YES, it's totally annoying that yet again, the assumption is that mom will be supine, but still, it's a handy little visualization, if not as high tech as this 3D one I posted before. Worth a watch!
Saturday, November 28, 2009
Thursday, November 26, 2009
Gratitude
Three generations in the kitchen. Lily & I wish you all a wonderful ritual sacrifice with pie. I'll be back to blogging when we return home next week!
Saturday, November 21, 2009
Weekend Movie, the Sequel: Ignorance Meets Knowledge
For the second week in a row, I cannot resist a double feature. This video on "extended" breastfeeding kicks some serious ass.
I unclasp my nursing bra to thee, Tori Caswell, creator of this video.
I unclasp my nursing bra to thee, Tori Caswell, creator of this video.
Weekend Movie: Mastering the Maneuvers
Okay, you really have to be a die-hard junkie to appreciate these two videos, but I found them to be very educational. Two maneuvers are known to help with shoulder dystocia, the difficult situation in which the baby's head has emerged yet the shoulder remains caught behind mom's pubic bone. One technique is the Gaskin maneuver, where mom turns over onto her hands and knees, named for the midwife of midwives, Ina May Gaskin. The other is the McRoberts maneuver, where the mother is supine, and her legs are flexed all the way back - think knees to ears, opening the pelvis as much as is possible on one's back.
Here's a 3D animation of this - it's REALLY short, blink and you'll miss it, but it shows exactly how this action works on mom's pelvis and the baby's shoulder.
With that in mind, watch this longer, real-life situation.
It seems clear to me that the change of position is the key thing here; in the video above, mom had already been on hands and knees, so the Gaskin maneuver is, well, moot. So McRoberts was perfect. On the other hand, if mom was in anything like lithotomy, switching to hands and knees a la Ina May could really do the trick.
The threat of cephalopelvic disproportion and thus risk of shoulder dystocia is a common scare tactic used to frighten women into unnecesareans. Whichever maneuver ends up being the appropriate one, what I love about the second video here is how clearly it demonstrates that, with a skilled care provider who is armed with the knowledge of these options, shoulder dystocia, while something to take very seriously and address swiftly, CAN be coped with. The midwife worked efficiently and confidently, and there was no sense of panic or dire emergency. I can't help but wonder how this would have turned out in a hospital setting.
Here's a 3D animation of this - it's REALLY short, blink and you'll miss it, but it shows exactly how this action works on mom's pelvis and the baby's shoulder.
With that in mind, watch this longer, real-life situation.
It seems clear to me that the change of position is the key thing here; in the video above, mom had already been on hands and knees, so the Gaskin maneuver is, well, moot. So McRoberts was perfect. On the other hand, if mom was in anything like lithotomy, switching to hands and knees a la Ina May could really do the trick.
The threat of cephalopelvic disproportion and thus risk of shoulder dystocia is a common scare tactic used to frighten women into unnecesareans. Whichever maneuver ends up being the appropriate one, what I love about the second video here is how clearly it demonstrates that, with a skilled care provider who is armed with the knowledge of these options, shoulder dystocia, while something to take very seriously and address swiftly, CAN be coped with. The midwife worked efficiently and confidently, and there was no sense of panic or dire emergency. I can't help but wonder how this would have turned out in a hospital setting.
Friday, November 20, 2009
From continuous support to a continuum of support
The third Healthy Birth Blog Carnival is nigh, and, following the other great Carnivals on Lamaze's Healthy Birth Practices, this time Science and Sensibility is calling for entries on the third practice: Bring a loved one, friend, or doula for continuous support.
Seems like a no-brainer for me to weigh in on, no? Well, you see, I am but a young padawan doula. Number of births I have attended in person thus far: one (mine). Much as I aspire to not only start attending births as a doula but eventually train as a midwife, I'm still very much inexperienced in the real birth world despite my book and web-learnin' on the matter. I am sure this Blog Carnival will offer up scores of excellent posts by birth veterans, detailing the benefits of that incredibly important continuous support during labor, as well as birth stories in which that labor support person (whether a pro or a family member or otherwise) plays a vital role in healthy, satisfying birth experiences, and I look forward to reading them.
But here's something that's been on my mind as a newbie doula (which I recently realized makes me a 'doubie'): I'm starting to feel that even within the midwifery model of care, the amount of support a woman gets drops off dramatically after the first few days postpartum. Forgive me if I'm playing Captain Obvious here, but I'm currently witnessing the impact of this firsthand, as well as starting to see this pattern in the birth, breastfeeding, and postpartum depression stories I read so voraciously, both in print and online.
Nowhere is this more apparent than in births that have taken place in hospital settings, of course. Let's take the matter of nursing for just one example of the value of postpartum support. A woman heads home after a birth which may or may not have gone smoothly, where she may have received terrible breastfeeding advice, where she may have been separated from her baby, where her baby may have been given formula from a bottle with or without her consent or even knowledge. She may have even been given a "gift bag" containing you-know-what. Think about this mother headed out of the hospital has been really been set up. She may already be on a downward spiral.
Let's say, though, for argument's sake, none of the negatives in the hospital scenario above have happened. Let's say that in every instance, she experienced the best case scenario: no artificial nipples, no separation, a good birth, and so on. The environment at home can vary WILDLY in terms of what kind of support she has, in terms of both quantity and quality. The father most likely only has a few weeks of paternity leave, if that. She may have extended family living nearby, but this is becoming rarer and rarer in contemporary society, so she might have her own parents or in-laws coming to visit and help out for a while. She may or may not have friends in the area who can help out here and there; sometimes a meal rotation has been set up for the first week or two.
Within whatever existing support system she does have, there may be experienced, knowledgeable breastfeeders - and there may not be. If many of the less desirable variables are present, any difficulty she experiences can be exacerbated. So many nursing relationships can be sabotaged by well-meaning but ignorant advice. If the mother had hired a birth doula, a few postpartum visits are typically included, which is a help, but is it enough to make up for regular, quality help from the rest of the mother's support system?
Even if we take the hospital out of the picture, continuity of postpartum care can be lacking. She might have even had a home birth. Midwifery care does provide for MORE postpartum care than a hospital birth provides, typically scheduling a visit for the day after, then the third day (often a day of reckoning), then a week later. It's definitely an improvement, but I feel that a lack of regular support at home, and lack of accessible and timely lactation support, can still be devastating. Midwives who attend home births (primarily CPMs but also some CNMs) may or may not be skilled in lactation support. I think it's fair to say that most know the basics, and the type of sabotage that sometimes occurs in hospital settings is highly unlikely, but when serious issues come up, the variation in skill becomes much more crucial.
When more lactation help is needed, then, outside help needs to be called for, creating a new set of variables in terms of skill and accessibility, as not all lactation consultants are created equal, and the best ones may not be in the area, or may be out of a price range. Days or even weeks can go by before help arrives, time during which the breastfeeding relationship can be damaged in a number of ways.
I don't know if there are existing studies comparing the connection between breastfeeding success rates and better postpartum support, but from what I understand, many developed countries which have universal health care also provide for home health care visits for all new mothers. Here's one glance at different countries and their breastfeeding rates from the State of the World's Newborns Report 2001 via Kellymom:
Is it asking too much of midwives that they also be well-versed in breastfeeding support, and that they spend more time devoted to postpartum care? I don't mean to ask this as an accusing rhetorical question. It really may be too much, given the depth of their expertise in birth and the devotion it takes to acquire their skills, not to mention the considerable existing demands on their time - and if that's true, then we need to start thinking about finding ways to pass that baton to another support provider much more regularly and smoothly than we currently often do.
There is La Leche League, if you have an active chapter in your area with good leaders who will do phone consultations, which is not a guarantee, and honestly not a substitute for one-on-one help from a trained professional. Speaking of, then there are the lactation professionals, the gold standard of which is the IBCLC. Fantastic people, most of them are - if you have access, and even still, there is a break in the continuity of care, a disconnect, a stranger stepping in.
Another factor in postpartum support of the friends & family variety: it tends to peak within the first few weeks, which is when such support IS most needed (particularly in terms of breastfeeding), true, but many mothers find that they really could use help beyond that initial period. Suddenly, dad is back to work, family returns home, friends have gotten their fill of the novelty of the new baby, and the meal rotation comes to a close. Suddenly mom finds herself more alone than ever, which brings me to another area where postpartum support is vital: postpartum depression, or more accurately, the spectrum of postpartum mood disorders.
Isolation is a huge risk factor here, and feeling 'abandoned' once the baby is 3 or 4 weeks old can feel devastating to a mother. In my DONA postpartum training, listed within the services that a postpartum doula provides, right alongside education in newborn care, aid in mom's emotional and physical recovery, light housework, and breastfeeding support, is "companionship". Simple as that. This is not an insignificant or trivial thing. Having another adult around to relate to can really be a lifeline to a mom who is sleep-deprived and struggling, especially if that adult is trained in recognizing the symptoms of postpartum mood disorders.
You can see where I'm going with all this. My bias as a new and eager postpartum doula is showing, I know. But I think there's a case for shifting our view of the journey to motherhood. The moment of birth IS profound and amazing and deserves the most devoted support throughout that experience as possible - but can we start to see that this is just one part of the journey, climactic though it may be? Can we start to see it as more of a continuum? What would it be like if something resembling continuous support (though obviously not as intensive or constant as labor support) lasted throughout what has become widely recognized as the "fourth trimester"?
After the long buildup of pregnancy, and the transforming apex that is birth, with much societal (not to mention medical) attention paid to both, many women often get the relative equivalent of a handshake and a "good luck!" Women and babies deserve more. WE as a whole deserve more. I'm not sure what form this would take. I like the concept of reframing care as, perhaps, perinatal, rather than divided into prenatal, birth, and postpartum. I absolutely think postpartum doulas are one way of finding a solution, of course, but I don't mean to make this post one big sales pitch for them (especially, again, as a novice). I'm open to more solutions. Maybe the concept of Freestanding Maternity Centers, as Rixa of Stand and Deliver recently pointed mentioned recently. and as Dr. Stuart Fischbein has endorsed, could include more extensive postpartum support that flows out of existing relationships, and could thus move towards more of a continuum concept, to twist a phrase.
I've focused here on breastfeeding and to a lesser degree on postpartum mood disorders, but even if neither proves to be a problem, mothers still deserve to have much more support during their "babymoon" than they often get. These were just examples of postpartum needs - there are so many others, too. Adjusting to our brand-new identities as mothers is an world-shattering experience - hopefully mostly in the best possible ways, but in the event that challenges arise, I think mothers with newborns deserve to have the equivalent of counterpressure on their sacrums, cool cloths held on their foreheads, and strong, caring hands to hold when the going gets tough.
Seems like a no-brainer for me to weigh in on, no? Well, you see, I am but a young padawan doula. Number of births I have attended in person thus far: one (mine). Much as I aspire to not only start attending births as a doula but eventually train as a midwife, I'm still very much inexperienced in the real birth world despite my book and web-learnin' on the matter. I am sure this Blog Carnival will offer up scores of excellent posts by birth veterans, detailing the benefits of that incredibly important continuous support during labor, as well as birth stories in which that labor support person (whether a pro or a family member or otherwise) plays a vital role in healthy, satisfying birth experiences, and I look forward to reading them.
But here's something that's been on my mind as a newbie doula (which I recently realized makes me a 'doubie'): I'm starting to feel that even within the midwifery model of care, the amount of support a woman gets drops off dramatically after the first few days postpartum. Forgive me if I'm playing Captain Obvious here, but I'm currently witnessing the impact of this firsthand, as well as starting to see this pattern in the birth, breastfeeding, and postpartum depression stories I read so voraciously, both in print and online.
Nowhere is this more apparent than in births that have taken place in hospital settings, of course. Let's take the matter of nursing for just one example of the value of postpartum support. A woman heads home after a birth which may or may not have gone smoothly, where she may have received terrible breastfeeding advice, where she may have been separated from her baby, where her baby may have been given formula from a bottle with or without her consent or even knowledge. She may have even been given a "gift bag" containing you-know-what. Think about this mother headed out of the hospital has been really been set up. She may already be on a downward spiral.
Let's say, though, for argument's sake, none of the negatives in the hospital scenario above have happened. Let's say that in every instance, she experienced the best case scenario: no artificial nipples, no separation, a good birth, and so on. The environment at home can vary WILDLY in terms of what kind of support she has, in terms of both quantity and quality. The father most likely only has a few weeks of paternity leave, if that. She may have extended family living nearby, but this is becoming rarer and rarer in contemporary society, so she might have her own parents or in-laws coming to visit and help out for a while. She may or may not have friends in the area who can help out here and there; sometimes a meal rotation has been set up for the first week or two.
Within whatever existing support system she does have, there may be experienced, knowledgeable breastfeeders - and there may not be. If many of the less desirable variables are present, any difficulty she experiences can be exacerbated. So many nursing relationships can be sabotaged by well-meaning but ignorant advice. If the mother had hired a birth doula, a few postpartum visits are typically included, which is a help, but is it enough to make up for regular, quality help from the rest of the mother's support system?
Even if we take the hospital out of the picture, continuity of postpartum care can be lacking. She might have even had a home birth. Midwifery care does provide for MORE postpartum care than a hospital birth provides, typically scheduling a visit for the day after, then the third day (often a day of reckoning), then a week later. It's definitely an improvement, but I feel that a lack of regular support at home, and lack of accessible and timely lactation support, can still be devastating. Midwives who attend home births (primarily CPMs but also some CNMs) may or may not be skilled in lactation support. I think it's fair to say that most know the basics, and the type of sabotage that sometimes occurs in hospital settings is highly unlikely, but when serious issues come up, the variation in skill becomes much more crucial.
When more lactation help is needed, then, outside help needs to be called for, creating a new set of variables in terms of skill and accessibility, as not all lactation consultants are created equal, and the best ones may not be in the area, or may be out of a price range. Days or even weeks can go by before help arrives, time during which the breastfeeding relationship can be damaged in a number of ways.
I don't know if there are existing studies comparing the connection between breastfeeding success rates and better postpartum support, but from what I understand, many developed countries which have universal health care also provide for home health care visits for all new mothers. Here's one glance at different countries and their breastfeeding rates from the State of the World's Newborns Report 2001 via Kellymom:
| Country | % of mothers who start | % who continue 6 months or longer |
| | ||
| Sweden | 98 | 53 |
| Norway | 98 | 50 |
| Poland | 93 | 10 |
| Canada | 80 | 24 |
| Netherlands | 68 | 25 |
| Britain | 63 | 21 |
| United States | 57 | 20 |
Is it asking too much of midwives that they also be well-versed in breastfeeding support, and that they spend more time devoted to postpartum care? I don't mean to ask this as an accusing rhetorical question. It really may be too much, given the depth of their expertise in birth and the devotion it takes to acquire their skills, not to mention the considerable existing demands on their time - and if that's true, then we need to start thinking about finding ways to pass that baton to another support provider much more regularly and smoothly than we currently often do.
There is La Leche League, if you have an active chapter in your area with good leaders who will do phone consultations, which is not a guarantee, and honestly not a substitute for one-on-one help from a trained professional. Speaking of, then there are the lactation professionals, the gold standard of which is the IBCLC. Fantastic people, most of them are - if you have access, and even still, there is a break in the continuity of care, a disconnect, a stranger stepping in.
Another factor in postpartum support of the friends & family variety: it tends to peak within the first few weeks, which is when such support IS most needed (particularly in terms of breastfeeding), true, but many mothers find that they really could use help beyond that initial period. Suddenly, dad is back to work, family returns home, friends have gotten their fill of the novelty of the new baby, and the meal rotation comes to a close. Suddenly mom finds herself more alone than ever, which brings me to another area where postpartum support is vital: postpartum depression, or more accurately, the spectrum of postpartum mood disorders.
Isolation is a huge risk factor here, and feeling 'abandoned' once the baby is 3 or 4 weeks old can feel devastating to a mother. In my DONA postpartum training, listed within the services that a postpartum doula provides, right alongside education in newborn care, aid in mom's emotional and physical recovery, light housework, and breastfeeding support, is "companionship". Simple as that. This is not an insignificant or trivial thing. Having another adult around to relate to can really be a lifeline to a mom who is sleep-deprived and struggling, especially if that adult is trained in recognizing the symptoms of postpartum mood disorders.
You can see where I'm going with all this. My bias as a new and eager postpartum doula is showing, I know. But I think there's a case for shifting our view of the journey to motherhood. The moment of birth IS profound and amazing and deserves the most devoted support throughout that experience as possible - but can we start to see that this is just one part of the journey, climactic though it may be? Can we start to see it as more of a continuum? What would it be like if something resembling continuous support (though obviously not as intensive or constant as labor support) lasted throughout what has become widely recognized as the "fourth trimester"?
After the long buildup of pregnancy, and the transforming apex that is birth, with much societal (not to mention medical) attention paid to both, many women often get the relative equivalent of a handshake and a "good luck!" Women and babies deserve more. WE as a whole deserve more. I'm not sure what form this would take. I like the concept of reframing care as, perhaps, perinatal, rather than divided into prenatal, birth, and postpartum. I absolutely think postpartum doulas are one way of finding a solution, of course, but I don't mean to make this post one big sales pitch for them (especially, again, as a novice). I'm open to more solutions. Maybe the concept of Freestanding Maternity Centers, as Rixa of Stand and Deliver recently pointed mentioned recently. and as Dr. Stuart Fischbein has endorsed, could include more extensive postpartum support that flows out of existing relationships, and could thus move towards more of a continuum concept, to twist a phrase.
I've focused here on breastfeeding and to a lesser degree on postpartum mood disorders, but even if neither proves to be a problem, mothers still deserve to have much more support during their "babymoon" than they often get. These were just examples of postpartum needs - there are so many others, too. Adjusting to our brand-new identities as mothers is an world-shattering experience - hopefully mostly in the best possible ways, but in the event that challenges arise, I think mothers with newborns deserve to have the equivalent of counterpressure on their sacrums, cool cloths held on their foreheads, and strong, caring hands to hold when the going gets tough.
Tuesday, November 17, 2009
Vitamin D deficiency -a risk factor for c-sections?
I just yoinked this thought-provoking bit of news from Bellies and Babies: Vitamin D deficiency leads to a fourfold increase in cesarean births.
From everything I have experienced and read, standard obstetric attention to nutrition tends to begin and end with a prescription for prenatal vitamins and perhaps a photocopy of some (possibly questionable) healthy eating guidelines. Folic acid and DHA have gotten more attention in recent years, which is a help, but clearly doesn't go far enough. Midwifery care often pays much more attention to nutrition (though still, one's mileage may vary), looking at each woman's diet in detail and talking about beneficial food sources of nutrients, not just supplements, th0ough there is certainly a place for them in most American diets.
Be sure to check out the full post at Bellies and Babies. She then talks more about the further ramifications of cesarean birth on the baby's health and future - all potentially connected to nutrition.
I'm reminded of a favorite quote from Hippocrates favored by my holistic lactation consultant: "Let food be thy medicine." What will it take for more people to start really taking nutrition seriously?
"Women with a vitamin D deficiency were almost 4 times more likely to have a cesarean than those with [normal] vitamin D levels," says senior study author Anne Merewood, an assistant pediatrics professor at Boston University School of Medicine. "Vitamin D is definitely involved in muscle strength…. contractions of the uterus [which is made of smooth muscle] may not be performing as well as they could be," making it difficult for the woman to help push the baby out herself.I think it would be a huge mistake to not continue to evaluate labor protocols and policies that work against women, of course, but this may be another big part of the picture, and should be investigated much further. I also had a bit of a gut response to the concept as potentially being yet another mother-blaming strategy, but I do think the information is too important to dismiss.
From everything I have experienced and read, standard obstetric attention to nutrition tends to begin and end with a prescription for prenatal vitamins and perhaps a photocopy of some (possibly questionable) healthy eating guidelines. Folic acid and DHA have gotten more attention in recent years, which is a help, but clearly doesn't go far enough. Midwifery care often pays much more attention to nutrition (though still, one's mileage may vary), looking at each woman's diet in detail and talking about beneficial food sources of nutrients, not just supplements, th0ough there is certainly a place for them in most American diets.
Be sure to check out the full post at Bellies and Babies. She then talks more about the further ramifications of cesarean birth on the baby's health and future - all potentially connected to nutrition.
I'm reminded of a favorite quote from Hippocrates favored by my holistic lactation consultant: "Let food be thy medicine." What will it take for more people to start really taking nutrition seriously?
Sunday, November 15, 2009
Formula-Fed America
Weekend at the Movies Part 2: I guess I'm having a double feature this weekend, but I couldn' t possibly wait to share this.
The info on the site is a little bit lacking, but hopefully there will be more soon, as it's very new. Could this be "The Business of Being Born" for breastfeeding? (Or perhaps a "Food, Inc." for babies?)
"Formula feeding is the longest lasting uncontrolled experiment lacking informed consent in the history of medicine." -- Dr. Frank Oski
UPDATE Monday 11/16: I emailed them, asking about release dates and screenings and such, and got this reply: "We are still in the process of filming and hope to wrap by early April, we are also still looking at different avenues for promotion and release, nothing is set in stone yet. Thank you for visiting our site! We will keep you updated!"
So, we'll have to wait a bit, but I am sure it'll be more than worth it. I'll pass along anything I hear, of course!
The info on the site is a little bit lacking, but hopefully there will be more soon, as it's very new. Could this be "The Business of Being Born" for breastfeeding? (Or perhaps a "Food, Inc." for babies?)
"Formula feeding is the longest lasting uncontrolled experiment lacking informed consent in the history of medicine." -- Dr. Frank Oski
UPDATE Monday 11/16: I emailed them, asking about release dates and screenings and such, and got this reply: "We are still in the process of filming and hope to wrap by early April, we are also still looking at different avenues for promotion and release, nothing is set in stone yet. Thank you for visiting our site! We will keep you updated!"
So, we'll have to wait a bit, but I am sure it'll be more than worth it. I'll pass along anything I hear, of course!
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