Talk Books: Pregnancy, Childbirth, and the Newborn

Mar29

Several months ago, I received an email from one of my former college students. His wife was newly pregnant and they had several specific questions. They asked for my help and recommendations with where to go for answers and without hesitation, I suggested a book: Pregnancy, Childbirth, and the Newborn. I was confident that not only would they find the answers they sought in the book, but also reliable, practical, helpful answers to questions they haven’t even thought to ask yet.

Co-authored by a foremost authority in childbirth and doula education, Penny Simkin, Pregnancy, Childbirth, and the Newborn was one of the first books I bought as a new childbirth educator in 2005. Now, newly revised and updated, the book has a companion website packed with resources to help you have a healthy pregnancy, a rewarding birth, and a nurturing postpartum.

One of the things I’ve always enjoyed about this book as a wonderful resource for childbirth educators are the line March 2016 119 drawings illustrating a variety of positions and concepts. This new fifth edition has lots of black and white photos as well. The fact that the book is co-authored by a world-renowned doula, a nurse/lactation consultant, a nurse/childbirth educator, a social worker, and a physical therapist, means it is an interdisciplinary resource benefiting from the skills and professional experience of each co-author. Childbirth educators and doulas as well as pregnant couples will want to check out the companion website which has a plethora of pdf handouts available on numerous topics including comfort techniques, nutrition, and parental leave.

Evidence-based, comprehensive, and encouraging, Pregnancy, Childbirth, and the Newborn is an ideal companion for both childbirth professionals and expectant parents.

—

Pregnancy, Childbirth, and Newborn is published by Meadowbrook Press, an award-winning publisher specializing in pregnancy & childbirth, baby names, parenting & childcare, and children’s books & poetry: Meadowbrook Press. Pregnancy, Childbirth, and the Newborn

Disclosure: I received a complimentary advance copy of this book for review purposes.

Tuesday Tidbits: Breastfeeding Wisdom & Social Context

Feb9

Like all of life, breastfeeding occurs in a context. While it is easy to simplify it down to a matter of “personal choice,” the issue is really much broader than that and people often overlook the powerful influence of the systems surrounding them on the accomplishment of women’s breastfeeding goals.

This article takes an in-depth look at why breastfeeding, and the benefits of breastfeeding, don’t need to be “debunked” or have a “case” made against them. (My only critique of the article is that it falls into the comfortable default of “formula as the norm,” by saying things about how babies that breastfeed have a health advantage. Actually, they don’t. What they have is a normal species-appropriate immune system developed in direct response to a diet of species-specific milk.) It is a long read and covers a lot of important ground so settle in…

What the World Health Organization, the American Academy of Pediatrics, and many other organizations failed for too long to note, however, is how difficult breastfeeding can be. Yes, they showed the world how beneficial breastfeeding was, and, yes, they helped design policy to ease the transition back to work. But the messy, exhausted moments that change a mother’s mind about breastfeeding? The bleeding nipples, the crying baby, and the paralyzing fear that the baby’s not eating enough? The back-to-work struggle and the boyfriend who thinks breastfeeding is dirty?

Those were, for a long time, left out of the breastfeeding conversation beyond a cursory, “Yes, it will be hard, but it will be worth it.” It’s this difficulty, and the fact that it remains unaddressed in many ways, that drives so many women to start supplementing with formula or to stop nursing altogether.

The most frequently cited challenges associated with breastfeeding include pain, supply issues, work-related pumping issues, and lack of support.

Source: The case for breastfeeding: what skeptics miss when they call it overrated – Vox

Luckily, breastfeeding also develops species-appropriate cranial development, jaw structure, and facial development. This also in-depth article looks at how the motions of breastfeeding shape and develop the skull and jaw muscles for life (at the end it also has some interesting comparisons of the shape of infant skulls after chiropractic adjustment soon after birth). Again, it uses language that implies breastfed babies receive a “benefit” in this area, while in reality breastfed babies simply have normal craniofacial development.

THE IMPORTANCE OF BREASTFEEDING – A Craniopathic Perspective | Speaking With Major

When we swing too far towards the science of breastfeeding though, we overlook the intense emotional impact of new parenting and the widespread lack of sociocultural support for healthy parenting, especially parent-baby togetherness. This is the context in which breastfeeding occurs and it is often one that actively or passively sabotages the breastfeeding pair. This mother writes heart-wrenchingly, and all too familiarly, about her postpartum experience:

I have many days when I feel truly well, and I have other days when I wonder if I’m still climbing. But in the meantime, I’m living life, I’m enjoying lots of moments and not enjoying others and learning to be fine with that. Because when well-meaning people tell you to “enjoy every moment” they are setting an unrealistic goal for any parent. Many aspects of parenthood are simply not enjoyable. Instead, I focus on feeling every moment, good and bad. If I feel afraid, that’s okay, I just sit with it and let it pass. If I feel sad, I allow myself to cry. And if I feel happy I clutch that joy to my chest and absorb it into my soul, and try to keep it safe forever.

Source: I Can’t Enjoy Every Moment – Postpartum Progress

Another powerful systemic variable is our national workplace culture and the lack of reasonable parental leave:

When it comes to women and work, the largest myth of all is that working is somehow optional. Like men, women work for personal fulfillment and a passion for their job. Also like men, women work to support themselves and their families, and always have. The reality in the United States today is that earning money is an absolute necessity for the vast majority of women. And the sad truth is that we aren’t doing anything to support them or their families — not because we can’t, but because we won’t.

Source: We act as if work is optional for women. It’s not. – The Washington Post

I often feel puzzled and angry with myself about why I can’t do everything in one day. “Is it really so much to ask?” I say, waking each morning with the optimistic faith that during that day I should surely be able to eat adequate food, exercise, play with my kids, spend time writing/reading/personally enjoying something, work on my many projects, and go to bed/wake up at a decent hour every day. Unfortunately, it apparently is too much and the most we can hope for is to “pick three”:

This sounds harsh, but it’s true, according to a recent interview with Storenvy founder Jon Crawford on Founder Dating. “Work, sleep, family, fitness, or friends–pick three. It’s true. In order to kick ass and do big things, I think you have to be imbalanced. I’m sure there are exceptions, but every person I’ve seen riding on a rocket ship was imbalanced while that rocket ship was being built. You have to decide if you want it,” Crawford declares.

Source: Work, Sleep, Family, Fitness, or Friends: Pick 3 | Inc.com

And, while picking three, things slip away. As I’ve written before, my daughter fell asleep with her head on my arm every night for nearly four solid years until Tanner was born. Now, her opportunity to fall asleep on my arm is hit or miss, depending on whether my arm is occupied with him, and increasingly, even when I do wiggle an arm free for her, she only lies on it for a few minutes before she says, “I’m going to lay in my own bed now,” where she then lies, snuggling her pile of pandas, until she falls asleep.

…I tried.

I tried to capture her smallness. I tried to hold on to the last breaths of her babyhood. But try as I might, it has slipped right out of my grasp. Despite my efforts to slow down and enjoy every moment since everyone told me it goes so fast… all I have left are memories and photographs.

But it doesn’t mean that I can re-live it. Not really. Some of my favorite memories of her as an infant will always be of bedsharing. She always started the night in her own bed, but after her first wake-up of the night, I’d scoop her out of her room and bring her into our cozy nest to feed her and quickly soothe her back to sleep. And for the most part that meant that we all got more sleep… except for the times I’d find myself staring at her while she slept. I’d watch her tiny chest move up and down, and memorize every little detail of her perfect little face. I’d think to myself this is crazy, what are you doing, go to sleep. But those memories, in the dead of night, the ones where there aren’t any pictures – are the clearest in my mind’s eye.

Source: The Beauty In Bedsharing | The best season of my life

This nighttime savoring may also be due to actual addiction to baby-head-sniffing…

Most of the women struggled to pinpoint the baby smell, although they generally said it was a pleasant one. Their brains, however, told a different story. When sniffing the baby pajamas, the dopamine pathways in a region of the brain associated with reward learning lit up, LiveScience reports. Other odors, like those of delicious foods, trigger this pathway, and the same dopamine surge is also associated with satiating sexual and drug-addiction cravings. This mechanism influences us by triggering “the motivation to act in a certain way because of the pleasure associated with a given behavior,” Medical Xpress writes.

Source: The Smell of Newborn Babies Triggers the Same Reward Centers as Drugs | Smart News | Smithsonian

Other related posts:

Tuesday Tidbits: Waterbirth & Healthy Babies

Jan26

“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)

via Tuesday Tidbits: Human Rights and Birth | Talk Birth

Tanner, our last baby, was my first waterbirth. I didn’t really consider water for my first baby. I did for the second and had a birth pool and supplies on hand, but he was born so quickly we had no time to use it. Alaina was born in the deep winter, so water didn’t appeal to me at all and I never considered having a waterbirth with her. With Tanner’s pregnancy, I was interested in trying things I’d never done before. I’d also read that water helps reduce or prevent tears and I really, really, really wanted to avoid tearing again and I thought it would be my last chance to try water and see if helped. He was born in the water and I did tear. I have no regrets about having opted for water with him, other than wishing I would have been able to get out of the pool a little earlier since he got pretty chilled from it. (In case you missed it: his birth story and birth video.)

So, I was interested to read this article about the safety of waterbirth. The conclusion was that water birth is safe, but that women actually had a higher, not lower, chance of tearing…

The findings revealed babies born in water, as well as their mothers, were no more likely to require a transfer or admission to a hospital. Moreover, the babies born in water did not receive a low Apgar score. This quick test is performed on a baby one minute after birth in order to determine how well the baby tolerated the birth, and five minutes after birth to tell doctors how well the baby is doing outside the womb.

Despite the positive, the researchers did find an 11 percent increase in perineal tearing, or vaginal tears among mothers who gave birth in water…

Source: Pregnancy And Water Birth: Giving Birth In Water Tub Poses No Risk To Mom Or Baby, Says Study

A commonly asked question about waterbirth is whether or not water slows down water (the consensus is that it often can if the woman gets in the birth pool “too soon”):

A woman should be encouraged to use the labor pool whenever she wants. However, if a mother chooses to get into the water in early labor, before her contractions are strong and close together, the water may relax her enough to slow or stop labor altogether. That is why some practitioners limit the use of the pool until labor patterns are established and the cervix is dilated to at least 5 centimeters.

Source: Does Water Slow Down Labor? | Talk Birth

I was 35 when Tanner was born, technically of “advanced maternal age.” Luckily, new research also indicated that us “advanced” types have a higher chance of living to “extreme old age” (maybe that should be “advanced, old age”?)

A Boston University School of Medicine study found that women who can still give birth naturally after age 33 have a higher chance of living to extreme old age than those who had their last child before age 30. But the report, published in the online version of the journal Menopause in April 2014 doesn’t imply that putting off pregnancy will add years to your life. “If you physically delay having children, that’s not going to help with longevity, Paola Sebastiani, a Boston University biostatistics professor and study co-author, told OZY. A woman with a natural ability to have children later in life suggests that her body – including her reproductive system – just happens to age at a slow pace. Some women’s biological clocks simply tick more slowly than most.

Source: Late Kids, Long Life? | Acumen | OZY

And, switching gears slightly, I enjoyed this post about that “a healthy baby is all that matters” refrain, that, while seemingly sensible on the surface, is actually an insidious phrase used to shut down women’s voices and deny their completely legitimate right to humane care in pregnancy and birth:

When a woman gives birth, a healthy baby is absolutely completely and utterly the most important thing. Got that? OK – do not adjust your wig, there’s more… It is not ALL that matters. Two things – just to repeat: a healthy baby is the most important thing, AND it is not all that matters. Women matter too. When we tell women that a healthy baby is all that matters we often silence them. We say, or at least we very strongly imply, that their feelings do not matter, and that even though the birth may have left them feeling hurt, shocked or even violated, they should not complain because their baby is healthy and this is the only important thing.

Source: A healthy baby is not ALL that matters – The Positive Birth Movement

This reminds me of the “birth and apples…” example I’ve used in teaching and activism for a long time:

It is not helpful because the expectation was not to not have a healthy baby–the expectation was to have a vaginal birth. It is comparing apples to oranges since there were two separate individual hopes: one the joy of a baby, the other her experience of bringing that baby into the world. The apple being the healthy baby we all want and usually bear, the orange being what we hope for in our trials and tribulations on the way there…

Source: Birth & Apples | Talk Birth

And, it also makes me remember that your baby’s birth is the beginning of a fresh new, lifelong relationship, one worthy of being treated with dignity and respect and honored as an important rite of passage. I explored a relational analogy in one of my most popular past posts…

You ask when the ceremony can begin and the clerk tells you not until your fiancé’s heart rate has been monitored for twenty minutes—“We need a baseline strip on him, hon. After all, you do want a healthy husband out of all this, don’t you?!” she says. You are asked to change out of your wedding gown and into a blue robe. When you express your dismay, you are reminded that your dress could get messy during the wedding and also, “Why does it really matter what you’re wearing? In the end you’ll have your husband and you’ll be married and that’s really what counts.”

Source: All That Matters is a Healthy Husband (or: why giving birth matters) | Talk Birth

In totally separate news, I have an upcoming free Womanspirit Wisdom mini class. Feel free to join!

Guest Post: Widespread Insurance Coverage of Doula Care Would Reduce Costs, Improve Maternal and Infant Health

Jan5

Leading Maternity Care Experts Release Issue Brief Encouraging Medicaid and Private Insurers to Cover Doula Care

WASHINGTON, D.C. – January 5, 2016 – At this time when most experts agree that not nearly enough women in this country receive high-quality maternity care, federal and state government agencies and health insurers should make doula care an option for more women by covering doula services. An issue brief released today by two leading maternity care advocates makes a powerful case for the health benefits of doula care for women and babies and the significant cost reductions that would result if more women used doulas – trained professionals who provide non-clinical emotional, physical and informational support before, during and after childbirth. The brief, Overdue: Medicaid and Private Insurance Coverage of Doula Care to Strengthen Maternal and Infant Health, is co-authored by Choices in Childbirth and Childbirth Connection, a program of the National Partnership for Women & Families.

In the brief, the authors summarize research showing that doula care reduces the likelihood of interventions such as cesarean birth and epidural while supporting shorter labor, spontaneous vaginal birth and other benefits to mom and baby. As the use of interventions decreases, so do associated costs, making coverage of doula care a cost-effective strategy for public and private insurers alike. The authors estimate that the reduction in cesarean births from the use of doula care could save Medicaid at least $646 million per year, and private insurers around $1.73 billion annually.

“Widespread coverage of doula care is overdue,” said Michele Giordano, executive director of Choices in Childbirth. “Overwhelming evidence shows that giving women access to doula care improves their health, their infants’ health, and their satisfaction with and experience of care. Women of color and low-income women stand to benefit even more from access to doula care because they are at increased risk for poor maternal and infant outcomes. Now is the time to take concrete steps to ensure that all women can experience the benefits of doula care.”

“Doula care is exactly the kind of value-based, patient-centered care we need to support as we transform our health care system into one that delivers better care and better outcomes at lower cost,” said Debra L. Ness, president of the National Partnership. “By expanding coverage for doula care, decision-makers at all levels and across sectors – federal and state, public and private – have an opportunity to improve maternal and infant health while reducing health care costs.”

The brief provides key recommendations to expand insurance coverage for doula care across the country:

Congress should designate birth doula services as a mandated Medicaid benefit for pregnant women based on evidence that doula support is a cost-effective strategy to improve birth outcomes for women and babies and reduce health disparities, with no known harms.
The Centers for Medicare & Medicaid Services (CMS) should develop a clear, standardized pathway for establishing reimbursement for doula services, including prenatal and postpartum visits and continuous labor support, in all state Medicaid agencies and Medicaid managed care plans. CMS should provide guidance and technical assistance to states to facilitate this coverage.
State Medicaid agencies should take advantage of the recent revision of the Preventive Services Rule, 42 CFR §440.130(c), to amend their state plans to cover doula support. States should also include access to doula support in new and existing Delivery System Reform Incentive Payment (DSRIP) waiver programs.
The U.S. Preventive Services Task Force should determine whether continuous labor support by a trained doula falls within the scope of its work and, if so, should determine whether labor support by a trained doula meets its criteria for recommended preventive services.
Managed care organizations and other private insurance plans as well as relevant innovative payment and delivery systems with options for enhanced benefits should include support by a trained doula as a covered service.
State legislatures should mandate private insurance coverage of doula services.

The issue brief and a new infographic illustrating the importance of coverage for doula care are available at http://Transform.ChildbirthConnection.org/Reports/Doula and www.choicesinchildbirth.org/our-work/advocacy-policy/doulacoverage.

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About Choices in Childbirth

Choices in Childbirth is a non-profit organization that works to ensure access to maternity care that is safe, healthy, equitable, and empowering. Our mission is to promote evidence-based, mother-friendly childbirth options through public education, advocacy, and innovative policy reform. Learn more at www.ChoicesinChildbirth.org.

About the National Partnership for Women & Families

The National Partnership for Women & Families is a nonprofit, nonpartisan advocacy group dedicated to promoting fairness in the workplace, access to quality health care and policies that help women and men meet the dual demands of work and family. Founded in 1918, Childbirth Connection became a core program of the National Partnership in 2014. Childbirth Connection programs serve as a voice for the needs and interests of childbearing women and families, and work to improve the quality and value of maternity care through consumer engagement and health system transformation. Learn more at http://Transform.ChildbirthConnection.org and www.NationalPartnership.org.

Tuesday Tidbits: How to Make Life Easier as a New Parent

Aug11

In all my years as a birthworker, I still find that one of the most overlooked topics in childbirth preparation is adequate preparation for postpartum—those early weeks, or months, with a new baby. In my personal life, I experienced a difficult postpartum adjustment with my first baby, an easier one with my second baby, and two delightful, nurturing babymoons with my last two babies. Years after training as a postpartum doula, good postpartum care remains one of my passions, so I really enjoyed this post from a mother of five. Her feelings of rushing to get back to “normal” feel very familiar even though almost twelve years have passed since my first, tender, postpartum adjustment:

“I remember coming home from going out for the afternoon with Hero at 7 days postpartum. After we got back to our tiny apartment I came down with a fever. I was probably wearing the cutest non-comfortable outfit I could squeeze into. I probably didn’t think that 7 days after giving birth required anything of me other than “getting back to normal.” Life went on, and I urged it faster. In fact, that’s the way I parented, too. Smile, laugh, roll over, sit, crawl, walk, run, milestone, milestone, grow, grow, grow…

When I think back on my postpartum times (for the most part) I remember being exhausted, being emotional, being upset at Kirby for not doing enough, feeling fragile, feeling sad, and feeling weak. And then I got pregnant with Peter… And by the time I had him, I had interacted with enough wise mothers who had screwed up enough to know better and they told me what to do and I listened. After five babies I could finally say I did it right. I’m not saying you have to do it like me. Maybe you’ve already got your postpartum flow down and you need no such advice. In that case, a w e s o m e…”

Now I realize that some moms can just go, and they are happier that way! I get that. But it took me too long to realize that that’s not me. And I don’t want you to spend too much time thinking that should be you if it isn’t. Don’t spend four days, don’t spend four weeks, and certainly don’t spend 4 entire babies feeling like a shell of a person trying to figure it out…

The Fike Life: How to postpartum like a boss.

Unlike my early memories of my first son’s life, rather than looking back with sense of regret and fatigue, I look back on the weeks postpartum with Tanner (fourth and final full-term baby) with a tinge of wistfulness for the sweet, delicate, care-full time we spent together, nestled in bed in milky, marveling wonder. The author of the post above describes it as a “little sacred space,” and that is exactly how I feel. It also needs to be fiercely protected.

I look at that one week postpartum as a little sacred space that I will never get back. It’s a space where, for the most part, it’s just that brand new baby and me. And I’m selfish about it. And not sorry. Life will keep plummeting forward rapidly and I won’t ever stop it. But I can have a week with a floppy new baby on my chest in my bed and I’ll take it. And I’ll protect it.

AND IF THAT DOESNT TUG AT YOU MOTHERLY HEARTSTRINGS KNOW THIS… (super practical advice I got from my midwife with Peter)

When you have a baby you are recovering from an injury that is deeply internal. Your blood needs to stay concentrated there to bring essential nutrients to heal your organs and make you strong again. When you get up and walk around, your blood abandons your core and flows into your extremities, which can massively prolong your recovery. Stay rested and keep yourself down as much as you can. Just think of your organs! They need you!

via The Fike Life: How to postpartum like a boss.

It isn’t just the weeks following a new baby’s birth that matter, the first hour matters too and can set the tone for the rest of the postpartum journey:

…The way your baby is cared for and nurtured immediately after birth significantly impacts their transition from the womb to life outside.

In a culture that commonly separates mothers and babies for routine procedures such as cleaning, weighing and measuring, most babies are missing that critical time of being skin to skin with their mothers, which has short and long term consequences for all.

As these procedures are not necessary to maintain or enhance the wellbeing of either mother or baby, there is no reason why they cannot be delayed beyond the first critical hour.

via 7 Huge Benefits of An Undisturbed First Hour After Birth | BellyBelly.

Why doesn’t this uninterrupted hour and subsequent caring postpartum support happen for all new families? One reason is related to the “treatment intensity” of the US birth culture:

The questions you post in your article are good ones: Are midwives safer than doctors? How can homes be safer than hospitals and what implications does this study have for the US?

It’s a super knotty issue and it shouldn’t be about the superiority of midwives over doctors or homes over hospitals. The debate we should be having is over “treatment intensity” in childbirth and when enough is enough. The concern is that patients can be harmed by doing too much and by doing too little–in the US I worry that we cause avoidable harm by always erring on the side of too much.

via An Unexpected Opinion on Home Birth | Every Mother Counts.

Another is related to routine hospital practices that are not evidence based:

1. Start with giving the birthing woman antibiotics in high doses so that the baby develops candida (thrush) and colic. Then mix in a lot of stitches, either to repair the perineum or the lower belly/uterus.

2. Separate the mother and newborn. Make the mother walk a long distance (with her stitched body) to be able to see/feed her newborn…

via 6 Point Recipe for Making New Parenthood as Difficult as Possible | Wise Woman Way of Birth | by Gloria Lemay.

On a related note, we find that breastfeeding gets off to a better start when birth is undisturbed. We also find that decisions about breastfeeding may be made months before the baby is actually born:

…Recently, a nurse contacted me asking for ideas for teaching an early pregnancy breastfeeding class. I think this is a great idea, since mothers’ decisions about breastfeeding are often made before the baby is conceived and if not then, during the first trimester.

via Breastfeeding Class Resources | Talk Birth.

It isn’t just postpartum during which we need these reminders about the “cycle of care.” The cycle of care of young children can be largely invisible, both to those around us and to ourselves. I’ve taken some time this week to appreciate my investment in my baby and cut myself a little slack on the other things I always want to “get done.” Brain-building is important work too!

Speaking of said baby, who has been taking his first steps this week at nine months old, I was amused this week to come across one of my older posts on family size decisions, in which I decreed my doneness with my childbearing years. Instead of embarrassing, I find the post oddly affirming or reinforcing that at some level I really did know that we weren’t quite “done,” there was still space in our family (and our hearts!) and there really was one more baby “out there” for us.

We decided we’d make the final, ultimate decision after she turned two, because too much longer after that point would make more of an age gap than we’d want. I posted on Facebook asking how do people know they’re “done.” I had an expectation of having some kind of blinding epiphany and a deep knowing that our family is complete, as I’ve had so many other people describe: “I just knew, our family was complete.” I didn’t have that knowing though—I vacillated day to day. What if I never know for sure, I fretted. Perhaps this sense of wistfulness and possibility with continue forever—maybe it is simply normal. One more. No, finished. But…ONE more?! And, I have a space in my heart that knows with great confidence that four (living) children would be the ultimate maximum for us. I definitely do not want more than four…so, does that mean there still is one more “out there” for us?

via Driveway Revelations (on Family Size) | Talk Birth.

However, I also find it to be true that four is most definitely the ultimate maximum. We laughed earlier this week remembering that a couple of weeks after Tanner was born I kept saying that I thought maybe we’d picked the wrong name for him. Mark asked me what I thought it should be and I said I kept thinking that maybe it should have been “Max.” While we joked at the time that this was because he is Maximus Babius, I only now caught on to the unintended double joke that he has definitely pushed our family size to our “max”!

Other tidbits:

I got this book about midwives in Mexico to review and have been zooming through it. It is SO good!

We’ve been working on new sculptures!

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We’ve added some new Moon Wisdom/First Moon bundles to our shop:

And, our new blessing cards came in. We were printing these on regular printer paper and are excited to have nice, professional cards instead!

We also still have five spaces left in the Red Tent Initiation program beginning at the end of the month:

Sign up for the Brigid’s Grove Newsletter for resources, monthly freebies, + art and workshop announcements.

And, as is our tradition, in honor of World Breastfeeding Week and National Breastfeeding Month, you can get 10% off items in our shop throughout August: WBW10OFF.

Guest Post: How does your body know when to go into labor?

Jul17

I recently received the following news story to repost. Many women have questions about when they will go into labor or concerns about pre-term labor. They may also worry about “never” going into labor on their own and may face pressure from care providers or family members towards induction. We often rely on signs like cervical changes, contractions, and increased cervical fluid (as well as proximity to due date) in order to help us anticipate the birthing day. I distinctly remember the interesting and counterintuitive experience of having the question of, “WHEN,” somehow feeling more and more mysterious and hard to predict the closer I drew to my own due dates (when really, the closer you get, the fewer birth-day possibilities remain! While it is very normal for babies to be born after their estimated due date, the possible window of when the baby will be born narrows with each day of pregnancy, simply because: babies do come out). Turns out, your baby’s birth-day timing has more to do with what is going on at a molecular level, than what you can observe from the outside!

(If this guest post is too heavy on molecules and too light on personal experience, you might want to check out one of my most popular blog posts: How do I know I’m really in labor? | Talk Birth.)

Key components of interest from the research below:

The molecule that triggers birth is the TLR4 molecule.
This molecule is activated by other molecules produced in the mothers tissues due to uterine stretch, by proteins that are released from a baby’s lungs just before birth, and by the placenta as it begins to reach the end of its life.
Factors that can contribute to a surge inTLR4 and lead to premature birth are:
- Bacterial infections
- Damage to the placenta
- multiple pregnancy

Here is the guest post with more!

———————————————————————————————————————————-

RESEARCHERS at the University of Adelaide have identified that the activation of the TLR4 molecule is key in controlling the timing of birth, acting as a trigger common to both preterm and on-time labour.

Professor Sarah Robertson, Director of the Robinson Research Institute and lead author of the study published this week in Endocrinology, said the research was likely to lead to new therapies in preventing preterm labour.

“Preterm labour, birth at less than 37 weeks gestation, affects 5-13% of pregnancies worldwide. It accounts for 28% of all neonatal deaths and can result in major health consequences for surviving children,” says Professor Robertson.

“In order to prevent preterm birth, we need to understand the physiological responses which lead to normal on-time birth, and our new research pinpoints a ‘master switch’ that influences the timing of birth.

“We know that several agents can bind and trigger the molecule TLR4 after release from fetal and maternal tissues in late gestation, including proteins that are released from a baby’s lungs just before birth.

“Other molecules that activate TLR4 are produced in the mother’s tissues due to uterine stretch, or when the placenta begins to reach the end of its life.”

Professor Robertson says that there are other factors that lead to a surge in TLR4 and premature birth, including local bacteria infections, damage to the placenta due to inflammation, or even multiple pregnancy.

“This is a surprising finding because TLR4 is generally thought to be involved in the immune response to infection, and had not previously been linked with normal processes in pregnancy,” says Professor Robertson.

“Now that we know how critical TLR4 is in regulating the timing of birth, we can commence testing drugs that target the TLR4 pathway.

“While this is yet to be looked at in a clinical setting, we believe this finding will ultimately lead to methods to effectively protect women at risk of going into labour early,” she says.

This work was supported by project and fellowship grants from the National Health and Medical Research Council of Australia, the Canadian Institutes of Health Research and the Australian Research Council.

Key contacts

Professor Sarah Robertson Director, Robinson Research Institute University of Adelaide

08 8313 4094 sarah.robertson@adelaide.edu.au

Thursday Tidbits: The Return

Jan15

Two months after Tanner’s birth, I still feel like I’m “coming back” from this trip.

And, speaking of returning, last night I went back to teaching my in-seat class. I am grateful to have a husband who accompanied me to keep the baby close on site for nursing as well as for helpful parents who rearranged their schedules/lives to take care of our other kids while we were gone.

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At class last night.

As I mentioned in a recent post, I’d mentally prepared to be “off” until January and now that it is January, I have a feeling of being sped up in an unpleasant way. So, I appreciated reading this essay and the reminder: you just had a baby.

You just had a baby.

So, let’s stop pretending like that didn’t just happen.

And let’s give you some grace and permission.

You don’t have to answer every email, every text or every invitation that comes your way. You don’t have to keep your house clean or make fancy dinners this week or plan your family vacation for the year. You don’t have to take your toddler to the dentist or figure out how to save for college right now…

You Just Had a Baby | Ashlee Gadd.

While I do keep up with a large variety of projects, ideas, communication, and relationships, there is not a single day that passes that I don’t drop a ball, forget something, let something go (intentionally or not), or let someone down. There are emails I don’t answer, calls I don’t take, and text messages I don’t respond to as well as laundry I don’t fold and piles of clutter than don’t get put away, not to mention all the blog posts I don’t write. This simply has to be okay. I’ve joked with friends and with Mark that my “word of the year” should actually be “ruthless,” meaning that I must be ruthlessly assessing of how I spend my time, ruthless about cutting out non-essentials. Every day involves a pile of choices and some of them are hard to choose between, or to not choose. I must be ruthless in my discernment—choosing wisely, choosing carefully, choosing mindfully. My real word of the year is “grow,” while at the same time the message I’ve frequently been picking up in moments of synchronicity and surprising overlap is “let go.” So, maybe I’ve actually got a trifecta of words this year!

I already wrote about the breastfeeding brain in a recent past post, but it appears that there are permanent changes to the maternal brain as well:

The artist Sarah Walker once told me that becoming a mother is like discovering the existence of a strange new room in the house where you already live. I always liked Walker’s description because it’s more precise than the shorthand most people use for life with a newborn: Everything changes…

The greatest brain changes occur with a mother’s first child, though it’s not clear whether a mother’s brain ever goes back to what it was like before childbirth, several neurologists told me. And yet brain changes aren’t limited to new moms…

via What Happens to a Woman’s Brain When She Becomes a Mother – The Atlantic.

And, speaking of mothers and their childbearing brains, Childbirth Connection has produced two phenomenal new resources. There is a report by Sarah Buckley on the Hormonal Physiology of Childbearing and a companion booklet for mothers that simplifies the research into a user-friendly booklet on the role of hormones in a healthy birth. Great resources for childbirth educators and doulas.

For more see: Hormonal Physiology of Childbearing | Transforming Maternity Care.

Tuesday Tidbits: Human Rights and Birth

Jul22

–Sister Morningstar (in Midwifery Today)

When 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 Rights 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.

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

The WHO Code: Why Should We Care?

May23

“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.”

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

Thesis Tidbits: Feminism, Midwifery, and Motherhood

Apr3

“Feminism catches fire when it draws upon its inherent spirituality. When it does not, it is just one more form of politics, and politics never fed our deepest hungers.” –Carol Lee Flinders (in The Millionth Circle)

Yesterday, I spent several hours finishing a blog post for Feminism and Religion regarding empowered self-care (it won’t run until next week). It is a primarily a personal narrative, rather than a political commentary, but as I was writing it, I learned about new legislation introduced in Missouri in an effort to effectively destroy the practice of independent midwifery here. I also have a friend whose family member just experienced terribly abusive treatment during the immediate postpartum period. I typed feverishly away with an absolutely excruciating headache and a million things on my mind, primarily the very many injustices experienced by women during the childbearing year. I was also left wondering HOW we can truly take care of ourselves when legislators and health care workers actively take dramatic and even cruel steps to prevent us from doing so?

Another friend wrote a comprehensive blog post about this malpractice insurance legislation and the issues involved with it. Midwifery advocacy organizations have already introduced a perfectly appropriate piece of legislation this session and do not need the proposed bogus piece of legislation that offers nothing in the way of protection for Missouri midwifery consumers and instead simply serves to drive midwives out of practice:

…Fortunately, midwives in Missouri do offer a grievance process and adhere to the practice standards set by the certifying agency NARM (North American Registry of Midwives). While there is already a high degree of professional accountability practiced in Missouri, this is because the state professional organization (Missouri Midwives Association) believes it is important and necessary for the professional practice of midwifery and not because the state has directed midwives to do so.

The state of Missouri has continued to be uninterested in working with midwives and home birth families to improve and safeguard the practice of midwifery.

Is there a better option? YES! HB 1363

Instead of HB 2189, we would like to suggest directing legislators to support HB 1363. This is a comprehensive midwifery licensing bill which does provide a mechanism for oversight and responsible, regulated practice. It also addresses the issue of malpractice insurance by requiring midwives to have coverage under the same conditions as physicians. It would also require Medicaid reimbursement for families desiring the care of Certified Professional Midwives and home birth.

via Missouri Legislature Works Against Women, Families and Midwives….AGAIN. | Midwives, Doulas, Home Birth, OH MY!.

I also recently finished a class on ritual theory for my doctoral degree program. The text for the class was To Make and Make Again: Feminist Ritual Thealogy by Charlotte Caron. In it, I was repeatedly reminded that gathering with other women in a circle for ritual and ceremony is deeply important even though it might just look like people having fun or even being frivolous, it is actually a microcosm of the macrocosm—a miniature version of the world we’d like to see and that we want to make possible. Returning to Caron, she explains something similar: “Ritual change is symbolic change, but it can lead to direct action or to ideological change, so it can be an important element in strategizing for change. One way of causing change is to re-form or alter the system. This involves recognizing that we are part of the system and that the system is dependent on feedback from its parts to keep it in balance, which means that we have the capacity to change” (p. 209).

Ritual experience can lead to practical action: spiritual praxis. But, this action does not need to look the same for all women, nor does it always have to involve large structures of society or even sweeping societal change.

“It is important to recognize that not all women will choose to act in the large structures of society. While it is hoped that all women will act toward justice, still electoral politics, lobbying, and revising the economic system may not be the spheres in which some women exert their energy. Ritual actions, raising children to be just and caring people, living in just ways in intimate and community relationships, and modeling different patterns and values are political actions to change patriarchal ideology. The choices of what spheres to devote energy to are important to honor. The constraints of women’s lives—when they are disabled, when they are dealing with past traumas, when they are raising young children, and when they are doing the many other things expected of women in our society—mean that women need to make choices that will allow them to live with integrity and well-being.” (p. 211)

A number of options of action are possible. “What is important are women’s choices to act in concrete ways in every circumstance, to know our neighbors, to raise children to be caring people, to live as if justice exists, to be just in personal relationships, and to live in the community in ways that model the values of justice and well-being for women and all of creation.” (p. 211)

As a mother who works extensively with other mothers, I appreciated Caron’s acknowledgement that raising children is a feminist act with potential to create change as well. “Another strategy for change is through raising children to be just and caring people. A media image portrays feminists as being against motherhood—but in fact, feminists make the best mothers. They raise children aware of themselves and the world, of options and values, of what justice means and how to work toward it, and how to be self-critical and self-respecting” (p. 203-204). Caron also explains that “in a just society, women would be free to make whatever decisions they needed to, for however long they needed to, in relation to political action in the public and the private sphere. All people would participate in the decision-making, and women would be supported in their decisions rather than, as sometimes happens, made to feel guilty for not doing enough or not valued for what they do.”

In connection with women being valued for what they actually do, Caron makes an interesting note about the visions women in her research hold for the future, for the possible:

“Interestingly, none of the visions described by women was based in self-fulfillment, in gaining personal power, or in one’s group having power and the expense of others. Instead, the interviewees talked about the elimination of social, economic, military, and other patriarchal problems, and about living in a world of valued individuals, healthy and diverse relationships, economic and environmental sustainability, equality for all, and shared decision-making and power” (p. 220).

Connected to these themes, one of my classic favorite quotes about women’s spirituality groups is this one:

“…Women’s spirituality groups can become birth centers for social change”

–Anne Rush in The Politics of Women’s Spirituality (p. 384)