a year ago http://www.sogc.org/guidelines/documents/gui221PS0812.pdf and i know other countries have done so as well. but what is "normal birth" in america and how best to advocate for it?

more to come on that topic as well as i mull it over.

Domestic Violence Awareness Month

2009-10-07T23:51:00.004-04:00

So October is Domestic Violence Awareness Month

I'm doing my part by going to the town hall meeting and making sure my congressperson knows I support removing the inclusion of domestic violence from pre-existing condition clauses in insurance contracts (pregnancy can also be considered a pre-existing condition btw)

the section of the healthcare reform bill thats relevant is

SEC. 2706. PROHIBITING DISCRIMINATION AGAINST INDIVIDUAL PARTICIPANTS AND BENEFICIARIES BASED ON HEALTH STATUS.
'(a) IN GENERAL.--A group health plan and a health insurance issuer offering group or individual health insurance coverage may not establish rules for eligibility (including continued eligibility) of any individual to enroll under the terms of the plan or coverage based on any of the following health status-related factors in relation to the individual or a dependent of the individual:
(1) Health status.
(2) Medical condition (including both physical and mental illnesses).
(3) Claims experience.
(4) Receipt of health care.
(5) Medical history.
(6) Genetic information.
(7) Evidence of insurability (including conditions arising out of acts of domestic violence).
(8) Disability.
(9) Any other health status-related factor determined appropriate by the Secretary.

and here is some background info

http://www.huffingtonpost.com/2009/09/14/when-getting-beaten-by-yo_n_286029.html

http://www.miamiherald.com/news/politics/AP/story/1266054.html

http://www.southernstudies.org/2009/09/domestic-violence-a-pre-existing-condition-for-insurers-in-some-states.html

friday follow-up

2009-09-18T17:40:00.002-04:00

regarding the perils of hombirth

so the today show did a recent scare segment re homebirth (originally titled 'the perils of midwifery' but later changed to 'the perils of homebirth' and naturally the birthing blogosphere has been abuzz

http://blackhillsportal.com/npps/story.cfm?id=3430
http://www.rhrealitycheck.org/blog/2009/09/11/nbc-today-shows-homebirth-scare-segment
http://mybestbirth.ning.com/forum/topics/the-perils-of-journalism-ricki

of course the topic of home birth has been a contentious one for quite some time as these earlier links attest.

http://www.babble.com/CS/blogs/strollerderby/archive/2009/04/18/home-birth-a-right-or-a-must.aspx
http://www.timesonline.co.uk/tol/comment/columnists/melanie_reid/article6101189.ece

some of the debate focuses on the rights to even have a homebirth, some on the safety of homebirth

the australian healthcare system has been duking it out over homebirth for a while . heres some of the latest from over there http://www.thepunch.com.au/articles/homebirth-wars-confusing-a-right-with-whats-right/

despite the evidence regarding the safety of homebirth http://www.bmj.com/cgi/content/full/330/7505/1416 the american college of obstetrics and gynocology has been on a campaign to remove the choice of homebirth... they put out a press release in february 2008 in which they re-iterated their stance http://www.acog.org/from_home/publications/press_releases/nr02-06-08-2.cfm and now they are using the media to skew public perception as to the dangers of homebirth and the competancies of midwives.

heres the thing though....

i think most women do take their own health factors into consideration when preparing for a home birth. most wome will change their plans when the situation requires it. there may be some disagreement as to what requires a change of plans: breech baby? twins? higher order multiples? postdates? what about vbac? but in other situations theres just not as much grey area and most women and midwives recognize that and respond appropriately.

according to this study http://www.jmwh.com/article/S1526-9523(08)00338-3/abstract a perception of GREATER safety was one of the major factors involved in planning a home birth.

The percentage of women choosing to birth at home has remained fairly steady for the past 2 decades http://www.uptodate.com/patients/content/topic.do?topicKey=~l0l0wKntyU7Dhn1

"From 1989 to 2003 the rate of home births in the United States declined from 0.69 to 0.57 percent of births, or by an average of 0.01 percent annually. The 2006 figures represent a very slight increase in both absolute numbers and rate, reaching 0.59 percent of all births [5]. This rate is comparable to that in other industrialized countries with two exceptions: England has experienced a slight rise in its home birth rate from 1.0 percent in 1989 to 2.7 percent in 2006 [6], while the Netherlands has maintained rates of home birth of approximately 30 percent [7]."

acog recently released a statement http://www.acog.org/from_home/publications/press_releases/nr09-11-09.cfm that basically says obs are practicing in a manner that is highly concious of the risks of litigation.

here are the results from the listening to mothers II survey http://www.childbirthconnection.org/pdf.asp?PDFDownload=LTMII_report this shows women are suffering as a result. rather than focus on the less than %1 of births that occur at home why not focus on improving the care women recieve during the %99 of births that occur at hospitals or birthcenters?

homebirth is already 100% LEGAL in every state in the us. the legality of attendance by a midwife is fast becoming just as legal.

In addition to the Lamaze 6 Care Practices that support Normal Birth http://www.lamaze.org/ChildbirthProfessionals/ResourcesforProfessionals/CarePracticePapers/tabid/90/Default.aspx

the coalition for improving maternity services has already created the mother friendly initiative in order to give hospitals and providers some concrete goals to focus on in improving their maternity care http://www.motherfriendly.org/mfci.php these steps are a good focus point for anybody involved in birth reform.

this is a good year for legal birth reform: we have a new president, congress is involved in overall healthcare reform. and the numbers are on our side 80% of women experience childbirth. within that majority of women i would guess theres enough support to protect by law the normal, healthy birth care practices that the evidence supports and women want

Lamaze Healthy Birth Practices

The six Lamaze Healthy Birth Practices below are supported by
research studies that examine the benefits and risks of maternity care
practices. Therefore, they represent "evidence-based care," which is the gold
standard for maternity care worldwide. Evidence-based care means "using the best
research about the effects of specific procedures, drugs, tests, and treatments,
to help guide decision-making." Please note: The English versions
were revised in 2009.

Let Labor Begin on Its Own

Walk, Move Around, and Change Positions Throughout Labor

Bring a Loved One, Friend, or Doula for Continuous Support

Avoid Interventions That Are Not Medically Necessary

Avoid Giving Birth on the Back and Follow the Body’s Urges to Push

Keep Mother and Baby Together – It’s Best for Mother, Baby, and
Breastfeeding

Ten Steps of the Mother-Friendly Childbirth Initiative For
Mother-Friendly Hospitals, Birth Centers,* and Home Birth Services
To receive
CIMS designation as “mother-friendly,” a hospital, birth center, or home birth
service must carry out the above philosophical principles by fulfilling the Ten
Steps of Mother-Friendly Care.

A mother-friendly hospital, birth center, or home birth service:

Offers all birthing mothers:

Unrestricted access to the birth companions of her choice, including
fathers, partners, children, family members, and friends;

Unrestricted access to continuous emotional and physical support from a
skilled woman—for example, a doula,* or labor-support professional;

Access to professional midwifery care.

Provides accurate descriptive and statistical information to the public
about its practices and procedures for birth care, including measures of
interventions and outcomes.

Provides culturally competent care—that is, care that is sensitive and
responsive to the specific beliefs, values, and customs of the mother’s
ethnicity and religion.

Provides the birthing woman with the freedom to walk, move about, and
assume the positions of her choice during labor and birth (unless restriction is
specifically required to correct a complication), and discourages the use of the
lithotomy (flat on back with legs elevated) position.

Has clearly defined policies and procedures for:

collaborating and consulting throughout the perinatal period with other
maternity services, including

communicating with the original caregiver when transfer from one birth site
to another is necessary;

linking the mother and baby to appropriate community resources, including
prenatal and post-discharge follow-up and breastfeeding support.

Does not routinely employ practices and procedures that are unsupported by
scientific evidence, including but not limited to the following:
shaving;
enemas;
IVs (intravenous drip);
withholding nourishment or water;
early rupture of membranes*;
electronic fetal monitoring; other
interventions are limited as follows:

Has an induction* rate of 10% or less;†

Has an episiotomy* rate of 20% or less, with a goal of 5% or less;

Has a total cesarean rate of 10% or less in community hospitals, and 15% or
less in tertiary care (high-risk) hospitals;

Has a VBAC (vaginal birth after cesarean) rate of 60% or more with a goal
of 75% or more.

Educates staff in non-drug methods of pain relief, and does not promote the
use of analgesic or anesthetic drugs not specifically required to correct a
complication.

Encourages all mothers and families, including those with sick or premature
newborns or infants with congenital problems, to touch, hold, breastfeed, and
care for their babies to the extent compatible with their conditions.

Discourages non-religious circumcision of the newborn.

Strives to achieve the WHO-UNICEF “Ten Steps of the Baby-Friendly Hospital
Initiative” to promote successful breastfeeding:

Have a written breastfeeding policy that is routinely communicated to
all
health care staff;

Train all health care staff in skills necessary to
implement this policy;

Inform all pregnant women about the benefits and
management of
breastfeeding;

Help mothers initiate breastfeeding
within a half-hour of birth;

Show mothers how to breastfeed and how to
maintain lactation even if they
should be separated from their infants;

Give newborn infants no food or drink other than breast milk unless
medically indicated;

Practice rooming in: allow mothers and infants
to remain together 24 hours
a day;

Encourage breastfeeding on
demand;

Give no artificial teat or pacifiers (also called dummies or
soothers) to
breastfeeding infants;

Foster the establishment of
breastfeeding support groups and refer mothers
to them on discharge from
hospitals or clinics

† This criterion is presently under review.

choices in childbirth

2009-09-11T20:27:00.003-04:00

so this is like a thursday post on friday.....

this topic has been on my mind lately. and this video from msnbc http://www.msnbc.msn.com/id/21134540/vp/32795933#32795933 brought it to the forefront for a blog post. i actually haven't watched the video b/c i don't have speakers on my computer right now but i did post a reply on the discussion (the question was basically what are your thought on the risks of homebirth) heres my reply

"Its always a risk/benefit analysis. There are risks and benefits to either scenerio and its a matter of choosing which risks are acceptable and which benefits are most important to you.

there are benfits to homebirth that show up in the research: fewer interventions, more skin-to-lskin, more rapid initiation of breastfeeding, greater satisfaction with the birth experience, one-to-one care for mom, etc

there are also risks. an emergent situation can arise that requires urgent action. sometimes a transfer to hospital care can be accomplished in time and sometimes time is of such essence that a transfer can't be accomplished in time. sometimes a woman will find labor to be more painful or more exhausting than anticipated and she wil want to tranfer for a non-emergent complication.

there are several kinds of midwives and the kind of training they have will vary but most midwives have training in ergency situations. most midwives can perform at least basic rescucitation on mom and or baby. many midwives carry oxygen, pitocin, suture equipment and other equipment to deal with emergencies. that would definately be a question to ask a midwife: "what kind of training do you have to manage an emergency?" "what are your transfer protocols?" etc

there are times when the benefits of a hospital birth will outweigh the benefits of a homebirth. if a woman goes into pre-term labor at say 32 weeks, or has pre-eclamsia, or an unmanaged health condition then a hospital birth may be the wisest choice. but there are very real rsks to hospital birth. some of these risks are the same risks anyone faces walking into a hospital : hospital aquired infection, medication errors, miscommunications between care providers during shift changes. some risks are specific to labor and delivery. the epidural delivers very good pain relief but it can also cause fever and a decrease in blood pressure. pitocin can jump start contractions but those contractions can be very intense and can even hyperstimulate the uterus leading to an emergency section. even some basic hospital procedures such as denying food and drink carry risks. you wouldn't run a marathon w/o adequate nourishment why expect to have a baby w/o eating and drinking?

the way transfers are managed is one area where improvement is sorely needed. a study was done recently that showed that there is so much fear on both sides that it is affecting the care women recieve when a transfer is needed. i think some kind of no-fault transfer policy needs to be implemented at a national level so obs can use their training when it is needed w/o fear of a lawsuit, so midwives can transfer women who need hospital services w/o fear of lawsuit....so everyone can share information freely and no one lets fear get in the way of care.

and as to the actual question, i've had 2 hospital births and one birth in a freestanding birth center. if i have another it will be a planned homebirth."

And this topic homebirth versus hospital gets to the heart of the matter. Your choices in childbirth boil down really to 2 things: your choice of healthcare provider and your choice of birthing place.

Many many women plan to just use whoever they've been using for well woman gyno care. You probably know and like your hcp. But this post from jen at vbac facts demonstrates how liking your hcp is not enough. http://vbacfacts.com/2009/08/26/an-ob-you-like-or-who-makes-you-comfortable-isnt-enough/

you pretty much have 3 choices in birth care: An OB, a family practice dr, or a midwife. any one of the 3 can be a good choice if they have a birth philosophy that works for you but in general obs will be the most interventive of the 3 and midwives the least interventive.

midwives work within the midwifery model of care. http://cfmidwifery.org/mmoc/define.aspx

The Midwives Model of Care

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.

An OB on the other hand is a sugeon trained in the technocratic model of care. this is a long read but explains the technocratic model in great detail http://www.davis-floyd.com/USERIMAGES/File/TECHNOCRATIC%20MODEL%20OF%20BIRTH.pdf

basically in the technocratic model the birthing mother is seen as a machine destined to malfunction at some point.

Afamily practice dr who still attends births is hard to find but if found is oftn somewhere in between midwife and ob in mindset.

regardless of the letters behing your hcp's name you have got to be sure your birth philosophy meshes with theirs. Because if she usually cuts an episiotomy she'll probably cut one on you too. If he only "allows" a 12 hour labor before he starts a pit drip to "move it along" thats probably the care you'll get too.

And then you also have to be sure that the place you choose to give birth is willing and able to be supportive of your birth philosophy also. What are their usual procedures? If everybody who goes to hospital A has to do some time on the fetal monitor you probably will too unless your dr or midwife has okay'd you not doing it in advance. if they don't "allow" most of their mothers to labor in the tub they probably won't "let" you either.

a good place to start is with this list from the coalition for improving maternity services

Having a Baby?
Ten Questions to Ask
©2000 Coalition for Improving Maternity Services (CIMS).

1. Ask, “Who can be with me during labor and birth?”
Mother-friendly birth centers, hospitals, and home birth services will let a birthing mother decide whom she wants to have with her during the birth. This includes fathers, partners, children, other family members, or friends.
They will also let a birthing mother have with her a person who has special training in helping women cope with labor and birth. This person is called a doula or labor support person. She never leaves the birthing mother alone. She encourages her, comforts her, and helps her understand what’s happening to her.
They will have midwives as part of their staff so that a birthing mother can have a midwife with her if she wants to.
2. Ask, “What happens during a normal labor and birth in your setting?”
If they give mother-friendly care, they will tell you how they handle every part of the birthing process. For example, how often do they give the mother a drug to speed up the birth? Or do they let labor and birth usually happen on its own timing?
They will also tell you how often they do certain procedures. For example, they will have a record of the percentage of C-sections (Cesarean births) they do every year. If the number is too high, you’ll want to consider having your baby in another place or with another doctor or midwife.
Here are some numbers we recommend you ask about.
They should not use oxytocin (a drug) to start labor for more than 1 in 10 women (10%).
They should not do an episiotomy (ee-pee-zee-AH-tummy) on more than 1 in 5 women (20%). They should be trying to bring that number down. (An episiotomy is a cut in the opening to the vagina to make it larger for birth. It is not necessary most of the time.)
They should not do C-sections on more than 1 in 10 women (10%) if it’s a community hospital. The rate should be 15% or less in hospitals which care for many high-risk mothers and babies.
A C-section is a major operation in which a doctor cuts through the mother’s stomach into her womb and removes the baby through the opening. Mothers who have had a C-section can often have future babies normally. Look for a birth place in which 6 out of 10 women (60%) or more of the mothers who have had C-sections go on to have their other babies through the birth canal.
3. Ask, “How do you allow for differences in culture and beliefs?”
Mother-friendly birth centers, hospitals, and home birth services are sensitive to the mother’s culture. They know that mothers and families have differing beliefs, values, and customs.
For example, you may have a custom that only women may be with you during labor and birth. Or perhaps your beliefs include a religious ritual to be done after birth. There are many other examples that may be very important to you. If the place and the people are mother-friendly, they will support you in doing what you want to do. Before labor starts tell your doctor or midwife special things you want.
4. Ask, “Can I walk and move around during labor?
What position do you suggest for birth?”
In mother-friendly settings, you can walk around and move about as you choose during labor. You can choose the positions that are most comfortable and work best for you during labor and birth. (There may be a medical reason for you to be in a certain position.) Mother-friendly settings almost never put a woman flat on her back with her legs up in stirrups for the birth.
5. Ask, “How do you make sure everything goes smoothly when my nurse, doctor, midwife, or agency need to work with each other?”
Ask, “Can my doctor or midwife come with me if I have to be moved to another place during labor? Can you help me find people or agencies in my community who can help me before and after the baby is born?”
Mother-friendly places and people will have a specific plan for keeping in touch with the other people who are caring for you. They will talk to others who give you birth care. They will help you find people or agencies in your community to help you. For example, they may put you in touch with someone who can help you with breastfeeding.
6. Ask, “What things do you normally do to a woman
in labor?”
Experts say some methods of care during labor and birth are better and healthier for mothers and babies. Medical research shows us which methods of care are better and healthier. Mother-friendly settings only use methods that have been proven to be best by scientific evidence.
Sometimes birth centers, hospitals, and home birth services use methods that are not proven to be best for the mother or the baby. For example, research has shown it’s usually not helpful to break the bag of waters.
Here is a list of things we recommend you ask about. They do not help and may hurt healthy mothers and babies. They are not proven to be best for the mother or baby and are not mother-friendly.
They should not keep track of the baby’s heart rate all the time with a machine (called an electronic fetal monitor). Instead it is best to have your nurse or midwife listen to the baby's heart from time to time.
They should not break your bag of waters early in labor.
They should not use an IV (a needle put into your vein to give you fluids).
They should not tell you that you can't eat or drink during labor.
They should not shave you.
They should not give you an enema.
A birth center, hospital, or home birth service that does these things for most of the mothers is not mother-friendly. Remember, these should not be used without a special medical reason.
7. Ask, “How do you help mothers stay as comfortable as they can be? Besides drugs, how do you help mothers relieve the pain of labor?”
The people who care for you should know how to help you cope with labor. They should know about ways of dealing with your pain that don’t use drugs. They should suggest such things as changing your position, relaxing in a warm bath, having a massage and using music. These are called comfort measures.
Comfort measures help you handle your labor more easily and help you feel more in control. The people who care for you will not try to persuade you to use a drug for pain unless you need it to take care of a special medical problem. All drugs affect the baby.
8. Ask, “What if my baby is born early or has special problems?”
Mother-friendly places and people will encourage mothers and families to touch, hold, breastfeed, and care for their babies as much as they can. They will encourage this even if your baby is born early or has a medical problem at birth. (However, there may be a special medical reason you shouldn't hold and care for your baby.)
9. Ask, “Do you circumcise baby boys?”
Medical research does not show a need to circumcise baby boys. It is painful and risky. Mother-friendly birth places discourage circumcision unless it is for religious reasons.
10. Ask, “How do you help mothers who want to breastfeed?”
The World Health Organization made this list of ways birth services support breastfeeding.
They tell all pregnant mothers why and how to breastfeed.
They help you start breastfeeding within
1 hour after your baby is born.
They show you how to breastfeed. And they show you how to keep your milk coming in even if you have to be away from your baby for work or other reasons.
Newborns should have only breast milk. (However, there may be a medical reason they cannot have it right away.)
They encourage you and the baby to stay together all day and all night. This is called “rooming-in.”
They encourage you to feed your baby whenever he or she wants to nurse, rather than at certain times.
They should not give pacifiers (“dummies” or “soothers”) to breastfed babies.
They encourage you to join a group of mothers who breastfeed. They tell you how to contact a group near you.
They have a written policy on breastfeeding. All the employees know about and use the ideas in the policy.
They teach employees the skills they need to carry out these steps.

Would you like to give this information (and more)
to your doctor, midwife, or nurse?
This information taken from The Mother-Friendly Childbirth Initiative written for health care providers. You can get a copy of the Initiative for your doctor, midwife, or nurse by mail, e-mail, or on the Internet.
To Get a Copy by Mail
Write to:

Coalition for Improving Maternity Services (CIMS)
1500 Sunday Drive Suite 102
Raleigh, NC 27607
Tel 1: 888-282-CIMS
Tel 2: 919-863-9482
Fax: 919-787-4916
E-mail: info@motherfriendly.org
http://www.motherfriendly.org

Permission granted to freely reproduce in whole or in part along with complete attribution.
To Get Copies on the Internet
http://www.motherfriendly.org

please vivist their site. they have lots of useful info on there.

i feel like this is a long post so i'll stop for now but i think i'll continue on with this topic tuesday....

just posting links to articles today

2009-09-05T15:09:00.002-04:00

apologies to my readers.... looks like links are not posting properly again

looks like the sue happy culture isn't a us only thing http://www.newsday.co.tt/news/0,106690.html midwives in spain are failing to renew their liscences due to a rise in negligency suits

heres a blog i came across today http://www.thehealthcareblog.com/ not specific to pregnancy/birth/postpartum but relevant nonetheless seems to give a good overview of the healthcare reform debate nd current healthcare policy and procedure

new drug, tafoxiparin for the prevention of prolonged labor during childbirth is in clinical trials http://www.reuters.com/article/pressRelease/idUS120679+04-Sep-2009+PRN20090904
sounds like its intended to be given prophylactically?

wish i could go to this birth film festival in orlando http://centralfloridagreenguide.com/2009/09/04/baby-international-film-festival-coming-oct-2nd-and-3rd/

this post http://womensphere.wordpress.com/2009/09/04/photos-of-childbirth-have-been-branded-pornography-in-zambia/ about a newspaper editor in zambia facing charges of pornagraphy for mailing a picture of a woman delivering a stillborn baby to a government oficial shows how deeply healthcare crisises affect birthing women all over the world. and how important it is to shed light on that. looks like the blog womensphere will be of interest in the future as well http://womensphere.wordpress.com/

and here are several links to articles about homebirth midwives in australia. you may be aware that homebirth advocates have had a rough time over there lately

http://www.abc.net.au/news/stories/2009/09/04/2677059.htm?section=justin
http://www.sbs.com.au/news/article/1083847/Government-U-turn-on-homebirth-laws
http://www.thechronicle.com.au/story/2009/09/05/city-mum-joins-homebirth-rally/
http://savehomebirth.com.au/news/

well looks like the little may wake up in a minute so i guess thats it for now. hopefully will get back to it later to post more.

eventually i would like to write some thoughtful original informative insightful post but ......

follow up friday

2009-09-04T20:35:00.002-04:00

todays the day i follow up on various news stories and blog posts i've read over the week and this edition should be good cuz i just finished cleaning out my email inbox....

first up The Breastfeeding Promotion Act introduced by Representative Carolyn B. Maloney (NY) and Senator Jeff Merkley (OR) in the senate on June 11

heres a link to the actual text http://bit.ly/Hi944 or http://maloney.house.gov/documents/women/breastfeeding/061009%20Breastfeeding%20Promotion%20Act.pdf

(sorry to make you cut and paste but links are wonky for some reason)

The Breastfeeding Promotion Act (H.R. 2819, S. 1244) includes five provisions:

Amends the Civil Rights Act of 1964 to protect breastfeeding women from being fired or discriminated against in the workplace.

Provides tax incentives for businesses that establish private lactation areas in the workplace, or provide breastfeeding equipment or consultation services to their employees.

Provides for a performance standard to ensure breast pumps are safe and effective.

Allows breastfeeding equipment and consultation services to be tax deductible for families (amends Internal Revenue Code definition of "medical care").

Protects the privacy of breastfeeding mothers by ensuring they have break time and a private place to pump (applies to employers with 50 or more employees, see text of legislation for details)

Heres a site that will look up your congresspeople. http://www.visi.com/juan/congress/ and heres a pre written letter to send with an auto everything if thats easier for you http://org2.democracyinaction.org/o/5162/t/6359/campaign.jsp?campaign_KEY=1697
Let them know how important this is!

#2 on my list is a new blog i found http://bfwlibrarymidwifery.wordpress.com/

haven't read it in detail yet but seems to focus on protocols for clinicians.....literature reviews, studies etc oh and its british.....

and here is a good post about the different types of midwives practicing in florida http://centralfloridagreenguide.com/2009/08/04/florida-midwifery/

ok well i'm posting for now but i'll prolly (maybe) edit to add more later

topical tuesday #1 - breastfeeding, galactagogues and regaln warning

2009-09-01T23:03:00.009-04:00

(edited to add more info thursday september 3)

have i mentioned i changed my weekly plan a bit? i'm doing topics in childbirth education on tuesdays and thursdays now....

on to todays topic "breastfeeding, galactagogues and reglan warning"

many many new mamas think they have a low milk supply. in fact according to this study

http://bit.ly/i95oY

"The perception that their infant was not satisfiedby breast milk alone was cited consistently as 1 of the top3 reasons in the mothers' decision to stop breastfeeding regardlessof weaning age (43.5%–55.6%)"

(most have a fine supply btw)

Now the best wy to asess milk supply is by observing weight gain and counting wet and poopy dipes.

the world health organization has new weight gain charts based on breastfeeding you can refer to. heres the one for girls http://www.who.int/nutrition/media_page/cht_wfa_girls_z_0_5.pdf and heres the one for boys http://www.who.int/nutrition/media_page/cht_wfa_boys_z_0_5.pdf

and heres a quick diaper counting link from kellymom http://www.kellymom.com/bf/supply/enough-milk.html (basically you want to see 6 or more wet dipes a day and at least 1 poopy dipe, though younger infants, less than a month old often have several little poops each day rather than 1 big one)

if your baby isn't gaining and isn't wetting and pooping it could be a supply issue. ( it could also be transfer issue - you could be making milk and s/he isn't taking it in ) in either case please see a healthcare provider to be sure baby is ok and see a lactation counselor or a lactation consultant to check for breastfeeding issues such as a bad latch.

if you determine a low supply is the culprit there are lots of ways to increase your supply but the simplest is just to nurse.

if you can arrange to spend a day or several in bed skin to skin with your babe that will often do the trick.
be sure to offer both sides before you call it quits on any one nursing session.
even if you have a sleepy baby be sure you wake him or her up every 2-3 hours to nurse

if increasing the time you spend nursing your little one doesn't increase supply you can add a pumping session or several into your routine.

and there are foods, herbs and medications that can increase supply if necessary. heres another link from kellymom http://www.kellymom.com/herbal/milksupply/herbal_galactagogue.html that gives a good list of various galactagogues and the dosages and side effects

and that leads me to the warning portion of this post: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm149533.htm

Reglan or metoclopramide is a drug used to treat reflux and other gastric conditions but it also increases milk supply. it is not fda approved for use as a galactagogue but is often used as one.

from the fda release linked above:

"Current product labeling warns of the risk of tardive dyskinesia
with chronic metoclopramide treatment. The development of this condition is
directly related to the length of time a patient is taking metoclopramide and
the number of doses taken. Those at greatest risk include the elderly,
especially older women, and people who have been on the drug for a long
time.
Tardive dyskinesia is characterized by involuntary, repetitive
movements of the extremities, or lip smacking, grimacing, tongue protrusion,
rapid eye movements or blinking, puckering and pursing of the lips, or impaired
movement of the fingers. These symptoms are rarely reversible and there is no
known treatment. However, in some patients, symptoms may lessen or resolve after
metoclopramide treatment is stopped."

topical thursday #2 - postpartum practices (placental procedures)

2009-08-20T19:54:00.002-04:00

well since i'm in my postpartum period, seems like a good topic for chldbirth education. one thats often glossed over in live cbe.

i guess there are two componets to the postpartum period: mother care and baby care.

and i guess postpartum actually begins when? after baby is born? before the cord is cut? after? lets just start with the 3rd stage of labor, delivery of the placenta

gloria leamy recently posted an excelent article about the "30 minute third stage" http://www.glorialemay.com/blog/?p=161

heres a different take on third stage mqnagement from the aafp http://www.aafp.org/afp/20060315/1025.html

basically the delivery of the placenta is managed either physiologically or actively. in a physiologic third stage the birth attendant does nothing other than watch for some time. loria suggests 30 minutes. the aafp states that there is a ower incidnce of postpartum hemmorhage in an actively managed third stage though. active management includes "uterotonic medication", early cord clamping and cutting, and controlled cord traction.

this from the article from the aafp:

"A Cochrane systematic review6 identified five randomized controlled
trials (RCTs) comparing active and expectant management that included more than
6,400 women. Compared with expectant management, active management was
associated with: a shorter third stage (mean difference, -9.77 minutes); a
reduced risk of postpartum hemorrhage (number needed to treat [NNT] = 12) and
severe postpartum hemorrhage (NNT = 57); a reduced risk of anemia (NNT = 27); a
decreased need for blood transfusion (NNT = 65); and a decreased need for
additional uterotonic medications (NNT = 7).6 Active management also was
associated with an increased risk of maternal nausea (number needed to harm
[NNH] = 15), vomiting (NNH = 19), and elevated blood pressure (NNH = 99), likely
caused by the use of an intramuscular ergot alkaloid as the uterotonic
medication in four of the five studies in the systematic review. There were no
advantages or disadvantages for the baby with either approach."
BTW: let me explain nnt and nnh. actually heres a wiki on it http://en.wikipedia.org/wiki/Number_needed_to_treat

dr. sara j. buckley weighs in in favor of a physiologic third stage here http://www.birthresourcenetwork.org/the-news/68-leave-well-alone-a-natural-approach-to-the-third-stage-of-labor dr. buckley takes the reduction in blood transfer from the cord to the baby into account in her article.
"While the aim of active management is to reduce the risk of haemorrhage for the
mother, 'its widespread acceptance was not preceded by studies evaluating the
effects of depriving neonates [newborn babies] of a significant volume of
blood.'10
It is estimated that early clamping deprives the baby of 54 to 160
ml of blood,11 which represents up to half of a baby's total blood volume at
birth. "
and here is a very detailed look at the third stage from childbirth connection
http://www.childbirthconnection.org/pdf.asp?PDFDownload=gecpc3ch33
this is actually taken from the book A Guide to Effective Care in Pregnancy and Childbirth (Oxford University Press, 2000)
In all that i just read it seems to boil down to what the mother wants. the risk of post partum hemmorhage is about 4%. some women would want to do everything to eliminate even that risk whereas others would prefer to have that time of undisturbed bonding as a new family.
in my own case i would have strongly prefered a physiologic third stage. but i can see that active management is an evidence based option as well. it does reduce risk....i just don't feel that the risk is high enought to warrant all the fiddling.
of course there is a third option...... http://en.wikipedia.org/wiki/Lotus_birth

BIRTH STORYor why its been a month since i posted

2009-08-20T19:40:00.002-04:00

originally posted on facebook
Saturday, August 8, 2009 at 8:14pm

so for the last few weeks of pregnancy my mom called every morning to make sure i was ok. which sounds nice but was actually annoying. she was worried i was going to go into labor and wait too late to call her and end up having the baby in the car.

little did she know.

i was getting impatient and started nipple stimulation tuesday. finally on tuesday night around say 7 i started to have some contractions that felt a little more intese than the braxton hicks i'd been having for months. they settled into a pattern of about 10 minutes apart and continued even evenn after a meal, a shower...soo around 9 or 10 we called mama.oddly enough cvs called right around then also to see how i was doing. i had been just about to call and tell them we were headed out. by the time she got there and we loaded everthing in the car it was around 11 when we headed out to savannah.

kurt had booked us a room at the courtyard at marriot on abercorn. we got their about 1 and had a late supper. krystals. deciided to just go on to bed, contractions petered out so i figured i just as well rest.

woke up early wednesday and had some snack-y things for breakfast. had some contractions. was waiting for them to get to be 5 minutes apart. ended up taking kellen to the pool but didn't stay in long cuz it started to storm. had contractions all day but never got to 5 minutes aoart, 1 minute long. had been continueing to stimulate the nipples and also walked the halls some. but eneded up going to bed again w/ no baby after a very long walk.

woke up thursday with not much to show for my walk except a sore back. was sick of clock watching and contracting timing and nipple stimulating. we decided to stay over even though it didn't seem like a whole lot was happening or at least not very quickly. but priceline wouldn't let us renew the same room a second time so we had to change hotel rooms. moved to the hyatt on river st.was focused on enjoying the extended vacation so we went out and had a nice seafood supper. blackened salmon for me, shrimp for the kids and raw oysters for the hubby. then a fabulous ice cream for desert.had some good contractions during supper but ignored them as much as possible.

later on in the evniong had more good contractions.started timing again around 12:30 am friday morning. definately stronger but not really a consistent pattern...averaged about 5 minutes apart and 1 minute long. took a hot bath to see if they would continue. they did. went back to timimng....was definately having to work with the contractions at this point. kurt was at the restaraunt/pub a couple of doors down so decided to call him because now they were like 2-3 minutes apart and getting more and more intense and averaging about a minute. called him and he was on his way out the door anyway. as soon as he got back we called the midwife. she said come on to the birth center.

i was so escited it was finally time to have this baby! i had honestly been pissed off earlier in the day for what i thought was a wasted trip to savannah. had been dissapointed with waiting and tired of being all keyed up for no reason. it was a big relief for something to finally be happening that was unmistakablely labor.

though i had read about prodromal labor and knew thats what was happening, the intellectual knowledge had not fuly prepared me for he emotional reality. it was so unexpected....even though i know every pregnancy, every labor and every birth is different my 1st 2 were such textbook cases. they were both born a day before their due date. both labors progressed in a typical manner.

of course i was induced with olivia so who knows how that would have gone had her labor and birth been undisturbed?

the kids were asleep and i knew my mama was tired so kurt and i took a taxi to the birth center. we got there right at 2:45 and withing seconds my midwife, jill, was there. she let us in and did an exam and i was 5 centimeters. she also put me on the fetal monitor for a little while, prolly about 20 minutes.

i hate enduring contractions flat on my back on a monitor. well i wasn't flat on my back she adjusted the exam table so i was itting up somewhat but just to be so imobilized was aweful. freedom of movement makes contractions so much easier to bear. but i tried my best to relax and breath through them.

another couple arrrived a little while after we did. which was kind of neat. and also gave us more time undisturbed.once she took me off the monitor (with perfect readings) we went on back to the birthing room. i wanted to get in the tub right away but she wanted me to wait until the nurse got there. she was afraid i would get in the tub and get relaxed and deliver before the nurse got there.

but i squatted and rocked my hips and leaned on various things and dealt just fine.every contraction made me feel like i needed to pee so i spent alot of time sitting on the potty too. it just felt good to squat like that but to still be supported. and kurt was ready to help however i needed him to but i wasn't feeling very verbal so i ended doing for myself somewhat. he was good for support to lean on and all though. and get my water and manage the fan and all the small things.

finally jill said i could get in the shower. it felt so good to blast hot water on my belly and especially my hips. i was feeling lots of pressure in my pelvis. i knew it would soon be time to push.once the nurse, amanda got there and they got the other couple settled in, i asked about getting in the tub and jill said she would have to break my waters to make sure wasn't any mec (meconium....1st baby poo) in the water 1st.

they don't let you do a water birth if there is b/c it can indicate fetal distress and if its aspirated it can cause a nasty infection too so they don't want any delay in case they need to suction or do any other resucitative actions. personally i think with light mec a waterbirth would be fine especially with good readings on the monitor but if they have protocols they have to follow, well thats ok. i would've prefered to have kept the bag intact but that close to delivery (and i knew i was close because i was getting that pusshy feeling with some of the contractions at this point) i was ok with it, especially if i wasn't getting in the tub w/o them doing it.so there was mec in the water. very light lime green mec.

i'm glad i hadn't had my heart set on a water birth. my main dissapointment was just knowing i wouln't have hot water as pain relief.i tried the birth stool for a little while. but ended up on the bed in a hands and knees position. it hurt really bad in my hips. a pain i had been anticipating because it had been such a suprise to me with kellen's birth.

they told me that it would feel better to push...they said to push past the pain. and that was kind of true.i could tell when she made her way into the birth canal. i felt very full down there. and i knew that within a few pushes we'd meet our baby! it didn't take but a few pushes and she was crowning. that was a very intense feeling. more painful than it was with kellen but ok. i had to really summon courage to keep pushing though. its funny how even knowing as much as i do, i still had that fearful feeling. of course there wasn't a whole lot to do but to push her on out.

kurt made me a little mad b/c he took my glasses off so he could wipe my face with a cold wash cloth. but it felt good once he did it and later i forgot they weren't on my face anyway.

jill suggested i stack a bunch of pillows in front of me to lean on. it gave me a more upright position. only a few pushes (and lots of encouragement!!!!) and she was out. that was at 5:01 am.they suctioned her just a bit. mostly snottyness i think not mec. then handed her to me and helped me lay down with her. she latched right on and nursed well.

and then the placental drama started.

i'd originally plannned to wait until the placenta was born to cut the cord but they needed to take some cord blood to see if i need to get rhogam b/c i'm rh negtive. i had it at about 32 weeks so it shouldn't be an issue but just in case we do have another one sometime i want to be sure.so we waited until the cord stopped pulsing and then i cut the cord. kind of neat. the ob cut olivias. kurt cut kellen's and now i've cut one.

w/in just afew minutes jill was ready for the placenta to come out. i really don't know why it was so urgent. especially since i had mentioned reading gloria lemays blog post on the 30 minute thrid stage and jill said she had shared it on her fb page.she kept saying that if it was right there at the cervix there wasn't any reason to wait.

she tugged on the cord very gently and waited a bit. encouraged me to try pushing. gave me some "placenta release tincture", finally ended up injecting some pit into the cord. (mind you i was nursing and they took B'Elanna away for some of this) (baby nursing is supirior to pit imho) she ended up basically going in and removing the placenta manully.

it was all completely unnecessary i think. not evidence based practice at all. i don't know, maybe there was some urgency she didn't fully communicate the reason for? she did say that it almost looked like there was a velatinous (sp?) insertion in the cord...a term i've heard but still don't really know exactly what it means. (i'll look it up and post a link.) anyways its not something i knew to mean urgency in placenta delivery.

i will say the placenta was the funniest looking placenta i've ever seen. she looked at it and had the other midwife double check and seemed like it did come out intact. haven't had any hemmorhage so i guess its ok.what makes me mad is that i had specifically asked about third stage management at a prenatal apt and was told (by the other midwife) that they practiced "watchful waiting"

after we had a chance to nurse a bit jill helped me get a quick shower and to pee.i had already peed in the bed all over the chux pads.at that point i said "i must not have torn much b/c it really didn't hurt to pee" ( you mamas know exactly what i'm talking about)she said she hadn't seen a tear and would look and see. barely a skidmark and it was on my episiotomy scar so if the tissue hadn't already been weakened i prolly wouln't have torn.

we stayed and nepped for a few hours. mama and the kids came around 12:30 and we all left around 2. we went straight to mcdonalds and then hheaded back to dublin. so nice to come straight home.i guess thats it. any questions.... feel free to ask!

veal chops

2009-07-20T10:11:00.002-04:00

note to self:

v = variable decels = c = cord compression = bad
e = early decels = h = head compression = normal
a = acels = o = ok if w/in 120- 160
l = late decels = p = placental deterioration = bad

So variable decels are when the heart rate goes UP above baseline during a contraction then down then Up again above baseline and then returns to normal. If you look on a strip it will look like "shoulders"

Early decels are when the heart rate goes down DURING a contraction. This is totally normal.

Late decels are when the heart rate goes down AFTER a contraction.

quoted from mdc thread linked in title

Stand and Deliver (formerly The True Face of Birth): Burn the male midwife!

2009-07-18T01:00:00.000-04:00

Stand and Deliver (formerly The True Face of Birth): Burn the male midwife!

rixa delivers as always....

i'll add my 2 cents in my "official" follow up friday post, but you've done an awesome job of getting the whole story....

topical thursdays #1: pain in labor and delivery

2009-07-16T15:23:00.008-04:00

i'm starting with the topic of pain in labor and delivery b/c i think that is the top concern most women have when they think about having a baby. and with rising epidural rates (i've heard various figures from 60-80%) i think its important to give additional information. because "epidural" does not equal "birth plan" :lol

in fact heres an article from sara buckley (who i heard speak at the ican conference and she was so awesome....gave so much info my hand was sore from taking notes) this is about the risks involved in choosong epidural pain relief.

http://www.sarahjbuckley.com/articles/epidural-risks.htm i'll just quote the last paragraph here but ireally encourage you to read the full article

"Conclusion
Epidurals have possible benefits but also significant risks for the laboring mother and her baby. These risks are well documented in the medical literature, but may not be disclosed to the laboring woman. Women who wish to avoid the use of epidurals are advised to choose carers and models of care that promote, support, and understand the principles and practice of natural and undisturbed birth."

the best book i've read about pain in l&d is grantley dick-read's "Childbirth w/o fear" http://www.amazon.com/Childbirth-Without-Fear-Original-Approach/dp/0061092487/ref=sr_1_2?ie=UTF8&s=books&qid=1247773081&sr=1-2 in it dick-read describes the Fear-Tension-Pain cycle that leads to pain.

Basically women these days having not seen normal birth (or often any actual birth...only the highly dramatized tv variety) tend to fear what they don't know. Fear leads to tension which leads to pain.

The solution is to learn about normal birth.

One of the important things to realize is that not every birth is painful. About 20% of births are actually painless. A film i highly reccomend is "Orgasmic Birth". http://www.orgasmicbirth.com/ I saw it last summer and it is so, I just can't even describe it.... inspiring, educational, just a fantastic film!

For births that do include pain, it's usually managable. My last birth never felt worse than bad menstrual cramps. Actually what surprised me most about that birth was the leg cramps I got while pushing :lol I didn't even feel the "ring of fire" during crowning. (although i did have a very intense sensation at my clitoris....not orgasmic, but not painful either just intense)

Highly effective non-medical techniques are available for pain managment during l&d. Heres a sampling:

Freedom of Movement: laboring and pushing and delivering in the position that is most comfortable for you will significantly reduce your pain sensations.

Freedom of movement is one of the 6 Lamaze Care Practices that supports Normal Birth http://www.lamaze.org/ChildbirthEducators/ResourcesforEducators/CarePracticePapers/FreedomofMovement/tabid/484/Default.aspx

Now for freedom of movement to be the most helpful you should familiarize yourself with common labor and delivery positions.

heres a slideshow from the mayo clinic with some ides http://www.mayoclinic.com/health/labor/PR00141

and heres some others from about.com http://pregnancy.about.com/od/laborbasics/ss/laborpositions.htm

http://pregnancy.about.com/od/laborbasics/ss/partnerposition.htm

http://pregnancy.about.com/od/laborbasics/ss/ballpositions.htm

Other pain management options include

WATER:

You don't have to have a full water birth to take advantage of the pain relieving properties of water. Most hospital rooms have at least a shower if not a full tub. If a tub is available you can relax in the tub and if a shower is your only option you can let the spray hit your belly or your back and get some relief that way. This is an option you'll have to work out in advance with your dr or midwife but well worth it.

A word of caution: I have read that laboring in water can slow your labor so this is an option you may want to hold off on until you feel you need it. Of course if things seem slow you can always get out too.

RELAXATION:

I think the Bradley Method and the Hypnobirthing Methods offer a great deal of insight into the use of relaxation during labor and delivery.

i have this book at home and it has some good relaxation exercises http://www.amazon.com/Natural-Childbirth-Bradley-Way-Revised/dp/0452276594/ref=sr_1_1?ie=UTF8&s=books&qid=1247801922&sr=1-1

and if you can take a bradley class they'll do lots of practicing too http://www.bradleybirth.com/

hypnobirthing involves relaxation via a self induced state of hypnosis http://www.hypnobirthing.com/ i don't have any personal experience w/ it but lots of mamas swear by it

and of course there are plenty of stand-alone methods of relaxation.

this blog post from women giving birth naturally covers a few of the most popular
http://www.givingbirthnaturally.com/women-giving-birth.html

and heres a different site that gives more tips on different techniques http://www.womenshealthmatters.ca/centres/pregnancy/childbirth/relaxation.html

things like deep breathing (you don't have to learn anything complicated just in through the nose out through the mouth), progressive muscle relaxation where you tense then release muscle groups starting either at the toes, the fingers or sometimes the head/neck shoulders, visualization techniques, etc can all be useful helps to achieving a relaxed state.

okay well the kiddo wants the computer now so i guess i'll have to add more next thursday.....

follow up friday

2009-07-14T15:22:00.008-04:00

male midwife dares to suggest epidural rate is too high http://www.guardian.co.uk/lifeandstyle/2009/jul/12/pregnancy-pain-natural-birth-yoga

some follow-up from salon http://www.salon.com/mwt/broadsheet/feature/2009/07/14/epidural_epidemic/index.html

and from london based delia lloyd http://www.politicsdaily.com/2009/07/16/no-pain-no-gain-the-value-of-epidurals-during-childbirth/

I posted rixa's reply seperately in the previous post. and she did an awesome job of collecting all the chatter. all i really have to say is trhat all the hoopla about him being a MAN is getting in the way of what he has to say. its sexist at the very least....i mean do we also question so strongly the pronouncements of other males dealing in birth such as the mostly male writers of obstetrical texts?

a study about bottle-feeding

http://www.guardian.co.uk/lifeandstyle/besttreatments/2009/jul/14/mums-who-bottle-feed-not-given-safety-advice

the study basically says that women who choose to bottle feed are ignored by the medical profession and not given appropriate safety info. i ahve to say i agree with this. i bottlefed my daughter from about six weeks and did not get any safety info wrt formula feeding.

when i got my lactation counselor certification they suggested giving formula feeding classes as well as breastfeedig classes. it wasn't until i took that class that i learned formula isn't sterile for instance. and how many moms are told to add water to the bottle before powder to ensure accurate measurements? i wasn't. lucky for my daughter i knew that.

i thnik pediatricians would do well to pay attention to this study and to pay attention to their patients and parents as individuals....

dick morris makes claims that govn't is telling women to quit having cesareans

http://mediamatters.org/research/200906250042

actually according to healthy people 2010 we do have a goal to reduce primary section rates from %18 in 1998 to %15 in 2010 and the repeat section rate from %72 to %63

however the site states

"(The targets presented here apply to the population as a whole and are not intended to be used as practice outcome objectives for individual physicians or institutions, as the medical needs of the patients in each practice will vary.) In addition to monitoring rates of cesarean births, the outcomes of these deliveries (for both the mother and the infant) should be watched closely to assure that changes in the mode of delivery do not put women or their infants at risk."

so section rate reduction is not being pushed in terms of a money saving strategy....thats really all i can find about obamas take on section rates....and of course these goals were crafted before obama took office anyway

anybody with more info? please comment....

and heres gloria lemays take on a letter posted on the american college of nurse midwives site http://www.glorialemay.com/blog/?p=147

i still don't know what i think about the situation. i'm an aspiring midwife. i'm currently thinking of going the cnm route rather than cpm because taht would allow me to bring the midwifery model of care to more women. if things were to change legally in this state to allow for legal recognition of cpms then i might go that route....

i do think the letter was unecessarily divisive, and i have not seen any research to support the conclusion that cpms are not qualified providers, BUT i do like the idea of a standardized education for cpms.

i don't see why apprenticeship couldn't be incorporated into that.

okay well this was kind of a lazy post but ithink its all i got for now....

two-fer tuesday #1

2009-07-14T14:17:00.002-04:00

just linking b/c the embed feature doesn't seem to be working for me

http://www.youtube.com/watch?v=tXVhaVATcbQ

this one is a mom comparing her epidural birth w/ her natural birth. guess which birth she prefered?

http://www.youtube.com/watch?v=JQn_nTia7FY

and that is ina may gaskin talking about birth.

ENJOY!

mailbox monday #1

2009-07-14T00:01:00.002-04:00

here it is the 1st installment in mailbox mondays! i'll be checking my e-mail every monday (which is significantly more often than i have been doing it) and posting links to all the good stuff.

i'm working backwards so the first few rounds are mostly going to be a few months back but hopefully it will become more current as i weed through.

1st up, an awesome resource http://www.nationalpartnership.org/site/PageServer the national partnership for women and families. they put out a daily report on women's health that you can sign up for here http://www.nationalpartnership.org/site/PageServer?pagename=daily2_fullreport (this link takes you to the days report, scroll all the way down to the bottom to subscribe)

and on to this article http://www.physorg.com/news157818920.html which is about the lack of consideration given to women's health in judical decisions the article is based on this study http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1345824# heres a quote from the abstract:

" judges regularly -- and often inaccurately -- cite the theoretical availability of alternative reproductive health services as proof that women's health will not suffer even if a law curtailing reproductive rights is upheld. I label this the "availability tool." Second, when alternatives are not available, decisions may blame women for the lack of availability. I call this the "culpability tool." Application of the availability and culpability tools in reproductive health cases can result in a truncated analysis of how laws impact women's reproductive health. "

heres an article about egg donation and possible risks to donors http://www.time.com/time/health/article/0,8599,1888459-1,00.html heres a quick quote:

"Right now egg donors are treated like vendors, not as patients. Patients need to be followed up," says internist Jennifer Schneider, who has been advocating for the government to track egg donors since 2007, a few years after her daughter, a three-time egg donor, died of colon cancer at age 31. "After the first few days of being discharged from the IVF clinic and seeing that there were no immediate consequences, they are never contacted again."

here is an awesome blog entry about the cyclical nature of womanhood and the disservice we do ourself in not respecting our rites of passage http://redtenttempletn.blogspot.com/2009/04/women-and-depression.html

just found a new blog to keep up with. this one written by a cnm in training http://nursemidwifeintraining.blogspot.com/ go check it out ya'll

a new study shows that women feel ignorant and uninformed re pregnancy and childbirth: http://ec.europa.eu/research/headlines/news/article_09_04_03_en.html
attributes this to hospital birth and geographic mobility

ok so i guess thats it for this mondays edition....

new organizational motivational plan

2009-07-12T09:32:00.002-04:00

Mailbox Mondays: when i shall in fact go through my inbox and post links to the good stuff

Two-fer Tuesdays: when iwill post two awesome birth related videos

Wild Wednesdays: for whatever tangent i'm on lately

Topical Thursdays: devoted to topics in childbirth education to be covered on a rotating basis

Follow-up Fridays: when i'll catch up on reading my favorite birthy blogs and give my take on what everybody else is talking about

At Your Cervix: What you may (or may not) know about labor and birth

2009-07-11T21:43:00.000-04:00

this was so good i just had to share it

At Your Cervix: What you may (or may not) know about labor and birth

risk

2009-06-24T14:32:00.003-04:00

so we talk about risk a lot in the birthing community. the risks of cesareans, the risks of breech deliveries etc.

i just started reading "the savvy woman patient" published by the society for women's health research and found out i was ignorant as to the two different kinds of risk: relative and absolute.

"relative risk is the amount of increase or decrease in whatever the study was designedto evaluate-breast cancer,heart disease,etc-over an entire population. So, for instance if a news report says that a certain medication doubles the risk of heart attack, it simply means that twice as many people taking the drug will have a heart attack as those not taking the drug.

absolute risk however, is the average persons risk of experiencing that side effect. so, for instance if you personally have a 5% risk of having a heart attack in your lifetime, then taking the drug increases your individual risk by another 5% resulting in a relative risk of 10%. in other words 10% is 5% doubled"

so if you're already at low risk of this or that and you double that low risk its still low risk.

just something to think about.

here are a few links on the topic as well

http://www.cmaj.ca/cgi/content/full/171/4/353
http://www.patient.co.uk/showdoc/27000849/
http://gim.unmc.edu/dxtests/effect1.htm
http://jco.ascopubs.org/cgi/content/full/21/23/4263
http://www.springerlink.com/content/cr5246mv1l130870/

ama is at it again

2009-06-21T15:14:00.002-04:00

the resolution regarding non-complient, hostile and abusive patients did not pass. but heres another resolution thats just as bad http://www.isms.org/physicians/special/ama/resolution605.pdf

i use the term "health care provider" often becasue not all healthcare providers are in fact physicians. my midwives are not physicians, my chiropractors are not physicians, heck my dentist is not a physician....

of course not all physicians are true HEALTH care providers.... 5 minute visit that ends with an rx? is that really health care?

i'll give them that hey do spend a lot of years in school and do have a lot of specialized knowledge....but so do other health care providers. and many of the other healthcare providers i use spend more time with me as a patient, give more counseling, and focus more on actual health.....

idaho midwifery bill

2009-06-20T20:30:00.001-04:00

need to get back and post re the new idaho midwifery bill

some quick links
http://www.legislature.idaho.gov/legislation/2009/H0185Bookmark.htm
http://www.campaignforliberty.com/blog.php?view=14569
http://www.google.com/url?sa=X&q=http://ptmi.blogspot.com/2009/06/interpretation.html&ct=ga&cd=7677g1wZtmk&usg=AFQjCNGHt-rohgPyy5XFrzb8RBeDKGlgXg

will have to think my own thought s on it though....

poor neglected blog

2009-06-20T14:07:00.002-04:00

haven't posted too much lately....the bigger i get the less motivated i am to do it

but have bben stewing on somethings posted on facebook....re you tube and birth videos.the nyt ran an article recently about the trend of posting birth videos and then kneelingwoman ( http://closetotheroot.blogspot.com/ ) posted some thoughts as to thefact that so many of us in the natural childbirth community claim birth as a sacred and private act and the contradictions inherent in posting a "private" act on the internet.

heavy stuff to be thnking about. i doubt i would post a birth video on you tube myself...the hubster is too private for me to be able to do that. i know its my body but yk its his baby too....

but there are some beautifule videos posted. here are some of my favorites:

http://www.youtube.com/watch?v=niJ6F2p9Ql8
http://www.youtube.com/watch?v=7E-wULAaD50

well i thought i had more favorited than i did but go searching.....

other thoughts, i have started the first of the childbirth education series....plan to work on it some more this weekend, and i'll also check my email and post whatever turns up in the inbox that's interesting

oh and one more thought...the pharmacists yesterday made the mistake of saying that for most women who have sexual problems its psychological...i called bullshit on that but now i need to do some research to back myself up. will share when i find it...

childbirth education

2009-06-07T22:35:00.002-04:00

this was such a great post filled with lots of good links i'm posting it all by itself

http://cfmidwifery.blogspot.com/2009/05/effectiveness-of-childbirth-education.html

the gist of it revolves around response to a study that came out recently that seems to indicate that childbirth education "doesn't work"

since i'm working on the first in what will become a continuing online cbe series i thought this would make a good kick-off

birth via videoconference, maternity services in australia, more benefits to breastfeeding.....

2009-06-06T19:35:00.006-04:00

cleaning out my inbox and came across this sweet story http://www.kfdm.com/news/rose-30232-says-birth.html we ncb folks tend to be suspicious of technology sometimes but in this case technology actually contributed to normalcy....

and heres an opinion from australia regarding intervention in birth http://www.smh.com.au/opinion/caesarean-scar-mongers-should-zip-it-20090220-8dkm.html?page=-1 the article has a strong anti-midwife tone to it as seen in this quote " ... a review of maternity health services ordered by the Health Minister, Nicola Roxon, and due to report in the next few weeks, is expected to place more pressure on women to reject the so-called "medicalisation" of childbirth. The review is expected to pave the way for a midwife takeover.
A discussion paper released last year raised the prospect of expanded Medicare access for midwives, independent of doctors, which will increase the numbers of more risky home births. ..." they go on to state that research shows the medcalization of birth to be improving outcomes.

however i think that was before the tragedy with janet fraser. (just checked and yes it was)

the australian press really went into hyperdrive after that as seen in this article which has lots of links.... http://www.news.com.au/dailytelegraph/story/0,22049,25294178-5001021,00.html

ooh and heres a blog post that links to the report mentioned in the original article above http://viv.id.au/blog/20090221.3841/maternity-services-review-medicare-payments-to-obs-up-from-77m-to-211m-since-2004/ heres the report link if you want to skip the blog post (although the post is pretty much a cheat sheet on the report ) http://www.health.gov.au/internet/main/publishing.nsf/Content/64A5ED5A5432C985CA25756000172578/$File/Improving%20Maternity%20Services%20in%20Australia%20-%20The%20Report%20of%20the%20Maternity%20Services%20Review.pdf

ireland is also reviewing their maternity services. apparently their system utilizes stand alone maternity hospitals http://www.rte.ie/news/2009/0220/health.html

and heres a study that indicates breastfeeding reduces risk of a relapse more that resuming medication for moms with ms http://www.theglobeandmail.com/life/health/article9936.ece " ... "It turns out that the women who are going right back on medications [and not breastfeeding] are doing the worst. They are at the highest risk of relapse," said lead researcher Annette Langer-Gould. ..." and heres an article that goes into a little bit more detail http://www.medpagetoday.com/MeetingCoverage/AAN/13030 and heres another article that references an older study that reached a different conclusion http://www.aan.com/elibrary/neurologytoday/?event=home.showArticle&id=ovid.com:/bib/ovftdb/00132985-200903190-00013

and heres an article from florida re midwifery business http://www.wctv.tv/news/headlines/40031382.html

heres an interesting article about nurse practitioners.... http://www.azcentral.com/news/articles/2009/02/21/20090221nursepractitioners0220.html

and an article about the societal impact of shorter maternity leaves http://www.sundayherald.com/life/people/display.var.2490823.0.0.php it contrasts a speedy return to regaular activity with the more traditional practice of babymooning

well the littlest little is up from a nap now so i guess i will close for now

supreme ct decision

2009-05-27T23:51:00.001-04:00

just a quick link for now http://www.rhrealitycheck.org/blog/2009/05/26/supreme-court-decisions-pretends-pregnancy-discrimination-doesnt-harm-women

Giselle's Total Waste of Bandwidth: A Different Kind of Consent Form

2009-05-27T00:06:00.000-04:00

Giselle's Total Waste of Bandwidth: A Different Kind of Consent Form

this was just too awesome....thing is they've known about these risks for awhile, i've been doing quite a bit of reading re cesarean section lately and some of the books are fairly outdated but they still mention all these risks

organizing in chicago, 10th anniversary in ireland

2009-05-24T15:31:00.002-04:00

heres an event coming up in chicago http://my.barackobama.com/page/event/detail/healthcareorganizingkickoff/gpcspr "This will be a discussion on how community based midwifery, doula, and holistic care in collaboration with physician consultation can assist in lowering maternity cost, reduce infant and maternal mortality, and aide in bridging the violence gap within the African American Community."

today is the 10th anniversary of the introduction of national midwifery service in ireland http://www.herald.ie/breaking-news/national-news/10th-anniversary-of-national-midwifery-services-launch-1749483.html

medical neglect, international news, bad dr, nunchal cords, and cord clamping

2009-05-23T22:17:00.003-04:00

not technically birthy but definately parenting related.... (could come up in various birthing situations though i.e. ct ordered cesarean type cases, vaccinations which start at birth now with the hep b ) anyway heres a link to an article from newsweek http://www.newsweek.com/id/199093/page/1

something from south africa on the importance of female assistants for pre-natal care and at birth http://www.plusnews.org/Report.aspx?ReportId=84516

heres a whole article about the retirement of a childbirth educator http://www.midiowanews.com/site/tab3.cfm?newsid=20319959&BRD=2700&PAG=461&dept_id=554434&rfi=6 how awesome that she was valued that much to be written up.!

and its so interesting when everybody posts on the same topic:
here are 3 blogs posting on delayed cord clamping
http://womantowomancbe.wordpress.com/2009/05/21/delayed-cord-clamping/
http://nursingbirth.wordpress.com/2009/05/17/the-deal-with-delayed-cord-cutting-or-%E2%80%9Chey-doctor-leave-that-cord-alone%E2%80%9D/
http://pinkyrn.blogspot.com/2009/05/delayed-cord-clamping-not-this-again.html

these just after i stumbled onto this http://blogginboutbirthandmore.blogspot.com/2009/05/we-are-only-mammals-who-do-it-this-way.html

i had decided to wait until the placenta is born to cut the cord for my upcoming birth already but it was neat to read ... and informative to read some of the arguments against delayd cord clamping (which you'll find primarily in the comments )

and ugh! http://www.chicagotribune.com/news/local/chi-autism-doctor-rosimay22,0,5086891.story ""Eighty percent of complications in childbirth are psychological," he said. "Babies can be killed by a mother's attitude."

and heres something new to research "nunchal cord" heres a quick link to a blog post about it http://jeremyscorner-grifter.blogspot.com/2009/02/cord-around-neck-is-not-emergency.html but there are quite a few dissenting comments so...

well suppers ready so...

Big Push For Midwives Issue Briefing This Thursday

2009-05-18T23:58:00.005-04:00

This Thursday the big push is hosting an issue briefing to tell congress why out of hospital maternity care must be factored into the national healthcare reform platform.

"Help the PushNation rise up to tell Congress about how access to out-of-hospital maternity care and Certified Professional Midwives (CPMs), who are specially trained to provide it, are a top priority in national health care reform! Help alert Congress to the Capitol Hill Issue Briefing on Thursday, May 21, focused on how out-of-hospital maternity care reduces costs and improves outcomes. "

TO GET STARTED: Download the specific-to-your-state information below.
DON'T SEE YOUR STATE?: Use this link http://zip4.usps.com/zip4/welcome.jsp to determine your ZIP+four code, and then this link http://www.house.gov/zip/ZIP2Rep.htmlto type in your ZIP+four code to determine your U.S. Representative. ... Also, this link http://www.senate.gov/general/contact_information/senators_cfm.cfm can help identify your U.S. Senators. Then you can use any of the other states documents below to help guide you from there.
TO SHARE: Send a link to this page http://www.thebigpushformidwives.org/index.cfm?fuseaction=enews.signup to all your Facebook friends and Twitter followers, as well as others in your personal and professional networks, with an urgent note on why this is so important to you, and why they should help too, today.
TO SHARE EVEN MORE: 1) Download the flier http://www.thebigpushformidwives.org/attachments/pages/DC+Birth+Briefing+5-21-09_FLIER.pdf and include in your emails to others, and 2) Share key information about the briefing on your blogs and organizational websites, and to your e-lists.
TO JOIN THE CAUSE: 1) Make sure you've signed up for PushAlerts on this page http://www.thebigpushformidwives.org/index.cfm?fuseaction=enews.signup 2) Make sure you've joined us on Facebook http://apps.facebook.com/causes/139482?m=8c3a5226&recruiter_id=21060214, and 3) Check out the state-level advococy orgs http://www.thebigpushformidwives.org/index.cfm/fuseaction/home.stateStatus/index.htm hard at work in your state. ... You may even consider joining one of them too

AND HERES MORE DETAILED INFO from the arizona specific flyer but just insert your state info from the above links

http://www.thebigpushformidwives.org/attachments/pages/[PushAlert]+DC+Birth+Briefing+5-21-09+for+ARIZONA.pdf

this just gives some suggested talking points and other tips

fda approves drug made from genetically modified goatmilk

2009-05-17T17:50:00.004-04:00

im a little late on this one since it was announced in februarybut :
http://www.bloomberg.com/apps/news?pid=20601103&sid=aqXXW3MCHV5Q&refer=us "The intravenous therapy, ATryn, is purified from the milk of goats whose parents were injected with a human protein that helps prevent blood clots, GTC said today in a statement. The drug will be used for surgery patients or expectant mothers who have a rare genetic disorder that keeps them from making enough of the protein, called antithrombin. " and heres a slightly more in depth article from the nyt http://www.nytimes.com/2009/02/07/business/07goatdrug.html?ref=business

a short piece in praise of epidurals http://www.thedailysound.com/020609coasting i had one with my first and didn't like it. nobody told me i'd be cathetered for one thing and that HURT. but i felt i'd be remiss if i didn't throw that in here

heres a quick link to the hypnobabies blog http://hypnobabies.wordpress.com/ not a method i am very familiar with but something i know folks are interested in. the first post i saw about the compatability of hypnobabies and christianity was interesting though http://hypnobabies.wordpress.com/2009/05/17/christians-using-hypnobabies/ i've occaisionally read articles that hypnosis is unchristian and this post did a good job of refuting that while pointing out that the monagan method used in hypnobirthing is a lot more "woo" here are a few comparisons btw the 2
http://www.birthnaturally.org/hypnobirthing.htm
http://www.pregnancybirthandbabies.com/comparison_between_hypnoclasses.htm
http://www.mothering.com/discussions/showthread.php?t=504143
seems like most of the people felt that hypnobabies was more comprehensive

heres some legislation thats pending in south carolina http://www.thestate.com/local/story/675868.html "Rep. Greg Delleney of Chester, the General Assembly’s most outspoken abortion foe, gained initial approval Thursday to require doctors to save any fetus that survives an abortion. The bill, which unanimously passed a House subcommittee Delleney chairs, is aimed at rewriting state law to recognize the “personhood” of the unborn.
If the bill becomes law, a person would be redefined as anyone at any stage of development who is breathing, has a heartbeat, a pulsation of the umbilical cord or definite movement of voluntary muscles after birth, whether that be by labor, Cesarean section or abortion.
Delleney says it has wider implications than just for abortion clinics."

guesss its time to close, gotta figure out supper

research reveals mistrust and hostility btw drs & midwives,unwed mothers

2009-05-16T21:45:00.004-04:00

http://feeds.sciencedaily.com/~r/sciencedaily/~3/7wCVtrWA398/090511151616.htm

well , duh! but worth a read....and kudos to the researchers for looking at the subject!

national womens health week was last week but its not too late to take charge of your own health. the theme this year was "it's your time" and the focus was mental health. heres a brochure put out by the us dept of health and human services office on womens health http://download.ncadi.samhsa.gov/ken/pdf/OWH09-CONSUMER/womenmentalhealth.pdf lotsa good tips in there

this is not really news. i think it was reported as part of the most recent report on childbirth numbers which i'm totally blanking on the name of but last week the washington post reported that the number of babies born to unwed mothers is on the rise http://www.washingtonpost.com/wp-dyn/content/article/2009/05/13/AR2009051301628.html?hpid=sec-health
i do'nt really know wha tt to think about the tone of the article... while i believe marrige is a great thing and i'm very happy that this, my 3rd child was concieved and will be born and raised in wedlock, i sure wouldn't marry the father of my first child. (my second is obviously being raised in wedlock as i married his dad but he was neither concieved nor born in it) i don't think marriage is the most important factor contributing to a kids future sucess... now a stable 2 parent home has been shown to lead to bettter outcomes for kids, i don't think many people would argue that thats better for kids BUT does that necesssarily require marrige?

what about kids who live with mom and dad, but mom and dad are not married? what about kids who live with mom and mom? or dad and dad? the preceding two examples of a stable 2 parent home CANNOT get married except in certain states...

i have heard of hetero couples who are rejecting marrige in solidarity with their homo friends and family who do not have the right to get married. also people who reject marrige by the state b/c of deeply held beliefs regarding state interference in what for them is either a private or a religious matter, or both. what of them?

additionally many women who are single parents are not single by choice (though some arre) ... some were abandoned by their boyfriends, some are pregnant because of rape or incest, some have left abusive relationships because having a child was the impetus they needed to get out of an unhealthy situation.

what of married mothers whos husbands are out of the home for extended periods of time such as soldiers on deployment or similar?

i just don't get all the hand-wringing that is going on over this!

in-box cleaning (too many of my post have this title) :)

2009-05-16T17:13:00.003-04:00

some cool stuff i've found today

first up a letter to the editor in a semi-local to me paper http://chronicle.augusta.com/stories/2009/05/16/let_524156.shtml it will be interesting to watch as the comments multiply. heres the original article btw http://chronicle.augusta.com/stories/2009/05/03/met_522588.shtml the title is Baby girl born just outside hospital and oh my at the comments on that one

heres something interesting from the uk http://press.psprings.co.uk/jme/april/300_me28662.pdf
‘‘You can’t handle the truth’’; medical paternalism and prenatal alcohol use this is a fascinating read and delves into some suprising links in some research btw better outcomes for children born to light drinkers, and how the hesitancy to just say "we don't know what the 'safe' level of alcohol consumption during pregancy is" is disrespectful to women's right to information....while it is easier to just say "no alcohol during pregnancy" it would make more sense to present the evidence and let women decid for themselves

heres some news about ritalin and the like (not super birthy but relavent to those of you already parenting wee ones ) http://www.slate.com/id/2218280/ this is just a summary article but heres a more in depth look http://www.nimh.nih.gov/science-news/2009/short-term-intensive-treatment-not-likely-to-improve-long-term-outcomes-for-children-with-adhd.shtml

and this article http://www.wtvq.com/health/4629-childbirth-class-trends.html states that "Researchers say the number of couples who are taking childbirth education classes is declining. With couples having busy schedules, many of those who choose the classes are opting for a single all day “crash course” rather than consecutive weekly sessions. In addition, the internet can provide expectant parents with plenty of information, pictures and videos to see first hand the labor and delivery process. " they didn't offer any references though. as a childbirth educator i obviously don't want to hear that fewer couples are taking classes though with all the information you can find on your own i can understand it.

lots of good comments on this blog post 16 Why Would Women Want to Experience Natural Childbirth? http://natural-childbirth-baby-care.com/natural-childbirth/why-would-women-want-to-experience-natural-childbirth/ homesite here http://natural-childbirth-baby-care.com/ a new resource to me

also here are all the entries for the birth matters virginia video contest http://www.youtube.com/results?search_query=BirthMattersVirginia&search=tag i need to watch and vote and so do you :)

ok well its a long post w/ lotsa links so i'll end it for now.... one of the wee ones wants the computer anyway

late childbearing may increase life expectancy

2009-05-16T01:33:00.002-04:00

http://uk.reuters.com/article/healthNewsMolt/idUKTRE54D51U20090514 according to this In the sample of 14,123 Utah women, those who had their last child between age 41 and 44 were 6 percent less likely to die during any year after 50 than were women who had children earlier. For those who had babies at 45 or later, annual mortality risk was 14 percent lower.

a blog post i found in support of paid maternity leave http://womensrights.change.org/blog/view/next_year_give_mom_the_gift_of_maternity_leave
touches on the irony of using disability leave as materninty leave which is what i'm doing for most of my leave

new blog i found

2009-05-14T00:08:00.002-04:00

just found a new blog i like....not as birth focused as some of my usual fare but still woman focused , strollerderby http://www.facebook.com/ext/share.php?sid=82564383292&h=Cb6bY&u=vecVp&ref=nf and heres a post i had to share also
http://www.facebook.com/ext/share.php?sid=82564383292&h=Cb6bY&u=vecVp&ref=nf

may add to this later....

home birth comic

2009-05-09T00:01:00.001-04:00

had to post a quick link to this http://www.facebook.com/ext/share.php?sid=85519287820&h=HeKw3&u=DACny&ref=nf thanks to navelgazingmidwife ( http://navelgazingmidwife.squarespace.com/ ) for posting the link on facebook

moms rising video, kerry ins bill, plan b

2009-05-07T19:08:00.004-04:00

this is too cute http://news.cnnbcvideo.com/index2.html?combined=&first=&name_id=&last=&id= and the obligatory further coverage http://salsa.democracyinaction.org/dia/track.jsp?v=2&c=N0wtoPaCJTo6VpYAgnZp4CjkUEXIPzWs

john kerry introduced a bll that sounds good http://kerry.senate.gov/cfm/record.cfm?id=312510 based on this report from the national womens law center http://action.nwlc.org/insurance . heres a relate article from RHrealitycheck http://www.rhrealitycheck.org/blog/2009/05/06/lets-end-insurance-discrimination-against-women-right-way

news on plan b http://www.muskogeephoenix.com/opinion/local_story_126163315.html

international day of the midwife

2009-05-05T23:35:00.002-04:00

well there are about 20 minutes left in the day so i thought i'd take a minute to post some of my favorite midwifery sites on the net

this is a new one to me http://www.internationalmidwives.org/Home/tabid/205/Default.aspx the home of the international confederation of midwives. this is the organization behind the day.

here are a few things i found googling "international day of the midwife"

something neat here http://sarah-stewart.blogspot.com/ and from the same person, a slideshow
http://www.slideshare.net/sarahs/internataional-day-of-the-midwife-2009-my-midwifery-story and here is a table of online events planned for the day http://onlineprofessionaldevelopment.wikispaces.com/International+Day+of+the+Midwife+2009

some midwifery organizations:

midwives alliance of north america http://mana.org/index.html
north american registry of midwives http://www.narm.org/
citizens for midwifery http://www.cfmidwifery.org/
national association of certified proffesional midwives http://www.nacpm.org/
midwifery today http://www.midwiferytoday.com/

midwifery blogs:

http://www.pamamidwife.com/
http://navelgazingmidwife.squarespace.com/
http://cfmidwifery.blogspot.com/
http://community.midwiferytoday.com/blogs/jan/default.aspx

and heres one thats not midwifery related but an awesome couse nonetheless
http://maternityhealth.org/GiftOfLife/

i'll have to fluff this out some more after the kids get to bed.....

midwifery legislation, new (to me) blog

2009-05-04T23:04:00.003-04:00

from my inbox upcoming midwifery legislation in ny " The Midwife Modernization Act " http://www.legislativegazette.com/day_item.php?item=844

also just tsumbled onto a cool new blog http://blogginboutbirthandmore.blogspot.com/ and its even semi-local. whats more they mention a dr in atl who does vaginal breech deliveries :) wwhich my midwives don't :( . hopefully i won't need it but anyway i know at least that theres somebody in ga that does it

more to come shortly....

cleaning out the ol inbox

2009-05-03T18:18:00.008-04:00

heres some coverage i found on the net re international day of the midwife

this is from new zealand http://www.scoop.co.nz/stories/BU0905/S00054.htm

heres a little woo for you....pre-birth communication. http://lovefrombaby.com/ not being closed minded by calling it woo btw. i'm into the idea. i'm not too much of a talker when it comes to the little one in the belly, so the idea of communicating in some other way is definately appealing to me. heres the article http://lovefrombaby.com/pre-birth-communication.html

i don't go into abortion too much in this blog but heres a bill that hits close to home being one state over http://www.goupstate.com/article/20090503/NEWS/905019935/1132/OPINION?Title=Abortion-waiting-period-Bill-hits-women-below-the-belt

national women's health week in may 10-16th. i'll have to remember to post on that then. but heres a quick link http://www.womenshealth.gov/whw/ included in the week is national women's check-up day...maybe a good day to schedule my dental cleaning....and heres something from webmd to go along with http://women.webmd.com/womens-top-5-health-concerns-6/default.htm and one more article re women's health today http://www.bio-medicine.org/medicine-news-1/Women-live-longer--not-better--largely-because-of-obesity-and-arthritis-44460-1/ , this study found that women are not necessarily leading better lives, just longer ones

heres an interstingblog post that ties meeting the healthy people 2010 goals http://www.healthypeople.gov/ well, the breastfeeding goals anyway http://www.healthypeople.gov/document/html/objectives/16-19.htm with the homebirth rate in various states http://www.puremothers.com/?p=903

quick quote from the blog

" The specific breastfeeding goals for 2000 and 2010 are to get
75% of new mothers to initiate breast feeding, for 50% to still be breastfeeding
at six months, and 25% at one year. The US did not meet the goal back in
2000 and, just twelve states met some of the criteria. Now, what is interesting
to me is that of the eight states achieving all three of the criteria, seven are
on the west coast and the other is Vermont. Alaska, Washington, Oregon, Idaho,
California, Utah and Hawaii all achieved success. "

" In 2006, 9 states had home birth rates that were at least double the national
average. Not surprising, Vermont had the highest at 2.4%, Alaska at 1.9%, Idaho
at 1.5%, Utah had 1.3%. These were the rural states listed. In
addition, some non-rural states had homebirth rates at least double the US
national average also. Included were Oregon at 1.6% and Washington with
1.4%! So six of the nine states that had better homebirth rates were in
our eight! (I want to mention that Montana was 2.3%, Wisconsin was 1.4%
and Pennsylvania was 1.6% with Lancaster County - Amish country - having the
highest rate at 14%). So, California and Hawaii didn’t make this
list. But, I think I’m on to something. Women who have successful
homebirths have less difficulty with breast feeding. They don’t experience
separation from their baby once it is born and most homebirth babies are born
full term - another indicator of a successful nursing relationship.
Homebirth moms usually get some initial lactation support from their midwives or
are referred to certified lactation consultants for on-going support."
she looks at breastfeeding legislation and vaccine exemption provisions as well
i may have already linked to this from peggy omara re breastfeeding and the case against, but she has some good info in here and this is what spurred the post i just linked to so here it is
http://www.mothering.com/guest_editors/quiet_place/quiet_place.html
and i'm linking to this so i can remember to research it further. http://www.wctv.tv/medicalminute/headlines/44184362.html it seems like 1 in 100 is an awefully hight rate of shoulder dystocia....
well this is a long post already and i am a strving preggo so i'll stop and eat and perhaps return later

doula month

2009-05-02T22:36:00.001-04:00

just found out may is also international doula month http://www.dona.org/

i think doula-ing may be the next step in my journey into the world of birthwork. so i'm very psyched to find this out. when i was at ican dona had a booth set up and their next conference is during my maternity leave and fairly close too....don't know if i can afford it but i'm thinking about going..maybe just for one day

2009-05-02T21:52:00.002-04:00

i haven't yet filled out my last post but here goes another anyway

so may 5 is international day of the midwife http://www.internationalmidwives.org/CongressesWorkshops/InternationalDayoftheMidwife/tabid/327/Default.aspx
super exciting! don't know that i'll do a whole lot to celebrate besides posting something on my facebook, and doing a nice entry here ..... maybe detailing the different kinds of midwives? the theme is "the woeld needs midwives now more than ever"

interesting. at ican one of the most controversial statements i hear was during the q&a w/ the writer/director/producer of pregnant in america http://www.pregnantinamerica.com/ suggested that everyone in the audience who wanted to go into midwifery go into l&d nursing instead b/c that was where they were really needed. he was just making a point about the lack of support that so many women who choose hospital birth have but at the same time i think everybody disagreed.

i can't say i haven't thought about l&d nursing as an alternative to midwifery. partly b/c of that. i mean i am the only person i know who has used a midwife. or delivered anywhere other than the hospital.

i think midwives are needed. but they need to be legally recognized, adequately compensated, and a real option for women. i'm driving 2 hours one way to all my prenatals and evetually to birth....not everybody can do that. there are only a handful of certified nurse-midwives in my state and direct-entry midwives, whether narm certified or not, are not legaly recognized health care providers here, so unless you can pay out of pocket for birth, you don't have many options.

so ithink its much more than just needing midwives.

of course its an international thing so in a lot places it is a different situation.

well supper is nearly ready so i'll close for now. and i will get back to the previous post eventually :lol

vaccines, homebirth safety, birth center legislation

2009-04-28T23:42:00.003-04:00

to be edited and fluffed out shortly

i believe i've posted about this before but heres a reminder.

"The American Association of Birthing Centers (AABC) is seeking federal legislation that would add freestanding birth centers to the list of health professionals and providers eligible for payment under the federal-state Medicaid program. ... Next week, AABC’s bill will be introduced in the U.S. House of Representatives by Rep. Susan Davis (D., CA) (San Diego). It will then be assigned a bill number and an official name. ... AABC is asking all birth professionals, birth advocates, and supporters of improving maternity care to help us lobby for this bill. Grassroots support phone calls to Congress is the single most important element in whether a bill like this becomes law. " more info to be found here http://cfmidwifery.blogspot.com/2009/04/grassroots-network-action-alert-help.html the bill is being introduced THIS WEEK!!!

also several of my favorite blogs have been talking about vaccines lately. so i'm researching the issue further myself. this is where i'm starting. http://www.fourteenstudies.org/index.html because this is, well i'm not sure i'd use the words anti-vax, but at least somewhat antagonistic towards the status quo re vaccination, i'm including a link to the cdc's site also http://www.cdc.gov/vaccines/ . there is so much to learn on this topic i honestly just quit researching after a certain point. but i feel like its time to re-open the topic.

and pinkyrn has been wondering if more folks are choosing homebirth and wondering about the safety compared to hospital birth. see this post
http://pinkyrn.blogspot.com/2009/04/home-birth-are-more-folks-choosing-this.html to which i posted a comment " i agree that birthing alone is outside of evolutionary and cultural norms though i can't make up my mind as to the actual risk involved. i do think if a woman chooses an unassisted birth she has a responsibility to have a back up plan for emergencies. she needs to take the time to read some resources in addition to internet forums and message boards, have an idea as to what constitutes a reason to transfer, an idea how to accomplish a transfer if one is needed, etc. that said attended childbirth can be just as safe as hospital birth and thats based on research. essentially the same conditions should be in place as i would expect for uc...but the presence of a midwife who knows what to look for in identifying emergencies and ideally has some medical back up herself, can make that back-up plan much more likely to function safely. regardless of what kind of homebirth a woman chooses i think she should consider her own health, anything that would risk her out of a midwife attended homebirth in most instances is at least worth researching, yk. also to be considered: ease of transport, distance to hospital, traffic, what kind of reception will she recieve at the hospital, etc....i think i have so much to say on this topic i'm going to steal my comment and post it on my blog :)
April 28, 2009 7:52 PM " and this " i forgot to come back and link any research re safety though i guess thats been covered because i was primarily refering to the new dutch study which yes is a different climate than the us in many ways. what is different about the dutch system? mmmm.... midwifery model is more prevalent, much better more centralized, standardized transport system, i'm not sure what else....maybe socialized healthcare has something to do with it? problems may be caught earlier even in low income women? in the us i think low-income is something of a risk factor whereas it wouldn't be there. i'm just speculating on that though. re wether or not more people are doing it i don't have full text on this but " In 2006, there were 38,568 out-of-hospital births in the US: 24,970 were home births and 10,781 occurred in free standing birthing centers [5]. From 1989 to 2003 the rate of home births in the United States declined from 0.69 to 0.57 percent of births, or by an average of 0.01 percent annually. The 2006 figures represent a very slight increase in both absolute numbers and rate, reaching 0.59 percent of all births [5]. This rate is comparable to that in other industrialized countries with two exceptions: England has experienced a slight rise in its home birth rate from 1.0 percent in 1989 to 2.7 percent in 2006 [6], while the Netherlands has maintained rates of home birth of approximately 30 percent [7]." http://www.uptodate.com/patients/content/topic.do?topicKey=labordel/15656 in the same summary i found this interesting in regards to safety "Mothers who had a home birth were ... much more likely to report not having had prenatal care. Such women could include unplanned, emergency home births, as well as mothers who wished to avoid traditional prenatal care." which does go along with my speculation as to why it may not be as safe here. according to this article in the ny times midwives in ny are getting more calls for homebirths http://www.nytimes.com/2008/11/13/garden/13birth.html i think that just goes to show more news coverage of homebirth though...
May 3, 2009 11:08 AM"

and congrats to rixa at stand and deliver! http://rixarixa.blogspot.com/

ican conference friday

2009-04-26T00:06:00.002-04:00

i had such a good experience friday. i learned so much.

the most poignant thing was when they asked everyone in the room who had had a cesarean to stand up...it was just a very visual reminder of the epedemic we are facing in this country.

when sara buckley was talking about the hormones involved in birth it went along so well with what i learned in my lactation class.

of course i got home from work today and had a ton of books on my reserve list at the library...get a little aknowledge and i just gotta have more!

i've got to get better at glad-handing and networking though....i wish i had bid on the buisiness cards at the silent auction

vit d, response to the case against breastfeeding, call for public comments on breastfeeding

2009-04-19T01:41:00.008-04:00

so now they're linking vitamin d deficiency with the increased rate of cesarean....

http://www.medscape.com/viewarticle/585864?src=mp&spon=16&uac=89759SZ

http://www.nytimes.com/2008/12/30/science/30baby.html heres a post from amy at birthing with confidence that gives some additional critique to the study.

http://www.givingbirthwithconfidence.org/?p=246 (i loved everything i read on this blog btw....it was a new one to me but now on my favorites list) i'm no expert at reading or critiquing scientific studies, but it seems to me that good nutrition during pregnancy is common sense. http://www.jhsph.edu/wchpc/publications/MCH-Summ.-6.pdf

are women more likely to be d deficient now? maybe since we're supposed to wear sunblock all the time.....i learned in my lactation class that 20 minutes in the sun was good for, well i don't remember the exact figure but quite a lot of vit d. and whats more it can be split up over the course of a day.

heres a reply to the case against breastfeeding that i really liked

http://www.chicagotribune.com/news/local/chi-bd-triage-breastfeeding-05-apr05,0,1912282.story obviously i'm pro breastfeeding. actually like i said to my dad (in reference to nursing in public ) " no body is really against breastfeeding are they?" and i think rosin really should have written a different article......maybe the case against promoting breastfeeding without also protecting and supporting it?

but i do agree that breastfeeding doesn't have to be an all or nothing thing....at least after a while. once you get a good supply established, good latch, all the basics....if it will really make that much difference to your own health and well being to use an alternate feeding method sometimes, well mama's health and happiness is directly realted to her babies health and hapiness. thats why its called the mother baby dyad.

speaking of breastfeeding health and human services has issued a call for public comments http://www.blsmeetings.net/owh_call_to_action_on_breastfeeding/

heres some unsurprising news related to women and health insurance

http://www.mercurynews.com/topstories/ci_12159324 i was just talking with a customer at work about basically this very subject. she paid $60 out of pocket for bcp....not coincidentally her company does not offer paid maternity leave either....

and heres a new study about birth control pills http://www.eurekalert.org/pub_releases/2009-04/aps-oci041509.php

it shows that bcps reduce muscle mass gain. interesting stuff considering how common use of oral contraceptives is. http://www.infoforhealth.org/pr/a9/a9chap2.shtml

chinese research, other news....

2009-04-13T23:53:00.004-04:00

had to pass this on though you may have to create an account to read the full article http://www.washingtonpost.com/wp-dyn/content/article/2009/04/12/AR2009041200967.html?wpisrc%3Dnewsletter&sub=AR

heres a quote

"In a provocative set of experiments involving mice, Chinese researchers have shown for the first time that an adult mammal can harbor primitive cells in her ovaries that can become new eggs and produce healthy offspring, they reported yesterday.
While much more research is needed to confirm and explore the findings, the work raises the tantalizing possibility that it could someday lead to new ways to fight a woman's biological clock, perhaps by stockpiling her egg-producing cells or by stimulating them to make eggs again. "

and heres a story that made me mad!

http://ipost.com/rd/9z1zlbv7p4l88e01oi0abmaa158n16h17hkrvts4mdg

as you probably know last year marked the highest number of births in the us ever. now i'm a pretty big environmentalist....i recycle, buy used, cloth diaper, etc but the joy of children far outweighs any environmental consequence in my mind....

and heres another risk of c-section deliveries....asthma
http://thorax.bmj.com/cgi/content/abstract/64/2/107

and heres something that pops up from time to time in my inbox the "natural" cesarean http://www.timesonline.co.uk/tol/life_and_style/health/article6028478.ece

can't say how i fee labout this as i've never had a section and wouldn't plan one .... i'd imagine some of these changes would be difficult to enact in an emercency cesarean, on the other hand some necessary cesareans are planned and anything to bring the experience closer to birth and further from surgery would seem to be a good thing

so i guess thats it for cleaning out my inbox :lol for now anyway :lol

still stuck on maternity leave

2009-04-13T17:55:00.002-04:00

well i'm still reading about maternity leave though i've realized that as primary breadwinner in my family a lot of what is out there doesn't apply to me....

not necessarily specifically re maternity leave but related things like sick leave....which i rarely use b/c if the kids are sick, well the hubster is home anyway so its not like i have to stay home

but before i get into all that, and even though io know everybody else in the birth community has already posted a link http://www.mama-is.com/the-birth-story-of-ean-campbell/ CONGRATS HATHOR!!!!

and a shout out to a new blog i just found that i really like http://breastandbellyblog.blogspot.com/

i found this " In an analysis of institutional factors that compel
employers to offer paid maternity and paid sick leave, sociologists Doug
Guthrie and Louise Marie Roth found that “pregnancy leave is tied to sick leave
policies within many U.S. organizations as a result of pregnancy legislation in
the 1970s and 1980s.”36 Based on a survey of more than 700 organizations, the
authors found that the percentage of women in an industry had no significant effect on paid maternity leave policies, but did have a significant effect on the probability that a firm offered paid sick leave.37 As a result, without paid sick leave, most low-income women are left with little or no paid time off after the birth of a child, and women tend to be concentrated in certain industries, like the service industry, that provides disproportionately few benefits.38"

thats from "women in the workplace: which women? which agenda?"

next on my reading list is a report from the commission on the fmla act of 1993
http://digitalcommons.ilr.cornell.edu/cgi/viewcontent.cgi?article=1002&context=key_workplace

eventually i'll move on from this topic and back to birthy business.....though really maternity leave is pretty relevant....i assume most of us don't want to go back to work within hours of having a baby

remeber the womens basketball coach who was hailed as some sort of hero when she was out coaching literally hours after a birth?
http://www.redorbit.com/news/oddities/868545/coach_at_game_hours_after_giving_birth/index.html

anyways real life is calling....

the continuing saga of maternity leave in the us

2009-04-10T21:17:00.003-04:00

despite being distracted by some of my favorite blogs http://pinkyrn.blogspot.com/ and http://momstinfoilhat.wordpress.com/ i am plugging through the reports i linked to yesterday

so far i've learned that most women work well into the 3rd trimester.

i'm personally probably working through to the day i start labor even though i know recent studies suggest taking off at least 2 weeks prior to the due date decreases the chances of cesarean delivery and longer maternity leaves tend to increase the duration of breastfeeding

speaking of breastfeeding heres yet another reply to the case against breastfeeding (thank's mom's tinfoil hat ! ) http://mothering.com/guest_editors/quiet_place/quiet_place.html

and yet another linkie-poo to thank mom's tinfoil hat for:
http://www.birthcenters.org/legislative-alerts/index.php?id=16
this one is a letter supporting birthcenter legislation that i am so going to forward to all the docs in town

but now family calls and my reading and posting must wait....and i have to work the weekend so it may be a while...

maternity leave

2009-04-09T17:58:00.002-04:00

so i'm followng up on the state of maternity leave, especially here in the us where i am though i plan to throw in some comparisons with other countries

first thing to catch my attention from my google search was this http://www.census.gov/prod/2008pubs/p70-113.pdf

how about that? a whole paper on the very topic i'm researching! and credible too since its from the census bureau :)

haven't read the whole thing yet but did just find this nugget

" The Family and Medical
Leave Act of 1993 (FMLA) mandates
up to 12 weeks of unpaid
leave for childbearing or family
care over a 12-month period for
eligible employees. Studies so far
have found little evidence that
such laws have increased the
amount of leave women take by
any considerable amount. 14"

wonder what the studies would show if the act mandated paid leave?

and i just found another paper i have to read entitled "Women in the Workplace: Which Women, Which Agenda?" written by Michael Selmi and Naomi Cahn

it appears to adress the fact that much of the policies, proposals and actual legislation serves the interests of professional women who can afford the income trade offs generally inherent in maternity leave policies

i pulled it up as a pdf and can't figure out how to link to it directly buts its the 5th link here http://www.google.com/ie?q=Wen-Jui+Hen+and+Jane+Waldfogel+Parental+Leave%3A+The+Impact+of+Recent+Legislation+on+parent%27s+leave+taking&hl=en&btnG=Search

i'll have to come back to this later tonite though....

note to self for brain acronym

2009-04-07T15:34:00.002-04:00

b = benefits
r = risks
a = alterntives
i = instincts
n = doing nothing

great tool for decision making during labor and birth

family planning

2009-04-07T00:05:00.002-04:00

i'm starting with a link to a n article from the san francisco chronicle http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2009/03/24/MN9416HD33.DTL

and also this http://momstinfoilhat.wordpress.com/2009/01/27/692/ and this http://momstinfoilhat.wordpress.com/2009/04/06/reply-turned-post-ive-heard-this-song-before/
from moms tinfoil hat

i'm not sure why the big whigs think not covering maternity and family planning services will save money?

re family planning, how many unintended pregnancies are the result of a lack of access to affordable family planning?

according to the guttmacher institute's report Abortion in Women's Lives ( http://www.guttmacher.org/pubs/2006/05/04/AiWL.pdf ) "Most U.S. couples want only two children. To achieve this goal, the typical woman spends roughly five years pregnant, postpartum or trying to become pregnant and three decades trying to avoid unintended pregnancy.1 "

thats 30 years of using some form of bc...and i only know of one methods thats free and charting your cycles and remaining abstinent during your fertile times is just not workable for all women all the time...

i just read thAT for every dollar spent on family planning we save 4$ on later use of social services....can't find anything to back that up just yet but it sounds good

as an aspiring midwife i don't always agree with acog but heres something they got right and this is from last year

http://www.acog.org/from_home/publications/press_releases/nr05-08-07-2.cfm

i think i'm going to have to expand and to tackle maternity coverage later as it is getting late....

birth plans

2009-04-05T16:49:00.002-04:00

today i want to talk about birth plans. i know the idea of a birth plan is somewhat controversial in birthing circles.....pam england (birthing from within) is not a fan although other than this http://www.truebirth.com/2008/03/the-birth-plan-trap/ i can't find much via google that goes into the cons of writing a birth plan theres this http://community.livejournal.com/trustbirth (scroll down to the very last entry) which doesn't specifically adress birth planning but does discuss the ways in which some hcps might try to change your plans....

i think really the thing that would be bad would be relying on a birth plan that you haven't gone over with your care provider rather than actually communicatng with said hcp

i think a birth plan is a great tool for figuring out how you envision your birth going and lots of people have already written a lot on that subject

a birth plan is really just a jumping off point to start doing your own research....presumable after choosing a provider who is already aligned with your general birth philosophy, someone who practices evidence based medecine etc

alot of what i'm reading as i look into this are posts from moms who were dissapointed that they made a birth plan but didn't have the birth go according to plan. there seem to be 3 main reasons this happens

1. unanticipated medical issue (in some cases an emergency, in other cases not)
2. hcp who have had their fingers crossed when they signed off on the birth plan
3. hospital policy

not too much you can do about the first assuming a non-preventable situation like say a prolapsed cord or something

the other two though....

i personally suggest researching your hcp before you start writing up a birth plan. finding out section rates seems to be the preliminary question. i called around town and rates vary from %30 to %9 where i am. (of course the birth center an hour and a half away has about a %4 rate so guess where i'm going :> )

not only should you research your individual ob or midwife but also the place of delivery which may have its own set of protocols in place

you can look at the mother and baby friendly hospital initiatives for more info as to what numbers to be asking about in terms of place of birth

http://www.motherfriendly.org/pdf/Having_a_Baby-English-8_5x11.pdf

also i'd be sure to have the hcp sign off on anything that goes against the typical standard of care for your chosen birth place and have it on file with the birthplace as well as brinbging a copy witrh you

as to figuring out what your birth philosophy is i found this post got me thinking http://labortrials.wordpress.com/2008/01/29/trust-birth-or-dont/

hth somebody....

April is Cesarean Awareness Month

2009-04-04T01:21:00.004-04:00

First off from my inbox today, courtesy nursingbirth at http://nursingbirth.wordpress.com/2009/04/03/top-8-ways-to-have-an-unnecessary-cesarean-section/ top 8 ways to have an unecessary cesarean. this is an addition to the top 7 ways to have an unecessay cesarean found here http://www.faintstarlite.com/2009/03/top-7-ways-to-have-an-unnecessary-c-section/

have to say i agree with every single point made

have to give the flipside though and let you know how to avoid an unecesarean....

1 labor at home as long as possible
2 eat and drink as needed during labor

did you know a recent study suggests that eating and drinking lightly during labor is ok?http://www.bmj.com/cgi/content/full/338/mar24_2/b784

3 labor in whatever position you want too
4 push when and how you feel like it
5 birth at home or in a freestanding birth center

see this study for homebirth cesarean rates http://www.bmj.com/cgi/content/full/bmj;330/7505/1416
and this from citizens for midwiferyhttp://www.cfmidwifery.org/pdf/cesarean2x.pdf

those are just off the top of my head

i'm sure there are more..... post your best tips on the comments