Friday, January 29, 2010

Weekend Movie: Taking on nonconsensual exams by med students

After finding out yesterday about the abhorrent practice of medical students performing pelvic exams on patients under general anesthesia without their consent, I MUST feature this documentary, Check out "At Your Cervix" (not to be confused by the fabulous eponymous blog).

"The documentary 'At Your Cervix' explores the connection between the way medical and nursing students are taught pelvic exams and the reality that most women experience them as painful and disempowering.

'At Your Cervix'
breaks the silence around the unethical methods used by medical and nursing schools to teach students how to perform pelvic exams; the most egregious being on unconsenting, anaesthetized women."

The original article: Time to end pelvic exams done without consent

Other blog posts on this outrageous practice, besides the one from Unnecesarean at the top of this post:

PhD in Parenting (from whom I got others): Canadian women are livid, and rightfully so
Sassymonkey: Not without my consent
Three Seven: I think I might throw up
Bad Moms Club: Bad Moms don’t Like Non-Consensual Nether-Probing
Living My Social Work: “Implied” Consent
Coffee with Julie: A pelvic exam without my consent?
Chaos Theory: Does the Canadian Medical Association Support the use of Roofies too?

Pissed off? Sign the petition from Her Bad Mother.

C-section Birth Plan: An Oxymoron? (Not even.)

Birth Plans. Normally, they're a collection of things to do or not do in order to give birth the way you prefer, and a major component of that for most women is avoiding a c-section. Same goes for a doula, right? In addition to helping create a birth that is as close to your ideals as possible, moms choosing to birth in hospital settings hire doulas to get their best chance at avoiding a cesarean.

So why would you even want to think about cesareans during your pregnancy, when you're focusing on visualizing your birth as positively as you can? And why would you bother with a birth plan if you know you're having one? Once the plan changes to surgery, whether it's in the heat of labor or in advance, isn't the whole raison d'etre for birth plans and informed choices out the window? Isn't it basically all the same?

Not at all. There are absolutely choices you can still make, choices that can make a huge difference in the experience for both your baby and yourself.
Hypothetical Reader: But I don't have any indication for a scheduled c-section, and no reason to think that I will be more likely to have an emergency arise during labor than any other low-risk mom. I want a natural birth if possible, or at least a low-intervention one. Are you saying I should write a backup cesarean plan? And doesn't thinking about this stuff risk manifesting it?
I remember all too well when I was facing the very real possibility of a cesarean, and a scheduled one at that - the very antithesis of the home birth that I had been planning and yearning for. Over the course of my pregnancy, my placenta moved from complete to partial to marginal, to finally, finally just over 2 centimeters (the minimum required to be in the clear for a vaginal exit) away from the os, at my 34 week ultrasound.

That whole story is a post unto itself, again, but I want to talk today about how I dealt with the possibility. Or rather, how I DIDN'T deal with it. Because I was intensely focused on doing visualization to help my placenta move upwards, I deliberately avoided reading anything at all about cesareans. I'm a pretty voracious reader, especially when it comes to this subject, and I read quite a few pregnancy books. But I confess to you all now, right here in virtual public, that I skipped right over everything that had to to with cesareans. I covered my ears and sang "Mary had a little lamb . . . (at home in her birth pooooool)".

Yes, it's true that I was able to dodge this bullet by the skin of my teeth, but in hindsight, I think this kind of willful denial was really not the best thing to do. Now, I'm not talking about turning it into a fixation that becomes a self-fulfilling prophecy, investing your energy into fear and anxiety. And as I said, I can relate. I understand not wanting to think about it too much. But I have read enough birth stories now where the mothers, in their admirable preparation for a natural or low-intervention birth, wind up heading into surgery for one reason or another, having absolutely no idea what was in store for them.

So to go back to our Hypothetical Reader, on the first question, "Are you saying I should write a formal backup cesarean plan?" No, not quite going this far (unless you have reason to schedule one, in which case, definitely yes; keep reading below), necessarily, but it is worth taking a deep breath, looking over some information on cesareans, and thinking about what your preferences would be if this were to arise. Perhaps write them down based on the examples to follow, if writing works for you. Take a few minutes to talk to your partner, doula, and anyone else on your birth team about these wishes. Confront it calmly, and then put it away. On the second question, "Doesn't thinking about this stuff risk manifesting it?" Again, this isn't about fixating on it and creating a self-fulfilling prophecy, this is acknowledging it and letting it go. Again, confronting it calmly, and then putting it away.

I want to share with you some really eye-opening and helpful information I've culled so far on the matter, most notably from Morgan of Adventures in Diapering and Beyond. (By the way, in case it's not already clear, let's assume for the purpose of this post that we're talking about necessary cesareans, both scheduled and unscheduled. You all know how I feel about unnecessary ones, and there's much to be said on them. But not today. Today we're talking about the ones that really do save lives.) First, Morgan herself gives a great explanation for using a birth plan for a cesarean here. An excerpt:

Why bother with a birth plan if you're having a c-section because you don't really have any say in what happens, right? Wrong. Even when you are expecting a c-section, there are still choices that you can make during and/or after the birth. Knowing what your options are can help you feel more a part of the birth experience rather than just an observer. While researching your choices, you will become better informed on what your doctor and hospital's expectations are and what you can/cannot do in a hospital setting.

Morgan provides a comprehensive collection of posts on c-section information, from questions to ask, what to pack, recovering from surgery, and a good visual guide for what to expect. She even shares a video of one of her own births. If yours needs to be scheduled, I would pore over every single link she provides. For those who aren't planning a cesarean but want to take my advice re: confronting it briefly but thoughtfully, her example of a c-section birth plan is a must. I'm going to quote extensively here, to illustrate just how many choices there really are, but all credit goes to her:
During Surgery:

*Catheter put in AFTER spinal (this is standard procedure at many hospitals)
*Volume down on heart monitor beeping
*Husband will photograph c-section
*One of the staff members from my dr.'s office will video tape Baby's birth
*I'm allergic to (x drug). Please make sure I am not given this drug.
*Warm blankets during surgery
*No sedatives after birth. I want to remember my Baby's first day of life.
*Please reinforce my uterus and use dissolvable stitches for closing me up [Note from Dou-la-la: I would recommend making sure that your doctor uses a double suture, as this increases likelihood of a safe VBAC. There is also evidence supporting sutures over staples - this is important to discuss with your doctor as well.]


*Please hold baby up for me to see as soon as Baby's born
*Husband to announce Baby's gender (or maybe not announce gender at all and allow me to see for myself)
*Keep cord long for Hubby to cut
*No Eye Gel, No Hep. B vaccine. I will sign the waiver ahead of time.
*Please bring Baby close to me during measuring & weighing.
*If Baby is doing well medically, please bring Baby to me as soon as she is suctioned, weighed, and measured. Please do not worry about cleaning her up much before bringing her to me.
*I would like to hold Baby while Baby is being foot printed, getting bracelets on, and while the paperwork is being filled out.


*Once back in our room to recover and been checked as stable, we would like to be alone with Baby to nurse.
*We would like to keep Baby with us at all times. If Baby must go to NICU due to medical reasons, my Husband will follow.
*If someone arrives to visit, please check with my husband or I as to whether we are up for company before allowing them in our room.
*Delay Baby's bath until the evening after Baby is born rather than bathing Baby right after birth.
*I am willing to be up and walking as soon as possible so I can get leg compressors off sooner
*I would like my Catheter out early the morning after surgery
*Baby will sleep with me in the hospital bed. While I am sleeping, there will be another adult in the room with Baby and I.
*I will be nursing on demand and whenever Baby is fussy to help stimulate my milk to come in and to soothe Baby.
Excellent, right? I think she has done a wonderful thing in providing all this information. make sure to also check out her post on Things I Wish I Had Known Before My 1st C-Section. It has lots of firsthand information about possible side effects, descriptions of some of the strange sensations and hospital protocols you MUST be aware of if you want to avoid them (like taking baby to the nursery while you recover). Morgan, my hat is off to you.

I also want to address some possibilities that may be outside the realm of most OB's experience, but if you have a really good one, they might very well be willing to try something new. If you poke around in the birth spheres on the internet as much as I do, you may have run across the term "gentle cesarean". Dr. Nick Fisk in the UK has been a proponent of this approach, pointing out that "while couples having normal deliveries have been given more and more opportunities to be fully involved in childbirth, very little has been done to see how we could make the experience more meaningful for those having caesareans."

The scent of lavender fills the air and classical music is playing quietly. On the bed, Jax Martin-Betts, 42, is calm, focused and in control. With the birth of her second child just minutes away, the midwife, Jenny Smith, is giving her a massage. Her husband, Teady McErlean, is whispering words of encouragement: just a tiny bit longer, and our baby will be in our arms!

It could be a natural birth at any maternity unit in Britain, but we are in an operating theatre at Queen Charlotte's and Chelsea hospital in west London, and the birth we are about to witness sounds a contradiction in terms: a "natural" caesarean section.

Jax has been on the theatre table for half an hour, and the obstetrician, Professor Nick Fisk, has almost completed the incisions through her abdominal wall and into her uterus. "OK, the baby is about to be born," he says. "Let's prop you up so you can see him coming out."

Smith removes the blue drape between Jax's head and her belly, and the head of the bed is lifted to give Jax a clear view. Fisk cuts into the amniotic sac and a fountain of fluid rises into the air before he rummages around to locate the baby's head. In a few seconds it comes into view, covered with the milky-white vernix that has protected it in the womb. For the next few moments, the atmosphere in the theatre is electric: Jax and Teady gasp in wonder at their new son, who is now looking around, although his lower body and legs are still inside his mother's uterus.

The "gentle cesarean" tried to make the environment more soothing and slows the pace of the entire process down, making the baby's entrance more gradual and thus, hopefully, more peaceful. It may even help in squeezing the lungs out, the way vaginal birth normally functions, and one of the distinct disadvantages of surgical birth for the newborn's respiratory function. The parents can see the birth if they wish, rather than being walled off by drapes, and the baby is given immediately to the mother, instead of whisking him or her away just because of protocols/habits.

This may or may be your cup of English Breakfast, so the specifics are up to you and your doctor, but if a necessary elective cesarean is required, you could think about incorporating some or all of this into your birth. I encourage you read the whole article - you might want to consider printing it and bringing it in to your doctor to discuss it.

In a similar spirit, Radical Doula featured a story on what was termed an "assisted cesarean", where the mother was able to catch her own baby! Check out this image:

A far cry from the usual image we see of someone holding the baby next to the face of the mom, who is strapped motionless to the table, unable to touch her baby. Radical Doula raises a very important point here, commenting, "But is this just an attempt to make an entirely medicalized process seem more mother-friendly? Luckily both the mother and doctor in this situation don’t want this procedure to encourage c-sections:"

But women should not consider assisted caesareans ahead of vaginal birth. “I still think a vaginal birth is the best way to birth your baby,” Ms Chapman says. “I don’t want women to choose to have a caesarean because of this,” [Dr. Gunnell] says. “We need to be very clear that this is not a good alternative to a vaginal birth; the caesarean section rate is very high . . . "But for those of us who don't necessarily have that opportunity [for a vaginal birth], this is a way of making an intervention experience a better experience.”

The original article also acknowledges that this certainly isn't going to appeal to everyone. Many women would shudder at the thought of seeing their own incision, for one thing. But if you look at the picture above and think this is a pretty amazing thing under the circumstances, why not at least ask your doctor? It's worth a shot. Even if he doesn't go for it, hey, maybe your other preferences won't seem like such a big deal anymore, by comparison. A nice bargaining chip, at the very least.

One final thought from Dr. Michel Odent. He was asked for his thoughts on how to make the best of the situation if a cesarean is inevitable, and he makes a case for allowing labor to begin on its own (hey, one of the Healthy Birth Practices, even if the context is a bit different) even if the end result is known.
Q: We now find ourselves preparing for a cesarean birth. We are wondering what things would be helpful to keep in mind/plan for/request in order to have the gentlest birth possible considering the circumstances.

The best way to deviate as little as possible from the physiological model of birth would be that the medical team is comfortable with the principle of an elective in-labor cesarean. In other words, the medical team would accept to wait until the day when you are in labor to perform an "in-labor non-emergency cesarean." This way it is a guarantee that the baby will have given a signal indicating that his or her lungs are mature. We know today that the baby participates in the initiation of labor. Furthermore, during labor contractions, the baby is exposed to hormones that make more complete the maturation of his or her lungs. This is why, as all pediatricians know, there is an increased risk of respiratory problems during the days following a cesarean performed before labor starts.
I think that's a pretty strong case, whenever the situation allows for it. Logistics would have to be managed, especially in terms of making sure your own doctor is available, or that his or her partners are also on board with whatever your plans are, but the effort is likely to be well worth it.

All efforts to reduce cesarean rates aside (and you know I'm all about that), a cesarean birth is still a birth, and is worth all the TLC you can possibly give to it, for both mom and babe. It IS possible to make it a healthier, less traumatic, and gentler experience. They both deserve it.


Hypothetical Reader: Wait, isn't one character glaringly absent from this whole picture? What about having . . . a doula?

Indeed, what ABOUT having a doula? This is addressed in a future post.

Top photo by Arif Tanju Korkmaz.

Saturday, January 23, 2010

Weekend Movie: A Walk to Beautiful

I had the opportunity to watch an incredibly moving and important documentary this week. "A Walk to Beautiful" tells the stories of several women in Ethiopia suffering from obstetric fistulas, caused by prolonged, obstructed labor that goes without treatment, their babies having died in the womb. The women (and young girls, too) are rendered permanently incontinent without medical care, and as such, become outcasts from their societies and even their own families.

Up to 5% of all pregnant women in the world develop fistulas, with a high incidence in places like developing countries in Africa where malnutrition is a root cause. Malnourishment causes insufficient skeletal growth, and thus the pelvises of many women truly are too small to safely deliver vaginally. This is true cephalopelvic disproportion, not the Big Baby Bull that is so often sold to women in our own American culture.

Here's the trailer:

Of course, watching this, I felt gratitude for living in a country and socioeconomic status where I have both quality midwifery for healthy, normal births with access to modern medical care for a complicated labor, should complications arise, and further for having grown up with more than enough nutrition to prevent stunted skeletal growth in the first place. But even more than that, I felt suddenly profoundly aware of another advantage I have that I take for granted every single day, one example of which I am exercising right now: the combination of information and connection to others.

The women in this video have been existing in emotional isolation, and sometimes near or complete literal physical isolation as well. They sometimes had no idea that there was a name for what had happened to them, or that it happened to other women, too. Literacy is an issue in itself, but even for those that are literate, information sources are scarce to say the least. They don't have an ICAN Facebook page. They don't have a bookshelf overflowing with empowering pregnancy books. They don't attend webinars. They can't watch "The Business of Being Born". They don't have a blog and a Google Reader full of birth-related material. They don't Tweet. (I certainly mean no disrespect to any of these things, participating in every one of those things listed myself.)

The Fistula Foundation, featured here in the film, provides not only treatment for afflicted women, but a safe haven. I was deeply affected watching these women, having been shunned and shamed for so many years (some from their early teens on, or younger), finally finding kindred spirits, finally a place of comfort and acceptance, a place to talk about their experiences. They are given not only care but caring company, for the first time since their unbelievably traumatic births. The camera captured some of the clinic's patients talking together about their stories, and I got the feeling that this may have been the first time they had ever been able to speak so freely about what had happened to them - and to someone who could really understand.

You can watch the full version below, and I hope that you do, but it's well worth purchasing the DVD to support the cause, or, if you watch online, consider making a donation to the Fistula Foundation, the organization behind this wonderful cause.

Thursday, January 21, 2010

Being "With Woman"

I've been working on a post about cesarean birth plans as well as how doulas fit into a picture that includes a cesarean, but I just can't concentrate on it. I'm too distracted thinking about a laboring friend of mine. Forgive me if this post is rambling and unfocused and more emotional than usual.

Obviously, I am pro-midwifery as a matter of principle, of course, and the ones I have met and encountered personally have all been wonderful, but I realize that this still does not mean all midwives are wonderful, deeply ethical, and compassionate people. There are bad apples in every profession. And unfortunately, I think my friend got one of them.

She has been coping with really difficult prodromal labor for a few weeks now. Her midwife is dropping her from care as of midnight CST, as she hit 42 weeks today. Now, this much is understandable, as regulations in the states that license midwifery require this. If she wants to keep her license, her hands are tied. I completely and totally get that. But this midwife is also refusing to shift into a supportive role, as is standard among home birth midwives upon transfer of care. This blows my mind.

Usually, when transfer of care happens, midwives will shift into a doula-like role (with the exception of the 11 illegal states, and my friend is not in one of them). This is true whether the transfer happens in active labor or whether care has to change hands prior to onset of labor. *I* was facing a scheduled section for a good chunk of my pregnancy, and my midwives didn't bail on me; in fact, they made it crystal clear that they would continue to be my allies throughout the whole process. Nancy literally said, "We're not just going to abandon you!" The explained all the things they could do to help me through the process (holding the baby to my chest if I was shaking too badly from the anesthesia, helping me get started nursing, running interference, helping dad deal, and so on) and make the absolute best of the situation if it came to that.

This woman actually said, point blank, "I'm a midwife, not a doula." I call serious Code Mec on this.

But let's back up a little more. This entire two weeks that my friend was coping with prodromal difficulty, the midwife somehow missed the fact that the baby is POSTERIOR. (For those who don't know, a posterior baby is in a bad position, causing slow progress and back pain for the mother.) This was discovered today by her apprentice (not the midwife, who never came over to see her at all today, this day being the last that she had a chance to deliver at home). My friend had gone the castor oil route yesterday, and things seemed to be picking up for a while - her water even broke (clear fluid, too, which is great). But then things slowed down again. Lo and behold, the apprentice immediately ascertains that she's posterior. So of course she's not progressing well, the head isn't engaged and pressing down on the cervix. How the HELL did the midwife miss this?

There ARE things you can do to turn a posterior baby, and I was talking to her about some of them . . . but these things (and also other measures that are no longer feasible, like chiropractic care) would have been much more helpful TWO WEEKS AGO, when her midwife SHOULD HAVE PALPATED THIS! I guarantee you the baby didn't just flip into posterior yesterday. So the midwife could have done something about it anytime within the last two weeks, but now, wouldn't you think she'd try to work with mom just this little bit longer, to try and help, and give it one last good shot (especially with ruptured membranes), to help with positioning, exercises, work with a rebozo, whatever? Keep an eye on mom's temperature and blood pressure and baby's heart tones (all of which are currently just fine)? Especially since she herself contributed to the situation by not picking up on an easily-identified malposition? And further, then recommended castor oil without verifying fetal postion first?


"I'm a midwife, not a doula." Are you even kidding me? Lady, let me remind you that the translation of midwife is simply "with woman". It does not mean "Almighty Birthing Empress Who Must Be In Charge, Or Else Might As Well Not Even Show". It just means being with her. I don't see how this can't evolve with the mother according to her needs, within the very definition of the word. Once again, it is completely standard for midwives to assume a supportive role upon transfer of care.

This is what happens when access to midwives is so limited - this woman is the only game in town for home births, so she can practice as uncaringly and, in my opinion, unethically as she wants.

Can you tell I'm pissed? I considered not posting this, as it's very emotional and personal, but if I'm going to be critical of many doctors and so many standard obstetric practices, it wouldn't be honest of me to not express this, too. So here's proof that I can dish it out to more than just OBs.

Okay, calming down, now that this is out of my system (sorta), I am focusing on sending my friend good energy over the miles. Please send some energy or prayers or whatever you do her way. Be "with" this woman in whatever way you can.

Monday, January 18, 2010

What to Expect When Hollywood Takes On Pregnancy

I probably don't have to explain why this is making pregnancy and birth advocates everywhere chase down their rolling eyeballs, but Lionsgate Films is actually planning to make "What to Expect When You're Expecting" yes, the instructional anxiety manual - into a feature film. (Here's just one example of why this book turns so many stomachs.)

Some are surprised to hear this, but honestly, given the celebrity baby obsession that constantly graces the tabloid covers, I'm actually not. Annoyed, and expecting the worst, yes, but not surprised. I suppose it was just a matter of time before Hollywood tried to capitalize on this more directly. I'm ONLY surprised the almost-as-irritating "Girlfriend's Guide to Pregnancy" (or perhaps even more irritating, depending on your POV) didn't get picked up first.

And, as The Feminist Breeder aptly points out in her comment on the article above, it's also possible that the publishers of the book have been seeing sales lagging, given the growing alternatives to their "classic" worst-case-scenario book, so this is as much a business move on their end as anything else. They point blank say as much in the article itself:
"We feel Heidi's book provides the perfect launching point to tell a funny and poignant story and start a wonderful franchise using this iconic and beloved brand," the upcoming film's producers said. "Heather [the screenwriter] has crafted a great tale, full of rich characters."
Ah, not just a measly little movie, but a franchise! Goody. So of course, the publishers must be thrilled. They've been putting out more and more variations on their original theme for a while now, not just the subsequent baby and toddler care books, but also with "Eating Well When You're Expecting" and "What to Expect Before You're Expecting" and who knows what else they'll come up with in time for movie tie-ins. They've been revamping the cover portrait of prematernal bliss over the years, from this:

To this:

And now this:

But obviously more drastic measures were needed. Thus, Hollywood, and whatever hackneyed jumble of cliches they're liable to come up with. I predict variations upon some if not all of the following elements: a childbirth class where the instructor is portrayed as a whacked-out hippie, breastfeeding advocates portrayed as shrieking harridans, the mother deciding to try to "go natural", then begging for the epidural (and possibly then told "Too late!", the message clearly being, you silly naive little thing, you should have just shut up and gotten it when we first offered), scenes of the father being hapless under pressure and nauseated by some aspect of the birth itself, and, of course, the doctor being the hero who saves the day. I'm sure the tone will be some combination of "He's Just Not That Into You", "Baby Mama", and "The Exorcist".

Let me take this moment to once again direct you to "Laboring Under An Illusion", an examination of how mass media portrayals of childbirth have affected us as a culture. I wrote about it a bit back here. (For my local peeps, we're going to be featuring this in our upcoming ICAN Birth Film Festival in April - more on that in the future.) I hope the makers of this film do even more promotion to offset whatever this "What to Expect" project unleashes.

Putting a fun spin on the news, Public Health Doula is holding a contest to see who can come up with the best plot proposal (the winner gets a copy of the new "Our Bodies, Ourselves"). Click on over to share your predictions/improvements/satire!

Kind of makes me want to rekindle my latent writerly ambitions and write my own danged screenplay. Seriously, I think the story of a woman seeking a VBAC and finding her way to midwifery, for just one example among scores of them, is as loaded with genuine drama and relevance as any great film out there. Maybe not a "franchise", but a moving, inspiring, and powerful journey. If *I* don't do it, I sure hope someone does.

Sunday, January 17, 2010


I usually feature a video on the weekends, but then I saw THIS. "Abundance" from the Piazza Maggiore, in Italy, taken by Gio. Thanks to Whoz Your Doula!

Abbondanza indeed!

My first blog award! Whee!

Thanks to Alanna at The Vanilla Bean for this Beautiful Blogger award! Insert joke about thanking the Academy here.

Okay, this is how this award works - I am to:

1. Thank the person who nominated me for this award - check
2. Copy the award & place it on my blog - check
3. Link to the person who nominated me for this award - check
4. Share 7 interesting things about myself - comin' up
5. Nominate 7 bloggers - the grand finale

So here are 7 possibly interesting things about me:

1. My original career was as a modern dancer (with plenty of glamorous day jobs to support my habit).

2. I can snort spaghetti up my nose and pull it out my mouth, then "floss". It's extremely sexy. If only I had a photo. Or better, a video.
3. My likeness as a baby is immortalized in a mural on the ceiling of one of the big rooms in the famous Brown Palace Hotel in Denver, where I grew up (in Denver, that is, not in the Brown Palace, a la "Eloise"). A local artist my parents knew used a bunch of baby pictures for his collage of chubby cherubim, of which I am the center cherub.

4. Taurus on the cusp of Aries.
5. My second career/upgraded day job was as a licensed massage therapist.
6. I was adopted at three days old to a loving family. 27 years later I was reunited with my birth mother and have been lucky enough to develop a wonderful relationship with her and her family over the years - and we did a lot of bonding through food. We wrote a little cookbook together, have a joint food blog, and even got to appear on the Food Network with the chili recipe from our cookbook. If I weren't being pulled MORE strongly into birth, I'd definitely be pursuing food seriously.

7. As a grown-up, I have lived in Denver, Boston, NYC, LA, San Francisco, Connecticut, and now . . . Erie. *sigh* I'm hoping that Portland, Oregon will be next.

On to my nominees, starting off with The Jills!

1. The Unnecesarean
2. Keyboard Revolutionary
3. Amber Strocel
4. Peaceful Parenting
5. Stand and Deliver
6. Woman Uncensored
7. Momotics

I follow a lot of other great blogs too, but to narrow it down, I had to keep it birthy. Cheers all around!

Wednesday, January 13, 2010

Training Your Team

I received this question from lovely reader Hilary:

I'm pregnant with my third, planning my first natural birth. I'm reading everything I can get my hands on. My husband is super supportive and reads whatever I ask him to. I'm thinking of having my two sisters, who are my best friends, in the room with me as part of my labor support team.

The only problem is, it's not like my husband or either of my single sisters has experienced a natural labor either, so I don't know how to prepare them to help. Are there books/videos/websites you'd recommend to help them prepare for the experience, possibly with some suggestions of things they can do to help? Thanks!

Hilary, congratulations! First, so glad that you're reading voraciously, and that your husband is so willing to absorb the knowledge, too. That's the ticket, girl. My first question is where you're planning to give birth. For the purpose of this post, I'm going to assume you'll be in a hospital setting. Much of the information will still apply if you're in an independent birth center or home, but I just wanted to note it for certain.

Okay, onward: The two best books for your whole team to read, IMO, are "The Birth Partner" by Penny Simkin, and "Your Best Birth" (the link to which is on my sidebar there). The former is just essential, does a fantastic job of explaining the stages of labor, and is very manageable. The latter is written in a way that it's addressed to the mother, but it would be very helpful for them to read through, particularly if you're in a hospital setting. It explains typical interventions, procedures and protocols in a wonderfully accessible way. The related website My Best Birth is also very helpful.

Another classic book that's terrific for labor supporters of all kinds is "Natural Childbirth the Bradley Way" by Susan McCutcheon. Like "The Birth Partner", it also breaks down the stages and processes of birth and addresses supportive techniques (it's assumed it will be the husband, as the original term for the Bradley Method is "Husband-Coached Childbirth", but could really apply to anyone). It also discusses various common interventions, how to fend them off and otherwise cope with a hospital setting. Though it is coming from the perspective of a specific 'technique', the lessons are very useful for anyone in a supportive role. Admittedly, this came out a while ago, and" Your Best Birth" is the most up-to-date of the three (by far), but the core information in them all is still helpful.

Next, are you attending a childbirth class? I would recommend an independent class, as in, not the one that the hospital offers - or at least, not ONLY that one. (Here's 9 reasons why.) It could be Hypnobabies, or the aforementioned Bradley Method, or Birthing From Within, or a more comprehensive class that uses a little bit of everything. Look around and see what appeals to YOU the most, and what's available in your area. What might be key is seeing if you could bring your sisters with you to some or all the classes - check with the instructors to see what's kosher, of course, but having them fully committed, informed, and on the same page as you would be a great bonus if at all possible.

As for videos, I do think y'all should have a "Business of Being Born" movie night if you haven't already! My next recommendation for you all to watch together, preferably with these handy printed PDFs, is the videos for Lamaze's 6 Healthy Birth Practices. I cannot think of a more succinct, clear, straightforward and current set of videos for just such a situation. These 6 Practices can seriously make ALL the difference if they're fully put into practice. Here's a sample, the video for the third Healthy Practice:

But then, of course, you're going to want to watch some actual births. Looking on YouTube for "natural birth" and "home birth" actually yields a lot of great examples, if not full-length instructional films. I of course cannot sing the praises of this collection of older videos from France enough. Other birth professionals out there, especially childbirth educators, do you have favorite films for your clients? Do share!

Now. ALL that said, being me, I still have to plug the option of a doula, even with your wonderful support system, for many of the reasons that I laid out in this post. As loving and devoted as your team may be, you stated that this is the first natural experience for all three of them, and sometimes having an experienced pro who knows the ropes can make the difference when the going gets rough. I say that not to cast doubt on the intentions or the abilities of your team, because with all three there and working harmoniously, you're going to be well-cared for. I just have to include it as another option.

Oh, come on, now, Anne, wouldn't it be overkill with three people already helping? Okay, assuming those people are very well-prepared as per the above, yes, it's possible, but there are still legitimate reasons to consider it. I just gotta throw it out there.

I hope you'll report back here about your experience, both in preparation and in execution (egad, what an awful way to refer to the birth of a child, please forgive me), and I wish you and your team the very, very best!

Monday, January 11, 2010

Vanity AND Perineum Intact

Tell me that's not one of the greatest, if not THE greatest moment-of-birth shots you have ever seen. How AMAZING is that?

And knowing the details makes it all the more delectable. This is the fifth child for this mother, the fourth VBAC, and the second HBAC.

And this gorgeous little boy? Eleven pounds. Nary a stitch.

This total freaking goddess is a friend of mine who gave birth at home last week. The title of the post are her own words, describing how, because she had held her hands over her the baby's head as it slowly emerged to feel what was happening and give support, the photographs of her crowning moments, which would otherwise be as graphic as they come, instead ended up being totally modest. Form AND function! Check out her great attachment parenting site at State of the Heart Parenting. Her other birth stories there are compelling - well worth reading in order. Positively revelatory.

Cheers and congrats to Justine, her kickass midwives, and her whole amazing family.

Saturday, January 9, 2010

Weekend Movies: Multiple Organisms

In case you haven't heard, a mother in Atlanta recently had a wonderful VBAC of triplets! Doulamomma reports:
The details are just coming out about this VBAC but apparently the woman had her triplets in a hospital attended by Dr. Tate. I am assuming she went natural, as in unmedicated, as that’s generally the way with a VBAC with Dr. Tate. From what I am reading so far, the first two babies were head down and the third was footling breech. Here are the babies stats according to the ICAN of Atlanta chapter posting.
3 girls, all vaginal, all Apgar 8/9.

A= 4# 6oz, 18.25in @ 10:24pm, vertex.
B= 6# 4oz, 18.25in @ 10:37pm, vertex.
c= 3# 11oz, 16.5in @ 10:39pm, double footling breech extraction.

All three babies are successfully breastfeeding as well.

What an amazing day for this mother, her family, Dr. Tate and the VBAC world as a whole!
Yes, yes, yes!

Great Apgars, all breastfeeding, with a fantastic doctor? I say THREE CHEERS are in order! (Ms. Unnecesarean resisted, but I shan't.)

In honor of this blessed event, I present this:

Congratulations to ALL these mamas!

Friday, January 8, 2010

First Contact: Connecting with a Midwife

I just got some wonderful news - a good friend of mine is pregnant! She emailed me to ask some questions about how to approach home birth midwives, how to set up consultations, and the overall protocol of what to do in the early weeks when a home birth is desired. I remember feeling a little confused about how it all worked in the beginning myself, so I thought, of course! I'll share it on le blog. (With permission, of course!)

Her original missive:

I am pregnant! 6 weeks. Ah, I really don't think I have ever been so happy about anything in my entire life. Really, this is a dream come true. As happy as this makes me, I am also well aware that anything is possible at this early stage. So, please do not say a word to anyone. We plan on keeping it to ourselves and immediate families until 10-12 weeks. Thank you.

Since you have been through all this and seem to have an endless supply of information, I would love to ask you a few questions. Please don't feel rushed to reply:

1. How many midwives did you interview?
2. When you called them up, did you ask to meet up with them for an interview? Or, did you make an appointment for an exam? Do you pay them the first time you meet up? Any good websites out there for questions to ask a possible midwife so that we don't forget anything?
4. Should I go to a doctor to get a blood test?
5. Do midwives do blood tests?
6. Any advice on how to approach a midwife?

I already have two/three midwifes that I want to meet with and then decide who to work with - that is what I should do, right? Both of them are home birth midwives with privileges at St. Vincents. Both come highly recommended. I just want to make sure I feel comfortable with them before I hire them. I want to call them soon, but I am not sure what to say to them... How does it work???

Thanks, Anne.
Here's my response, with a few embellishments. PLEASE, midwives, doulas, experienced home birthers and others, correct me on anything that I might be mistaken about. Because she lives in New York City, there are some rules and regulations about which I only know the bare minimum. Comment and correct away!
Oh, I am just so tickled. WHEEE!

Ahem - on to your inquiries:

"1. How many midwives did you interview?"

I interviewed two. I honestly really liked both, but it came down to distance, primarily. One was just too far away - we could have made it work if there were no other options, but since I liked Nancy just as much as Vicki, why not go with her? And I'm oh so glad I did, as I just adored Nancy and her apprentice Gengi - though I'm sure I would have had a wonderful experience with Vicki & Co at Birth and Beyond as well. (To think I could have been attended by the great Amy Romano, by chance? I wasn't even reading her mighty Science and Sensibility blog at the time. Ah, close calls with greatness.)

"2. When you called them up, did you ask to meet up with them for an interview? Or, did you make an appointment for an exam? Do you pay them the first time you meet up? Any good websites out there for questions to ask a possible midwife so that we don't forget anything?"

With EACH of them, I called, told them my approximate due date and said I was interested in a home birth and would like to do an consultation. They each met with me for about an HOUR apiece, and I had really great conversations with them both. This consultation is, generally speaking, very much standard among midwives - I would have raised an eyebrow at anyone who wanted to charge me for an initial consultation.

BUT - and this might be a big but - New York State has its own set of laws and regulations regarding midwifery (it does with massage, too - every other state is pretty much the same, but ooooh, special New York has to have its very own system! *affectionate eyeroll*). You're going to be dealing with CNMs (Certified Nurse Midwives) as opposed to CPMs (Certified Professional Midwives), which won't necessarily affect the quality of your care, since these particular women deliberately chose to go into home birth, but it may affect some of their standards of practice in ways that I might not be aware of. Hope that makes sense!

Then you would go home, talk it over with your husband, weigh the pros and cons of the various contenders, and once you've decided, THEN make the first Official Prenatal Appointment.

As for payment, this varies from midwife to midwife no matter where you are. I'm sure most would absolutely LOVE it if you paid it all right up front, but I know that many will work out a payment plan as well, usually to be completed before or at least by your guess date (I will confess, it took me a a bit longer to pay off my remaining balance after Lily was born, but we did it! Thanks again for your flexibility and understanding, Nancy!)

[I will address the Questions to Ask in my next post, as that is a whole topic unto itself!]

(Was there a number 3? Or was that just Pregnancy Brain?) <----- Very much a real syndrome, as I'm sure you're discovering.

"4. Should I go to a doctor to get a blood test?"

Just to confirm pregnancy? Not necessary, unless there are specific personal reasons to do so. For example, if you had a history of miscarriage and wanted to get a series of *quantitative* blood tests done (this is where they measure the levels of hCG to make sure they're increasing appropriately), I could see why this might be something you want to do. But just for confirmation, no.

"5. Do midwives do blood tests?"

I assume we're talking about the overall initial blood workup, not testing to confirm pregnancy. Some midwives can and some can only do a few things, like blood sugar, not the full workup. Now, since you'll be working with CNMs, they most likely will do blood tests - that's one of the perks! If, as in my case, you were working with CPMs, you would "outsource" it by going either to a cooperative OB office, as I did, or going directly to a lab to get them, and would then bring the results back to the CPM.

Urine tests can always be done by either. And my midwives tested my blood sugar around 28 weeks, just, again, not the entire workup. YOURS very well might be able to do it all. I hope that's clear!

6. Any advice on how to approach a midwife?

With an 8x10 B&W glossy, a resume, and a prepared monologue.

Or, just give them a call and say that you just found out you're pregnant and are strongly considering home birth (even though you're already clear in what you want), and would like to do a consultation to find out about her practice and how it works. Like I said, this SHOULD be common courtesy/procedure, I'm just not 100% on NYC. DO ask whether there is any cost for a consultation, just to be sure. And then she'll take it from there! The first official prenatal visit, separate from your consultation, once you've selected a provider, might not happen until 12 weeks, depending (some might meet earlier - I'm just saying, don't be surprised).

"I already have two/three midwives that I want to meet with and then decide who to work with - that is what I should do, right? Both of them are home birth midwives with privileges at St. Vincent's. Both come highly recommended. I just want to make sure I feel comfortable with them before I hire them. I want to call them soon, but I am not sure what to say to them... How does it work???"

Already having a few to choose from is great! I definitely think you should meet with them all. Don't worry about not being far enough along, either - making these calls at this date is common and fine. And bringing your husband with you for the consultations is also very much accepted - some spouses/partners have reservations and meeting with the midwives helps address their concerns.

Okay, I'll give it a rest. PLEASE do not hesitate to ask other questions or just share more info!

Now, as I said, another entire post can and will be written about what to actually discuss in that consultation! Feel free to add your thoughts on that in the comments as well, and stay tuned!

(Man, I wonder if I'll ever run out of things to blog about. I have so many juicy up and coming posts already, and I just keep adding to the list . . . )

Tuesday, January 5, 2010

Breastfeeding Laws, State by State. All of 'Em!

I just have to share this fantastic resource far and wide. Here it is, a comprehensive, state-by-state listing of all the breastfeeding laws on the books. If you have a nursling or are pregnant, look up the laws for your state, and consider printing it out to carry in your purse, just in case. Pass it on to anyone you know who has a baby or is pregnant! Bookmark it for future reference when traveling, too.

You'll see that most of the laws deal with protecting a mother's right to nurse publicly (also known as a baby's right to EAT). Some states also have specific laws regarding providing for pumping breaks and adequate facilities in the workplace, and some address exempting nursing mothers from jury duty. Note that in NO state is nursing in public prohibited in any way, but there are three places that don't have any specific protective laws on the books. Everybody give dirty looks to American Samoa, West Virginia, and Guam.

Thanks to Colleen from Thoughts from a Doula for the link!

Quote pop quiz

"You are assisting at someone else's birth. Do good without show of fuss. Facilitate what is happening rather than what you think ought to be happening. If you must take the lead, lead so that the mother is helped, yet still free and in charge. When the baby is born, the mother will rightly say: 'We did it ourselves......!' "

Who do you think said this?

(If you saw this on my Facebook profile, you're lovingly disqualified. And no Googling!)

Saturday, January 2, 2010

Weekend Movie: Taye Diggs, his "Warrior" . . .

. . . and the emergence of his "Inner Gangster".

This is actually from back in October, but if you haven't seen these clips, I thought they were well worth sharing, since we were discussing fathers and doulas just the other day. Here, Taye Diggs discusses the recent birth of his son on Jimmy Kimmel. I just love how amazed and reverent and loving he sounds about the whole experience. He even discusses placenta encapsulation! (Or, as Kimmel hilariously calls the placenta, "the big gross follow-up baby".)

Side note: NOW I remember where I learned that they use cream cheese for vernix on in TV births! I was racking my brain on that one the other day. Also note: Taye and Jimmy were confused as to the origin of the word "doula". It's actually adopted from the Greek, meaning, simply, "woman who serves".

And a similar, shorter appearance on Ellen. (When he refers to a "midwife lady", he actually means the doula, it was just a slip.)

I think he deserves major credit for talking about all this openly, and also for managing to do it with humor but WITHOUT resorting to a lot of the lazy, hackneyed, husband-disgusted-by-childbirth cliches we've all come to take for granted in the media over the years. Congrats again, Taye and Idina. Hope little Walker is doing stupendously!