Resovled.

The time has come. There are other resolutions, of course, involving things like finances, flossing, playing more with Lily, and making a dent in my exponentially-growing reading list, but the cliche simply must be a priority this year. Annie over at PhD in Parenting inspired me to share this on the blog itself, so mixed in amongst the birthing & nursing & doula content, you'll occasionally get an update on this.

I figure this is common enough as a mothering-related experience (and indeed, a common female experience, period, parity aside, but that's another topic, what with all the social context such a topic requires) that it might be useful or interesting to readers on some level, especially those who are in a similar place themselves, or who have been there, or soon will be. There's even a breastfeeding-specific point I want to make, so read on!

In PhD in Parenting's original post, she said, "I want to lose weight. I want to do it for all of the right reasons and some of the wrong ones. But mostly I’m doing it because I want to feel like myself again." I think this was simply and honestly and beautifully put. Much of what follows is an elaboration upon the comment I wrote.

Count me in. You phrased it exactly as I have: I want to feel like MYSELF again.

Lily is 20 months now and I STILL haven’t lost all the baby weight! Now, I gained a whopping 65-70 pounds during my pregnancy – I was forbidden exercise due to my placenta previa. This is a story I'll have to tell here one day; I have a lot to say about my experience of parallel care with a mainstream medical practice as compared to the care I got from my home birth CPMs. Anyway, from week 18 all the way up to my last ultrasound at week 34, I was on strict pelvic rest (nothing in the vagina at all, and no sexual activity of any kind) and was warned against anything but the gentlest prenatal yoga. As most of you know, I went on to have a wonderful home birth, but as a formerly extremely active person, this had a huge impact on my weight.

Then, after Lily's birth, we had unforeseen challenges with nursing, which took up a tremendous amount of time and energy (totally worth it in every way, I'm certainly not saying otherwise), and I was living alone about 75% of the time, as Aaron was only able to commute to stay with us for a week or so every month. So, yeah, solo baby care, compete with pumping every 3 hours around the clock no matter what, including the wee hours? Exercise just did not make it to the priority list at all, much less the top of it, aside from an occasional walk. What can I say? What's done is done.

Enough explanation/excusing myself. The situation today: I’ve lost about 50, net total (including a brief period of gaining some back during a complicated period of what might, in retrospect, have been some minor postpartum depression - yet another thing to post about in the future), but still have 25 left to go, since I was already 5-10 pounds above my healthiest weight when I got pregnant. But even with all those factors, you'd think by now I'd be back to normal or at least close to it, already.

I’m still nursing, but with less overall output – you know how it goes with a toddler. It’s funny, I’ve been kind of reluctant to talk about it publicly because one of the many great benefits of breastfeeding absolutely is weight loss – so if I’m still at it, why are these particular pounds so stubborn? Well, I recently developed a theory, based solely on myself and what I’ve observed in friends and many online anecdotes: I think perhaps breastfeeding helps you lose the weight you were SUPPOSED to gain in pregnancy, i.e. 25-35 pounds-ish, or whatever it was for your particular frame and body type – I actually did drop 25 pounds extremely quickly. But then, any additional, excess weight you packed on? You’re on your own. And if you gain weight back?! God help you.

Totally just my theory. It makes me feel better, anyway.

SO. I’m restarting the 30 Day Shred, and hitting Zumba at the Y at least 3 days a week, and hopefully power yoga 2-3 times as well. I would attend yoga classes daily if I could afford it and work out the child care - I know many people cultivate amazing home practices, and I admire that deeply, but I thrive on the classroom and the relationship with the teacher. I'm sure my former life as a dancer has much to do with that. Routine is also always key for me - I need to keep a regular schedule of classes or otherwise scheduled workouts. As far as the food end of it goes, after a lifetime of experimentation (see above re: former life as dancer), I know myself well enough to know that carbs are my nemesis, and thus a modified South Beach-ish approach (absolutely NOT Atkins), with lots and lots of vegetables, is the most effective way for me to go. An aside: Kalyn's Kitchen is a great resource for low-carb dieters and for foodies in general - amazing low glycemic & South Beach -friendly recipes for food lovers of all kinds.

Okay, I feel renewed and fortified in my ambitions. By Lily's second birthday on April 14th, I WILL feel like myself again. Realistically, I'll still have 5-10 pounds to go, but I'll be almost there. And then by June? Dare I commit to posting a bathing suit shot here? Yes I do.

I've thrown up a ticker on my side bar - I used my original starting weight, to remind myself of how far I've come already. The little scale marks where I'm at today, beginning anew. Annie is much braver than I, sharing bathing suit shots, but I'll still pony up a humbling picture or two. Here's a real "before" shot, visiting LA when I was, unbeknownst to me, exactly one week pregnant. And hey, it's at the beach, if not suited up:

And good grief, here I am about 36 weeks later:

I KNOW. Gah. (Cute kiddo, though, eh? Daughter of one of my best friends.)

Here I am today, basically, as of a few weeks ago:

I know you can't see much of the body - I purposely don't pose for many shots were you can. I cal always tell where I'm at by my face, though. Here's one where, even if it's not a great pic in general, you can see more bod, sling-draping and weird position aside:

Stay tuned for the "After" shot.

(Uh, it might be awhile.)

Wordless Wednesday: My Future IBCLC

I'm now tandem nursing, apparently, as per Lily's demands.


Future lactation consultant? "Positioning looks good, now let's work on that latch."


Examining tongue for possible tight frenulum.


Changing the diaper (hey, it even came with cloth).


The really funny thing? I have to back up a little here. Despite my referring to it as "nursie" or just "nurse" from day one, Lily insisted on inventing her own word for breastfeeding, which is not in any known language but basically sounds like "Boh-tee" or "Buh-tea". So random, right?

Well, one day, Aaron (her daddy) forwarded me this, which he had just come across and which completely weirded him out. Normally I don't pass these kinds of tired old "isn't extended breastfeeding freaksome" sketches along, for obvious reasons (tired, old), but here's the thing: listen to what he calls it.


Whoa, right?

And the name of her first doll, the baby version of the American Girl line, pictured here, that she got for Christmas? Bitty Baby.

*boggle*

Fathers and partners and doulas, oh my!

The blogger known as Baby Making Machine is prolifically sharing her pregnancy experience, and much to her credit, she is asking a lot of questions about everything, including birth. One of the topics that has come up for her is to doula or not to doula, and she blogged about one specific, lovable, handsome "doula dilemma": namely, her husband.

He had a few arguments I tried to take into consideration: 1. Doulas are for rich people. 2. I want to help, I want to be your doula (or my "dulla oblongata," as he jokes).

The first argument, while I can see his point isn't necessarily true. To him, if we can make it through labor like many of our family and friends have without one, why spend the money? "Having someone you pay there to help is something rich people do." Well... Many doula's I've found in my area don't have rates on their sites because they work with people to set the right price on an individual basis. Most I've found prices for seem to range from the $200-$1500s but I hear some are in the $2000s, depending on location, experience, services, etc. Most of my friends seem to either have a friend and get one for free, or paid about $300-$600. Everyone has said it's worth every penny.

Now, looking at those numbers my husband says no way. He's rather use that money on things for the baby, or classes, books and material we can take together to be prepared for labor. But I heard you can get doula's who are getting certified and need live births to help you for free! I wrote to my local DONA lady to get the list of women in my area who will be certifying over the next year so I can contact them about helping me out. I told my husband this and he was a little hurt that I was so insistent on this. Which brings me to the next point... Him wanting to help.

I've read great articles and posts here and there about doula's helping husbands know how to help their wives, but he really wants to be the primary support. He really hasn't had a strong opinion about too many things in this pregnancy process unless I pry, so having him out and tell me how he really feels about it made me think again. He told me he wants to take classes with me and learn how to help me through it, but he doesn't want someone with us 24/7 and "taking his place." I can even picture him shying away because there's an extra woman there, and not wanting to help as much... If I had other help.

This is something that comes up for other women, too, so I thought it was worth addressing at some length. I started out just responding to her blog, soon realizing it was definitely a reply-turned-post, and then I couldn't get my comment to appear on her page at all due to some bogus HTML issue, so I just threw it all up here, period. Hope this is helpful to FutureMama (as she goes on Twitter) and to any other mom out there with a reluctant partner.

Again, kudos for taking such a thoughtful approach. I can already sense that this might be a reply-turned-post . . .

I want to briefly echo what Mommy Bee said about epidurals: I completely respect your right to make an informed choice, but do be aware that just because you've decided you want one does not guarantee that you will get one, or that when you do get it it will work, so the need to be prepared and to have support is just as valid even if you feel an epidural will likely be part of your birth experience. There are all kinds of benefits to laboring for quite a good ling time without one, reasons having less to do with the effects of the drugs on the baby and more to do with the effective progress of dilation and with optimal positioning of the baby for birth. As you'll learn when you go through childbirth ed classes and/or read further on your own, the baby's position in your pelvis is key, and the more movement and versatility of position you can bring to your labor the better. Doulas are experts here.

And let's say you labored a good long time without an epidural, and then decide to go ahead and get one. It's not like it's just Game Over at that point: there are still so many decisions to be made, and you have a say in every. single. one of them. Are you going to receive Pitocin as well? If so, how much and how quickly? What about AROM? What about episiotomies? There are so many choices to be informed about. (Do read "Your Best Birth" if you haven't already! It breaks the whole cascade of interventions down masterfully and easily. Immensely readable.) Due to her experience and education, a doula can be vital in keeping abreast of your goals and preferences, and help you ask all the right questions. She helps you advocate for yourself.

As for whether a doula is desirable if you aren't necessarily going for a 100% natural birth, my honest opinion is absolutely. Even if you have a c-section, a doula can be a godsend in dealing with hospital personnel and procedures and protocols. Marfmom's experience is a good example of this. I actually have an upcoming post planned for my own blog on exactly this topic, as inspired by a Twitter conversation the other day: how doulas benefit cesarean birth experiences.

Anyway, I can understand why your husband feels so strongly that he wants to be the primary support - and he ultimately will be, either way! But others here have given good examples of situations where, for all their good intentions, their partners were unprepared for the reality of the hospital setting. No matter how much they read (and if he does do a lot of reading, that is AWESOME and all the better, I don't mean to discount that; some husbands can't even manage that) and how attentive they are in a childbirth ed class, many of them become deer in headlights when faced with the White Coat of Authority suggesting something you both know you don't really want. At those moments, mothers sometimes lose their former allies to fear, and suddenly the man who had been their rock and their solace is now saying "Well, honey, maybe we should just do _____ after all; he IS the doctor . . ."

I'm not saying this WILL be the case with your husband - he really does sound like a peach. But some of the other husbands caught off-guard were wonderful guys, too - it's just a completely foreign experience for them, navigating the thorny maze of hospital protocol.

And this is where doulas are trained and experienced and prepared. It's not just about knowing back massage techniques, offering sips of Recharge, repeating affirmations with you, helping you walk around, bounce on the birth ball or relax in the tub, though those are all useful too. It's about helping both of you make your way through this sterile, high-tech, foreign land.

That brings me to the other point I wanted to mention. You are becoming a mother that day, and that, along with bringing this new being into existence, is the main attraction, of course. But your husband will also undergo a transformation that day. He is becoming a father. As much as he intends to be there for you, he is, by definition, also having his own experience of birth. This is a good thing! And he can still support you, and can still make attending to your needs at the top of his priority list. But the fact remains that a doula is the only person who is 100% there only for you and your support. This takes some of the pressure off your husband. Space has now been created for him to both share this experience with you AND have his own experience of transformation. He will still be your rock and your solace - and he can now breathe a little easier, knowing that someone is there to help you both advocate for your needs.

I hope that came across with compassion - it was meant to. It's truly hard for men to admit that they need help sometimes, especially when it's help in an area that they feel they SHOULD be responsible for. Often they insist on being the sole supporter simply because they think they should be, when in reality they might not feel comfortable once they're actually in the situation. When this is questioned, they can feel their authority threatened, even when they know, rationally, that this isn't really the case. I say let's give the guys a break!

As for the notion that doulas are for rich people, I wholeheartedly disagree that good care and support should only be reserved for the wealthy. This is why doulas have been fighting to be covered by insurance, and are finally starting to succeed, and why many doulas will work on a sliding scale, and why there are organizations providing doula support to low-income mothers in some areas (this is not available everywhere YET, obviously, but you'd better believe we're working on it). And even when none of the above apply, doulas in the certification process will work for free or close to it.

One final question: Labor can last a long time. Ask him how long can he go without using the bathroom. If for NO OTHER REASON than filling in for him so you won't be left abandoned when he needs to pee, you deserve to have this.

:^)

To wrap up: I second (or third, or whatever) the notion of interviewing a few to see who you mesh with, and I agree that it's a good idea to let them know of your husband's ambivalence in advance. If they're experienced doulas, they've addressed this before, I assure you.

And one last idea on cost: if you don't find someone who is in the process of certifying (which I am SURE you can, if you decide to go that route), you could also consider putting it on your registry, so to speak. I can think of no better shower gift, myself (unless it's a postpartum doula). There just might be someone in your life who would be happy to provide such a boon to you. Why not put it out there?

Cesarean recovery, with note on medication and breastfeeding

I just came across this extremely helpful blog post by Birth Activist - and mother who's been through it herself - and I had to share it here. I really like how she breaks it down for both in the hospital and after, and also acknowledges emotional recovery.

The entire post is a definite must-read and must-bookmark-for-future-reference, but here's an excerpt from the section on recuperating while in the hospital:

• Get as much help as you can from family members, your partner, nurses, and other hospital staff. That is what they are there for and during the hours, and days immediately after your surgery, you will need it even if you do not want it.
• Stay hydrated and eat. You may not want to eat, but working on eating a well balanced and healthy diet, as well as staying hydrated (stay away from sugary drinks such as fruit juice and soda) will help to make you start to feel semi human again.
• If private rooms are available opt for one so someone (family member or friend) can stay with you to help you during this time.
• Use a pillow between your legs, and/or on your side to help sleep to be more comfortable. In the days, and even weeks following your cesarean it will not be easy to get comfortable. This is completely normal. It took me almost a full 2 months to even get comfortable in my own bed at home after my second c-section.
• Take pain medication that is being offered if you are in pain. With my first child, I was breastfeeding and was overly concerned about any of the medications being transfused though my milk so I opted for over the counter pain medication such as motrin instead. But it certainly made my recovery longer, and made taking care of my son harder. (As ICAN recommends, ask your provider about a stool softener, as narcotic pain medication can cause constipation.) [See Dou-la-la's note below.]
  
• Get up and walk around. It may hurt like hell, but it will help to get you back on your feet sooner rather than later. The longer you wait, the more painful it will get up, and the harder it will be.
• The use of a pillow to protect your stomach while coughing, standing up, nursing or moving around in bed is a smart idea.
• Do not hesitate to ask for a lactation consultant in the hospital. Breastfeeding after a cesarean section is more difficult not just for mom because of her incision, but also for baby. Check out the ICAN white paper on Breastfeeding After a Cesarean.

I have something to add on the breastfeeding and medication issue: this is one area where MANY doctors, nurses and other practitioners are simply ignorant on the safety of many medications. This is especially true for cesarean recovery and for postpartum depression: women are given the choice between being in pain (physical for the former, emotional for the latter) and breastfeeding. This is patently unfair to both mom and baby. There's a fantastic post from Raising My Boychick on this - it's specifically about mental health, but the general principle is very much the same:

Perhaps you've been lucky enough to have missed this scenario, but I, at the intersection of those with lactating breasts and those with mental illness, have seen it far too often: a woman goes to her psychiatrist, generalist, family doctor, nurse practitioner, or psych nurse, for help with, oh, depression (postpartum or otherwise), or anxiety, or mood disorder, or sleep problem. Being a careful parent and a conscientious patient, she discloses that she is breastfeeding her child, so that she and her health care practitioner can find the healthiest, most appropriate medications for her (should they mutually decide medications are necessary).

This is when, in a sane society, her physician or nurse would nod, draw on hir vast knowledge of and experience with medications appropriate for breastfeeding, and say "No problem, that only rules out a very few classes of drugs, there are lots of things we can try still." Or, barring that, would reach for the copy of Hale's zie keeps handy in hir office, or would call one of the many breastfeeding-knowledgeable pharmacists zie keeps on file as references. The woman and the health care provider she employs would then work together to pick a medication most appropriate for her particular situation.

That is not what usually happens. Too often (ever would be too often), the physician, upon hearing said disclosure, automatically replies "I don't want to give you anything until you wean/terminate breastfeeding/stop doing that."

There is so much wrong with this situation, I hardly know where to start.

(Read on, it's well worth it.)

Many, MANY more medications are perfectly safe for breastfeeding moms than some physicians and other care providers are aware, and in the cases of some medications that are unsafe for breastfeeding moms, it is usually just a matter of substituting another medication that has equivalent benefits for mom, and no side effects for baby. Some doctors know the difference, but alas, some don't. This is where being your own advocate is vital!

THE bible for medication and lactation is the Thomas Hale guide. Owning the book is a great idea if you're a nut like me (plus it's fun to throw "lactational pharmacology" into casual conversation), but if not, do check out his website and bookmark it for future reference.

Tangent aside - thanks again, Birth Activist!

Do They Know It's Christmas?

Again with the off-topic, but I had to share. Few things can sum up one of the most authentic expressions of the meaning of Christmas AND celebrate fabulous New Wavey Britpop nostalgia in one fell swoop. I can usually hold it together until the line "Well, tonight thank God it's them instead of you," and then it's all over. (Does Bono not look like he's about twelve here?)

This whole song chokes me up and give me a big happy at the same time, and I feel both ancient and instantly right back in junior high. I hope it brings you a smile and a sniffle as well.

Back to birth and babies and boobs tomorrow: for today, Merry Christmas everyone.

Perineal Massage Helpful? Tain't Necessarily So.

[Title edited as per comments.]

I recently received this question from reader Cathy in a comment:

I recently discovered your blog and love it. Can you do a short post on perineum massage if you have the time or direct me to a resource you particularly like? I tried it, but I feel too tight, it hurts, it burns, and I'm afraid I'm going to bust my cervix, haha. I've read over and over "how-to", but I'm a visual learner, and I can't find a video or even illustrations of the technique. I used my thumbs up to the first knuckle, so I don't think I'm doing it completely wrong. I used avocado oil (okay) and Easiotomy Cream (not nice - seemed to burn more.) I guess "For External Use Only" doesn't just mean "Don't put this stuff on toast." Thanks in advance.

FIRST AND FOREMOST: "Easiotomy" cream has to be either the greatest or most horrible product name I have ever heard. HA! When I shared this on Twitter (I mean, how could I resist?), @Crunchynurse had the best response: "Maybe they should call it 'Easy Outta Me' cream." Rimshot!

But seriously, folks. This is a topic well worth addressing, as you're liable to hear different things from different people on the matter. Your timing is excellent, as I recently came across a very interesting post from Peaceful Parenting about it. I did some more poking around on the matter (on the internet, people - get your minds out of the gutter) and found some other resources as well. But before we get to it, I do have a few questions: Is this your first baby? If not, did you have an episiotomy with a previous birth? Was perineal massage recommended by your care provider? If so, what was their reasoning for it? Also, what are your overall plans for birth?

I ask because my initial reaction is summed up well by Gloria LeMay in her "Guide to an Intact Perineum", in which the only thing she has to say about perineal massage is: "Folklore abounds about doing perineal massage prenatally. No other species of mammal does this. Advising a woman to do perineal massage in pregnancy implies a lack of confidence that her tissues have been designed perfectly to give birth to her infant." And I quite agree, from everything I have read so far. A woman who is well-supported in healthy birth practices, i.e. who is able to move freely during her labor, is not numbed and immobilized, and who is able to push in a physiologically sensible position, has already reduced her risk of tearing. Being in a lithotomy position not only closes off the pelvis, making it more difficult for the baby to rotate normally, it also puts all of the pressure right ON the perineum.

Equally important if not more so is whether the woman is able to follow her OWN urges to push (or to not actively push, as the case may be - the uterus can do the work all on its own for many) and can take her time. In many hospital settings, as soon as the mother is complete (dilated to 10 centimeters), the staff often seems to go into pit crew at NASCAR mode, 'breaking' the bed to put the mom's legs up, insisting that the mother start bearing down immediately, shouting at her to pushpushPUUUUSH (this would have been intolerable for me, just on a personal note), even counting to ten, telling her to hold her breath - all adding up to directed, valsalva or 'purple' pushing, which has been shown to lead to pelvic floor problems for the mother on top of being problematic for the baby to boot.

In case it isn't clear, I feel pretty strongly that the most important factors in avoiding tearing and episiotomy are, first, an environment that supports healthy birth practices, as summarized briefly above, and, second, a care provider whose standards of practice don't include routine or frequent episiotomy. This is really the bottom line. Jill of Unnecesarean fame responded to my aforementioned tweet about the Easiotomy cream, first quoting the product's ad copy: "'A well-prepared mother can greatly reduce the need for an episiotomy'... Cream won't save u from one if your doc does 90% epis."

Ay, there's the rub.

. . . I do apologize. That was totally uncalled for. So without further ado, here's that post by Peaceful Parenting on perineal massage, noting that it is prefaced by many of the same caveats I've shared as well, including LeMay's statement. Some highlights:

It may just be that the best advice for keeping your perineum intact is not to spend hours upon hours massaging prenatally and supporting during birth - but rather to let labor and birth unfold naturally, normally, in its own time, with PATIENCE and a mother's bodily instincts (of how to move and position and when to push) as the guide. Maybe the reason no other mammal tears (or needs to be cut) during birth is not because their perineum is so different - but because birth is treated differently.

However, the "how-to" question of perineal massage is one that I've been presented with frequently. So, for those who feel like this is right for them and something they wish to embark upon, I'd like to highlight some answers here. I don't believe that getting to know our bodies - how they work, how they feel, etc., ever does us any harm. If perineal massage serves no other purpose than to allow you to know what it feels like to have your perineum stretched, gives you an opportunity to feel the tinglings sensations that come with it, so that it is not 'surprising' (and thereby fear-creating) on your birthing day, then it will serve a good purpose.

This last part is echoed in a post by Barefoot Birth on perineal support, saying that "Gentle perineal massage during the last weeks of pregnancy could help a first time mom get acquainted with different sensations in the perineum." Peaceful Parenting then goes on to give what seems like a good protocol for gentle perineal massage, focusing more on exploring rather than stretching. In step 11, I note that they mention hot compresses being applied during labor, along with providing perineal counterpressure/support - to me, this also seems much more important than trying to stretch the tissue artificially in advance.

Readers, especially birth professionals, I'm very interested in your thoughts and experiences on this. On (another) personal note, when I asked my own midwives about this, they felt that massage prior to labor was not only not necessary, but could actually weaken or damage the tissue, especially if done too roughly. I'm interested in studies and experiences that speak to that concern as well. Please share!

I hope this gives you some food for thought, Cathy! I encourage you to read the entire post from Peaceful Parenting - it's wonderfully thorough, even including an excerpt from William and Martha Sears on the same subject. I'm also curious to hear your answers to the questions I posited early on, so I can get a better idea of where you're coming from. I'm hoping you'll keep me posted on your pregnancy in general. And if you have any leftover Easiotomy cream once the babe arrives, I'll gladly take it off your hands, for placement in my future museum of fascinating birth- and baby-related products!

*****

By the way, I like the concept of "doing requests". Though I have enough drafts and outlines on other birth and birth-related topics to last me a good long time, I'm happy to get ideas from readers, too. Would you like to get some info, with my thoughts, on a particular topic? Feel free to send it my way!

Wordless Wednesday: Our Lady of Lactivism

Please consider a donation for this mom. (WARNING: Very upsetting story of loss.)

I was planning a post on perineal massage for today. This is quite the change of topic, and outside the normal subject matter of this blog, but it's just such an extremely heartbreaking story that I thought it was worth doing whatever I could to bring attention to it.

I just read about this terrible tragedy and am utterly heartbroken: a 27 year old mother just lost her 8 month old baby, 4 year old son, and husband in one fell swoop - a house fire. The week before Christmas. Not that there is ever, EVER a good time for the most devastating loss I could ever even imagine, but that just seems like an extra bit of cruelty. I honestly don't know how I could go on living after such a thing, I really, truly don't.

Please, consider sending a donation her way. And if you have a blog, and/or are on Facebook and/or Twitter, please help spread the word. A mention from you could bring in desperately needed donations for this poor woman (and her stepdaughter as well, who lost her dad and half-siblings). If you belong to a church, synagogue, mosque, or any other organization that gives charitably, this could help, too.

Thanks for reading this. On top of anything else you might be moved to do after reading this, please take a moment to hug your children and loved ones extra-tight, and give thanks for them.

Anne

Another news story on the tragedy.

Weekend Movie: The most famous UC of all

Okay, so, not terribly realistic. Though I suppose it's possible Jesus was born without an umbilical cord . . . It's still better than "Maternity Ward".

I must say, I like the depiction of the star.

More or Less Wordless Wednesday: O hai Santa.

Calling Santa


Texting Santa

We're getting an early start on holiday travel this year, so posting may be sparse over the next few weeks. Hope everyone is enjoying the season, no matter how you celebrate!

The Third Day

The other day I shared the news about the home birth of friend/distant relative. Today, another online friend (an online one from afar) is having a tough first week postpartum, and it reminded me of my own beginnings. There was so much that was wonderful - and so much that was not just grueling, but frankly, terrifying. For many moms, the Third Day is the day of reckoning. Hormonally, you're undergoing the biggest changes you will ever undergo in your life apart from puberty and menopause, and both of those take place over the course of years, not days or even just hours. Going from being pregnant to not being pregnant, and then from not-lactating to lactating . . . And then there's the sleep deprivation, and the overwhelming reality of one's responsibility as a mom hits you - well, sometimes it's just not very pretty. If you're reading this, you've probably been there.

Here's my crash course boot camp story, in a nutshell:

Day 3 into 4 was the time of staring into the abyss for me. OH, but I was an absolute wreck. I had only slept a few scattered hours total since the birth, my hemorrhoids were terribly inflamed, making it impossible to get comfortable in any position, but especially sitting, my milk had just come in and I was hugely engorged with what felt like rocks in my boobs and ARMPITS and had no idea whether it was normal, I was freaking out about Lily's umbilical cord getting funky, and worst of all it was becoming clear that she was having trouble latching, though I had no idea just how epic this would turn out to be (but that is entirely another story).



I felt completely buried by my endless task list. In addition to just caring for a brand-new precious baby, I had to make sure to 1. learn to use the breast pump, 2. take both of our temperatures regularly, 3. make sure I was getting enough fluids, 4. do fundal massage to help my uterus keep contracting down, 5. keep replenishing my witch hazel and comfrey pads in the freezer to soothe my bottom, 6. do lots of skin-to-skin contact with her, 7. swaddle her, 8. feel confused about which of the former two I should be doing at any given moment, 9. put her in the sun periodically to help with her mild jaundice (and at one point I was CONVINCED I had done so for a few minutes too long and given my newborn a sunburn and was despondent), 10. figure out how to use my Maya Wrap, when thanks to the extremely confusing DVD I couldn't even get it threaded . . . And all of this was on top of nursing difficulties. Yeah, I was a little overwhelmed.


I remember sitting at the computer at 6 am with cabbage leaves stuffed into my bra, tears rolling down my face, posting a pitiful thread on Mothering.com's forums asking for help. I had never felt so pathetic. I remember sobbing hysterically - and I do mean hysterically - when Lily wet her diaper while lying on a heating pad - it leaked (I hadn't gotten the hang of using the waterproof covers yet) and I was suddenly convinced that she could have been electrocuted and it was all my fault. I remember on day 4, having not ventured out of the house since I was in labor, Aaron convincing me to take a walk during a time when Lily was asleep. I wasn't up for a long walk, but he begged me to please, at least get some air, just for 5 minutes. Clearly he could see that I was becoming seriously unhinged. So I agreed to walk to the mailbox. I ambled out the front door, dazed, and then realized I had walked out there with my shirt COMPLETELY unbuttoned and hanging open, in the state I'd been walking around the house in. Thank goodness no neighbors were around to see, and it did give me the first laugh I'd had.

I never saw why a postpartum doula would be such a big help before I had that day, and then I totally got it.

(Note the breast pump tubing.)

Can you relate? Share your own Days of Reckoning?

O Happy News!

Remember the pregnant mama-to-be whose concerns I responded to in Letters to a Young Homebirther? Well, I'm happy to announce that her daughter was born at home in the wee hours this Sunday morning.

If she would like to share her birth story here, it could be my first guest post!

CONGRATULATIONS MAMA!

Weekend Movie: Nursing in Public . . .

. . . Restrooms?

Continuing the thread from the other day's post, here are some great commercials promoting breastfeeding - wherever baby needs to nurse. First from Canada:



And in a similar vein from Australia:



There are even more in this post from Peaceful Parenting. Enjoy!

When Lactivists Attack!

No, not a new reality offering from Fox. I'm speaking of the phenomenon on Twitter that has been happening on a regular basis since the #bfing hashtag entered the Tweetgeist, wherein someone makes a snide remark about breastfeeding, usually regarding nursing in public or duration of nursing beyond whatever age they feel personally feel is acceptable, and the RTs with #breastfeeding, #bfing and #lactivism start a-flying*. The original Tweeter is then inundated with responses from breastfeeding advocates worldwide, and almost invariably gets more and more defensive by the @reply.

I've joined in too, when my timing is right, and have witnessed even more. Most of the instigating remarks, I'm sad to say, I've kind of gotten used to - I mean, spend even a few months online reading about the topic in various internet forums, and you're bound to encounter tired old tropes like the typically ignorant "If he can ask for it, he's too old to nurse," and the mockery of all things logical that is "I know it's natural and all, but so is poo - do it in privacy of the bathroom." But I truly heard a new one just a few days ago.

Are you sitting down? Well, I guess you probably are, seeing as how this is on a computer screen. Are you currently in the process of consuming a beverage? Finish swallowing, put the drink down. Okay, then, read on**:

AlanArbelaez: Theres a woman #bfng out in the open, tits exposed. Wtf is wrong w/her? It's like a man feeding his baby w/his penis.

It's like a man feeding his baby - with his penis. I'll give you a moment to process that.

Yes, this really was taken from him verbatim. What's amazing is that only a handful of lactivist Tweeps descended upon him - and did a fine job, might I add, most notably MommyNews, LactatingGirl and Morgaine_LaFay. Kudos, ladies. In terms of sheer numbers, he got off easy, relative to the statement he made. But I was truly astonished that he didn't backtrack whatsoever. Subsequent Tweets of his included these gems, roughly in order of the 'conversation':

@MommyNews you wouldn't want to see a mans penis out in the open like that right? Well why is it ok for her to have her tits out?

@MommyNews If a woman wants to breastfeed in public, do everyone a moral and ethical favor and COVER UP!

@Morgaine_LaFay It's not about looking or not looking. It's the fact that you are showing your breast in public that offends people.

@MommyNews no, what offends me is the pure lack of common sense and her audacity to breastfeed in public without covering herself.

@LactatingGirl I don't want to. Milk bottles exist! use one and you can avoid annoying your kid and the public.

@LactatingGirl I kno that, but as a collective opinion, people find exposed breasts in public, offensive. Surely you can't disagree on that!

RT this. I will stop being offended when i can look at woman breastfeeding and she won't look back at me with a mad/weird look on her face.

Finally, he retweeted one of his own, a friend chiming in to support his views:

RT @phyliciax3 @Alan Arbelaez I saw a lady doing that last month, couldnt believe it! lol; people act like its normal, cover urself @ least!!

I came in after the fact by about an hour, so couldn't do much more than RT the "feeding a baby with his dick" quip, to which he later responded, saying:

Alan Arbelaez @Dou_la_la That actually sounds hilarious! but no, you are twisting my words. check the convo @MommyNews and i had before you RT stuff.

Which I had, of course (see above), and I informed him that directly quoting someone cannot possibly be "twisting" their words. It's not even remotely taken out of context, either. So goes another day of great rhetoric on the internet. Are we as a (very loosely defined) community overreacting to things like this? Why get worked up about one isolated Tweet, or even one Tweeter? He's just a 19 year old kid, after all.

Why? Because underlying his outward projection of pseudo-chasteness is the perversion of the primary, if not entire, biological raison d'etre for breasts, period. If that sounds intolerably prudish, bear with me (I've got nothing against a little healthy perversion in the right situation). The original purpose of breasts is actually not to provide visual stimulation for men or accessories to their arousal, not that you'd guess it if you were an alien to this planet leafing through pretty much any magazine or channel surfing on even basic cable. Breasts have become sexualized - fetishized, I daresay - by our culture. Hence, our 19 year old's joke about feeding a child with his penis really does reveal EXACTLY what he thinks about breasts: they are sexual organs, and hey, his penis is a sexual organ, so in his mind, why would feeding a baby with his penis be any different? Many a true word is Tweeted in jest.

The above is not to say that I don't relate to the aesthetic appeal of the human body, including the female form - I most certainly do. Do I buy into it to a degree, even if mostly unconsciously? Like an animal lover reconciling their dietary compromises with their idealism, I have to admit that I do. I own cleavage-revealing clothing and bust-enhancing bras, and have been known to, let's say, exploit my own figure from time to time. And it's also not to say that a woman's own experience of her breasts as an erogenous zone is not legitimate - believe me, I most definitely understand that too. But this is all about context, and about reducing the damage, just as it is with the analogy of our food choices, and starting to change the entire framework. I am certainly not saying it has to be one way or the other - breasts are EITHER for aesthetic and sexual pleasure OR for feeding babies only. I don't believe this has to be mutually exclusive. But I do think that choosing the former over the latter is both destructive and completely irrational.

Getting more fundamental, why else is changing this perception important? Because every negative remark to the effect that a mother had the "audacity" to nurse her child - i.e. feed her child according to the biological norm - within view of another adult is a remark that shames, and that shame may contribute to another woman deciding to cut her breastfeeding relationship short, or to never start one at all. It may cause her to feel guilty and uncomfortable and defensive about nursing throughout her baby's time at the breast, to the detriment not only of her baby but of herself as well. And our already low breastfeeding rates are nothing less than a national health crisis.


*Twitter terminology: RT is a retweet, as in reposting someone else's statement. And putting # in front of a word is called a hashtag, which makes that tweet searchable & thus spreads it to a wider audience of people looking for tweets on that topic.

**If you're unfamiliar with Twitter, the posts with @ plus a name right afterward are Tweets from this guy replying TO the person named, i.e. if it started with @Dou_la_la, it would be addressed to me.

EDIT: I originally withheld the name of the Tweeter in question, but it was recommended that I go ahead and name names, since it's all public domain by definition anyway. I gave it some thought and decided to go ahead. Congrats, young master Arbelaez!

Shameless repost: Race, Class, and the Pregnant /Nursing Mom

Well. Ahem. Sooo . . . if you're plugged into the same birth-blog-o-sphere I am, you know that the neighborhood has been all abuzz on race issues. She Who Shall Not Be Named Or Even Linked has been fomenting much of it (and needless to say, both derailing and monopolizing the comment threads, which is admitttedly her greatest talent), and sadly, a major casualty has been that two of my favorite bloggers, who each have tremendous things to offer the birth advocate community, went at each other's throats. (They're both in my blogroll, and they're both there to stay - you know who you are and I remain a fan of you both, like it or not, SO THERE.)

I've been following all the threads with great interest, finding some great new perspectives, but haven't added much of my own, as inevitably my points have been precipitated by another by the time I get a chance to weigh in. BUT, I will say that I feel class is at least as relevant as race (intertwined as it so often is), and I had some thoughts on the matter a while back - I thought I might as well go ahead and repost them, by way of officially entering the conversation.

As someone who is entering the field of birth and breastfeeding, however gradually, I aspire to make sure I am always being sensitive to these issues and making whatever small contribution I can to bridging the divides. So, here are my months-old brief thoughts on race and class issues, using breastfeeding as a particular and similarly affected matter.

*****

Very important short film: How Racism Impacts Pregnancy Outcomes



I recently had a brief but thought-provoking conversation with one of my best friends, who works as a manager of a clinic that serves homeless people (quite an amazing, admirable place, by the way). We weren't taking about her work specifically, just chatting about parenting, as moms tend to, and the topic of nursing came up, as it tends to, and turned to my particular unusually challenging experience. I mentioned how helpful chiropractic care and craniosacral therapy had been to us, and while not discounting that kind of care (her clinic employs naturopaths as well as allopaths, so she certainly recognizes the importance of offering choices in care), she observed that it's impossible for her to see these kinds of circumstances without seeing the class issues that accompany them.

She does have a point, of course. I was able to seek out this care, at least in part, because of the resources that were available to me; due, again, at least in part to my class level, my education level, the type of community my peers are based in, and any number of other socioeconomic factors. We are by NO means rich, and frankly, we still have quite a bit of debt left from the whole ordeal, but still, we were able to some of the funds together, no matter how strapped it left us. Put an impoverished woman in my same position: would she be able to pay for a lactation consultant even once, let alone multiple visits? Would she have had information about what her options were? Would anything beyond visits to a pediatrician that are covered by Medicaid be considered frivolous by her family and other members of her peer group?

It's a complex issue, to say the least, and I thought of this conversation when I saw this brief video this week. Please check it out, and give some thought to how race and class might affect access to the care that has been important to you, and the services you believe are important for others. How can we help this to change?

All the Baby Mamas - Put a Sling on 'Em!

Let's all take a breather from the latest interweb skirmishes and enjoy this little piece of awesome:



Please help spread this gem far and wide!

Weekend Movie: BAM! ("Birth in 3 Minutes")

Once again, contemplating use of technology in training.



For me, the question is, how much does this script change when there's a real human being (or two) involved?

Whole Foods Parenting

I was browsing through the great Free Range Kids site the other day, after rewatching "Food, Inc." with some family members, and it occured to me that the metaphor could be carried even further. Don't many of my goals in parenting correlate pretty much exactly to my ideals in food? I want Lily to be free-range, as above, and also cage-free, as much as possible. I would like her to be largely grass-fed, and pray that I can keep her free of growth hormones, antibiotics, and preservatives. Cruelty-free should go without saying. Finally, I aspire to enjoy her locally and seasonally as much as I can manage.

Shouldn't I want as much for my kids as I do for my food sources?

Wordless Wednesday: Our Thanksgiving in DC

Love at first latch

Gloria Lemay just posted a great piece about the importance of skin-to-skin contact after birth, and how it relates to the First Nursing Session. We know it is important to establish nursing soon after birth, but HOW soon? Is it possible to push it too much? Let's assume mom and baby have not been separated, which is the central issue. Does the first latch have to be within the first 5-10 minutes, or is there a greater window of time to work with? An excerpt, quoting IBCLC Leslie Wolff:

I feel that skin to skin after birth for the first two hours is SO important -more important than making a big effort to get that baby to breastfeed.. MAINLY because I realize that it helps the dyad - mother and baby - to recover from the birth experience, is a Win-Win situation that requires no effort, there is nothing to “succeed” in - it is just a “being” situation that is beautiful for Mom and baby. And if the baby goes for the breast - great..and if not, or the breast is offered and the baby doesn’t GO FOR IT - that’s fine. . . I know that babies are “supposed to” “immediately” start breastfeeding beautifully - but I see so many mothers and babies that are SO content just lying there Skin to Skin, relaxing, bonding in their own special way. In the past, before I discovered the beauty of Skin to Skin, I remember many frustrated Moms and babies doing their best to breastfeed, because Mom and Dad both knew that was the best thing to do immediately after birth.

I was recently reading "Your Amazing Newborn", by the wonderful Dr. Marshall Klaus, and I was interested to read that he thought that pushing the baby to latch on as! soon! as! possible! after the birth was unnecessary, and even a little interventive. As I'm sure you know, he writes extensively about following the baby's unhindered, natural cues as much as possible within the first hour or so after birth, and goes on to explain the self-attachment behaviors at length.

I can completely see where the impulse comes from, though. Delaying breastfeeding for TOO long via separation of mom and baby is so often a huge problem, so I understand the emphasis on getting breastfeeding, and making this a major priority. But it makes much more sense to me, having read Klaus and now this, to allow mom and baby to take some time to just BE. The baby's just undergone the biggest transition there ever was or will be, after all! Let the kid take a moment to just adjust to breathing, for one thing, and simply being with mama. Like Leslie wrote, if nursing is part of that just-being, GREAT, and it really is the foundation of the mother-child relationship, after all - but if it's not immediate, let them find their own way within the first couple of hours, I feel. As long as mom and baby are not separated unnecessarily, are in a supportive and nurturing environment, and skin-to-skin is encouraged, it's bound to happen organically, so to speak.

(Click the photo for some great resources from a Baby-Friendly initiative in New Zealand.)

Weekend Movie: How Childbirth Works

YES, it's totally annoying that yet again, the assumption is that mom will be supine, but still, it's a handy little visualization, if not as high tech as this 3D one I posted before. Worth a watch!

Gratitude

Three generations in the kitchen. Lily & I wish you all a wonderful ritual sacrifice with pie. I'll be back to blogging when we return home next week!

Weekend Movie, the Sequel: Ignorance Meets Knowledge

For the second week in a row, I cannot resist a double feature. This video on "extended" breastfeeding kicks some serious ass.



I unclasp my nursing bra to thee, Tori Caswell, creator of this video.

Weekend Movie: Mastering the Maneuvers

Okay, you really have to be a die-hard junkie to appreciate these two videos, but I found them to be very educational. Two maneuvers are known to help with shoulder dystocia, the difficult situation in which the baby's head has emerged yet the shoulder remains caught behind mom's pubic bone. One technique is the Gaskin maneuver, where mom turns over onto her hands and knees, named for the midwife of midwives, Ina May Gaskin. The other is the McRoberts maneuver, where the mother is supine, and her legs are flexed all the way back - think knees to ears, opening the pelvis as much as is possible on one's back.

Here's a 3D animation of this - it's REALLY short, blink and you'll miss it, but it shows exactly how this action works on mom's pelvis and the baby's shoulder.



With that in mind, watch this longer, real-life situation.



It seems clear to me that the change of position is the key thing here; in the video above, mom had already been on hands and knees, so the Gaskin maneuver is, well, moot. So McRoberts was perfect. On the other hand, if mom was in anything like lithotomy, switching to hands and knees a la Ina May could really do the trick.

The threat of cephalopelvic disproportion and thus risk of shoulder dystocia is a common scare tactic used to frighten women into unnecesareans. Whichever maneuver ends up being the appropriate one, what I love about the second video here is how clearly it demonstrates that, with a skilled care provider who is armed with the knowledge of these options, shoulder dystocia, while something to take very seriously and address swiftly, CAN be coped with. The midwife worked efficiently and confidently, and there was no sense of panic or dire emergency. I can't help but wonder how this would have turned out in a hospital setting.

From continuous support to a continuum of support

The third Healthy Birth Blog Carnival is nigh, and, following the other great Carnivals on Lamaze's Healthy Birth Practices, this time Science and Sensibility is calling for entries on the third practice: Bring a loved one, friend, or doula for continuous support.

Seems like a no-brainer for me to weigh in on, no? Well, you see, I am but a young padawan doula. Number of births I have attended in person thus far: one (mine). Much as I aspire to not only start attending births as a doula but eventually train as a midwife, I'm still very much inexperienced in the real birth world despite my book and web-learnin' on the matter. I am sure this Blog Carnival will offer up scores of excellent posts by birth veterans, detailing the benefits of that incredibly important continuous support during labor, as well as birth stories in which that labor support person (whether a pro or a family member or otherwise) plays a vital role in healthy, satisfying birth experiences, and I look forward to reading them.

But here's something that's been on my mind as a newbie doula (which I recently realized makes me a 'doubie'): I'm starting to feel that even within the midwifery model of care, the amount of support a woman gets drops off dramatically after the first few days postpartum. Forgive me if I'm playing Captain Obvious here, but I'm currently witnessing the impact of this firsthand, as well as starting to see this pattern in the birth, breastfeeding, and postpartum depression stories I read so voraciously, both in print and online.

Nowhere is this more apparent than in births that have taken place in hospital settings, of course. Let's take the matter of nursing for just one example of the value of postpartum support. A woman heads home after a birth which may or may not have gone smoothly, where she may have received terrible breastfeeding advice, where she may have been separated from her baby, where her baby may have been given formula from a bottle with or without her consent or even knowledge. She may have even been given a "gift bag" containing you-know-what. Think about this mother headed out of the hospital has been really been set up. She may already be on a downward spiral.

Let's say, though, for argument's sake, none of the negatives in the hospital scenario above have happened. Let's say that in every instance, she experienced the best case scenario: no artificial nipples, no separation, a good birth, and so on. The environment at home can vary WILDLY in terms of what kind of support she has, in terms of both quantity and quality. The father most likely only has a few weeks of paternity leave, if that. She may have extended family living nearby, but this is becoming rarer and rarer in contemporary society, so she might have her own parents or in-laws coming to visit and help out for a while. She may or may not have friends in the area who can help out here and there; sometimes a meal rotation has been set up for the first week or two.

Within whatever existing support system she does have, there may be experienced, knowledgeable breastfeeders - and there may not be. If many of the less desirable variables are present, any difficulty she experiences can be exacerbated. So many nursing relationships can be sabotaged by well-meaning but ignorant advice. If the mother had hired a birth doula, a few postpartum visits are typically included, which is a help, but is it enough to make up for regular, quality help from the rest of the mother's support system?

Even if we take the hospital out of the picture, continuity of postpartum care can be lacking. She might have even had a home birth. Midwifery care does provide for MORE postpartum care than a hospital birth provides, typically scheduling a visit for the day after, then the third day (often a day of reckoning), then a week later. It's definitely an improvement, but I feel that a lack of regular support at home, and lack of accessible and timely lactation support, can still be devastating. Midwives who attend home births (primarily CPMs but also some CNMs) may or may not be skilled in lactation support. I think it's fair to say that most know the basics, and the type of sabotage that sometimes occurs in hospital settings is highly unlikely, but when serious issues come up, the variation in skill becomes much more crucial.

When more lactation help is needed, then, outside help needs to be called for, creating a new set of variables in terms of skill and accessibility, as not all lactation consultants are created equal, and the best ones may not be in the area, or may be out of a price range. Days or even weeks can go by before help arrives, time during which the breastfeeding relationship can be damaged in a number of ways.

I don't know if there are existing studies comparing the connection between breastfeeding success rates and better postpartum support, but from what I understand, many developed countries which have universal health care also provide for home health care visits for all new mothers. Here's one glance at different countries and their breastfeeding rates from the State of the World's Newborns Report 2001 via Kellymom:

Breastfeeding Rates Around the World

Country	% of mothers who start	% who continue 6 months or longer
Sweden	98	53
Norway	98	50
Poland	93	10
Canada	80	24
Netherlands	68	25
Britain	63	21
United States	57	20

Is it asking too much of midwives that they also be well-versed in breastfeeding support, and that they spend more time devoted to postpartum care? I don't mean to ask this as an accusing rhetorical question. It really may be too much, given the depth of their expertise in birth and the devotion it takes to acquire their skills, not to mention the considerable existing demands on their time - and if that's true, then we need to start thinking about finding ways to pass that baton to another support provider much more regularly and smoothly than we currently often do.

There is La Leche League, if you have an active chapter in your area with good leaders who will do phone consultations, which is not a guarantee, and honestly not a substitute for one-on-one help from a trained professional. Speaking of, then there are the lactation professionals, the gold standard of which is the IBCLC. Fantastic people, most of them are - if you have access, and even still, there is a break in the continuity of care, a disconnect, a stranger stepping in.

Another factor in postpartum support of the friends & family variety: it tends to peak within the first few weeks, which is when such support IS most needed (particularly in terms of breastfeeding), true, but many mothers find that they really could use help beyond that initial period. Suddenly, dad is back to work, family returns home, friends have gotten their fill of the novelty of the new baby, and the meal rotation comes to a close. Suddenly mom finds herself more alone than ever, which brings me to another area where postpartum support is vital: postpartum depression, or more accurately, the spectrum of postpartum mood disorders.

Isolation is a huge risk factor here, and feeling 'abandoned' once the baby is 3 or 4 weeks old can feel devastating to a mother. In my DONA postpartum training, listed within the services that a postpartum doula provides, right alongside education in newborn care, aid in mom's emotional and physical recovery, light housework, and breastfeeding support, is "companionship". Simple as that. This is not an insignificant or trivial thing. Having another adult around to relate to can really be a lifeline to a mom who is sleep-deprived and struggling, especially if that adult is trained in recognizing the symptoms of postpartum mood disorders.

You can see where I'm going with all this. My bias as a new and eager postpartum doula is showing, I know. But I think there's a case for shifting our view of the journey to motherhood. The moment of birth IS profound and amazing and deserves the most devoted support throughout that experience as possible - but can we start to see that this is just one part of the journey, climactic though it may be? Can we start to see it as more of a continuum? What would it be like if something resembling continuous support (though obviously not as intensive or constant as labor support) lasted throughout what has become widely recognized as the "fourth trimester"?

After the long buildup of pregnancy, and the transforming apex that is birth, with much societal (not to mention medical) attention paid to both, many women often get the relative equivalent of a handshake and a "good luck!" Women and babies deserve more. WE as a whole deserve more. I'm not sure what form this would take. I like the concept of reframing care as, perhaps, perinatal, rather than divided into prenatal, birth, and postpartum. I absolutely think postpartum doulas are one way of finding a solution, of course, but I don't mean to make this post one big sales pitch for them (especially, again, as a novice). I'm open to more solutions. Maybe the concept of Freestanding Maternity Centers, as Rixa of Stand and Deliver recently pointed mentioned recently. and as Dr. Stuart Fischbein has endorsed, could include more extensive postpartum support that flows out of existing relationships, and could thus move towards more of a continuum concept, to twist a phrase.

I've focused here on breastfeeding and to a lesser degree on postpartum mood disorders, but even if neither proves to be a problem, mothers still deserve to have much more support during their "babymoon" than they often get. These were just examples of postpartum needs - there are so many others, too. Adjusting to our brand-new identities as mothers is an world-shattering experience - hopefully mostly in the best possible ways, but in the event that challenges arise, I think mothers with newborns deserve to have the equivalent of counterpressure on their sacrums, cool cloths held on their foreheads, and strong, caring hands to hold when the going gets tough.

Vitamin D deficiency -a risk factor for c-sections?

I just yoinked this thought-provoking bit of news from Bellies and Babies: Vitamin D deficiency leads to a fourfold increase in cesarean births.

"Women with a vitamin D deficiency were almost 4 times more likely to have a cesarean than those with [normal] vitamin D levels," says senior study author Anne Merewood, an assistant pediatrics professor at Boston University School of Medicine. "Vitamin D is definitely involved in muscle strength…. contractions of the uterus [which is made of smooth muscle] may not be performing as well as they could be," making it difficult for the woman to help push the baby out herself.

I think it would be a huge mistake to not continue to evaluate labor protocols and policies that work against women, of course, but this may be another big part of the picture, and should be investigated much further. I also had a bit of a gut response to the concept as potentially being yet another mother-blaming strategy, but I do think the information is too important to dismiss.

From everything I have experienced and read, standard obstetric attention to nutrition tends to begin and end with a prescription for prenatal vitamins and perhaps a photocopy of some (possibly questionable) healthy eating guidelines. Folic acid and DHA have gotten more attention in recent years, which is a help, but clearly doesn't go far enough. Midwifery care often pays much more attention to nutrition (though still, one's mileage may vary), looking at each woman's diet in detail and talking about beneficial food sources of nutrients, not just supplements, th0ough there is certainly a place for them in most American diets.

Be sure to check out the full post at Bellies and Babies. She then talks more about the further ramifications of cesarean birth on the baby's health and future - all potentially connected to nutrition.

I'm reminded of a favorite quote from Hippocrates favored by my holistic lactation consultant: "Let food be thy medicine." What will it take for more people to start really taking nutrition seriously?

Formula-Fed America

Weekend at the Movies Part 2: I guess I'm having a double feature this weekend, but I couldn' t possibly wait to share this.




The info on the site is a little bit lacking, but hopefully there will be more soon, as it's very new. Could this be "The Business of Being Born" for breastfeeding? (Or perhaps a "Food, Inc." for babies?)

"Formula feeding is the longest lasting uncontrolled experiment lacking informed consent in the history of medicine." -- Dr. Frank Oski

UPDATE Monday 11/16: I emailed them, asking about release dates and screenings and such, and got this reply: "We are still in the process of filming and hope to wrap by early April, we are also still looking at different avenues for promotion and release, nothing is set in stone yet. Thank you for visiting our site! We will keep you updated!"

So, we'll have to wait a bit, but I am sure it'll be more than worth it. I'll pass along anything I hear, of course!