Some reminders for postpartum mamas & those who love them

Postpartum with Alaina, February 2011

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

Matrescence

In Uganda there is a special word that means “mother of a newborn”–-nakawere. According to the book Mothering the New Mother, “this word and the special treatment that goes with it apply to a woman following every birth, not only the first one. The massages, the foods, the care, ‘they have to take care of you in a special way for about a month.'”

There is a special word in Korea as well. Referring to the “mother of a newborn child,” san mo describes “a woman every time she has had a baby. Extended family and neighbors who act as family care for older children and for the new mother. ‘This lasts about twenty-one days…they take special care of you.'”

These concepts—and the lack of a similar one in American culture—reminds me of a quote from Sheila Kitzinger that I use when talking about postpartum: “In any society, the way a woman gives birth and the kind of care given to her and the baby points as sharply as an arrowhead to the key values of the culture.” Another quote I use is an Asian proverb paraphrased in the book Fathers at Birth: “There is a proverbial saying in the East: The way a woman takes care of herself after a baby is born determines how long she will live.” While this quote usually gets some nervous laughter, I think it is impresses upon people how vital it is to plan for specific nurturing and care during this vulnerable time.

Dana Raphael, the author of Breastfeeding: The Tender Gift, who is best known for coining the word “doula” as it is presently used, also coined another valuable term: matrescense. “Nothing changes life as dramatically as having a child. And there was no word to describe that. So we invented the word—matrescence—becoming a mother.”

The postpartum law of threes

I also share the “law of threes” with my clients which I learned from an article titled “Baby Moon Bliss” by Beth Leianne Curtis in Natural Life, Fall 2008:

A helpful tool I share with students and clients of mine is what I describe as the ‘law of threes’ when beginning the postpartum period. The first three days after your baby is born, try to stay in bed or at least in your bedroom. Many other cultures worldwide have much longer ‘lying in’ periods for mother and baby. If you can give yourself the much-deserved rest of focusing on breastfeeding, sleeping, eating, and recovering from the work of labor, your body and your baby will thank you for it. While birth is a healthy, normal event, honor the recovery process that your hard working body needs and deserves. The less you physically do in the initial few days following childbirth, the better and stronger you will feel in the weeks ahead. …Next, prepare to have three weeks of meals readily available for breakfast, lunch, and dinner….” (don’t forget plenty of snacks at easy reach for breastfeeding!)

Finally, understand that those first three months after birth are truly a time to embrace the unexpected…for some mothers, after three months is when breastfeeding really begins to be fun and easy. Many parents find that at the end of this [fourth trimester] transitional time, baby has moved through any colicky phases and that suddenly baby looks and acts more like a ‘real person.’…Physically, this is when your body begins to return to its pre-pregnancy state.

When I present about this topic to groups, sometimes I hear the following types of remarks: “Getting back out made me feel better, I would be miserable lying around in bed all day”—at the time when my own first baby was born, I would have said this was true for me as well, but looking below the surface shows me something else. Someone who hadn’t planned for a nurturing, comforting, supportive postpartum cocoon and who hadn’t given herself permission to rest, relax, and restore. The same high-achieving style that served me well in the workplace did not nourish me physically or emotionally as a tender new mother. I firmly believe that a nurturing postpartum downtime lays foundation for continued “mother care” self-nurturing for the rest of your life.

Then, in my notebook, I found the following relevant quotes that I had saved from the book Natural Health After Birth by Aviva Jill Romm:

“Too often women develop the mindset that a good mother gives all and takes nothing for herself. Remember, this is a great cultural fallacy. A good mother gives of herself to her children, but she has to have a self to give. A good mother nurtures herself, develops her own interests, even if in small ways, and grows as a person along with her children. Children don’t need us to be martyrs; they need us to be their mothers. A self-actualized mother sets an example for her own daughters that becoming a mother expands identity, not limits it.”

–Aviva Jill Romm, Natural Heath After Birth

“To put a child on Earth, an immense amount of creative intelligence flowed from the Great Spirit, through nature itself into your body, heart, and mind–remaining now, as an integral part of your own spirit. This energy is yours forever. Like a pocket, deep and filled with magic seeds of creativity and healing, this is the source of unconditional loving from which every wise woman since the beginning of time has drawn her strength.”

–Robin Lim

“Motherhood is raw and pure. It is fierce and gentle. It is up and down. It is magic and madness. Single days last forever and years fly by…Be gentle with yourself as you travel, dear mother. Don’t miss the scenery. Don’t miss conversation with your traveling companions. Laugh at the bumps and say ‘ooh, aah!’ on the hairpin turns. Buckle your seat belt. You’re a mom!”

–Aviva Jill Romm

Helpful articles

Planning for Postpartum—this is one of my past articles that I remain proud of

How other cultures prevent PPD—helpful article by Kathleen Kendall–Tackett

DONA’s handout for making a postpartum plan—I think couples should spend at least as much time to developing a postpartum plan as they do to making their birth plans.

Support & Sanity Savers handout for class from Great Expectations—this is one of my very favorite postpartum handouts to use for birth classes, particularly the last page which is a “request for help after the baby is born” letter to prospective helpers that includes a “coupon” for people to fill out with what they’re willing to do for the new parents.

The Grassroots of Safer Birth: Get Karen There

Jan20

“Midwives speak the same language, regardless of politics: women come first.”

–Palestinian Midwife (quoted by COHI)

I have found that it is easy to get so caught up in local or national birth activism that I forget to even consider the birth climate and concerns of other regions of the planet.

Why should we care?

Most simply, because lack of access to good maternity care is a huge issue around the world, with a profound impact on women, mothers, babies, families, and communities. Some selected facts (via COHI):

Nearly 400,000 women will die each year from pregnancy-related causes and 99% of these deaths will occur in developing countries, according to the World Health Organization (WHO).
For each woman who dies, 20 others will suffer from serious complications.
The five leading causes of pregnancy-related deaths are bleeding, infection, high blood pressure, prolonged labor and abortion complications. In poor countries, a mother’s death leaves her newborn at risk of dying as well.
The majority of pregnant women die because of the three major delays that have been identified as:

Delay in the woman, her family or community members’ recognition of a life-threatening problem and the decision to seek care.
Delay in a woman’s access to transportation to a health facility, especially at night.
Delay in the woman’s access to qualified health workers with access to essential equipment and supplies.

Women and children constitute as 80% of the world’s refugees and displaced people.
In areas where conflict and turmoil is rampant, nurses and midwives are the primary reproductive health care providers. They provide up to 80% of direct patient care around the world every day.

Recently, I was asked to participate in a fundraising effort to get midwife Karen Feltham to Haiti. Spearheaded by BirthSwell in connection with the amazing organization Circle of Health International, the fundraiser already reached its goal before my post was scheduled to run! That’s what I call some effective grassroots organizing! The fundraiser is still open for contributions however, and now any additional funds raised will be used to sponsor other midwifery volunteers to disaster areas in need of support. COHI knows that the majority of pregnant and birthing women worldwide are cared for and by midwives and believes that, “midwives should be involved in the effort to foster change by bringing about increased access to services, support and care for women everywhere.”

What can you do?

Make a contribution!
Get connected! Visit the fundraiser’s indiegogo site and be sure to share it on Twitter, Facebook, and your listserves. (The indiegogo site has great tools and widgets for sharing – try them out!)
Tweet about the fundraiser using hashtag #getkarenthere
Make sure to follow COHI on Facebook!

I have a personal tradition of getting a new We’Moon datebook every year and I was pleased to notice that part of the proceeds from the 2012 edition goes to support Circle of Health International also. COHI focuses on: “Working with women and their communities in times of crisis and disaster to ensure access to quality reproductive, maternal, and newborn care.”
COHI lists the following as their core values:

Grassroots social change by creating local, community driven collaborations in order to foster social change from the top down, as well as from the bottom up.
Nonviolence in terms of active resistance requiring one to act when faced with injustice. Leadership at COHI is supporting women to lead, to be forces for change in communities healing from conflict and disaster, and in organizational movements to support women in leadership roles.
Volunteerism through the giving of time, money, knowledge, and general support with the goal of easing the suffering of others.
Activism in individual responses to inequity and injustice.
Supporting women and their families in their right to make their own decisions in all aspects of birth spacing and family size, while protecting access to the resources required to honor their choices.

I value all of the above as well, which is why I’m pleased to be involved with the effort to Get Karen There!

Health Clubs, Heart Health, & Birth

Jan7

One of the things I enjoy about the book Mother’s Intention: How Belief Shapes Birth, by Kim Wildner is how straightforward, matter-of-fact and unapologetic the author is when exploring concepts, realities, facts, and beliefs about birth. In a section addressing perceived risk and birth, she shares an effective analogy about health clubs and heart disease paralleling the accident-waiting-to-happen mentality of modern obstetrics:

A multitude of things CAN go wrong with any system in the body, but seldom DO. Take the heart/circulatory system for example. Heart disease is the leading cause of death in the US. 873 per 100,000 die of heart disease (CDC). (Remember, natural birth is between 6 and 14 per 100,000 in the US, depending on the population.) Some have arteries on the verge of clogging. Some have heart defects they are unaware of. Some have damage they don’t know about. Something could go wrong at any minute and immediately available surgery can undoubtedly save lives.

Using the logic of obstetrics, all health clubs should be in hospitals and all fitness trainers should be cardiac surgeons. Any independent health club with ‘lay’ trainers would be ‘practicing medicine without a license,’ subject to prosecution. It’s for your own good.

In fact, in order to know if a problem is developing, close monitoring and ‘management’ is required. We will need to place straps on the muscles to measure the intensity of the workout. of course, it will be restrictive, but we need to know how hard the muscles are working to know if the heart can take it. We’ll need to monitor heart rate, blood pressure, fluid output. We’ll need to give an IV because with sweat excreted, you could dehydrate, and of course, we simply can’t take the risk of letting you drink anything lest you need emergency surgery….

Later in the book, the author employs another helpful analogy, again using cardiology as an example to make a point about inappropriately applied maternity care interventions:

What if…

You went to the doctor complaining of chest pain…not bad pain, but bothersome. To rule out a heart problem, the caregiver listens to your heart. He scowls, then excuses himself to make a phone call. He comes back in and tells you that you need to be admitted to the hospital for a test that requires the use of a drug. The drug has a low risk of serious complications, which is why you must be in the hospital, but he feels confident in taking that risk.

You go, and within minutes of having the drug administered, you have a heart attack. You are rushed into emergency open-heart surgery. Complications arise, but they are dealt with. You nearly bleed to death, but with a blood replacement you recover.

The repair doesn’t go well, which may mean you will need further surgery later…maybe even a heart transplant. You definitely will need to change your previously active lifestyle.

Later, you discover the call your care provider places wasn’t to a specialist, but an HMO lawyer who advised him not to let you walk out the door, just in case the routine examination missed a serious problem. You also learn there were less dangerous ways to determine if there could be a minor problem.

It turns out, you really did have a minor case of heartburn. All you have been through was avoidable, but “As long as everyone’s ok now…that’s all that matters”…right?

A comment like that, to a mother who has suffered unnecessarily, when she would have–or could have had–the result of a live, healthy baby without such sacrifice, disregards her feelings of loss.

Parents should be expecting more!

In Open Season, by Nancy Wainer, she refers to OBGYN care is referred to as “gynogadgetry.”

In The Doula Guide to Birth, I marked another quote that feels very relevant to the others above: [a March 2006 study in the American Journal of Obstetrics & Gynecology] “reviewed all fifty-five of ACOG’s current practice bulletins, calling these articles ‘perhaps the most influential publications for clinicians involved with obstetric and gynecological care.’ The study concluded that ‘among the 438 recommendations made by ACOG, less than one third [23 percent] are based on good and consistent scientific evidence.'”

Enough said.

The Illusion of Choice

Dec30

A choice is not a choice if it is made in the context of fear.

Informed choice is a popular phrase with birth professionals and healthy birth activists. I’ve read impassioned blog posts from doulas and birth activists claiming that if we support women’s right to homebirth, we must also support her “choice” to have an elective cesarean. But, I believe we have constructed a collaborative mythos within the birth activist community that an informed choice is possible for most women. The statistics tell us a different story. I do not believe that women with full ability to exercise their choices would choose many of the things that are typically on the “menu” for birth in mainstream culture.

What’s on the menu?

Women give their blanket “informed consent” to all manner of hospital procedures without the corollary of informed refusal–is a choice a choice when you don’t have the option of saying no?

In many hospitals, women are STILL not allowed to eat during labor despite ample evidence that this practice is harmful–is a choice a real choice if made in the context of hospital “policies” that are not evidence-based?

Women are told that their babies are “too big” and then “choose” a cesarean. Is a choice a choice when it is made in the context of coercion and deception?

Women choose hospitals and obstetricians that are covered by their insurance companies. Is a choice a real choice when it is made by your HMO?

Women choose hospital birth because they cannot find a local midwife. Is a choice a real choice when it is made in the context of restrictive laws and hostile political climates?

Women often state they are seeking “balanced” birth classes that aren’t “biased” towards natural birth (or towards hospital birth), but is a choice a choice when it is made in the context of misrepresented information? Because, as Kim Wildner notes, balance means “to make two parts equal”–what if the two parts aren’t equal? What is the value of information that appears balanced, but is not factually accurate? Pointing out inequalities and giving evidence-based information does not make an educator “biased” or judgmental–it makes her honest! (though honesty can be “heard” as judgment when it does not reflect one’s own opinions or experiences).

On a somewhat related note, recently, the subject of “quiverfull” families came up amongst my friends and comments were made about feminists needing to support those women’s “choice” to have so many children. However, I worry about women who are making reproductive “choices” in the context of what can be a very repressive religious tradition. Women’s choices about their lives are not always made with free agency. And, that is where some feminist critiques of other women’s choices come from–a critique of the larger context (patriarchy) rather than the woman herself. Is a choice a choice when it is made in the context of oppression?

Where do women get information to make their choices?

In his 2010 presentation, Birthing Ethics: What You Should Know About the Ethics of Childbirth, Raymond DeVries uses data from the Listening to Mother’s studies to help us understand where women are getting their information about birth—this is the context in which their “informed choices” are being made and this is the context we need to consider.

Our choices in birth and life are profoundly influenced by the systems in which we participate…

Some choices shaped by the system

Women learn from books and experiences of others (and self):

The number one book women learn from is What to Expect When You’re Expecting, which has been number four on NY Times Bestsellers list for over 500 weeks and counting.

According to De Vries, via the Listening to Mothers data, this is what women tell us about how they learn, what they learn, and upon what their choices are based:

Television explains birth
Pain is not your friend
But technology is
Mothers are listening to doctors (and nurses)
Medicalized birth allows mothers to feel capable and confident
Interfering with birth is mostly okay
Our health system works (mostly)
We like choice
We want to be “informed”

He also explains polarization: “We seek information to confirm our opinion. Contrary information does not convince, it polarizes.” How do we share information so that women can make truly informed choices without polarizing?

As advocates, I think we sometimes fall back on the phrase “informed choice” as an excuse not to be outraged, not to despair, and not to give up, because it promises that change is possible if only women change and most of us have access to change at that level.

Birthing room ethics

In another presentation, U.S. Maternity Care: Understanding the Exception That Proves the Rule, DeVries explores the ethical issues surrounding choices in birth, noting that “choice is central at all levels – but can choice do all the moral work?” We wish to respect parental choice, but information does not equal knowledge and we often err on the side of treating them as one and the same. In maternity care, often there is no choice. Tests become routine or practices become policy, and “information [is] given with no effort to understand parental values (the ritual of informed consent).”

Is choice possible while in active labor?
De Vries also raises a really critical question with no clear answers—is choice really possible during active labor? He also asks, “should a healthy pregnant woman be allowed to choose a surgical birth? But is it safe? The problem with data…Interestingly, those who think it should be allowed find it safe, and those who oppose it, find it to be unsafe.” When considering where this “choice” of surgical birth comes from, he identifies the following factors:

The desires of women
• Preserve sexual function
• Preserve ideal body
• The need to fit birth into employment
• Options offered by health care system

The desires of physicians
• Manage an unpredictable process
• The limits of obstetric education

Why should we care, anyway?

Another popular phrase is, “it’s not my birth.” I agree with the opinion of Desirre Andrews on this one:

“I do not believe in the saying ‘Not my birth.’ Women are connected together through the fabric of daily life including birth. What occurs in birth influences local culture, reshapes beliefs, weaves into how we see ourselves as wives, mothers, sisters, & women in our community. Your birth is my birth. My birth is your birth. This is why no matter my age or the age of my children it matters to me.”

Victims of circumstance?

While it may sound as if I am saying women are powerlessly buffeted about by circumstance and environment, I’m not. Theoretically, we always have the power to choose for ourselves, but by ignoring, denying, or minimizing the multiplicity of contexts in which women make “informed choices” about their births and their lives, we oversimplify the issue and turn it into a hollow catchphrase rather than a meaningful concept.

Women’s lives and their choices are deeply embedded in a complex, multifaceted, practically infinite web of social, political, cultural, socioeconomic, religious, historical, and environmental relationships.

And, I maintain that a choice is not a choice if it is made in a context of fear.

But, what do we know?

I read an interesting article by anthropologist and birth activist, Robbie Davis-Floyd, in the summer issue of Pathways Magazine. It was an excerpt from a longer article that appeared in Anthropology News, titled “Anthropology and Birth Activism: What Do We Know?” In the conclusion, Davis-Floyd states the following:

“Doctors ‘know’ they are giving women ‘the best care,’ and ‘what they really want.’ Birth activists…know that this ‘best care’ is too often a travesty of what birth can be. And yet on that existential brink, I tremble at the birth activist’s coding of women as ‘not knowing.’ So, here’s to women educating themselves on healthy, safe birth practices–to women knowing what is best for themselves and their babies, and to women rising above everything else.”

I believe that every woman who has given birth knows something about birth that other people don’t know. I also believe that women know what is right for their bodies and that mothers know what is right for their babies. I’m also pretty certain that these “knowings” are often crowded out or obliterated or rendered useless by the large sociocultural context in which women live their lives, birth their babies, and mother their young. So, how do we celebrate and honor the knowings and help women tease out and identify what they know compared to what they may believe or accept to be true while still respecting their autonomy and not denigrating them by characterizing them as “not knowing” or as needing to “be educated”? As I’ve written previously, with regard to education as a strategy for change: People often suggest “education” as a change strategy with the assumption that education is all that is needed. But, truly, do we want people to know more or do we want them to act differently? There is a LOT of information available to women about birth choices and healthy birth options. What we really want is not actually more education, we want them to act, or to choose, differently. Education in and of itself is not sufficient, it must be complemented by other methods that motivate people to act. As the textbook I use in class states, “a simple lack of information is rarely the major stumbling block.” You have to show them why it matters and the steps they can take to get there…

And, as the wise Pam England points out: “A knowledgeable childbirth teacher can inform mothers about birth, physiology, hospital policies and technology. But that kind of information doesn’t touch what a mother actually experiences IN labor, or what she needs to know as a mother (not a patient) in this rite of passage.”

The systemic context…

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

And, then I read an amazing story like this grandmother’s story of supporting her non-breastfeeding daughter-in-law and I don’t know WHAT to do in the end. Can we just trust that women will find their own right ways, define their own experiences, and access their own knowings in the context of all the impediments to free choice that I’ve already explored? What if she says, “why didn’t you TELL me?” But, if we share our information we risk polarization. If we keep silent and just offer neutral “support,” regardless of the choice made, then doesn’t it eventually become that the only voice available for her as she strives to make her own best choices is the voice of What to Expect and of hospital policy?

“Our lives are lived in story. When the stories offered us are limited, our lives are limited as well. Few have the courage, drive and imagination to invent life-narratives drastically different from those they’ve been told are possible. And unfortunately, some self-invented narratives are really just reversals of the limiting stereotype…” –Patricia Monaghan (New Book of Goddesses and Heroines, p. xii)

—-
Related posts:

What to Expect When You Go to the Hospital for a Natural Childbirth
Birth & Culture & Pregnant Feelings
Asking the right questions…
Active Birth in the Hospital
Why do I care?

References:

De Vries, Raymond. May 20, 2010. Birthing Ethics: What You Should Know About the Ethics of Childbirth, Webinar presented by Lamaze International.

De Vries, Raymond. Feb. 26-27. U.S. Maternity Care: Understanding the Exception That Proves the Rule. Coalition for Improving Maternity Services (CIMS). 2010 Mother-Friendly Childbirth Forum

Guest Post: Alcohol and Breastmilk

Dec23

Just in time for the holiday season, a note to clarify the issue of nursing moms drinking alcohol.

Your milk alcohol level will be exactly the same as your blood alcohol level. So if you’ve had a couple of drinks and hit the legal limit, your milk has about the same alcohol content as fresh fruit juice or a non-alcoholic beer–.08%ish. Alcohol does not concentrate in the milk, and as your liver clears it from your blood, the milk alcohol level will also drop. There is no need to pump and dump for a healthy baby! If you are concerned about even very minimal amounts of alcohol in the baby’s system, nurse before you go out, and time your drinking so that you give your liver time to metabolize it before the baby would want to nurse again.

The takeaway message: Long before you have enough alcohol in your milk for your baby to even notice, you would be so hammered that you would hardly remember you even had a baby. The concern for occasional drinkers is not really alcohol being passed to the baby, but mom and dad remaining sober enough to care for the baby–and that’s a really big deal where co-sleeping is concerned! Safely sleeping with a baby means being stone cold sober. Period.

Merry Christmas, Happy Holidays, and a great New Year to everyone!

Please note that I’m really only talking about moms who have a drink now and then, not habitual heavy drinkers. We just don’t know what effect continuous long-term exposure to alcohol might have on a baby.

Lynn Carter is an IBCLC in Kirksville, Missouri.

Last Minute Gift Idea: Rescue Gifts

Dec15

I received a press release recently with a neat last-minute gift idea that has relevance to birth activism—a symbolic gift of a safe birth kit for a mother in the developing world (I investigated a little and the organization is a legitimate humanitarian organization.) Here is the information:

Rescue Gifts help refugees and others who have been impacted by war and natural disaster. Holiday shoppers can choose a gift that inspires them and dedicate it in honor of a special person in their lives. The International Rescue Committee will send gift recipients a beautiful acknowledgement card with the gift giver’s personalized message.

There’s a perfect gift for everyone:

For a mom: A Safe Delivery ($24) can ensure critical supplies for the safe birth of a child in a crisis zone.

For a spouse: Emergency Food ($68) can deliver a month’s supply of vitamin-rich therapeutic food for at least 50 malnourished children in places wracked by food shortages or famine.

For the foodie or friend with a green thumb: A Community Garden ($60) can provide tools and seeds to refugees who have been resettled in the United States, so that they can grow their own fresh, healthy food in an IRC community garden.

For a teacher: A Year of School ($52) can supply the tuition, books and other materials for one year of a child’s schooling in a country recovering from war.

Shoppers who spend $75 or more will receive a fashionable organic cotton “Rescue” T-shirt designed and donated by Threads for Thought, or they can opt to have it sent as a gift.

Rashida Jones, IRC Voice and star of NBC’s “Parks and Recreation,” is promoting the Clean Water Rescue Gift and giving it to her friends this year. She says, “At an IRC refugee camp in Thailand, I saw that the ready availability of water transforms lives. I am buying this gift for my friends this holiday season.”

Parks & Recreation is one of my favorites TV shows, so it is fun to have that connection too. Of course, I inquired as to what exactly a “safe delivery kit” entails, because I do not want to inadvertently be promoting non-evidence based Western medical care practices in countries relying heavily on traditional midwives. I was told that, “as such, the Safe Delivery Rescue Gift represents the typical amount of money needed for the IRC to provide supplies and assistance necessary for a safe delivery. However, Safe Delivery Rescue Gift donations will be used where and when most needed in our wide-ranging humanitarian work in more than 40 countries and 22 U.S. cities. The IRC does provide and support pre and post natal care for new and expectant mothers and their babies. This includes training and equipping midwives like the ones in Tham Hin refugee camp in Thailand, although midwifery is not the only childbirth model that the IRC supports.”

If you’re looking for a last-minute stocking stuffer for a humanitarian minded friend or family member, or for a birth activist buddy, you might find the right gift at Rescue Gifts!

Birth and the Women’s Health Agenda

Nov13

Ready to be on the agenda, dangit!

In the Fall issue of The Journal of Perinatal Education (Lamaze), there was a guest editorial by perinatologist Michael Klein called “Many Women and Providers are Unprepared for an Evidence-Based Conversation About Birth.” In it he notes:

Childbirth is not on the women’s health agenda in most Western countries…It never has been. Osteoporosis is. Breast health is; violence against women is. Why not childbirth? Because women, understandably, do not want to be judged only by their reproductive capacities. Women are multipotential people. Among many potentialities, they can rise to the top of the academic and corporate world. Giving birth is just one of many things women can do. But now is the time to add childbirth to the women’s health agenda; it is because of the lack of informed decision making that birth should be added to that agenda, lack of information, misinformation, and even disinformation. The time is now.

…What really matters is attitudes and beliefs, which are much more difficult to change than putting away the scissors and hanging some plants. These are systemic issues. (emphasis mine) It is all about anxiety and fear. The doctors are afraid…The women are afraid…Society is afraid and averse to risk.

So how can you make a revolution when so few individuals are unhappy with current maternity care practices? The most unhappy and well-informed women select midwives, if available. The most fearful women select obstetricians. Providers are not going to initiate the revolution to make childbirth a normal rather than high-risk, industrialized activity…Women are going to have to take the lead…

The problem is not that obstetricians are surgeons. They are. The problem is that society has invested surgeons with control over normal childbirth.

I keep wanting to write an article called, “is evidence-based care enough?” because we see this phrase used so often in birth advocacy work. It is kind of the companion phrase to the, “women just need to educate themselves” line of thought, that, quite frankly, is also just not enough. And, I think the reason it isn’t enough—all of our education, all of our books, and all of our evidence—is because it isn’t information itself that really needs to change, it is women’s feelings and beliefs about birth (and the medical system’s feelings and beliefs about it too, in addition to their practices) and changing those sometimes feel like an insurmountable task. As I’ve written before, much of the time it isn’t that we actually want women to know more, we want them to act differently. And, a choice made in a context of fear is not an informed choice at all.

Guest Post: More Business of Being Born Mini-Review

Nov9

In conjunction with the More Business of Being Born giveaway I’m currently hosting, I’m also pleased to share this mini-review of the first installment (Down on the Farm) guest posted by my friend and colleague, doula Summer:

More Business of Being Born

Down on the Farm: Conversations with Legendary Midwife Ina May

Reviewed by Summer Thorp-Lancaster

http://peacefulbeginnings.wordpress.com
http://summerdoula.wordpress.com

The first installation of More Business of Being Born, Down on the Farm: Conversations with Legendary Midwife Ina May, is infused with loving scenes of midwifery care, loads of vital information and even a few jokes (such as a gift referencing Ina May’s infamous “sphincter law”). We are given an up close view of the well-known Farm in Tennessee, whose Midwives boast an exemplary track record of Midwife attended, out-of-hospital births. This record includes a less than 2% cesarean section rate in over 2500 births. Throughout the interviews, Ina May’s (and the other Midwives featured) reverence and respect for the Midwifery Model of Care is ever-present. Her passion for the safety and overall well-being of the motherbaby is palpable and stirring.

It would be impossible to cover the many aspects of birth, or even just Midwife attended out-of-hospital birth, in a full length film, let alone an episode, but this piece successfully touches on many topics and will (hopefully) lead to further discussion amongst viewers. As an activist, I found myself left with a renewed sense of action or purpose, a desire to do more and help more so that all mamas and babies have the opportunity to experience birth as the positive, loving and intimate experience it was meant to be as well as a deeper understanding of the crisis surrounding our medical model of birth. I would recommend this film to everyone, as the state of maternity care affects us all.

Milk, Money, & Madness

Sep7

In early August, I received a press email from Evenflo about their “in-law feeding frenzy” video. While I recognized they were attempting to be playful and funny, I chose not to share the video with my readers because I found several elements of it problematic. Rather than recognize the opportunity to create an internet stir over the video, I just wrote back to the company and told them, “I try not to encourage the notion of other people having a chance to feed the baby, so I do not plan to use the video myself—I would have been more pleased with it if somehow mom stood her ground and helped in-laws see that there are other ways to be involved with the baby other than by feeding it expressed milk. I don’t promote the idea that mothers need to pump, ‘just because.’” Considering what a controversy has now boiled up this week over Evenflo’s “funny” breastfeeding video, I confess I sort of feel like I missed my opportunity for a major wave of blog traffic by exposing the ad and expositing on the problems therein when I received it in August! 😉 However, when considering the controversy, I thought of some wonderful quotes I’d saved to share from the book Milk, Money, & Madness and so I’m sharing them instead.

Dia Michels is one of the co-authors of Milk, Money, and Madness and I’ve actually heard her speak twice—once in 2003 when I was pregnant with L and then in 2007 at the LLL of MO conference. I’m surprised at how thoroughly riveting a book about the “culture and politics of breastfeeding” can be and I highly recommend it to breastfeeding and women’s health activists.

In perfect response to the Evenflo video, we have this quote:

“Babies need holding, stroking, dressing, bathing, comforting, burping, and, within a short time, feeding solids. Dad can do every one of these. The desire to participate should not be confused with the need to give the baby the best of what each partner has to offer.”

I hear from people SO often that they want Daddy to be able to participate in baby care by giving the baby a bottle. There are LOTS of things that fathers can do for their babies, other than feeding—bathing, snuggling skin-to-skin, diaper changes, playing, babywearing, and just plain walking around holding the baby while mom takes care of her own needs.

And, here is an excellent quote with regard to public breastfeeding/breasts as sexual objects:

“When the attitude is taken that a woman’s breasts belong to her and no job is more important than caring for one’s young, the confusion between breastfeeding and obscenity goes away.”

And, then considering the argument that bottle feeding “liberates” women from the tyranny/restrictiveness of breastfeeding:

The liberation women need is to breastfeed free of social, medical, and employer constraints. Instead, they have been presented with the notion that liberation comes with being able to abandon breastfeeding without guilt. This ‘liberation,’ though, is an illusion representing a distorted view of what breastfeeding is, what breastfeeding does, and what both mothers and babies need after birth. [emphasis mine]

I’ve noted before that I am a systems thinker and I think this way about breastfeeding as well as many other experiences—breastfeeding occurs in a context, a context that involves a variety of “circles of support” or lack thereof. Women don’t “fail” at breastfeeding because of personal flaws, society fails breastfeeding women and their babies every day through things like minimal maternity leave, no pumping rooms in workplaces, formula advertising and “gifts” in hospitals, formula company sponsorship of research and materials for doctors, the sexualization of breasts and objectification of women’s bodies, and so on and so forth. According to the book, “…infant formula sales comprise up to 50% of the total profits of Abbott Labs, an enormous pharmaceutical concern.” And the U.S. government is the largest buyer of formula, providing it for something like 37% of babies. (I should have written that quote down too!)

I have a special interest in how women are treated postpartum and Milk, Money, and Madness has some gems to share about postpartum care as well:

An entirely different situation exists in societies where technology is emphasized. The birth process is seen from a clinical viewpoint, with obstetricians emphasizing technology. A battery of defensive practices are employed, some of which are totally irrelevant to the health of either mother or infant. Skilled technicians spend their time and the family’s money on identifying the baby’s gender and performing various stress tests. All the focus is geared toward the actual birth. After the birth, mother and baby become medically separated. The infant is relegated to the care of the pediatrician, the uterus to the obstetrician, the breast abscess to the surgeon. While the various anatomical parts are given the required care, the person who is the new mother is often left to fend for herself…All the tender loving care goes flows to the infant; the mother becomes an unpaid nursemaid. [emphasis mine]

When I do breastfeeding help with mothers, I always make sure I address the whole woman and do not focus only on the mechanics of breastfeeding. Recently a mother told me, “I don’t know if it was your breastfeeding advice or just the encouragement that helped most, probably both.” Women need both—“technical assistance” and emotional support. Sometimes, all they need is the emotional support and they can figure out the rest with some undisturbed time with their babies. The pendulum in breastfeeding support is shifting from active, “education” based strategies, to the recognition that often the best we can do for mothers is give them time to get to know their babies. Rather than offering positioning “advice” and “breastfeeding management suggestions,” we need to give her space, stand aside, and offer encouragement as she discovers her baby and the biological dance they are hardwired to engage in. The Milk quote continues with:

This may appear to be a harsh evaluation, but it is realistic. In western society, the baby gets attention while the mother is given lectures. Pregnancy is considered an illness; once the ‘illness’ is over, interest in her wanes. Mothers in ‘civilized’ countries often have no or very little help with a new baby. Women tend to be home alone to fend for themselves and the children. They are typically isolated socially and expected to complete their usual chores, including keeping the house clean and doing the cooking and shopping, while being the sole person to care for the infant… (emphasis mine)

According to the U.S. rules and regulations governing the federal worker, the pregnancy and postdelivery period is referred to as ‘the period of incapacitation.’ This reflects the reality of the a situation that should be called ‘the period of joy.’ Historically, mothering was a group process shared by the available adults. This provided not only needed relief but also readily available advice and experience. Of the ‘traditional’ and ‘modern’ child-rearing situations, it is the modern isolated western mom who is much more likely to find herself experiencing lactation failure.

I think these quotes are important because I think there is a tendency for women to look inward and blame themselves for “failing” at breastfeeding. There is also an unfortunate tendency for other mothers to also blame the mother for “failing”—she was “too lazy” or “just made an excuse,” etc. We live in a bottle feeding culture; the cards are stacked against breastfeeding from many angles–economically, socially, medically. When I hear women discussing why they couldn’t breastfeed, I don’t hear “excuses,” I hear “broken systems of support” (whether it be the epidural in the hospital that caused fluid retention and the accompanying flat nipples, the employer who won’t provide a pumping location, the husband who doesn’t want to share “his breasts,” the mother-in-law who thinks breastfeeding is perverted, or the video that promotes expressing milk so other people can feed the baby). Of course, there can actually be true “excuses” and “bad reasons” and women theoretically always have the power to choose for themselves rather than be swayed by those around them, but there is a whole lot that goes into not-breastfeeding, besides the quickest answer or what is initially apparent on the surface. As I said above, breastfeeding occurs in a context and that context is often one that DOES NOT reinforce a breastfeeding relationship. In my six years in breastfeeding support, with well over 600 helping contacts, I’ve more often thought it is a miracle that a mother manages to breastfeed, than I have wondered why she doesn’t.

For more about the relationship between birth and breastfeeding, check out my previous post: The Birth-Breastfeeding Continuum.

Check out those exclusively breastfed thighs!

Book Review: Homebirth in the Hospital

Aug31

Homebirth in the Hospital
by Stacey Marie Kerr, MD
Sentient Publications, 2008
Softcover, 212 pages
ISBN: 978-1-59181-077-3
www.homebirthinthehospital.com

Reviewed by Molly Remer, MSW, ICCE, https://talkbirth.wordpress.com

I would venture to say that most midwifery activists and birth professionals have said at some point, “what she wants is a homebirth in the hospital…” This comment is accompanied with a knowing look, a bit of head shaking, and an unspoken continuation of the thought, “…and we all know that’s not going to happen.”

Well, what if it is possible? A new book by Dr. Stacey Kerr, Homebirth in the Hospital, asserts that it is. She was originally trained at The Farm in TN (home of legendary midwife Ina May Gaskin) and after going to medical school realized that she, “…needed to balance my new knowledge with my old priorities. I missed the feeling of normal birth, the trust that the birthing process would occur without technology, and the time-tested techniques that help women birth naturally. And so it was that I went back to midwives to find the balance.”
If you are a dedicated homebirth advocate, I recommend reading Homebirth in the Hospital with an open mind—clear out any cobwebs and assumptions about doctors, hospitals, and birth and read the book for what it is: an attempt to create a new model of hospital birth. What Dr. Kerr proposes in her book is a model of “integrative childbirth”—the emotional care and support of home, while nestled into the technology of a hospital.

The opening chapter explores the concept of integrative childbirth and “the 5 C’s” of a successful integrative birth: choices, communication, continuity of care, confidence, and control of protocols (“protocols are the most disempowering aspect of modern maternity care…”).

This section is followed by fifteen different birth stories, beginning with the author’s own (at a Missouri birthing center—my own first baby was born in a birth center in Missouri, so I felt a kinship there).

The births are not all happy and “perfect,” not all intervention-free, and most are quite a bit more “managed” and interfered with than a lot of homebirthers prefer (one is a cesarean, several involve epidurals or medications). I, personally, would never freely choose a “homebirth in a hospital” (I also confess to retaining a deep-seated opinion that this phrase is an oxymoron!). However, that is not the point. Over 90% of women do give birth in a hospital attended by a physician and I appreciate the exploration of a new model within the constraints and philosophy of the hospital.

The book closes with a chapter called “how to be an integrative childbirth provider.” The book has no resources section and no index.

I certainly hope that doctors read this book. I am also glad it is available for women who feel like homebirth is not an option or not available and would like to explore an integrative approach. Even though my opinion is that none of the births are really “homebirths in the hospital” as most bear little resemblance to the homebirths I know and love, unlike the content of the standard hospital birth story, they are deeply respectful births in the hospital and that’s the issue truly at the heart of this book.

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