Friday, July 31, 2009

Third time's the charm!


Cesarean vs. VBAC: A Dramatic Difference from Alexandra Orchard on Vimeo.

This is one of the best chronicles of a VBAC - specifically a HBA2C - I've ever seen. This does include graphic footage of the two surgeries, which is a rarity now, as the legal climate prevents filming these days. So just be warned if you're squeamish.

Be sure to watch all the way to the mom's letter to her doctor at the end.

Thursday, July 30, 2009

License to Nurse

On a regular basis, stories pop up in the news, on blogs and on message boards, about the latest mother asked to cover up or move to the bathroom or simply cease and desist breastfeeding her baby in a public area. Yeah, I know, it staggers the imagination that in 2009 this still happens, but it does. Anyway, the most recent incident that I know of was at an IKEA store in Brooklyn. I'd call for a massive nurse-in, since I could use some new shelving and maybe some glassware, it really does appear that this is not at all the policy of the company, just an isolated ignoramus of an employee.

But if you do find yourself faced with some busybody who's not familiar with your legal right to nurse anywhere you need, it would be handy to have one of these snazzy cards printed out. It breaks down the law state-by-state (and the overwhelming majority of states explicitly support your right to nurse ANYWHERE you have a right to be, period). So carry this in your wallet and flash it at any naysayers!

Pardon the crappy cameraphone shot, I just thought a visual would be nice.

"Hi, my name is Anne, and I'm a Birth Junkie."

Everyone else: "Hi, Anne!"

I found this revealing If you _____, you might be a _______ list from Woman to Woman Childbirth Education (circuitously as usual, via Enjoy Birth's response in kind on her own blog). So I'll follow Enjoy Birth's cue with my own answers in bold:

You might be a Birth Junkie…

  • if you blog about birth (more than just your own birth for historical purposes) or if your birth story is at least two pages long Check and check.
  • if you failed math, but can quickly convert grams to pounds and ounces (approximately) Not quite there yet, but it's a goal. I did get my only D ever in math (that memorable report card was 4 A's and a D), so -partial credit?
  • if you can say “vagina” in a sentence without blushing Oh please. Of course.
  • if you can correctly use “os” in a sentence Are you kidding? I love the wizard of os! (Okay, that was horrible. Yes, I can. Ahem: The opening to the cervix is called the os. See?)
  • if you can’t remember who won any gold medals for the US in the last Olympics, but you know US statistics for maternal and infant mortality, and the national C-section rate (bonus points if you know your local hospital(s) epidural, induction, and C-section rates) — if you’re not from the US, insert your own country Last I checked we were at a 31.8% national average c-section rate, and were about 27th on infant mortality (i.e. dead last in the industrialized world). Don't know the local rates at the moment. As for the Olympics, I heard something about some bong-smoker . . .
  • if you can list the mother-friendly and baby-friendly guidelines from memory, and know which hospital in your area (if any) fulfills those goals Not totally from memory, but I could probably do a fill-in-the-blank. I do remember hearing that the local ones do NOT pass muster, sadly.
  • if you can recite the midwifery model of care Well, I could pick it out of a lineup.
  • if when you’re discussing something related to birth, you receive those polite but puzzled looks… right before your conversation partner moves away I totally recognize the glaze-over, usually shortly before the inching-away.
  • if you see a circle about 4″ big, and you think “that’s fully dilated” I will now!
  • if you have birth-related artwork somewhere in your house (includes placenta pictures and belly casts, etc.) This I do not, but I regret it.
  • if you currently have or ever did have a placenta in your freezer I have one right this very moment. Plus a lotta breastmilk.
  • if you have ever consumed placenta Nay, but next time, if there is one, I'd like to do the encapsulation thing. Chowing down on placenta chili is just a wee bit much for me, though I would consider it my doula honor to make it for a client! My veggie chili did get me onto the Food Network briefly, after all. (This is actually true.)
  • if you have a model of a pelvis, uterus, or some other female organ Dang it, no, but I totally covet one.
  • if you always keep honey sticks on hand It's already on my list for my doula bag. Plus my homemade "Larabars".
  • if you’ve ever gone to the bookstore and hidden “What to Expect When You’re Expecting” (or some other similar non birth-junkie book) and replaced it with some pro natural-birth book Okay, I haven't actually *hidden" WTEWYE, but I have moved "Pushed" to more prominent spots. I HAVE hidden "Babywise" though. And I'd do it again! Though I now think placing little cards inside with the link to is probably the best bet. Making up those cards has been on my to-do list for a while.
  • if other women get tired of telling you their birth stories before you get tired of hearing them Oh yeah. Especially on my favorite message boards.
  • if you have a library (or would love to acquire one) of birth-related books and videos This I do.
  • if you have 10 or more birth-related videos saved to your account on YouTube Not quite 10, but almost.
  • if you appear on any YouTube (any internet) video talking about birth, in labor, or giving birth (picture montages count) Not really, though there is a picture of me looking exasperated in the birth tub out there in a few spots.
  • if at least half of the blogs you regularly read are birth-related Oh, way more than half! It's either birth, cooking, or hilarious cakes gone wrong.
  • if someone tells you she “had to have” a particular intervention and you can come up with several alternatives that were never mentioned to her (bonus points if she doesn’t get mad or defensive) I am not quite so bold yet. I'm very good at sharing that info if the mom is seeking it, though.
  • if you refuse to play the “my birth was worse than your birth” game Totally.
  • if you feel like you know your fellow online birth junkies (even though you’ve never actually met them) better than you know some of your flesh-and-blood friends A few of them, fer sher.
  • if ten or more of your Facebook friends (or other equivalent) are people you’ve never actually met but know them through birth-related functions (blogs, email lists, etc.) Again, not quite 10, but getting up there.
  • if you’ve ever gone to a birth conference I can dream, can't I?
  • if you’ve ever emailed, mailed or called your state or national representatives about a birth-related matter YES!
  • if someone tells you her baby is breech and you give her names (bonus points if you know phone numbers) of chiropractors skilled in the Webster technique or people who can perform moxibustion I have, once so far! once I start work, I'll always know the best for both in whatever are I'm in. I'd add the best IBCLC to that referenc list too.
  • if you know what counterpressure is and how to apply it (bonus points if you’ve done it) Check! *cracks my LMT knuckles*
  • if you know what a rebozo is (bonus points if you’ve used one) I do, though I've not used one in labor yet. I was wondering recently if I could use my un-ringed Maya Wrap for this.
  • if you encourage your children, especially young children, to watch birth videos When she gets old enough to understand what she's seeing (she's 15 months), you better believe it.
  • if you can get hoarse from watching TV birth shows (like A Baby Story), because you’re yelling through the screen at the woman or her care providers Oh. I'm like a soccer hooligan. Shameful really.

And finally

  • if you regularly read this blog, you know you’re a birth junkie! Ta-dah!

Try it yourself! And remember, admitting you have a problem is always the first step. Keep coming back - it works if you work it.

Wednesday, July 29, 2009

Preaching to the choir

Well, you'll probably find a lot of these kinds of posts 'round these parts, but hey. It's still good to share resources, particularly when a skeptical spouse or mother-in-law or someone else in your support system needs some extra convincing.

Anyway, I thought this was a very good, pretty thorough endorsement of doula care, with a nice breakdown of all the whats and hows and whys: A Doula: The MUST-HAVE for Expecting Parents.

I only have one criticism, though it's kind of a big one - be aware that she presents OBs as though they are the only option, with no mention of any kind of midwife, even CNMs. But aside from that, it's quite spot-on. And then again, truly, the places doulas are needed most are in hospitals, with OBs.

But you knew that.

Tuesday, July 28, 2009

"Childbirth ed? Why bother? I'm getting the epidural!"

A few days ago, Public Health Doula wrote this excellent post: Don't Count on Your Epidural, which in turn was inspired by Reality Rounds' equally excellent post No Epidural for You, You Bad Girl, and I thought the lesson was too important to not pass it on. A snippet from the former:

This is something I wish more women understood. Just because you expect to get pain relief in labor, you may not get it. You may never get it: you may have a fast labor, or show up too late, or have to wait too long for the anesthesiologist and by the time he shows up the baby is crowning. (If he ever shows up.) You also might have to wait for hours. When you get one, your epidural may not work, or only work partially.

So why bring this up? An excerpt from the latter explaining the importance of childbirth education (I'm sure I'll start shortening it to its common moniker 'CBE' soon enough) no matter what you think your preference might be:

Whenever I lead my unit’s birthing tours, invariably the subject of pain relief comes up. “How long will it take to get my epidural?” (number 1 question). “If I want a natural childbirth, can I change my mind and get an epidural?” . . . I always recommend to all my birthing tour moms to take a natural childbirth class, even if they want an epidural the minute they are in labor. I do not recommend these classes based on any philosophical or scientific belief that natural childbirth is superior, but on a realistic knowledge that you are not guaranteed an epidural. Let me say it again, YOU ARE NOT GUARANTEED AN EPIDURAL. Those are tough words to hear when you have your heart set on an epidural. I tell those moms to take a class on natural methods of pain relief, because you can not predict how your birth will go. Having some alternative methods of pain relief, like the jacuzzi tubs we have in every labor room (I call them the aqua epidurals), or using imagery,or hypnobirthing, or whatever, will give you back a sense of control over the pain. I have no idea how many of these moms take my advice. My guess is not many.
And you never know - it's possible that, stalled in her desire for the epidural she thought she wanted and forced by circumstance to call upon her own resources (hopefully including a support system, whether it be spouse, family, doula, or all of the above), and due to the preparation she thought was superfluous at the time, some mothers might actually find that they are doing just fine on their own.

As I read these posts, another thought occurred to me. The women who don't take the advice to do any childbirth education classes, assuming they can get the epidural promptly and on demand, and then find themselves having to wait several hours or more (or not get it at all, occasionally), they have left themselves no other resources for dealing with the pain whatsoever. They may not know to get out of the bed, or change positions, or use focused breathing, or massage techniques, or using water if a tub or even a shower is available. It's even possible that they might not even be aware of how dramatically different the pain is with Pitocin for induction or augmentation.

Even without augmentation, labor pain may be exaggerated as a result of not knowing that it would be in their best interest to avoid protocols that force them to be supine and immobile - just to name a few out of a host of examples, can she get a saline lock instead of a full scale IV? Can she have intermittent monitoring with a Doppler rather than be strapped to a cEFM for the duration?

And therefore, their experience of "natural" childbirth is one of being a helpless, passive victim to intolerable pain . . . and on the cycle goes of another woman telling her friends and her sisters and her daughters and anyone else who broaches the topic with her how horrific labor pain is, and how any woman who doesn't want an epidural is insane, and the fear cycle is perpetuated further.

By now, readers surely have a sense of my own preferences, but I'll say it again: I totally support women in making different choices than I might, including epidurals or other analgesia - as long as they are informed choices. A woman who goes into labor without any childbirth education (and I would include independent reading as long as it's thorough; I don't necessarily think it HAS to be a formal class, though I do think it's a good idea for most, particularly for their first births) because she's heard from friends and has seen in a bunch of sitcoms how magical the epidural is, and assumes that she can get it with a snap of her fingers, rendering pain management a moot point - she is not making an informed choice. And that uninformed choice can unfairly influence others.

Sunday, July 26, 2009

Big Push Petition

If you haven't heard about The Big Push for Midwives, familiarize thyself now! It's a much-needed organization focusing on increasing access to Certified Professional Midwives, a.k.a. CPMs, a.k.a. the type of midwife recently dissed in the rather underhanded ACNM letter to Congress I posted about recently (ACNM being the Certified Nurse Midwife group).

In addition to the fantastic response to this letter by MANA, The Big Push has also responded in their own way, by creating a petition asking for health care reform to specifically include CPMs. Sign it here!

Wednesday, July 22, 2009

Two births, two mothers, two vicious legal battles.

Two stunning stories revolving around birth and legal rights are currently in the news, each from unique yet equally enraging situations.

First, the somewhat, kinda sorta good news: there's a update to the outrageous case of Catherine Skol, a mother who was mistreated, verbally abused, and I would say physically abused as well, by her obstetrician during her labor last March. She filed a civil suit against Dr. Scott Pierce in December, and while that has yet to transpire, he has been suspended by the medical center, and the the Illinois Department of Financial and Professional Regulation has fined him $500 and put him on one year's probation. He was also required to attend various continuing ed courses, including a class on physician-patient communication - though it's unclear whether he will actually attend these, since he resigned in February this year.

This consequence is pretty petty, if you ask me. As one commenter pointed out, fines for parking tickets can be higher than that! But let's remember that this is not the consequence of the actual lawsuit yet. I can only hope that the upcoming civil suit will serve up some more serious consequences. I'm a little unclear on whether he resigned only from this particular hospital or is giving up medicine permanently. If it's only the former that is true, then I hope the civil suit forces him to lose his license forever. This is not a person who should be practicing medicine. Anyone can have a bad day, but if you read the details in the link to Unnecesarean above, you'll see that this is so over the top that there's no other conclusion to be drawn. Anyone who is capable of treating just ONE person this way should never, ever be allowed to care for another patient. Period. I'll be eagerly awaiting the civil suit.

Now for the indubitably bad news: after three years of struggling with custody issues, a mother who refused to consent to a cesarean in April 2006 ago has now had her parental rights terminated. The details of the case over the course of time are convoluted and full of conflicting opinions and versions of events, but one thing is crystal-clear: the custody challenge began when she refused to sign the consent form for a c-section. It should be noted right here and now that the baby was then born vaginally, without incident.

Read the case for yourself. I find the precedent to be nothing short of terrifying. Mothers beware: if you have ever been on any antidepressant medication, and then have the temerity to stand up for yourself when pressured to submit to an unnecessary c-section, it is now established that you can be declared an unfit parent and your child can be taken away from you. I cannot imagine the nightmare of waging this battle for three full years, even if the ending were a happy one. To lose in the end, too? I don't know how I could go on.

All props to the mighty Unnecesarean for information on both of these stories.

Monday, July 20, 2009

MANA responds to ACNM's letter to Congress

YES! In response to the letter I posted/ranted a bit about a few days ago, we now have a truly awesome response letter, from Geraldine Simkins, the president of MANA* . . . who just so happens to not only be a CNM herself, but an actual member of ACNM as well as MANA.

To wit:
I am a CNM and a member of the ACNM and I say very emphatically- not in my name! I do not support your recent decision to publicly and aggressively oppose the efforts of a broad-based coalition of six national midwifery and consumer organizations seeking federal recognition of the Certified Professional midwife. Your position, to me, is indefensible.
She goes on to rip them a new orifice, based on the following: lack of evidence, differing values, the impact of taking this stand, their disingenuous claims, their lack of vision, how much midwifery matters and how important increased access of care is for all populations, but particularly underserved ones. It's masterfully written, and well worth reading the whole thing. She concludes:

I repeat to you- not in my name. As an ACNM member, I will not comply with your requested action; I will actively oppose it and encourage others to do join me in doing so. Your position on CPMs does not represent what I value, what I hope for, and what I work untold hours to achieve. I have written this letter at the urging of the fourteen members of the MANA Board of Directors. Seven of the Board members are CPMs, four are CNMs, one is a CPM/CNM, one is a CM, and one is a DEM. They represent a true cross-section of the midwives in practice in this nation. We stand for diversity, tolerance, and unity among midwives and within the profession of midwifery. We advocate and work for a midwife for every mother, in every village, city, tribe, and community in this country and across the globe.
The bolding is mine - I think this underscores the fact that this really isn't, or shouldn't be, about CNMs versus CPMs and the turf wars accompanying such territorial squabbles. Thank you for this, MANA, and thank you Geraldine.

*For those who don't know, the Midwives Alliance of North America is the primary organization (with NARM, which functions a bit differently) for all types of midwives. Truly some righteous babes.

Sunday, July 19, 2009

Weekend movie

Just some relaxing Sunday viewing for you.

Those who know me probably think that by this, I'm being sarcastic and the clip will really be some horrible blood-pressure-raising expose on some new obstetric fad, but nope. Check out this nice Today Show piece on doulas.

Nice guest appearance by Jacques Moritz!

Friday, July 17, 2009

CNMs to CPMs: We're telling on you!

ACNM, the organization for Certified Nurse Midwives, has just written a letter to Congress questioning - or some might say attacking -the validity of the CPM (Certified Professional Midwife) designation. Read more about this in their own newsletter.

Specifically, what they're taking issue with is that the CPM credential does not require a graduation from an accredited institution - even though the C in CPM obviously means they've been certified, and that certification is recognized by the same national organization that oversees all certifications, including CNMs. But this isn't enough for ACNM:
Until the CPM community has developed a uniform process to ensure that all CPMs have graduated from an accredited educational institution, Congress should not recognize this class of provider in its entirety.
This would invalidate a huge number of existing CPMs, to say nothing of closing off that door for many student and prospective CPMs, as it leaves out midwives who have done their hands-on training through an apprenticeship. I know, for example, of some midwifery trainings that are done as distance learning, along with an extensive apprenticeship. Let me emphasize, again, that these apprentice midwives will still pass the crucial certification in order to become CPMs, therefore holding up a strong and consistent standard. There are only 11 accredited midwifery programs in the country! Simply by pure location, this shuts out any prospective midwife who isn't lucky enough to live in one of those 11 areas.

ACNM's letter goes further than the accreditation issue, also critiquing NARM's requirements for CPM preceptors, talking specifically about minimum requirements for clinical experience. I'll be really interested in hearing what the group Big Push for Midwives will have to say about all this, active as they have been in promoting the education of more CPMs.

I know there has always been tension between these two groups. Hell, there can be tension within each of these groups! And I think it's important to not stereotype either side. As Joyce Roberts, a past president of ACNM, put it, "CNMs think DEMs have copped out, and DEMs think CNMs have sold out." On the one side we have 'medwives', and on the other we have 'madwives'. Personally, I've liked and disliked members of each, would feel comfortable with some of each group and uncomfortable with others, and every woman has to choose the individual who's the right fit for her.

So, is it just me, or does this all really come off as a slap in the face from ACNM? Or do they have a point? I'm willing to consider that more rigorous education may be needed, as programs can vary in quality. But does it have to be as drastic as this?

"One group needs to tighten up, and the other group needs to lighten up!"

-- Katherine Comancho Carr, President of the American College of Nurse-Midwives, 2005

Can't we all just get along?

Disclamer. (The first of many, I'm sure.)

I want to add one thing to the previous post. (Promise I won't be too-long-winded about it.)

I just need to say that, when I say "OBs", and when that extends into the universal "They", especially when I'm feeling ranty, I do know that I'm painting with a really broad brush. I definitely recognize that there are INCREDIBLE obstetricians out there, truly wonderful people who care about and believe in women, who regard the wisdom of nature (in most cases) with both faith and humility, and who are as concerned as many of us are about the crisis going on today. Here's part of a great post from Keyboard Revolutionary:

Ya know, sometimes I feel bad for the good physicians out there. I know they exist. We all do. We've all shaken our fists in righteous indignation at the rants of Marsden Wagner. We've listened intently to the poetic, thickly accented declarations of Michel Odent. We've swooned over the tender ministrations of "Dr. Wonderful," a.k.a Dr. Robert M. Biter. God bless those diamonds in the rough, particularly in the obstetrical field. It must be twice as hard to shine when the lumps of coal around you are so horrifically ugly.
I pretty much worship every person she mentions, and would add to that list Christiane Northrup, Sarah Buckley, Jacques Moritz (Abby's doctor in Business of Being Born), and I know there are others. I know it's just a disclaimer, but I feel it's an important one.

In that same post, Keyboard Revolutionary also makes the point of the irony of having to hire a doula at all - how insane has it gotten when we hire someone to, in many ways, protect you from the person who is supposed to be giving you care? Navelgazing Midwife's take on all this was more blunt: "Women don't just need doulas anymore, they need bodyguards."

Thursday, July 16, 2009

A bit more Pit ("to distress")

The phrase that's been shaking up the birthin' blog zeitgeist continues to reverberate. When I shared the link on Facebook, a bewildered friend of mine asked why, WHY would they deliberately do this when it's clear that c-sections are so much riskier for both mom and baby? "What do they get out of it? Is it just a money thing or what?"

I think it's several things. I agree that it does have to do with money, but it also has a lot to do with - dun dun DUNN - fear of litigation. OB's malpractice insurance is through the roof, and the prevailing mindset among OB's is that "you don't get sued for the c-section you do, you get sued for the c-section you didn't do." Remember in Business of Being Born, when one OB was recalling her teacher saying, "Section 'em! Just section 'em! They can never fault you if you section 'em." This an enormous part of why it has spiraled so out of control.

As a result, many, many doctors are 'practicing defensively'. They speak of this openly, too. It makes me pretty near apoplectic with rage - it is essentially admitting that they are putting their own self-interest before the well-bring of their patients. And now that it's out that many OBs are INTENTIONALLY endangering mothers and babies? As far as I'm concerned, "pit to distress" throws the entire Hippocratic oath right out the freaking window. It's not "First cover thy ass . . . and then maybe do no harm as long as I'M comfortable."

There are still other aspects to it besides money and fear of litigation. There's also, frankly, convenience. We often joke about OBs doing c-sections in order to get home for dinner or get to their tee time, and it sounds exaggerated, but I have read so many first hand accounts of doctors saying right out loud, with NO SHAME! Nursing Birth corroborated this - she hears it all the time. Not from every OB, of course, but it literally does happen. Remember, again in Business of Being Born, an OB talking about how studies of c-section rates spike around 5 pm, and then again around 10 pm. He said the first is "I want to get home for dinner," and the second is "I don't want to be up all night." Right from the horse's mouth, people.

A fourth factor is harder to quantify, but has to do with their entire philosophy. They often seem to reach a point in labor when they're just tired of putting up a pretense of letting nature take its course, or, as they often patronizingly refer to it, "letting her try" for a normal birth - which is not what they're really, truly trained to do - they're trained in active management of labor, meaning their belief system revolves around the idea that THEY are in control of labor, that THEY are the active verbs in the sentence,"delivering" babies, rather than women birthing them. So why should they sit around and wait for a woman to find her own way through the labyrinth, when they can hook her up to machines and churn the baby out - and take credit - one way or another.

This IS a huge problem, and solving it is complex, but I really take issue with all of the above. (In case you can't tell.) What's the answer? The litigation problem is very real. How do we solve that? I cannot and WILL NOT ACCEPT that the answer is to increase the c-section rate even further. We're already at an abhorrent national average of 30%, and in some areas it;s even higher. Florida recently made it to a whopping 50% -with some counties near 70%. SEVENTY!

Part of me wants to say that women need to change what they're suing for, and start suing FOR unnecessary c-sections, and for other horrific experiences, like the recent case of Catherine Skol (read that only if you really want to shoot your blood pressure up - and I wouldn't advise any pregnant women to even look). But that's just me feeling spiteful, really; I don't seriously believe that even more lawsuits are the answer, in an eye-for-an-eye payback payback kind of way (though I definitely support Ms. Skol). That won't solve anything. But I do fully believe that part of the solution to the litigation crisis is for maternity care itself to change, fundamentally.

What has to change, I feel, is the entire active management philosophy - the mindset that many hospital maternity care providers maintain (as a whole - there are notable exceptions, of course). A perfect example of this occurs in Business of Being Born, when touring a L&D department; a nurse gestures to an IV bag and says "And this is Pitocin, which is the medication given through the IV that causes contractions." That struck me from the very first time I saw it - the way she phrases it, it really seems as though she BELIEVES that Contractions Are Caused by Pitocin. Not that it's a facsimile of the real thing, not that it's a synthetic substitute, not that it's an artificial means we occasionally have to use in certain circumstances when extra help is needed. No, IT causes contractions.

Very revealing, n'est-ce pas?


I wanted to share a few other great posts on the topic. I was interested to see that even what I'd consider a more mainstream source,, has weighed in. It's currently at the top of the list when you Google "pit to distress", in fact. I was a tad worried that it might downplay the whole thing, but I was totally wrong. While the initial post basically explains the concept and then recounts the chain of outrage from Keyboard Revolutionary to Unnecessarean to NursingBirth ( the three most influential posts, I'd say), at least the information and the links are out there to a wide audience! There are a few good comments, too.

I also really liked Your Birth Right's thoughts. As another L&D nurse and midwife, she, too has some practical advice on avoiding this if you're in a hospital, gives good quotage, and uses this apt metaphor on navigating a hospital birth that gave me warm fuzzies, being a former dancer:

Pregnancy, labor, delivery, induction and the like, especially when you make the decision to have a hospital birth becomes a fine balancing act. It’s almost like doing a dance where the choreography is completely spontaneous. Nurses have to spin around policies and procedures, leap over doctor’s orders, plie’ to patients wishes and occasionally do an arabesque just to keep her sanity. There are many nurses who have learned to do the dance and these nurses are able create a waltz, a jitterbug, or a fine ballet, whatever is necessary to help their patients achieve the birth they desire. Many others however, either don’t care or don’t have the skill set and never catch the rhythm to make that happen.

Maybe it's a bit more like extreme contact improv, actually. Or possibly a workshop with Elizabeth Streb's SLAM.* But anyway . . .

*Shout-out to any dancers out there.

Wednesday, July 15, 2009

ICAN Webinar - attend right from your own desktop!

The intrepid Unnecessarean asked all of us birth folks to pass this along in whatever way we can. Happy to oblige!

On Monday, July 27th, 9 pm EDT, ICAN (the International Cesarean Awareness network) will host a webinar that you can attend from your computer. This 2 hour web seminar will cover:

  • Different kinds of care providers you can use, and the pros and cons of each
  • How to empower yourself to make educated choices during your pregnancy and during labor
  • What factors contribute to your chances of having an unnecessary or preventable cesarean
  • What is the "downward spiral of intervention"
  • Why avoiding an unnecessary cesarean is safest for you and your baby
  • When cesareans are truly necessary
This is NOT just for women seeking VBACs - this is cesarean prevention for everyone. This should be especially useful for moms without a local ICAN chapter around, or who can't get around easily. Anyone currently pregnant could only benefit from this. Thanks, ICAN.

Pass it on!

Tuesday, July 14, 2009

If you need to birth in a hospital, for whatever reason . . .

. . . you must view these videos! Unnecessarean posted the other day about these FABULOUS videos, put up by Mother's Advocate, and I can't not pass them along. These are short and very well done, broken down into 6 components:

1: Let Labor Begin on Its Own
2: Walk, Move, and Change Positions
3: Have Continuous Support
4: Avoid Unnecessary Interventions
5: Get Upright and Follow Urges to Push
6: Keep Your Baby With You

Obviously, I'm a home birth advocate (uh, have I mentioned that?), and these 6 items are pretty much a given with home birth, but I certainly recognize that it's not for everyone and not appropriate in all circumstances. These videos are a GREAT tool. It's especially helpful to see all of this in action IN a hospital setting, as Unnecessarean points out. True, you could see all of this in YouTube home birth videos (assuming they remain uncensored), but I can see how someone planning for a hospital birth could watch those and be thinking, "Well, that's all lovely and good, but how is that possible in a hospital?"

But I'll pipe down and let the videos speak for themselves! Really, I think this could be enormously helpful towards optimizing a hospital experience.

And after all, optimizing a hospital experience is my entire raison d'etre as a doula. I admit that the thought of entering the belly of the beast gives me pause. Home birth is where my heart is, and where I hope to end up eventually, as a midwife, when my children are old enough for me to undertake such a calling - because I do feel it as a calling. But doula work is what makes the most sense for me in the present, given my family circumstances (FYI, I plan to focus on postpartum work initially, sort of working backwards, because while it still revolves around the mother's schedule, it's not quite as spur-of-the-moment as labor support). And doula support, let's face it, can be a bit, well, redundant in a home setting. With good midwives and family and friends around, the role is pretty much covered in most cases.

It's hospitals where they - we - are most needed. This is where a woman and her spouse or partner need to have an anchor, helping them navigate the labyrinth. Whether this calls for advocating or not is up for some debate, but either way, empowering them to assert their rights and make their own choices. I know I'm going to have to grit my teeth at times. I know I'm going to witness things that make me cringe, I know I'm going to have to support choices I don't necessarily agree with (frankly, this last part will be good for me). I'm aware that a lot of doulas eventually get fed up and burnt out at seeing the crap they've had to see over the years.

But I also know they DO make a difference, so come hell or high water, I'm committed to it until I burn out myself or until I can take the next step towards CPM-land. Sharing videos like these with my clients (see how nicely I brought that tangent full circle?) will be immensely helpful.

Sunday, July 12, 2009

Lily’s Home Water Birth, or, The Timely UPS Man

This blog, by nature, would be incomplete without my own birth story. So without further ado:

Prelude: Even though I was only 36 weeks along, plus change, and I figured I had a couple of weeks after I stopped working to go into my OCD nesting frenzy, I had the overpowering urge to clean the floor late Sunday night. I swept and then mopped, and was about to start cleaning the bathroom but talked myself out of it, since I was so exhausted. It was late, and after all, there was plenty of time.


Monday morning. I woke up at 10, since I had a late start and planned to do some errands before my first client arrived at the office at 2 – including picking up the home birth certificate form from the town hall. As I lumbered from my bedroom into the kitchen, I trickled some fluid onto the floor. I was aghast for a second, thinking I had peed, of course, but my bladder wasn’t full & I just, well, didn’t feel like I had peed. The little puddle had a slightly red tinge to it, but since it wasn’t the huge gush we’ve come to expect thanks to movies and TV, I wasn’t sure. I went straight to the bathroom, where I promptly passed my lovely mucous plug.

It was supposed to be my last week of work – I had just worked on Saturday and then ran around doing some errands on Sunday, including attending my home birth support meeting. The day after next, Wednesday, was supposed to be my 36 week home visit, where my midwives, Nancy and Gengi, were to come to my house for the first time, meet with my labor support team, and talk extensively about how to prepare the house, the tub, and the birth kit – not to mention myself. The following week I had set aside to clean, pick up gear, organize, and then after that, I was planning to just rest and relax for my final week or two – and Aaron would come out to Massachusetts at some point in there in order to be ready. At some point soon, by birth kit would arrive (my midwives, like most, have each client order their own birth kit – a package of standard supplies like gloves and Chux pads and peri bottles, which can be customized for the preferences of both midwife and client), as well as the La Bassine birthing pool, both of which had been ordered one week ago.

(Note: there were some discrepancies with my due date – one method put me at 36, and one put me between 37 and 38. But since ‘first babies tend to be late’, we all figured we should err on that side. Right? Also, it had only been two weeks since the placenta previa that had cast a shadow over my pregnancy was finally confirmed to have ‘migrated’ out of the way, at a 34 week ultrasound – after getting many more ultrasounds throughout than I would have liked. I had feared that I wouldn’t even be able to deliver vaginally, let alone at home, and had been on pelvic rest and forbidden exercise from week 18 on. But this is another story.)

So, mucous plug, check. Some fluid, check. I knew that losing the plug can sometimes mean the onset of labor, but I also knew women who lost theirs and then walked around for another week or two. Unsure whether this was going to drag on, I called Nancy & left her a message – little did I know that she had had a late birth on Saturday and was then laid up with a migraine on Sunday. I texted Aaron and told him not to freak out just yet, I wasn’t sure what was happening – but to be on alert. Then I logged into my message boards with a cup of half-caf, as per my usual morning routine, and contemplated what to do. As I hung out there, I started to notice some contractions, but they were very, VERY mild and quite far apart – well over 10 minutes. These were different from the Braxton Hicks ‘toning’ contractions I’d been having for months; in fact, about a week prior I had had just a few of these ‘real’ yet mild contractions one evening. About three or four – and then they stopped. I thought nothing more of it at the time.

Eventually I decided to get on with at least some of my day. I went to the town hall, but the right person wasn’t there yet – I was told to come back at 1. I got gas & went home until then, and made a few more calls. I let my office know that, while I wasn’t sure I was in labor, I “might not feel up to coming in,” so maaaaaaaaybe we should cancel my clients. Just to be on the safe side. Then I called the birth kit company – it turns out there had been glitches with my order even though I placed it a week ago. I wasn’t sure what we were going to do if this was really labor.

My friend Patty was going to be my doula, so I called her next. I had JUST talked to her yesterday to remind her about the home birth visit scheduled for Wednesday, and she had gotten back into town that very day from a weekend away. She was at work, but promised to stay by her phone and would plan to try and leave early, just in case. I decided to go ahead and page Nancy on her labor or emergency-only beeper.

My contractions were becoming a little more real, but nothing too intense; I could still talk through them. I started to keep track of the times, and they were indeed becoming more frequent. Since I hadn’t heard back from Nancy yet, I called Gengi, her (very experienced) apprentice. She answered right away, and listened to everything that had transpired. She would try and get ahold of Nancy, and would plan to come up and check me early in the afternoon if I continued to progress, bringing some paper strips to test my fluid & see if it was really amniotic fluid (I was still skeptical). Gengi also said she would stop by Nancy’s and put together a birth kit for me, since I didn’t have mine yet. I thought sadly of my puny bathtub and what a poor substitute it would be for the luxurious-looking 100 gallon birthing pool.

I had a little lunch, noticing that I was now needing to stop what I was doing as each one hit. Nothing major, just wanted to stop and breathe a little. I decided I’d better go back to the town hall, this time having contractions all the way (fortunately, it was only a 3 or 4 minute drive). The town clerk was there this time, and was rather alarmed by the whole situation (though perfectly friendly).

I got my paperwork and had her explain it as best she could – she had never had to hand one of these out before. I leaned on the counter and put my head down with each contraction. When I got back home, I walked to mailbox & it was becoming clear that the contractions were getting stronger – I had to come to a dead stop halfway up the driveway. I also noticed that I was still occasionally trickling fluid. And then, I cleaned. I know, I should have rested, but I also really needed to do the bare minimum, at least. Now I knew why I’d had that totally uncharacteristic late night urge!

I let Patty know that this was maybe starting to take off, and I was worried about all the things I hadn’t yet picked up that were on the checklist in addition to the birth kit itself, like receiving blankets and towels. She made a list and headed out to the store on her way to my house. Finally I tried to relax in the gliding rocking chair as I waited for Gengi and Patty (Nancy had been reached, but needed to rest up for a while if this was it – in true midwifery fashion; the baby always arrives when it’s least convenient for the midwife.) I kept writing down time of contractions - I think by now they were about 5 or 6 minutes apart – and tried to remember to keep drinking water. I continued texting with Aaron, as I had been all morning. He had finally wrested himself free from clients and was on his way.

Suddenly there came a knock on the door. I didn’t think either Gengi or Patty would be here just yet. Lo and behold, there stood a UPS worker, holding the box that contained my inflatable birthing pool. I stammered at him in surprise that I just couldn’t believe he was here, that I was actually in labor that very moment! He seemed unimpressed.

I set the box on the counter and went back to the rocking chair – and this is where things start to get a little blurry. Gengi arrived about 10 minutes later, in an orange sweatshirt and jeans, and immediately went into action setting things up, saying we’d do an exam soon. Though Gengi was still an apprentice (apprenticeships take years and years), she was also very experienced, professionally and personally: her first baby was a cesarean due to a breech baby, her second was a vaginal birth in a hospital, and the last three were all born at home. I adored her as much as Nancy and felt totally safe in their hands. She also happened to be LDS, which made me feel oddly connected to my biological – and Mormon - side of the family, was very slim and calm in bearing, and devoted to homeopathy as well as midwifery. Patty arrived soon after that, and she started pitching in to help Gengi with the setup, including assembling the pool.

It was right about here that I started having to vocalize, not just breathe. I was surprised by this, as I’m not normally a vocalizing kind of person. Always been shy about it in yoga classes when invited to “sound it out” and such. But this was completely unavoidable. Gengi kept reminding me kindly to keep my tones low – not as in quiet, but as in deep (naturally, I could be as loud as I wanted). I continued to hang out mostly in the rocking chair. The few times I went to the bathroom and had a contraction on the toilet, I noticed that it seemed to intensify.

Okay, time for the moment of truth already. It was time to do the exam. We went into the bedroom and she checked me there. She pulled out her gloved hand, index finger straight and middle finger cocked at an angle, and regarded her fingers thoughtfully. My jaw just about hit the floor when she said “I’d say you’re at about six.” Up until that point, irrational as it is, I hadn’t REALLY believed I was in real labor; that this was really happening. It couldn’t be! I had 3 or even 4 more weeks! I didn’t have all her diapers, or our changing table, or the breast pump – and I never, ever got to take any time off! Wow. WOW.

And, of course, this is where things really took off. I decided to take a shower, since I hadn’t done so yet and it would be a while before the tub was ready. It was less than relaxing - I had several contractions in the shower, and Gengi had to come in and go over a questionnaire with me while I was in there (important stuff that was normally covered during – you guessed it – the 36 week home birth visit, like whether we would do the PKU, the eyedrops, vitamin K, etc.). I kept having to pause and rest my head against my arm on the shower wall.

When I was done, I got into some comfy pajamas and decided to experiment with being on my hands and knees, since the glider wasn’t doing it for me anymore. It was okay, but not great. I thought I’d try lying down, just to see. I made it through exactly one contraction that way. It was completely unacceptable. Actually, correction: it was FUCKING EXCRUCIATING. (Forgive me, but there's just no other way to accurately capture that sensation. It wasn't just the pain itself, which seriously went up to 11, but the sense of becoming completely unmoored and unhinged and just plain lost in the despair of it.) I rolled over on my side to see if that improved things, and it was the tiniest bit better, but still sucked unbelievably. I would have lost my mind if I had been forced to lie in a bed. Back on my hands and knees I went.

Meanwhile, Gengi and Patty did a record-breaking job of getting the birthing tub inflated (blowing into it – no fancy electric pump or even a manual bicycle-style one) and filled, including the eventuality of running out of hot water from our tiny tank (it was 29 gallons – and the tub was 100). They then had to constantly boil all the biggest pots I had on the stove - all the while things were getting more intense with me, of course. Fortunately, being me, I got a lotta pots.

Patty took over all communications, as I was losing the ability to speak. I had made a list of all the key people who needed to be called. Aaron checked in regularly, driving frantically, the poor guy. He could hear me bellowing and braying in the background with each call.

At some point my cat made herself scarce.

Gengi and Patty took turns coming in to the bedroom to deal with me. The hands and knees just was not working as well after a while – after some uncomfortable experimentation, I finally found the one thing that worked for me. I had to sit upright on the edge of the bed with my feet pushing into the floor (the mattress and box spring were right on the floor). I needed back support, so I tried having Patty sit behind me, back to back.

This was the ticket. With each contraction I pushed my feet into the ground and leaned hard in to Patty, clutching her hand for dear life, and moaned to the heavens. Sometimes she would moan along with me, trying to help keep my tones low. Gengi came in and did soothing strokes down my legs and gave me gentle, empowering words from time to time. She also used the Doppler to listen to the heart rate periodically, though I never again had another internal exam. This went on for a while, until the rest of my water broke, and this time it was the full flood. I yelled for Gengi.

Digression: Somewhere along the way, I completely lost all verbal ability. “Those lights are starting to bother me. Can we turn them down, or maybe off?” in my mind became “Lights. Too bright,” out loud. “Oh, wow, Gengi, come here - I just felt a lot of fluid gushing with that last contraction,” became “Fluid! Fluid!” Communicating in proper sentences took so much effort – it would have been indescribably awful to have to try and discuss anything. I still had the fully articulated thoughts, but there was a total disconnect between my thoughts and expressing them. It was amazing just how withdrawn into myself I became. My Self, I suppose.

Back to the flood: Gengi came in and started to fiddle around with the amnio testing strips, then scrapped it since it was obvious that this is what it was, and she could see that it was clear. She helped me out of my pants and moved me to a birthing stool after I had more gushes of fluid, both of which took some effort. This is where it started to hurt more in between contractions – there was no longer a break between, as there had been all along, just a slight easing off. I heard Gengi make a call to Nancy. “I think you should come now.”

This grew and grew in intensity. I had always been the most afraid of the moment of crowning, of the dreaded “ring of fire” sensation, as it has been described. I had never truly grokked that my vagina would have to stretch just as much on the TOP as it did on the bottom. This has been described as the “bowling ball” sensation, which is quite accurate – that combination of pressure and stretching was almost constant. Someone in my homebirth meeting the day before who had recently given birth talked about the discomfort of rectal pressure, and this was the case with me. (The final stretch of the perineum that I had so feared was really nothing. Not that it felt good, exactly, but after three hours of Lily descending through my vagina, it barely registered.) Soon after this, I had a few contractions with double peaks & hit transition. Dear GOD.

Nancy arrived right around 8:00, just as the pool was finally, ready set up in the center of the kitchen (my support team had been working on it this whole time, along with the rest of the setup – blankets wrapped in paper and ready to go in the preheated oven, instruments and gloves set up, a cornucopia of herbs, some methergine and pitocin (purely in the case of postpartum hemorrhaging, never for inducing or augmenting labor,), suctioning and resuscitation equipment at the ready. At last, with much help, I climbed in and yanked off my shirt in one motion, and immediately clung to the side, resting my head on the cushioned edge.

So began the next three hours.

Nancy knelt by the pool, despite wearing her trademark long denim skirt and sassy boots, and held one hand while Patty usually held the other, between giving me sips of Recharge, the natural version of Gatorade. That’s another thing I thought was so clichéd, along with vocalizing: would I really want to hold someone’s hand? What’s the big deal? Would it make that much of a difference? Yes, yes it would. Patty told me later that at one point I was squeezing so hard she thought her hand might really fracture, but that she somehow managed to detach herself from it, like, “Hmm, I think my hand might actually break. How interesting.” (She said nothing about it at the time, bless her.) We tried a cool cloth on my forehead, as the water was warmer than I’d have liked (but needed to be a certain temperature minimum to deliver underwater safely), but it just felt annoying. I slapped it away.

On we went. Gengi continued to check the heart tones periodically (the Doppler could go underwater, no problem). After a while I started to doubt myself. I actually did have an urge to push earlier, but I didn’t trust it. It seemed too early, and I had heard stories of women pushing before they were complete and creating swelling, or being similarly counterproductive when a ‘lip’ was there. As a way of encouraging my progress, they got me to reach in and touch my baby’s head. I had a hard time believing that this was really, truly my baby, right there, being touched by the outside world for the first time. I think even said “Are you sure?” out loud – though I also remember reasoning silently, “Well, what else would have hair INSIDE my vagina?”

I felt a little more confident then, but found that it hurt too much – and was too scary - to actively push during contractions (some women feel relief in this, but others don’t – everyone is different). I preferred and felt it best/right for me to actively push as each contraction ended, and focused on allowing my uterus to push in its own, which it normally really does, if you can get out of its way – the 'expulsion' or ‘fetal ejection reflex’.

Where was Aaron? Still just driving as fast as he could, poor guy. He continued to check in with Patty. I managed to summon the words to tell her that when he arrived, to make sure to do so as quietly and calmly as possible. Any disturbance would be jarring to me, I knew. Introducing a foreign person who wasn’t yet part of the vibe, for lack of a better word, would have been upsetting, no matter how much I wanted him there, and I needed to have Patty run interference, since I didn’t feel capable of communicating that myself. Even necessary conversations between the ‘team’ members was a bit irritating to me, unavoidable as it was; they all did intuitively keep such conversations to a minimum and cast their voices low, wise women that they are.

Once in the pool, I only changed positions twice – starting as above, leaning forward on the side, then turning over to lean back on it. At one point Nancy tried to convince me to get out and try pushing on the toilet, but I just knew deep down, and from the previous contractions I had on the toilet, that it would be too intense for me. I needed to take my time, no matter how exhausting, so Nancy let it go. Thank God I had providers who trusted me and my body. They were like guardians, Nancy behind me holding my hand, Gengi across from me watching with the big flashlight (I needed the lights very dim). Patty circled around as needed.

Reassuring me, Nancy pointed out, when I had a moment of whimpering, that almost every woman cries a bit during childbirth at some point. I remember asking Gengi to pray for me a little – not out loud, just to silently say a small prayer, and she nodded.They said very little during this final stretch, for which I was deeply grateful, save for intermittently checking in with the Doppler and telling me softly that I was fine, and what a wonderful thing I was doing, giving my baby such a gentle birth. I’ll always have that impressed upon me, the memory of these strong and mostly silent, endlessly patient women standing guard, protecting me, encouraging me without prodding, graciously witnessing.

At last, I felt that it was time to commit, that this would just have to be it, and I really gave in to it, finally. It was like a crossing over. I pushed more actively. I ended up in leaning back position. “Curl your body around your baby,” Nancy encouraged, and doing so (tilting my pelvis, still buoyed by the water, and contracting my torso, almost as if doing a crunch) really progressed things. I remember feeling some movement from inside the birth canal around this time, knowing she was shifting position, trying to help find her way out. What a new sensation that was . . .

After such a long pushing phase (though I also had a sense of time suspension – I went into labor determined NOT to watch the clock obsessively, once it was safe to stop timing contractions, anyway, and it worked; once I was in hard labor it didn’t even occur to me to check the clock), the finale happened so quickly. I wonder if anyone else perceives it that way. The final moments were just – boom! boom! boom!

I heard Gengi’s voice: “Crowning . . . the head is out (here Gengi quickly checked for a nuchal cord, and then I reached down in disbelief to touch her too) . . . Reach down for your baby!” And there she was, clasped to my chest. 11:03 pm.

I always thought I would be sobbing with joy – and the joy was there, but I was also just in complete and total shock. “Oh! Baby! Samily (our prenatal name for the mystery fetus, a combination of 'Sam' and 'Lily')!!! Baby baby baby,” was all I could muster at first – you can hear this in the short, murky videos Patty took of the final moments. She lifted up her head for a split second with wide open eyes, looking as surprised as I was, and as pink as can be. Love at first sight. Who cares if it’s a cliché?

They had me keep her in the warm water for a minute for warmth (head out, of course) as they put her hat on, checked her breathing (she let out rough and healthy little squawky cries) and got the blankets ready. I asked tremulously if it was a boy or a girl, and Nancy told me to take a look & find out. I lifted her teeny leg – surprise! I had been so sure it was a boy. “Wow, look at that!” Nancy said. I had to check twice to be sure. It’s such a small detail, but I’m glad I got to discover that for myself, that no one announced this to me. “Do we have a name?” Nancy asked, and I told her “Lily.”

After a nice rest, enamored with this little creature, it was time for the placenta. Nancy kinda had to talk me into it, as it seemed so anticlimactic, and all I wanted to do was hold and gaze at Lily, massaging the vernix into her skin, but on this one matter they were pretty firm. So Lily was handed to Patty and with a few pushes - not painful, if a little uncomfortable - and the gentlest possible cord guidance, it was done. We put it in a silver mixing bowl since we wanted to wait for Aaron to cut the cord (and wanted to let the cord stop pulsing on its own, anyway, to make sure she got as much healthy blood and stem cells as possible). Nancy showed me the cord and had me feel its pulse, knowing I was interested in such details.

They then had me get out of the tub, reluctant as I was; there had been a little more bleeding than usual, and they needed to assess it properly and couldn’t do so in the water. Out I went, and my babymoon continued (the bleeding was fine; notable, but within the range of safe). I offered the breast, but she didn’t root, and seemed uninterested, so we decided not to push it (this, of course, setting the stage for our much larger trial by fire, though we didn’t see it at the time). I managed a snack, and finally, Aaron arrived to cut the cord, and took her in his arms for the first time.

Eventually I was examined on my bed, and there was no tearing to speak of save for a tiny bit on the inside, nothing justifying any stitching or anything. Nancy helped me waddle gingerly to the bathroom and made sure I was able to pee and generally tidied me up, showing me how to use the peri bottle and the cool comfrey-witch hazel compresses Gengi had prepared and stored in the freezer. I slipped into the mesh underpants that I’d wear for the next few weeks and put on a huge mattress-like pad (I wouldn’t notice the freakish ‘roids until the next day). While I was gone, Aaron carefully dressed Lily in her first wee onesie and teeny little fitted diaper.

They examined her thoroughly at about 2 am, noting her extreme molding, her long delicate French manicure, the tie on her upper lip (the posterior tongue tie wouldn’t be diagnosed until later), and her overall great health. The team stayed until a little after three, though they’d be back the next evening and then several more times again. Exhausted as I was, I hardly slept that night, curled cozily next to her in our bed. I just could not stop staring at her.

The most amazing day of my life, in general. About 13 hours, official start to finish. I am still in awe that my body did this – it really did. It knew exactly what to do. As one woman put it in the film “The Business of Being Born”: “I knew I couldn’t do it - and then I did it. I hit that wall, and I scaled it.”


Epilogue: My birth kit arrived two days later.

Article on swanky new L&D departments

The esteemed Navelgazing Midwife posted this on Facebook: "Definitely Not Your Mother's Maternity Ward" - and I found it very revealing. An excerpt:

At Ridgeview Medical Center in Waconia, women can now give birth in rooms with whirlpool tubs and wi-fi. At Fairview Southdale, new moms can hire a massage therapist or a portrait photographer.

Even Hennepin County Medical Center has upgraded its maternity ward, with pastel decor and a deep tub for water births.

All three are part of a major marketing offensive by hospitals to win a coveted demographic: mothers.

Thanks to a cultural obsession with pregnancy and babies, new moms are more informed and more demanding than ever. Many come to the hospital clutching "birth plans" and expecting to be indulged. Make them happy, the thinking goes, and they'll become lifelong customers.

The comments are quite interesting - many of them very akin to my own thoughts on it. I'm all for improving facilities, but too often it seems redecorating is a superficial substitute for actually changing problematic POLICIES. I couldn't care less about whether or not I can get a postpartum pedicure if their policies dictate a 24 hour deadline for labor. The comments, again reflect this; one woman writing, "My experience at Fairview Riverside was that they advertised one thing but delivered another (no pun intended!) They ignored the birth plan that they had encouraged me to make, kept trying to drug me and didn't believe I was in labor until the baby was on his way out. The after care was even worse!"

Exactly as I feared. Putting considerable funding and resources into "adding frills" (as the article itself puts it) without putting any effort into overhauling policies is just perpetuating the real problem. And it's the worst kind of condescension. I can just picture a Chief of Medicine (of course, I'm visualizing Bob Kelso) glancing at some poll results and sighing with exasperation. "Hmph, it seems that more women are wanting 'birth centers'. FINE, we'll give 'em a 'birth center'. Throw up some curtains, add a rocking chair, cover the equipment cabinets with wood paneling, and hire a manicurist. That oughta do it."

Unfortunately, it seems to work. I belong to a message board with a lot of mainstream mamas - wonderful people, but just largely mainstream - on it, and it comes up again and again, how they toured a hospital that just had the nicest maternity ward, they had hot tubs and lactation consultants and everything! But - without asking a lot of very careful, critical questions (I mean critical in both the 'harshly evaluating' and the 'extremely important' senses), there's no way of knowing whether the tubs would be available, and under what circumstances (is constant fetal monitoring mandatory, or is intermittent allowed? What about ROM?), or what KIND of lactation consultants they are and what hours they work, and on and on. It's the same old bait and switch. I genuinely hope these moms have good experiences, I do. From the bottom of my heart. But I've swallowed the red pill, and can never see only the face value of the hospital world again.

And frankly, I seriously object to the characterization of women as being under the influence of a "cultural obsession" and wanting to "be indulged". Excuse me??

Here's a revealing post from Keyboard Revolutionary on the trompe l'oeil performed by these maternity ward Extreme Makeovers.

Friday, July 10, 2009

My inaugural post.

This blog is long overdue, probably. I've been interested to the point of intermittent obsession with pregnancy and childbirth (the genesis of which I will post about later) for years, decades even. The thought of eventually becoming a doula has flickered on and off for the past eleven years, I realized, ever since my two best friends from high school had their first children within a month of one another.

The time just never seemed right. I had other things that needed to happen first - I had to live out a little more of my modern dance career, I needed to upgrade my day job from various obsequious positions like barista and bartender to licensed massage therapist (something that will serve me well as I serve women, I hope), and most importantly, I needed to have a baby of my own (another topic that I will wax philosophically on anon). Not all doulas have given birth themselves; it's not a hard and fast requirement, but this was important for me.

Now that Lily is over a year old, it's finally time to start the enterprise in earnest. I'll be doing both labor and postpartum training, and plan to do each certification with a different organization (for the third time, more on that later). the plan is to start this fall, within a few months. In the meantime, I'll be hitting the reading lists for both. Being me, it happens that I have many (if not most) of the titles on my shelf already. Did I mention the obsessive?

So why start the blog early? A little bit plain ol' "Why not?" And a little bit serious, garment-rending outrage at the "Pit-to-distress" scandal (because that's really what this is, an absolute scandal) that has erupted in the birthing blogosphere over the last few days. Please, anyone who is pregnant or knows anyone who is pregnant, I cannot overstate the importance of reading this.

Fellow birth advocates, I am starting to think that this exposure of OBs using "pit to distress" could be their Waterloo, or our watershed, or some other idiom signifying real change in our maternity care.

And so, I thought I'd start weighing in, instead of just constantly loading my Facebook feed with these articles and haranguing the other posters in the parenting section of my favorite message board.

I don't yet know what will come of this, if much -there are already so many terrific birthy blogs out there (my blogroll will soon overflow, whenever I get around to adding the links). At the very least, it'll be an outlet, and a chronicle of various doula trainings and eventually doula work (and midwifery, period, though that is FAR in the future), and probably will include the occasional snapshot of life with a Lilybean. (My other blog is a food blog I co-author with my birthmom, and we choose to stay on-topic at all times over there. Check it out, though!)

Thus, yet another birthy blog is born.