Thursday, February 24, 2011

NEWS! Dou-la-la: Future IBCLC


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 . . .

Thursday, February 17, 2011

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



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.

Friday, February 11, 2011

Weekend Movie: Delayed Cord Clamping

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.

Tuesday, February 8, 2011

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

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).

Wednesday, January 26, 2011

When DNA isn't just DNA

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.

Monday, January 10, 2011

Birth Sense on The Impact of Labor and Delivery Nurses

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.