Birth: the Adventure

So this was all over my facebook this week

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

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

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

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

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

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


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



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

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

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

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

Birthing Naturally has a similar tool on their site.

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

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

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

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

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

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

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

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

(more to come)

Bloggin' Bloggin'

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

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

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

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

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

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

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

My laptop is my soapbox I know I know I know

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

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

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

my breastfeeding story

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Ten Steps to Successful Breastfeeding

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

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

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

4. Help mothers initiate breastfeeding within 1 hour of birth

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

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

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

8. Encourage breastfeeding on demand

9. Give no pacifiers or artificial nipples to breastfeeding infants

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

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

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

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

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

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

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

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

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

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

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

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

AIDS news

New reports spotlight the AIDS crisis.

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

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

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

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




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


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


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

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


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

maternity clothes for teens?

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

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

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

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

Hobo Mama: Tips to help parents assume the best intentions

Hobo Mama: Tips to help parents assume the best intentions

Just read this great blog post. LOVE it!

breastfeeding advice on the interwebz

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

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

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

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

cesareans and "choice"

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

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

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

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

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

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

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

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

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

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

womens health news

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

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