Is Your Hospital Listed Here?

As of July 2009, there are 83 hospitals in the US that have been evaluated and deemed "Baby Friendly" by the Baby Friendly Hospital Initiative.

To be included on the list, facilities must meet 10 criteria, created by the World Health Organization, encourage breastfeeding by helping mothers initiate breastfeeding, appropriately training all staff, avoiding formula unless medically indicated, allowing “rooming in,” and other practices. These steps are also included among the Ten Steps for Mother-Friendly Care outlined for the Mother-Friendly Childbirth Initiative.

I'm surprised by this list -- I thought that a few more Boston area hospitals would be listed, and the single one that did is not the one I anticipated.

A Bumper Sticker (or a few of them!) is Worth a Thousand Words

Here's a photo that my brother-in-law took while vacationing in Philadelphia over the weekend. When I saw it, I jumped up and down, clapping my hands.

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OK, Massachusetts Mommies! Get ready, get set...NURSE YOUR BABIES IN PUBLIC!!!!

Look what Massachusetts law now allows us to do. Although most of us have been doing it for years, now we nurse our babies in public -- at a restaurant, mall, you name it -- under full protection of the law!! (But I must say, I think the lead line of the article has a typo; "shouldn't" not "should.")

I fully intend to continue breastfeeding my baby in public -- now if only the weather would be as mommy-friendly as the law!

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.

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.

High-Tech vs. High-Touch Maternity Care

Please click on the title above to read a simple, straightforward summary about the benefits to keeping interventions low in childbirth, from Consumer Reports -- a fairly benign publication that reaches out to a wide segment of people, not just alternative health or alternative birth populations!

Selma Hayek promoting maternal/child health in Sierra Leone

Please click on the title above to see Pampers and Selma Hayek use their name and brand recognition for a truly humanitarian purpose in Sierra Leone.

Two things strike me here in this video: 1) often as breastfeeding advocates and educators, we begrudge the obstacles to our goals (think: mall foodcourt nurse-ins, Applebees demanding a diner cover herself up, Facebook banning photos of breastfeeding -- yet the struggle of a developing nation is so primary and undeniably, utterly humbling. It should serve as a reminder that American women are breastfeeding in luxury, regardless of what we encounter in our professional lives; 2) Selma Hayek breastfeeds an ailing baby, and it exemplefies generosity, selflessness, beauty, and grace in one gesture.

Fence-Sitting

I told a good friend that, unexpectedly, I was pregnant. She said to me, "But you work as a doula. You are surrounded by pregnant women and newborn babies all the time. It's not that surprising that you're pregnant!" Another good friend's response was "You also work as a counselor in an abortion clinic. You know how these things happen -- how could you be surprised that you're pregnant?"

So that's what it's like sitting on a fence. My husband and I agreed not to make any decisions right then and there, and gave ourselves permission to ride a rollercoaster of emotions, come to any number of decisions, and then change them again until we finally settled on something that felt right.

A fellow doula offered her congratulations, saying "What a gift it is to go through a 3rd pregnancy, knowing all that you know about childbirth." And true, if I chose to continue the pregnancy, I had a plan for my prenatal care and very definite goals for my labor and birth. But the truth is symmetrical; I also knew every step of the abortion procedure. I knew exactly where to go, nothing to eat or drink after midnight until after my procedure was done, and that I needed to ask for an anti-nausea agent in my IV sedation. I knew that the doctor would write words on my medical report to indicate that the procedure was complete, and the likely words would be "fetal parts", "villi", "sac" or "POC," which stands for Products of Conception.

This is actually my 4th pregnancy, as I had a miscarriage between my two daughters. The gravity of the loss I felt at that time took me by surprise. I grieved as if someone had died, and I was barely 7 weeks at the time. Ironically, four years later, here I was waiting to be 7 weeks, so that if I were to terminate, there would be less likelihood of complication. But unlike my miscarriage, this time I had a choice, and I had never felt such ambivalence. I didn't want to bring another child into the lives of my daughters just because I was afraid to have an abortion. How was it that I could offer support and smiles and reassurance to dozens of women who make that choice every week?

I do occasionally sit with ambivalent women at the clinic. Women who take more than 20 minutes to fill out a single registration form, women whom we see through our security cameras sitting in the car long after they've shut off the engine. When I talk with them in counseling, I tell them that it is one thing to consider abortion, to look it up online, to make the appointment. But it is a different thing altogether to show up, to sit in the waiting room with a dozen other women who are there for the very same reason, and then actually go through with it. Some of them, especially if they are very early in the pregnancy, I counsel to go home, (I always wish I could open the front doors and shout out to the protesters, "Letting one go!") because a 1st trimester procedure can be done up to 14 weeks into the pregnancy. Because she has the time, I suggest she talk to her friends, garner the support she needs, and then if she returns, I assure her it will be easier. I imagined myself as the patient with any of my fellow counselors sitting in the room with me, explaining to me all that I already knew. And in my mind I could see them sending me home, and with a kind smile, saying "Maria, you are not ready to make this decision today."

Nine weeks into my pregnancy, I had my first prenatal appointment with a midwife. I chose not to share with her that my pregnancy was due to an act of carelessness. I also didn't disclose that abortion was still an option (which makes me feel silly in hindsight, as I rarely sit down with a woman at the abortion clinic who is voluntarily terminating her pregnancy despite having begun prenatal care). Nine weeks was also when I began spotting. I had been spotting for a few days by the time I saw her.

She sent me for an ultrasound, and I remembered my previous pregnancy loss. I wondered if maybe God was punishing me. For getting pregnant so thoughtlessly and then responding with indecision, my penance would be miscarriage, and then my husband and I would never, ever, ever take a chance again. I would continue my thriving doula career, coaching women through childbirth and breastfeeding, knowing that I would never again be a laboring or nursing mother, because we would never again let an accident like that happen. I lay on the exam table in radiology, the technician rolled the transducer over my belly, and there it was: a tadpole with a little flashing light, a heartbeat. I cried through the rest of the exam, which I hadn't done years before when the ultrasound had shown no heartbeat. I felt relief that I wouldn't have to experience that again, the bleeding, the clots, the pain that wrapped around my waist from back to front - the labor of a miscarriage. And though it would be a while yet before I would feel a rush of attachment for the image on the screen, I knew that my third journey into motherhood had already begun.