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Tuesday Tidbits: Pregnancy and Infant Loss Awareness Month

October is Pregnancy and Infant Loss Awareness Month. Many of us are all too aware of the face of pregnancy loss and the 1 in 4 women who will have this experience as part of their journey through the childbearing year. When my third baby died during my second trimester of pregnancy in 2009, I found the image of tiny footprints on my heart to be a very significant symbol. Since that time, I always keep footprints charms on hand to share with other mothers. I’d hoped to create a new sculpture in honor of this year’s awareness month, but didn’t manage to do so. Instead, in honor, we created a new memorial bracelet for mothers impacted by babyloss. A portion of the proceeds goes to benefit the local pregnancy loss support group in making jewelry items for memory boxes.

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Footprints on My Heart Memorial Bracelet by BrigidsGrove on Etsy.

Our shop also picks one organization a month for a donation to a nonprofit organization. Our October donation went to Brittany’s Blankets for Tiny Babies. We sent footprints charms and forget-me-knot charms:
New Etsy Pictures 004
My Sacred Postpartum class started on October 1st and our first week’s assignment was art journaling about our birth experiences. It has been almost five years since my first miscarriage-birth and while sometimes I feel like I seem weird or like I “shouldn’t” keep counting it, I’ve always given Noah’s birth equal weight as a birth experience in my childbearing life.  So, I included a page for his birth story in my art journal as well.
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(Side note: I have been seeing a chiropractor recently to make sure I’m in good alignment for my upcoming birth and it means a lot to me that she remembers and counts Noah’s birth experience too, saying things like, “well, since you’ve had four births before,” even though I’m in her office with only three kids.)
I’ve mentioned before how powerfully I needed other women’s stories after my own miscarriage experiences. My two favorite books for this are:

I’ve also shared the link to my friend’s miscarriage-birth story in a past post. It is one of the most powerfully written miscarriage stories I’ve ever read. October also marks her due date with that baby and so I want to honor her memory by sharing the link to their birth story again today:

…Three words. It only took me three words to tell you, friend, acquaintance, or stranger, what happened to me. I wonder how many more words it will take to tell myself — the MAMA, the bearer of lost life — what happened.

11 weeks. Saturday night. Walgreens bathroom. By myself. Cabernet Sauvignon in the public toilet. Doughnut-sized clots of tissue that just kept coming. The sensation of birthing jellyfish. Sticky red hands from trying to clean myself up, pulling red chunks out of my underwear. Staring into the toilet and wondering how in the world I could possibly flush it I did, after a long time and many tears. Drips running down my legs and polka-dotting my feet. Telling an employee there was a bloody mess in the bathroom. Walking out of Walgreens in blood-stained jeans.

Did you like it better when I had only said three words? I liked it better when I was still pregnant.

via Losing Susannah | Peace, Love, & Spit Up.

I did note in an article I just read this week via a different friend who recently experienced miscarriage, that personal stories can also be unhelpful to others though, especially when they redirect from the woman in front of us to our own experiences (though, I would venture to say that is because so many of us feel as if we have to hold our own stories close to our hearts, and therefore somewhat unresolved, because of a lack of cultural permission to talk about them normally):

I am left feeling more alone than I ever thought possible. Solicited or not, countless women say to me, “Why is no one talking about miscarriage. No one talks about postpartum depression either. All of these things women go through that nobody talks about. Why are we not talking about it if everyone is going through it?” It’s only now that I realize why I don’t want to share my experience as openly anymore. The more I talked about it, the less understood I felt.

All I yearn for is the simplest of engagement, “How are you feeling?” Four words. Nothing more.

Instead, I am bombarded by horror stories of women losing their longed for dream in a pool of blood or heroic war stories of women whose histories in no my way resemble mine and go on to have healthy children. Are the details of someone’s sister’s friend’s friends’ 4 consecutive miscarriages supposed to be heartening?Women use my openness about my loss as a springboard to delve into their reproductive aches and pains, recent or decades old. The sharing feels tinged — needing to be less this, more that, better than, more than, and most definitely triumphant in achieving their desired family size. I propose that we simply listen to one another, with presence of mind and heart, no matter the level of uncomfortability.

via Grand Losses: Musings on My Miscarriage | Christy Turlington Burns.

This article is extremely powerful and I highly recommend it. The author goes on to explore how women blame themselves for their reproductive losses:

Miscarriage is simpler than all of that. It is loss of life that wasn’t sustainable.

I have fantasies of shouting this from rooftops and tweeting random cryptic notes containing the facts about pregnancy loss in the hopes of galvanizing women’s perceptions of themselves. I daydream about pleading with women not to blame their beautiful bodies for their reproductive devastations. I wish I could dare every woman who has at some point or another wondered if they were somehow the root cause of a reproductive disappointment to turn that question on its head. “What if you are not the reason that this happened to you? What if it just is?” I can’t help but wonder if this would illicit more anger, more grief, more relief, and/or more hope. Or maybe something else completely. I am confident that it would engender less competitiveness, less perfectionistic strivings, and more self-love.

via Grand Losses: Musings on My Miscarriage | Christy Turlington Burns.

Related past posts:

Tuesday Tidbits: Miscarriage Care | Talk Birth.

Tuesday Tidbits: Miscarriage and Story-Sharing | Talk Birth.

Tuesday Tidbits: Miscarriage | Talk Birth.

 

 

 

Tuesday Tidbits: Science, Mother Blame, & Postpartum Psychosis

“There is nobody, out the other side of that sort of strong birth, who is not better prepared to meet the absolutely remarkable challenges of parenthood. When the power and trust is transferred to the mother, when she delivers her child, rather than ‘is delivered’ when she chooses, rather than ‘is allowed’, no matter what sort of technical birth she has, she is stronger, fiercer, and better…”

–Stephanie Pearl McPhee (The Yarn Harlot)

August 2014 019Just a short Tidbits post for today…

Over the weekend, I appreciated reading this article about an unusual topic: postpartum psychosis.

Two weeks previously, Jessica was in perfect health, enjoying a career as an actress, comedian and writer and at the end of a straightforward pregnancy with her actor husband Matthew Bannister.

“I describe Albert’s first weeks as ‘peace and war’,” she says. “The birth was gentle; I delivered Albert myself in a pool in our dining room. I remember looking down as he was born, seeing this baby blinking up at me under the water, and feeling such love. Then came a tidal wave of terror.”

The first days of parenthood were the blur of joy and shock common to most. “It was a time of epic contradictions: you’ve lost so much of yourself and you’ve never been more whole,” Jessica explains. Yet by day three she began to display symptoms of a rare illness affecting one to two in every 1,000 UK mothers…

via Postpartum psychosis: How Jessica Pidsley was driven to the edge by the rare illness – Features – Health & Families – The Independent.

I also read a significant article about epigenetic research and motherblame:

So why is it that the complex science of human development, in particular, is so readily distilled into this single, unhelpful message: “It’s all about mom”?

Of course, science is influenced by values in all sorts of ways: in the questions we address, the conclusions we prioritize, and the applications we pursue. But when dealing with complex causal processes and the assignment of causal responsibility “it’s the mother!”, values can affect the conclusions we draw from science in an especially pernicious way. That’s because we think of causal claims as simple descriptive facts about the world — as value-free. But a growing body of empirical work shows they’re not. In fact, the way we make causal claims depends a lot on how things normally happen and on how we think they should happen.

via Using Science To Blame Mothers : 13.7: Cosmos And Culture : NPR.

This in turn reminded me of my own past post about asking the right questions, which I shared on a friend’s Facebook page in response to all of the recent media attention being paid to newly developed date rape drug detecting nail polish.

We MUST look at the larger system when we ask our questions. The fact that we even have to teach birth classes and to help women learn how to navigate the hospital system and to assert their rights to evidence-based care, indicates serious issues that go way beyond the individual. When we say things about women making informed choices or make statements like, “well, it’s her birth” or “it’s not my birth, it’s not my birth,” or wonder why she went to “that doctor” or “that hospital,” we are becoming blind to the sociocultural context in which those birth “choices” are embedded. When we teach women to ask their doctors about maintaining freedom of movement in labor or when we tell them to stay home as long as possible, we are, in a very real sense, endorsing, or at least acquiescing to these conditions in the first place. This isn’t changing the world for women, it is only softening the impact of a broken and oftentimes abusive system…”

Asking the right questions… | Talk Birth.

And, while not completely related to the topics at hand in today’s post, but absolutely relating to quality mother care, I wanted to share a link to a fundraising project from my doula, Summer:

Who's <br />
Your <br />
Doula?

“…Smyth comments that ‘the role of mother is not immediately intelligible to those who find themselves inhabiting it’ p. 4. This is certainly borne out in the confessional writing and memoirs of young feminist women, who try to make sense of their experiences as a new mother. They write of a crisis of selfhood, feeling undifferentiated in ‘a primordial soup of femaleness’ Wolf 2001 and of experiencing a gendered, embodied and relational self for the first time Stephens 2012…”

via Tuesday Tidbits: Story Power | Talk Birth.

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Tuesday Tidbits: Human Rights and Birth

“It takes force, mighty force, to restrain an instinctual animal in the moment of performing a bodily function, especially birth. Have we successfully used intellectual fear to overpower the instinctual fear of a birthing human, so she will now submit to actions that otherwise would make her bite and kick and run for the hills?”

–Sister Morningstar (in Midwifery Today)

486253_470181139659475_1370955888_nWhen I end my introduction to human services class and then again when I begin my social policy class, I ask my students to consider the above: What would happen if everyone cared? What would happen if our first reaction was compassion? What would happen if we focused on what matters? What would happen if we assumed everyone had inherent worth and value and deserves humane care and compassion?

I have said for a long time that women’s rights in birth represent a human rights issue, so I was very interested to receive word of a Human 10360685_10152979214427627_4161278366266845515_nRights in Childbirth campaign:

Women do not lose their basic human rights once they become pregnant. And yet, across the globe, women’s human rights are compromised and violated around childbirth. Examinations, interventions and procedures that pose risks to both mothers and their babies are routinely performed without informed consent, or through coerced compliance via threats or fear. When women come out of childbirth with post-partum PTSD from disrespect, abuse, or obstetric violence, the goal of a “healthy mother and healthy baby” has not been met.

via Home | Human Rights in Childbirth.

Childbirth IS a women’s rights issue and a reproductive issue:

Childbirth is a women’s rights issue and a reproductive justice issue. The United States maternity system is one of the costliest in the developed world, yet our birth outcomes compare poorly to those of other industrialized nations. Among industrialized countries, we consistently rank last or second to last in perinatal and maternal mortality rates. Moreover, birth is depicted in mainstream media with fear, medical intervention, and crisis…

via Business of Being Born: Classroom Edition | Talk Birth.

But, childbirth is also, quite simply, a human issue:

This is the whole point—women’s rights aren’t about “taking” rights from anyone else OR about demanding “special treatment,” they are important for a HUMANE WORLD for all people. I think it is hilariously awful that “women’s rights” are considered a political issue and that there is a section about “women’s rights” in the “opposing viewpoints” database for my social policy class. As long as women’s rights are considered a political issue or as something about which an opposing viewpoint can be held, rather than as self-evident, we are in continued, desperate need of revolution.

via Women’s Power & Self-Authority | Talk Birth.

Human rights in childbirth include access to the provider of one’s own free choice, so on a related note check out this set of consumer-oriented materials about the midwives model of care offered by collaborative effort of several midwifery organizations and endorsed by several others:

“Normal Healthy Childbirth for Women & Families: What You Need to Know” clearly explains and advocates the benefits of normal, physiologic birth for the average health care consumer. This helpful tool was created from a 2012 consensus statement developed by ACNM, the Midwives Alliance of North America, and the National Association of Certified Professional Midwives.

via OMOT Normal Birth Document Feature Page.

The below quote may seem obvious to birth advocates, but it is revolutionary in terms of health care. When Citizens for Midwifery shared this quote, they noted that, “One the KEY findings of the Lancet Special Series on Midwifery affirms the importance of women and their families participating in planning of health care.” For more from this special series on midwifery, go here: TheLancet.com.

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And, in case we get so caught up in theorizing about appropriate care that we forget the lived experiences of the women who need it, read this tough, sobering article about why “going in pushing” does not a VBAC birth plan make:

Karen’s story is not uncommon and nor is the advice she was given about “going in pushing” but when we tell women they can not be cut unless they consent are we telling the truth? Whilst it’s true that legally the hospital can not physically force you into an operating theatre without your consent, they are not afraid to gain consent using underhand methods…

via Go In Pushing – It’s not a VBAC Birth Plan – Whole Woman.

And, of course, some relevant quotes to remember:

“If women lose the right to say where and how they birth their children, then they will have lost something that is as dear to life as breathing.” –Ami McKay

“Mothers need to know that their care and their choices won’t be compromised by birth politics.” – Jennifer Rosenberg

via As dear as breathing… | Talk Birth.

Is there anything that can be done, or are we facing an insurmountable struggle? I think we can remember that our “small stone” birth activism does matter:

While reading the book The Mother Trip by Ariel Gore, I came across this quote from civil rights activist Alice Walker: “It has become a common feeling, I believe, as we have watched our heroes failing over the years, that our own small stone of activism, which might not seem to measure up to the rugged boulders of heroism we have so admired, is a paltry offering toward the building of an edifice of hope. Many who believe this choose to withhold their offerings out of shame. This is the tragedy of our world.” Ariel adds her own thoughts to this: “Remember: as women, as mothers, we cannot not work. Put aside your ideas that your work should be something different or grander than it is. In each area of your life—in work, art, child-rearing, gardening, friendships, politics, love, and spirituality—do what you can do. That’s enough. Your small stone is enough.”

These quotes caused me to reflect on the myriad methods of “small stone” birth activism that can be engaged in as a passionate birth activist mother embroiled in a season of her life in which the needs of her own young family take precedence over “changing the world”…

via Small Stone Birth Activism | Talk Birth.

And, on a fun note, you might enjoy this lovely homebirth treasury on etsy: Home Birth by Kayleigh on Etsy. 🙂

“Thousands of women today have had their babies born under modern humanitarian conditions–they are the first to disclaim any knowledge of the beauties of childbirth…” –Grantly Dick Read, Childbirth without Fear

“I am not free while any woman is unfree, even when her shackles are very different from my own.” –Audre Lorde

“Humanizing birth means understanding that the woman giving birth is a human being, not a machine and not just a container for making babies. Showing women—half of all people—that they are inferior and inadequate by taking away their power to give birth is a tragedy for all society.” –Marsden Wagner

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Press Release: New Crowdfunding Campaign Helps Those Grieving Pregnancy And Infant Loss

(Guest post)Baby in My Heart Pendant (pewter, babyloss, miscarriage, stillbirth).

Press Release: New Crowdfunding Campaign Helps Those Grieving Pregnancy And Infant Loss

View PDF Version: http://goo.gl/9cQRKy

Reconceiving Loss, an online resource center for pregnancy and infant loss and healing is working to develop a digital archive to document the experience of loss from miscarriage through to neonatal death. The project is being put together in partnership with the film Return To Zero, starring Minnie Driver (in July 2014 Minnie was nominated for Emmy as the best actress in this film).

The genesis of the project was the stillbirth of the co-founder’s second child in 2005.  1 in 4 pregnancies end in miscarriage. 1 in 160 children are stillborn, and 25,000 die within thirty days of their birth in the US alone. As Co-Founder Tara Shafer explains, “We were fortunate to be able to access resources that helped us navigate this bewildering and lonely loss. Many families are not as fortunate.”

Reconceiving Loss (http://reconceivingloss.com/about-us) invites individuals to participate in a public project to document pregnancy and infant loss. Anyone who has suffered the fear, guilt, loneliness and trauma of losing a child either in the womb or stillborn knows how far-reaching the psychological impact can be. This is a chance to heal through telling your story. Your participation both as a reader and creator is crucial for others.  Reconceiving Loss has a number of digital resources to support healing from baby loss.  With a goal of just $10,000 USD all donations will help them to provide supportive tools to individuals as they work to develop their own healing narrative. “We hope that in building this archive (growing, publicizing, curating) we will also be able to develop additional supportive materials so that people who participate can receive high levels of care and support as they work through traumatic events.”, explains Shafer.

Speaking in such a public way about something that is almost never discussed and considered ‘socially taboo’ shifts the way in which July 2014 157individuals, and families address and understand those who have experienced baby loss.  This crowd sourced Indiegogo campaign is a meaningful and healing way to show support and solidarity anyone impacted (husbands, siblings, and mothers). Donations of any size are welcome and rewards include books, DVDs and even tea.  The first 25 people to donate $50 will receive a copy of graphic novel, “Goodbye, Au Revoir, and Slan.” This novel describes the experience of stillbirth through the eyes of a young sibling. For $100 you can get the Return to Zero DVD complete with all bonus materials. This DVD features an extra on the Reconceiving Loss digital archive. Help break the silence and enable everyone to connect through their shared loss.

This project is making a difference for those following a difficult path. “The long-term psychological impact is profound and is still not talked about. …Since we launched the archive, we have received submissions from people who suffered loss decades ago. They have carried it with them in silence they have longed to break.”This project will help many individuals to share their own stories while learning about others. Donate what you can and help break the silence.  The biggest perk of all is knowing that you are helping many people now and in the future. Even if you can’t donate – share the links widely. See the links below for more information.

Reconceiving Loss Indiegogo Campaign

For more on this topic check out the articles by Reconceiving Loss Co-Founder Tara Shafer in Psychology Today (Begin Again) and in the Huffington Post
For more information on this press release visit:
http://www.getnews.info/new-crowdfunding-campaign-helps-those-grieving-pregnancy-and-infant-loss_5274.html

Media Contact
Company Name:
 Reconceiving Loss
Contact Person: Tara Shafer
Email: tarashafer1@gmail.com
Country: United States
Website: https://www.indiegogo.com/projects/reconceiving-loss-archive-documenting-loss

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Tuesday Tidbits: Miscarriage

In the book A Silent Sorrow, the authors quote a responsive reading from the book Bittersweet…hellogoodbye (a book for creating memorial services for miscarried or stillborn babies). The responsive part of the reading from the other people assembled can be unique to your own spiritual path, so “Be with us [divinity name]” or “Hear us, [divinity name]” or ‘[divinity name] grant us healing and strength. Personally, I would simply leave off any divinity name and use plain old “Hear us” or “grant us healing and strength,” because then each person present is able to attach whatever additional meaning to the words they prefer, rather than having it represent any sort of specific belief.

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Some “seconds” of our baby in my heart design were added to our etsy shop this month.

Leader:

For the time of unending tears, pain, and struggle;

times of not being understood by family, friends,

times of longing and emptiness,

times of not being in control,

times of searching within and without.

We pray…

(response)

Leader:

For all the memories of our baby;

for any brief moment of being with our baby,

for those who walked the journey of mourning with us,

for each time of remembering.

We pray…

(response)

Leader:

For the times of letting go.,

for the times of reaching out,

for each new day and each ray of hope,

for the gifts our baby left us:

in giving us new eyes with which to see,

new ears to help us hear others,

a new heart to love more deeply,

and for new values in our lives.

We pray…

(response)

[p. 233]

I’m also letting go of the book Avoiding Miscarriage by Susan Rousselot (see previous post for bookshelf reduction currently in progress). In it, she acknowledges the depth of the experience of miscarriage:

A miscarriage is, by its nature, a life-changing event. From the moment a woman knows she is pregnant, she wonders how that pregnancy with change her life—she imagine the future with that child. How will this impact my work? What changes will need to be made to the house? And what sort of mother will I be?… That unborn child can turn out to be anything, and because of that it is a dream of the future. When that dream is shattered, we don’t just lose a few weeks or months of pregnancy; we don’t even just lose a ‘fetus’ or a ‘baby.’ It is as though we lose a whole lifetime—the lifetime we were going to share with that child. We didn’t mean for the idea to take on such huge proportions, but it did because we are human, and as humans we think about the future, and we wonder.

Like any traumatic event, there is no ‘right way’ to deal with a pregnancy loss. Some women will grieve as intensely as they would the loss of a full-term birth. Others will feel they are doing okay. Some women will react by resolving to take life less for granted. Others may harbor a lingering distrust of their own bodies. Some women may want to take a long time to grieve. Others may want to put the experience behind them by redoubling the pace of their lives…

…Many women who experience a miscarriage feel a powerlessness stemming from the fact that they couldn’t control what was happening inside their own bodies. This feeling is often exacerbated by the good, but often misplaced, intentions, of doctors or others who take charge of the miscarriage—or dismiss it—in an attempt to spare the woman further distress. (p. 67-68)

Regarding the use of the word “worse” in categorizing grief and loss, I shared with a friend recently that one of the things I learned from my own losses and working with other mothers through the organization I co-founded (The Amethyst Network), is that there is no hierarchy of loss and grief. They are all real. They are all valid. There is no prize for the worst experience. And, we can hold the experiences and feelings of each as valid without needing to categorize by who had it worse. Each is hard and “worst” in its own way. It is okay to let the pain hurt and to take as long as you need.

Last week I read this very raw and real miscarriage story and shared the link on TAN’s Facebook page:

“As glad as you were to tell who you told about the pregnancy, you are exactly a hundred thousand times as unglad to bear this news. You call your boss first, because the primary impact on your immediate life is that you will need to be off work for at least a couple of weeks. This is what they call a “missed miscarriage,” where the fetus lived to perhaps eight or nine weeks of gestation, but your body stayed pregnant all the same, put you through that nightmare of sickness and stress for nothing. Less than nothing. That anger comes a little later, not just yet. In any event, you won’t be back at your desk until the material of the pregnancy is gone, one way or another…”

How to Have a Miscarriage | The Hairpin

And, I received an announcement of a new book from a woman who previously emailed me to talk about my own miscarriage memoir. I look forward to reviewing her book soon.

At 33 weeks pregnant, Amy is certain something bad will soon happen, it had too many times before. Deep down she fears it’s only a matter of time before the baby she’s carrying will die. Despite the fact that Amy had been repeatedly slapped in the face with multiple miscarriages, she still can’t seem to quiet that tiny voice in the back of her head that’s screaming at her to not give up hope. Follow Amy’s true story as she stumbles through her journey with humor and warmth, all while dealing with the neuroses that came along with getting her hopes shattered time and time again. All she has to do is close her eyes and she’s lurched back to the memories of her losses; on the floor in her bathroom, in the hospital, and even at her place of work. No one knows what the internal mind of a woman who’d lost five babies and suffered so many let downs goes through. Can Hope ever truly survive memories such as these?

Chasing Hope: A Mother’s Story of Loss, Heartbreak and the Miracle of Hope

Last week, we decided to design some new European charm bracelets to honor the experience of babyloss, whether through miscarriage, stillbirth, or infant death. Half of the profits from these bracelets will be donated towards a scholarship to help a local bereaved mother attend Stillbirthday’s Love Wildly event in Kansas City in December.

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“Miscarriage is a death in the heart of life, a death that happens inside the body of a woman. Sometimes a child just brushes the earth lightly, and is gone before the embryo is anything more than a few cells. Even so, there may already have been a strong connection, love, the beginning of hopes and dreams for the child. Later in a pregnancy, when the being has made itself known through kicks and a visible bump, a whole community may have already begun to make a place for it. Whenever a miscarriage happens, it is a loss that cuts deeply, and needs to be grieved…” –Jackie Singer (Birthrites)

via Birthrites: Miscarriage | Talk Birth.

Guest Post: Pelvic Exams Need Rethinking

June 2014 045I almost never reprint any of the random articles, press releases, and news tidbits that find their way to my email address. However, this one was too interested to skim past. Conclusion: The pelvic exam has been a standard part of a woman’s annual checkup for decades — yet it serves no clear purpose and may do more harm than good.

Considering that I’ve written about Pelvic Exams I Have Known (watch for my eventual stand-up routine, 😉 ), I found this very interesting…

UC SAN FRANCISCO
Jennifer O’Brien, Assistant Vice Chancellor/Public Affairs
Source: Elizabeth Fernandez (415) 502-6397 (NEWS)
Web: www.ucsf.edu
Twitter: @EFernandezUCSF

TO COINCIDE WITH PUBLICATION IN ANNALS OF INTERNAL MEDICINE

UCSF Commentary: Pelvic Exams Need Rethinking

The pelvic exam has been a standard part of a woman’s annual checkup for decades — yet it serves no clear purpose and may do more harm than good.

That’s the conclusion of a new guideline by the American College of Physicians (ACP) based on a review of scientific literature spanning more than 60 years. In an article to be published July 1, 2014 in the ACP’s flagship journal, Annals of Internal Medicine, the national organization of internists strongly recommends against pelvic examinations for adult women who are not pregnant and show no signs of disease.

In issuing the new guideline, the nation’s largest medical-specialty organization contends that pelvic exams rarely detect “important disease” or reduce mortality. Under the new guideline, the ACP advises that pelvic exams are appropriate for women with symptoms such as vaginal discharge, abnormal bleeding, pain, urinary problems, or sexual dysfunction.

The recommendation is expected to be controversial, according to an accompanying editorial by George F. Sawaya, MD, a UC San Francisco professor of obstetrics, gynecology and reproductive sciences, and epidemiology and biostatistics; and Vanessa Jacoby, MD, a UCSF assistant professor of obstetrics, gynecology and reproductive sciences.

“The recommendation is based on a systematic review that found no data in support of the examination but did find evidence of harms ranging from distress to unnecessary surgery,” they wrote in the commentary.

Sawaya and Jacoby point out that tens of millions of pelvic exams are performed annually at well-woman checkups in the United States but whether the exams actually benefit asymptomatic women has largely been unstudied. To help fill the void, surveys recently have sought to establish the goal of clinicians in performing the exams: some physicians contend the exams help detect benign uterine and ovarian lesions while others mistakenly say they effectively screen for ovarian cancer, noted Sawaya and Jacoby.

The editorial called into question the nature of the medical literature review by the ACP because some of the research analyzed focused on older women and failed to evaluate “the most important goal of the pelvic examination cited by obstetrician-gynecologists – detecting noncancerous masses.”

“Thus, it is reasonable to disagree with using these findings to recommend a major change in clinical practice for women of all ages attending well-woman visits,” Sawaya and Jacoby wrote in their editorial. “Many will ask ‘Have all of the pertinent clinical questions been addressed?’”

“Deciding when evidence is sufficient to conclude that an intervention should be promoted, discontinued, or submitted to further study is challenging,” they continued. “The determination relies largely on judgment about evidence quality and the likelihood that more evidence will tip the balance in making either a favorable or an unfavorable recommendation.”

Numerous routine screenings, including mammograms and prostate tests, are being reevaluated for their medical and financial value.

In their commentary, the UCSF authors stress that whether or not the new guideline actually changes current practice, it could lead to a better evaluation of the benefits and harms of pelvic exams.

“The pelvic examination has held a prominent place in women’s health for many decades and has become more of a ritual than an evidence-based practice,” said the authors.  “With the current state of evidence, clinicians who continue to offer the examination should at least be cognizant of the uncertainty of benefit and the potential to cause harm through a positive test result and the cascade of events that follow.”

UCSF is the nation’s leading university exclusively focused on health. Now celebrating the 150th anniversary of its founding as a medical college, UCSF is dedicated to transforming health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. It includes top-ranked graduate schools of dentistry, medicine, nursing and pharmacy; a graduate division with world-renowned programs in the biological sciences, a preeminent biomedical research enterprise and two top-tier hospitals, UCSF Medical Center and UCSF Benioff Children’s Hospital San Francisco. Please visit www.ucsf.edu.

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The WHO Code: Why Should We Care?

“Knowledge serves no purpose if it is not spread around. As the poor get poorer and the rich get richer, an entrenched ignorance is kept in place through a culture created and maintained by commercial interests.” – Gabrielle Palmer, The Politics of Breastfeeding

The international WHO Code of marketing breastmilk substitutes reached its 33rd anniversary this week. This means that for 33 years the United States has failed to live up to international standards AND for 33 years infant formula corporations have successfully ignored the WHO Code. In addition, they have convinced over half of U.S. hospitals to serve as marketing shills for their products—distributing their marketing materials—-samples, coupons, booklets, and other ads-—in health care settings in a manner that is well-established to undermine women’s breastfeeding success and to have a negative impact on infant health. Quite simply, getting breastfeeding “advice” from a formula company in a form of a cute little booklet with a happy baby on the front is like getting nutrition “advice” from McDonald’s. It is not neutral or benign and it does not have the interests of mom and baby at heart, it is a skillful marketing tactic, nothing else. I have long repeated the Ban the Bags catchphrase: Doctors’ offices and hospitals should market health and nothing else. To be clear, I would consider all medication-sponsored posters, etc. to fall in same category, not just formula. Refusing to honor the WHO Code isn’t actually illegal, however. The US voted against the proposal in the first place—on the original signing of the Code there were 118 votes for the Code, one against (the United States!), and 3 abstentions. Eventually more than 160 countries participated in the WHO Code. When the United States did accept it, they adopted it as guidelines to distribute to large manufacturers. Providers should follow it, but they can actually can do what they want. UNICEF has a state of the code chart that breaks down which country does what with the Code. US is under the no action category along with a small handful of other countries that includes Somalia and Kazakhstan.

This issue is a systemic problem and it goes WAY beyond just the individual mom and her baby!  Breastfeeding or not breastfeeding is actually a political and public health issue in the US, not simply a “personal choice.” Personal choice is the language American people and formula manufacturers love to use and it is a very, very successful manner of appealing the individualist nature of our culture, but in this case it is actually code for, “let huge multibillion dollar corporations exploit women at will and our health care providers will even help them do it!

While the WHO code has no legal teeth in the US (it IS law in some other countries, but it was written in terms that allow national governments to make their own decisions about how/if to enforce or participate in it). It is still VERY important for health care providers and US distributors and marketers to be aware that their actions are out of sync with international guidelines and that they are in violation of international standards.

…breastfeeding, like all aspects of women’s lives, occurs in a context, a context that involves a variety of “circles of support” or lack thereof. Women don’t “fail” at breastfeeding because of personal flaws, society fails breastfeeding women and their babies every day through things like minimal maternity leave, no pumping rooms in workplaces, formula advertising and “gifts” in hospitals, formula company sponsorship of research and materials for doctors, the sexualization of breasts and objectification of women’s bodies, and so on and so forth. According to Milk, Money, and Madness (1995), “…infant formula sales comprise up to 50% of the total profits of Abbott Labs, an enormous pharmaceutical concern.” (p. 164) And the US government is the largest buyer of formula, paying for approximately 50% of all formula sold in the nation…

via Breastfeeding as an Ecofeminist Issue | Talk Birth.

These past posts take a look at the systemic context surrounding breastfeeding women and how it impacts their “personal choices.” January 2014 041

Breastfeeding as an Ecofeminist Issue

Preventing Culturally Induced Lactation Failure

A Bias Toward Breastfeeding?

Tuesday Tidbits: Breastfeeding Research

Wednesday Tidbits: World Breastfeeding Week!

Controversies in Breastfeeding

The Impact of Birth on Breastfeeding

 

 

Breastfeeding as an Ecofeminist Issue: Collage Project

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Since January I’ve been working with an independent study student from Prescott College on a self-designed course called Breastfeeding and Ecofeminism. Her class ended this month and her final project was a collage making the connection between the world body and the female body and reflecting the idea that how we treat women and their bodies as a culture is mirrored by our global treatment of the planet (and, conversely, if we change how women’s bodies our treated, our treatment of the planet will also change). As she worked on her collage, she also made a series of digital collage images for use on social media (see above), using quotes from her reading for the course.

“Governments and commercial companies will ‘invest’ billions in expensive new technology: roads, bridges, airports, dams or power generation plants, ‘for the good of society’. They may even ‘invest’ in schools and hospitals, but the crucial primary investment in the emotional, physical and mental health of all humans, which breastfeeding and mothering provide, is invisible.”

Gabrielle Palmer (The Politics of Breastfeeding, p. 333)

As my student remarked, this is an atrocity. AND, it is one that is largely “invisible” to the average person.

I also find this quote relevant from The Politics of Women’s Spirituality:

“Human life is valuable and sacred when it is the freely given gift of the Mother—through the human mother. To bear new life is a grave responsibility, requiring a deep commitment—one which no one can force on another. To coerce a woman by force or fear or guilt or law or economic pressure to bear an unwanted child is the height of immorality…If they were genuinely concerned with life, they would be protesting the spraying of our forests and fields with pesticides known to cause birth defects. They would be working to shut down nuclear power plants and dismantle nuclear weapons, to avert the threat of widespread genetic damage which may plague wanted children for generations to come…” (p. 420).

For one of her digital images, she chose one of my favorite quotes from Reweaving the World in an article that touches on birth as an ecofeminist issue:

Here are some photos of her final collage project:

photo 1 photo 5 photo 3

“Knowledge serves no purpose if it is not spread around. As the poor get poorer and the rich get richer, an entrenched ignorance is kept in place through a culture created and maintained by commercial interests.” – Gabrielle Palmer, The Politics of Breastfeeding

International Day of the Midwife!

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International Day of the Midwife is today and Virtual International Day of the Midwife has a free online conference! The lineup of presentations is really rich. Check it out here

In celebration of this day, we’re offering a 10% off code good for use on any of the items in our etsy shop! Use 2014SPRING10OFF. 🙂

“It’s hard to describe if you’ve never been there, but to watch a woman access her full power as a woman to give birth is awe-inspiring, and I never get tired of being witness to it. It’s an honor to watch that transformation take place.” ~ Julie Bates, CNM

I’ve been blessed with care, love, and attention from midwives for many years. They’re irreplaceable and the model of care cannot be beat.

Here is a quote I shared on Facebook yesterday from midwifery legend, Ina May Gaskin:

10150680_850255348324885_8097255052427107934_nAt the end of April, Marsden Wagner passed away. An OB and outspoken birth rights activist as well as author of Born in the USA and participant in many documentary films about maternity care, Wagner was an incredible asset to birthing women and midwifery in the U.S. He will be missed.

“Humanizing birth means understanding that the woman giving birth is a human being, not a machine and not just a container for making babies. Showing women—half of all people—that they are inferior and inadequate by taking away their power to give birth is a tragedy for all society.” –Marsden Wagner, MD

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