Strong Beautiful Birth

Midwife Fun at Miles for Midwives!

2011-10-03T10:22:00.000-07:00

Saturday's Miles for Midwives was a blast, as predicted! We avoided the rain and had a very fun- run/walk. It was so nice to see familiar faces: midwives, doulas, friends, and past clients. I sat at the NYC Homebirth Midwives' table giving away coupons to well-woman visits with Clementine Midwifery.

Chi Chi showed her support by running and wearing last year's shirt:

Finally, I am SO proud to say that I have such wonderful people in my life whose thoughtfulness and generosity enabled me to surpass my fundraising goal of $500. With the support of friends, family, and clients, we raised $615! Many, many thanks to all. Your gifts will truly go a long way in supporting midwives, the women who benefit from their care, and reproductive choice.

See you next year!

Miles for Midwives... TOMORROW!

2011-09-30T08:19:00.000-07:00

It's that time of year again: the 9th Annual Miles for Midwives 5K Fun Run and Birth & Wellness Fair is taking place Saturday, October 1st (tomorrow!) in Prospect Park, Brooklyn. This is one of my favorite events of the year. It brings together runners, families, midwifery supports and all others who support women's health for a day devoted to maternity care improvement and community wellness. Proceeds from this event benefit the work of the American College of Nurse Midwives and Choices in Childbirth to improve maternity care in our community.

Many of you know why we need to support midwives, but for those of you who need a refresher, here are some great things about midwives:

Midwifery is individualized, holistic, preventative women's healthcare
Midwives help women have safe, normal pregnanies and births
Midwives provide well-woman care from menarch to menopause, focusing on the physical, emotional, and social wellbeing of women through education and counseling
Midwives help with conception, too, providing fertility counseling and intrauterine insemination for lesbian couples and single-moms-by-choices

Please support midwivery at Miles for Midwives! Join the race by registering here, or simply come to enjoy all the activities, wander through the Wellness Fair, and admire all the cute babies. Here's what you might see tomorrow (the pup, Chi Chi will be there again showing her support!):

If you are not based in New York City or can't join me at the race, please consider donating! I've set up my very own fundraiser page with a goal of raising $500.

It's going to be a great day for an even greater cause. I really hope to see you there!

End of Summer Roundup

2011-08-31T10:14:00.000-07:00

With Labor Day fast approaching, I wanted to get one more post in and let you all know about all the exciting birthy things that have happened this summer:

The NYS Department of Health is embarking on a largescale restructuring of NYS Medicaid. My fabulous supervisor at Healthy Start Brooklyn, who helps run the free doula program for low-income Brooklyn mamas that I participate in, has submitted a proposal for Medicaid to cover birth doula services. This measure is a public health no-brainer: better health outcomes for mamas and babies AND a big time money saver in the long run (remember my early post: women who work with doulas are more likely to have undisturbed births, and undisturbed birth is super cheap). We need as many people as possible to chime in and suggest that Medicaid cover doula support. Go to this link, click on the Help Redesign Medicaid box to the left, and since my supervisor has already submitted a detailed suggestion, all you need to write is "Medicaid should cover doula services."

I was on the NPR blog, baby!

There was a great segment on homebirth on ABC's Good Morning America, featuring Karen Jefferson, a great NYC midwife who I had the pleasure of interviewing for the senior undergraduate thesis:

Finally, Miles for Midwives 2011 is on October 1st! Don't worry, I'll follow up with more information on participating and donating soon.

Wishing everyone a Happy Labor Day!

Please do not ban... birth pools?

2011-06-03T07:49:00.000-07:00

The FDA is weird, dude. Last week, they seized a shipment of birth pools in Portland because they are suddenly... scared of them? Claiming they are medical equipment, the FDA justified their siege by arguing that as medical equipment, birth pools must be registered and regulated. Until then, seize and destroy!

The FDA quickly returned the pools, unscathed, but are putting the issue to a vote this Tuesday. Write your local FDA rep and explain how this is all just ridiculous. The NYC rep is Dilcia Granville, PhD, and her e-mail address is dilcia.granville@fda.hhs.gov. Here's what I wrote to her, feel free to borrow or copy:

Dear Dr. Granville,

I am writing to express my disappointment in the FDA regarding your recent actions confiscating and attempting to ban birth pools. Birth pools are no more medical equipment than are ice packs, warm compresses, or simple bandages, non-medical and non-regulated items used to increase the comfort of patients in pain. Birth pools are an extremely effective non-medical means of decreasing pain during labor, often as effective as epidurals without the extravagant cost of equipment and anesthesia staff and without the serious side effects, including bleeding, spinal headache, maternal fever, maternal hypotension, fetal heart rate decelerations, and difficulties breastfeeding. Please make the smart public health move and support the use of birth pools.

Thank you,
Leda Ward, CD(DONA), Certified Lactation Counselor

i am not a good enough feminist

2011-05-06T09:06:00.000-07:00

Being a feminist today is effing confusing. I am so grateful for Gloria Steinem and Betty Freidan and all they've done for me, but I don't know if I identify with them. Would they look down on me because I want to be a stay-at-home-mom at some point? Do they think I am disregarding and erasing all the hard work they've done for me? I don't. But do they? Do I? How do I know if I am being a good enough feminist?

Luckily! that question and more will be explored this weekend, coming to a former Pearl Paint store near you! in the form of an art exibit! put on by some of the most confused and powerful feminists of our generation! Come out and see some fab ladies' work. The article I posted a little while back, in which I was interviewed, will be in the publication.

Check 'er out: i am not a good enough feminist.

Every little miracle

2011-05-05T15:27:00.000-07:00

I watched this today, and could not hold the tears back. That's saying something, since I see a lot of beautiful births.

In addition to showing homebirth in a mainstream format (!), this commercial captures the miracle of every birth, every baby, every parent, and every family:

Mid-wives-drash

2011-04-24T19:23:00.000-07:00

Last week, I celebrated Passover at the home of friends. At this seder, the hosts invite their guests to comment on various parts of the seder. Last year, as we read the Exodus story, I noticed this part for the first time:

And the king of Egypt spake to the Hebrew midwives, of which the name of the one was Shifrah, and the name of the other Puah. And he said, When ye do the office of a midwife to the Hebrew women, and see them upon the stools; if it be a son, then ye shall kill him: but if it be a daughter, then she shall live. But the midwives feared God, and did not as the king of Egypt commanded them, but saved the men children alive. And the king of Egypt called for the midwives, and said unto them, Why have ye done this thing, and have saved the men children alive? And the midwives said unto Pharaoh, Because the Hebrew women are not as the Egyptian women; for they are lively, and are delivered ere the midwives come in unto them.

And I decided that the following year, I should comment on that part. So I did. And after some requests, I thought I'd share what I said here:

I’ve wanted to become a midwife since before I can remember, and I’ve also celebrated Passover since before I can remember. But it was only last year that I really noticed this small section in Exodus about midwives. As we just read, Pharaoh leaves it up to the Hebrew midwives, named Shifrah and Puah, to make sure all Hebrew boys are killed as soon as their moms get off that birthing stool. The midwives not only disobey Pharoah by refusing his command to kill the Hebrew boys, but they also outright talk back to him (and lie) when he asks why they disobeyed, saying basically, “Hebrew women are just too good at giving birth, we don’t even get there in time.”

To me, this anecdote is incredibly rich. As with all things I love about birth, it speaks to the power of women and that incredibly powerful, inexplicable force pushing women to bring forth life from their bodies. However, it also speaks to the powerful role that these particular women, these midwives, played in the eventual rebirth of the Jewish community, our passage from a life of slavery out into a life of freedom.

Shifrah and Puah are some righteous babes. I find the meaning of their names fascinating: Shifrah stems from the Hebrew verb to swaddle or clean, as in a baby, and Puah comes from the Hebrew verb to cry out, as a laboring mother does during birth, as does her newborn baby during the first moments of life. There’s some more depth to their names, however. Some rabbis have postured that Shifrah and Puah were actually Moses’s mother and sister, Yocheved and Miriam, making the roles of these women even more central to the eventual redemption of the Jews in Egypt.

In English, midwife means “with woman”, but it seems that Shifrah and Puah, or Yocheved and Miriam, were also, and perhaps more profoundly, with their community and with God. They could not separate their work with women from their service to God and to their community. Their duty was not only to usher women through the passage of childbirth safely, but also to usher an entire population through a period of time when survival was uncertain. Shifrah swaddled the babies, giving them security when it suddenly felt like there was nothing to hold on to, and Puah cried out when the mothers cried out, signaling that their suffering was, in fact, surmountable. As Yocheved and Miriam ushered their community through the parting of the Red Sea, it is said that Yocheved cared for the elders, almost swaddled them, while Miriam danced and sang and cried out with joy. While these midwives enabled women to give birth and nurture their babies, male or female, they also used their hands and hearts for something more: undying support, encouragement, and selfless love as the Jewish people gave birth to their freedom.

I owe many thanks to Ruchi, a far more knowledgeable Jew-ess and doula friend of mine, who by some Passover miracle, found the time to respond to my questions just hours before the seder she was hosting.

Chag Sameach, Happy Easter, and most of all, happy birthing.

My Clients Are the Most Best

2011-04-15T08:37:00.000-07:00

Two of the many perks of being a doula are:

-meeting really interesting people with all different kinds of skills
-being privy to various birth announcments, pictures, videos, and general updates as the teeny little blob I met on that big day slowly becomes more and more of an actual person.

Earlier this week, those two perks came together, when one of my recent clients (who happen to be very clever filmmakers) sent me their video birth announcement. Published here with permission, of course:

Birth Announcement from Ben Coccio on Vimeo.

Most best birth announcment ever!

Overall, there's good news

2011-04-05T17:27:00.000-07:00

Oy! No posts since December? I'm hiding my head in shame.

My excuse is that I've been overwhelmed with the 2011 shit storm of misogynistic politics and can't handle writing about it all. For example: South Dakota and Nebraska thought it would be fun to legalize the murdering of abortion providers, while Utah thinks it's a gas to prosecute women as murderers for having miscarriages.

You see? I can't even comment. It's just too much to handle. Ok, one comment about Utah: Whether or not you agree with abortion, whether or not it is legal and safe, it is a truth of human experience that women will find a find a way, any way, to terminate unwanted pregnancy. But if women had access to safe abortion, they wouldn't be so tragically desperate as to subject themselves to intentional violence. This bill says a great deal about how much these politicians value women's lives.

But recently, there has been very, very good news! Planned Parenthood's budget was NOT cut last week! Ina May came to town! Doctors defended homebirth! And I've attended some truly beautiful births this year.

I witnessed a vaginal twin delivery in which baby B was footling breech. Baby A slipped out like butter, and before the doctor could try a manual version (to turn Baby B), it's teeny little foot poked out. Then its cute tush! It was magical.

I spent all night long with a mother, rocking her baby down. As the sun rose and the snow fell, she felt her baby coming, and whispered, "He's coming, he's coming." Magical.

Ina May came to town to promote her new book, Birth Matters: A Midwife's Manifesto. She bestowed upon us some true gems of hilarity, common sense, and wisdom, including this little query, directed toward anyone skeptical of the normalcy of vaginal birth: "Why do we all think that only men's thingies can get really big and then really small again? Ours can, too."

She also shared this video of an elephant giving birth, complete with elephant CPR. It's intense and graphic (as Ina May said, a two year pregnancy requires a LOT of amniotic fluid), but incredibly beautiful and life-affirming.

Ina May also told us to blog more. Yes, Ina May, I will. I will blog more. I will blog the good word! Such as news like this: a year or so ago, some American doctors published a study in the American Journal of Obstetrics and Gynecology (AJOG) that claimed that neonatal mortality rates were higher among planned homebirths than hospital births. Earlier this month, some other doctors took another look at that study and realized it was completely flawed. And by the way, these other doctors happen to be Canadian and Dutch, hailing from two nations where homebirth rates are higher, c-section rates are lower, and infant and maternal mortality rates are lower than ours. So I'm more likely to believe the doctors whose patients are dying less. Here are their conclusions in Medscape and AJOG.

Finally, I got to spend an hour talking about myself with a fellow rad Barnard chick a few weeks ago, and now the fruits of that conversation are forever imprinted on the scrolls of the internet. More specifically, in an article in Yale's feminist blog, Broad Recognition, about how doula work takes feminism in a pretty different direction than we've seen before. It's going to later be part of an exhibit at Concrete Utopia called "i am not a good enough feminist" (I effing love that title).

I think that's enough information and links to satisfy your birth brains for now. Don't fret, there will be more soon!

Seven Doulas for Seven Moms

2010-12-20T15:45:00.000-08:00

Apparently there was something in the water this weekend and EVERYONE and their sister went into labor. This is what it looks like... when doulas cry.

6am Saturday morning, a doula named Amadoma called me. I said, "How are you?" to which she replied, "I'm so stressed out!" She had three clients go into labor at the same time. Her back-up doula, Erin, was at another birth, and Erin also had three clients go into labor at once. So Amadoma found another doula, Alison, to cover her, but then that Alison had an asthma attack in the middle of the birth. So Amadoma called me. So I went to that birth. But then, one of my clients went into labor. And my back-up, Koyuki, had a cold. Thankfully, mama #1 labored fast and mama #2 labored slow. I left mama #1, went home, showered, ate, soaked my feet in hot water, and went to mama #2.

That's 7 moms for 3 doulas. All the moms eventually got doulas, after lots of frantic phone calling. WHEW!

In other news, Choices in Childbirth released the 2011-2012 New York Guide to a Healthy Birth today! After visiting a client for a postpartum follow-up, I walked over to CIC's headquarters to pick up my copies. It's beautiful! You can pick up copies at any maternity-centered place (clothing stores, yoga studios, etc, Metro Minis included obviously) or order copies (paying only for shipping) from CIC here.

And to finish up, here is a cartoon depicting the 7 babies who just got born this weekend. OMG.

Goodbye Metro Minis... Hello Clementine Midwifery!

2010-12-15T14:08:00.000-08:00

Tuesday is my very last day at Metro Minis. My very last day fitting mamas and papas into baby carriers, explaining the ins and outs of cloth diapers (pun on poop? not on purpose...), and holding squirmy babies while mamas and papas try to understand baby carriers and cloth diapers. I'm really going to miss that place.

So why am I leaving? Well, I was recently presented with a new and very exciting opportunity that I simply cannot pass up. Drumroll please...

Clementine Midwifery! Homebirth midwife Stacey Rees has asked me to work as her assistant office manager and birth assistant. OH YEAH!

This job - working alongside a midwife - has actually been what I wanted to do since graduating. I became a doula (went to the training during senior week... I am a DORK) because I thought it would help me land a job with a midwife. Didn't happen that way. So I decided to use that training, began working as a doula, and found out I really loved it. But I also needed a part time job, so I found the truly wonderful Metro Minis. Then, a few months ago, it was time for my annual gyno check up. I was in the market for a new midwife and decided to see Stacey since she just relocated her office to my neighborhood. At the end of the appointment, I said, "If you ever need help, I'm around..." And the rest is history.

The lesson here is: if you want a job, get a pelvic exam. Is that funny, or weird? I think it's funny.

Anyway, I've already had a few days of work at her office. I've been restructuring the content of her website, inputting patient info into her electronic medical record system, and updating her phone system. And answering phones: "Hello, Clementine Midwifery, this is Leda"!

Stacey recently forwarded this video to me, and I am in love with it. It's a short and very clever animated depiction of a hospital midwife's shift. The graphics are amazing and the midwife is wonderful:

My favorite part: when the midwife answers the phone. Watch what the phone cord becomes...

Fully Cooked

2010-11-22T13:35:00.000-08:00

As one of my clients has just successfully avoided an induction (mostly due to her doctor not wanting to attend her birth on Thanksgiving), the topic on my mind today is "full term" babies and unnecessary inductions. Then I saw this crazy video, and thought, now THAT baby is READY:

Fully Cooked -

I'm a Top Blog!

2010-11-14T13:15:00.000-08:00

I'm so pleased and flattered to announce that this blog has won the 2010 Top Postpartum Care Blog Award! Strong Beautiful Birth sits among 25 other top blogs, including Penny Simpkin's blog!

The award is given by Medical Billing and Coding (I guess my post on my NPI helped with that) and the people at Blogging Awards.

The best part is, my blog was nominated for this award by my very own readers. Thank you so much!

Waiting game

2010-11-09T12:31:00.000-08:00

I've got a client right now in the early stages of her induction... meaning nothing is really happening, so I am finding ways to occupy my time while my phone sits no more than 6 inches away from me. Every so often I stare at it, waiting for it to ring and tell me it's time to go. I'm not with her, but I am so with her.

I thought I'd keep my mind on birth and visit this little place I wish I visited more. Since it's been a while, there is so much I want to say.

First, Miles for Midwives was a blast. It was the largest they'd had, with 460 runners, 50 sponsors, and a huge crowd of others. And my little fundraiser page raised $200! Thank you so much to everyone who came and donated.

Of course, I forgot my camera, and the pictures I took on Michael's phone didn't come out, so I've got limited ones to show you. Here's one of the Metro Minis table. Joanna, the co-owner, is on the left wearing a beautiful Girasol wrap, while in the background, physical therapist Lisa Hoffman identifies a postpartum mom's diastasis (she teaches a free class at Metro Minis about it!). We also had cloth diapers, Kleen Kanteens, and other baby carriers on display:

And here's one of Michael and me and my brother's dog, Chi Chi, after they finished the race:

Dogs love midwives too!

The Miles for Midwives goodie bag was super sweet and chock full of coupons. I'm going to give most of them to my clients, but here are some I thought I'd post here. Give me a shout if you want any of them:

$10 off an 8 week series at the Prenatal Yoga Center
10% off online orders at Magnificent Baby
Free breastfeeding diary with any purchase at Yummy Mummy
50% off your first two treatments at Garden Acupuncture
10% off any class or workshop at Birth Day Presence
$25 off your first BodyTalk session at Wisdom House Wellness
$10 off any $50 online purchase at Jake and Ella
This isn't a discount, but it's nice to know: 15% of what you pay for a 5-class Hypnobirthing course goes to Choices in Childbirth!

Miles for Midwives also kicked off National Midwifery Week. And I was so happy to see this banner as I was walking into a hospital for a birth that week:

After all this celebration, you're thinking, Leda has to add something cynical, right? It wouldn't be a complete post without some complaint, right? Have no fear! The bad news is here:

What is this all about? The IRS has decided that breast pumps cannot be tax-sheltered, but other items like acne cream can be: "I.R.S. officials say they consider breast milk a food that can promote good health, the same way that eating citrus fruit can prevent scurvy. But because the I.R.S. code considers nutrition a necessity rather than a medical condition, the agency’s analysts view the cost of breast pumps, bottles and pads as no more deserving of a tax break than an orange juicer." Yeah, except orange juicers don't prevent cancer. And diabetes. And asthma. Or have the potential to save the US $13 billion in health care costs (reported in the middle of the article).

Whew. Now that the bad stuff is out of the way, I can be done.

And maybe I'll go to this birth someday...

Published Eavesdropper, Bad Doulas, and Birth Rape

2010-09-27T11:03:00.001-07:00

Once again, a comment I was blessed to hear was selected for posting on the prestigious www.myobsaidwhat.com. MOSW is a hilarious and depressing blog for childbirth people to submit hilarious and depressing comments made by other childbirth people. My experience reading this blog usually goes like this:

first post on page: HAHAHA that's awful!
next: haha, oh dear, still awful
next: furrowed eyebrows, why are you like this?
next: sobbing, WHY DEAR GOD WHY?

I'm only giving you one to read, my submission. I give an elaboration of the situation in the comments section.

Thankfully, the mom took this comment in stride and laughed along with her OB. Part of me was glad to see that it didn't bother her. But another part of me wasn't. This kind of reaction, which I've seen a lot, reminds me of an argument that anthropologists Wendy Simonds, Barbara Katz Rothman, and Bari Meltzer Norman make in Laboring On. She wonders if doulas are actually making the politics of birth worse. Doulas often help women come to terms with this kind of treatment so that they retain a positive birth memory. But by doing so, are we wooing them into complacency? Preventing them from realizing the righteous anger that could encourage change and improve birth?

Someone made this comment on the post, explaining that the situation could be defined as "inappropriate vulgar language in intimate examination by a larger, stronger physical power over me."

While extreme, that definition is techically accurate. Which brings us to the controversial discussion of "birth rape" (my two cents on the topic: it exists).

In this particular birth, I didn't feel the need to talk about the comment her OB made at the postpartum visit, to see how she felt about it or encourage her to write a complaint. I just didn't think it affected her to the extent that she might need such kind of healing.

Instead, I'm warning everyone against this doctor. Is that good enough for the anthropologists?

Published with Blogger-droid v1.5.8

Coming soon: Miles for Midwives!

2010-09-18T15:41:00.000-07:00

The 8th Annual Miles for Midwives 5K Walk/Run is taking place Saturday, October 2nd in Prospect Park, Brooklyn. This is one of my favorite events of the year: families, midwives, doulas, and all others in the birth-world and most importantly, all birth-world supporters join together to improve maternity care. In addition to the race, there will be a Wellness Fair with activities including yoga, reiki, acupuncture, massage, henna, and more. There will also be a silent auction and a Kid's Corner with games for all. I'll be there straddling two roles: doula/midwife supporter/future midwife and Metro Minis enthusiast, as I'll be manning the store's table!

Join the race by registering here, or simply come to enjoy all the activities, wander through the Wellness Fair, and admire all the cute babies.

If you can't make it but want to help out, please consider donating! I've set up my very own fundraiser page with a goal of raising $500.

It's going to be a great day for an even greater cause.

Happy Labor Day

2010-09-06T11:44:00.001-07:00

In honor of labor day today, I'm going to direct you all to a video depicting the astonishing power of a mother's touch.

Why would you ever use a warmer when this can happen?

Happy Labor Day to all!

Pride and shame (or something less dramatic)

2010-09-05T09:17:00.000-07:00

I recently passed my one-year anniversary as a doula! To celebrate it, I finally put up a bulletin board and stuck all my pictures of babies, mamas, thank you notes, and birth announcements:

The bottom section has gifts clients have given me that I need to use. Yeah, that's $40 of BamCash and a gift certificate for a 60 minute treatment at a spa. All those hours of massaging butts really do pay off.

On an unrelated note, I woke up today to a Facebook message from a previous client:

"Hey you! My sister said she saw you on TV yesterday. Were you interviewed at Metro Minis?"

Yes, yes I was. I did not think they (WPIX Channel 11) would air it, nor did I think ANYONE would see it. I'm a little embarrassed (do I really sound like that? why did I have to wear that shirt that day? and my hair!) But, posting it here is for a good cause (go Metro Minis!) and there's other good information (about Lactation Consultants and postpartum physical therapy) so go ahead, watch.

From oneness to separateness

2010-08-22T10:02:00.000-07:00

A post this Sunday afternoon about something not quite doula-related... but baby-related and on my mind.

When clients ask me for a good newborn/parenting book, I often recommend Dr. Sear's The Baby Book. But shh... I've never actually read it entirely (it's a big book, ok?) So, now I am doing the right thing and reading it. And it's wonderful. Baby books, whether the authors admit it or not, are never simply medical manuals for little people, answers for what to do when they have a fever, when they don't stop crying, when they have rashes. They are also very much philosophical treatises on how to handle little people in all their aspects- medical, behavioral, social, psychological. Most parenting books also put love into the equation, acknowledging that parenting is also about love (sounds like a duh, but sometimes, in these books, it's not).

The Baby Book is co-written by a husband and wife team, pediatrician William Sears and nurse and lactation consultant Martha Sears. It's all about love. They are major proponents of a currently rather hip parenting method called Attachment Parenting ("hip" with this explanation: the name is new, the practice among parents is going through a resurgence, the principles are old), based on 7 principles. The Baby Book has the following 7 "Baby B's" (while Attachment Parenting International has a slightly different version). The headings are taken from the book, the parentheses are my quick interpretations/explanations.

Birth Bonding -- Connect with your baby early (prepare for your birth, empower yourself to have the birth you want for you and your baby, skin-to-skin attachment as early as possible following delivery, fall in love)
Belief in your baby's cries -- Read and respond to your baby's cues (trust that your baby can communicate with you, help your baby develop trust in others and the power of their voice by responding to their communication/taking it seriously. Example: avoid letting them "cry it out" at night)
Babywearing -- Carry your baby a lot (safer for preemies than incubators, reduces colic, enhances communication, makes parents' lives easier. Also, come to Metro Minis :)
Bedding close to baby (co-sleeping/bed-sharing/sharing sleep. Very controversial, yet almost every parent does it at some point or another, because, as they'll admit as soon as you do, everyone gets a lot more sleep)
Breastfeed your baby (do I have to explain?)
Beware of baby trainers (this is my personal FAVORITE. Do we eat on a strict schedule, like we think babies should only eat every 3 hours? No. Do we have restrictions on how much time our meals should take, like we think babies can only nurse on one side for 10 minutes? No. Do we force ourselves to "sleep through the night" when we have to go to the bathroom or grab a midnight snack? No. Neither should babies. Watch your BABY, not the clock, or someone else's expectations.)
Balance and boundaries (the previous 6 B's are a lot about giving and giving and giving. Remember that being a good parent means knowing when it is time to give back to yourself and your marriage so that you actually have the energy and resources to give to your little one again)

I want to write a little thing about common nay-sayer statements and how I would respond, but I'm hesitant, having never actually tried any of this with a child of my own. Screw it. That disclaimer disclaimed, here's the nay-sayers and my responses:

"My baby's constant crying is ruining my life and my marriage! We're going to start sleep training." If your baby is crying, there's something the baby needs that he is not getting. Trust this. If he is crying an unusual amount during the night- not up all night for one isolated night, not teething or sickness, not his third week of life, etc- there may be something else wrong. Be a baby whisperer. Did she go through birth trauma? Does your baby have food allergies? Did you recently return to work or move or hire a new nanny? Try to address these issues during the day, make minor adjustments if possible to make it easier at night. And yes, sometimes babies cry just because they want to be held. Sometimes I do, too. And then the next night, I'm fine. They'll be fine, too, as long as you listen to them, show them that when they communicate, they deserve to be heard.
"Isn't it unsafe to bed-share?" Studies about bed-sharing injury included cases in which the adult was drinking, doing drugs, or forgot they were sleeping with the baby. Dr. Sears has information about how to safely bed-share.
"I can't breastfeed for six months/one year/until he self-weans! I have a career. I'm a feminist!" Yeah, the personal is political. This issue is systemic, your barriers to breastfeeding are systemic: there aren't appropriate spaces for breastfeeding at work or in public in general (Would you like your milk pumped in a bathroom stall? Neither would your baby), there isn't appropriate time given. In my own personal feminism, and I think others would agree with me, I want equal opportunity without sacrificing my womanhood. I don't really know how to answer this question, except by saying that this is not an issue mothers can fight as individuals, choosing work without breastfeeding or breastfeeding without work, if they want both. Either way, you're losing the fight- maintaining equal opportunity while losing your womanhood, or vice versa. Tell your boss she can spare the conference room for ten minutes four times a day, she'll be happier when you don't call out of work as often as that woman who couldn't breastfeed because your kids won't get sick as often as hers did. This is something we have to really work on.
"Won't I spoil the baby if I respond to every cry/let him breastfeed as long as he wants/share my bed?" These practices are only considered to "spoil" babies because we now have the resources to practice separateness. Back in cave-times, for our babies to survive, we had to respond to every cry, we had to breastfeed as long as possible, we had to sleep close to our babies to protect them. Now, we have lots of food and two bedroom apartments without bears that might eat our children. But as humans, our biology has not caught up with our modern advancements. Somewhere deep in your baby's brain, she thinks she is very, very unsafe if you are not listening to her (there are bears!) By being attached to your baby, you are not spoiling him in the sense that you are giving and giving inappropriately. It's actually perfectly appropriate.

The nicest thing about The Baby Book is their constant reminders that your child is only a baby for a very, very short time. There is no avoiding the fact that babies have high, high needs. Enjoy this short period where you feel you can respond to those needs immediately with love. You won't have that luxury for long.

"Life is a series of weanings for a child: weaning from your womb, weaning from your breast, weaning from your bed, and from your home to school. The pace at which children go from oneness to separateness should be respected in all these weaning milestones."

Great Success! MMA and CLC

2010-08-11T17:51:00.000-07:00

I have two pieces of excellent news. First, The Midwifery Modernization Act passed and was signed into law! This is a big sigh of relief for midwives and their mamas-to-be everywhere.

Second, I recently became certified as a Lactation Counselor! In the training, I learned fascinating, fascinating things about breastfeeding. Here are some of my favorite nuggets of knowledge:

During pregnancy, your breasts secrete an anti-bacterial oil that protects your baby from germs when he/she begins nursing. This oil appears as the absolute first sign of pregnancy, before you can test positive for pregnancy on a urine or blood test
Newborn babies do not differentiate between feeling full and sucking. As long as they are sucking, they feel full. It is reason, more than "nipple confusion", why pacifier use is discouraged until at least two weeks of age- before this, they might suck and suck and suck, and never cue to you that they are hungry, putting them at the risk of under-feeding
"Good" babies are weird babies. Ever hear a mom say, "my baby is so good, she never cries, she nurses every four hours for ten minutes exactly, and sleeps 5 hours during the night"? Either this baby is a freak, or this mom is a liar. Because human milk is very dilute (like us, it's about 70% water), babies need to nurse frequently, ideally, every two hours. And if one day, your baby is nursing more than usual, or for longer sessions, your baby is not being "wrong" for getting off "schedule." Babies are like real people: some days, we eat more than others, and sometimes, we eat slower or faster.
The best way to achieve the first latch on is to let the baby self-attach. None of this "shape your breast like a cone and shove the baby's mouth at it" stuff. Self-attachment leads to a better latch, meaning less pain for the mom and more milk for the baby and more chances of breastfeeding success later on. On the rare occasions when mama and baby are left alone after birth, I've seen beautiful self-attachment. Watch the "breast crawl"
Breastmilk is magic. We know that already, but I thought I'd say it again. In many ways, breastfeeding is so crucial to baby's and mom's health that it is quite risky (and medically expensive, later on) to not breastfeed. Here's a recent NY Times article touting its magic
DOULAS! A study found that the more stroking, smiling, and talking a woman receives during labor, the more she strokes, smiles at, and talks to her newborn, leading to more successful hunger-communication and thus, breastfeeding

A Metro Minis co-worker and doula friend of mine, Koyuki Smith, also became a CLC. A drop-in breastfeeding group led by us CD(DONA)s/CLCs is in the works at Metro Minis...

The Midwifery Modernization Act

2010-06-07T07:48:00.000-07:00

Hello again, long-lost readers! It has been too long. Today is an important day, so important that it brought me out of my writers-strike and back into the blogosphere (ugh, I hate that word, but its the only one that fit. Sorry.)

Why is today important? The Midwifery Modernization Act, a bill that if passed will drastically remove barriers for homebirth midwifery care, is moving through both the NY Senate and Assembly.

The Midwifery Modernization Act proposes to do away with the requirement for midwives to have a signed Written Practice Agreement (WPA) with a physician or hospital in order to be licensed legally. With the closing of St. Vincent's last month, homebirth midwives lost their licenses, as St. Vincent's was the only hospital in New York City that would sign WPAs. Currently, no hospital in New York City will sign a WPA for homebirth midwives, so all homebirth midwives are actually practicing illegally right now.

Originally, the thinking behind the WPA was that it would make homebirth safer by requiring midwives to establish a relationship with a hospital and physician that they could rely on for transfer during complicated births. However, if no one is willing to sign a WPA with midwives, it's doing nothing but pushing homebirth underground and making hospital transfer a much more complicated and tense situation.

If we can get rid of the WPA, midwives can practice at home legally. My assemblyperson happens to be the chair of the committee that the legislation is going through, so I've already sent her an e-mail and fax and called her today. You can find your senator and assembly person here and do the same. And here is a sample letter you can send:

I am writing to express my full support for bill S5007 /A8117, the Midwifery Modernization Act (MMA). This legislation would amend the Education Law to remove the requirement for a midwife to have a written practice agreement (WPA) with a physician in order to practice midwifery. The education and training that licensed midwives receive is what ensures quality care, and not the WPA. Instead, it is a barrier to practice and limits access to care and choice of provider for New York women and families.

Midwives are licensed independent providers who routinely consult and collaborate with other providers as needed in order to provide safe care to their clients. Research has shown that midwifery care has good outcomes, including lower cesarean rates, shorter hospital stays, and higher rates of breastfeeding among the women they serve. By requiring a WPA, midwifery care is limited by a physician’s willingness to sign rather than the skill and scope of practice of the midwife.

Importantly, the MMA will not expand or change midwives' scope of practice. As a consumer of women’s health care, it is important to me to have the option of choosing a midwife.

If midwives are unable to practice in my community because there are a limited number of physicians or because those who are there refuse to sign an agreement, this limits my birthing options and access to care. Midwifery care is evidence-based, cost-effective, and essential to the well-being of New York women and families across the state, especially for underserved populations, including rural and/or low-income women.

By supporting this bill you ensure that women across New York State have access to midwifery care, birthing choices, and a healthy New York.

Sincerely,

A Birth Story- Brought to you by The Doula Project

2010-04-04T12:31:00.000-07:00

I'm a member of The Doula Project, an budding organization dedicated to "supporting women across the spectrum of pregnancy." It's an incredible organization- the founders are expanding the definition of doula so that we might reach out to women in need of all kinds of reproductive support. We offer free birth doula services to women who cannot otherwise afford it, we support women emotionally and physically during abortion procedures, and we offer birth doula services to birth-mothers choosing adoption through the Spence-Chapin adoption agency.

I joined last summer when I had lots of cover letters and no job, was uncertain about taking the leap of becoming a doula, and basically needed to be involved in something other than writing cover letters and being uncertain about becoming a doula. Fortunately, joining the Doula Project was one of the best decisions I ever made, and has enriched my birth doula work in truly profound ways.

Last February, one of the "5 in 15" births was a volunteer birth I took on through The Doula Project. One of the founders asked me if she could post the birth story I wrote for my client on The Doula Project website's blog. I changed names, my client gave me the go ahead, and it's now up on their site! Take a look here: http://www.doulaproject.org/news/birth-story.html

The 5 births in 15 days

2010-03-14T15:53:00.001-07:00

There is so much to write about. I have plans for so many posts, so here is a list. Maybe I'll get to them someday:

The closing of St. Vincents/my GREAT birth experience there
My thoughts on the relationship between pain management (medical or not) and birth outcomes
A post that I already started, sitting in my drafts folder, about the NY Times article on Freda Rosenfeld, the lactation consultant
Not birth related, but relevant to early parenting: the debate about babywearing, the safety of "slings", and where Metro Minis, my place of regular employment, fits in!
The really groundbreaking Amnesty International report on maternal mortality in the US (I'm very proud because I helped work on it as an intern last spring)
The recent NIH conference on VBAC (Vaginal Birth After Cesarean)

It's been a while, but for good reason. I attended my first birth since late November (had to take a break for health reasons) on Febuary 16th. Then another February 20th, five days later. Another February 26th, 6 days later. Another March 2nd, four days later. Another March 3rd, one day later. That is 5 births in 15 days.

FIVE births in FIFTEEN days. I'm birth-exhausted. Both of clients with due dates in March have given birth, so I'm just waiting on my April clients and I feel lucky to have this break (although I am on call for two of those April clients right now). I have five clients lined up for April, and I'm just praying, praying, praying, that they won't all give birth in 15 days. 30 days would be great. Could you do that for me, ladies?

I like giving stats on births, so let's recap the 5 in 15. All in-hospital. One had a midwife, four had doctors. One was induced (for low-fluids). All had epidurals. Three were c-sections: one was for "failure to progress", one was for "non-reassuring signs" in baby's heart rate, and one was scheduled in advance for breech presentation. Shortest (meaning my time spent at the labor, not the length of the labor itself) (and not counting the scheduled c-section, because that's about 40 minutes): 10 hours. Longest: 30 hours. Two tied at 30 hours.

But the most exciting birth by far, was one I was unfortunately unable to attend. On March 11th, one of my clients woke up to some mild contractions. Listening to both my advice and that of her childbirth educator, she went back to sleep, thinking her first-time labor would be a long one. She woke up two hours later, contractions still mild, and turned on a movie. She called me after the movie and told me, with great poise and lucidity, that she was in labor. Gauging her stage of labor by her voice, I thought "she's still in early labor" and said my usual "Great! Call me when anything changes or gets more intense" (among other things, I'm not that boring of a doula). I get a call from her husband one hour later and he says "We're going to the hospital, she can feel the baby coming out." I thought, "Yeah right. I spoke to her an hour ago and she sounded no where near this stage. She didn't even sound like she was in active labor. She probably just feels some premature pushing pressure." But, I leave for the hospital, and by the time I get above ground, I get a message from her husband:

"We didn't make it to the hospital, because she had the baby in the taxi! It's a boy!"

I learned a very important lesson. When a mom says, "I feel the baby coming out", ask "Do you feel like you have to push, or do you feel the baby's head literally coming out of your vagina?" Because later, she told me she felt the baby's head literally coming out of her vagina.

Full story here.

First, too many births at once, then a missed birth? Can't a doula get a break?

Acupuncture in Pregnancy

2010-02-23T21:12:00.000-08:00

The Wall St Journal published this article today about the effectiveness of acupuncture for treating depression during pregnancy. True, true, true. I'm a big proponent of acupuncture during pregnancy (and beyond). I thought I'd take this time to give a shout out to my favorite acupuncturist Stephanie Propper. She's not only an L.Ac, but she also has a masters in obstetric Traditional Oriental Medicine. I've sent clients to her for turning their breech babies, inducing labor when medical induction looms ahead, and for just regular prenatal care. She also does acupuncture during homebirths (or any birth location where she'd be allowed to practice acupuncture), providing pain relief (acupuncture can actually provide anesthesia), preventing stalled labor, and generally keeping Mama calm and confident.

Want her contact info, let me know.

"Don't eat... the #1 Cause of Death During Labor is Aspiration!"

2010-01-28T09:00:00.000-08:00

(Title taken from one of my most loved/loathed blogs, www.myobsaidwhat.com)

The New York Times recently summarized the results of a study on eating and drinking during labor. Conventional practice forbids eating and drinking everything, except some ice chips here and there. Reason for this: if Mama has a full stomach (even of liquid), she could vomit and choke while under general anesthesia during a c-section. But general anesthesia is only used for emergency c-sections, because it is the fastest acting type of anesthesia. Most c-sections are not emergent, however- the nice thing about labor is that it usually lets you know something's wrong well in advance. Mama usually has at least an hour, usually many more, of bad signs (irregular fetal heart rate, meconium, weaker and spaced out contractions, stalled dilation) before the decision of a section is even brought up. And in that hour, maybe you transfer from home or birth center to the hospital, and in the hospital, your doctor or midwife starts taking some necessary interventions to avoid that section. So if you do make the decision for a section, you get a regional anesthesia, mosey on over to the operating room fully aware and not nauseous, without the danger of aspiration. But given this usual c-section course of events, mamas are still forbidden to eat or drink.

(I HATE ice-chips. Some people like them but I despise them. When I'm thirsty, I drink, I don't chew and hurt my teeth with stupid, useless ice chips. When I'm in labor, even if I'm in a hospital and they don't let me have anything but ice chips, as soon as that nurse leaves my room, hand me my liter of coconut water and I'll be a happy girl.)

In the Times article, a doctor spoke about this antiquated reasoning using a great parallel: ' “My own view of this has always been that you could say one shouldn’t eat or drink anything before getting into a car on the same basis, because you could be in an automobile accident and you might require general anesthesia,” said Dr. Marcie Richardson, an obstetrician and gynecologist at Harvard Vanguard Medical Associates in Boston.'

Thankfully, the study found that there is NO harm or benefit to eating or drinking during labor. Some hospitals are finally lifting the ban on drinking, so women can drink if they want to. Yay!

But I'm interested in the study's claim that there is no benefit to eating and drinking during labor. The uterus is a muscle, and muscles need hydration and energy in the form of carbohydrates in order to work effectively. I've heard a number of doctors and midwives say that proper hydration is crucial to the effectiveness of contractions and mamas' energy when pushing time comes. And I've seen that when contractions slow and become less effective, midwives and doctors blame dehydration and push liquids or IV fluids. I couldn't read the whole study, unfortunately, so I couldn't tell if every woman in the study had an IV- I have a feeling that they must have, if eating and drinking had no benefit. With an IV, extra liquid is indeed unnecessary, for the mama's purely physiological functioning.

But what about her emotional functioning? I believe so fully that labor is the most intense example of the mind-body connection. When women feel strong, they birth strong. Their emotional state sends cues to their body, telling their body whether the environment is safe enough for a vulnerable baby to enter. If mama feels out of control, can't make decisions for herself, feels trapped, her body is going to read that and slow its birth process, because there must be some danger in her environment causing her to feel that way, and her body won't risk allowing a baby to enter into that environment.

Imagine: you've been laboring for 15 hours without anything to drink. Your mouth and throat feels like cotton and all you get is three or four ice chips every twenty minutes. Forget about plain old discomfort in your mouth- what about some compassion? Someone to actually listen to you, validate your frustrations, instead of threatening you with death during an emergency c-section, when the question of a c-section, nonetheless an emergency c-section, hasn't even been raised. Before, you were thirsty and tired. Now, you're worrying about an emergency c-section and vomiting into your lungs. What kind of message does that send to your body? Maybe your body says- there's way too much anxiety here for a baby to be born. Then you've got a self-fulfilling prophecy (well, nurse or doctor or midwife self-fulfilling prophecy): they say c-section, and a few hours later, you get c-section. Not necessarily because they forced it on you when they decided, but maybe because that one tiny remark set off a chain of events in your body, preventing the birth of your baby in any way except surgically.

So, enough with the pessimism, because the results of this study are wonderfully promising. I promise, my next post will be a happy one- just like more births will be if women eat and drink as they please.

Nina's Needlepoint!

2010-01-17T18:47:00.001-08:00

It's finished! She's going to put it on a pillow, which we'll put on our designated breastfeeding chair at Metro Minis. Don't worry, I'll also document the progress of the pillow...

Unnecesareans

2010-01-13T19:02:00.000-08:00

The WHO recently released results of a survey in which they found that nearly half of all births in China are surgical. China's c-section rate is 46%. I hate to get over-dramatic, but this is appalling. Not because I'm so ideologically attached to vaginal birth, but because this is actually really, really dangerous. The WHO recommends that a nation's cesarean rate should be no higher than 10-15%. Above 15%, the risks of cesarean surgery outweigh the advantages to moms' and babies' health. Looking at it from another perspective, that means that, under ideal maternity care conditions, only 10-15% of labors will truly necessitate surgical intervention in the form of a c-section, and 85-90% of labors will progress normally and safely.

So, to explain why, when the cesarean rate is above 15%, the risks of c-section surgery outweigh the benefits to mom and baby. These risks exist with any c-section, but when the life of the mom or the baby depends on immediate delivery, these benefits of saving the lives of the mom and her baby outweigh the risks of the surgery alone.

But when a c-section is done on woman whose labor falls into the 85-90% that are normal and healthy, mom and baby are exposed to these pretty scary risks completely unnecessarily. Immediate risks to the mom include: infection, surgical injury, blood clots and stroke, emergency hysterectomy, less early contact with baby, depression and psychological trauma . Long term risks to the mom include: chronic pelvic pain, difficulty passing bowel movements, increased likelihood to be injured during future surgeries, future infertility, depression and psychological trauma, and maternal death. Short and long-term effects on the baby include: surgical cuts, breathing problems, difficulty breastfeeding, and asthma throughout childhood and beyond. And if the mom wants (and is able, despite the risk of fertility problems) to become pregnant and deliver again, here are the risks to both her and her baby: ectopic pregnancy, placenta previa, placenta accreta, placental absorption, uterine rupture, stillbirth or death shortly after birth, low birth weight, preterm birth, fetal malformation, and central nervous system injury to the baby. (all above found here)

Now, China's rate is pretty scary, but how does our country fare? In 2007 (most recent data available, from Choices in Childbirth's New York Guide to a Healthy Birth), 31.8% of births were done by c-section. In New York state, it was 33.7%. Rates in the New York city metro area vary, but no hospital has a rate below 15%. The lowest is 18.5% at North Central Bronx Hospital (whose maternity ward is staffed entirely by midwives, by the way). The highest is 52.7% at Lawrence Hospital-Bronxville in Westchester.

It was not always this high. Let's compare cesarean rates to maternal mortality, if we want to see a quick correlation between c-section and maternal health. In 1987, the year many of my peers were born, the US c-section rate was 24.4% and the mortality rate was 7.2 deaths per 100,000. We have to use 2003 now for the most recent data. In 2003, our c-section rate was higher, 27.6%. Guess what was also higher? Our maternal mortality rate: 12.1 deaths per 100,000. I'm not saying that this absolutely means that c-sections cause more maternal deaths, because that is beyond my powers of statistics to prove. I am saying that the conventional wisdom of c-sections allowing birth to be safer is completely false, and that most people hold this conventional wisdom is very dangerous for women's and babies' lives.

Why why why why why why why why??????????

Reasons are hard to quantify. This one is a myth though: that women are choosing c-sections as a matter of convenience. When women say they chose the c-section, they also say that they didn't get to that decision on their own, but from pressure from their doctors about time and convenience, and inadequate and biased information given about the risks. Other reasons include a general lack of faith in vaginal birth and "low priority of enhancing women's abilities to give birth," "side effects of common interventions" (a common cascade: epidural, epidural slows labor, pitocin to speed labor, pitocin stresses the uterus and the baby, baby is stressed and uterus isn't working right, c-section), casual attitudes about surgery and c-section in particular, limited access to information and awareness of the risks, and again, providers fear of malpractice claims and lawsuits (a bit plagiarized from Childbirth Connection- they just say it so good!)

I'm sick of talking and thinking about this. My solution: midwives. They specialize in protecting safe, vaginal births. Obstetricians are great surgeons and indispensable for the 10-15% of births that require c-section. But for the 85-90% of births that don't, let's save women's and babies' lives by letting midwives take care of them. A funny parallel is this: OBs are SUVs that you only need in conditions you'll find yourself in 10-15% time. Midwives are regular cars that do the trick the rest of the time, quite well.

On that note, I'm out. With my phone attached to me at the hip for when one of my clients needs some doula love.

PS: I didn't come up with the awesome title of this post, it comes from the title of a really good blog, http://www.theunnecesarean.com/blog/).

Back to Doula-land

2010-01-11T18:48:00.000-08:00

I'm back, after a completely doula-free, off-call holiday period. It was weird not being on-call, and it's hard to be on-call again. I keep double-checking that my phone is on, if I have enough hard copies of birth plans in a client's file, if my birth ball pump is in my bag.

My last week was a blitz of work at Metro Minis, potential-client meet-and-greets, prenatals with clients, and the always exciting, always overwhelming Birth Focus Meet the Doula Open House, which is basically speed-dating for doulas. Good news: I was only able to interview with three couples, but I got hired by two of them! I'm chalking a lot of it up to the fact that I'm one of the more experienced doulas of my lower-priced level...

Tomorrow, I'm going to an orientation for the doula program at Healthy Start Brooklyn. Healthy Start is a federally funded program that is trying to address infant mortality, low birth weight, and racial disparities in perinatal outcomes. I'll be matched with women enrolled in the program and it seems like I won't only be their birth doula, but also in some ways, their whole-mom-life doula. Part of prenatal meetings won't just be determining who'll be around to help immediately postpartum; they'll also be about helping the mom put in outlet covers, cabinet locks, and setting up the crib and changing table. Before I ask questions like, "Do you want to be able to eat and drink during labor?" I'll have to determine if they have food security at all. And If I see any evidence of domestic violence, I have to report and address it. This is going to be intense. But these are the women who could benefit from doula care the most, so I'm excited to try.

Nina at Metro Minis is making a needle-point representation of the international symbol for breastfeeding. It's hilarious and awesome. Here's the symbol, but I've got to take a picture of the actual needle-point when its done:

Great Success! With Insurance! Seriously!

2009-12-19T13:59:00.000-08:00

A few weeks ago, the National Uniform Claim Committee- the organization that, among other things, assigns taxonomy codes for insurance reimbursement- decided that doulas are healthcare providers worthy of receiving third party insurance reimbursement! On Thursday, I applied for my National Provider Identification number and received it yesterday. Now, my clients can send a copy of my invoice to their insurer and maybe, possibly, god-willingly, their insurance will cover some or all of my bill. I already know of one doula who was paid by an insurance company.

This is a fantastic step for doulas towards gaining recognition as legitimate providers of healthcare services. I explain this on my website, but I think Debra Pascali-Bonaro, doula, childbirth educator, and doula trainer (my trainer in fact!), says it even better: "When we look at the data, we know that having a doula is not only nice, it shortens labor, makes it easier, lowers the cesarean birth rate, lowers the use of all interventions and actually helps the baby have a healthier birth. We often say, with that data, if the doula were a drug, we'd all be scrambling for it. It would be unethical to without it." If the doula were a drug, insurance companies would cover it like nothing else.

One small step for the insurance industry, one giant leap for doulas!

Bellevue, Birth Center No More

2009-12-15T09:56:00.000-08:00

A few weeks ago, I attended a birth at Bellevue Hospital in downtown Manhattan. A warm, smart, and unassuming couple from Queens, Regina and Jason (names changed, of course) were incredibly knowledgeable about their options for their prenatal care and birth. They had decided early in her pregnancy that Regina would deliver their first daughter in Bellevue Hospital's Birthing Center, a section of the hospital staffed by midwives and equipped with queen-sized beds, bath tubs, birth balls, and birthing stools, all in the name of allowing the process of birth to unfold undisturbed. Now, this couple didn't choose the birthing center because it was the delux suite, the "spa" version of birth. (Although, I'm not denying that it is better to cuddle with your husband on a queen-sized bed than a regular hospital twin). They choose it because its outcomes for low-risk women were incredible, with a c-section rate of 4%. Because it was an incredibly safe place to give birth.

Regina and Jason also chose the birthing center because, like Elan McAllister of Choices in Childbirth said (in the GritTV link I introduce below), it was a "culture of faith." When midwives and nurses allow birth to progress undisturbed, as they do in the birth center, they are displaying to mothers their faith in birth, their faith that birth can progress undisturbed. Their actions proclaim their faith that it is actually possible for a woman to have a baby without an IV line, constant fetal monitoring, and supplemental hormones. With every touch, every glance, they are telling these women that they can do it.

Now, this is what happens when you, a woman with a low-risk pregnancy, like the vast majority of pregnant women, enter your delivery room for the first time in a traditional labor and delivery ward. Your nurse brings over an IV line and begins examining your veins before you can even say you don't need it, you're low-risk and you won't be receiving any extra medications through the line. Simultaneously, another nurse applies the fetal monitors to your belly, before you can ask that you only be monitored occasionally, because again, you're low-risk and your baby doesn't need constant monitoring. Then a nurse asks, "Do you want an epidural?" when the thought of pain relief hadn't even crossed your mind yet. Three very simple actions. But these three simple actions send a strong message: we don't think you can do this. So, Regina and Jason chose the birthing center, because, well, they thought Regina could do it.

If you noticed earlier that I was speaking about the Bellevue Birthing Center in past-tense, good job! Bellevue Birth Center officially closed on October 1st, 2009, without much warning or explanation. Its closing received the attention of the New York Times, WNYC, and GritTV, and not to mention, Regina and Jason, about five weeks before Regina's due date. In their response, the media highlighted something about the birth center that I think is the most important: the birth center at Bellevue was the only in-hospital birthing center in Manhattan to accept patients with Medicaid or without any insurance whatsoever. So this notion of birth centers and undisturbed birth as a celebrity trend, or only for those who can want the "spa" birth? Not at Bellevue. Like the New York Times article says, the birth center at Bellevue "was the only one of its kind dedicated not to Manhattan's trend-conscious set, but to poor, mostly immigrant women on Medicaid."

Why did it close? HHC, Bellevue's parent company, is suffering a staggering deficit. So cost is probably the first problem that would come to mind. But undisturbed birth is CHEAP. No meds to pay for, no expensive monitoring machines. No epidurals, which cost the hospitals anywhere from $1000-$2500, plus no staffing the extra anesthesiologist who must be there to administer it. And, with a 4% c-section rate, Bellevue is saving $10,000-$20,000 on each c-section the birth center avoids.

Decreased demand? Elan says that yes, Bellevue was experiencing a decrease in demand for maternity services, but ONLY on the traditional labor and delivery ward, NOT for the birth center. What was changing however, was how many women were cleared as low-risk and could use the birthing center. And this, ladies and gentlemen, is where we enter the dreaded field of medical-legal practice. In a survey conducted by the American College of Obstetricians and Gynecologists in September, 29% of obstetricians agreed that they are conducting more c-sections out of fear of liability issues, not out of safety needs. In other words, as the report of the survey says, "As the negative state of the medical liability environment continues, OBGYNs across the US are forced to make changes across their practice that ultimately hurt patients" (quoted from the WNYC report above). Because when you get sued for malpractice, and you didn't document that you did everything, monitored constantly, gave her every medicine possible, that you were constantly waiting for and expecting the birth to go wrong, you lose a staggering amount of money.

So it actually is about cost: the cost of malpractice insurance, the anticipated cost of some staggering malpractice suit lost. (But let's not forget, Bellevue was actually saving money by allowing more of their patients to use the inexpensive birth center). So the closing had a lot to do with cost, but it's more about fear. Fear that birth almost always goes wrong, fear that women can almost never do it, and fear that the hospital will be punished for trusting birth and women's abilities. But in this case, the hospital survives as if nothing happened, and women, mostly low-income women, are punished.

Regina and Jason decided to stick with Bellevue Hospital, and gave birth on the labor and delivery floor. They walked in and were greeted with an IV, a fetal monitor, and an offer of an epidural. But Regina was already doing it. Fully dilated once she entered the hospital, Regina began pushing and, with the gentle assistance of her fantastic midwife, gave birth to a completely gorgeous little girl only a few hours later. She did it.

Now, for an introduction

2009-12-12T11:52:00.000-08:00

Like I said, my name is Leda and I am a birth doula. I live in Brooklyn and I attend births wherever my clients take me.

To date, I have attended twelve births of thirteen babies (one woman had twins). One woman gave birth at home, one woman gave birth in an out-of hospital center, and one woman labored in an in-hospital birthing center and delivered on the hospital's traditional labor-and-delivery floor. All of these women, totaling three, gave birth with the assistance of one or more midwives. Nine women gave birth in hospitals, and of those nine, four gave birth with the assistance of obstetricians, four with midwives, and one with a family practice physician. Let's summarize the care provider breakdown: 12 women, seven midwives, four obstetricians, one family practice physician.

Ten women gave birth vaginally (and if that word makes you giggle, you might want to just stop now, because it's going to get worse for you. But I promise I"ll try to avoid talking too much like Julianne Moore in The Big Lebowski), and two women gave birth via c-section. Six women labored with epidurals, six without. The longest birth I attended lasted about 36 hours and the shortest lasted about three hours.

Now, to explain why I might have a shred of clout, of relevance, of reason for others to read this blog, I guess some resume touting is in order? I guess? Ok, let's do it.

My first foray into actualizing my interest in women's healthcare (which was born long before I can remember) was an internship with NARAL Pro-Choice America during my last year of high school. Fast forward to college, when the birth light bulb went off, and I began writing as many papers as possible on birth and maternity care (from the first one on the transition of birth from the home to the hospital to the last one on breastmilk kinship in rural Islamic communities). I traveled to India for my semester abroad, and for my "independent study project", I studied the nature of maternity care in Varanasi through interviews with 25 mothers of different ages, castes, and religions. I came home and began conducting research for world renowned midwife Ina May Gaskin on maternal mortality in the US, to support her Safe Motherhood Quilt Project (like the AIDS quilt, a quilt for women who have died of childbirth-related causes). Then I continued that research for Amnesty International USA, supporting their project on maternal health as a human right. And the piece de resistance, my sociology major thesis! 102 pages of blood, sweat, and tears on midwifery, midwives' feminist ideology and how knowledge is produced. Or you might say, "Midwives and the Ideology of Empowerment: The Relationship Between Ideology, Practice, and Knowledge Construction". It's pretty sweet.

Now, I doula. For private clients, and clients I meet through organizations like Birth Focus and Birth Day Presence. I also doula for teen mothers residing at Inwood House, and soon, I hope to doula for women giving their babies up for adoption through The Doula Project. Also through The Doula Project, I abortion doula, meaning I help women during termination procedures, and I doula for women who face miscarriage, stillbirth, or fetal anomaly.

Now, I blog. About birth. Birth work. Birth health. Birth news. Birth rights.

Birth. Strong beautiful birth.

Dear Baby, Happy Birthday

2009-12-09T14:34:00.000-08:00

My name is Leda and I am a birth doula.

In lieu of a more detailed introduction, I'd like to share a birth story. I have a feeling that I'll have a lot to complain about in this blog, so let's start with some joy and optimism. For each of my clients, I write a letter to their baby detailing the events of their birth, something their parents can read to them as they grow older. But even though I address these letters to their children, I write them also for the parents, to help them remember the experience, even after long hours of intense emotion, physical exertion, and exhaustion may have caused some mild memory loss. The following is a compilation of stories I've written, weaved together to create a fully anonymous yet narrative story. All names of babies, parents, and care providers are (and will be for the rest of this blog) changed.

Laura Anne Cauller's Birth Story

September 19th, 2009

Dear Laura Anne,

While you were being born, I was your mommy's doula. I wanted to write you this letter about your birth because it was so wonderful. The most amazing part of your birth was the overpowering love everyone felt upon your arrival. You are a lucky, lucky girl.

It all started in the late evening of September 18th, 2009. Around 11:00 pm, your daddy started singing to you inside your mommy’s belly. As he sang, your mommy felt something different inside her, so she said to him, “Keep going! I think your singing is starting something!” As daddy kept singing, your mommy kept feeling that something different and soon realized that what she was feeling was probably labor contractions and that you were on your way! Your mommy and daddy

were so happy that you decided to come on your own, because otherwise your mommy would have been induced the next day. We knew right away that you would grow up to be strong and assertive, making decisions all by yourself!

In the morning, after a night of waking up every ten to twenty minutes to a contraction, mommy and daddy decided it was time to call me. I came over to the apartment at around 9:30 am to find your mommy peacefully lying on the bed, with your daddy leaning over her and gently stroking her hair. I knew immediately that no matter what, your mommy would be ok as long as your daddy was there to support her.

In between contractions, mommy was very chatty, chipper, and giggly. During contractions, she would become very quiet, close her eyes, and breath very slowly. She was doing so beautifully. We decided to take a walk to distract ourselves and help mommy’s labor progress a bit. It was very windy, but many people were out walking, too. We wondered what they thought of us, three people walking very slowly, stopping our pace and conversation every so often for your mommy to lean on daddy and get through the contraction.

We returned home, and over the next few hours, your daddy and I took turns giving your mommy massages, getting her food and water, and walking with her up and down the hall to speed her labor. We tried many different positions to help with the labor, and mommy liked this one the best: she would wrap her arms around daddy’s neck and hang down, swaying her hips back and forth while I massaged her back.

When mommy's contractions were three to four minutes apart and lasting one minute, I asked her how she was feeling and what she wanted to do. She mentioned that she might want to go to the hospital and get an epidural so that she could manage the pain better. I was very surprised because she appeared to be managing the challenge of labor with such strength and poise! But she said she didn’t want to be a “rock star” and keep going without the help of an epidural. We assured her that that made a lot of sense, especially since she had been such a rock star since her contractions began at 11:00 the night before! At around 4:30 pm, your daddy and I got ready for us all to leave for the hospital.

When the taxi came, daddy went down to meet the driver and tell him that he was about to make a very special trip, which was taking a woman to the hospital so that she could have a baby and become a mommy. He said, “Drive more carefully than you ever have before!” I helped mommy out of the apartment and into the car. During the drive, I gave mommy some crackers and Gatorade so she could keep her strength up. We told her when bumps and stops and turns were coming and she told us when contractions were coming so that the driver could slow down.

We arrived at the hospital minutes and quickly made our way through a maze of hallways and found the labor and delivery section. Daddy had to fill out some paperwork about mommy, so I helped mommy get some attention from the nurses. I said, “She’s in very active labor!” and a nurse directed us into a small room where the midwives would soon come. Mommy’s contractions were coming closer and closer together and were more and more intense, but she was still doing so beautifully. She even stayed strong and confident when we had to deal with a very rude nurse!

Stephanie, the midwife, arrived and greeted mommy with a big, warm smile. She checked mommy's cervix to see how far along she was in her labor, and found that mommy's cervix was dilated to seven centimeters. Now, when a woman has a baby, her cervix has to dilate to ten centimeters before the baby can come out. So seven centimeters meant that mommy was almost done and that you were so close to being right here in this world! We were all so proud of her.

Your mommy said she was ready for an epidural, so Stephanie went to get the anesthesiologist. When he arrived, he told your daddy and me that we had to wait in the hallway while he gave mommy the epidural. Your daddy was not happy about being separated from your mommy! But soon after, we came back in and your mommy looked so comfortable and serene. It was definitely the right decision for her.

With the epidural in, your mommy chatted away for the next hour. She was on the phone non-stop with friends and relatives to say that you were coming. We all thought this was very funny. At 10:00 pm, mommy said that she felt an urge to push. Stephanie checked mommy again and found that mommy's cervix was fully dilated to ten centimeters and that you had already come down a little! We were so excited that mommy could begin pushing!

Mommy wanted to find the right position in which she could push and decided that she would sit up and that daddy would sit behind her with his arms wrapped around her belly. And this is when your daddy really shined. He stayed right with mommy, whispering in her ear words of encouragement and love, stroking her hair, and wiping her forehead with cool cloths. The best support, I think, was during the moments in between pushes when he repeated, “I love you, I love you, I love you.”

The minutes passed, and so did more and more pushes. Around 10:45, we began to see your little head. When daddy saw your head and mommy felt it with her fingers, they were in awe. In a few more pushes, we all saw your beautiful face, and at 10:51 pm on September 19th, 2009, your whole body slipped out and you were placed into your mommy’s arms for the first time. The whole room gasped with delight. I will never forget the expression on your mommy’s face: her eyes widened with incredible awe, as if she were viewing a miracle—which, of course, you are. She turned to your daddy with those wide, joyful eyes, who returned her gaze with the happiest of smiles, and then gave mommy a big kiss. Mommy said, "Hello baby! What a beautiful baby girl!"

Stephanie and the nurses were pretty pleased with you as well. You scored a 9 out of 10 on your first physical exam, meaning you were a very healthy baby. We were all so happy to hear you cry, to hear your strength! Almost immediately, you began moving your little head around and sticking out your tongue, telling us that you were hungry. I helped you and your mommy begin nursing, to comfort you and fill your little belly up with mommy’s good milk. It was pretty clear from the start that you two would make a great nursing team.

I left your mommy and daddy to give them some private time with you and to decide on your name. I ran into the waiting room and exclaimed to your Grandma, Grandpa, Nanna, Granddaddy, and Aunt Linda, "She's here!" Everyone was hugging and celebrating and asking us a million questions: “What does the baby look like?”, “What did her crying sound like?” and on and on. They could not wait to meet you.

Soon, Grandma's phone rang and it was your mommy, telling us all to come back in and meet you. We paraded past the nurse’s station without caring that it was past visitor’s hours, and thankfully, they didn’t say a word! When everyone came into the room, mommy was sitting up on the bed, looking beautiful and proud, daddy was holding you, and you were peacefully sucking away on daddy’s pinky finger. With all of your family, the room was full of happy tears, joy, and love.

It was a particularly special moment when your mommy and daddy announced your name. They named you (as you know by now!) Laura Anne, the names of your maternal great-grandmothers (Grandma's and Nanna's mommies), two very special women. You should be so proud to carry such a legacy.

Beautiful Laura Anne, I am so happy for you and for all that life is sure to bring you. Remember how lucky you are to be surrounded by such love. It was a joy and a blessing to share your birthday with you and your family.

With love,

Leda (your mommy’s doula)