Preventing Culturally Induced Lactation Failure

How often does it happen that women truly are physically unable to breastfeed?

No one actually has a solid answer to this question. The common estimate is a very hazy, “less than 1%.” I’ve said it, very hazily, plenty of times myself. But, what does that really mean? I’ve certainly talked with a lot of struggling mothers over the years—many of whom go on to continue to breastfeed successfully, but who might very well not have done so without encouragement, reinforcement, and practical suggestions. If they never reached out for help, might they have ended up as part of that semi-mythical 1%? How about those mothers that absolutely stagger me with their ability to keep going and keep trying when I would understand completely if they decided to quit and in fact question that I, personally, would have been able to continue if faced with the same obstacles—where do they fit in? Maybe just in the category box labeled amazing.

Yesterday, I read an article on the Breastfeeding Medicine blog that really shook my personal framework up a bit:

…I would argue that there’s a very fine line between “sensationalizing” and “truth in advertising.” Reproductive biology is imperfect — some couples can’t conceive, and some pregnancies end in miscarriage or stillbirth. The silence around these losses and the isolation that women have historically experienced has probably worsened the suffering for many women. On the other hand, emphasizing these risks and creating a culture of fear harms the majority of mothers who will have successful pregnancies and births.

Lactation is probably a few decades behind infertility and pregnancy loss in coming “out into the open” as a generally robust, but not invincible, part of reproductive biology.

via Establishing the Fourth Trimester « Breastfeeding Medicine.

Wow! Brain boggled in reading this. Heart clenched at thinking that I may have treated someone as casually in breastfeeding loss as other mothers have been treated over and over again in pregnancy loss. The author goes on to explain that women used to be blamed for having miscarriages and we just might be doing the same thing to women who physically can’t breastfeed. I have never in my wildest dreams considered adding “lactation failure” to my understandings of the things that can truly go wrong during the childbearing year. I usually consider, “some mothers are physically unable to breastfeed” to essentially be in the same territory as dragons and unicorns. I’ve remained firmly convinced for, like, ever, that it is culture that fails mothers and babies and not women’s bodies that fail. And, I truly wonder if it is ever possible (except for in cases of insufficient glandular tissue, metabolic disorders, breast surgery/removal, and clear physical malformations) to really tease apart whether a mother is actually experiencing lactation failure or sociocultural failure. I remain fairly convinced that in many cases it is impossible to know—but, that a mother (or physician) may certainly experience it as “lactation failure” and thus add that data point to the 1%. I have long maintained that a lot of people forget that breastfeeding occurs in a context and that context doesn’t necessarily support breastfeeding. However, I do also know from years of experience that motherbaby physiology can lead to problems too and we often overlook that in assertions about breastfeeding.

How do we get breastfeeding off to a good start?

At our 2011 Big Latch On event.

How do we make sure that mothers do not experience sociocultural breastfeeding failure? It begins with the birth. Birth and breastfeeding are not discreet events—they exist on a biological continuum. When I attended the La Leche League International conference in 2007, there was an exciting emphasis on “the motherbaby” as a single psychobiological organism. The womb is the baby’s first habitat and following birth the baby’s “habitat” becomes the mother’s chest—otherwise referred to as “the maternal nest.” In short, a normal, healthy, undisturbed birth leads naturally into a normal, healthy, undisturbed breastfeeding relationship. Disturbed birth contributes to disrupted breastfeeding. In a previous article on this topic I wrote:

New mothers, and those who help them, are often left wondering, “Where did breastfeeding go wrong?” All too often the answer is, “during labor and birth.” Interventions during the birthing process are an often overlooked answer to the mystery of how breastfeeding becomes derailed. An example is a mother who has an epidural, which leads to excess fluid retention in her breasts (a common side effect of the IV “bolus” of fluid administered in preparation for an epidural). After birth, the baby can’t latch well to the flattened nipple of the overfull breast, leading to frustration for both mother and baby. This frustration can quickly cascade into formula supplementation and before she knows it, the mother is left saying, “something was wrong with my nipples and the baby just couldn’t breastfeed. I tried really hard, but it just didn’t work out.” Nothing is truly wrong with her nipples or with her baby,

I know that my birth experiences significantly impacted my breastfeeding experiences in that my babies were never separated from me after my peaceful, undisturbed births (one birth center, two homebirth). They went directly from being born to my breast, keeping the physicality and continuity of our relationship unbroken and undisturbed. That is not to say that we never experienced any challenges, I struggled with oversupply with all of them—which reminds me of attending another LLL conference presentation by Diana West in which she stated that she is seeing much fewer “normal course of breastfeeding” issues in her practice and instead of noticing an “epidemic of both low milk supply and oversupply.” She asked the room if we were noticing the same thing and many of us raised our hands. One possible theory is the amount of endocrine disruptors in our food supply. Again, is that actual lactation failure or is that ecological failure?!

Some time ago I wrote an article for the Friends of Missouri Midwives newsletter in which I asked for submissions regarding the topic of how birth experiences impact breastfeeding. A doula wrote to share her experiences:

My births definitely affected my breastfeeding experiences. I prepared extensively for my first child’s birth. I felt fully educated about birth and also breastfeeding. I planned and had a natural birth. Being empowered by that helped me know I could handle and be successful at breastfeeding too. My two unassisted births were “all me”. There was no one telling me what to do. I was confident in that and that also helped build my confidence one again in breastfeeding. I will also go on to say that not only did my natural hospital birth and subsequent home births help in breastfeeding, but also generally as a mother. They empowered me to know that I was capable of a lot more than I could ever imagine! (Which is great on a day with three little ones screaming around the house!)

And, a local physician also had input about the question:

Gosh, my own experience–how can I know how my birthing influenced my breastfeeding? Since the nursing part was so easy, and I birthed at home (thank heavens), well, how would I know if it would have been different if we had done it differently? But I know this: it is SO much easier being a breastfeeding supportive physician to home born babies than it was trying to support breastfeeding when the birth was distorted. In my experience, the only other thing that makes that much difference is La Leche League attendance. I think mothers and babies are designed to experience labor and birth and then breastfeed. When things go differently–like when labor is started early for some reason, or when mothers don’t get to experience their labors and births because of epidurals or other drugs or cesarean sections, then the breastfeeding is more likely to be challenged.

Babies are programmed to learn to nurse in that first hour after birth. They need to be in contact with their mothers for that time to do that. It doesn’t take much intervention to undermine that. Our babies are working so hard, learning to live on the outside of the womb–changing everything, including their breathing, their circulation, their digestion, elimination, integrating new and overwhelming sensations–and also learning the complex skill of finding the nipple, grasping the nipple, holding the nipple, milking the nipple (and don’t forget to swallow and breathe!). We should leave them alone and not ask them to do one more thing–like meet Grandma, or deal with the nurse, or warm back up from a bath.

So here’s my advice: If you want to breastfeed and do it effortlessly:

1. Get great prenatal care from the best midwife you can find

2. Plan and achieve a home birth

3. Go to La Leche League regularly during pregnancy and nursing.

This doctor then wrote back to me again with some additional comments about breastfeeding and La Leche League:

La Leche League makes a BIG difference. In my experience, mothers who are members have far fewer reasons to call me for advice (of any kind, really). And when they do, they tend to be focused, easy-to-answer questions or requests. So, instead of “my nipples hurt,” it is, “I’ve been reading/talking to/consulting with various sources and I think that I have nipple thrush. The things I have tried haven’t worked and I am not ready to try Nystatin. Can you prescribe this for me?” LLL ladies ROCK!

I am convinced that a thousand little adjustments get made in the wise nursing circles–a comment made, a slight modification of a nursing position, an encouraging word, a question asked, a behavior modeled. With these gentle, under-the-radar moves, nursing just gets easier or stays easy. The woman and her circle never consider that a “nursing problem” existed. No big intervention needs to happen.

Without these “interventions” nursing problems DO develop, and then the rescue team gets called in–people have big feelings, do big or little interventions, they help or they don’t and people feel like heroes or failures and “breastfeeding problems” get into the story-telling. But what gets lost is how easily these things are “prevented”.

Midwifery is like this. Parenting is like this. Life is like this.

I really appreciate her closing observations here about wise nursing circles. I believe it can be in these circles that we find the women who know and we can certainly give each woman who we come into contact with the best chance at preventing or overcoming culturally induced lactation failure.

Birth Activism Opportunities!

Dec20

Recently I got an email letting me know that I’ve been nominated for the Health Activist Hero Award in this year’s WEGO Health Activist Awards! Nominations are open through December 31st, 2012, after which judging will begin. You can “endorse” my nomination by clicking on the badge. You can also follow the happenings on WEGO’s Pinterest board. You can also nominate someone! There are 16 award categories and there’s no limit to the number of people you can nominate with this quick form.

Second, Freedom for Birth just released a free 15 minute version of their documentary online. Check it out!

Talk to Your Baby

Dec15

I already know that you can learn a lot from chickens about giving birth. This summer, I had another profound birth-mothering experience with one of our chickens after she hatched her first baby. During the last several days of incubation, mothers hens “talk” to their babies a lot through the eggshells and the babies respond. It is part of how they get to know each other and imprint before hatching. Then, after baby hatches, the mother hen continues to talk and cluck to the baby in a reassuring manner—she calls to the babies when separated and she calls a special call when there is something good to eat and she clucks softly and reassuringly at bedtime as she snuggles them all beneath her. There is a specific type of “soothing” noise they make to stressed or lost babies and a specific sort of excited sound they make to let the babies know something good is happening. There are also distressed sound that means, “run to me now, there might be danger!”

The baby chick who tried desperately to get to a mama who would talk to it (this mama, interestingly, is the same one I wrote about in the Birth Lessons from a Chicken essay several years prior).

We had three broody chickens at the time, each in their own little separate nest box in the broody coop. One of the hens had hatched a baby already and was in the neighboring box. The inexperienced mama hen hatched her baby and she would not talk to it. The baby freaked out. It flailed, it freaked, it stumbled all around. It dragged its tiny little wet, not-even-able-to-walk body to the very corner of the nest box as far away from the mother as possible. It flung itself into the wall where it could hear the neighboring mother clucking to her baby. The baby peeped more frantically and loudly than I’ve ever heard a chick cry out before, it sounded like it was in grave distress and danger. We moved it back to its mother and she fluffed out her wings around it just like she was supposed to do and I thought all would be all right, but…silence. The mother did not talk. Her baby desperately struggled out from under her, still not able to walk, still wet, and flung itself back into the corner, sinking down under the straw, crying piteously. Silence from the mother.

Talk to your baby, we pleaded. Your baby needs to hear you. Please talk to your baby. Silence. The baby squished down on the wire slats, pressed into the corner of the box, screaming at the top of its chick-lungs. The mother in the next box became distressed as well, calling back to the baby more and more loudly. The chick became more frenzied and flopping. The baby in the next box picked up on the fear and began peeping loudly as well. Still, the new mother sat silently and unresponsive. Talk to your baby. We left her alone, thinking her instincts would kick in, but as time passed and we could hear the chick screaming from all the way across the yard, we went back to interfere. We tried twice more to put it back under her and again the same routine repeated. We became concerned the baby would die if its level of distress continued, particularly with forcing itself down and under the straw and into the wire, so we made the decision to remove it and put it in “foster care” with the other, responsive mother. We thought she might attack it, since it wasn’t her own hatchling and because it was several days behind her own baby, but she snuggled it right up, clucking in reassurance, and it went to sleep, the next morning it was fluffy and quiet and perfectly happy with its new mother. The red hen continued to sit, silent, and unresponsive, and of course I felt horrible for stealing her baby and giving it to someone else after she’d worked so hard to hatch it. Luckily for the mental health of all involved, she successfully hatched one more baby and did take care of it, albeit still quite silently compared to all other mama hens we’ve experienced.

What does this have to do with birth?

Babies are primed to hear their mothers’ voices after birth. They expect to be snuggled into the maternal nest. Mammal babies expect to receive a warm breast and to hear comforting words in their own language. I feel fortunate that my own birth pause was respected after all my children’s births and that each baby felt only my hands and heard my voice for their first minutes of life. I talked to all my babies, soothingly and lovingly, and then brought them to my breast. My midwife and the other people around me did not interfere with these sacred, timeless moments of introduction.

It has been several years now, but I’ve worked with a couple of mothers for breastfeeding help postpartum who were unwilling or unable to talk to their babies, even with direct encouragement to do so. Baby was expecting mother’s voice and mother was unable to give it. Not surprisingly to me, these mothers experienced significant difficulty in getting baby to breast. I believe baby is expecting mother’s voice as a guide to the breast as much as it is expecting the smell of her and the sound of her heartbeat. Baby is not expecting multiple, strange voices from nurses (or even helpful breastfeeding helpers like me!). Baby is not expecting gloved hands. Baby is not expecting bright lights or loud noises. Baby is most definitely not expecting to be “helped” to the breast and “shoved” on as many mothers describe experiencing after their births. In Breastfeeding Answers Made Simple, the author emphasizes that what motherbaby pairs need most to successfully breastfeed is time alone to get to know each other. Mother and baby need to explore each other’s bodies and to listen to each other. She points out that with many people in the room, even well-meaning people, mothers have trouble getting to know their babies and getting babies to breastfeed. She says the most helpful strategy to supporting early breastfeeding is to get out of the way and let mother talk to her baby, smell her baby, touch her baby, meet her baby, and learn about her baby.

The non-communicative mother and her second baby, who was okay without much talking.

What are we really imprinting upon many newborns at birth in our culture?

As Sister MorningStar writes in her article The Newborn Imprint in Midwifery Today issue 104, Winter 2012…

If you have had the misfortune, as nearly all of us who can read and write have had, to see a baby born, perhaps pulled out, under bright lights with glaring eyes and loud noises of all sorts, in a setting that smells like nothing human, with a mother shocked and teary and scared; if you have witnessed or performed touch that can only be described as brutal and cruel in any other setting…

Every baby born deserves uninterrupted, undisturbed contact with her mother in the environment the mother has nested by her own instinctual nature to create. Any movement we make to enter that inner and external womb must be acknowledged as disturbing and violating to what nature is protecting. We do not know the long-term effects of such disturbance. We cannot consider too seriously a decision to disturb a newborn by touch, sound, light, smell and taste that is different and beyond what the mother is naturally and instinctually providing. Even facilitating is often unnecessary if the motherbaby are given space and time to explore and relate to one another and the life-altering experience they just survived. They both have been turned inside out, one from the other, and the moment to face that seemingly impossible feat cannot be rushed without compromise. We have no right to compromise either a mother or a baby.

I am deliberately leaving out the issue of life-saving because it has become the license for full-scale abuse to every baby born… [emphasis mine]

If mother has been taken to an operating room to give birth, or if mother is for any reason overwhelmed, exhausted, scared, vulnerable, hurt, and traumatized, she may have great difficulty in talking to her baby. If the room is full of people, baby may have difficult hearing her mother’s voice and feeling her welcoming touch. If baby is greeted by a bright light and masked face instead of her mother’s voice, baby may cry loudly in distress and eventually “shut down” into sleep rather than immediately to breastfeeding.

What can we do?

Beyond the obvious answers in carefully choosing place of birth and birth attendant, we can talk to the babies. If birth has been long, scary, or otherwise difficult, talk to the baby. If baby needs immediate care after birth, try as hard as humanly possible to have that care take place on mother’s chest and in reach of mother’s voice. If baby has to be separated from mother, talk to the baby. Call out to him. If mother can’t call out to the baby, father can talk to the baby. If father is unable, doula or midwife or nurse can talk to the baby. Welcome her to the world, reassure her that she is safe and all will be well. Speak gently and soothingly and kindly, never forgetting that this is a new person’s introduction to the world and to life. Our first and deepest impulse is connection. Before Descartes could articulate his thoughts on philosophy, he reached out his hand for his mother. I have learned a lot about the fundamental truth of relatedness through my own experiences as a mother. Relationship is our first and deepest urge and is vital to survival. The infant’s first instinct is to connect with others. Before an infant can verbalize or mobilize, she reaches out to her mother. Mothering is a profoundly physical experience. The mother’s body is the baby’s “habitat” in pregnancy and for many months following birth. Through the mother’s body, the baby learns to interpret and to relate to the rest of the world and it is to the mother’s body that she returns for safety, nurturance, and peace. Birth and breastfeeding exist on a continuum, with mother’s chest becoming baby’s new “home” after having lived in her body for nine months. These thoroughly embodied experiences of the act of giving life and in creating someone else’s life and relationship to the world are profoundly meaningful experiences and the transition from internal connection to external connection, must be vigorously protected and deeply respected.

“Birth should not be a celebration of separation, but rather a reuniting of mother and baby, who joins her for an external connection.” –Barbara Latterner, in New Lives

“No mammal on this planet separates the newborn from its mother at birth except the human animal. No mammal on this planet denies the breast of the newborn except the human.” –James Prescott (neuropsychologist quoted in The Art of Conscious Parenting)

“A woman’s confidence and ability to give birth and to care for her baby are enhanced or diminished by every person who gives her care, and by the environment in which she gives birth…Every women should have the opportunity to give birth as she wishes in an environment in which she feels nurtured and secure, and her emotional well-being, privacy, and personal preferences are respected.” –Coalition for Improving Maternity Services (CIMS)”

As dear as breathing…

Dec3

“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

Birth politics have been on my mind this week as I’ve come across various debates from within the birth profession about the regulation of midwives and the question of licensure, and then also the seemingly ever-present critiques of homebirth from outside the homebirth community. I don’t feel as if I have time lately to fully follow all the issues, but Citizens for Midwifery’s recent response to ACOG’s newest homebirth and maternal rights smackdown contains some important thoughts:

AJOG editorial rejects the ethic that autonomy is a fundamental human right

This article represents a serious attack on home birth and on patient centered care in the United States. The attack is based on poor research and runs roughshod over established rights to bodily integrity…

…not only does the article attack home birth, it also represents an attempt to “export” to the rest of the world a position that the obstetric profession, not mothers, should have the final decision on birth, at a time when that isn’t even legally defensible here in the United States…

…One contradiction stands out as the authors call for “safe, respectful, and compassionate” hospital delivery. No hospital birth can be truly respectful if the birth is happening in the hospital because the physician disrespects the woman’s right to an alternative and has rigged the system to eliminate access to all legal alternatives…

via Citizens for Midwifery

Related thoughts:

Maternal-Fetal Conflict?

The Illusion of Choice

“Woman-to-woman help through the rites of passage that are important in every birth has significance not only for the individuals directly involved, but for the whole community. The task in which the women are engaged is political. It forms the warp and weft of society.” –Sheila Kitzinger

The Of COURSE response…

Nov16

“As long as women are isolated one from the other, not allowed to offer other women the most personal accounts of their lives, they will not be part of any narratives of their own…women will be staving off destiny and not inviting or inventing or controlling it.” –Carolyn Heilbrun quoted in Sacred Circles

I recently finished taking a class in Ecofeminism, which makes connections between the exploitation and domination of women and the exploitation and domination of the planet. Naturally, as I also did with breastfeeding as an ecofeminist issue, I made many connections between the theme of the class and birth rights for women. The author of the book Ecofeminist Philosophy, Elizabeth Warren explains that when you are part of an unhealthy social system, you are likely to experience predictable, even “normal” consequences of living in that system: “This element of predictability explains the appropriateness of what I call the ‘Of course’ response: ‘Of course, you feel crazy when men say it’s your fault that you were raped, or that you could have prevented it.’ ‘Of course, your life has become unmanageable…'” we live in a culture that expects women to do it all and to always love parenting. If we look at our mainstream culture of birth as an unhealthy social system, I find the same response is appropriate. You really wanted to have a natural birth and then your doctor scared you into having an induction and you ended up with an epidural, of course you feel like you ‘failed.’ You feel healthy and beautiful, but now your doctor tells you that you’ve “failed” the GTT and are now “high risk,” of course, you feel stressed out and…like a high risk “patient.” You tried really hard to labor without medications, but you were “strapped down” with IV’s and continuous monitoring, of course, you felt like a trapped animal and like you had no other choices but medications. Of course, you feel upset and discouraged that your baby is ‘rejecting’ you and your breast after having been supplemented with bottles in the nursery. Of course, you are crying all the time and wondering if you are really cut out to be a mother, when your husband had to return to work after two days off and you are expected to be back at your job in five more weeks. And, so on and so forth.

“The ‘Of Course’ response affirms that those who feel crazy, powerless, alone, confused, or frustrated within unhealthy systems such as patriarchy are experiencing just what one would expect of them.” What the model of medical birth as an unhealthy social system reveals is that “no matter where one starts on the circle…one eventually comes round to one’s starting point. The circle operates as an insulated, closed system that, unchecked and unchallenged, continues uninterrupted…” How does one break free of an unhealthy system? “Getting the right beliefs by rearranging one’s thinking is an important part of the process, but it is not enough.” [emphasis mine. Here, Warren goes on to explore the issue of rape, but I have adjusted her words to be about birth instead] One can have the “right beliefs” about the prevalence of unnecessary cesareans, one’s rights as a childbearing woman, and the institutional nature of birth in our country and still experience an unwanted and unnecessary cesarean section. One can understand connections among faulty belief systems, language that devalues women, women’s bodies, and the birth process, and patriarchal behaviors of control and domination and still witness the catastrophic impact of this domination. “So, even if one must start with oneself and one’s belief system, one cannot end there. Since the problem is systemic, the system itself must be intervened upon and changed—by political, economic, social, and other means.” –Karen Warren in Ecofeminist Philosophy, p. 211. (emphasis mine)

Sometimes I honestly feel like I am one of the few people who really notices or labels the powerful systemic context in which women give birth in America. A lot of pregnancy and birth books and pregnancy and birth bloggers focus on individual responsibility and “education.” If women are always expected to “stand up for themselves” in the birth room and “get educated” so that they, personally, can prevent themselves from having unwanted interventions, of course our rates of unwanted interventions continue to rise.

“Through the act of controlling birth, we disassociate ourselves with its raw power. Disassociation makes it easier to identify with our ‘civilized’ nature, deny our ‘savage’ roots and connection with indigenous cultures. Birth simultaneously encompasses the three events that civilized societies fear–birth, death, and sexuality.” –Holly Richards (In Cultural Messages of Childbirth: The Perpetration of Fear,” ICEA Journal, 1993)

Call for your experiences – the impact of birth trauma and beyond | Rebecca A. Wright

Nov11

http://rebeccaawright.com/

An online friend and sister birth professional, Rebecca Wright, emailed me recently to share some information about an important new project that she is launching:

I’m planning to write a book on birth trauma that will centre on women’s voices and experiences. It’s not going to be so much dwelling on birth trauma (though there will be an element of that as I want people to understand that whether an experience was ‘objectively’ traumatic or not, it can have an enormous impact – and I think a lot of women say to themselves, ‘my experience wasn’t as bad as some others I hear about’ and so don’t feel able to validate their own feelings and experience). What I really want to focus on is a) the impact of birth trauma (or of ‘difficult’ birth experiences) on mothers, babies, partners, families; b) the many individual paths to healing from birth trauma that people have walked; c) rediscovering your power in birth and motherhood following a difficult or traumatic experience.

She’d like to reach out to mothers, but also their partners, and doulas (midwives, nurses, doctors, etc.) and she’s also interested in hearing from practitioners of whatever sort who work with women and families around these issues.

Full details are available on her blog:

I want this book to be made of women’s voices (and men’s as well). I want it to be a place where the unspoken is spoken clearly and openly. I want it to be a book that honours the sacredness of each birth journey, and each path to healing. I want it to be a book that opens doorways for those who are feeling lost or alone so that they can find hope and a way forward that is suitable for them personally. Most of all, I want it to be a book that shows that it is possible to reclaim your personal power in birth and mothering following a difficult or traumatic experience in birth.

via Call for your experiences – the impact of birth trauma and beyond | Rebecca A. Wright.

Make sure to check out her project and see if you can lend your voice to what sounds like a beautifully healing book!

And, speaking of birth trauma, a while ago, I also received a question via Facebook asking for recommended resources for healing from traumatic birth. Check out the series on Giving Birth with Confidence about traumatic birth prevention and recovery. Or, look into Solace for Mothers.

Woman-Centered Collaboration

Oct8

I’ve posted a couple of times about a collaboration with the Women’s Health in Women’s Hands launch of the feminist women’s health classic Woman-Centered Pregnancy and Childbirth as a pdf version for free online. When I wrote my What to Expect post based on Woman-Centered Childbirth in 2009, I had no idea that one of the authors of the book would later find me on the internet, let alone distribute postcards at the National Rally for Change in Los Angeles containing a quote from me and link to my site. As I’ve said several times lately, I just love the internet. It is amazing to me that these types of connections and collaborations can occur over long distances and without face-to-face contact. Very cool!

Anyway, this week I received a promo launch packet for the online release of the book. It includes two printouts from my own website and the re-formatted flier based on my blog post, as well as a folder and postcards.

And, then I took picture of the packet and included my own vintage copy of the original Woman-Centered Childbirth book 🙂
This has been a fun link between past and present activism and between a foremother in birth activism and my current self!

Bits of the (Birth) Net

Oct6

The following is a collection of the bits and pieces that caught my attention and then were shared via my Talk Birth Facebook page during the last two weeks.

Listening

From a good article by the National Association of Mothers’ Centers in Mother Support: When Words Get in the Way…

Words, whether written or voiced, are so very fragile. They can be bent or twisted, even become unrecognizable from their initial intentions. They can have different cultural meanings, regional understandings, and generational perceptions.

There will always be the opportunity for miscommunication…

Such a good reminder. What you say and what people hear are often two different things. What you say and what you mean can be different. How your words are received and interpreted can be very important and intent in many ways doesn’t matter! Communication is transactional process. A two-way process. And, it is symbolic. Meaning can never be fully interpreted and understood completely.

This article also reminded me of one of my own older articles, Listening Well Enough, which came to mind because I’m finishing up with the training of two women. The essay describes my own experience when I was training as a breastfeeding counselor in 2005.

Privacy

The topic of what to risk sharing online came up with friends recently and I enjoyed this article about answering the question of How Much Of Your Private Life Should You Keep Private On Your Blog?

Childbirth Education

“Childbirth education is beginning too late in pregnancy; it needs to begin in the first trimester or even before women become pregnant…”

The above is one of the concluding points from an interesting article from Birth Works International about supporting women without epidurals.

Good article from Lamaze about your breath and how it can help during pregnancy and birthing!

Virtual labor simulator!

Pushing Positions

Very interesting article on What is the Evidence for Pushing Positions? Apparently there is more blood loss and second degree tears with upright pushing positions. Personally, I CANNOT imagine giving birth in a supine position. But, I’m also really, really, tired of tearing (tired enough that it is one of the factors in our decision not to have “just one more!” baby). For more thoughts about pushing, see previous post on Following Your Body’s Urges to Push…

And speaking of upright birth, Barbie homebirth photos! 🙂

Informed Consent

Valuable article addressing 10 Responses to Pressure to Consent (remember, it isn’t “informed consent” if you do not have the option of saying NO!)

Posts I’ve written about informed consent:

Conscious Agreement and Informed Consent

The Illusion of Choice

Honesty in Birth Preparation

Information ≠ Knowledge

Can I really expect to have a great birth? (updated edition)

Prenatal Yoga

Online video prenatal yoga class: Prenatal Yoga – when you feel good, your baby feels good.

And my own prior posts on the subject:

Incorporating Prenatal Yoga into Childbirth Education Classes

Birthing Room Yoga Handout

“Birth, this elegant, simple, yet intricate process has had unnecessary, complex, expensive technology superimposed onto it, creating a dangerous environment for birthing women.” -Alice Bailes

Loved this article on what really matters for midwives!

Epigenetics

NEW STUDY: Epigenetics: Mother’s Nutrition — Before Pregnancy — May Alter Function of Her Children’s Genes. “As parents, we have to understand better that our responsibilities to our children are not only of a social, economical, or educational nature, but that our own biological status can contribute to the fate of our children, and this effect can be long-lasting,” said Mihai Niculescu, M.D., Ph.D., study author from Nutrition Research Institute at the University of North Carolina at Chapel Hill, in Chapel Hill, N.C.–Epigenetics: Mother’s Nutrition — Before Pregnancy — May Alter Function of Her Children’s Genes

After CAPPA this year, I wrote about epigenetics here: Epigentics, Breastfeeding + Diet, and Prenatal Stress

Call the Midwife

Fun! Ms. Magazine linked to one of my blog posts about midwifery in their post about the PBS show Call the Midwife! And, after posting to the CfM Facebook page about how I didn’t get to watch the show myself because I have no TV channels, CfM fan Jackie clued me in that Call the Midwife is available online (no TV channels required!) Yay! 🙂

Older Posts of My Own

Birth Culture: “Birth is cultural, the way eating is cultural. We don’t just eat what our bodies need to sustain us. If we only did that, there would be no reason for birthday cake. Birthday cake is part of our food culture. The place you are giving birth in has a local culture as well. It also partakes of our national birth culture. Not everything doctors do regarding birth makes the birth faster or physically easier for you or the baby. Some things are just cultural.” -–Jan Mallack & Teresa Bailey

Creating Needle Felted Birth Art Sculptures: My first foray into birth art, before I fell in love with using polymer clay!

Centering for Birth: “Centering is a breath awareness strategy that I’ve adapted for use in birth classes based on the ten second centering process described in the short book Ten Zen Seconds…” Free handout available about centering for birth! (I was reminded of this post by Enjoy Birth!

Breastfeeding as an Ecofeminist Issue:“What happens when society and culture pollute the maternal nest? Is that mother and baby’s problem or is it a political and cultural issue that should be of top priority? Unfortunately, many politicians continue to focus on reproductive control of women, rather than on human and planetary health…”

During a week when I didn’t have time to craft delightful new blog posts, it was fun to have a post from a couple of months ago suddenly getting all kinds of hits and Facebook shares. Thanks, internet! ;-D (Around 150 shares on Facebook apparently. I ♥ Facebook!)

On Parenting Books

Mama Birth: Sadly, Parenting Books CAN’T Actually Raise Your Child: Enjoyed this post! (But I recommend NOT reading the comments on the original article she links to about “detachment parenting.” I lost about 30 minutes of my life, felt my blood pressure rising, and only made it to page three!)

“The revolution must have dancing; women know this.
The music will light our hearts with fire,
the stories will bathe our dreams in honey
and fill our bellies
with stars.“

-Nina Simons via Rebecca A Wright, Doula

Domestic Violence During Pregnancy

Sep26

By Molly Remer, MSW, ICCE, CCCE

Violence during pregnancy is an unfortunately common experience. Between four and eight percent of women experience domestic (intimate partner) violence during their pregnancies. The incidence of violence increases for women with unplanned or unwanted pregnancies with 26% of pregnant teens experiencing intimate partner violence and 15% of all women whose pregnancies are unwanted being in an abusive relationship. Indeed, murder is the second only to car accidents as the most common cause of injury related death for pregnant women.[1] Sadly, these statistics are likely higher in reality due to underreporting or misclassification.

Despite prevalence and severity, domestic violence is not often addressed in the birth community. Books directed at pregnant women rarely even mention violence in pregnancy (and most do not even include it at all), even though the incidence is similar to the rate of premature births and much higher than the incidence of various pregnancy related complications that generally warrant at least a paragraph in birth literature (such as placenta previa). Likewise, books and training programs for doulas, birth educators, and other birth professionals, generally neglect to address intimate partner violence.

An introduction to the issue of domestic violence during pregnancy requires an understanding of the following dynamics:

Cycle of Violence—the concept that violent behavior in a relationship tends to occur in three distinct phases. In the tension building phase, the battered partner feels as if she is “walking on eggshells.” The abuser’s temperament and mood becomes increasingly unpredictable and volatile and culminates in the explosion/eruption phase in which an acutely violent incident occurs. Early in a relationship, this phase is often followed by the honeymoon phase during which the batterer is contrite, asks for forgiveness, offers gifts, and assures the woman that, “it will never happen again.” The length of each phase varies by couple and with their relationship. Over time, the tension building or explosion phases may be very prolonged, with little or no time spent in the honeymoon phase.

The cycle of violence continues to repeat and tends to escalate in severity, despite the assurances that the batterer makes during the honeymoon phase.

Domestic violence is about power and control. It is NOT about anger management, substance abuse (though substances can increases violent incidents), or “nagging” from a girlfriend or wife.

The abusive partner tends to tell the woman that the violence is her fault and that she provokes or deserves the abusive incidents. He often isolates her from people and situations that will help her know otherwise.

Abusive relationships may involve physical, emotional, or verbal battering and frequently some combination of the three. Physical abuse includes pushing, choking, kicking, sexual abuse and other means of physical control/harm as well as punching or slapping. Verbal and emotional or psychological abuse involves name calling, insults, berating, shouting/screaming, humiliation, threats, intimidation, destruction of property, isolation, activity restriction, abuse of pets, and withholding of economic, physical, or emotional resources. Women often forget to acknowledge some physical forms of violence like choking or pushing as “real” abuse and will often not consider themselves abused unless they have been punched or slapped by their husband or partner.

Women stay in abusive relationships for numerous reasons. Battered women often leave their relationships several times before they end it for good. Reasons are dynamic, complex, and individual. Some very basic reasons include hope, love, and fear. The most dangerous time in the relationship is when she leaves—it is then that she is most likely to be severely injured or killed. As a society, we should NOT be asking why women stay, we should be asking how we can stop domestic violence from happening.

So, what can you do? If you are a pregnant woman who is being abused, please contact your local domestic violence shelter or hotline. Or, call the National Domestic Violence Hotline at 1-800-799-SAFE. Even if you do not feel ready to leave your relationship, many shelters offer “outpatient” support groups and counseling. If you are a prenatal health care provider (midwife, doctor, nurse, physician assistant), please include domestic violence screening questions during your prenatal visits and be alert and responsive to signs of violence. If you are a doula, birth educator, or other birth professional, include a discussion of domestic violence during your classes or prenatal visits and encourage exploration and acknowledgment of these issues during your networking with other birth workers. You may also wish to download and read the Center for Disease Control’s guide, Intimate Partner Violence during Pregnancy: A Guide for Clinicians. If you are a friend or relative of a pregnant woman experiencing abuse, help her develop a safety plan and encourage her to seek the services of a domestic violence shelter.

Though it can be very awkward to address domestic violence issues with women directly and can feel like an intrusion into private lives, if you choose silence, you contribute to a continued culture of fear, shame, denial, and invisibility for the many women experiencing violence during this time in their lives. Acknowledging the reality and prevalence of violence against women in our culture and encouraging open, respectful, and assertive dialog about it is a powerful tool in reducing the occurrence. Strive to help bring violence against pregnant women into public view instead of considering family violence to be private, family business. Women and babies are too important for us to remain quiet.

Portions of this article are excerpted from the booklet Talking to a Battered Woman: A Guide for the Short Term Helper by Molly Remer, MSW, ICCE. This booklet is available as free pdf file on Molly’s website (http://talkbirth.me). Molly is a certified childbirth educator, the editor of the Friends of Missouri Midwives newsletter, a breastfeeding counselor, and a college professor.

[1] National Coalition Against Domestic Violence Fact Sheet “Reproductive Health & Pregnancy,” http://www.ncadv.org/files/reproductivehealthandpregnancy.pdf

This article was originally published in Citizens for Midwifery News and was later reprinted in International Doula along with a companion sidebar by Susan Hodges.

Guest Post: Abuse of pregnant women in the medical setting

Sep26

This post is a companion piece to my article, Domestic Violence During Pregnancy, and was previously published as a sidebar in Citizens for Midwifery News and later in International Doula.

Abuse of pregnant women in the medical setting

By Susan Hodges, founder and past President of Citizens for Midwifery

Have you or someone you know experienced rude, abusive or violent treatment at the hands of obstetricians or other hospital staff? Abusive behavior, in or out of the hospital, can include threats, coercion, yelling, belittling, lying, omission of information, lack of informed consent, misrepresentation (of medical situation, of interventions, of reasons they “need” you to do something or not do something), and so on. For example, nurses yelling at a woman to push is abusive, even if the nurses don’t intend to be abusive. An OB lying to a woman that her baby is “too big” (something that neither he/she nor anyone else can predict), telling her she “needs” intervention, and then not providing complete information about the risks and benefits of the intervention, is abusive behavior. Unwanted and unnecessary surgery (such as episiotomy or an avoidable cesarean section) is no less violence against a woman than hitting or strangling – most of us have just not thought about it in that way. The fact that most women are persuaded that they “needed” the intervention, that it was because their body was somehow defective, is another aspect of the abuse (blaming the victim).

While the situation is different from domestic violence in some ways, it is also similar. Abuse in the medical setting is also about power and control, the pregnant or laboring woman is often blamed for her situation, and verbal and emotional abuse can be similar. Because we are taught to “trust your doctor”, and in fact there is an explicit assumption of trust in the “fiduciary relationship” between the woman and her doctor who is an “expert”, most of us do not think about the possibility of abuse, and many of us stay with the OB or feel we have no choice about our health care providers or settings, especially when we are in labor. Also, the doctors and staff generally are not even aware that their behavior or actions are abusive.

Forty years ago, domestic violence happened, but was hidden and accepted. A lot of women had to do a great deal of work to come up with the language and the legal strategies, and to educate women, law enforcement, judges, mental health workers, and many others to get us to the point where we are today, where at least the problem has a name and at least some of the time women can fight back with the law on their side.

It is extremely difficult to deal with an abusive OB (and it might be hidden abuse, manipulation, etc.) in the middle of labor, just as is very difficult to effectively deal with an abusive spouse in the middle of the abuse. The childbirth community is only just now beginning to recognize that women are being abused in many ways in the present system of maternity care. We don’t really have special words for it yet. We do have some legal underpinnings to fight at least some of it, but we are in the very early stages. It will take recognition of the problem on a larger scale and by women who are not being abused by OBs to bring this issue to public attention, create language for it, and use legal tools to end it. We have a lot of work to do.

Have you experienced abuse? At the least you can file a complaint. See “Unhappy With Your Maternity Care? File a Complaint!” at http://cfmidwifery.org/Resources/item.aspx?ID=1

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