Saturday, March 28, 2009

A C-Section rate of 18%???

Click on the title above to read about the amazingly low c-section rate at a New England hospital (woe that it is not in Boston...). The national average is 34%, and the hospital credits the Midwifery Model of Care for its low c-section rate. Let's hear it for midwives!!

Saturday, March 21, 2009

The Third Time's the Charm

Probably from a random mailing list, I now have an annual subscription to an early parenting magazine. I was surprised when I saw the issue in my mailbox, as I had stopped reading any kind of parenting magazine a while ago, perhaps after my oldest turned 3. I found the content somewhat repetetive, and the recipes are nearly all irrelevent to a family dealing with a child's food allergies. Plus, the bewildering nature of babies was over for us (or so we thought!), so who needed a magazine?

My infant, nearing 8 weeks old, will sleep longer if she's on my body, so often I'm relatively immobile on the couch while she dreams away. Somewhat bored - and thoroughly jaded - I picked up the magazine and read the article "10 Signs Your Baby Loves You."

Sign number one - baby smiles. I remember those days, particularly with my oldest, colicky daughter; I kept waiting and waiting for the tiniest smile in between the screaming jags. If only the little corners of her mouth would turn upwards, it would mean she was content, even if just for a moment. The article wisely states that mothers should disregard the notion that it is just a gas bubble making their babies smile. Happiness is happiness, and so be it. Another sign that the babies love their mothers, according to the article, is their stare. It explained the vision of infants, and how at this developmental stage, they can see about 7-10 inches away from their faces. And wouldn't you know it, that's about how far away the face is of an infant's mother when she's feeding her newborn. Though they have no concept of it, the article promises that babies are in love with their mothers.

I rolled my eyes and picked up People magazine instead.

Just yesterday, I attended a Mom and Baby Yoga class for the first time. My first was far too screamy to attempt anything like that, and with the arrival of my second daughter, I barely had a chance to brush my teeth, let alone have the luxury of a yoga class with just her. I could tell I was the only Repeat Mom there. The First-Time Moms were enthralled with their babies, never breaking eye contact, drizzling teeny kisses at the toes of their infants as they swooped into Downward Dog, lifting their babies high above their heads with a "whee!!" as they elevated them into the air for Mountain.

Me? I just wanted a good stretch, to feel my body move again after a long pregnancy filled with modified bedrest, a rapid labor, and tentative post-partum weeks. I loved moving my body independently and realizing that my muscle tone, strength , and flexiblity still bore some semblance to what they had been. But I felt some pressure to do as all the other bright-faced, adoring new moms did. As I moved into Sphinx, I did as I was instructed and opened my eyes wide, my mouth too, all in rounded, surprised O's, and made eye-contact with my baby.

And wouldn't you know it? There she was, her unblinking eyes staring me down. Her haphazard, newborn jittery limbs quieted as she made micro-movements with her mouth to mimic me. Her tiny lips formed a tiny O, just like mine, and her eyes were riveted to me for the rest of the class.

Monday, March 16, 2009

The Divisiveness of The Atlantic Monthly's "Case Against Breastfeeding"

These are the kinds of debates I hate, largely because I refuse to take sides. Yes, I'm a doula. Yes, I have a bias for normal birth, and yes, that leads neatly into a bias for breasfeeding. But Hannah Rosin has some interesting points.

Having not done a literature review myself about the nutritional comparisons between breastmilk and formula, I am surprised, and frankly still skeptical, that medical meta-analysis is not overwhelmingly in favor of breastfeeding. And while I do know breastfed people and formula-fed people who are of equal health and intelligence, a part of me never questioned breastfeeding. Even if breastmilk were an utterly neutral liquid, it is what my body makes solely for my baby, who was also made by my body. In the natural order of things, of course I chose breast over formula.

But I like that Rosin is honest about the fact that breastfeeding is no picnic. Continuing to breastfeed your baby does require significant accomodations with work (many women will nurse for their maternity leave, and the return to work marks the end of nursing), patience from other children (how many times has one child needed something as soon as I settle in to nurse another?), the division of labor in the home, and yes --sleep. Episodically, I have been nursing for the last 7 years, for about a year and a half at a time. I cherish it, though sometimes I've been downright resentful that my husband can't nurse, too. And though it's been all natural and made-by-mom, one of my children has anaphylactic food allergies. Who would have known that until I eliminated her allergens from my own diet, my breastmilk was actually toxic?

And though I cherish nursing, not all mothers do. Though many of them want to, it is painful, and they cannot continue, regardless of the support of numerous lactation consultants. (And I am a little taken aback by the way Rosin diminishes lactation consultants. Perhaps it is because she doesn't understand how, LC's -- most of them nurses -- have assisted enough women with breastfeeding to meet the thousands of contact hours needed to be certified. ) For others, due to a variety of hormonal reasons, milk production is low, which can then lead to the relentless path of nursing-pumping-supplementing with the dreaded formula leaving no time at all to actually enjoy a newborn baby, but plenty of time to be anxious that the baby is dehydrated and starving. And for some mothers, mothers who are equally devoted to their children and absolutely selfless in ways of mothering that I could never be, breastfeeding requires mental and emotional space that is just too intimate, maybe even stifling. I have worked with too many women for whom breastfeeding was at the cost of their mental health, and I find that unacceptable. No amount of colostrum or antibody is worth that.

But what I find most upsetting about the article is not the article itself, but the comments that are being left in the blogosphere, comments that question Rosin's personal decisions, her parenting skills, and her devotion as a mother. The comments only prove that there are indeed breastfeeding fascists out there, as the author calls them. I don't like this debate because there is no answer, only judgment, and its a tension that I see in the birth world too often. It is the breast vs. bottle chapter, like the natural vs. medical childbirth chapter preceding it, in the book of how women deride each other's choices. Rosin's article shows that statistics can be used to prove a point as well as its counterpoint, but nothing is more salient than a community of mothers who feel supported and respected by their peers, employers, family members, and care-providers, so much so that they feel confident in the informed choices they have made and can resist the need to judge the choices of others.

Wednesday, March 11, 2009

Ummm, WHO delivered that baby?

I have been co-moderating a mothers e-group for a few years. It is a wonderful, supportive, and caring resource of information for moms in Boston. Every now and then, a newly pregnant mom asks for recommendations on an OB or midwife (usually an OB). The responses come pouring in, women sharing their stories about the tender prenatal care they received from one provider or the wonderful support given by the OB who happened to be on-call when they went into labor. But the one thing that makes me crazy is that this is said, over and over again: "Dr. (insert name) delivered my baby."

It doesn't matter how it happened: medicated or unmedicated, induced or spontaneous, vacuums or forceps. Mothers deliver their babies. Doctors and midwives attend births, assist births, catch babies, and perform procedures, but Mothers Deliver Their Babies! Even the babies who are born via the surgical skills of high-risk OB's, their mothers deliver them from the safety of their bodies, releasing them into the big, wide open, world to give them life.

Curtain Call

Has the fat lady sung?

Somehow, unimagineably, I've gotten my period. My youngest is only 6 weeks old, and I am nursing around the clock. With my other daughters, four, maybe even five months went by. Of course, I crawled the internet, using every combination of search term possible, and out of the possible explanations for the bleeding -- placental site not healing, retained placenta, or onset of menstruation -- I'll take menstruation. But everything I read says that rarely a breastfeeding woman may get her period at 6 weeks postpartum.

I'm beginning to dislike that word rare. It is rare to experience problematic bleeding in late-term pregnancy; it is rare for a placenta to abrupt from the uterine wall; it is rare for a labor to be precipitous. Yet all of it has happened to me in a single pregnancy. I am the 1 out of the such-and-such number.

My husband and I, after our initial shock, embraced the idea of a third child. I told myself that while pregnant I would savor each minute, as this opportunity was a gift; even better than a second chance -- a third one. To be a mother for a third time meant that the anxiety was gone, as was the worry that I was always doing something wrong, or that something in the pregnancy was going wrong. I had faith in my body when the exhaustion felled me, trusted my circle of friends enough to rely on them heavily for the care of my children when I couldn't get off the couch, and believed so much in the process of undisturbed birth that I didn't panic when the force of rapid labor yanked me by the wrists and tied me to a runaway train, screeching to a halt with the birth of a baby in less time than it takes my first two daughters to watch a movie.

And now it's all over. My period has returned. The pregnancy and birth are behind me, and it happened in an instant.

My precious, impossibly perfect third daughter is sleeping in my lap as I write this. Her breath makes the sound of tiny whispers, and her eyelids flutter as she dreams. Her lower lip quivers occasionally. She is the last baby I will nurse, the last baby whose sweet milky breath I will feel against my face, whose soft, round downy head I will caress. I want to savor this, too, but just as I grab hold of one moment, it slips through my palms and is gone.

Tuesday, March 3, 2009

Is it REALLY about the epidural?

When I tell people I'm a doula, one of the responses I get is a shake of the head, coupled with "Nah, I go for the drugs!" Or "Why should I experience pain if I don't need to?"

I loved this entry from the blog "Empowering Birth." What woman wouldn't want to walk away from her non-medicated birth experience with the sense that now she can accomplish anything in the world? What woman wouldn't want that feeling from ANYTHING? What mother wouldn't want that feeling for her daughter? The craving for this experience is what motivated me to have my third child with midwives at a birth center.

But as I delve deeper into the world of birth -- as a mother who has had three wildly different birth experiences, as a doula who has attended many births, and as an aspiring midwife -- I dare to say that it is NOT about whether a laboring mom gets an epidural. Pain is subjective. What one woman can tolerate for 24 hours, another may not be able to tolerate for 24 minutes. Is one woman stronger than the other? Is one woman's birth better than the other? A woman's body has the ability to grow and birth a child. There is, in fact, nothing more natural than that act of creation and birth, epidural or drug free, at home or in a hospital. Witnessing a birth is a phenomenal, powerful experience no matter how the birth happened and what circumstances led to its unfolding.

Because I am a trained mental health clinician, I know that people have all kinds of experiences and make very different decisions than someone else would in the exact same circumstance. None of it is up for judgment, and as a birth professional with a background in mental health, I'm very cautious about even the mildest suggestion that a woman who chooses an epidural is less-than or that the babies had a less-than birth. In fact, I'm very cautious about the suggestion that a woman who chooses an elective, first-time cesarean is less-than.

My birth passion is more focused on freedom of choices. Is a pregnant or laboring woman making a decision about her baby's birth out of fear? Does she have the supportive people she needs to form a circle around her? Is she making an informed decision about her body, which decades of trends and popular culture have taught her to dislike and distrust, if not abuse? Natural childbirth is not only about the epidural. It is about our culture; our love and reliance of technology over our instincts. It is about our need to control a normal, healthy process that should be allowed to take its own path and power and time, and intervening only when it is medically necessary. It is about a culture that focuses on liability and lost income or productivity more than the intangibles, like faith and trust.

Actually, I think that the last thing natural childbirth is about is that epidural. It is about all that is normal about birth. That we don't know when it will begin, nor do we know how long it will take. It can surprise us, and yet if we can remain watchful while still being patient and respectful of the process, it will reveal itself as all that it is meant to be.