(Note to self, make sure I don't accidentally post this on my food blog . . . )
SECOND WARNING: This is going to be graphic.
I've been touting the potential benefits of placenta consumption, specifically in the form of encapsulation, which is by far the most palatable means of so doing for most, myself included. Check out the site Placenta Benefits for tons of information, including articles on its benefits (such as reducing bleeding and lochia, helping to prevent postpartum depression, and aiding abundant lactation), how to get one's placenta released from the hospital if you birthed there, collected scientific research and so on. I missed out on the chance to do this with my own placenta, sadly, but I'm currently working with a postpartum client who was not only game to give this a try, but also gave me permission to both write about and share photographs of the whole process. DID I MENTION THIS WAS GOING TO BE GRAPHIC?
P.S. This is going to be graphic!
Ready?
I was alerted to the happy birth of her second daughter within hours of the happy event, I hightailed it over to her house to pick up the goods as soon as possible, and set to work.
And here's the healthy specimen. I like my Culinary Institute of America logo on the cutting sheet there, don't you? Anyway, her midwives had already removed the umbilical cord and wrapped it up neatly, storing it in the refrigerator until I could get there to pick it up. (This was a home birth, so we didn't have to worry about obtaining it from the hospital.)
I donned gloves and got down to business. The process involves three major steps: steaming the placenta, then drying it either in a dehydrator or an oven on a very low setting, and then grinding it into a powder. First it was thoroughly rinsed, then cut into several pieces in order to fit manageably into the steamer.
I then steamed it with a sliced lemon and a few chunks of ginger, for both preservation and odor. The scent of this has been remarked upon; it's not unpleasant. One friend of mine found the scent disturbing specifically because she thought it actually smelled quite tasty; like, she kept thinking "Mmm, pot roast," and then remembering immediately what it actually was. Others have described it as rather gamey, like cooking elk or deer, if you have experience of that. I wonder if it might not be best described as the scent of offal cooking. Big game offal. With Asian flavor profiles, due to the citrus and ginger.
OKAY, if you're still with me, after steaming the placenta for 15 minutes on each side, I sliced it into smaller strips and placed it into my preheated low oven. There it remained overnight, and because it wasn't quite done yet in the morning and I had to depart for work, on the advice of my friend Justine (who you might remember from our placenta playdate), I cranked the oven up for just a few minutes and then turned it off altogether. Perfect.
And there it is! All that was left to do was grind it up. Lucky for me, I have a Vita-Mix blender, the Cadillac of blenders, but a good food processor would do the trick just fine. It pulverized it in about 10 seconds.
I then made the mistake of not letting the dust settle before opening. Clouds of placenta dust poofed out the top, and I couldn't help inhaling quite a bit, then having a huge coughing fit. Suddenly I knew exactly how Buffy feels when she dusts a vamp and accidentally gets a lungful.
That's all there is to it! I filled a few capsules just to get her started, but there's no need to do all of them at once, and I'm told they can actually get sticky if left too long. The rest went into a ziploc baggie along with some fenugreek and blessed thistle (not a huge amount of either), and I brought it right over to mama, who has been taking them regularly ever since!
I'm so grateful to her for allowing me to have this experience, as it's definitely something I want to be able to offer to all my clients in the future, and I'm also glad to have been able to share it with you! (If you made it to the end of this, you're officially a member of the birthgeek club. Check your inbox for the secret handshake and exclusive decoder ring.)
I'm still here, guys, I promise! It's been almost 2 weeks since my last post, I know. I happened to go away to a BlogHer Food conference and was caught up in first the preparation, then the event, then the aftermath. You know how these things go. I'll be back in the swing of it all soon.
But one thing I wanted to touch on briefly: I was literally on my way out of town as a pretty major scandal hit the birth & parenting blogosphere, regarding circumcision. I watched this unfold in various airports via my phone's limited internet capabilities. I did comment on both Facebook and on a few blogs where it was being discussed, but under the circumstances, didn't have anything I felt was cohesive enough for a full blog post of my own. (In brief, a baby whose health was already jeopardized by a heart condition was circumcised and subsequently died of heart failure which may or may not have been exacerbated by the blood loss which resulted from the circumcision. Some intactivists then took it upon themselves to brutally attack the family on their own blog, as well as other blogs, for making this decision. Don't try looking for the most vicious comments now, as they've been censored pretty much everywhere they appeared, but trust me - I saw them, and so did others, including the family. See the link above for more detail.)
Now it seems the furor has mostly dissipated, so I'm almost reluctant to bring it up again and risk stirring the pot. But it was a pretty remarkable situation, and I do want to address it here.
I write about topics that ARE somewhat controversial, but I have yet to really take an official stand on what I see as the three Big Ones: Vaccination, Unassisted Birth, and Circumcision. I'm still not going to get into the first two, but it will probably not surprise anyone to learn that I am generally opposed to circumcision. I tread quite lightly about it when it comes to friends and clients, particularly when there are religious convictions involved, but yes, this is my position.
But do I consider myself an "intactivist"? Until the episode of this past week, I would have said yes. Now, I'm not so sure. Is it a matter of semantics, to say that I'm anti-circumcision but not an intactivist? Probably. Is it also, then, unfair to lump all intactivists together, since it was the vocal, hateful FEW zealots that got all the attention and most hurt the grieving family, and not the majority of intactivists who would never be so disrespectful? Also quite probably. But I found the actions of some intactivists, however few, so utterly abhorrent that I'm reluctant to ever ally myself with such people ever again.
I may change my mind, but this is how I feel at the moment. VBACtivist, lactivist, even a snacktivist, but not an intactivist.
Along with breastfeeding support, giving tips on infant care, and light housecleaning, one of the most popular functions of a postpartum doula is, happily for me, meal preparation! I love this part of my job almost as much as holding sweet little bundles in order to give mama a break.
Relatives and friends like to bring over casserole-style dishes, which are highly practical as they can be frozen, stored efficiently, and are easily reheated - they can, however, be a bit on the heavy side. I have a few favorite recipes for new families, with an emphasis on nutrition and digestibility, but I recently tinkered around and figured out what might be the ultimate meal for a new mama. A midwife in Jennifer Block's book "Pushed: The Painful Truth About Childbirth and Modern Maternity Care" described the postpartum meal that she always prepares for her clients as being nourishing, quickly absorbed, high in iron and in fiber; it's typically based in greens and brown rice, then sweet potatoes, or any other favored vegetable. My version includes spinach (though you could use fresh kale or chard), brown rice and tomatoes. You could omit the tofu and use more cheese; I would just caution you to keep it minimal, as constipating foods can be especially difficult in the early postpartum days.
For the sweet potato component, I simply toss some sweet potato slices in olive oil, garlic powder, smoked paprika and a touch of salt, then bake them on a cookie sheet at the same time the spinach-tomato casserole goes in. Finally, I'm sharing a recipe that was NOT mine originally (though I tweaked it), some lactation cookies; shared once before on this blog, but hey - so worth sharing again. These treats include several galactagogues. Bring these three items over to any new mama - satisfaction guaranteed.
SPINACH, TOMATO, TOFU & BROWN RICE BAKE
2 cups brown rice (I prefer short grain) 1/2 teaspoon salt 1 10 ounce box frozen chopped spinach 3 tablespoons olive oil 1 medium onion, chopped 1 red bell pepper, chopped 4 cloves garlic, minced 14 ounces firm tofu, frozen, then defrosted and squeezed thoroughly dry 28 ounce can crushed tomatoes 1 tablespoon dried basil, or about 1/4 cup fresh, if you have it on hand 1 teaspoon dried oregano 1/2 cup Parmesan cheese or, for a vegan option, 1/4 cup nutritional yeast
SWEET POTATO ROUNDS
2-3 sweet potatoes, sliced about 1/4 inch thick 2 tablespoons olive oil 1 tablespoon garlic powder 2 teaspoons smoked paprika 1 teaspoon salt
Step one is easily done while you prepare the rest. Combine rice with 4 cups water and a dash of salt in a large pot and bring to a boil, then reduce to a low simmer, cover, and cook for 45-50 minutes. Remove from heat when done (try not to peek until at least 45 minutes have elapsed), fluff with a fork and set aside.
Preheat the oven to 375 and add the prepared sweet potato slices, if making, as soon as it comes to temperature. Set the timer for 20 minutes and start checking them then; you'll want them to get to golden brown on the bottom before you flip them (just once). We're going for overlap with the casserole, or they may be finished at the same time. Either way works.
As the rice cooks, do the rest of your prep, including defrosting the spinach if it hasn't been done yet, then removing the excess moisture by wringing it in a dishtowel or pressing it through a fine-mesh sieve. Ready? Okay, now we heat the olive oil over medium-high in a large saute pan, then add the onion. Saute for 3-4 minutes, until starting to soften, then add red pepper and cook another 4-5 minutes, then in goes the garlic for another minute or so. Add the defrosted, squeezed tofu - you'll want to crumble it right into the pan; the consistency will be a bit like ground meat. Saute it with the vegetables and oil for a few minutes. Add the crushed tomato, bring to a simmer and then let it cook for 5-10 minutes over low, stirring occasionally, until liquid has reduced a bit. Add spices, spinach, and about half the cheese, stir well.
Now spread the rice out in the bottom of a 9x12 glass or ceramic baking pan (sprayed with a touch of nonstick, just to be safe), then layer the spinach, tomato, tofu mixture over it. Sprinkle remaining Parmesan on top and bake for about 2o minutes (using which ever rack isn't occupied by the sweet potatoes, which at this point might need to be flipped to brown on the other side, then rotated to the other rack anyway).
When both are finished, get going on the cookies, if you haven't started already/eaten your way through the dough.
LACTATION COOKIES
1 cup butter (or palm shortening) 1 cup sugar 1 cup brown sugar 4 tablespoons water 2 tablespoons flaxseed meal 2 eggs or Ener-G egg replacer 1 teaspoon vanilla extract 2 cups all-purpose flour OR flour of your choice 1 teaspoon baking soda 1 teaspoon salt 1 tablespoon ground fenugreek 3 cups thick cut oats 1 cup chocolate chips 2 tablespoons brewer's yeast
Prepare a baking sheet with parchment paper or a silpat liner.
Mix the flaxseed meal into warm water with fork, set aside 3-5 minutes. Cream butter or palm shortening and sugar. Add eggs or prepared egg replacement. Stir flaxseed mix into butter/shortening mix and add vanilla, blend well.
Sift together all dry ingredients except oats and chocolate chips. Stir wet ingredients into dry, then stir in the oats and the chocolate chips. Drop by heaping spoonful onto on baking sheet and bake 8-12 minutes.
These are easy to healthify if you want to make them vegan and/or avoid white flour or refined sugar: just substitute a gluten-free or a whole grain flour, and use brown rice, pure maple syrup, or a substitute of your choice in place of the sugars. As denoted, palm shortening can replace the butter and Ener-G egg replacer for the eggs.
I'm dying to see this. (Movie night soon, o friend of mine who has a copy?)
This is particularly timely as one of the videos we watched in last weekend's doula training was "Once a Cesarean: Vaginal Birth After a Cesarean", in which a VBAC-seeking mama reached the end of her pregnancy with a persistent breech. Lucky for her, this was filmed about 20 years ago, when some American OBs still offered vaginal breech as an option - no longer the case today. (More to say on this film and the ensuing discussion, which will be saved for another post.)
Best training EVER. (Okay, it was my ONLY birth doula training so far, but I can't imagine a training being more awesome than this. This was our group, and I'm second from the right, perched on the birth ball.)
I'm fortunate to have now had the opportunity to "sample" three of the most significant doula & childbirth education organizations out there. My postpartum doula training was with the big guns, DONA International. I've been doing the distance learning program for childbirth education through CAPPA. And it's now been five days since I finished the toLabor (formerly ALACE) Birth Doula Workshop in Chicago.
I genuinely have enjoyed aspects of all three. DONA's postpartum training was thorough, enjoyable and efficient, run by wonderful veteran Susan Martenson. The CAPPA training is a little tricky to get a feel for since I'm doing the work independently, but based on the written materials included as well as the video portion of the distance learning (consisting of footage from an actual workshop), I think this is a very worthwhile program as well; quite challenging, as it should be, but well-structured. And I was lucky enough to convince The Feminist Breeder to be my study buddy as we worked through the manual and videos, Skyping once a week to talk about our progress and bounce stuff off each other. (Yo Gina, have you gotten to those essay questions yet? Ay caramba! Buzz me to vent when you do.)
But this has been the zenith of my experiences so far. First, it was the culmination of a process I began about a year ago, in fact, when I applied and was approved to sponsor this workshop in my own area; in exchange for coordinating, promoting and otherwise acting as local contact people for the training, sponsors are then able to take the workshop for free. I was thrilled and enthused, and set about doing everything I could to make this happen. Alas, after months and months, the deadline drew nigh and in this arid birth climate (more on that in a moment) we only had two - TWO - people signed up (there was a minimum of 12), and toLabor had to make the difficult decision to pull the plug. Fortunately for me, they were generous enough to invite me to attend a workshop in another area. As I have a few friends in the Chicago area and it was a reasonable drive away (well, moreso without a toddler, but such is life), I signed on with the Chicago group.
My arrival at the location of the workshop itself was like walking into an oasis from two years of wandering the desert. It was held at Mother Me, a collective space where doulas, childbirth educators and other birth professionals pool their resources to serve the needs of pregnant women - birth preparation classes, massages, prenatal yoga, and more; it all happens here. What really blew my mind? This isn't even the only place like it in the area. There were even other collectives like it IN THE SAME BUILDING. And this is just one area in Chicago proper. It's all over the place - travel a bit outside the metro area and you can also find places like Birthing Babes (which happens to be TFB's latest gig, but it's just one example).
You must understand where I'm coming from. In my area, there is ONE independent childbirth education teacher - a truly excellent teacher (I sat in on her class and had a ball), but still. One. The only other options are the hospital's own class or the 4 week series taught by a "crisis pregnancy center", where for ten dollars people can take the series and get (I am not making this up) a free car seat. What's truly amazing about that $10 plus a car seat series? They are having trouble filling their classes.
There is a small but dedicated local chapter of ICAN, comprised of fabulous women who I not only consider good friends, but care deeply about birth and do everything they can - but in this climate, where there are only a handful of active doulas and even those doulas are being challenged by some OB offices' policies, their battle is mighty indeed.
The local cesarean rate, you ask? 37.6% as of 2008.Some L&D insiders estimate that it has easily risen beyond that in the last two years. I'm sure that's just a coincidence.
So yeah. To walk into this space was a glimpse of paradise, of the way the world CAN BE. Everything being relative, I am positive that the local birth pros could tell me quite a bit about the challenges they face in their own area, and I don't mean to discount that. But seriously, Chi guys, take just a moment to appreciate the fact that your community exists and thrives to ANY degree, because it could be so much worse.
So back to the training! Where to even begin with how amazing this was?
There was plenty of material that one would consider standard and expected; a thorough breakdown of the stages of labor, a risk/benefit analysis of every standard current intervention, discussion and practice of positions and techniques used to support laboring women, and much conversation of the way to walk in the world as a doula, supporting women's choices with information yet without judgment. All well-organized, all as thorough as can be in an 18 hour training; the time constraints were my only criticism, but it's an unavoidable given in this setting.
There are some features that are unique to toLabor's training, however, features which are controversial, and I'm going to address them and share my own feelings about them.
Since its inception, toLabor has included two unique hands-on experiences in the workshop. The first is the palpation of actual pregnant bellies, provided by volunteer mothers-to-be on the second day of the workshop. We also used fetoscopes (not Dopplers) to listen for fetal heart tones. There were four women who graciously offered themselves, and we divided into four groups, each group getting to work with two of the mothers. It was amazing to really have a chance to take our time really sensing and feeling a baby in utero other than the quick, cautious feel of a friend's kicking action - typically the only experience we ever get outside our own bellies, if we're had them. We took turns locating each woman's fundus, at first gingerly and then with more confidence, then worked at identifying anatomical landmarks - not quite as formally as using strict Leopold's maneuvers, but as accurately as we could, with continuous feedback from the mother (and the occasional commentary from the baby, too) and help from our classmates.
The fetoscope was also a revelation, truly a shame that they are used less and less often. It IS much quieter than the blaring of a Doppler, true, but it is also so much clearer without the associated static (Rixa writes about this here), not to mention risk-free (exactly how much risk is associated with Doppler use is a matter of some debate, which I won't get into here). It looks like this, in case you haven't seen:
And you use it either like this:
Or like this:
Therese, our fantastic and intrepid instructor, explained that this was absolutely, positively NOT about learning to palpate pregnant abdomens in order to do so on our clients. She was crystal-clear about the limitations of our scope of practice all weekend long, on this and other matters. This was an experiential, well, experience, simple as that. She described it as learning to touch, and while I agree with this, I also saw it as an opportunity to get some practice communicating with and just plain being around pregnant women, period, getting more comfortable talking with them about their lives and bodies and babies. To an experienced birth pro, that probably sounds so basic as to defy a need for practice, but I would argue that some of us still have nerves about it, and want to make sure we're both confident and respectful.
The second experience is the one that triggers the most raised eyebrows, and understandably so. If you're a part of this birth pro community, you might have heard about it, and yes, it's true. In this workshop, under extremely careful guidance, we had the opportunity to give and receive a very brief vaginal exam. All volunteer, working as partners with one another - no one had to participate, and indeed, we did have a few women sit out (though I'm not even sure who did, as we were all just focused on what we were doing ourselves).
Let me make this clear as can be: This, like the palpation of the pregnant bellies, is a learning experience ONLY. This was not instruction on how to perform pelvic exams on our clients, EVER, and it could not have been made more clear that doing so was strictly prohibited (unless this is something that is already within one's professional scope of practice; if an RN were participating in the workshop in order to learn how to give better hands-on support - but even then, it couldn't be clearer that a vaginal exam would be done in his or her capacity as an RN, anyway, not as a doula). A pregnant pelvis would feel completely different anyway, as would a cervix that was in the process of dilating - the assessment of which is a different skill altogether.
Those participating paired up, donned sarongs and slipped off their underwear, grabbing gloves, chux pads and tissues. The women receiving first lay in a circle with their heads together, a configuration which preserved modesty completely. We had learned the sterile technique for donning gloves, and once they were in place, we sat with our dominant hand raised in a fist, awaiting a touch of lubricant from Therese. She then guided us through what was ultimately a very short exploration; not rushed, but not terribly lingering either, with lots of feedback from our recipients. We first felt for the cartilaginous tissue of the cervix itself, then upward for the pubic symphysis and on each side for the ischial spines, giving us a tactile understanding of what the pelvic outlet comprises. Finally we felt for the downward slope of the sacral curve, and we were done. (No speculums, by the way, just gloved fingers, straightforward verbal instruction, and respectful caution.) We efficiently switched off and repeated the process in opposite roles.
What was this about, for me? First and foremost, it was about context, about taking the discussion of the baby's journey out of descriptions, diagrams, vinyl models of the pelvis and even 3d animations, and just for a moment giving us live, real, conscious, flesh and blood experiences. It also (unexpectedly for me) demonstrated the subjective nature of what we're discussing. Sometimes I hear birth stories where there is a discrepancy about how dilated a mother is, or how a position was misread, and my initial reaction definitely included a bit of "What? How could they, the PROFESSIONALS, not get that right?" And it's so much clearer now. So increased understanding for the care provider's perspective was an added bonus.
A third and more nebulous purpose of this exercise has to do with our culture's vaginaphobia, as Therese aptly put it. Does participating in this solve the problem, does it instantly cure us? Probably not, but it sure goes a good way towards demystifying the area, which is certainly apropos for those of us who care enough about birth that we were in the room in the first place. Which leads into addressing the controversial-ness of this part of the workshop.
The controversy DID come up, though not at length or with any specificity. We were not given details of debates past or identities of accusing parties, but it is clear that there are those out there who disapprove of this part of the workshop. I'm willing to listen to anyone's thoughts on this, if they take issue. Everyone has a right to their opinion, and I'm certainly willing to concede that there may be a POV that I have not considered.
But if the argument is (as it does seem to have been in the past) that toLabor/ALACE, by including the palpation and the vaginal exams in their workshop, is tacitly approving of doulas performing either one as part of their professional service, I wholeheartedly, emphatically disagree. I would even go so far as to say that suggesting that the inclusion of these exercises might be interpreted as permission to do so professionally is a bit of an insult to the intelligence of the participants. Anyone making this argument is simply not listening to the explanation and detailed description of the exercises, and has certainly never taken part in the workshop, since as I stated previously, it could not have been made more clear that this was never, EVER to be done on clients. Some toLabor participants are interested in becoming midwives in the future (i.e. me), as toLabor definitely appeals to the midwifery-minded (being explicitly based in the midwives model of care) so perhaps there's some legitimate confusion out there.
Is there a chance that some doula out there could go rogue and start doing so anyway? Sure, it's possible. But that is an irresponsible act by an individual, and in no way reflects on the training organization. It's just as likely that a CAPPA doula would turn off a fetal monitor, or a DONA doula would take it upon herself to start removing IVs, or turn down the Pit, or even simply start answering for the family regarding their decisions. ALL of which are terribly irresponsible, ALL of which reflect poorly on us as a community, ALL of which are repudiated by the major organizations. None of which means that the rogue doula's training organization has approved of their individual ethical breaches.
Now, on the flip side, none of that is to say that if you haven't been through these exercises at a toLabor training, you therefore aren't a good enough doula or that an organization's training isn't adequate without them. Not at all. It's not for everyone! It's not even for everyone who attends the toLabor training itself - I mean it when I said there was no sense of judgment at all. But let's please recognize, as a larger community, that there is a place for a variety of experiences, just as there is a place for a variety of doulas, and for some, this is going to appeal greatly to their learning style and if it does (not that it has to), it will only serve to enrich their work and thus their service to women.
There, I feel better.
Suffice it to say, I can't recommend this training highly enough. I would happily do the whole weekend over again, and in fact, I just may get to in the spring, if I'm lucky enough to be selected as a sponsor when I move to my new location in Portland (from a desert to an oasis to the freaking rainforest). In closing, here's a bad camera phone shot of my own workshop, followed by some quality shots from the toLabor site itself.
And here's the healthy specimen. I like my Culinary Institute of America logo on the cutting sheet there, don't you? Anyway, her midwives had already removed the umbilical cord and wrapped it up neatly, storing it in the refrigerator until I could get there to pick it up. (This was a home birth, so we didn't have to worry about obtaining it from the hospital.)
I then steamed it with a sliced lemon and a few chunks of ginger, for both preservation and odor. The scent of this has been remarked upon; it's not unpleasant. One friend of mine found the scent disturbing specifically because she thought it actually smelled quite tasty; like, she kept thinking "Mmm, pot roast," and then remembering immediately what it actually was. Others have described it as rather gamey, like cooking elk or deer, if you have experience of that. I wonder if it might not be best described as the scent of offal cooking. Big game offal. With Asian flavor profiles, due to the citrus and ginger.
That's all there is to it! I filled a few capsules just to get her started, but there's no need to do all of them at once, and I'm told they can actually get sticky if left too long. The rest went into a ziploc baggie along with some fenugreek and blessed thistle (not a huge amount of either), and I brought it right over to mama, who has been taking them regularly ever since!
