Friday, July 30, 2010

Postpartum OCD, A Retroactive Self-diagnosis: Part 1 of 2

I've been mulling this post over for quite a while. I've mentioned it in passing before, and the combination of one topic in Breastfeeding Cafe's Blog Carnival plus actress Bryce Howard's deeply affecting piece about her own postpartum depression (scroll down a bit in the link) is finally the catalyst. I've long since missed the deadline for inclusion on the topic in the first carnival, but I decided to go full steam ahead anyway, and then found out about the World Breastfeeding Week (which is next week, by the way) Carnival by The Leaky B@@b.

As prelude, an excerpt from Howard's story:
It is strange for me to recall what I was like at that time. I seemed to be suffering emotional amnesia. I couldn’t genuinely cry, or laugh, or be moved by anything. For the sake of those around me, including my son, I pretended, but when I began showering again in the second week, I let loose in the privacy of the bathroom, water flowing over me as I heaved uncontrollable sobs.

When I visited the midwife for a checkup, she gave me a questionnaire, rating things on a scale from 1-5 so that she could get a sense of my emotional state. I gave myself a perfect score. Despite my daily “shower breakdowns” months passed before I even began to acknowledge my true feelings.
Boy, do I know those shower breakdowns. But even beyond that, the last part really resonated with me, as I imagine it would with many women. The Edinburgh Scale - the standard for assessing postpartum depression - is a great tool . . . in theory. I suspect far too many women do exactly what Howard did above, and what I almost certainly would have done: answered dishonestly in order to prove our maternal aptitude (whether proving it to the person giving the test or to ourselves). Part of it may be pride in the sense of ego, part of it may be fear of having our children taken away from us if we admit to our true feelings.

But another huge part of it may be denial - I had a hard time admitting my feelings to myself even at the time, and I actually didn't recognize many of my own symptoms until long after the fact, through the process of working with other women postpartum. This was heightened by the fact that I believe my own postpartum mood disorder is one that doesn't get quite as much attention as "regular" postpartum depression (I say that with tongue firmly in cheek, as there is nothing regular about it for those who are experiencing it) or the extremely rare but headline-generating postpartum psychosis.

One of the two postpartum anxiety disorders that are part of the greater PPMD spectrum along with depression and psychosis is postpartum obsessive-compulsive disorder (the other is a panic disorder). Despite being reasonably aware of postpartum depression, I had never even heard of the OCD variation at the time.

Many of you have read my unusually difficult nursing story, particularly after linking to it in the conversation that followed a recent piece, and I've always been willing to talk openly about that, but I've never talked publicly about the deeper psychological undercurrents that accompanied the whole saga. I haven't even talked much about it privately, even to my good friends. So please forgive me if this comes across as a bit of a purge.

I did start off with a pretty acute case of the Baby Blues, the most benign and the most common of all postpartum mood variations. It's hormonally driven, and not considered a disorder - frankly, it's quite a normal and expected, temporary state, as 75 to 80% of all mothers experience this to some degree. This much of my tale I did actually write about already, in this post:
That third day. I still shudder to think about it. I had probably slept a total of 4 or 5 hours since the birth. A foreshadowing of the breastfeeding difficulty to come was a growing concern, as Lily showed no rooting reflex and seemed totally uninterested in nursing, and had not yet effectively latched on, so I was desperately pumping to ensure that my supply would still come in without Lily stimulating me, and to produce a few drops of colostrum which then would be cupfed to her.

Adding insult to injury, my hemorrhoids were positively frightening, making every position uncomfortable. I needed to take both my and Lily's temperature regularly, I needed to massage my uterus gently but regularly to help it shrink back down, keep replenishing my witch hazel and comfrey pads in the freezer to soothe my perineum and bottom . . . all endless tasks I could never seem to keep up with enough. I also had to put Lily in the sun for a few minutes several times a day to help with her mild jaundice, and at one point I was CONVINCED I had given my newborn a sunburn and was despondent.

Then, I could never decide whether it was better to swaddle her or keep her skin-to-skin with me - whichever one I chose, I'd feel guilty that I wasn't doing the other. I had a gorgeous
Maya Wrap ring sling given to me at my shower, but for the life of me I couldn't figure out how to use it thanks to the incredibly confusing instructions on the DVD that came with it. I watched it over and over and over again, and couldn't even get beyond the intro part of threading the damned thing. I finally threw it across the room in exasperation. Then Lily's umbilical cord started to look seriously funky, possibly gangrenous in my increasingly paranoid mind, and I had NO idea what was normal. More than anything, the sheer responsibility of it all was starting to really hit me. At one point I had her wrapped up and lying on a heating pad, and her diaper leaked, wetting the pad (I hadn't gotten the hang of using the waterproof covers yet). I decided that I had almost electrocuted my own daughter in my carelessness andshecouldhavediedanditwasallmyfault and proceeded to sob hysterically - and I do mean HYSTERICALLY - over it for at least half an hour.

My milk then came in and left me freakishly engorged with what felt like rocks in my boobs and armpits. Again, I had no clue, no sense of what was normal, and rather than resting when Lily slept, I took to scouring the web for advice. I remember sitting at the computer on the message boards at 6 am with cabbage leaves stuffed into my bra, weeping and feeling like the most pitiful mother ever to barely-qualify for the title.
. . . Yeah, you could say I was a little overwhelmed.

Later that day, starting to see how unhinged I was becoming, Aaron wisely insisted that I take a walk, as I literally had not once set foot outside the house since I was about 6 hours into my labor. Lily was asleep, my list of tasks would wait for 5 minutes. I protested a bit and finally reluctantly agreed to walk out to the mailbox, at least. I put down my checklist and I ambled out the front door in a daze, and got about three steps before suddenly realizing I had walked out there with my shirt COMPLETELY unbuttoned and hanging open, the state I'd been walking around the house in. Thank goodness no neighbors were around to see, and it did give me the first laugh I'd had.

Hopefully, as I grow into my field, I'll be able to help mothers through the labyrinth with a little more grace than I.

This was the baby blues, no doubt about it. The third into the fourth day, man, this was what it means to stare into the abyss.

Not a happy mama.

Things DID ease up a bit for almost week, but just when I thought I was out of the woods, our nursing took a turn for the worse. I thought we had ironed out our initial difficulties. She seemed to be nursing, even though I had always thought that the sucking sensation would be much more vigorous than what I was experiencing. She was producing enough diapers, and put on a few ounces, almost regaining her birth weight. She was 7 even at birth, dropped to 6 lbs 10 oz by day 3 (perfectly normal), and then went back up to 6 lbs 14 oz. I thought it was all basically behind us.

Then it all went to hell.

She had a day where she slept a LOT - over three and even four hours, and she hardly nursed at all. I knew this amount of sleep for a brand-new-born could be a very bad sign, and I started to worry. Since she'd been nursing so much the day before, the first lactation consultant I had worked with thought it was a growth spurt. Well, overnight, we had our first glimpse of real hell - 7 hours of trying to nurse and flailing around and crying instead. It was like she had just FORGOTTEN HOW.

Not a happy baby.

This went on for four days, and her diapers started to dwindle. She still wet, but went for well over 72 hours without any poo, and then the wet diapers, too, started to become less frequent. Nursing still happened on something of a pattern, but it always started with at least 10 minutes of fussing and crying and flailing before she eventually settled down - usually falling asleep after what seemed like far too short a time. Despite this, she still slept, had quiet-alert stages, and displayed no signs of extreme hunger like constant rooting, frequent crying, no physical signs of dehydration like 'tenting' of the skin or 'brick dust' uric acid crystals in her diapers.

Here's the most emotionally difficult part to talk about, regarding this phase: I was getting very frightened. And understandably, the people who were closest to me wanted to reassure me. I was told over and over that she was fine. Babies just cry like that sometimes. She'll poo eventually - she has to, she's eating, isn't she? It's good that she's sleeping - you're lucky! Look at those chubby cheeks, she's not starving. She would be rooting if she was hungry. She'll eat if she's hungry enough. Sometimes breastfed babies just don't poo for a while. Trust your body. She's fine. And inside, my gut was screaming No. NO. She's NOT fine. Something IS wrong. Her cries DO have meaning. She needs help. I need help. But I kept suppressing my gut. I listened to the reassurances and tried to ignore the sense of unease growing into dread and finally terror.

A video of her nursing behavior at the time (I cannot believe I'm posting this), taken in case we needed to show a lactation pro:

My heart still aches hearing those cries. Look at her there, my poor innocent babe trying so hard, and so hungry and upset and bewildered. I put on a brave face for the camera, and make some sort of blase-looking remark the end, but I guarantee you, the memory of sobbing along with her during these nightmarish feedings will never leave me. One of the other things that pains me about this video is the way she's dressed. I had been trying to do skin-to-skin much of the time, until a relative arrived to help out of the extreme goodness of her heart (seriously), and with the best of intentions, subtly convinced me that I really ought to keep her in layers of clothing and bundled up warmly instead. And I didn't fight it. I had so little fight left in me.

Anyway, I finally had Judy, the lactation consultant, come back because I wanted her to evaluate my latch and observe her nursing behaviors. What we finally figured out, after some experimentation, is that her tongue was not coming forward to suck - therefore it was taking forever for my letdown to happen and she was frustrated because she just wasn't getting anything! (Her posterior tongue tie was still not identified, despite this observation.) We concluded that she must have been getting SOMETHING eventually, since she still had some wet diapers, but nowhere remotely near the amount she should. Because she was not able to actively remove milk from the breast, the initial letdown was all she had been getting. The day before she came, Lily had only three wet diapers the entire day, and hardly soaked ones at that. You can actually see the growing despair in the written diaper tracking logs I kept (more on those later).

Most devastating of all, we weighed her again. She dropped to 6 pounds 5 oz during this time. I just wept at that. I had failed her. I had not listened to my instincts when I knew deep down that something was going very, very wrong, and I allowed well-meaning others to reassure me and talk me out of my fears. And I had utterly failed her. My baby had suffered because of my incompetence at the most fundamental aspect of being a mother.

When we weighed her, the lactation consultant and my mother both apologized to me right then and there. "I have to admit, I didn't believe you," Judy said of the increasingly panicked calls I had made to her over the last several days. Extremely long story short, Judy set me up to start finger-feeding her with a syringe, explained the "suck training" technique I was supposed to try, as well as the pumping schedule I would need to follow until she was back on the breast - none of us having any idea how many months this would take.

My postpartum obsessive compulsive disorder took root in these early weeks, but this is all prelude. Next up, in part two, I discuss how the disorder played out in the months to come.

Wednesday, July 28, 2010

Wordless Wednesday: Breastfeeding Cafe Carnival - Babywearing!

This post was written as part of The Breastfeeding Cafe's Carnival. For more info on the Breastfeeding Cafe, go to For more info on the Carnival or if you want to participate, contact Claire at clindstrom2 {at} gmail {dot} com. Today's post is about the importance of breastfeeding. Please read the other blogs in today's carnival listed below and check back for more posts July 18th through the 31st! 

Friday, July 23, 2010

Weekend Movie: Supply & Demand

Another documentary on breastfeeding in the works! I blogged about "Formula-Fed America" before, but hadn't known about this one until Best for Babes posted about it. Doesn't it look promising?

Soo, anyone have any tips for getting these movies shown in podunk kindsa places? Not everyone can hop on the subway and catch a matinee at the Angelika (anymore).

*If you haven't read about the new BYOBoobz Party concept from BfB, check it out.

Wednesday, July 21, 2010

Wordless Wednesday: Breastfeeding Cafe Carnival - Favorite Breastfeeding Photos


This post is part of The Breastfeeding Cafe’s Blog Carnival, today's theme being, of course, Favorite Breastfeeding Photos. For more info on the Carnival click here, or if you want to participate, contact Claire at clindstrom2 {at} gmail {dot} com.

Monday, July 19, 2010

Birth Trek: The Next Generation

I recently received the following comment:
Hello, my name is Brittany and I am 17 years old. I am passionate about birth, and it is something I would like to study more, I think I would like to become a childbirth educator. Is it possible to give me any info on where to start?
And I thought it was well worth sharing a response with y'all, especially since I've been wanting to do another book recommendation post. SO:

Hey Brittany! It's so heartening to know there are young women out there like you. (And saying that makes me feel positively ancient, by the way.) I would definitely check out CAPPA's trainings. In particular, I think you'd be FANTASTIC for CAPPA's Teen Educator Program! Did you know there was such an awesome thing? Well, there is. And it needs passionate young women just like you. Look here! You do need to be 18 to become certified, but no reason why you can't get started on the preparation now - especially the reading list.

I can recommend a zillion practical, informational books - but before I even get into my favorites on that topic, I'm going to recommend you start with one of my two favorite memoirs of all time: "Baby Catcher: Chronicles of a Modern Midwife" by Peggy Vincent (the other is the poignantly hilarious "Operating Instructions: A Journal of My Son's First Year" by the poignantly hilarious Anne Lamott -not much about birth, but everything, oh, everything to do with becoming a mother). "Baby Catcher" has tons of great birth stories, and is a fabulous glimpse into the life and evolution of a midwife, from hospital to home. Full of humor and so engagingly written. It's the perfect prologue.

My other top recommendations, getting into the nitty-gritty: A great one to start with is "Your Best Birth". It's a very user-friendly breakdown of all the options a laboring mother faces, peppered with great birth stories. Taking it a step further, the most recent edition of "The Birth Partner" by Penny Simkin is thorough, authoritative, well-organized and loaded with great information and suggestions. For a book that covers the whole of pregnancy into birth, my favorite is "The Complete Book of Pregnancy and Childbirth" by Sheila Kitzinger. And if I could get every woman in America to read just ONE BOOK, it would be *drum roll* "Pushed: The Painful Truth about Childbirth and Modern Maternity Care" by Jennifer Block. It's less about the breakdown of the labor process (though you glean plenty of info along the way as well) and more about politics, but anyone entering the field should find this gripping and galvanizing.

I mentioned in an earlier post that I have over seventy titles in my ever-expanding library, and yet I still haven't gotten my hands on "Gentle Birth, Gentle Mothering" by Dr. Sarah Buckley. I have a feeling once I do, it will rise to the top of the heap. I think it's fair to give it an unofficial recommendation. It would be a good idea to get some basic info about breastfeeding as well. Any of the books in this post are fabulous. I also know there's a brand-spanking-new edition of La Leche League's classic "The Womanly Art of Breastfeeding". I'll fess up: I haven't been crazy about past editions. But the buzz about this latest edition is overwhelmingly positive. I know some lucky bloggas have gotten review copies (any ideas on how to be cool enough to get one of those?), and I eagerly await their $0.02.

How about some just plain birth stories? The classic, of course, is "Spiritual Midwifery", which is chock full of amazing stories, dated as it may be (you just have to look at it as a historical piece, in a way, though one that still has relevance). The more recent "Ina May's Guide to Childbirth" has plenty of them too. I really liked the collection "Adventures in Natural Childbirth", which compiles natural births in all possible settings, home, birth center and hospital. And finally, the locally produced "Birth: It's Positive" has inspiring stories from many mothers, with an emphasis on VBACs. My own story is included, too. Proceeds go to our local chapter of ICAN, but I bring up the book not just to plug it, but because the stories are well-worth it.

Non-reading preparation: I'm betting you've already seen "The Business of Being Born". If by some chance you haven't, hie thee to Netflix to put it in your queue, or hey, as of TODAY it is currently half off on Amazon - may as well add it to your arsenal, since you know you'll want to later anyway. I think "Orgasmic Birth" has its strong points as well as its weak ones, but either way, it's a worthwhile watch for you. ("Pregnant in America", I'm sorry to say, was a major disappointment. I should have known by its subtitle, possibly the worst subtitle ever to actually make it onto the cover of a DVD without someone putting a stop to it: " . . . A Nation's Miscarriage". Seriously.)

And you know, I was about to write And whatever you do, stay away from "Birth Day", "Maternity Ward" and "A Baby Story"! but actually, for your purposes, I do think they're useful to watch, after you've started to read the books on the list and watch the other movies. Watch them in balance with the above, and with the plethora of glorious natural, home, and/or otherwise empowered births available on YouTube now. Soon, like me, you'll be shouting at the screen like a World Cup fanatic.

Brittany, I'd love it if you kept me in the loop about how everything's going for you, should you pursue this teen certification, or any other trainings. Right on.

Make it so.

[I'm really not a Trekkie, actually, but in order to geek up a "next generation" reference authentically, I'd have to get into the whole Slayer lineage, and which is probably a bit too obscure. But for any Buffistas out there, I'd say Brittany is quite the promising Potential.]

Thursday, July 15, 2010

The difference between "I can't" and "I won't" - and why it matters to all of us.

This should sound familiar.

A woman posts on a public online parenting forum, expressing feelings of discouragement about how her breastfeeding is going. She doesn't think she has enough milk, and has been supplementing with formula in a bottle, including one overnight feeding, as her mother-in-law wants to help her get more sleep (and has insisted that she move the baby from the bassinet in the master bedroom to the crib in the nursery). She has tried pumping but says she's not getting more than an ounce at a time, further cementing her belief that her breasts are just not working correctly. She confesses she's about to throw in the towel.

In just about every forum that exists, the response is usually immediate: breastfeeding advocates of all stripes begin offering advice for all kinds of different strategies she could use to get her nursing back on track. (If you're reading this, you probably thought of a few things right off the top of your head already, didn't you? I know I would have, if I hadn't written it myself.) Some of the comments are phrased more supportively and sensitively than others, but the objective is to arm the mother with information and cheer her on. Then, when the mother quits breastfeeding, if she feels guilty about it, the source of that guilt, in her mind, becomes the breastfeeding advocates who she now perceives as pushing and judging her.

And the lactivists feel frustrated that their advice and efforts seemed to go unused, or fell on deaf ears altogether. But why be frustrated? This was just one woman, and it's ultimately her choice, her prerogative as a parent to weigh the risks and benefits of her feeding choices and how they will impact her child. It doesn't affect the lactivists personally. It's really none of their business.

Why DO breastfeeding advocates, or lactivists, if you will, often get very worked up about, and seemingly invested in, other women's breastfeeding stories, particularly if their attempts to breastfeed were unsuccessful? Why do we seem to insist on making the personal into the political? Where does individual choice come into the discussion? Sensitive questions with complicated answers. Part of the answer includes the public health aspect, the impact on both infant mortality, and even the economy - all of which are extremely well-covered by other bloggers and a huge variety of articles.

One aspect of the answer I'd like to zero in on: I think one major reason many lactivists work so hard at helping women to succeed does go beyond helping that individual woman. This individual help is the most important thing, of course, and while one could argue that breastfeeding might not be the right choice for every mom, as some have observed, it is right for every baby*. Yet here's where it goes deeper: every time a woman publicly struggles with some aspect of breastfeeding - say, on a message board, or a blog, or on Twitter, and then succeeds due to being given good resources, support and information, other women see this example and learn from it. And every time a women publicly struggles and does NOT get the same quality of response, other women see this example and learn from it as well - and may not have any idea that the right resources, support and information could have made any difference. [Disclaimer: there are situations where breastfeeding is truly not possible, as in the infant conditions in the footnote, and the exceptional instances where low milk supply is a reality. They are incredibly rare, but also very real and certainly deserve respect (and frankly, more research).]

But even beyond that, there's another part of the picture that circles back to the matter of mother's individual choice. I saw this comment by Mary Woodring on the Facebook page for Peaceful Parenting the other day, and hereby hit "Like" a thousand times over. THIS is the rub, and the inspiration for this post:

"When a woman is unwilling to breastfeed, but tells people she was unable, it inflates statistics and seeds fear in other women that breastfeeding is an unreachable ideal for most women."


Thank you.

There IS a flip side to that - and I can already feel the murmurs. In order for women to feel safe about publicly admitting that they were simply not willing to breastfeed, and that it was a choice, not some failure of their anatomy or - another frequent claim - "refusal" by their child*, we, as a breastfeeding advocacy community, need to be able to accept those choices and not condemn or harass these mothers who have made different choices.

Now, two immediate points: First, I definitely feel that the lactivists who TRULY do bully and judge mothers are in the minority. Far too often, advice is solicited, and then when things aren't working or the mother makes a different choice, the advocate becomes a scapegoat and a target of their own guilt, as in the example above. We've all seen it happen. But we also all know there are times when lines are crossed and unfair judgments are made . . . even insults. This needs to stop, and we need to make an active effort, even in the cases where guilt over the choice to formula-feed is directed at us inappropriately, I feel that it IS worth it to make doubly sure that we are kind and nonjudgmental. Annie of PhD in Parenting recently wrote a masterpiece on this matter, a post which I have made my personal mission to work on embodying. It's not easy. It does involve biting my proverbial tongue and sitting on my literal hands at times. But in order to move forward and start being able to make a clearer distinction between the "I couldn't" moms and "I wouldn't" moms, I think it's very much necessary.

Secondly, and I can't emphasize this part enough: being willing to accept mothers who have made the choice to formula feed and treat them respectfully does not, not, NOT mean cutting back on promoting information about the benefits of breastfeeding/risks of artificially feeding. Nor do we reduce efforts to provide moms with solid support and resources and information, and especially easing the access to all of the above. On the contrary, I feel it's all the MORE reason to redouble such efforts.

There are many, many moms out there who had no desire to breastfeed for any number of reasons, many of them cultural but some of them personal - and yet, after learning more, and more, and more about how dramatically it would benefit not only their babies but themselves, they slowly changed their minds. I know one such mother who started out being totally turned off by breastfeeding with zero plans to do so herself - who is now becoming a lactation consultant as a result of her experience. You probably know one too. They're out there, and they matter, and they can become some of the best counselors of all, since they've been there themselves.

If information and resources are copious and available, some of those moms who were initially unwilling might make the transition all on their own, and then, in the absence of judgment, the remaining mothers would be able to be honest and forthright about their choice WITHOUT perpetuating myths about their "inability" to breastfeed.

Let's all assume that mothers, with very few exceptions, actually do do the very best they can with the information they have at the time. Look how this gives moms the benefit of the doubt, assuming the best intentions, AND underscores the need for copious, accurate, easily accessible information. I am CERTAINLY not saying we throw in the towel, far from it. I'm saying we need to work harder and work smarter. Getting the information out there as positively and honestly as we can without diluting the message (that might seem cryptic, but it's best saved for another post) is mission critical. And I feel that reducing the number of mothers who state publicly that they could not breastfeed when it isn't actually true could have a major impact.

You may say I'm a dreamer, but I'm not the only one (I hope).

*Remember, only one in every 30,000 to 60,000 of all babies actually has galactosemia, and congenital lactose intolerance/lactase deficiency are likewise extremely rare - the conditions unrelated to mom's own diet that would cause a baby to have difficulty with the milk that was biologically designed for them, and are true contraindications.

[And no, the picture doesn't have much to do with this post unless you really stretch it into the abstract. But I thought it was fun nonetheless, no?]

Friday, July 9, 2010

What do Girl Scouts have to do with birth?

I was remarking to The Feminist Breeder yesterday that with all the certifications I'm already doing and all the ones I want to do in the future (not too distant, please), it's starting to feel a little like collecting Girl Scout Badges. (How I would love it if some crafty WAHM on etsy came up with placenta encapsulation badges, lactation educator badges, birth doula badges, and a sassy sash to boot!)

So, as I'm focusing on trying to blast through my Childbirth Education certification through CAPPA's distance program, you may have noticed a, shall we say, sluggishness to my posting of late. I have at least a dozen topics I'd like to get to, and absolutely plan on completing them in the future, but developing a solid curriculum and (gulp) lesson plans for each of my 7 (or 8) classes is taking up pretty close to all my available time at the moment. I'd like to be finished by August, so hopefully we'll resume a more normal operating schedule by then. I'll still be posting, just more leisurely-ly, as you've seen of late.

Off to ponder what kind of a catchy name I can give my class . . .

Side note: I went to catalog all my birth and breastfeeding and baby books, in order to give my students a list of my lending library. Turns out I have SEVENTY TITLES on my shelves! Whoa. And the crazy thing? . . . I need even more. Someone may have to stage an intervention.

Friday, July 2, 2010

A long overdue Weekend Movie: Crisis in the Crib

Straight up confession right off the bat: I totally own up to being one of the bloggers that the Courtroom Mama component of The Unnecesarean (which has been sprouting new and ever more formidable heads, like a fabulous birth junkie hydra) calls out in this post on the extremely important short film by Tonya Lewis Lee, "Crisis in the Crib". As she explains the impetus for her post:

I have to admit that I put off seeing “Crisis in the Crib” for a long time. Because I knew it would be sad? Because I fancied myself some sort of expert on the issue? Because it seems so far away from my own experience? Who knows. But when Jill sent me a Google Blog Search for “Crisis in the Crib,” my heart stopped for a moment: nearly none of the blogs that I read had covered it.

We’re not talking “my indie film video store doesn’t carry Braveheart.” We’re talking about the very set of people who should be writing about infant mortality—mostly birthy blogs, feminist blogs, and mothering blogs—didn’t mention the film. Sure, there were some; for example, Elita at Blacktating did a quick hit as a part of her Happy Black Girl Day list of “black girls who understand the importance of birth autonomy, breastfeeding and natural parenting.” I don’t read All the Blogs in the World, and maybe I’m not reading the “right” stuff, but it makes me sad to know that I have 1000+ unread items in my Google Reader, probably 3/4 of those about birth or mothering, and none of them will have mentioned the film.

Lamely: I DO think I remember sharing it on Facebook (sometimes I fear that Facebook lulls us into the illusion that we're actually DOING something by hitting "share"; ahh, sedentary modern activism). But really, no contest. Guilty as charged.

So I finally got around to watching it and, as expected, I was mightily impressed. Please watch it here (not available to embed), it's only about 30 minutes and if you regret taking the time to watch it, I will personally pay you one million dollars*.

And what are my thoughts? All over the map. Emotionally hit hard by the reality of the situation, first and foremost. And yet, also conflicted about my place in addressing this.

Is it arrogant for me to speak about this? Would my thoughts on the solutions be perceived as judgments? Or is it arrogant for me to NOT address is because it's 'not my problem'? I can see how, coming from my place of acknowledged privilege, making pronouncements about what the approach to solving the problem ought to be could be way out of line. And I definitely have my own biases - Courtroom Mama sums up quite a lot of my own thought process here:
Watching “Crisis in the Crib,” I could see the water I swim in for a moment and realized that I sometimes have “birth blinders” on. I care so much about unnecessary interventions and evidence-based care that it’s tempting to look at our flagging position in rank for maternal and infant health and say “see! It’s the unnecesareans and the pitocin and the EFM!” But the truth, as the documentary shows, is more complicated.

"More complicated" is an understatement. There are just so many factors. Interventions and unnecesareans? Possibly a part of it. But there is SO much more. Prematurity? And thus health of mom when pregnant, which connects to nutrition, which connects to poverty, period? Low breastfeeding rates? Crappy maternity care? It's hard to even know where to begin.

Back to the film, I REALLY liked the emphasis on preconception health, hearing their volunteers speak forthrightly about that - and not just for the mothers, for the fathers too. It's more indirect than being the host organism, but every bit as influential in terms of the environment into which babies are brought. Spike Lee (husband of Tonya) underscored this point as he brought up a related point, the impact of absentee fathers. 7 in 10 African American households are headed by a single mother. Connect that to the impact of stress on our health, and the lack of involved fathers becomes a considerable culprit.

I also loved that they touched on treatment BY doctors, as discussed with a doctor overseeing one of the NICUs in Memphis - that even when some women do have access to health care in the first place (not always the case), assumptions about are made about her, about her lifestyle and her circumstances. My take on that is that this could alienate a mother from seeking more care (in terms of pregnancy as well as overall health) until it's dire, life-threatening stuff. This same doctor brought up the importance of the village, something that warrants much more discussion.

One criticism: I would have liked to see more attention paid to low breastfeeding rates among African Americans. In the film, unless I completely spaced out, there was almost none - you really had to be looking and listening for it (being me, of course, I was). Yes, absolutely there are many other major factors, but one of them is prematurity, and the influence of breastfeeding on preemie outcomes can't be understated. And those benefits, of course, continue to improve a baby's health (not to mention the mother's) for the duration of nursing and beyond.

Other thoughts: I'm just so impressed with Tonya Lewis Lee and her efforts. It was great to look in on a think tank of 300 health professionals, all discussing the social determinants of health. And the preconception peer counselors pounding the pavement with their direct, person-to-person outreach cast an even more glaring light on my armchair activism. Feeling my privilege. Feeling very humbled. What's my role? How do I help?

Well, one very, very small step would be getting more people to see this movie (all credit to Courtroom Mama). So this weekend, before you go see "Toy Story" or "Knight and Day" or "Eclipse", give half an hour to contemplating this issue.

*Terms: one dollar a year for a million years