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Talk Books: Pregnancy, Childbirth, and the Newborn

March 2016 121Several 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 119drawings 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.

Thursday Tidbits: Everyday Sheroism in Birth and Life

February 2016 005Do you know how many days have gone by in which I’ve said: “well, I didn’t write my dissertation today?”

This past Monday I got to say: I *DID* WRITE MY DISSERTATION TODAY!!!!!!!!!

It may be a first draft rather than a final submission, depending on suggestions from the reviewers, but there is a huge qualitative difference between someone who is writing a dissertation and someone who has submitted a dissertation and who might need to make revisions. It is 187 pages and 88,000 words and involves one year of original research with 100 pages of collated research results. Five years of classes, study, and contemplation, with also doubling my amount of offspring during this time. I grew this dissertation project at the same time I was growing Tanner from a tiny newborn to a walking, talking toddler. And, I feel like I just pushed out the biggest baby of my life. I cannot even describe the energy expenditure this required of me. I feel so satisfied and very, very proud of myself.

At Red Tent last week, when we passed the rattle, we each had a moment to share something we needed to be “compassionately witnessed.” After making a good effort at doing daily dissertation work throughout December, I’ve been semi-half-hearted on it since, averaging one “good” day of intensive work on it per week. I was hoping to have it finished before we go on a trip this month, but I was feeling so strained and drained and tense that adding it to my to-do list felt almost cruel and possibly ridiculous. When it was my turn for compassionate witness, I shared with the circle that I had reached a point in which I could no longer distinguish whether finishing my dissertation was self-care or self-harm.

After making manifestation bracelets together at Red Tent.

After making manifestation bracelets together at Red Tent.

Now, in hindsight, I recognize the “transition” stage. I’ve known for a while now that it is part of my personal process with big projects to have to be able to have a time and a place in which I am able to say, I don’t know if I can do this. And, to have that fear and self-doubt, and vulnerability simply witnessed. And, then, do that thing anyway. It is hard to find a space in which this is “allowed.” Very often well-meaning suggestions are to cut myself slack, to lower my expectations, or to give myself a break. I have discovered that just like these comments are not actually helpful to a woman in labor, they are not helpful to me in “labor” with other big projects either. In fact, I think there is a secret “dark” side to many popular self-care messages, primarily because what we sometimes might pass off as “self-care” is actually a “shadow comfort” (to borrow Jen Louden’s term) and is actually a meanings of inhibiting ourselves, holding ourselves back, or sabotaging ourselves (or those around us, when we offer the “out” of quitting or not following through…of letting ourselves down). When I was able to let out the fear and doubt, only for a few minutes, and have it simply received, it was as if something unlocked within me and suddenly I knew I had it in me after all. Only a few days later, after several focused bursts of intense writing, I submitted my completed project.

Anyway, a long story just to make this point: I felt SO good after submitting it. I may never have been so proud of myself. I was giddy, thrilled, exhilarated, excited, and exuberant. “What if I had QUIT?!” I yelled, “then I would never have gotten to feel like THIS!” When I lower expectations, sure, I might meet them, but when I keep my expectations high…and meet them. There is nothing that can replace that feeling. And, guess what, it keeps stretching me to reach just a little higher and a little higher. And yes, the self-harm shadow side of continuous life-stretching is that I can be trapped into “striving and striving and never arriving,” but the self-care amazing life side, is that I prove to myself that I can do incredible things and that I accomplish that which may have felt impossible for a time.

Bringing it back to birth, I read this post about ten things not to say to a woman in labor and the first reminded me of my own big “push” to finish the dissertation and how compassionate witness is infinitely more valuable than sympathetic shadow comfort enabling:

Scenario 1: If a woman is trying to make a rational and educated decision while in labor (a very difficult thing to do when in pain!) about whether or not to get an epidural (which is a big deal, by the way) by saying “you don’t have to be a hero” is playing to her emotions and vulnerability which isn’t fair. If she’s questioning this choice instead of immediately signing up for anesthesia, she likely has a reason for the hesitation. I guarantee she doesn’t want an unmedicated birth to become “a hero”. Maybe she was hoping for a natural birth, or wants to reduce the chance of further interventions like pitocin, or maybe she’s wanting the best start for her baby. I don’t know. But by saying “you don’t have to be a hero” to help her make a decision is basically blowing her off when she is in a very vulnerable position. It’s a low blow.

Source: 10 Things to NEVER Say to a Woman in Labor | Mother Rising

And, here’s the deal…women in labor and postpartum are heroes. They are incredible. They are amazing. We should never deny them that knowledge, particularly if all we are offering in return is a patronizing platitude masquerading as compassion. This “One Day Young” photo project captures that sheroism:

These goddesses headed to a WIC peer counselor's office this week.

These goddesses headed to a WIC peer counselor’s office this week.

“In those first 24 hours, it’s like this warrior comes out in women,” says Jenny. “They gain this inner strength to protect the child and you can see it in the photos. “They’re like those heroic pictures of soldiers on the battlefield or the footballer after the match, still full of the adrenaline of achievement. This moment isn’t often captured in women, but what they’ve just achieved is just as important as that goal or that battle, and that moment deserves to be recorded and celebrated in the public arena.”

Source: Empowering Photo Project ‘One Day Young’ Reassures Women That Childbirth Is Nothing To Fear

At the same time, birth can be very hard work and the recovery can be intense and long-lasting. Culturally, while we may minimize, invalidate or deny women’s power, strength, and amazingness in birth, we also often minimize, invalidate, and deny their vulnerability after birth.

We don’t talk about postpartum pain — bleeding, stitches, not being able to stand upright, or easily walk around. We don’t talk about the struggles of early breastfeeding: cracked and bleeding nipples, mastitis, and worries about producing enough milk. We are only beginning to talk about postpartum depression and anxiety. And it almost seems as if new fathers and adoptive parents don’t matter at all. The rhetoric from those who don’t want change paint a rosy picture of motherhood, but the realities of these anti-family policies are much more grim. In a recent TED talk, I share a number of heart-wrenching personal stories from women who have suffered as a result of having to return to work too soon.

Source: Maternity Leave Policy Postpartum Pain – Susan Crowe

After submitting my dissertation, I was heard to say that I felt like I needed a long nap and maybe several large gifts. After the intensity and unpredictability of giving birth, a ceremony might be in order, either a sealing ceremony like I experienced, or a birth reclaiming ceremony as is described in this article:

“I wasn’t at the birth, but it was super quick and the mother felt traumatised. I came in on a Monday, and the baby looked a little pinched. I asked the mother about feeding and she said she thought it was going okay. I offered to change the baby’s nappy – I took it off and it was bone dry. I asked how long it had been on and it was over 12 hours. The maternal health nurse was due over that day, so we had a bit of time to suss what was going on, since I was a breastfeeding counsellor as well. From chatting, we realised her milk had not come in and the baby was clearly not getting anything.

The mother was super stressed and her baby was about a week old — and clearly not in fabulous shape. I talked about a birth reclaiming ceremony and we ran her a lovely warm bath. It was daytime, so we closed the curtains and played soft music. As she climbed into the bath, I saw her high, tense shoulders drop right down and she let out a big sigh. When she was ready, I stripped her baby, and placed the baby on her chest. We sat quietly, not saying a word. The mother started to cry, then sob, totally overwhelmed by the responsibility of being a parent and not doing a good enough job. All the while, looking at her sleeping baby, holding her.

As the mother eventually finished crying… her milk started to roll down her breasts. She looked at me, so surprised, and said, “Is that what its meant to look like?”

Source: Birth Reclaiming Ceremony – Could It Help You Heal? | BellyBelly

Finally, I like to share this link. I haven’t actually watched any of these, but for people who like TED Talks, this sounds like an interesting round-up!

11 TED Talks for Pregnancy and Birth — Tulsa Birth Doula, Bethanie Verduzco, CD(DONA) – Hello Sunshine Birth Services

February 2016 022What else is up with me this week:

  • The etsy shop is on limited inventory until March 1.
  • I’ve been working on the materials kits for both the Red Tent Initiation and Womanspirit Initiation courses that I have coming up. They’re beautiful and I’m so proud of both of them. Every time I pack up a kit, I feel so thrilled. Both trainings begin March 21st and still have spaces available for registration if you’re interested!

February 2016 116

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

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 infographiccase 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: Postpartum Planning

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My post from last week about recovering from childbirth sent me on a blog-excavation mission for all the posts I’ve written about postpartum care. This is just a sampling (I’ve written a lot on the subject):

“I needed a maternal figure, a dedicated and present midwife, dear and loving friends. I was blessed with one out of three. It could have been worse. The only people I know who did just fine in the postpartum period are those who score the triumvirate: well cared for in birth, surrounded by supportive peers, helpful elders to stay with them for a time. The others, wild-eyed at the supermarket, prone to tears, unable to nurse or sleep or breathe, a little too eager to make friends at baby groups – I can spot them at 20 paces. We form a vast and sorry club…”

via My friend breastfed my baby | Life and style | The Guardian.

Source: Weekly Tidbits: Birth, Postpartum, the Triumvirate, and Anthropology | Talk Birth

Other, experienced women can be our most powerful source of support:

Women around the world and throughout time have known how to take care of each other in birth. They’ve shown each other the best positions for comfort in labor, they’ve used nurturing touch and repeated soothing words, and they’ve literally held each other up when it’s needed the most…

–The Doula Guide to Birth

Source: Tuesday Tidbits: Postpartum Recovery | Talk Birth

I’ve spent a lot of time talking and writing about the culture that surrounds us and the resultant impact on our birth, breastfeeding, and early parenting experiences:

The United States are not known for their postpartum care practices. Many women are left caught completely off guard by the postpartum recovery experience and dogged by the nagging self-expectation to do and be it all and that to be a “good mother” means bouncing back, not needing help, and loving every minute of it.

Source: Tuesday Tidbits: Postpartum Mamas | Talk Birth

It isn’t just me writing about the impact of culture on maternal mental health, this post calls it like it is:

Let’s stop torturing mothers. Let’s stop ignoring the problem of expecting new mums to get back to normal. They are not normal, they are super important, and we need to value them and treat them with the greatest respect, if we don’t want them to break into a million pieces, shattering the lives of all those around them.

Source: Torturing new mothers and then wondering why they get mentally ill. | Mia’s Blog

This insightful article full of helpful tips for supporting postpartum women by my friend Summer got a lot of attention when I re-shared it on Facebook last week:

An unfortunate by-product of our society’s refusal to see birth as a monumental event is the lack of a babymoon or restful, supported postpartum period. Most of the time, moms and dads are expected to pick up with their everyday lives almost immediately.

The Incredible Importance of Postpartum Support | Midwives, Doulas, Home Birth, OH MY!

I offer some survival tips here: Postpartum Survival Tips | Talk Birth

And, one of my favorite guest posts that I’ve ever hosted on this site is this one about postpartum planning: Guest Post: Mothers Matter–Creating a Postpartum Plan | Talk Birth

When considering postpartum planning as well as talking about it to others, I find that visualizing the placental site that is healing can be a helpful jolt reminding us how important good postpartum care is:

“Remind them that a true six-week postpartum window allows for the placenta site to fully heal and supports minimized bleeding and stronger recovery.” An excellent tip for educators and doulas from Barbeau is to illustrate size of placental site healing area with hands like small dinner plate—if this was outside the body, how would you care for yourself…

Source: Timeless Days: More Postpartum Planning | Talk Birth

And, some final reminders about good postpartum care for women themselves and for those who love them:

I recently finished a series of classes with some truly beautiful, anticipatory, and excited pregnant women and their partners. I cover postpartum planning during the final class and I always feel a tension between accurately addressing the emotional upheavals of welcoming a baby into your life and marriage and “protecting,” in a sense, their innocent, hopeful, eager, and joyful awaiting of their newborns.

This time, I started with a new quote that I think is beautifully true as well as appropriately cautionary: “The first few months after a baby comes can be a lot like floating in a jar of honey—very sweet and golden, but very sticky too.” –American College of Nurse-Midwives

Source: Some reminders for postpartum mamas & those who love them | Talk Birth

December 2015 029

Thursday Tidbits: Recovering from Birth

December 2015 029“Before I had children I always wondered whether their births would be, for me, like the ultimate in gym class failures. And I discovered instead…that I’d finally found my sport.”

–Joyce Maynard

People often use running a marathon as a metaphor for birth. Turns out that science has discovered that birth is actually more difficult…

“The researchers used MRI equipment typically used to diagnose sports injuries to explore the full scope of trauma that a woman’s body experiences during childbirth. The MRI images revealed that almost 25 percent of women had fluid in the pubic bone marrow or fractures that are similar to stress fractures that athletes often suffer. And 41 percent of women had pelvic muscle tears.

Also revealed by the study is the startling statistic that 15 percent of women never fully recover from the birth-related pelvic injuries.”

Science Says Childbirth Is Harder Than Running a Marathon – In The Loop Tips & Advice | mom.me

The same research was covered in this post as well:

Childbirth, as anyone who’s been through it knows, can feel very much like an extreme sport. And, it turns out, some childbirth-related injuries are surprisingly like sports injuries, including the very long time they need to heal.

The bottom line, Miller says, is: “if women don’t feel that their body is back to what they expected after six weeks, it’s not in their heads. Women do some self blame or feel like they’re not as robust as their sister or friend. But they may have one of these injuries not visible on clinical exam.”

Source: Childbirth As An Extreme Sport — And Why Its Injuries Can Take So Long To Heal | CommonHealth

I do have to admit that I perhaps would have re-titled the articles: “Science Reports Something Most Women Have Known Since the Beginning of Time,” but, oh well. Picky me.

I’ve written about birth and marathons in several past posts. Giving birth is the original “extreme sport.” One that tests your reserves, your endurance, your courage, and your stamina like nothing else. Truly, we have the comparison wrong. Running a marathon is kind of like giving birth, rather than vice versa! The first older blog post of mine isn’t related to childbirth/sports injury, but instead the emotional satisfaction of finishing your “marathon”:

She goes on to share: “I want that feeling of going beyond what you think is possible for laboring women. If you let go of control and allow the process to unfold, you are so proud of yourself. Then pride morphs into self-confidence and trust. What a perfect combination for parenting. When it comes down to it, you have to do this by yourself, be it labor or running. You might hear other laboring women around you or have the support of crowds in a race, but it’s still up to you. there’s a start and a finish and only you can see it through. Fortitude brings a new self-awareness and strength that feels overwhelming…I know one of my greatest challenges in the vocation of perinatal education is getting women to trust the process and her own capabilities before labor. My practice runs helped prepare me for the marathon, but there is no practice run for labor. Women must rely on their confidence and the legacy of the many women who have birthed before them…”

Source: Births & Marathons | Talk Birth

Women giving birth often experience a sort of post-race euphoria:

Those who push themselves to climb the last hill, cross the finish line, or conquer a challenging dance routine often report feelings of euphoria and increased self-esteem…women who experience natural birth often describe similar feelings of exaltation and increased self-esteem. These feelings of accomplishment, confidence, and strength have the potential to transform women’s lives. In many cultures, the runner who completes the long race is admired, but it is not acknowledged that the laboring woman may experience the same life-altering feelings… —Giving Birth with Confidence (by Lamaze International)

Source: Birth Feelings | Talk Birth

And, they can draw on those feelings for strength again and again:

“Whether it be the thick memory of enduring a non-medicated labor and finally pushing our third child into the world, despite feeling as though I hadn’t an ounce of energy left, or the meager sprint I managed as I neared the finish line of the marathon…, I hold tight to these images as proof that I can and will be able to rise to the occasion–again and again, if and when I need to-–because the ability to do so is in my very bones. Because I am a woman.”

Source: Woman Rising | Talk Birth

Mothering can also feel like a marathon:

“My body? I was ashamed to admit that, after two powerful homebirth experiences, I no longer felt intimately connected to my body. Pregnancy and giving birth were all about every little feeling in my body; mothering felt like a marathon of meeting everyone else’s needs and rarely my own…Most days, the question I asked was, ‘How are their bodies?’ My body was in the back seat, unattended, without a seatbelt.”

Source: Tuesday Tidbits: Birthing Bodies | Talk Birth

This article about recovering from a Cesarean Birth After Cesarean (CBAC) is packed with helpful information:

As we have discussed, everyone celebrates a VBAC but many CBAC mothers feel alone and unsupported, both in their physical and emotional recovery. This needs to change.

Source: The Well-Rounded Mama: Physical Recovery After CBAC

And, this article has some ideas to share about lowering back and pelvic pain during pregnancy: The Birthing Site – 5 Things you can do to Help Lower Back and Pelvic Pain in Pregnancy

All of these posts and topics remind me of the importance of planning wisely for postpartum:

My son’s birth was a joyous, empowering, triumphant experience, but postpartum was one of the most challenging and painful times in my life. I had not given myself permission to rest, heal, and discover. Instead, I felt intense internal pressure to “perform.” I wondered where my old life had gone and I no longer felt like a “real person.” A painful postpartum infection and a difficult healing process with a tear in an unusual location, left me feeling like an invalid—I had imagined caring for my new baby with my normal (high) energy level, not feeling wounded, weak, and depleted.

Source: Planning for Postpartum | Talk Birth

November 2015 013

Guest Post: How childhood stress can affect female fertility

cropAugust 2015 048

Related to my Tuesday Tidbits post from earlier this week, this guest post touches on the relationship between childhood stress and later female fertility.

How childhood stress can affect female fertility

“Early life events may impact later reproductive strategies.”

Can events you endured as a child really impact your ability to have children yourself? New research in the Journal of Psychosomatic Obstetrics & Gynecology examines the mechanism by which adverse experiences in childhood impact female fertility.

In their paper ‘Adverse childhood event experiences, fertility difficulties and menstrual cycle characteristics’, Marni B. Jacobs et al. explore the hypothesis that negative experiences in childhood can result in menstrual cycle irregularities, which consequently impact fertility. They relate their hypothesis to life-history theory, which talks of balancing the preservation of one’s health and the production of offspring that will survive to reproduce themselves, and theorise that “early life stressors may predispose an individual to adaptively suppress fertility when situations are less than optimal, leading to periods of fertility difficulties even following previous births.”

The study examined data from 774 women of reproductive age, 195 of whom were pregnant. It analysed fertility difficulties, menstrual cycle irregularities and adverse childhood experiences, through a mixture of in-person interviews and take-home questionnaires.

Following their research, the team came to the conclusion that those women who had experienced negative events at a young age – such as “abuse, neglect, household dysfunction or parental substance abuse” – were more likely to have faced fertility difficulties and abnormal absences of menstruation lasting three months or more, and also took a longer time to get pregnant. Their research also suggests that certain harmful events in childhood can potentially have a greater impact on fertility than others.

Adverse childhood event experiences, fertility difficulties and menstrual cycle characteristics by Marni B. Jacobs, Renee D. Boynton-Jarrett & Emily W. Harville published by Taylor & Francis.

* Read the full article online

Guest Post: Postnatal Mental Health

11998990_1661958487349700_7935437715757927025_nI received notice of a new article published in the Journal of Psychosomatic Obstetrics & Gynecology looking at the types of distress experienced by postpartum women and the type of support available. It indicates that current classification of “postpartum depression” and other postpartum mood disorders are inadequate to convey the range of women’s experiences, nor do they properly account for the role of support in their lives.

Before I share the article, I wanted to note something I’ve done recently to support postpartum health. I donated to the fundraising effort to buy a permanent location for WomanSpace, the local community center devoted to supporting women. It is spearheaded by Summer Birth Services, an organization offering birth, postpartum, and breastfeeding support to Rolla area mothers. We can’t undervalue the importance of organizations like this! WomanSpace offers meeting space for groups, classes, and workshops for a wide range of purposes for all ages, stages, and phases of a woman’s life.

For women in any community, you might want to check out a free virtual retreat for women (unaffiliated with any of the above): Nurturing You.

Postnatal mental health: Are women getting the support they need?

“I really did not feel like I fitted the box.” New research indicates the need for postnatal support that encompasses all mental health issues, not only postnatal depression.

The study, published in Journal of Psychosomatic Obstetrics & Gynecology, examines the postnatal symptoms of distress experienced by women, and the support options they were offered. Rose Coates et al. argue that “Current classification and assessment of postnatal mental health problems may not adequately address the range or combination of emotional distress experienced by mothers.” To understand women’s own experiences, the team interviewed 17 women, all of whom had a child under one and had experienced a postnatal mental health problem.

Through the interviews, the women reported a number of different postnatal mental health symptoms, with tearfulness and anxiousness the most frequently mentioned. In addition a number of women each reported feeling: stressed, isolated, lonely, angry, low, panicky, frustrated, worried, scared and overthinking. Despite these symptoms of postnatal distress, the women found that they didn’t identify with postnatal depression, and many of them were left “bereft of information, advice and support” about other types of distress. The paper notes that “there was a perception that health professionals were focussed on postnatal depression and once it had been ruled out there was no further investigation.”

At the time of their distress some of the women had been assessed for postnatal depression by health care professionals through answering a questionnaire. This paper questions whether this alone is really sufficient to identify distress, and suggests that alternative methods of assessment would be conducive to identifying and supporting women with a number of different postnatal mental health issues. The authors conclude that “Identification and recognition of symptoms and disorders beyond postnatal depression needs to be improved, through evaluating different approaches to assessment and their acceptability to women.”

Post provided by Taylor and Francis Group.

Tuesday Tidbits: Parental Leave

centeredmamaI’m teaching Introduction to Human Services right now. In this class, I emphasize systems theory and the complex, dynamic interplay between people and the environment. I cannot stop being a birth activist, nor can I stop being a social worker, so of course, one of the examples I use in class is adequate parental leave. Yes, parental leave. We talk about maternity leave more often in the U.S., but I consider it practically criminal that so many workplaces expect fathers to return to work within a few days after a baby’s birth. This isn’t fair to babies, mothers, fathers, or to workplaces or communities. As I explain to my students, we place people into abnormal situations and expect them to cope normally. When they don’t cope “normally,” we decide they have a disorder and need some medication or possibly parenting classes (or even removal of children). I also make sure to share this quote: It is no measure of health to be well adjusted to a profoundly sick society (Krishnamurti).

For Natasha Long, who was back three weeks after her third child, Jayden, was born in 2012, the worst part was missing out on bonding time with her son.

Long, who was 29 at the time, was determined to make sure Jayden got breast milk. But the factory where she worked, ACCO Office Supplies in Booneville, Mississippi, didn’t have a lactation room. So when she was on breaks, she had to run out to her truck. She sat in the cab, worried that someone might see her, and pumped, while tears rolled down her face and over the plastic suction cups attached to her breasts.

Long cried because she wanted to be holding her baby rather than sitting in the parking lot of a factory in her old Yukon Denali. But exhaustion clearly also played a role in her emotional state. Her job was simple—to place stickers with the company logo on the bottom right-hand corner of plastic binders and then box up the binders. But the shifts were long—from 6 a.m. to 6 p.m.—and she put in four or five a week. Because the factory was an hour’s drive from her home in Okalona, Mississippi, Long had only 10 hours left in the day to do everything else, including tend to her three children, spend time with Jayden’s father, and sleep. By the time she got back in the evening, her children, who were being looked after by her father during the day, were on their way to bed. To pump breast milk before leaving for work, she had to get up at 4 a.m.

After just a few days of this crazed schedule, Long began to develop strange symptoms, including a headache that never seemed to go away and a choking sensation that left her feeling breathless. She started biting her fingernails to the quick—something she’d never done before—and crying a lot. “I felt like I was alone,” says Long. “I wanted to fall off the face of the earth.” Long had never been depressed. But when she went to the doctor, he surmised that her physical symptoms were rooted in her mental state, which was itself rooted in her schedule. When her doctor said he thought she was depressed, Long worried that if child welfare authorities found out, they might take her children away. She had seen other people’s children put in foster care. But when her doctor prescribed her antidepressants, she took them.

Source: The Real War on Families: Why the U.S. Needs Paid Leave Now – In These Times

The issue here is not women’s inability to cope, it is that society’s expectations are disordered.

Here is another good article about the perils of no paid leave in the U.S.:

“I was in the car with my candidate with my brand new baby, a first-time mom, and I was driving to a fundraising meeting to shake somebody down for some cash,” Spradlin said. “I mean, I’m still bleeding. So I’m like, well, what pants do I fit into that are black, just in case I bleed through them. And these are not reasonable ways to behave. I mean, postpartum hemorrhage is a true and real cause of death of women.”

Spradlin is now a lactation consultant, a health-care professional who helps women having trouble breastfeeding. Too often, she said, “trouble breastfeeding” is really just a symptom of a deeper problem—a system that denies too many women the chance to heal and bond with their babies because they can’t afford to take more unpaid time off of work…

Source: Bleeding Wounds and Breastfeeding Hell: The Costs of No Paid Maternity Leave in America

I’ve mentioned several times before that in my ten years in breastfeeding support, I’ve more often marveled that a woman continues to breastfeed, than I’ve wondered why she doesn’t.

I feel like almost every woman I meet or every one I speak to online is seeking community. We’re looking for the “tribe,” we’re looking for the village. We don’t want to do this alone.

The truth is, creating a village sometimes just isn’t possible and there have been many times as a mom a “break” isn’t realistic. Balance, thriving, creating time for you — sometimes, those helpful tidbits tossed out to drowning moms just make me feel like yet another thing I’m failing at…

Source: To the Mom Without a Village – Babble

The problem I note with self-care advice to “ask for help,” is that most people are in similar situations–it is hard to ask for help when the people you ask, also need help!

As we muddle our way through our own home-based life, often “too busy” and “too chaotic” and “not enough time,” I absolutely loved this article about messy importance of the every-day, the real, and the complicated:

…Joy will be there waiting when we’ve adequately tidied our lives, is simply another disempowering cultural story. A story that has an entire generation of humans (and particularly mothers) feeling bad about ourselves, scrambling to “keep up,” and futilely spending billions in attempts to find solace…

Source: Revolution from Home » Blog Archive Life Is Meant to Be Messy (You’re Not Doing It Wrong)11998990_1661958487349700_7935437715757927025_n

 

Talk Books: Touching Bellies, Touching Lives

touchingbelliesEvery so often I end up reading a book that is nothing like I was expecting and yet is totally amazing. Touching Bellies, Touching Lives is one of those books. Subtitled “Midwives of Southern Mexico Tell Their Stories,” I was expecting a collection of birth stories from Mexican midwives. While there are birth stories, and everyone knows that I love birth stories, this book is so much more than a birth story collection. It is a personal pilgrimage, a preservation of the legacy of midwives, an examination of cultural birth practices, and a sobering first-hand account of the declining culture of traditional midwifery in Mexico. Many people may have the misconception that in Mexico or other South American cultures, midwifery is commonplace and maybe even flourishing. In Touching Bellies, we come to understand that Western medical practices are encroaching at a steady pace and that many midwives are elderly, retiring, and not being replaced. A steady theme runs throughout of women going to midwives for “belly massage,” but going to “modern” facilities to have their babies (unfortunately, they’ve imported some U.S. 1950’s-style practices in terms of birth position, birthing alone with no husbands allowed, and being treated dismissively in labor. This is along with a cesarean rate over 40% and up to 70% much in some cities).

The author, Judy Gabriel, takes multiple trips to Mexico on her quest to document the lives and stories of Mexican midwives (most of whom are age 65 and many of whom do not live to see the end of the book). She photographs the midwives and, with some hurdles with language barriers, listens to their stories–asking about the first birth they attended as well as any births that were problematic for them. She returns to them bearing hearing aids, dresses, and photos of family members from the United States. She travels through rough terrain and to distant villages on her quest to listen and learn from these midwives. I was completely absorbed by Judy’s dedication to her mission and her personal insights and life lessons as she travels and learns.

The “belly massage” practice for which Touching Bellies gains its title was endlessly fascinating to me (and to Judy, the author) with midwives regularly helping position the baby, release tight muscles, and ease aches and pains through a gentle process of abdominal massage and fetal manipulation. This aspect of midwifery care was so pervasive that when Judy would ask in a village where the midwives are, many people would not understand and say that they don’t know what she is talking about. When she asks for the woman who massages the bellies of pregnant women, everyone knows where to tell her to go.

In this quote, a 75-year-old midwife tells the story of helping a woman who is in premature labor. The doctors have tried to stop her contractions without avail and now say she must have a cesarean and the baby will most likely die:

“…The mother-in-law said, ‘This woman knows more than you doctors. You may have gone to the university, but, excuse me, for you doctors it is always puro cuchillo, puro cuchillo [just knives, just knives]. Leave the midwife to work in peace, and you’ll see what can be done without knives.’

So I did my work. I rocked the girl in a rebozo and massaged her belly, moving the baby up. The contractions stopped.

The doctors asked, ‘How did you do that?’

I said, ‘You were standing right there watching. I did it in front of you. I’m not hiding anything. You saw me rock her; you saw me massage her.’

‘Is that all you had to do?” they asked.

I said, ‘Yes, that’s all I had to do. What else would I have to do?’

(The baby survived and was born at full-term six weeks later.)

The dedicated care for women, in touching their bellies, touches their lives. Almost all of the midwives in the book have access to nurturing touch and almost no other resources available and yet almost all of them report never losing a baby or a mother in childbirth.

I absolutely loved reading Touching Bellies, Touching Lives. It is an extremely interesting, thought-provoking, and thoroughly fascinating journey. The information about the gradual decline and near-extinction of midwifery in Mexico is sobering, but the book does end on a hopeful note.

You can read more about the book here as well as see some of the interesting documentary-style photographs of the midwives from the book (one of the points of Judy’s travels was to photograph the midwives and share pictures of their families in the U.S. with them and vice versa). The book itself is available via Amazon.

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

Talk Books: A Passion for Birth

Sheila

“We are only now beginning to discover the long term destructive effects on human beings and families of treated women as if they were containers to be opened and relieved of their contents.”

–Sheila Kitzinger

Sheila Kitzinger’s new autobiography, A Passion for Birth, is an absolute treasure. One of the most long-term and pivotal influences in the world of birth activism, I have quoted her work more times than I can count. In fact, I judge the quality of a book by the number of pages I dog-ear to return to. I turned down the corners of so many pages in A Passion for Birth, that it will take me a year’s worth of blog posts to share all the provocative quotes that caught my attention! While Sheila always included a personal flavor in her other books, this book is truly about her, her life, her passions, her family, her activism, her work. Interwoven throughout is the social justice oriented thread of her absolutely devoted dedication to women, feminism, and childbirth activism. Her book is very real, relatable, and readable as well as often charming. She doesn’t hold back from treading into controversial waters, however, and she is straightforward and unapologetic even when writing about topics that can be divisive in the birth world.

I was pleasantly surprised to discover the full-color series of photos in the center insert to the book, they range from Kitzinger’s childhood, a homebirth picture of the birth of one of her daughters, and ending with a poignant photo of Sheila’s casket, decorated by her family, resting easily on some chairs in the dining room of home she so loved.

An internationally recognized author and expert, Kitzinger was an anthropologist and one of the first professional people to acknowledge that women’s birth wisdom, stories, and experiences are worthy of study and attention. Spanning an impressive career of more than fifty years, Kitzinger’s anthropological and activist work was undertaken at a global level and her clear and unwavering commitment to social justice work and activism is a thread running strongly throughout her entire autobiography. The book takes us from Sheila writing and studying while sitting in a playpen in her yard (an effort to have a work area undisturbed by her five children!) to traveling with her family to Jamaica to study the birth customs and stories of the women there. Her identity as an anthropologist is clearly reflected in the cross-cultural birth experiences she surveys and describes and the autobiography includes lots of travel! It also includes homey touches like favorite recipes and descriptions of family traditions as well as stories of her own four homebirths, including that of twin daughters. I found myself wanting more content about her life with children, her life as a mother, which, while acknowledged and integrated through the text, was curiously absent from much of the narrative’s exploration. I was also curious to know more about the accident and serious brain injury experienced by her daughter Polly, which was mentioned somewhat incidentally (though it clearly had a significant impact on the family), as was the passing mention in a photo caption referencing her husband Uwe’s eye removal surgery.

Highly recommended to anyone with an interest in birth work, birth activism, feminist studies, women’s health, or anthropology, A Passion for Birth was compelling, inspirational, funny, straightforward, assertive, honest, candid, wry and dedicated.

“The way we give birth is an expression of culture. It can be spontaneous and instinctual, but it is still patterned by the society in which we live.”

–Sheila Kitzinger

Stay tuned for an ongoing series of themed posts based on additional content and thought-provoking quotes!

In a pioneering career spanning more than 50 years she campaigned for and oversaw a radical change in maternity care, placing women’s rights and choices at the very heart of childbirth. Her passion, research and knowledge of childbirth have had enormous impact on millions of women worldwide.

A Passion for Birth | Sheila Kitzinger | Pinter & Martin Publishers.

Publishing and purchasing details: 

Author: Sheila KitzingerSheila
Published: 7 May 2015
Binding: hardback
Format: 240 x 160 mm
Pages: 384
Illustrations: colour and b/w photographs
Pinter & Martin edition available: worldwide
Translation rights: Pinter & Martin

Also available from: Amazon.co.uk | Wordery | The Hive | Waterstones | Foyles | Mail Bookshop | Amazon.com

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

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