thoughts on contraception

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

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

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

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

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

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

what is a partogram?

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

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

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

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

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

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

International Doula Month

Happy International Doula Month

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

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

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

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

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

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

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

trying to start good habits

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

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

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

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

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

BABY STEPS BABY STEPS.....

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

thoughts on international day of the midwife 2010

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

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

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

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

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


The Midwives Model of Care includes:

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

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

Minimizing technological interventions

Identifying and referring women who require obstetrical attention

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


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

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

So who knows what i'll end up doing?

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


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

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

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

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


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

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

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

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

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


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


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

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

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

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

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

cool contest alert

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

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

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

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 InitiativeFor
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.