Seven Doulas for Seven Moms

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!

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

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!

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

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

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!

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

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)

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

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.

1. 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)
2. 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)
3. Babywearing -- Carry your baby a lot (safer for preemies than incubators, reduces colic, enhances communication, makes parents' lives easier. Also, come to Metro Minis :)
4. 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)
5. Breastfeed your baby (do I have to explain?)
6. 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.)
   
7. 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

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

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

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

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

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!"

(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!

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

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

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: