Dou-la-la

Alfie On A Shelf: An Alternative to Creepy Elf Surveillance

2011-11-21T14:31:00.001-05:00

Y'all have probably seen Elf On A Shelf, the combination of book and ornament/decoration/toy that's become a big holiday hit - a phenomenon, even. The idea is that he's Santa's tiny spy, who monitors the children in every household, comes to life when no one is watching, and reports back to the North Pole with nightly reports on who's been naughty and who's been nice. It takes the deeply ingrained cultural idea of Santa Claus as bestower of karma and brings it to a whole new Orwellian level (not to mention the Chucky doll creep factor). And it's hugely popular.

Some parents are just fine with this, and might find it a useful tool*. It's totally not my style of being, though, and I know it squicks some other like-minded parents out, too. What to do? It's always fun to find new holiday traditions, and I see the appeal of introducing a new game every year - with the original Elf, you move him around each night and the kids try to find his new surveillance spot. I'm the type of person who likes things like leaving hoofprints and making Reindeer Crap cookies, so I totally get the fun of finding novel ways to engage in holiday hijinks. So I devised an alternative.

I hereby present Alfie On A Shelf, a friendly reminder to treat your child with unconditional love this holiday season, and try to avoid the temptation to depend on bribes as a means of controlling our kids' behavior, naughty and nice lists notwithstanding.

Anyone have an in with a manufacturer?

*Disclaimer: I totally understand that every child is different, and some parents may find it useful to introduce rewards in some situations. Even parents who hold unconditional parenting as an ideal do find it necessary at times. And using the concept of Santa to introduce the idea of karma or other values is legitimate, even if I disagree. It should go without saying, but I know these things can be sensitive among parents, and it's always worth acknowledgement.

Thanks to Rebekah Folsom for the Photoshopping!

Beyond Reckless

2011-10-17T22:40:00.007-04:00

I must express regrets that I'm too wrapped up in both studying for my Oregon massage therapy licensure exam and Boob School homework to address this properly in my own wordstuffs, but lucky for me, Barbara Herrera (Navelgazing Midwife) took the words right out of my brain.

I posted a link to this important post about the Lisa Barrett debacle by 10 Centimeters on my Facebook page. In the thread that ensued, a sarcastic comment to the effect of "I'm soooo glad you all know what's best and have decided to control every mother's birth" was posted. And Barb's reply, well, warranted me lifting it almost in its entirety, in the interest of me shouting it from the rooftops.

The reality is FOUR BABIES DIED in her care. That is not disputed by anyone. No verdict needs to be given by anyone. That is a FACT. FOUR. And TWO within a very short time. These are babies that DIED. Gone. Forever. That their mothers will never breastfeed, but will feel their breasts swell trying to sustain the babies that are gone. Buried. Or cremated.

Midwives do not lose babies like this without being beyond reckless. Taking the cases she's taken... and bragged about... is vile beyond anything anyone supporting homebirth could imagine.

Hollering about a women's rights in birth is one thing, but doesn't ANYONE have a responsibility to see that everyone comes out alive and healthy? Why HAVE a midwife if you want to do anything and everything? Midwives like Lisa make homebirth look like the stupidest thing a woman could ever want to do -and that simply is not so.

Homebirth NEEDS parameters in order to be safe. Every woman is NOT a candidate for a homebirth. And until the hollering masses like you lose babies yourselves at the hands of these horrid midwives, you're likely to continue being the sheeple you profess to not be. Instead of sheeple towards the medical way, you're sheeple thinking you can "Trust Birth" no matter what.

But, you'll be wrong. Just ask the moms of those babies that died because of Lisa Barrett.

Testify, Barb. Amen.

Tangled: Disney gets a little crunchy.

2011-10-05T01:37:00.007-04:00

Did you ever notice that in the Disney version of Rapunzel (I have a 3 year old kid; seeing it was inevitable, and actually somewhat enjoyable despite my grmph-ing), Rapunzel's mom has a birth complication that is treated botanically, saving both her and the baby princess? It's true. With a special flower that imparts the essence of the sun. Skip ahead to about :50 in the opening:

I wonder if she ate the royal placenta? Maybe that's in the DVD extras.

The KIT Project: Help make this a reality.

2011-08-23T22:29:00.005-04:00

I've mentioned Jennifer before, the lactation consultant who worked miracles with Lily and I. What makes her so wonderful is not just that her knowledge of breastfeeding is absolutely encyclopedic and second to none (which it is), but that she also sees beyond the symptoms, looking deeply and tirelessly into the underlying source of whatever dysfunction the dyad is expressing at the breast. It is truly holistic lactation support.

I do believe she represents the best future of lactation consultants, and should become even more of a leading voice in the community than she already is - and yet there is a whole other dimension to her life work, which includes educating parents on holistic health. Fortunately for us, she has developed a "Kit" which includes everything a parent needs to begin supporting their family's health naturally and, again, holistically.

Check out this great detailed post about the incredibly valuable content, and see what some of the parents who have benefited have to say, such as:

“…The kit has empowered me; I feel confident that I can care for my family’s health and well-being using this arsenal of knowledge Jen has given me. Before I had the kit, when my children were sick I would feel helpless to ease their symptoms and help their bodies heal, but now I have tools at my fingertips to help them to feel better and recover quickly. I highly recommend this kit, and I highly recommend Jennifer.” -- Kate Cordick-Burns Heiser, CT, USA

In order to launch this product for greater availability, some up-front investment needs to happen - but as with so many worthy projects, if everyone who encounters this gives just a little, we can make this a reality. And this NEEDS to become a reality. (I badly want this kit myself!)

So please click the IndieGoGo link above, check it out, and consider contributing! Make it so.

A suspicious new endorsement by singer Jewel, and a note from Anne re: life.

2011-08-16T14:37:00.013-04:00

Working out at the gym the other day, I was rocking out with my iPod and reading a trashy magazine. Hey, some people can read Pynchon and listen to Mahler, I need brain candy and synthpop. (I also choreograph song parodies as I'm trudging away. If anyone ever needs a breastfeeding promo set to Madonna, I'm your woman. Call me Madoula.) Anyway, I came across an Oscar Mayer ad, and though I'd normally flip right past it, something in the jumbled images caught my eye.

Apparently Jewel is now shilling for Oscar Mayer. But leaving aside how icky I think this processed crap is in the first place, something else really, REALLY bothered me. Can you guess what it is before scrolling down to see a close-up?

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.

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Okay, here's the zoom-in, also turned upside down:

That right there, in what we're apparently supposed to think is Stuff You Find In Jewel's Bag, is a copy of Babywise. No doubt about it. See?

I'm sure people following my blog are familiar with the most notoriously awful book on parenting ever there was, but just in case, you'll find all you need to know here.

So, was this an intentional endorsement? She just had her first baby a month ago (congratulations on your baby boy, sincerely), so it's possible that this was on purpose (not the Boudreaux's Buttpaste in there as well). Or was this purely a matter of "Hey, young photographer's assistant, run out and grab a bunch of mom stuff. I dunno, diaper cream, I guess, whatever. Jewel can't possibly care what it looks like she's promoting if she's doing an Oscar Mayer ad, anyway,"?

Anyone else bothered by this? I'm not, like, ready to torch her Texas ranch or anything, but some sort of explanation would be nice. If, in the end, only kindness matters, "Babywise" is philosophically about as far from that as you can get.

****

And now for something completely different:

It bums me out that I haven't had more time for blogging in recent months. I normally try to maintain SOME boundaries between the blog and my real life, which may seem odd given the intimacy of many of the experiences I've shared here. But I'm not a "mommy blogger" in the strictest sense, if there is strictness in such things - while I certainly have blurred the lines at times, my focus is not on chronicling my parenting experience; my shared experiences have all been mostly on-topic.

But, suffice it to say, low-income single parenthood is seriously kicking my ass. There are LOTS of good things in the works for Lily and I, lots to give us hope and the gumption to stick it out - but the day to day present is quite difficult most days. Alas, this means blogging here is something that falls by the wayside during more strenuous times, which, again, bums me out because it's something I find very satisfying. This is my internal soundtrack* many days:

Point being, I'm not going anywhere, and as ever, hope to be able to produce more frequently in coming weeks and months. Just forgive the sporadic-acity and check in on me once in a while.

*Moment of teh fun: I managed to get out for some grown-up fun last week, and entered a pub trivia contest that was ALL JOSS WHEDON! And our team, Big Damn Heroes, won by a landslide.

Once More With Feeling: Contemplating BBAC

2011-06-07T02:19:00.007-04:00

Welcome, Second Time Around Carnival of Breastfeeding readers!

Finger-feeding at about 6 weeks. Still at the beginning of a long, strange trip.

Could I do it all over again? Would I?

I do hope to have a second child someday. No, there are no current plans or even prospects, but I would love for Lily to have a sibling, I'd love to give birth again, and, honestly, I really would love to have the chance to have a normal, or at least a less abnormal, nursing experience.

When I got to act as a wet nurse a few times for a friend's baby, it choked me up the first time she latched on and chowed down happily - this was something I never got to experience with a newborn or even a young infant. By the time Lily and I made it, she was a roly-poly, active, distractable 5 month old on the verge of crawling - a very different creature than the little borrowed bundle I was guest-nourishing. Don't get me wrong, I was thrilled beyond belief that Lily was breastfeeding at all. It was just . . . different.

When we were in the midst of Lily's struggle, I found myself succumbing to moments of desperate jealousy of other moms with newborns or young babies who were able to nurse. My fantasies of motherhood had involved a lot of babywearing, strolling about with the baby nursing and sleeping in my ring sling at the grocery store, in cafes, on long walks. I envisioned making my way through my reading list while I nursed with my feet up in my glider with an ottoman. Tethered to the pump, I looked at those other moms through heartbroken, envious eyes.

Needless to say, I didn't get halcyon days of early motherhood. Please don't mistake this for bitterness - what I DID get was the learning experience of a lifetime, for which I have found my way to be grateful (the Anne of 2.5 years ago is telling me to piss off, but never mind that). It has led to what I feel is a true calling for me, a real vocation. It has given me insight and painful empathy for the mothers I will be serving, having experienced many of their woes firsthand. And it was a real triumph for both of us to be able to overcome everything that we did. I genuinely am not bitter.

Serenity at last.

But the question remains: could I do it again?

I would pray to be blessed with normalcy, but there is NO guarantee. I know much more now, to put it lightly. I would be prepared for any and all of the factors that affected us last time - tongue tie being the biggest, but the other components as well. What's the likelihood of facing some, most, or even ALL of these again with a second baby? Impossible to predict. Another tongue tie is certainly a strong possibility, as heredity is involved, but if we got it addressed immediately, our chances would be much better. Wouldn't they?

No guarantees. What if lightning strikes twice? Can I walk through the fire again? So many life factors come into play. Lily was a first baby. It would be so hard to repeat the process all over again with another child to care for, though as she gets older, she may be independent enough that having to take many of these measures could be more feasible than if she were still a young toddler. What would my financial situation be? What if I needed to return to work earlier than I did with Lily? How would that affect us? All of it daunting - yet not totally deterring.

I would imagine that it's something like a mom preparing for a VBAC after an unwanted cesarean, or looking at another birth after any difficult birth experience, period. Although I was blessed with a really wonderful birth, some aspects of our nursing experience were on the traumatic side, though it was a slow-motion trauma that occurred over months and months. What do VBAC-seekers do? They prepare with information, they seek out good care providers and other support, they evaluate their prior experience and look at factors that affected the outcome, considering whether these are likely to recur. And they work on the emotional healing as well - many times the preparation for the the next birth is a part of the healing process in itself. I'll dub myself as a mom seeking BBAC, then, perhaps: Breastfeeding Baby After Challenges (or Craziness).

So this time around, I'm armed with information, with resources, with experience, with support. I doubt I could be more prepared. Will this be enough? Only one way to find out.

Let's take it from the top.

*****

Please stop by the other Breastfeeding Carnival participants' posts and leave some comment love:

Ambular Logic: Breastfeeding the Second Time Around

Blacktating: Second Time's The Charm

Motherwear Breastfeeding Blog: Seven reasons why breastfeeding is usually easier the second time around

Reporter2Mother: Lessons Learned

Good Enough Mum: The Second Time Around

Three Girl Pile Up: Totally Different and Completely the Same

Treasured Belle: Tandem Nursing

Christine's Contemplations: Nursing Styles Between Siblings

TouchstoneZ: Once More With Feeling

Something of The Night About Them: Guest Post

2011-06-04T05:29:00.000-04:00

In the spirit of sharing that's going around lately, today it's MY turn to share a truly lovely, evocative piece by Mars Lord of Mammy Doula. A good read to reflect on for the weekend!

There's something of the night about them.

What is it that happens to some midwives after 8pm? These normally smiley, friendly, font of knowledge midwives seem to take on something of the night. The smiles are gone. The time to sit has vanished (yes I know it's a rare occurrence in the life of a day time midwife, but please… don't interrupt the atmosphere building). There's a need to make and keep everyone quiet.

It is hard to see the breastfeeding posters in the dark. The muted lights must have something to do with that. The breasts of the Mothers have mysteriously failed to function and time has become the enemy. There is much rushing about to be done. There is much keeping of order. It is as though the job spec has changed and the Mothers are to be ignored.

Perhaps the bells that call the midwives only work from 8.30am to 8.00pm. The only sounds heard are the ones demanded babies be taken out of the Mothers' beds and placed dressed and wrapped in plastic containers on wheels.

It now, in the dead of night that Mothers are most at risk. They are more prone to making decisions that they (possibly) regret the next day. That dark lady of the night comes wielding a bottle of 'elixir'. The magic substance that will make their babies sleep and restore quiet and calm to a night ward. Here is when a Mother might agree to testing for her baby. She's been strong in the day, because she knows that baby is fine and the doctor has told her it's borderline and there is no urgent need to act. But now, as the darkness surrounds her and she's groggy from sleep, someone talks to her to tell her how risky borderline is and so assents.

She has never been so tired. The labour was long, the golden hour when it was her, baby and partner slowly getting to know each other is almost a distant memory. Since then she has been hussled into a shower, her baby handled by any number of people. Her attempts at sleep thwarted by a baby that needs feeding, gazing at, kissing, holding and loving. It is hard to sleep when the only baby crying appears to be hers. Jiggling isn't working. No one has read the manual to her. Are her breasts producing enough milk? There's no way, she thinks, of telling. She is fearful of waking the other babies and starting the cacophony of a postnatal ward.

And as she finally succumbs to sleep in walks someone to check her blood pressure, check the baby, check the bins, call her to breakfast.

Being informed is the key here. The Mothers that we support as partners, parents, birth partners, Doulas, need to know that they have someone that they can call in the middle of the night. They should be aware that it is a different culture in the postnatal ward at night than the delivery suite in the day or even early evening. I often hear people talking about their birth experiences and an incredibly high percentage talk about the awful postnatal care, particularly at night.

To those wonderful angels of the night that come in with calming, soothing voices, and time to give to the new Mothers, despite the files falling from their arms. Thank you. You have been far more important than you know.

-- MammyDoula

Mars Lord
Mother of 5
Birth and Postnatal Doula
www.mammydoula.co.uk
www.doula-lly.blogspot.com

Guest Post on The Leaky Boob: Good Cop, Bad Cop

2011-06-01T11:58:00.004-04:00

Hey, check out the post I wrote for The Leaky Boob: "Good Cop, Bad Cop - On The Breastfeeding Police". A snip:

YES, I do think that women who feel they ‘can’t’ produce enough milk have often been sabotaged (i.e. booby-trapped) in ways they are unaware of. And one of the things that most often thwarts them is misinformation.
HOWEVER. Statements that imply that really, everyone can breastfeed and if they didn’t succeed, they just didn’t try hard enough, mind over matter? EVERY BIT as misinformed as the bad advice that might have led a mom to undermine her supply or her belief in her supply. I know it’s highly unorthodox for a breastfeeding advocate to call other breastfeeding advocates out when their intentions really were good, but I see so much poor advice online that it’s really starting to get to me.

And later:

This does NOT mean that there is not a place for peer support. There so absolutely is is – La Leche League turned the tide on breastfeeding half a century ago and its very foundation was peer support. But part of being a trustworthy resource is knowing when something is beyond your knowledge – even for professionals, certain things are beyond one’s scope of practice, and it is crucial to have the honesty and humility to know when to refer.

Please hop on over and take a look!

Weekend Movie: Formula for Disaster

2011-05-29T18:45:00.002-04:00

Have you seen this short but potent documentary on formula marketing in the Phillipines? It's available on YouTube in its entirety in 5 short segments. A great illustration of the coercive power of marketing, and why the WHO Code is so incredibly important.

The Parallel Paradox Part 4 - Placenta Previa Resolved

2011-05-24T02:12:00.001-04:00

And finally, the resolution.

We left off in part three (see parts one and two) with my 20 week visit with the CNMs, my sense of optimism bruised but not broken, relieved to have the biweekly cervical checks come to an end, especially now that they had to be performed by Steely Dan here:

I wouldn't be returning until week 28, for what I hoped was the final follow-up ultrasound, in which I would surely be given the green light for a vaginal birth, since the overwhelming odds were in my favor that, by the end of pregnancy, the placenta would have safely 'migrated' off the os by the minimum 2 centimeters necessary.

So, for the nest two months, my goal was to try to regain a sense of normalcy, if cautiously so. I would follow the recommendations against any exercise beyond the gentlest of yoga and abstaining from any and all sexual activity, but would also practice visualization, including my invented nightly ritual of focusing on positive images of unobstructed birth, while gently massaging my belly with upward-moving strokes (again, not a technique or treatment of any kind, just a form of meditation and positive thinking). I choked down my Floradix dutifully and started to enjoy my visits with my CPMs again. I even brought food on several occasions, and stayed for well over an hour PAST my appointment time. Can you imagine doing such a thing with your own care provider, if you've worked with someone other than a CPM? I laugh even now to think of what any of the CNMs would have done if I'd walked in with a picnic basket, or suggested we order a pizza and get to know each other a bit.

And overall, though I was still concerned, I generally worked on trying to relax about the whole thing, and focus on impending motherhood, which was, after all, the whole point.

Yet for all my fixation on positivity, I was still struggling with guilt over possible contributing factors to the previa. It can happen to anyone, but there are also risk factors that drive up the odds, such as smoking (which I no longer did, but had for 15 years) and prior uterine surgery, including D&C (guilty as charged). And I also often wondered if I was really just blowing the whole thing out of proportion. Some women who have cesareans have a hard time with it in many ways, yet others are really pretty much fine, given the added recovery time. Was I being insensitive to these moms, wringing my hands over the possibility?

[Also? I gained some weight. To say the least. Hey, I was forbidden my normal level of pretty vigorous exercise, plus I happened to be pregnant over the holidays. And I wasn't even allowed to have sex - of any kind. What else was I going to do but eat? I'm not endorsing this behavior, mind you, but in all honesty, this was my emotional response. And yes, I got pretty massive. I hope to be much more healthful if I get a second chance at pregnancy, because it's definitely not a great idea to gain 65 pounds to yield a 7 pound baby - I'm just being honest. Don't follow my example on this if you can help it.]

Fast-forward to 28 weeks. I show up to the CNM/OB practice after much-appreciated 2 month hiatus, this time with babydaddy in tow (prior to this, he had only attended the prenatals with our homebirth midwives, as we still lived in separate states and had to choose carefully). By this point I was feeling pretty confident that we'd be hearing good news, but I definitely needed to make sure I had support this time, just in case.

The technician was the same one I had seen several times before, and she knew how important this was to me. It was evident in her face as she silently scrutinized the screen, my heart racing, her brow furrowing as she searched and searched for an angle that would show us some good news. But she finally pursed her lips together, sadly shook her head, and said she was sorry, but it looked like it really hadn't moved at all since the previous visit 2 months prior, where 'complete' had given way to 'partial', but was mostly a matter of semantics (dealing, as we were, with millimeters).

I remember feeling like the air just went out of the room. "At all? Not even a little?" I said, fighting back tears and unable to make eye contact with Aaron, knowing if I did I would lose it completely. She offered to try looking with the good old transvaginal wand again (see above), and I agreed. But no, it was definitely still right there brushing up against the os. Too close to call safe for a vaginal exit. We could try again in another month, she said, and gave me a sympathetic look and rub on the shoulder.

I went to get my pants back on while Aaron went to wait in the exam room, since we hadn't yet seen the midwife (it was scheduled so that we'd know the results of the ultrasound first, sensibly), aware that the whole office could likely hear me crying. Again, I was self-conscious about whether I was blowing this all out of proportion - after all, this place had hear plenty of tears before, and for reasons much more tragic than mine. The BABY was doing just fine, no one questioned that. And that was and remains the most important thing. So I did my best to pull myself together as I stopped by the nurse's station to give my vitals.

"Your blood pressure is a LIT-TLE high, my dear," the nurse singsonged as she removed my cuff. She meant no harm, I know, but really, come on. The likely reason for the high reading could not have been more apparent. "Well, I'm a little upset right now," I said. "Can we please get a second reading?" She agreed, and let me sit and breathe for a few minutes. The second reading was perfectly fine. I proceeded into the exam room.

This time, we did not have Ms. Worst Case Scenario, but another CNM I'd met with once before. Besides a mild reprimand for the amount of weight I had gained, she was kind but down to earth, who made it clear that her own recommendations were different regarding home birth, but still managed to be supportive of my choices as long as I was low risk - which, at the moment, I was certainly not.

She saw the freshly-updated chart and gave me a look of genuine sympathy. "I know this wasn't what you were hoping for." Still trying to keep it together, I managed to get the words out: "So, do I need to meet with one of the OBs here now? To schedule a cesarean?"

"No, not at all. We really don't need to do that yet. It's getting later in your pregnancy, but there is still time. We'll definitely do at least one more ultrasound."

"Really?" At the moment, I wasn't thinking clearly at all. I had really felt like the jig was up.

"Anne, we WANT you to deliver vaginally if possible. Yes, we would prefer that you do so in the hospital, but whatever you choose to do, there's still a chance it could move." I felt a bit better, and we went through the rest of the brief checkup - everything with the baby looked fine, as per usual.

The following week's visit with my home birth midwives was therapeutic, also as usual. But given the update, I thought it was important to discuss what would happen if the placenta still hadn't moved after my next ultrasound. They explained that, just as if a situation arose in labor that mandated transfer, they would shift into the roles of doulas for me. "We're not just going to abandon you!" This was so reassuring. For all my positive affirmation and work on 'manifesting' a normal vaginal birth at home, I really hadn't let go of the mindset that if I did need to have a cesarean, all would be lost. Nothing would be familiar, I would have NO support, and I might as well surrender every other aspect of my pregnancy and my baby's birth to the authorities. Not a terribly productive or helpful perspective.

We started talking about a variety of ways to make the experience better; more gentle for baby, less traumatic for me. It the medication was making me shake so I couldn't hold the baby, they would help me maintain skin-to-skin contact. If the baby and I needed to be separated, they would stay with me so Daddy could go with baby. They would help me just as much as they would have if we were at home, just in a different role.

So it was from here that I started to work towards making peace with the possibility. Not just "giving up" and resigning myself to a cesarean, as I was oddly ready to do with the CNM, but simply finding some acceptance and letting go of the desire to completely control Lily's birth. Instead of resisting the concept with all my might, it was time to step back, recognize that there was a chance that this might be, and make peace with the fact that if this were the case, I needed to be grateful that there was still a safe way for my baby to be born, even if it wasn't my ideal, and find ways to make the best of it.

At this point, you might be wondering: Had I not chosen to do some parallel care in the first place, and got all my prenatal care with the home birth midwives, what would have happened? What would the CPM approach to a placenta previa be? How would it even be identified if there were no ultrasound involved? Well, many CPM clients (or women seeing home birth CNMs) opt for an anatomy scan at 20 weeks anyway, but if mom wants to avoid unnecessary sonograms in the first place, a skilled midwife can locate the placenta via auscultation - i.e. listening to the flow of blood through a fetoscope or with a Doppler. If neither of the above happens, there is typically a "warning bleed" at about 34 weeks, which would alert mom and care providers to a persistent previa and the decisions would proceed from there. (Any bleeding in the 3rd trimester, though usually painless, should be taken seriously and reported immediately.)

Though my next ultrasound was originally scheduled for 32 weeks, we decided to change it to 34, wanting to give it as much time as possible. I had continued learning as much as I could about previas from various sources. One had explained that the uterus did the most upward growth in the very last trimester, and moreover, it continues in the last part of the last trimester. I also confirmed that the placement of my placenta, though low, was also anterior, which was also encouraging - though a posterior placenta will still move up with the uterus, there is more growth in the front, as the uterus obviously doesn't grow back toward the spine but forward and up.

I had mostly given up on finding any sort of "treatment" when one day, while poking around online, I found a reference to an acupuncture technique that addressed placenta previa. I couldn't believe I never encountered it before, but investigated a little more. It seemed fairly obscure and quite specialized, but why not see if I could find someone familiar with it. The first practitioner I called had no idea what I was talking about. The second had heard of the technique but never done it themselves, though they were willing to learn. I said I'd keep that in mind if I couldn't find another person.

Third time was the charm! She knew what it was, how to do it, and had practiced it before. So for about a month and a half, I went in twice a week to have the needles placed, relaxing for half an hour, continuing my visualizations and affirmations. The time flew by, and before I knew it, it was the week of what I again hoped to be the final ultrasound - but this time, I felt much more relaxed about it. If it hadn't moved, we'd check again at 36 weeks, and then again, and if it had to be, then, que sera sera, and I'd have, as a friend and wise yet snarky mentor put it, "another fucking learning experience."

A few days before I was to go in, I was surprised to the [local CNM/OB practice] pop up on my phone. Lo, it was Ms. Worst Case Scenario, the one who had made sure I knew that "either it's going to move or it's not, and no amount of thinking you do is going to change that." She was calling to recommend scheduling an amniocentesis. Why, I asked? Well, because just in case my ultrasound showed no movement of the placenta, we needed to test for lung maturity so we could go ahead and schedule my c-section.

I was momentarily thrown, but then addressed her calmly. Wasn't there a risk, with amniocentesis, of triggering labor? She admitted that yes, there was. A small one, but still a real one. I then declined the test for the time being, (politely, I promise), told her about the acupuncture, and explained that I just wanted to see what the ultrasound said first, and then, if we needed to start taking those steps, I would take them. I wasn't trying to take unnecessary, reckless risks, I just needed to give my body every opportunity to correct this on its own. She actually quite responsive to this explanation, and said that she understood where I was coming from. In the end, I actually found this phone call rather empowering.

The 34 week ultrasound showed almost 3 cm of clearance off the os. Everyone at the CNM/OB practice shared my happiness, and didn't seem to take it too personally when I told them I didn't plan on returning.

You basically know the rest: not even 3 weeks later, I went into labor and gave birth to my daughter at home, 13 hours later. There were no complications, but my intrapartum bleeding WAS noted as "significant". Not something that was alarming, but something my midwives paid close attention to, making sure I exited the birth pool in order to assess it more clearly. They stayed for 4 hours after the birth, until they were absolutely sure everything was fine, left detailed instructions of what to track and watch for (maternal and neonatal) over the next 24-48 hours then returned the next day as well as the third.

I never had any bleeding during my pregnancy - no warning bleed at all, not even a drop since the extremely faint spotting that occurred right around the time implantation would likely have been happening.

So what's the moral of the story here? Would it have moved without the acupuncture? Possibly. It's not even a stretch to say probably. But not only did it help to finally be able to DO SOMETHING actively, I do think there's a chance it did help, and a tiny bit of help is all that was needed to make a huge, huge difference. The conclusion is also NOT "refuse all interventions and tests". There are times when interventions and tests are absolutely essential - I'm not trying to demonize the CNMs. I know they were good people trying to do the right thing, and that they DID care about both of us. I do think, though, that like many things that seem on the surface to be the "best of both worlds", parallel care is not worth the stress and dissonance of trying to have it both ways, so to speak. A little more faith in my body and a more positive outlook would have done wonders.

I also feel that diagnosing previas as early as mine was diagnosed does nothing but cause unnecessary stress. So many placentas are low-lying or even some grade of previa at the beginning, simply because there is so little surface area during the first part of pregnancy. I found in my reading that the placenta grows faster than the fetus for about the first 20 weeks of pregnancy, in fact, and only then does that ratio start to slowly reverse itself. That, combined with the upper segment of the uterus doing the last bit of growth at the very end, should provide some much-needed reassurance to moms who have been given the scarlet P in an early ultrasound.

What if, however, you happen to be the rare person whose placenta really does remain in a place that blocks the cervix? This was something I had to come to terms with. I think there is some peace to be found in knowing that your cesarean was, unquestionably, a medically necessary one. There's no doubts about it being an "unnecesarean" at all, as there can sometimes be with CPD or FTP. So, though it's easy for me to say in hindsight and as someone who got to have a vaginal birth after all, I really feel there is much value in this perspective. (And hopefully, the experience can also be made as gentle and positive as possible; see below.)

"Previa moms", DON'T PANIC. There is every chance that it will migrate. The odds are SO in your favor. Yes, watch for bleeding and take it seriously, and don't take up pole dancing as a hobby all of a sudden, but really, don't live in fear and let this overshadow your whole pregnancy. Enjoy your baby and have some faith in your belly. As my own mom was fond of pointing out - they're a lot more trouble on the outside than they are on the inside.

Related links:

Part One
Part Two
Part Three
Cesarean birth plans
Doulas and cesareans
Movie: The "natural" cesarean

Winner of the "Arms Wide Open" giveaway . . .

2011-04-28T17:28:00.002-04:00

. . . is Jennifer, commenter number 5! Jennifer, email me at annetegtmeier [at] gmail [dot] com with your snail mail address and we'll send it off to you posthaste. (If I don't hear from you within a week, we'll draw another number, to be fair.)

It seems especially meaningful to share a midwife's memoir as we memorialize another.

Thanks to all my readers for taking in our sharing of Briana over the past week. It's something that has affected us quite a bit, so I appreciate having an especially relevant place to share it. I'm hoping to get the grand finale to my previa story up next, but sometimes life and all it encompasses - including death - takes precedence.

Briana Blackwelder (at my son's birth) from David Perry on Vimeo.

Thank you for bearing witness.

Briana's Words, Briana's Wisdom

2011-04-27T18:36:00.003-04:00

Created by my sister Kate and her husband, Neil. This uses footage from her adoption documentary project (more of which, including the conversation all 4 of us featured subjects got to have together, will be included in the final project).

Briana's Words, Briana's Wisdom from Kate and Neil on Vimeo.

If you watch, definitely make sure you catch the very ending.

A scholarship fund has been created in her honor at the Midwives College of Utah. Please consider donating to her legacy.

In memory of a young midwife

2011-04-25T18:40:00.006-04:00

This is Briana Blackwelder, a 28 year old midwife and good friend of my sister, who was killed in a car accident this weekend.

I was lucky enough to get to meet her just a few months ago, en route to Portland, when we stopped in Provo and stayed the night with family. My sister is working on a documentary film project about adoption, which I mentioned in this post a ways back. Kate is in DC, but since I was stopping through, this meant that 4 out of 4 interview subjects would be in the same city for the blink of an eye, so she arranged for us to meet and Skyped herself into what was a wonderful conversation between us all - my mom, a birth mother; myself, a relinquished child; Kate's friend Ashley, a birthmother-to-be; and Briana, Ashley's midwife. This was all caught on film, and editing is underway.

After the conversation, I got to chat with Briana for a bit longer, talking about my hopes of attending Birthingway and about some of her own experiences, and I truly looked forward to getting to know her more in the future. Hindsight often magnifies these fleeting things, especially when tragedy and grief are involved, but I don't think it is any exaggeration to say that this was a truly extraordinary person whose genuine vocation as a midwife emanated from her very being. In addition to the inexpressible loss her family is suffering, the world of midwifery has experienced a huge loss as well.

I'm reposting the Vimeo video from my previous post about the film; it focuses on Ashley, but in the process, you get to see Briana in action for an all-too-brief moment, starting at about 4:30. An all-too-brief moment in an all-too-brief life.

Women's Bodies, Women's Wisdom from Neil Ransom on Vimeo.

When Kate's film is finished, we'll be able to see her interview footage, and I very much look forward to hearing everything she has to say. I'll share this with you as soon as it's available.

Please take a moment to hold her in your thoughts or your prayers or in whatever way you honor the departed.

Memorial services will be held on Wednesday in Salt Lake City, if you're a local.

Big Birthday Giveaway! "Arms Wide Open"

2011-04-21T15:37:00.004-04:00

At long last, my first giveaway! I've been looking forward to doing this for some time, but was awaiting a ripe opportunity. Hence, my birthday.

I love a good midwife memoir, and just started this the other night, at long last: "Arms Wide Open: A Midwife's Journey". I'll be giving my thoughts on the book soon enough, but wanted to get the giveaway going first!

SO! Standard blog giveaway rules. One point each for: Following me on Google Friend Connect (over thar in the sidebar), liking my page on Facebook, following me on Twitter, or subscribing via RSS. Post a separate comment for each! I'll give it a full week, then choose a winner via Random.org. Winner gets a free copy of the book, of course!

Enter away!

The Parallel Paradox Part 3 - Dealing with Placenta Previa

2011-04-18T06:56:00.000-04:00

Continued from parts one and two.

After getting off the phone, and calming down, I drove directly to my local natural parenting store, where I'd been going for cloth diapers, slings, and a home birth support group. Surely their abundant bookshelves would offer up some helpful and reassuring information, somewhere in all the books I'd been devouring for their information on natural/home birth and holistic pregnancy.

On the contrary. I looked in index after index after index. And each book in turn referred me to a page that mentioned the several universally-agreed-upon contraindications for a vaginal birth. I might as well be walking around with a pre-prolapsed cord. Some mentioned that placentas can migrate late in pregnancy, but offered no further information. All the crunchalicious books I had found so empowering were now shutting a door in my face, or so it felt.

One of the employees that I had become friendly with came over to offer some help, and I told her what was up. "I guess I'm just feeling pretty powerless right now," I said, fighting tears but still self-conscious that maybe I was blowing the whole thing out of proportion. She reiterated what the perinatologist had said about the likelihood of migration, and though she didn't know anyone who'd dealt with this personally, she had known of some women on a message board who had. I decided to check in on the message boards when I got home.

Before I logged on, though, I decided to browse through my own shelves and see if I found anything new. All of my own books produced the same result as the books at the store - "Previa, placenta, 176, contraindication to vaginal delivery"; "Placental abnormalities, 242, previa"; "Placenta previa, 52, reasons for cesarean"; "Previa, placenta, 67, abandon all hope" - except for one. One very unexpected resource.

When she got the news of her impending grandmahood, my birthmom ran right out and picked up what seemed to be THE book, the bible, even, for pregnant women, and was recommended as such by the bookstore employees: "What to Expect When You're Expecting". Now, as you'll gather from that snarky link of mine there, this is a book that, generally speaking, is not held in the highest regard by many naturally-minded people. Those on the spectrum of crunch tend to see it as very conventional, quite pro-intervention, and unnecessarily anxiety-provoking. Yet this book was the one place that went beyond listing placenta previa as a flashing red light, offered me some more information, and even managed to be reassuring.

It explained that previas are present at only 1 in every 200 births, that "A low-lying placenta is fairly common but as pregnancy progresses, the placenta usually moves upward and away from the cervix." It went on to say that nothing (nothing!) needed to be done about it - no mention of pelvic rest or limiting activity. "You don't even have to give your low-lying placenta a second thought." I wondered if I should have the authors call [insert Connecticut OB/CNM collaborative practice name here].

The book then mentioned a few risk factors for placenta previa, including smoking and previous uterine surgery. Though I had already quit, I did smoke for 15 years, and 'uterine surgery' does include D&C, which, as the perinatologist had so sensitively clarified in categorizing its non-spontaneous nature, was also true in my case. Enter guilt: because of mistakes and poor choices past, my baby was now at risk. Add that to my custom blend of fear and helplessness.

Yet despite feeling this guilt, I felt a little better about my odds, and a little more armed with information. I had a longer talk with Nancy, my midwife, about things I might be able to do for myself under the circumstances. "The worst part is that there's nothing that I can do about it!" I cried. "Oh, but there is," she said. No, she didn't know of any acupuncture or homeopathic treatments, as I had been wondering, but talked about visualization as a powerful tool, and explained how placentas tend to be attached to parts of the uterus with good, iron-rich blood supplies. I devised a regiment where I would take Floradix*, a natural and non-constipating liquid iron supplement, every day, and every night I would utilize my massage skills and use upward strokes on my belly to help me visualize my placenta migrating upwards. (This is not a medical treatment or even an official massage technique, simply a tactile aid to my own visualization and positive-thinking process.)

As the week wore on, I talked with others who offered comfort and support, and also valued the use of visualization. One of my wise massage therapy co-workers and mentors was especially adept at 'manifestation', and helped me fine-tune what I was going for. One important point was to work on visualizing and verbalizing things in the positive - in her view, the Universe doesn't respond to our negations of things in our statements, but to the things themselves. I know, I know, can I vague that up a little more? For example: in a birth plan, rather than asking for "no episiotomy", you would ask for and envision "an intact perineum." So, in my case, rather than asking for and focusing on "no placenta previa", I worked on manifesting "a clear and open cervix".

Does this all sound awfully "woo" to you? I know. It kind of is. I'm actually really not much of a woo person in general, but this was all I had. It helped me to think I was doing something for myself, being active in the process, and taking back some power in some small way, rather than sitting around feeling passive, powerless, and sorry for myself, victimized by a cruel combination of questionable past choices and lousy luck.

All this was prior to my next cervical check with the CNM practice. I had one more to go before they would give me the no-cerclage-necessary all-clear, and the perinatologist had sent them his recommendation to do all subsequent internal exams via transvaginal ultrasound. So I returned to the CNMs about a week after the Level II ultrasound that diagnosed the previa, a week that had started out as an emotional Space Mountain, but during which I had gradually found my way to feeling more stable and optimistic, however hesitantly. Assuming my cervix was still closed, I was planning on discontinuing the parallel care, but was a little uncertain now that my placenta had thrown a wild card into the mix.

I started with a trip to the ultrasound technician's room, where she confirmed the same placenta location, and also noted that my cervix was still long and closed - no sign of 'incompetency'. I then went into an exam room to wait for whoever the rotation assigned to me that day, feeling a little wary but fairly resolved, based on everything I had learned.

The CNM that entered the room was the one I had come to think of as Ms. Worst Case Scenario, the youngest one in the practice and also, in my experience, the most conservative. It had been she who raised the alarm about my cervix to begin with, and had exerted a substantial amount of pressure regarding prenatal testing. Now, she looked over my revised chart with its fresh new scarlet P, and reviewed all the precautions I needed to take, including pelvic rest and no strenuous exercise. I agreed to all of the precautions, and then started to explain what I was doing on my end, with visualization and positive thinking.

She cut me off with a shrug, saying, and I swear I quote this word for word, even after all this time, "Well, either it's going to move or it's not, and no amount of thinking you do is going to change that."

Long pause.

You know, you don't have to believe in what I was talking about. I had my own doubts. But my GOD, it was obvious that the whole placenta situation was really , really upsetting to me, and even more obvious that this was something that was helping me to feel better about it. Would it have &@#$!ing killed her to at least pretend to be - well, not supportive, because that was clearly beyond her, but to simply remain neutral? Sure, YOU might not think it would help, but there's also no way it would hurt, so what the hell was the problem? Even a noncommittal nod, a "Mmm-hmm . . ." and a change of subject would have been preferable to just dismissing me outright.

I shouldn't have let it affect me, but I was already on shaky ground. I tried to remind myself that, AGAIN, this was just the world that she came from, and she wished me no ill will; on the contrary, she was giving me the care that she believed in, and was trying to do what was best according to her belief system. A placenta previa WAS something to take seriously (none of my posts are intended to suggest that it isn't.). And again, in contrast with other major pregnancy complications, fetal OR maternal, things certainly could have been worse. I knew better. Already, I knew better, yet her words took the wind right out of my fragile fledgling sails.

Slowly, I was realizing how I had been swept along in a cascade of interventions, prenatally. Hospital tickets aren't only issued for the grand finale-ride of labor.

We went on to have a bit of an argument about whether or not it was okay for me to fly home for Christmas. I had mentioned my plans to visit family in Colorado, and she grimaced as though I was suggesting I take up jousting. Asking her to explain her concerns, as every book and website I visited stated that travel was fine at this point (it might be unpleasant when feeling nauseous in the 1st trimester, and that in the third, the concern was that IF one should happen to go into premature labor, one would be away from appropriate care - not that it caused premature labor), that 2nd trimester was the safest time of all. Did my previa make some kind of difference?

She said her concern was the possibility that an abrupt change in pressure, should there be an incident, could cause my water to break. I was learning to speak up, however hesitantly, and have fewer l'esprit d'escalier moments five minutes after leaving the office where I thought of all the things I wished I could have said in the moment, and I pointed out that this unlikely scenario could happen to ANY pregnant woman. So was she really suggesting that no pregnant woman should ever board a plane, period? She waffled a little, but essentially said yes. There was a risk, and if that risk came true, how would you live with yourself?

This is pretty much where I realized that East was East, West was West, and never the 'twain shall meet. I was trying to reconcile two very, very different worlds, and had fallen into a strange kind of mostly self-created trap as a result. The fact that I had been needing to decompress after every CNM visit had already demonstrated that there was a fundamental dissonance in mindsets. However unintentionally, I had bought the hospital ticket. I went into the situation thinking that parallel care would be "the best of both worlds", but it became ever clearer that it was not nearly as simple as that. The kind of care given (and sought) in pregnancy IS, in part, a manifestation of various sets of beliefs. I don't think it's remotely as black & white - or as polarizing - as "Trust Birth" vs. "Fear Birth", but there IS a spectrum between those two poles, and these particular CNMs** and I were clearly many, many miles apart.

I left that visit with a stamp of approval regarding my cervical competency, informed them that as a result of said competency, I was not planning to continue parallel care in general, but did need to return for a follow-up ultrasound at 28 weeks. The odds were totally with me. One more spin on the hospital ride, I hoped and prayed and visualized - to see if it had migrated.

Here I break with what would make the most sense in serial narrative form, and post a spoiler:

It hadn't.

*Note: I'm a fan of Floradix, but word to the wise, plan to have something in hand to 'chase' it with immediately. Great product, revolting taste. I always followed with orange juice.

**It bears reiterating that I am not at all trying to slam CNMs in general - this is, again, just my own experience.

Goin' to Boob School.

2011-04-15T11:27:00.006-04:00

On the board in one of our classrooms. Like it says: Boob.

In the midst of all the birthday craziness, and crossing the line from *sniff* toddler to preschooler, I also started Boob School this week! Officially, I'm part of the first degree program for lactation at Birthingway College of Midwifery, in case you missed the memo, which qualifies us to sit for the IBCLC exam. Our first day was great, a 4 hour orientation and then 4 hours of Anatomy & Physiology (which I could have transferred, but I really want the information anew). Today, sleep-deprived and homework in hand, I'm off to Breastfeeding I.

Things I theoretically want to focus on over the course of the next two years:

Tongue tie (obviously), based on the intensity of my own experience.
Low supply, both perception and reality. The fear/belief that she isn't making enough milk is one of the biggest reasons moms give up nursing, and it largely isn't true - often a growth spurt combined with a care provider not well-versed in advising moms on breastfeeding is the killer combination. And the flip side of that is that there ARE true supply issues, and I want to know everything there is to know about them.
Herbal galactagogues in depth. Over and over, I see the question "How do I increase my supply?" And a chorus of totally well-meaning people say, "Fenugreek!" It's just so much more complex than that, and I'm looking forward to learning all about exactly how it all functions.
The role of maternal nutrition, particularly with regard to food sensitivities and intolerances, something I haven't written about here yet. Or have I? No, if I have it's only been in passing. I think.
Women with long term challenges (again, obviously), especially in terms of using breastfeeding tools like the Lact-Aid, and with special attention to how to transition OFF the tools.

I also have an idea for a study, perhaps an independent one, that I would loooooove to do in tandem with someone, potentially a medical student or someone going for a masters, say, in public health. Possibly more people than that. If that sounds like you, buzz me! Anyway, it could possibly be a thesis, and something valuable for the field as a whole.

Whew! Is that an agenda or what? I realize things may and probably will change over the course of time - just like I thought I was going to do practically nothing but sports massage while I was in school for massage therapy, yet the work I was drawn to once I was in practice was quite different. But still, it's helpful to have some direction at first.

Three Years of Lilybean

2011-04-14T03:33:00.003-04:00

Beloved firstborn girlchild, I offer you a prayer on this, your third birthday, courtesy of Tina Fey.

First, Lord: No tattoos. May neither Chinese symbol for truth nor Winnie-the-Pooh holding the FSU logo stain her tender haunches.

May she be Beautiful but not Damaged, for it’s the Damage that draws the creepy soccer coach’s eye, not the Beauty.

When the Crystal Meth is offered, May she remember the parents who cut her grapes in half And stick with Beer.

Guide her, protect her when crossing the street, stepping onto boats, swimming in the ocean, swimming in pools, walking near pools, standing on the subway platform, crossing 86th Street, stepping off of boats, using mall restrooms, getting on and off escalators, driving on country roads while arguing, leaning on large windows, walking in parking lots, riding Ferris wheels, roller-coasters, log flumes, or anything called “Hell Drop,” “Tower of Torture,” or “The Death Spiral Rock ‘N Zero G Roll featuring Aerosmith,” and standing on any kind of balcony ever, anywhere, at any age.

Lead her away from Acting but not all the way to Finance. Something where she can make her own hours but still feel intellectually fulfilled and get outside sometimes And not have to wear high heels.

What would that be, Lord? Architecture? Midwifery? Golf course design? I’m asking You, because if I knew, I’d be doing it, Youdammit.

May she play the Drums to the fiery rhythm of her Own Heart with the sinewy strength of her Own Arms, so she need Not Lie With Drummers.

Grant her a Rough Patch from twelve to seventeen. Let her draw horses and be interested in Barbies for much too long, For childhood is short - a Tiger Flower blooming Magenta for one day - And adulthood is long and dry-humping in cars will wait.

O Lord, break the Internet forever, That she may be spared the misspelled invective of her peers And the online marketing campaign for Rape Hostel V: Girls Just Wanna Get Stabbed.

And when she one day turns on me and calls me a Bitch in front of Hollister, Give me the strength, Lord, to yank her directly into a cab in front of her friends, For I will not have that Shit. I will not have it.

And should she choose to be a Mother one day, be my eyes, Lord, that I may see her, lying on a blanket on the floor at 4:50 A.M., all-at-once exhausted, bored, and in love with the little creature whose poop is leaking up its back.

“My mother did this for me once,” she will realize as she cleans feces off her baby’s neck. “My mother did this for me.” And the delayed gratitude will wash over her as it does each generation and she will make a Mental Note to call me. And she will forget. But I’ll know, because I peeped it with Your God eyes.

Amen.

Tina Fey, Bossypants, 2011

But also know this, oh baby my baby, even if you do get bad flash tattoos and take acting and lie with drummers, I'll still love you more than you will ever, ever know.

- Mama

Support Global Maternal Health with "Every Mother Counts"

2011-04-12T02:24:00.005-04:00

Whether you're a Starbucks fan or not, you might want to stop by sometime soon. Not for a coffee (unless that's your bag), but to pick up a CD. Say what?

Starting today, April 12, Starbucks stores will be selling a compilation called "Every Mother Counts", a companion to the documentary on global maternal health that I cannot WAIT to see, directed by Christy Turlington, titled "No Woman No Cry":

It's enough that proceeds from CD sales go to the CARE and the Every Mother Counts organization, but check out this track listing:

Martha Wainwright - 'Leave Behind'
Carla Bruni - 'Le Loup, La Biche et Le Chevalier (Une Chanson Douce)'
Gwyneth Paltrow - 'This Woman's Work'
Madonna - 'Promise to Try'
Patti Scialfa - 'Children's Song'
Toshi Reagon and Bernice Johnson Reagon - 'There and Back Again, Pt. 2'
Angelique Kidjo - 'Sweet Lullaby'
Ani DiFranco - 'Present/Infant' (remix)
Dixie Chicks - 'Lullaby'
Rosanne Cash - 'Motherless Children' (acoustic version)
Sheryl Crow - 'Lullaby for Wyatt'
Jennifer Lopez - 'One Step at a Time'
Karen Elson - 'The Last Laugh'
Sinead O'Connor - 'Petit Poulet'
Martha Wainwright - 'No Woman, No Cry'

Pretty awesome, right? It's worth it for the Dixie Chicks track "Lullaby" alone, which, if you haven't heard, check out this rendition of an already heartbreakingly beautiful song:

I've also always adored that Madonna song, love pretty much anything by Sinead, and am, well, intrigued, at least, to see what Gwyneth does with "This Woman's Work".

Here's the Facebook page for Every Mother Counts. Please check it out!

By the way, I am not being compensated in any way for promoting this, I just think it's incredibly cool and wanted to pass it along.

The Parallel Paradox Part 2 - Diagnosis of Placenta Previa

2011-04-10T18:46:00.001-04:00

And so the stage was set.

Despite not having any health insurance, and despite my own reservations, I agreed to the CNMs' recommendation, returning to their practice to have my cervix checked every 2 weeks. As frustrating as this was, I only planned to continue this parallel care until week 20, when they had decreed we could stop the cervical checks. Once I got the all-clear, I was done with them, and would continue my care with Nancy and Gengi alone.

So began a pattern where after each visit to the CNMs, I would visit my CPMs to decompress from the experience (or make a lengthy phone call, if we had no appointment that week). Nancy and Gengi, who I thought of as my 'real' midwives - not because CNMs (a.k.a. nurse midwives) are not legitimate, but because I had started out with no intention of getting any care from them; I had just stumbled into it - did an admirable job of talking me down after each CNM experience.

Fortunately, as those who get CPM care know, these visits were always at least an hour long, sometimes more. The old joke is that with an OB you wait for an hour and see them for 5 minutes, and with a CPM you wait 5 minutes and see them for an hour. (In my experience, which is only my experience, with these particular CNMs, you'd get about 15 minutes rather than the OB's 5.) With Nancy and Gengi, sometimes the first half an hour or more would have to be devoted to therapeutically working through the damage from the last CNM visit. It mostly had to do with my potentially-incompetent cervix, but there were plenty of other opportunities to instill other doubts and insecurities, too. You've gained HOW much weight already? Aren't you getting any prenatal testing done? And what about those suspicious dates?

At week 14, I stayed after my cervical check to get a dating ultrasound, in order to clear up the discrepancy between my conception date and the extra centimeter or so my belly was measuring. I had only planned to get one anatomy scan at around week 20, but hey, what's one more compromise? I got my first glimpse of the precious, and determined that the dates were possibly a week off, though it was impossible to tell for sure (but hey, what's an extra cost for no reason at all?). I also was told that my amniotic fluid might be a little bit high (but hey, you PROBABLY don't need to worry about it yet).

And then, literally as I was on my way out, the technician seemed to make a last-minute decision to share one more piece of information with me, something she had been hesitating about.

"Just so you know, right now it looks like your placenta is lying a little low." I must have looked alarmed, because she immediately added, "Most of the time it'll resolve by the end of your pregnancy. It's pretty common for it to be low this early.'

I left the office feeling uneasy, but decided to take her word for it and investigated no further at the time, focusing on the pictures of my sweet wiggly little being, the fetus we came to know as Samily - Sam if it was a boy, Lily if it turned out to be a girl.

More cervical exams with the CNMs, more ranting and railing therapy sessions with my midwives.

Eventually, week 18 arrived, time for the Level II ultrasound I had agreed to as my one concession to prenatal testing. For this, I went to the UCONN Health Center, where the most advanced technology and high-risk specialists were located. Somehow, walking in, I still looked forward to it, being as interested in all things pregnancy and birth as I was. Surely it would be objectively fascinating as well as personally moving to get such an in-depth look at my future baby. First, a friendly technician set me up, spreading the gel and connecting the computer screen to a larger screen where the images were projected on a huge wall in front of me.

There she was (though they complied in keeping the gender a secret), my gorgeous baby. I was captivated, glued to the screen as the technician took measurements and pointed out various parts. There may have been a point where she furrowed her brow and looked worried about something, but I'd be lying if I said I remembered or even noticed at the time - I was too enchanted by the black & white silent movie of my dream come true, shifting and squirming and already looking cuter than any ultrasound I'd ever seen - my motherly bias was already in evidence.

Then the perinatologist entered the room, a bearded and professionally aloof man in a long lab coat. After briefly greeting me, he turned to my chart, reviewing a few things like my age and how many weeks I was. Then he asked about number of pregnancies, seeing that his was not actually my first, and asked, about abortion, "Okay, was this a spontaneous abortion?"

Excuse me while I digress here for a minute. Not only was that completely unnecessarily awkward and uncomfortable, I am fully aware that the medical term for a miscarriage is "spontanous abortion". Is there ANY woman, ANYWHERE who would actually refer to her own miscarriage as a "spontaneous abortion"? For crying out loud. I realize that one's history is important, but there has to be a better way to clarify. Anyway, already off on the wrong foot, I begrudgingly confirmed that no, it was not.

After going over Samily's measurements, which all appeared to be perfectly normal, he moved on to the placenta. Which brings us back to where I opened.

"At this point, we're calling it a complete previa."

After a nanosecond of shock, I burst into tears. I could already see myself on the operating table, right then and there. My hopes of a home birth or even a natural hospital birth, dashed. My body, a betrayal. The doctor, to his credit, tried to reassure me. He explained that, as the technician had mentioned, the odds were in my favor that the placenta would migrate upward as my uterus grew, and that most previas diagnosed this early would 'resolve' by the end of the pregnancy.

There are varying degrees of placenta previas. There are complete previas, which refers to when the entire cervix is completely covered; then partial ones, where only part of the cervix is overlapped; and also marginal ones, where the edge of the placenta just barely borders the cervix but is still close enough to be a concern. My own, to be more specific, though it was complete, was not centered over the os (the 'mouth' of the cervix), as depicted here:

Rather, mine was positioned so the lowermost edge of the placenta lay over the cervix. A bit more like this:

He then used the analogy of drawing a dot close to the opening of a balloon before it's blown up all the way; the dot won't actually relocate, but it will appear to move upward as the balloon grows. This was likely to happen with me - likely, but not guaranteed. I nodded through my tears as he explained that a follow-up ultrasound would be scheduled for about 28 weeks, and this meant that I was on pelvic rest until it was determined that the placenta had cleared out of the way. No sexual activity of any kind at all, especially anything that could cause orgasm, and nothing in the vagina, period. For the next 10 weeks, I was also to avoid any exercise more strenuous than gentle yoga.

Oh, and (double-checking my charts) due to the need to continue checking my cervix for at least one more appointment, the exams would need to be done via transvaginal ultrasound, rather than fingers. Yes, that's right, I was on order to have nothing in my vagina, nothing, not even the gloved fingers of a conventional medical professional . . . unless it was a big expensive medical dildo-like medical instrument. THAT was fine. I agreed, of course, and tried my best to hold it together until I left the office.

As soon as I hit the elevator, I finally let myself sob and sob. The doors opened on a group of young doctors, and I quickly walked by their sympathetic looks, feeling ashamed. Even then, I had perspective. I knew that this medical center had seen more than its share of sobbing pregnant women, and the reason for that sobbing was often much more serious than my own. I knew that this very moment there were women receiving far worse news than I, news of terrible congenital defects or other heartbreaking outcomes. I knew that given the opportunity, plenty of women would trade places with me in a heartbeat. A mere c-section compared with one of the "incompatible with life" triosomy abnormalities, just for one example? No question.

But being aware of this, and trying to count my blessings, didn't quell my sorrow or my fear in that moment. I called the father from my car, followed by my midwife (my 'real' midwife), both of whom did their very best to reassure me. A for effort.

Part 3 coming soon.

The Parallel Paradox: My Experience With Placenta Previa, Part 1

2011-04-06T06:25:00.000-04:00

"At this point we're calling it a complete previa."

The perinatologist stated this so casually, so technically, so matter-of-factly. A complete placenta previa, detected during the Level II ultrasound I had agreed to do at 18 weeks, as what I thought of as a fair compromise to all the other prenatal testing options offered (and encouraged, frankly) by the CNM practice I had been seeing in tandem with my home birth CPM. The quad screen produced too many false positives, the CVS seemed way too invasive and risky. But hey, I had thought about doing a basic anatomy scan at around 20 weeks anyway, so why not do a sonogram that would be a little more thorough? Including a consultation with a perinatologist to boot? What could be the harm?

Backing up for a moment: Unless you're brand-new to this blog, you already know the happy outcome of my pregnancy: I had an uncomplicated home water birth with a healthy baby girl. What I've never talked about here is the story of the pregnancy itself, including, yes, a placenta previa that cast a shadow over the whole experience, threatening to change my plans for not only a home birth, but any hope of a vaginal birth at all.

Periodically, I see moms posting about their own previa diagnoses, on message boards and Facebook and the like, and my heart goes out to them - I know just how uncertain and anxious and helpless the feeling can be. I always swore that I would someday write out my own story in order to offer up a positive spin on the whole angsty saga. Only 3 years later, I'm finally getting around to it.

The story has more to it than just the painstakingly slow migration of my placenta, however; the experience of getting what's commonly referred to as "parallel care" from a conventional medical practice has lessons - and pitfalls, in my case - of its own. It's hard to separate one aspect of the pregnancy from the other, I've found each time I begin to approach it, so I tell the two tales together.

So before we get back to the perinatologist delivering the bad news to me, a bit on how I, a mom who was planning on homebirth from day one, had even gotten there in the first place.

When I decided on my home birth midwife, Nancy, a wonderful CPM with a very experienced apprentice, I had no intention of getting any extra prenatal care. But in order to get my blood workup done, Nancy recommended I go to a practice in the area that was relatively friendly to the idea of home birth. Emphasis on the relatively; they did not formally offer parallel care, but knew that some of their patients would occasionally be doing this anyway, and so had a waiver on hand releasing them of responsibility. Fair enough - but I didn't go into their practice even expecting to go that far. The plan was just to get the blood work and be done.

But when I made the appointment, the receptionist asked if I wanted the CNM rotation or the OB rotation. I thought it was nice that they offered a choice, and asked for the CNMs, of course. When I arrived, it turned out that I had been scheduled for a full initial prenatal appointment, not just the tests. "Well, why not go ahead and get checked out?" I thought.

"What could be the harm?"

Well.

In that first appointment, the CNM I happened to get was the youngest in the practice, and in my experience, the most conservative. She looked over my history, and with great concern, noted that I had needed a cone biopsy on my cervix due to moderate dysplasia, a full 15 years prior (with no abnormal pap smears since). This was something I had discussed with Nancy and Gengi already, who thought there was a small the scar tissue might be an issue when it came time to dilate, but otherwise saw no need for additional concern. They had worked with plenty of other moms with similar procedures in their pasts and had no issues during pregnancy or in labor.

This CNM, however, saw only the worst case scenario, recommending that I have my cervix checked for "incompetency" every two weeks, until I reached 20 weeks, and if it should show signs of prematurely dilating, they would put a cerclage in place, essentially stitching it closed until late pregnancy. The fear was put in me. My body was flawed, my baby at risk. How could I say no, and risk a miscarriage? Never mind that this was at an extreme additional expense: I should also note that this was all going to be out of pocket, since try as we did to get me health insurance, not one company would take me once I was already knocked up, since pregnancy was a pre-existing condition. We were already planning on paying Nancy her fee out of pocket, but hoped to at least get something for any additional care that was needed. To no avail.

In that same initial visit, the alarm was raised about my dates. Despite knowing exactly when I had conceived, I was "measuring large" for what was supposed to be a 12 week pregnancy, and I was more or less ordered to get a dating ultrasound, even though I had been hoping to get only one anatomy scan at around 20 weeks - again, just to be on the "safe side". I tried to reason my way out of this early ultrasound, hoping that we could just wait until 20 weeks and get a date estimate then, but apparently the sonogram's dating accuracy declines as time goes by, and she insisted that without accurate dates, they couldn't properly continue my care.

I reluctantly agreed to return in 2 weeks for this, along with my next cervical examination, and with some additional strong words encouraging me to decide on a variety of prenatal testing options, we finished the visit. I walked out feeling shaken and manipulated. Not because she meant me any harm - on the contrary, she was just recommending what, according to her training, was the safest course of action. She was only doing her job. But my feelings about my pregnancy were permanently changed, my belief in my body was shaken, and I found myself unable to stand up for what I believed and wanted.

To be continued.

Simianlac: The Closest Yet to Mother's Milk

2011-04-01T00:00:00.002-04:00

No, This Time We Mean it: Really Really REALLY Close to Mother's Milk

For some time now, breastfeeding advocates have noted that whenever formula companies release a new product, much of the marketing focuses on insinuating that this new recipe makes their variation closer than ever before to human milk, typically by featuring synthetic versions of various ingredients found naturally in mother's milk (i.e. the essential fatty acids DHA and ARA, vital for brain development, with particularly disastrous results in artificial form).

Other concerns aside from attempts to replicate specific components of human milk include the protein content of the formula, based in cow's milk. These proteins are significantly different than those found in human milk, due to the fact that they are designed for a large ruminant, the offspring of which will be walking almost immediately after birth, in contrast to the needs of the human infant. Dr. Nils Bergman groups mammals into four types with regard to the nutritional needs of their young: Cache mammals, follow mammals, nest mammals, and carry mammals.

That last category is us. In "Breastfeeding Made Simple", Bergman describes it like so:

Carry mammals: This group includes the apes and marsupials, such as the kangaroo. The carry animals are the most immature at birth, need the warmth of the mother's body, and are carried constantly. Their milk has low levels of fat and protein, and they are fed often around the clock. Humans are most definitely carry mammals. Human milk has the lowest fat and protein of all mammalian milks. That, and our immaturity at birth, means human infants need to feed often and are meant to be carried and held.

Breastfeeding advocates and many health professionals have long recognized that cow's milk, and thus cow's milk-based formula, is therefore not biologically appropriate for human infants. This manifests in a number of ways, including the way the proteins are broken down in the baby's stomach, forming tough, rubbery curds that are difficult to digest. Yet aside from turning to soy formula -which introduces a host of other issues - there seemed to be no other real alternative source for the times when breastfeeding is not possible. Chemically enhanced and artificially fortified cow's milk it was . . .

. . . until now.

Abbot Laboratories introduces an exciting new choice in infant formula. Their scientists have been paying attention to these breastfeeding advocates, and conceding their point in at least one argument. "The illogical practice of using milk from a completely different type of mammal with vastly different nutritional needs has been a concern of ours for some time," says Dr. Jane Fossey, a head researcher in Abbot product development. "We have finally found a way to deliver the closest approximation possible to human milk. Rather than using ruminant livestock, simply out of cultural habit and convenience, we decided to try turning instead to another member of the primate order."

Introducing Simianlac.

Simianlac, available in powder and ready-made varieties, is manufactured in the first chimpanzee dairy in North America. Dr. Fossey emphasizes that the chimps are free-range and fed an organic diet, being rounded up only every three hours to be milked. "We're also proud to announce our partnership with Medella, and use only the comfortable, convenient Pumping Style model on our chimps."

At long last, human babies in need of supplementation will have a product that really, truly, seriously, for real now, comes as close as possible to their own developmental needs. Simianlac will hit the market in April. Look for samples in your hospital bag!

Simianlac. Don't monkey around with your baby's milk.

No chimps were harmed in the making of this post. Nor were any real people or companies. There's no such thing as Simianlac. Pure April Fool's silliness.

OR IS IT???

Yes, it is.

FOR NOW.

Postpartum Visits Revisited: Yes I said yes I will yes.

2011-03-30T13:50:00.003-04:00

My attention was drawn this morning to an excellent, straight-to-the-points post entitled "How to Be the Best Postpartum Visitor in 15 Minutes Or Less". It is spot-on. By way of introduction, she says:

This visit is NOT about you. It is not about the parents hosting you and putting on a cup of tea so you can sit and visit and hold the baby. Think about how you would feel if you had either had surgery or ran a triathlon. What would you want people to do for you? This visit is about blessing the parents and making their life a little bit easier. Your prize is getting a quick peek at the cute new human.

Quite. I can't tell you how many moms are expected to play hostess to their visitors while they're still undergoing major healing, and possibly even more significantly, adjusting to the seismic shift that has just taken place in their lives. Postpartum visits need to be made in loving service TO the mother and new family. Here's her list of criteria for the perfect visit:

1. Bring a healthy meal. Include a salad or fresh vegetables. Only use disposable dishes. There is nothing more annoying than
a) having to wash more dishes when you have a new baby
and
b) having to try to return dishes to all sorts of random people when you have a new baby
2. In addition to your meal, bring cut up veggies and fruit, unsalted trail mix or nuts, or other such healthy snacks for daytime munching for mom to eat while she's nursing.
3. Go into the kitchen and spend 5 minutes clearing off a counter, washing a sink-full of dishes, loading the dishwasher etc. Don't ask permission, just do it. Then set the table for their dinner.
4. Before you leave your house, put some paper towels and some powdered bathroom cleaner like Commet or Ajax in a baggie. Stick it in your purse. While you are at the house, go and use the washroom...and while in there do a three minute bathroom shine-up, using your paper towels and cleaner.
5. Coo over the baby, but wash your hands before touching it.
6. If they want to eat right then, heat the food up and put it on the table, give everybody kisses and then leave.
7. Take the garbage out when you go.

Awesome, right? Even if your visits are professional (as a doula or lactation consultant or some other solicited service) there's still wisdom in the core message.

This post reminded me of a post I did on the same a while back, "The Answer is Always Yes", from which I excise one final point to add to the basically perfect list above.

I have one final suggestion. This is something to tell her in response to the inquiries of other friends and relatives who will want to visit. Almost invariably, when people arrange to come calling on a new family, they ask "Is there anything I can bring you? Pick up at the store? Anything?" THE ANSWER IS ALWAYS "YES". ALWAYS! This goes back to the learning-to-ask-for-help thing. It is SO HARD for us to get this lesson, and stop trying to prove we are superwomen who can do everything all by ourselves immediately after delivering the placenta, but there's no time like the postpartum period to start feeling comfortable with it. Have her keep a notepad by the phone, or in a very handy place if she relies on her cell. This notepad would be a great inexpensive gift, especially if a pen is attached so she doesn't have to look for one over and over. She can then keep a running list of things that she and the household need, just jotting them down as she goes. Orange juice, witch hazel, baby wipes, red raspberry leaf tea, onions, sanitary pads, flax meal, Rescue Remedy, dark chocolate, burp cloths, fresh fruit, a new thermometer, WHATEVER. If the list is literally empty, and she can't think of *anything* else - ASK FOR TOILET PAPER. It can always be added to the household stash. Make her repeat it with you: "The answer is always 'Yes'!"

It's more of an exhortation to the new mother, but friends and loved ones who are aware of this idea can encourage her in their phone calls prior to the visit, and help her to say embrace the yes.

Confession: I myself have been guilty of not bringing food in disposable containers. Yes, they're less environmentally friendly, but using them once in a blue moon (of the babymoon variety) is pretty benign, and there are also disposable products made of recycled materials one can use - check out Whole Foods or other similar businesses. I hereby apologize to anyone I put in the position of chasing me down to return a casserole dish!

Fun Friday Fact: The Other White Meat*

2011-03-25T17:18:00.006-04:00

Like how I titled that as if "Fun Friday Fact" was a real thing, like Wordless Wednesday or Meatless Monday? Nope, I just made it up, because I couldn't think of any other way to tell you this little tidbit. It has come to my attention that Cervadil, the prostaglandin insert used vaginally to ripen the cervix when inducing labor, is apparently derived from . . . pig semen**.

It sounds like something totally make-believe, like the kidney thieves urban legend, or a plot element on South Park, or a nickname for a Wack Packer on Howard Stern. But try as I might to discredit this, every source I've been able to find so far seems to confirm that Cervidil is indeed a porcine product.

I have nothing further to say. Aside to note that I hope the label specifies that it is decidedly not kosher. Please, if this is untrue, someone in the know, disabuse me of this notion.

*Title credit to Justine at State of the Heart Parenting
**There's a plethora of other links out there, but I include this one because it includes a sentence I never thought I'd read, "I'd much rather have my husband's semen inside of me, than a pig's."

New Car Seat Recommendations - and a Note to Self re: Compassion and Judgment

2011-03-21T12:58:00.005-04:00

Much happier forward-facing, much safer rear-facing. Sometimes mom just can't win.

The big news du jour is the new recommendation on car seats, specifically keeping them rear-facing until kids are two, rather than the previous official recommendation of one. It's pretty amazing to see how heated the discussion can get on something that might, on the surface, seem so simple and straightforward.

One commenter, ChiMomWriter, wrote this comment in the midst of a heavy debate on Christie Haskell's article: "My daughter screamed continuously on any car trip when she was younger, so I turned her around as soon as she turned 1. I agree with safety, but it was far more dangerous day-to-day for me to spend half of my time driving facing backwards trying to get to her. My son is more laid-back because he can see his sister."

I totally understand where you're coming from. Life is not always so black & white, and you don't know the variables in everyone's situation. I'm NOT arguing against the recommendation, I understand it & reluctantly agree with it. I am just saying I know what it's like to be a shut-in because of your kid's hatred of the car.

Words cannot express how relieved I am that Lily is over 2 and I don't have to face this decision now. Life with her while rear-facing was. an. absolute. nightmare. She's still not great in the car, but turning her around was like night and day for her temperament. I completely understand the safety reasons - no need to show me links of car crash decapitations, thank you, I've seen them and I get it - but am really feeling for the moms with difficult car babies today.

And the greater lesson here is a reminder on empathy when it comes to parenting, safety, child health and other choices. On the Facebook discussion, this comment was made, in re: some parents expressing reluctance or frustration with the news:

Oh and some pet peeves of mine is when people are giving information and resources to make some one or something more safe, and they ignore them. Why would you not want your child to be more safe with something so easy? It blows my mind.

It blows my mind that everyone doesn't exclusively breastfeed, if able, until 6 months and then continue until a minimum of two years. It blows my mind that everyone doesn't cosleep when the reduction of SIDS is so apparent. It blows my mind that people eat and feed their children processed garbage on a daily basis. And so on, and so on, and so on.

But guess what? Life is not always so black and white, and you don't know the variables in everyone's situation. And this applies not just to the moms championing the car seat recommendation, but to me, too, when considering parenting choices like all of the above. I do try to be mindful of this already, but it's good to get a direct and sobering dose of one's own medicine once in a while anyway, just to underscore the point.

I'm NOT arguing against the car seat recommendation, I understand it and reluctantly agree with it. I am just saying I also do understand what it's like to essentially become a shut-in because of your kid's seething hatred of the car.

So, does anyone who loves this recommend have any suggestions on how to improve life for moms with littles who are miserable in the car? Because for many, turning them forward improves their temperaments DRAMATICALLY. If Lily were under 2 when this came out, I'd feel like hanging myself (no hyperbole at all). The difference was that dramatic - and I was no longer trapped in the house losing my mind because of a kid who would scream bloody murder at any drive longer than 5 minutes.

Orgasmic Birth? It's not what you think.

2011-03-17T19:02:00.007-04:00

Take a wild guess what this is.

Go ahead.

Think about it.

Okay. What did you come up with? A new product from Good Vibrations or Toys in Babeland? That's what would make the most sense, right? That would have been my guess. And I would have been wrong.

See, a company called "Materna" has developed a product to help prevent tearing during labor. Steely Dan there is inserted into your vagina - yes, your vagina, while in labor - and then expands gradually over a few hours. That's right, rather than focusing on helping women find more physiologically appropriate ways to push, including good positions and lack of directed valsalva pushing, they thought a mechanized, expanding dildo was a better idea.

Is it too early for April Fools?

I was tipped off to this by Navelgazing Midwife, who directed us to head over and take Materna's survey. I encourage you to do the same. It's hilariously gobsmacking. Here's one of their questions:

21) Based on the explanation of the device's features, do you have any questions or concerns about its usage? Please list below.

I answered: "Yes. One question. ARE WE ON THE SAME PLANET? Because the idea of laboring with a slowly expanding DILDO up my vagina is not something that makes any sense whatsoever. Your logic is not our Earth logic."

My favorite part is the very next one, though:

22) Do you have a color preference for the device?

I checked "Other", and suggested that it have Sarah Jessica Parker's face on it, since this product is much better suited to Sex & the City than a labor and delivery ward.

And I thought the hemorrhoid preventing device was bad enough. Can you even imagine using one, let along both? OMFG.

Weekend Movie: The "Natural" Cesarean

2011-03-11T20:59:00.004-05:00

This is a great portrayal of new possibilities. Cesareans can be made gentler, kinder, and more mindful of the humanity of all parties. I've written a before on ways to improve the experience of a cesarean, and am thrilled to see this video getting out there! I especially love the emphasis on keeping the mother and baby together at all times if possible, with skin-to-skin as the foundation. Bravo to this whole hospital team for being open enough to question their own habits and being willing to find a new way.

What did you think of this?

"Pregnant in America": My post-dates reaction

2011-03-07T20:12:00.006-05:00

A Facebook friend just watched the documentary "Pregnant in America", and asked me if I wouldn't mind elaborating on my thoughts on the film. Who, ME? Mind elaborating? Have we met?

I'm not going to really do a formal review, per se, of the film because it's been about a year since I saw it myself, so I'll just share some impressions.

No, I didn't care for it at all. Maybe it's because I've been spoiled for all birth documentaries by "The Business of Being Born", which is not a perfect film but it IS a very, very well-crafted one. On top of presenting the information well, they manage to include just enough of the personal narratives to make it relatable without tipping the balance. It's entertaining, it uses humor without going over the top, it's paced expertly.

In my recollection, the couple in "Pregnant in America" - or rather, the filmmaker and father, since he is the central figure - don't achieve that kind of balance in any area. It is about them/him. This in itself could be compelling, as there are plenty of films out there that document a person's life or a particular personal story, but I found the director (and star!), Steve Buonaugurio, to be completely unsympathetic. He's abrasive, contentious from the get-go, and even downright combative at times: he seriously ambushes hospital personnel in the parking lot and tries to interrogate them. He's clearly fancying himself Michael Moore, but with none of the perspective and humor. Say what you will about Moore, he's a talented filmmaker (I happen to be a fan, but I understand if you're not crazy about him or his politics or both).

In one segment, Buonaugurio literally has "The hospital is the enemy" written on a flip chart. Let me take this opportunity to state that he does NOT speak for me, nor for many and I would dare say the majority of the birth advocates I know in real life and online. We have major, major problems in this country's maternity care, but the hospital is NOT the "enemy". I do agree that we overmedicalize many things, including birth, but there are times - yes, including some births - when the hospital is not only not the enemy, but the hero. Most of us know people who have been saved by hospitals in one way or another. A statement like that is an insult both to the people who have been saved and to the many people who work in hospitals and DO care very deeply, and have made their life work out of that caring.

So let's battle about policies with which we disagree, absolutely. But alienating the hospital altogether is a boneheaded, belligerent move. I found him so incredibly abrasive that I found myself wanting to disagree with him on just about everything he said, even though I'm ostensibly on the same "side". And yes, I keep referring back to him and him alone, because his wife, Mandy? Merely a bit player, a backdrop for his big opportunity to create a shocking expose.

There are some positives in the film. I really appreciated some of the interview footage, especially that of Joseph Chilton Pierce, along with mainstays Ina May Gaskin and Dr. Marsden Wagner. And . . . that's about it, really.

I'm most floored by his reaction to his own baby's hospital transfer. The couple did have a home birth that went well, until the baby's heart rate started deviating enough that the midwife advised transfer. The baby is kept for observation, but nothing is ultimately found to be a permanent problem. We're left in the dark as to the details. Buonaugurio is furious about the whole thing, and acts as though he is being persecuted by the NICU stay. I can understand being frustrated and scared, but I will always believe in erring on the side of caution. Can you imagine if the midwife had ignored these signs and it DID turn out to be something serious? The outcome could be tragic. But no, it's all about him.

There are so many other far superior films about the same topic. "The Business of Being Born" is the mack mommy of them all, of course. Again, it has its flaws, but it's worlds apart on a technical level, and it manages to maintain an even-handed demeanor despite coming from a clear bias; some opposing views are represented (even if minimal), and the film's perspective comes from clearly presented facts (some would say oversimplified, and they have a point) as well as from multiple personal testimonies. Buonaugurio just bludgeons you over the head from the start and never lets up. And I think he makes us all look like a bunch of narrow-minded, humorless zealots in the process.

There's a lesser known film called "Born in the USA" (not to be confused with the Marsden Wagner book) that is quite good despite being somewhat dated at this point - overall, though, it's still very relevant. I liked that part of the film focuses on a CNM struggling a bit within the limitations of a hospital setting. There's also a scene where a group of OBs and residents all get together for a peer review session that is quite the eye-opener; I'm actually surprised they allowed cameras in. Give it a watch, just keeping in mind that it's not the most current. I would even recommend "Orgasmic Birth" over "Pregnant in America", despite having some reservations about it.

Finally: Also? WORST TAGLINE EVER. Are you ready for it? "Pregnant in America: A Nation's Miscarriage".

I mean, really. I can't make that kind of crap up.

Happy IBCLC Day! (How timely is that?)

2011-03-02T12:53:00.007-05:00

Today is the day where I thank my lucky stars that I had access to one of the very best IBCLCs out there, Jennifer Tow of Intuitive Parenting Network, LLC. Due to some serious challenges, my daughter Lily would never have been able to nurse without her expertise, immense patience and the support of her nursing support group. (If you haven't read the whole crazy epic, it's laid out here if you have the stamina.)

Our booby-trapped world needs more qualified, educated, and dare I say, real lactation consultants. The impact of bad breastfeeding information and advice (often well-intended but poorly-informed) cannot be underestimated. Take a look at this piece, aptly named "A Little Knowledge is a Dangerous Thing", about a self-styled "breastfeeding specialist" in the UK, Clare Byam Cook. She happens to be a retired midwife, but has no formal training in breastfeeding beyond her personal experience. Read the piece for yourself and cringe - then imagine how many mothers have had their breastfeeding lives impacted by this kind of sabotaging misinformation, without having any idea that this specialist is a specialist just because she decided to call herself one, and that her advice could easily sabotage a nursing relationship. Or better, check out her appearance on a British talk show comparing breast milk to Coke, among other bon mots.

Point being, beware the self-appointed expert. When seeking advice, be aware of what kind of training and experience they have*, or whether it's personal experience and self study - not at all without value, but something to be taken into account. Am I saying one HAS to be an IBCLC to have anything to offer on breastfeeding? Of course not. Mother to mother support has gone on for thousands of years. It's the very foundation of La Leche League, to whom we all owe a debt of gratitude for helping breastfeeding to reemerge after losing it for several generations.

However, those lost generations mean lost connections and often a dearth of accurate information that still affects us today, especially when it comes to addressing more serious conditions. Peer support is a fantastic thing, but being able to refer out to a specialist when needed is imperative. And I say all this from a place where I currently have my own limitations. My training has included basic breastfeeding, but extreme emphasis on the basic. Anything challenging that arises is considered beyond our scope of practice, and rightly so.

Did an IBCLC help you and your baby? Consider giving them a shout-out today.

*While the IBCLC is the gold standard, there are other designations, like the CLE and CLC. that are valuable as well. LLL leaders also go through a solid training.

NEWS! Dou-la-la: Future IBCLC

2011-02-24T19:31:00.003-05:00

Just got word yesterday that I've been accepted into Birthingway's brand-spanking-new lactation program, a 2 year degree that includes enough credits and clinical hours to be eligible to sit for the daunting IBCLE (the certifying exam for all IBCLCs).

ZOMG.

I am so excited, and nervous, and a little worried about balancing it with my new life, but mostly? STOKED. I still plan on eventually pursuing midwifery, likely through the same school, but in order to meet my daughter's needs, I think that this will be better suited to our lives once she is older. I'm thinking that won't be for at least 5 years, bare minimum. Probably more like 10. And in the meantime, I'll be able to work in a field I'm equally passionate about - doing doula work along the way!

Wish me luck! And lots of financial aid . . .

Wordless Wednesday: Babies vs. Toddlers

2011-02-23T11:03:00.005-05:00

Nursing in Captivity: On Bethenny, Gorillas, and Why It Really Does Take a Village

2011-02-17T12:07:00.008-05:00

Photo of lactation consultant in the wild?

Another day, another internet kerfuffle about nursing in public, semi-fondly abbreviated as NIP. Just this morning, a friend of mine was quite rudely told to relocate to the bathroom at a YMCA, despite living in a state where the law is very clear on supporting breastfeeding anywhere the mother already has the right to be.

I was asked to go to the bathroom or locker room to breastfeed, and not nicely. To clarify, there was NOTHING obscene about it either, because I had a blanket covering myself. I even asked the guy if I had a right to be there and if so, then I have the right to breastfeed my child there. To which he replied, "I don't care."

And many of you have no doubt heard about Bethenny Frankel and Rachael Ray dissing "public breastfeeding" (which is in itself a bit of a problematic term, just like 'extended' breastfeeding; both imply a deviation from the norm by virtue of the modifier) a few days ago. Best for Babes reported on the exchange and transcribed this:

Shea: “I’m expecting my second child and strongly thinking of breastfeeding. What are your rules for public breastfeeding, like where is it appropriate?”

Bethenny: “I think, unless you are Pamela Anderson, you shouldn’t be showing anyone your breasts besides your husband and your baby.”

Rachael Ray: “Exactly.”

Bethenny: “I really do. I think you should find a corner, or there is always a back room, I just think it makes other people uncomfortable. When you are a mother you think everyone is ‘in on’ what you’re ‘in on’, [. . .] but they’re not. Because I didn’t know anything about [breastfeeding] until I was pregnant and I was sensitive to the fact that it would have flipped me out. So I think, just keep it private. But definitely breastfeed and do things your own way, but in that one way, I would keep it a little bit private. Whipping out your boob at the dinner table is a good diet tip for everyone else.

So let me make sure I'm clear on this . . . it's okay to show your breasts in public as long as they are of Pamela Anderson quality, but if they're substandard, you should refrain from risking even exposing a tiny square inch of skin to use them for their primary biological purpose? Having a tough time wrapping my head around the logic. I certainly do think breasts can be appreciated aesthetically as part of the female form, but to render them shameful and even nauseating (thanks for the diet tip) in any other context is just ridiculous. As an aside, I wonder what Pamela Anderson herself thinks of this? She's known to have nursed both her boys.

But here's the greater point: I sometimes wonder if the reason this issue is so important is understood by those outside of our inner lactivist circles, which, let's face it, just like any other circles, can become a little echo-chamber-y. I worry specifically when clogging up my Facebook feed with the latest insult to nursing mothers, wondering if I'm annoying that random 8th grade friend I reconnected with. Is she in a similar camp? What was her experience like? Does she just think I'm a rabid, intolerant member of the Breastapo? Why is this all so important?

The issue of nursing in public is not just a matter of supporting the rights of individual mothers and their babies, though this is also vital. The issue of nursing in public is important because nursing in public is important. In itself, it is important. Why? Because to normalize breastfeeding, truly normalize it, we need to SEE IT. All of us. We need to see it as kids, we need to know that's where most babies get their milk, we need to grow up watching our mothers and others mothers and then our friends and sisters and neighbors.

It sounds overly simple. Certainly there is more to it than that, but it is a vital component of the societal change that needs to happen. How's this for timing? An interview with James Akre, author of The Problem with Breastfeeding, that came out last week says it all, and then some:

Q. Can you explain what you mean when you say that it’s not really mothers who breastfeed after all?

A. Essentially, what I’m saying is that it’s not just women who breastfeed, but entire cultures and societies that do – or variously don’t. In other words, cultures and societies as a whole are responsible for producing and sustaining the complex value system that results in more or less breastfeeding by the mothers and children in their midst.

I base this observation on a single universal constant across time and geography: With only the rarest of exceptions, all mothers love their children and want what is best for them. And translating this love into “best” feeding behavior is invariably a culturally determined value. Thus, our best hope of seeing more mothers and children breastfeeding longer lies in transforming the society in which they are born, reared, come of age, beget, birth and nurture.

We often talk about the role choice plays in our lives, which is understandable given how fond we are of describing our behavior in terms of rational decision-making. But where child-feeding mode is concerned – to breastfeed or not – do we “choose” whether to breastfeed based on carefully worked out criteria? In the main, I think not. We respond the way we have learned to respond, which is why I insist that if we want to change a society’s predominant artificial-feeding mode we need to change society in all its structural complexity and not just focus on one or two contributing factors in isolation.

I'm applauding everything here, but I especially appreciate his point in the last paragraph regarding choice. If you read this blog, you're likely a consumer of other social media as well, and of social media that addresses this topic, so you've seen it. You've been there. An article or incident involving nursing in public (or another breastfeeding issue) is brought up, and if enough people are involved, more often than not, the conversation slowly winds around into women talking about their choices, defending them, or explaining them, or talking about how they feel attacked for them. I think that while individual choice is ALWAYS part of the equation, and absolutely always needs to be respected, we sometimes lose sight of the greater context.

So when it comes to nursing in public, when we advocate for it, it's not about trying to force our own standards of modesty onto other individuals for the sake of winning an argument or feeling like a superior mother. It has everything to do with normalizing breastfeeding, helping to return it to its status as the societal as well as the biological norm.

Now, all my pontificating might very well feel like an awful lot of pressure for those individual mothers, and let's be realistic, for all my talk of the collective, we still experience our lives as individuals. A young mother who's just learning to breastfeed and doesn't feel comfortable breastfeeding in public (perhaps the word "yet" can be applied, perhaps not) shouldn't feel guilty for wanting to nurse in more privacy, whether that means using a nursing cover or going to a more secluded spot. But the more common it becomes, the less likely it is she will feel uncomfortable in the first place, and moreover, the more likely it is that she will be able to troubleshoot some basic breastfeeding difficulties should she encounter them. We NEED to see breastfeeding.

Sometimes the sentiment is expressed: "But if breastfeeding is so natural and normal, shouldn't it come naturally?" Some things that are natural and normal also require a degree of learning, most importantly, modeling. Consider the case of the gorilla who had difficulty nursing her first baby.

I first learned of this story when doing my postpartum doula workshop with DONA, but it's also cited in "So That's What They're For". In a nutshell, a gorilla raised in captivity got pregnant without ever being around other mother gorillas and their young. When her baby was born, she just plain didn't know what to do - would hold the baby close to her breast but facing the wrong way, and so forth. The zookeepers eventually had to intervene and artificially feed the baby.

When she became pregnant again, someone had an anthropologically intriguing idea. The zoo contacted the local chapter of La Leche League and had some members start going to the zoo with their babies, feeding them in front of the gestating gorilla so she could see how fellow primates did it. And when her baby was born, she ultimately was able to nurse. Even when she stumbled a bit at first, the LLL taught her by example, and she prevailed. It wasn't by convincing her with studies on the benefits of gorilla milk. It wasn't through guilt or judgement. It was just by example.

If we are ever able to restore breastfeeding as the norm, what of the mothers who, as we often repeat but sometimes are not heard, truly cannot breastfeed? I know it's a sensitive matter, and feel strongly about two points on that: First, if breastfeeding is the norm, then obtaining donor milk or a wet nurse would not be prohibitively difficult or expensive, at least not more so than formula feeding. And second, whether using donor milk or formula (because as rare as galactosemia is, it does exist), it would be understood that if a mother was not nursing, she had a good reason for it, and that mother would be treated with respect and compassion.

O fanciful utopia, I know. But let's keep reaching for it. Continuing with the uncanny timing, another article came out last week, a characteristically great piece from the Academy of Breastfeeding Medicine. Most of the content focuses on workplace support specifically, rather than public nursing, but the title could just as well apply here, too: It takes a society to breastfeed a child.

Only when breastfeeding is normal, when society allows space for this normal behaviour, when children are part of our society and when breastfeeding is part of our society, it is possible for the majority of women to fulfil their own breastfeeding goals.

Protecting nursing in public is not merely about preventing the violation of individual rights, it's about transforming society altogether. Somehow, we need get to a place where we stop treating breastfeeding like it is a special bonus rather than the ho-hum ordinary thing that it is, as Akre puts it; where we can drop the double-edged language of "benefits" and "best" feeding. And for the reasons I've discussed here, nursing openly is a part of that path. When we can finally drop the "public" and the "extended" from references to mothers feeding their children whenever they need, for as long as they need, and just call it breastfeeding, period, we may have finally made it.

Weekend Movie: Delayed Cord Clamping

2011-02-11T20:17:00.003-05:00

Haven't featured a weekend movie in a while, but this is really worth watching. From the always thought-provoking Dr. Nicholas Fogelson of Academic OB/GYN: a great presentation on delayed (a.k.a. non-premature) cord clamping.

Here's part one; click through to YouTube for the subsequent parts (totaling 50 minutes - again, so worthwhile).

At least watch as far as the orangutan baby being born.

Dou-la-la arrives in Shangri-La: It's OUR vagina!

2011-02-08T19:45:00.008-05:00

Oh, hai! Did I not mention that I'd be heading into some pockets of radio silence as I embarked upon a massive move across the country to start life anew as a single mom with my soon-to-be three year old? It must have slipped my mind. Well, belatedly, it's true, though the biggest chores (packing, storing, and driving thousands of miles with the blizzardy cold weather nipping at our heels all the way) are completed. I'll still be settling in for a while.

But here I am, the promised land, Eden, Valhalla, Nirvana. Where else for a birth nerd but PORTLAND, OREGON? The home of Birthingway College of Midwifery. Land of a thousand doulas. Where being TOPLESS at any time, in any place is protected by law, so nursing in public? The very definition of moot. Where every neighborhood has its own farmer's market and home birth midwifery practice. Where cloth diapers are so commonplace that some of the natural parenting stores (note the plural) sell them secondhand. Where the school choices are so bountiful they just plain make my head spin. Where the most glorious bookstore in the country features gluten-free offerings in their cafe. (Okay, that last one's not so on-topic, but you get the idea. The restaurants, the arts, the open space, the natural beauty and mild climate, I could go on and on until you want to throttle me with your envy.)

Where I am thrilled to be raising my daughter.

The country is getting a nice taste of the extreme quirkiness that is Portland through Portlandia, and that "Dream of the 90's" video promo from the show is getting a lot of play. Hilarious and true, but the following song really sums up the feeling of Portland for me.

It's not MY vagina, it's OUR vagina.

That's the mighty Storm Large, not me, but it's how I FEEL, man. Video filmed in and with residents of Portland, including the openly gay mayor in the nightclub scenes (he's the prominently featured, dapper, handsome fellow).

When DNA isn't just DNA

2011-01-26T14:43:00.007-05:00

Me, my mother, and my new baby sister, brought home 1 week
prior, circa nineteen seventy*mumblemumble*.

(That is to say, pretty much never.)

Adoption is always a part of me, but has been actively on my mind more than usual recently, for a few reasons. A few days ago, a blog post that's mostly about egg donation but also gets into the virtues of adopting really got my attention. Then there was the startling and emotional reveal from Oprah that she had found a half sister who had been relinquished for adoption in secrecy (along with the news that Oprah herself had given birth as a teenager; the baby sadly passed away). And finally, a film project currently being produced about adoption by my own "birth sister" has sparked some very thought-provoking discussion.

I read a timely post a few days ago by Christie Haskell, a blogger I respect and like very much, entitled "DNA doesn't make a family". Simple statement, yes? But even seeing the title and the opening lines, even before reading the rest of the post itself, my gut was protesting. No, DNA alone - whatever that could possibly mean - does not equal Family.

But DNA is almost always more than just DNA.

I understand the importance of the nurture portion of the equation. It's what my parenting decisions are based on, in fact. But the ability to make statements like the above is a luxury that only non-adopted people* can make. If DNA did not matter, there would be no such thing as genealogy, no such show as "Who Do You Think You Are", wherein various celebrities are taken on a globetrotting tour of their lineage. Who could ever possibly care about their ancestors if all that mattered were the actions of the people who raised them, period, black and white, end of story? If DNA made absolutely no difference, ancestry would be of no interest to anyone.

Even beyond the ancestral threads of DNA, though, the core experience of adoption is also more than merely biological, animal, anatomical.

The writer of the post in question, Christie Haskell, who publishes on The Stir at CafeMom (and again, also rocks as a person, as a writer, and as an advocate, for the record), opens with this: "Both of my kids are biologically mine and my husband's. There are times I've actually felt guilty that we had our own biological kids instead of adopting, especially knowing how many children out there need homes." I admire Christie very much, and the bulk of her post turns out to have more to do with egg donation than adoption, but adoption is part of the discussion, both in her writing and in the ensuing comments section, and in that discussion I see some very common sentiments about the moral merits of adoption that, based on my experience, I view somewhat critically.

In case you don't know my background, in a nutshell: I was adopted when I was three days old, have had a generally good relationship with my parents, and am fortunate beyond belief to have been able to not only reunite with, but also develop a close relationship with, my birth mother. And not just with my birth mother, but also with her family, including her children, my half-siblings. My younger sister was adopted when I was 4 years old, at two weeks of age.

Recently, the eldest of my birthmother's children, Kate, started filming a documentary about adoption as a class project. It tells the stories of three women, all of whom have had adoption play a significant role in their lives, from three different angles. There's me, the daughter who was relinquished. There's my birth mother, who gave her baby away when she was 16 years old. And there's my sister's friend Ashley, who is currently pregnant and is looking into an open adoption for her baby. (She also interviews the midwife who will be attending Ashley's birth.)

Before we go further, I implore you to listen to this excerpt of Ashley's interview. Yes, it's 95% just her talking, but this is one extraordinary person in an extraordinary situation - I was hanging on every word. Prepare to be equally heartbroken and blown away by her sorrow and her insight.

Women's Bodies, Women's Wisdom from Neil Ransom on Vimeo.

So, returning to the post that got my own wheels turning. During my own interview process, both on film and in outside discussions, Kate and I spent some time discussing the Standard Public Narrative of adoption, the one where adoption is an inherently virtuous act, where adoptive parents are the shining armor benefactors, the baby is lucky to be rescued from what would surely be a terrible fate, and the birth mother is, if anything, an afterthought - an afterthought who is often commended for her courage and/or thanked for her sacrifice, but ultimately doesn't really count. Because DNA doesn't make a family.

I could go on and elaborate on why this is a problematic paradigm, but what I'd end up doing is just parroting much of what someone else already wrote (and blew my mind in the process). Instead, I'm going to quote an old post of mine which includes excerpts from her piece. Be warned, her language is very strong, and she makes this clear by the title itself, "Adoption Sometimes Gets All Fucked Up". Not for the faint of heart, but if you can, I strongly encourage you to read this if you've ever had any thoughts about adoption, from any angle. Starting with my commentary:

I just happened to read a blog this week that shook me to my relinquished core. It was written in response to the recent scandal wherein an adoptive mother "returned" her behaviorally difficult child to Russia, with the note: "To whom it may concern: After giving my best to this child, I am sorry to say that for the sake of my family, friends and myself, I no longer wish to parent this child."

The blogger, Fugitivus, talks more specifically about international adoption, but also about the larger issues that accompany any adoptive scenario, and tackles them with insight and anger and empathy and perception and pulls no punches whatsoever, including 'polite' language: Adoption Sometimes Gets All Fucked Up 101 (consider yourself warned on the cussin').

This is NOT an easy read (in content OR length). But it's an amazingly, *brutally* honest one, full of difficult truths. But I am so grateful that someone is willing to lay some of this stuff out there, stuff I've never seen anyone acknowledge before. And simply as a person who has sometimes thought some of the very things that she reveals to be privilege at work, I am humbled and all the more grateful for having had that privilege called to task. I can own up to it. One snip, though I encourage you grab a coffee and read the whole thing with an open mind:
For our modern, legal concept of adoption to exist, families must be broken. Adoption is not, and can never be, a best-case scenario. It relies upon the worst-case scenario having already come to fruition. From there, you’re working with what is instead of what should be. That should be will never go away. For the entire lifetime of everybody involved in adoption, that should be exists, and it hurts. What is can still turn out to be wonderful, beautiful, incredible, but what is will never be what should be. It is that should be that necessitates education, sensitivity, and trigger warnings, because it never goes away.

When a story like this arrives, the impulse is to compare it to the opposite and compare it to more of the same. The news drags up stories of other Families Gone Wrong, and Families Gone Inspiring As Hell. A false dichotomy is implied: there are adoptions that go right and adoptions that go wrong. But the truth is, behind every adoption is a family that went wrong. . .

My main point here is to warn everybody against coming up with – and expressing out loud and in public – black and white assumptions about how good or bad adoption can be. Adoption is not easily judged as good or bad, because adoption itself is a symptom of something else. If the origin of adoption is the destruction of a family, then nothing that comes from that can be explicitly good. At the point where adoption is a viable option, we have already failed to do our best, and all alternatives are an equal failure of the village that should have been raising this child.

To be more concrete, avoid sentiments such as, “You would rather zie should have…” As in, “You would rather he stayed in the orphanage?” or “You would rather his adoptive mom be arrested?” or “You would rather he be in American foster care?” There is no perfect option; they are all painful, and they are all wrong, because none of them should have to be options.
This really resonated with me. There's an incredible pressure that many adoptees feel to only express gratitude for their situation, with the implied belief that their birth parent was an undesirable person from whom you have been rescued (open adoption is changing that somewhat, in many cases). Expressing any feelings of grief or loss marks you as an ingrate, an "angry adoptee", as Fugitivus mentions, and is seen as questioning the benevolence of one's birth parents. Sometimes even curiosity is unacceptable. Identity is the very definition of multi-faceted: biology is certainly not the only thing, but it is a very real piece of it, and absence of its knowledge can be felt as a loss. Yet wondering about the biological piece of your identity is often viewed as a slap in the face to the adoptive parents. How dare you want to know about these other people? After all we've done for you. Nurture is the only thing that matters, nature plays no part. We're your REAL family now.

She's not saying that adoption never turns out wonderfully, not at all (she addresses that further here, in a post about the above post); my own story has MUCH that is wonderful, make no mistake - but she's talking about it in ways that step outside of what have become the only acceptable storylines about adoption in our culture:
I also understand the desire to keep adoption a positive narrative. There are so many kids in the world who need homes, and putting some of the uglier sides of adoption out there diminishes their chances of finding any home. Of course, I don’t believe in any home for children — I believe in the right home, the permanent home, and I don’t think that home can be found if the pill is sugared so much it’s not a pill anymore. So, it’s a perspective I understand, but now that I’m not a member of the adoption industry anymore, it’s not a game I’m willing to play.

I hope that sheds some light on why I bristle a bit at simplistic sentiments extolling the virtue of adoption that ignore the significant pain that is its very source (all experiences being variable). To mention this pain is frequently being, at best, a party pooper, and at worst, in my case, an ungrateful, angry adoptee.

There is the pain of the mother relinquishing her baby, due in the majority of cases to her circumstances, not out of lack of love or desire for the child. And there is also the pain of the baby - more difficult to quantify, since babies cannot speak to tell us exactly how this affects them, but you only need to look as far as this blog and the internet circles we all run in to find reams of writing on the precious minutiae of how birth affects the baby. Skin to skin, immediate contact, rooming in, initiation of breastfeeding as soon as possible and desired, low intervention - it's all stuff I believe in and advocate and promote.

For so many adoptees (though again, doors are now being unlocked by open adoption situations), none of the above could ever happen. Is this nature being violated, or nurture? I'd say it's both, actually; that how our babies are born is where nurture becomes an extension of nature. In fact, I posit that birth is, potentially, where the synthesis of the two factors begin - and BOTH matter. What does that mean for adopted babies, many of whom were whisked away from their mothers within seconds, literally never to be seen again? It means that nurture must become all the more important, and this has so much value, but I don't think this means we should pretend that the primal wound, the separation of the dyad, didn't happen or doesn't matter.

Point out that it would be better if babies could remain with their mothers, in an ideal world - and people will seriously say "But what about all the wonderful infertile couples out there who can't have children of their own?"

Really think about that. What is being said here? What is being implied, however unintentionally? I know no one in this day and age could actually consciously believe that some women should have to breed on other womens' behalves, in some sort of Handmaid's Tale dystopian nightmare. Nor that babies should have to endure separation from their mothers simply because they are a desired commodity. But that statement diminishes the experience of the biological mother and baby in favor of the couple who wants a baby for themselves.

To reiterate something Fugitivus states but I feel is worth repeating: This is not to say that adoptions don't make wonderful next-best-things in many cases. They do. They did in my case. But I think it's important to respect, deeply, the source and the history.

There needs to be a follow-up to this post. I set out to address all my thoughts in one fell swoop, but as I've already meandered all over the place, I best not try your patience with the next part. Coming up: During my interview for Kate's documentary, she asked me two questions that had me stumped. I rambled on and improvised, but they both deserved much more than I was able to come up with on the spot.

1. You say that in an ideal world, adoption wouldn't have to exist. What would that ideal world look like?

2. What do you think Ashley's baby would say to her, if she could?

To be continued.

*Some adoptees feel differently, too - I don't claim to be the spokesmodel for all of us. But I do know and have read enough about our experiences to be familiar with certain common threads.

Birth Sense on The Impact of Labor and Delivery Nurses

2011-01-10T10:46:00.005-05:00

Every once in a while a post comes along that's just so good I have to write a post that consists of just about nothing but "Read this post!" And so it is with the latest from Birth Sense, a.k.a. The Midwife Next Door, with How a Labor Nurse Impacts Your Birth. Everything she writes is a home run, frankly, but this is a grand slam, I think.

You are pregnant, and excited! You like the idea of a home or birth center birth, but think that, for your first baby, it would be a good idea to be in the hospital just in case there are any problems. After all, you don’t know yet if your pelvis is big enough, or if you’ll have other complications. Maybe with your second you’ll consider a home birth.
You’d like to have a midwife, but there aren’t any midwives with hospital privileges in your area. But you’ve found a great OB who definitely has the heart of a midwife. She even encourages you to write up a birth plan! You’ve toured the hospital labor unit, and the rooms are beautiful. Some even have large jacuzzi tubs to labor in. You’re confident you will have a lovely, home-like birth in the hospital. You’ve done your homework, and are looking forward to a beautiful experience.

Wait a minute. . .factor in your labor nurse. Or nurses. No problem, you think. The nurses have to follow whatever orders the doctor gives them, right? Right?

The conversation in the comments is very much worth reading, too. There is, of course, the expected "But I had/am a wonderful L&D nurse! Therefore this isn't true!" There are ABSOLUTELY some wonderful nurses out there. No question. At Your Cervix is definitely one of them, but she's certainly not alone. If you had one of these, or are one of these, awesome. I say that with zero sarcasm or snark - really, that's awesome. But we all know people whose births were derailed by someone who was not so wonderful.

You can have done ALL your homework, taken the best classes, and selected a truly supportive provider in OB/CNM choice, and even hired a doula - and if you get one of these nurses, you're still going to have to battle for your birth . And who you wind up getting is a total crapshoot. Having a doula IS probably your best defense here, though as discussed, if you have a nurse who is hostile to them, it can actually backfire in some rare cases, I'm sorry to say. I don't mean to diminish the importance of childbirth preparation, using a doula (obviously), or especially careful choice of care provider, but it is still true that whether you go with an OB or a CNM, they are going to be present the least amount of time. This may be different with some CNMs, but despite their best intentions, many others are just as overscheduled and likely to have to be running-in-at-the-last-minute to catch, snip & run as an OB. (Again, there are exceptions.) And in the meantime, the nursing staff can make it or break it.

Many a post or article written about the pitfalls of hospital birth results in commenters sharing their own positive hospital birth experiences. I have no doubt that these stories are true; with some, their hopes and criteria for their birth might be quite different than mine, but with some, they might be quite similar. I firmly believe the biggest factor in those positive stories is the roll of the dice that is the L&D nurses. If you're choosing hospital birth, hire a doula to improve your odds, absolutely, but be very aware of the impact they can have, and follow Birth Sense's advice in her post on how to get your best chance.

Lact-Aid Demo: In which I take one for the team and bare it all for the greater good.

2011-01-04T16:19:00.014-05:00

If you're a mother who found herself struggling with either supply issues or your baby's serious latch issues, you might have needed to supplement, whether with your own pumped milk, whenever possible, donor milk, or, if neither is available, formula. With getting back to exclusive breastfeeding as a goal, if you were getting informed support from a reputable source, you may have been advised to try an at-the-breast supplementer, such as a Lact-Aid or an SNS (the "supplementary nursing system" by Medela) in order to avoid the pitfalls of using a bottle too early, nipple/flow confusion in particular. Finger- or cup-feeding are also frequently recommended by good lactation professionals, and are great in the short term, but some mothers occasionally need to supplement for longer while their supplies are established or their babies suck coordination is improved.

But without adequate instruction - and good demonstration - these supplementers seem devilishly complicated to the point of maddening, and understandably, many mothers get fed up with trying to figure them out. A search online for a decent YouTube video turns up a few Jack Newman offerings. I have the utmost respect for Jack Newman, and the information he makes available is incredibly valuable - but to be brutally honest, these supplementer videos are of little to no use to a mother who is trying to figure the damned thing out, and in particular, how to get their baby latched using the supplementer all by herself, which is going to be the reality for 99.9% of all moms out there. He's doing it all FOR her. It's nice to show it in action, and promote its benefits, but not helpful at all in learning HOW.

Moveover, the way he pushes the tubing into the baby's mouth after the latch is established is completely impossible to do if you're using a Lact-Aid instead of an SNS (which I do strongly recommend; more on that later), because its tubing is so much softer than that of the SNS. This is one of the reasons a Lact-Aid is preferable in the first place, but you MUST put the tubing in at the same time the baby latches on.

So, I'm taking it upon myself. Pretty much literally. Why? Because I believe so strongly in supplementing at the breast whenever supplementing is needed, whenever it is possible. In addition to the way supplementers circumvent nipple confusion, it also makes it possible for mothers who have supply issues to increase the amount of stimulation, and thus production, their breasts are getting. (Regular pumping sessions may still be advisable for a while - please consult an IBCLC about this if it is your own situation - but why not kill two birds with one stone? Pumping and supplementing is hard enough.)

And perhaps most importantly but more challenging to quantify, it IS breastfeeding, and will help to improve baby's latch (again, see IBCLC for advice on how to monitor this) AS you are feeding, whereas with a bottle, even slow flow and/or "breast-like" bottles like the Breastflow, one can only cross one's fingers and hope too much damage to baby's technique isn't done. Using paced feeding and an upright position helps, but it's challenging.

This is also personal: The Lact-Aid made it possible for us to make the transition to the breast after struggling for months, and I firmly believe we never would have made it without it.

An important note: I mentioned that there are two major types of supplementers out there, the Lact-Aid and the SNS by Medela. I have used both, and FAR AND AWAY, I feel that Lact-Aid is the superior product. I write about this in our nursing story, but in a nutshell: It is much, much more user-friendly in several ways, including the way you wear the bags around your neck, the fact that no taping is necessary, and the fact that the tubing itself is very soft and shouldn't disturb baby at all - they probably won't even notice, especially if they're newborns. I started using it when Lily was 4 months old and she was fine, whereas the harder tube of the SNS makes many a baby balk. YES, it's true, I also have ethical issues with Medela, but I promise you I felt this way long before I learned of some of Medela's questionable practices.

Make no mistake: if you choose to use the Lact-Aid, and I sincerely hope you do if supplementing is necessary, there is still going to be a learning curve. I cannot tell a lie: the first few days are pretty much gonna suck. But every feeding is practice, and within a few days, you'll start to really get the hang of it. And in a week or possibly two, it'll be down pat. To be honest, for the first couple of days, I only did Lact-Aid feeds a few times a day, during the times when Lily (and her mom) was at her 'best', i.e. not in the middle of the night. And then I gradually added more Lact-Aid feeds in. You might want to try phasing-in this way, too. Take it one feed at a time.

OKAY. Without further ado, here's a very short video, starring my boob and the baby of one of my clients, with whom I became friendly. I actually had been donating some milk to her privately as a result (she had breast reduction surgery years ago, and like some, though not all, BFAR moms, had to supplement a bit). I also occasionally babysat, and we mutually decided, Well, if she's getting my donated milk anyway, why not offer it from the tap?

Let me be clear: this isn't exactly an official extra service I regularly offer to clients, it just kind of worked out that way. I had worked with them on using the Lact-Aid, too, and one day, after struggling with descriptions and coaching, I said hey, since I've nursed her anyway, would you mind if I simply showed you on myself? She was totally fine with that, and so I did. It was IMMEDIATELY much easier for her. And then it occurred to me that, due to the dearth of existing videos it might be helpful for the internet masses to see as well. She offered up her beautiful little one for me to film (isn't she precious?), and here we are, our other kiddos chattering in the background.

There you have it. Please, in the comments, ask me about anything that needs clarifying, or anything to do with the Lact-Aid. One thing I can think of right off that merits a bit more explanation: If you want to start off the feed with milk from the breast and add the supplementation at the end, which is preferable, you can either delatch and relatch, or, even easier, as I demonstrate, simply start the feed with the tubing pinched off in one of the notches in the body of the Lact-Aid device, then, when babe's sucking slows down, release the tube from the notch and the supplement will start to flow. Oh. and one other note, the bag of milk is hanging kind of low here - you can adjust the strap so it's much higher, and you can nurse in lots of different positions.

Again, feel free to deluge me with questions.

Somehow I knew it would just be a matter of time before, one way or another, I showed my boobs on the internet. But here it's for a noble purpose, right? RIGHT? If it convinces even one mom go with the Lact-Aid instead of a bottle, or instead of tearing her hair out with an SNS - and then giving up and going with the bottle, it is all worthwhile.

*~*ADDENDUM*~*

When I shared this with my own LC, Jennifer of Intuitive Parenting Network, she quoted my statement, "Because I believe so strongly in supplementing at the breast whenever possible, any time supplementing is needed," and said "I am allowed to smile, right?"

I feel it's only fair to point out what she's getting at, which is that when faced with doing this myself, I fought it tooth and nail. I talk about this in the link to our nursing story I posted towards the beginning, but I think it's worth repeating here as well. Yeah, I literally resisted using this for months. MONTHS. My experience trying to use an SNS at about 6 weeks was just so indescribably awful that I desperately wanted to avoid using anything like it ever again if I could. So I kept pumping around the clock and bottlefeeding my milk to Lily. I was using the upright "paced" technique, and I would try various ways to offer the breast before, during, after, and in-between feedings, but I was still bottlefeeding her. And was really making little to no progress towards our goal. Treading water is all it really amounted to, and driving myself nuts with frustration in the process.

Jennifer, and other moms in our support group who had trod the Lact-Aid path tried many times to convince me that the Lact-Aid was going to be a much different, much better experience, and more importantly, because I was at a total standstill in progress with the bottlefeeding, it would likely be the one thing that got me over the hump. And they were absolutely right about both things. If I had tried using the Lact-Aid earlier than I did, I could have started nursing her many weeks, even months earlier than we finally did. No exaggeration.

People often commend me for sticking it out the 5 months it took to get Lily nursing, and I appreciate that and do take it in, but honestly, the stubbornness that I tapped into to get her ON the breast is the same stubbornness that made me resist using the Lact-Aid, and therefore held up our progress much longer than was probably necessary. I just had to get to the end of my rope, my absolute wit's end, the point where I was truly on the edge of just giving up altogether and EPing for her. I was trying to figure out how I could make my peace with this decision, and I realized that the only way I would ever be able to be okay with giving up on breastfeeding is if I truly KNEW that I had tried everything. And the Lact-Aid was the final frontier. If things didn't work after that, then I would be able to forgive myself, knowing that I had done my very honest best. But only then.

So I took the proverbial deep breath and threw myself into it. And it was tough for a few days, but after that, grew progressively easier - and I saw progress. Real progress. Within 3 weeks she was only taking about 2 ounces per day from the supplementer (I used it at every feed, but only released the flow of the tubing when she was starting to slow down). I kept using it for another week, just to be on the safe side, but really, we had made it. We had crossed over. And it was totally the Lact-Aid - and those who convinced me to try it - that did it.

I'm grateful beyond words that Jennifer can now smile at my stubborn ass. If you're facing anything similar to what we faced, any variation on it - look, DON'T follow my example. Don't torment yourself for months, fearing that breastfeeding will be impossible for you, out of fear of some frustrating feedings and having to learn a new technique. Supplementing at the breast is a godsend in the right situation. Just do yourself a favor and use the superior product, commit to overcoming the learning curve (because you WILL), and go for it. I'm rooting for you!

Pop Quiz! From perky to ptosis: what's to blame?

2011-01-03T14:52:00.007-05:00

Which of the following affects the shape and overall appearance of your breasts?

A. Number of pregnancies

B. Age

C. Yo-yo dieting

D. Smoking

E. Breastfeeding

F. A through D, but not E

If you guessed F, ding ding ding, you are correct! This was studied recently, not by a bunch of lactivists, even, but by a group of cosmetic surgeons. Despite the myth that a nursing baby ravages one's bosom of its beauty, it turns out that the most significant changes occur as a result of pregnancy, period, regardless of the infant feeding choices made thereafter.

Age is also a major factor, of course, as gravity gets to all of us, losing and gaining large amounts of weight, which in turn loosens the skin and weakens the Cooper's ligaments which help give the breast its structure, and, possibly most surprising, smoking status is a significant factor as well. For the same reason that smoking causes wrinkles - the breakdown of elastin - smoking contributes to sagging of the breasts, clinically known as 'ptosis'. (Fitting term. Makes me think "ptooie!")

Alas, there is a very pervasive belief out there that breastfeeding, rather than pregnancy or any of the above, directly causes sagging, or otherwise 'ruins' one's breasts. This is especially disheartening when one looks at the perceptions of young women: a survey in the UK found that almost a third of them planned not to breastfeed because they believed it would "ruin the look of their breasts". I don't think it's a stretch to guess that the numbers in the US would be similar.

It's frustrating, to say the least, knowing that the same women who would deny both their babies and themselves breastfeeding due to this myth (especially considering that many of those same women maybe smokers). Add to this the possibility that smoking mothers might also believe that they would be better off formula feeding their babies due to nicotine being passed into their milk. While there is no denying it is far, far better to quit, if a baby IS to be in the household of a smoker, breastfeeding is absolutely still the better choice, as it helps to protect the baby from some of the damage that they would be exposed to regardless. (See Kellymom.com for more in this.)

But I digress. Back to aesthetics. I bring this up because of a debate that took place a few days ago. How exactly do we begin to break down what seems to be a deeply-ingrained belief in this harmful myth? Well, one breastfeeding advcacy site, Dispelling Breastfeeding Myths took the initiative and started a volunteer gallery of post-breastfeeding breasts, issuing a call over ye olde information superhighway for submissions from mothers. And some other breastfeeding advocates, like Just West of Crunchy, took issue with this approach.

Where do I stand? I'm going to go out on a limb and say that I see both sides.

Oooooh, courageous, I know. But truly - I understand that this is a serious problem that needs a really assertive approach to start changing public perceptions, and a provocative approach has a lot of appeal. But I also see that there may be some real problems with execution and interpretation, and it IS sadly true that a lot of the furor about nursing "in public" (used in quotes because really, it shouln't ever need the qualifier) is framed by the opposition as the exhibitionism of mothers who just love to use any excuse to, as the phrase goes, whip 'em out.

Once more with feeling: breastfeeding DOES NOT affect ptosis. Pregnancy does, as does number of pregnancies. Age does. Genetics may. A history of SMOKING does. History of large amounts of weight being gained and lost in general does (sometimes associated with pregnancy, but also on its own). But whether or not a woman chooses to USE her existing expanded breast volume to feed her baby does not change the shape of the overall breast. Now, the nipple, yes, it will become somewhat more drawn out. But sagging? It has been studied and dismissed.

So, as I stated in JWOC's comment thread, can we brainstorm? What are some other ways to get the word out that breastfeeding does NOT ruin the shape of your breasts, and moreover, that smoking is far more harmful? Can we come up with a different provocative way to get this message out?

P.S. If you need some more food for thought and visual illustration, check out this gallery of the ravages of smoking on one's appearance. The pictures of twins are particularly potent.

P.P.S. PhD in Parenting has a good post on this study as well.

Resolved for 2011

2010-12-31T16:43:00.003-05:00

A few posts a-brewing, as always, but today feels like I ought to post something either more reflective or more forward-looking. I think forward-looking wins out!

One of my 2011 resolutions is to use social media more effectively. YES REALLY. So in light of that, I finally got around to creating a Facebook fan-page-type-thing. See over yonder in the left sidebar? ---->

Not much content up there at the moment, but that'll gradually change. Along with connecting me to y'all more directly, it'll make it a little easier to segregate the things I share from my 'real-life' Facebook friends who have little to no interest in all this stuff (there are a few, strangely, I know).

So take a second to "like" me, pretty please, and I'll have a whole slew of new fun for you in the New Year. It might even involve my own boobs. (It's not what you think.) (No, not even YOU.)

Here's to onward and upward, and cheers to you all! See you on the flipside.

Guess what Elmo's thinking about today? Wait, wait, don't tell me . . .

2010-12-28T15:44:00.026-05:00

I'm a big-time NPR fan. "Morning Edition" in the morning and "All Things Considered" in the afternoon, "Fresh Air" whenever I can catch it, "This American Life" on the weekend, I'll even listen to "Car Talk" and enjoy it despite not knowing a thing about cars beyond getting from point A to point B. And one of my favorites is the quirky news quiz show, "Wait, Wait, Don't Tell Me". I love it all, and have given regularly to several stations over the years. Call me a latte liberal if you will, but NPR is most definitely a staple of my life. I feel incomplete unless I've played along with puzzle master Will Shortz on Sunday's Weekend Edition.

So I was surprised and frankly pretty annoyed to hear the following subtle dig against breastfeeding on "Wait, Wait" this past weekend. The guest of the moment, via phone, was Denis Leary, and Sesame Street was the topic:

SAGAL: So we're going to ask you three questions about that landmark kid's show.

Mr. LEARY: Oh boy.

SAGAL: Taken from the new authoritative history of "Sesame Street," called "Street Gang" by Michael Davis.

Mr. LEARY: Okay.
SAGAL: All right. First question, as I'm sure you remember, or maybe you don't, "Sesame Street" was known for introducing kids to real world concepts in a gentle way.

Mr. LEARY: Uh-huh.

SAGAL: One of the notable early examples was an episode in which one of these things happened.
[Doul-la-la note: I already know what's coming.]
Was it A: Mr. Hooper's grocery store was vandalized? B: folk singer Buffy Sainte-Marie breastfed her baby right in front of Big Bird?

(Soundbite of laughter)

SAGAL: Or C: special guest star Elizabeth Taylor explained to Grover why she had had four different husbands?

(Soundbite of laughter)

Mr. LEARY: Oh man, I'm going with A.

SAGAL: You're going to go with A?

Mr. LEARY: Yeah.

SAGAL: It was Buffy Sainte-Marie.

Mr. LEARY: I can't believe it.

(Soundbite of laughter)

Mr. LEARY: Really?

SAGAL: Yeah, she really was. She was a guest on the show for the first five seasons.

Mr. LEARY: Really?

SAGAL: They went through her pregnancy and the birth of her baby, off-screen I hope. And so she breastfed him on camera and Big Bird asked about it and eventually said, "You know, that's nice" said Big Bird.
[Dou-la-la notes: more laughter and disbelief here.]

Mr. LEARY: I can't believe Buffy Sainte-Marie breastfed her...

SAGAL: It's true.

Mr. FELBER: I can't believe Big Bird was okay with it.

And cue more laughter, and then they moved on.

Now really, I don't bring this up to bitch the regulars or the hosts of "Wait Wait" out. I really do love the show, I have nothing against Denis Leary, and might even, if pressed, admit to having a bit of a geeky audio crush on Peter Sagal, rivaled only by my other radio boyfriend, Ira Glass. I wouldn't say I'm furious about it, either - irritated, yes, but it was just a passing exchange. Perhaps it's even a bit of a stretch to call it a 'dig', maybe it's nothing more than a bit of juvenile squeamishness. I'm not calling out the lactivist dogs, asking for a boycott or even a letter-writing campaign. It's not like they're working some anti-breastfeeding agenda, it was just a thoughtless moment. But thoughtless as it was, it's also a revealing moment, and really goes to show, despite some higher initiation rates, just how backasswards we've become about it all today.

Here's the shocking segment:

Despite rendering Leary, Sagal, Felber et. al. shocked at the thought that Big Bird might be "okay" with observing a mammal feeding her young as nature designed, this was actually not the only time this was included on Sesame Street. The producers and writers apparently thought it was important and relevant enough to children that they included it again, years later, when principal actor Maria had her own baby, and they delivered essentially the same scene, with a child as the inquisitive party rather than Big Bird:

Now, I don't have the media archives to determine whether or not either of these caused waves of shock or outrage or anger or disgust among the parents of decades past. I've never heard of any major letter writing movement, and if a few viewers were disgruntled, I haven't heard anything about it. (That doesn't mean it didn't happen, so if anyone out there with access to Lexis Nexis wants to do me a favor and run some searches, I'd be grateful.)

But imagine that either Buffy or Maria did such a thing on Sesame Street today. What do you think would happen? How might the public react? With the advent of the internet, would the blogs and boards light up with frenzied debate over whether such a thing were appropriate? Would massive boycotts ensue? Would lawsuits be threatened and FCC fines be levied?

I would venture a pessimistic guess that all of the above would probably take place (note the furor over Katy Perry's cleavage earlier this year), and that would be only if the Buffy/Maria segment were re-broadcast or reproduced: mother nursing baby, unapologetically but still quite discreetly. Can you imagine if it were taken a step 'further', as it was in yet another 70's children's show?

Because on Mr. Rogers, there was once an absolutely beautiful segment on all kinds of animal mommies feeding all kinds of animal babies: kittens, calves, puppies, piglets, and humans. And in that segment, we not only see a human mother nursing, with the baby's head in the appropriate place, but we see her areola.

And not only her areola, but her NIPPLE.

And not only her nipple, but her nipple DRIPPING MILK.

And this happens twice!

Unfortunately, copyright restrictions have since made the video unavailable online, though one intrepid viewer managed to catch part of it. I prefer the full video, putting the humans in context with all other animals, and with Mr. Rogers' sweet introduction and closing words. But in a pinch, we at least have the most SHOCKING images, so I can at least prove I'm not making it up. Warning: aforementioned dripping nipple included:

Sorry if I've offended your delicate/momentarily juvenile sensibilities, Misters Sagal, Felber and Leary, should you happen to chance upon this - Mr. Rogers seemed 100% fine with it, in his quintessentially gentle and loving way.

Being me, of course, I wish PBS were in a position to bring these kinds of scenes back, though I realize today's kid requires a little more razzle-dazzle; say, in the form of a certain Red Menace (as he's known in our household). So, should any contemporary Sesame Street writers stumble across this, consider it a spec script for a new segment of Elmo's World (though those of you with littles know full well that once you know the format, it pretty much writes itself).

ELMO'S WORLD TITLES, OPENING THEME.

ELMO

Hi everybody! Welcome to Elmo's World! Elmo's so glad to see you. And so is Dorothy! Say hello, Dorothy!

[Close-up on Dorothy's fish bowl. Elmo giggles.]

ELMO

GUESS WHAT ELMO'S THINKING ABOUT TODAY? Ya-da-da-DAH!

Nursing. You know, nursing!

[Elmo opens the door to see an image of a human mother nursing her baby. Kazoo theme plays over montage of various mothers nursing their babies in various positions. Newborns, in slings, twins in the football hold, a mother pumping and then a baby being bottlefed the expressed milk, toddlers, closing with an image of a happy baby delatching with a milk-drunk grin.]

ELMO

Elmo wants to know more about nursing. Let's ask Mr. Noodle! Oh Mr. Noodle!

[Window shade flies up to show Kristen Chenoweth in Noodle Family costume.]

ELMO

Oh look! It's Mr. Noodle's sister, Ms. Noodle! Let's ask her. Hi Ms. Noodle!

[Ms. Noodle waves enthusiastically, cuddling a baby doll.]

ELMO

Ms. Noodle, how do you nurse a baby?

[Ms. Noodle furrows her brow, then gets an idea. She pulls out a cell phone, makes a call, then goes to the door frame accept a pizza delivery. She takes out a piece and holds it to the baby's mouth as Elmo and his chorus of kids protests.]

ELMO

No, no, Ms. Noodle, that's not how you nurse a baby! Babies need milk. Try it again!

[Ms. Noodle mouths the word "Milk?", then lights up again and exits. She reenters leading a cow on a rope, lays the baby doll beneath the cow, and begins to milk it, aiming the milk into the baby's face. Elmo and the peanut gallery protests again as the sound effect of a baby starting to cry begins playing.]

ELMO

No, not like that either, Ms. Noodle! The baby wants milk from her mommy, not a baby cow's mommy! Keep trying!

[Ms. Noodle picks up the baby and tries to comfort her as she cries. In the process, the baby doll "roots" and eventually latches on. A look of happy understanding passes over Ms. Noodle's face as Elmo and the kids cheer their approval.]

ELMO

That's it, Ms. Noodle! You did it! Yay!

[Ms. Noodle sits back in a a rocking chair, happily nursing away. The shade closes.]

ELMO

That was neat. She figured it out! Now Elmo wants to ask a baby. Hi baby!

[Camera pans left to a gurgling baby held in his mother's lap.]

ELMO

Baby, how do YOU nurse?

[Straight to the point, baby latches on and demonstrates. Elmo laughs.]

ELMO

Thanks baby! Now Elmo wants to learn more about nursing. How can Elmo learn even more?

[Close-up on Dorothy, with a statue of a Madonna and child in her bowl.]

ELMO

Oh, that's right, Dorothy! We can ask the computer!

[Computer bounces around, and then opens up an email to Elmo from a 7 year old fan, with a shot of her riding her new bike with training wheels. She tells Elmo about her baby sister who was recently born and had to use a Lact-Aid supplementer for a little while until her mama's milk came in all the way. "It was kind of like using training wheel for my bicycle!" she says. "And now my mama can nurse without the Lact-Aid, and I can ride my bicycle all by myself." Closing shot shows the young fan riding down the street.]

ELMO

Wow! There's all kinds of ways to nurse a baby. Do you think we can find out even more? How?

[The television starts bouncing around.]

ELMO

Oh yeah! TV! Let's see what else there is to learn about nursing!

[The usual TV cartoon segment music begins playing, with the oddly brusque, matronly woman narrating. She tours a zoo, showing all the baby animals being nursed by their mommies, and ends by singing a song about all the animals sleeping with their mommies close by.]

ELMO

Aww, that was so sweet. Elmo sometimes curls up with his mommy too!

[Knock on the door]

ELMO

Hey, someone came to visit Elmo! Let's see who it is!

[BABY BEAR, his little sister CURLY BEAR, and MAMA BEAR enter.]

BABY BEAR

Hi Elmo! I understand you wewe cuwious about nuwsing! I though maybe my Mama Bear could answer some of your questions!

MAMA BEAR

Sure, Elmo, ask anything you like!

ELMO

You nurse Curly Bear?

MAMA BEAR

That's right. It's really good for both of us. [Curly begins nursing.]

ELMO

Is it hard to do, making milk?

MAMA BEAR

It can take some getting used to, and sometimes mommies need some help from other mommies, but once you get started and learn how, mamas' bodies just know how to do it!

BABY BEAR

And she used to nuwse me, too!

ELMO

But Elmo doesn't understand. Elmo's seen Papa bear giving Curly Bear a bottle!

MAMA BEAR

Well, he does, sometimes. I can't always be with Curly, so I pump some of my milk ahead of time and store it in a bottle so Papa Bear can feed her too. That way Curly always has healthy mama's milk to eat!

ELMO

That's amazing! Elmo loves nursing.

BABY BEAR

Me too!

CURLY BEAR

(delatching): Me three!

[Everyone laughs.]

ELMO

Yay nursing! Hooray for nursing! Let's all sing The Nursing Song!

[The piano bounces out, and they all jauntily sing "Nurse nurse nurse! Nurse nurse nurse!" to the tune of "Jingle Bells".]

ELMO

Time to go now! Say goodbye Dorothy!

[Close-up on Dorothy's bowl.]

ELMO

Good-bye everyone! Bye!

[Closing music.]

~Fin~

I can dream, can't I?

* Photo of Lucy Lawless is from when she was poster woman for World Breastfeeding Week. (Can you dig the potency of Xena's breastmilk?)

Away in a manger, no Hooter Hider for his head.

2010-12-24T15:33:00.004-05:00

Merry Christmas to all who celebrate!

Some (semi) good news, and some pretty danged bad news

2010-12-21T15:51:00.003-05:00

Two items hot off the presses this week. Which should I start with? The (somewhat) good news, you say?

First, some research just emerged which relates to both birth and breastfeeding. The impact of IV fluids - mother's intrapartum fluid balance - on a newborn's weight loss had been studied, and a connection was found between mother who received more than 200 ml per hour and newborns who lost an "excessive amount of weight" (up to 10 percent is normal and to be expected) in their first days. It turns out that, as many have suspected, babies can take in some of that excess IV fluid themselves.

How does this impact breastfeeding? Neonatal weight loss that is greater than the norm frequently prompts formula supplementation, when in fact feeding issues have nothing to do with the excessive drop in weight; baby is simply shedding the extra fluid. Early formula supplementation is a major booby trap, so it's good to have a solid basis for avoiding it whenever possible.

It's also worth noting that IV fluids often have a second significant impact on the new breastfeeding relationship: mothers who have received IV fluids can also become extremely engorged, beyond the normal fullness of mature milk 'coming in', making it (a) much more difficult for baby's little mouth to latch on, and poor latching can lead to both inefficient milk transfer and degrees of discomfort for the mom that range from irritating to excruciating; and (b) severe, if temporary, discomfort for the mother.

This is not to say that there isn't a place for IV fluids, when necessary. But though it may not be thought of as a serious intervention in the way that we think of, say, internal monitoring or episiotomies, it is still an intervention, and should be considered carefully, both pros and cons. We now have evidence of another significant con, and it should be factored into the decision-equation.

And, the bad news. Up from 2008's figures, the U.S. cesarean rate climbed once again, from 32.3% to 32.9%. Yup, that's a new all-time high, rising nonstop for 13 years running. Unnecessarean has all the news and blues about that over yonder, check it out to commiserate and lament.

A Paradigm Shift is Afoot: from "combination feeding" with formula to informed milk donation

2010-12-01T18:38:00.001-05:00

There has been a rather seismic movement afoot (pun intended) in the online breastfeeding community, as it were, over the last few weeks. If you're not in the loop, the gist of the situation is that a breastfeeding advocate named Emma Kwasnica has galvanized a Facebook-centered milksharing network online: Eats on Feets. Such a thing isn't 100% new, as a site called MilkShare has been working at the same for a while now, and those in the know might be able to find donors on boards like Mothering.com (I've unloaded my freezer to several strangers on MDC myself). But this is taking flight like nothing has before, and I think it has everything to do with harnessing the power of Facebook and social networking in general, and how integral it has become to many of our lives.

Other bloggers have done a great job detailing the phenomenon that is Eats on Feets, such as The Motherwear Breastfeeding Blog and One of Those Women. There's much to discuss, including the (over)reaction of the Canadian government - and I won't try to reinvent the wheel here; check out their posts! But this awesome recent development ties into something I've been struggling to write about recently anyway, which is the matter of supplementation, which, in our current Western society, is set by default to formula.

Some refer to the choice to supplement (often electively, but sometimes out of necessity) as "combination feeding" or "mix feeding". It sounds innocuous enough, right? I've heard it referred to as "the best of both worlds", and despite the crystal-clear recommendation from both the AAP and the WHO to breastfeed exclusively for a minimum* of six months, the number of women who breastfeed at all are combination feeders. By a huge majority.

Initiation rates have gone up in most areas (though there's still room for improvement), and this is a positive thing. But after even a few weeks, the number of women exclusively breastfeeding drops dramatically. Check out the CDC's latest report card: By 3 months, the number of women exclusively breastfeeding is only 33%, and by 6 months . . . 13.3%. The numbers for continued non-exclusive breastfeeding are a little bit better, if only by comparison to those exclusively breastfeeding: by that same 6 month mark, 43% are breastfeeding in combination with formula.

Let's look again from the flipside: by 6 months, 86.7% of all American babies are consuming formula.

There has been a lot of great material written about why our numbers for breastfeeding are so low. Many advocates and authors of such pieces focus on the fact that real world support is still so deeply lacking. Our initiation rates are high - should be higher, again, but still, 75% is better than it used to be - and this tells us that the message that Breast is Best has definitely gotten out there. And then, when challenges arise, it is pretty much luck of the draw whether or not the support you get will be enough to allow you to continue. Were I living in a different area, and didn't have access to the excellent IBCLC that I did, I myself would not have been able to breastfeed. It's no hyperbole. I would have been another casualty of this booby-trapped system.

But as I said, wonderful articles and posts abound on this topic. I want to think more about combination feeding and why, and how, it is so acceptable, commonplace, and even encouraged - including encouragement by professionals, despite the unmistakable consensus of their own organizations on exclusive breastfeeding.

Here's my loose hypothesis: the prevalence of combination feeding is yet another result of the well-intentioned but deeply flawed "Breast is Best!" message backfiring. How so? It's tricky, but think about statements like "Every little bit counts - it's liquid gold, after all!" and "Any breast milk is better than none!" Such sentiments abound. Are they true? Well . . . yes. But I think there's a perception out there that breast milk is so powerful that even one feeding a day is enough to confer its benefits. Breastmilk, an omnipotent panacea of mythical, even supernatural proportions - surely it will cut through all the well-documented risks of commercial, artificial infant milk. Right?

IS some breast milk better than none? Well, I'd be hard-pressed to say no. Yes, it is. But saying "yes" is so far from saying that some breastfeeding is even close to the same as exclusive breastfeeding. The immunological benefits of breastmilk are some of its most powerful, the introduction of formula actually negates these very benefits. Look at this recent study from BMJ, examining the protective effect of exclusive breastfeeding on infections in infancy. It concluded that "Partial breastfeeding was not related to protective effect."

And here's another piece on a larger study released earlier this year:

"Significantly, the study showed no health benefits for infants who received formula along with breast milk, even when partial breastfeeding extended a full six months . . . . None of the antibodies found in breast milk are able to be duplicated in manufactured formula, resulting in a significant lack of protection for formula-fed babies against infectious diseases. Formula is unable to match the complexity of breast milk, the consistency of which adapts over the first few months of a baby's life, changing to fit the baby's needs as he or she grows."

Allow me to repeat that - I apologize for belaboring the point, but I want to make sure it's not missed: "The study showed no health benefits for infants who received formula along with breast milk, even when partial breastfeeding extended a full six months."

Pretty far from "Every little bit of liquid gold counts!", isn't it? Why is this? If breast milk is so powerful - and it IS; believe me, I'm not saying it isn't the very definition of a vital substance - then how can the introduction of a little formula negate it? Much of this has to do with the effect it has on our intestinal, or 'gut' bacteria. This IS where our immune system is centered, and what takes place when foreign proteins are introduced is significant. If you have never read The Case for the Virgin Gut, I implore you to do so**. From the piece:

"When babies are born, they have sterile gastrointestinal tracts. If babies are exclusively breastfed, they develop a natural healthy gut flora. (When I speak of the gut, I mean Baby's insides where the food goes until it hits the diaper.) This means that the major flora in breastfed babies has reduced numbers of bad types of bacteria and increased numbers of good bacteria. Formula-fed babies have increased numbers of bad bacteria, leaving them at more risk for illness.
Having knowledge of the importance of what is normal for newborns inside may help some mothers in making a decision about whether or not to supplement their babies for convenience in the early weeks. Very few mothers know how totally different babies are on the inside when artificial food is added to their diets. Some mothers add the formula in the hopes that their babies will sleep longer at night. Knowing that only one bottle a day can totally change the protective environment of their baby's gastrointestinal tract may give them pause to reconsider before instituting this practice.
The case for the virgin gut is a valid one. There is much research to support avoiding supplementation if at all possible. A huge increase in diarrheal diseases occurs in babies who do not have optimal "intestinal fortitude," which is only possible with guts that have never been exposed to infant formula."

Yet again, something touted as the best of both worlds is revealed to not be the best of either, something I've blogged on before - it's practically a series.

Where does this leave us? Despite the overbearing harpy cliche, I'm coming to feel that breastfeeding advocates, including lactivists and educators as well as some medical professionals, ARE extremely sensitive about pressuring new moms, and want so badly to be reassuring and accepting and above all, non-judgmental . . . so much so that they/we end up understating the risks of formula feeding. Do what you can. Of course some breast milk is better than none. It's okay. You do what you can.

It's a conundrum. We DO need to be supportive. We DO need to be inclusive. We DO need to be non-judgmental. But we also need to make sure that mothers have all the relevant information, all the facts, in order to make empowered choices. Choice, yes, but informed choice. We need to not undermine parents right out of the gate by telling them that (as I witnessed from a professional firsthand) The breastfeeding bag they give you at the hospital has a bottle of formula in it, and that's there to tell you that hey! it's okay to do both! You don't have to choose!

As anyone reading this blog is likely aware, in addition to the risks for the infant, supplementation not done carefully leads to diminishing supply, and if the mother is not aware of how this works, mom's assumption is that something is wrong with her, that she "just couldn't make enough milk", and the slippery slope to total cessation of nursing has already begun. There has to be a way of being compassionate and inclusive without saying things like, as I have also heard with my very own ears from a pro, "If you want to nurse for 6 weeks and then start using formula, that's okay! Whatever works for you! If you want your husband to give a bottle of formula overnight so you can sleep, that's okay! Whatever works for you!"

But there ARE cases, as we know, where supplementation IS necessary. There is no denying that. We want to reduce these cases, but there absolutely are times when it is needed, such as moms with hypoplasia/IGT, or with some BFAR moms, for instance. And here's where the paradigm shift comes in.

It's time that donor milk becomes a real possibility for mothers.

Despite formula companies spending millions to convince you that their product is the "next best thing" to human milk, the WHO designates formula as fourth best - dead last, in other words. The first choice is simply mother breastfeeding her own child, and then pumped milk from the same mother to her own child. Then, third best, is donor milk from another mother, not formula. Yet when supplementation proves to be necessary (either temporarily or long-term), the default in our society is to go directly to formula. Then begins a cycle of figuring out which formula is less difficult for the baby's system. Do we try the "gentle" variety? What if milk is the problem - do we do soy? If that's not working, on to the hydrolyzed and painfully expensive kinds. What if donor milk was a viable option? What if it wasn't just a vague possibility - difficult to pull off in the short term and even harder to do over any substantial length of time - what if donor milk was, instead, the default?

Now, milk banking has been around for a while, and while I think it's basically a good thing (as in HMBANA), to say that it's prohibitively expensive for most families is an understatement, and can be difficult to impossible to get unless your child is ill. Doctors can prescribe it and SOME insurance companies are starting to cover it - but we're a long ways from this being the standard. There's always talk of making banked milk more plentiful and accessible (as the Canadian government stated in response to the growth of Eats on Feets), but that time has definitely not yet arrived.

Doesn't milk sharing and direct donor milk (as opposed to the pasteurized kind one can gets from banks) carry some risk, though? Yes it does. There are diseases that are communicable via breastmilk, and it's absolutely wise to vet the donor in whatever way both parties feel comfortable, wether there's a formal or an informal process in place. I've given milk directly to moms who knew me and trusted me, and have done a little bit of wet nursing, but to one mother who found me via MDC, I submitted a medical record of my most recent blood workup, which I thought was totally fair and the other mom seemed satisfied by this. It still involves some trust, but the risks taken in accepting donor milk must be weight against the risks of infant formula. PhD in Parenting has already done a bang-up job of doing just that (though of course every parent has to make this comparison on their own, as she illustrates).

As someone who participated in a nursing support group where milksharing was common, and donated literally gallons of my own milk to several babies, I am so pleased that since mothers are frustrated with the admirable but glacial progress of milk bank accessibility, they are making their own informed choices, taking this into their own hands - and feets.

*This is something that gets lost in translation, telephone game style. I have heard and read more than one mother claiming that the recommendation is to breastfeed for six months, period. They literally interpret the recommendation -whether second or third or fourthhand through peers, or not explained well enough by professionals, or misread in a book - as endorsing breast feeding for six months and no longer.

** Another helpful link on the subject: Just One Bottle Won't Hurt - Or Will It?

Have you ever been experienced?

2010-11-14T17:00:00.003-05:00

I got the following email and although it's a quick reply, I thought I would share it with y'all (with Stephanie's permission), since some others might be curious too.

Hello!

I have been a stalker on your blog for a while now, and I am just now getting the courage to write you. My name is Stephanie Fritz. I am currently a senior in the Sociology program at the University of Indianapolis. Over the past two years I have become increasingly fascinated with the reproductive rights of women, and alternate services provided to women during the pregnancy process. I have become increasingly fascinated with the concept of home birth, midwifery, and doula services. I am far from becoming pregnant or even considering having a child, but I have begun considering doula training. I have looked into the different programs for Doula training out there (particularly DONA), but I wanted your opinion on where I should start to find out if this field is truly for me?

I guess my main concern is the viability of it as a career. How are you faring? Also, how did you fall into this?

Thank you!

Stephanie Fritz

Why did I bold that one sentence? I wanted to respond to this part first and foremost. The biggest piece of advice I have for Stephanie, far more important than sorting through the various programs and certifications and reading materials, is to ABSOLUTELY go for it now! The fact that you haven't given birth, in my opinion (I'm curious to hear others' opinions too), is really not much of a disadvantage at all. Doulas attend all kinds of women having all kinds of births, even if they are mostly in the hospital, realistically speaking.

I have had one birth of my own, and even if I only attended all natural home water births, they would still all be different. Mine was 13 hours in active labor. Very different than a 29 hour labor. Very different from a 5 hour labor. Yes, I know what 'a' contraction feels like . . . but that means I only know what MY contractions felt like. I have no idea what a a posterior baby and thus the dreaded "back labor" feels like from the inside. I didn't have to transfer, no resuscitation was necessary, I had an extremely long pushing phase, there are all kinds of things I didn't experience firsthand. You catch my drift: having had ONE birth isn't all that different from having NO births, in a weird sort of way.

But my main point to you, Stephanie, is that having no children at the moment is actually a huge, HUGE advantage, logistically. It might not seem like a big deal to you now, because you've never had to think about it, but trust me, having to arrange for child care in order to attend births can be a massive, stressful undertaking. There are work and class schedules to deal with, and I've so been there and know what a whopping headache that can be, but it's still more workable than a doula with kids (unless she's independently wealthy, I suppose). To illustrate that, I should remind you that I'm actually still IN training for the labor support portion of my doulahood, largely because figuring out how to attend the necessary number of births for my certification is ridiculously complicated due to child care issues.

I could kick my twentysomething self for not having started this process years and years ago, when I first became aware of the concept of a doula. DONA itself was newish, and within a year. three of my closest friends all got pregnant. I had always been fascinated by birth, and now my interest kicked into high gear. I learned along with them, reading the Sears books and "Natural Childbirth the Bradley Way" by Susan McCutcheon. I had plenty of dancing left to do, but definitely felt a strong pull towards birth even then, and one of the mamas-to-be was the first to suggest doula work. I considered it, and ultimately decided against it for the time.

I hate to say I regret the decision, since regret is such a waste of energy, and it's true that I did have all kinds of other experiences . . . but it really would have been a good choice. So I say if you're feeling that same kind of pull - go for it! Especially now.

Which organization? I can't say enough nice things about toLabor's workshop. I did DONA's postpartum training and have been working through CAPPA for my childbirth ed, and I think they all have their strengths, but toLabor was truly a transcendent experience. Do consider it! Reading recommendations: there are of course tons of great books out there, my favorites of which are over there on the right, but I'd prioritize the latest edition of "The Birth Partner" as well as "The Doula Book" by Ananda Lowe.

As for making a career out of it? I'll . . . have to get back to you on that. (See above re: logistics and childcare.)

My first encapsulation, with bonus Buffy reference. GRAPHIC!

2010-10-25T10:09:00.016-04:00

(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.)

A note on intactivism

2010-10-18T10:22:00.006-04:00

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.

Check out this well-written intactivist's response to the situation.

My Babymoon Bake: A perfect first meal for a new mama!

2010-10-06T16:48:00.007-04:00

Many of you know I have another blogging life - the food blog I share with my mom, Fab Frugal Food! Today, worlds collide.

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.

[This will be my first "cross-posting" - I'm sharing this post on Fab Frugal Food as well!]

-- posted by Anne

Weekend Movie: A Breech in the System

2010-10-03T10:25:00.003-04:00

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.)

Anatomy and Physiology: a Birth Doula Training

2010-10-01T00:09:00.012-04:00

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.