Wednesday, August 31, 2005

Blog Day 2005

If you have a blog, please participate in Blog Day 2005 (today). It's a day for bloggers (and blog readers) to connect across the internet...and learn about bloggers you might not otherwise find.

I thought I'd find a few examples of topic blogs on areas I'm interested in but don't already link to.

So many people with artistic talents post a daily drawing. Here's but one inspiring example:

I learned many dog owners blog about their dogs. I adore pugs and give you this as a representative pug blog (with its own links to others):

The extreme runner in me enjoyed reading multiple runner blogs. I was particularly inspired by this one:

As a birdwatcher, I occasionally visit birder blogs. Here's one:

And then some blogs are just on interesting but obscure topics. Like this one on pencils:

Happy Blog Day. I look forward to seeing what other bloggers bring to my attention.

Tuesday, August 30, 2005

But aren't all babies born at night?

A doctor in California analyized the outcomes of more than three million babies born over a seven year period in the nineties and found that babies born at night were more likely to die in their first month of life than babies born at other times. [Apparently the rest of the world learned about this at the beginning of August, but it took our local paper until today to pull the story off the wire and fill a few column inches with it; so if this is old news to you, I apologize.]

What? How could time of birth affect longevity? Should we be listening more closely to astrologers?

My first reaction was disbelief. It seemed impossible that there could either be some biological advantage to being born during the day or, conversely, that the overall fitness of a baby would be reflected in the time of day it chose to arrive.

Fortunately for my sensibilities, my disbelief was well placed. But it was also short-sighted. I had not considered that factors EXTERNAL to the birth (i.e. the quality or capacity of hospital care) could vary by time of day. It appears this last explanation might be at the heart of the story. As another article on the research reports:

[T]here was evidence to suggest structure, staff and diagnostics might have a role. To study structure, the researchers compared singleton non-very low birth weight babies to more higher-demand very low birth weight multiple births. Interestingly, the low-risk singletons showed the higher mortality risk than the multiples. Dr. Gould and colleagues suggested delivery rooms might be understaffed should a low-risk birth suddenly develop problems.

"This paradoxical findings suggest a compromised system that retains some ability to identify and mobilize for a high-risk delivery," they wrote, "but fails to optimally address unexpected problems that arise in low-risk deliveries."

Hospitals could well be better prepared for newborn complications during the day, when high risk patients are being brought in for inductions and Cesareans.

Having had my initial confusion cleared up, one detail remains to confound me. 56.7% of the births occured between 7:00 a.m. and 6:59 p.m. More than half the babies were born during the day or early evening. My impression of birth is that it's an affair of night's darkest hours. The drives through town when all the lights are flashing red instead of cycling through their colors, the surprise of walking out of the hospital to night air twenty degrees colder than when I walked in, the bedrooms and labor rooms eerily lit by only a computer monitor. These are what I think of when I think of birth.

But I looked through my records just now and 8 of 18 births that I've attended have been between 7 a.m. and 7 p.m. When I remember those births, I do recall sun shining in the windows, or heading home in time to share lunch with the family. Interestingly, my brain has labeled those daytime deliveries anomalies. It holds the close, quiet night as the norm.

Monday, August 29, 2005

News Roundup

First, please notice I've cleaned up my blogroll. Welcome Milliner's Dream and RedSprial, two doula blogs. Also welcome to Of Life, Education, E-bay, Travel and Books and The Examining Room of Dr. Charles, another two blogs that I enjoy reading for their interesting content. I wish a fond farewell to Chez Miscarriage, the infertility blog with a happy ending.

Next, congratulations to DONA doula Debbie Young and business partner Tammy Ryan who've opened a resource center for pregnant and post-partum women in Iowa. It offers everything from childbirth classes to lactation consultants. Excellent idea, gals.

I'm so enthusiastic because I've had a similar idea for a few years. Actually I have two business (or non-profit) ideas. One would be a store that sells everything pregnant and postpartum women need. Homebirth kits, belly casting kits, nipple shields, nursing bras and clothing, cloth menstruation pads, boppys, nursing stools, herbs, teas and tinctures, and books, of course. I'd also have space in the back for childbirth classes, play groups and post-partum depression groups to meet.

The other idea is a clearinghouse for pregnancy and post-partum needs. Imagine if with one phone call you could line up a birth or postpartum doula, lactation consultant, therapist/counselor, as well as register for classes on childbirth, breastfeeding, newborn care, postpartum adjustment and infant massage. This same location would offer support groups, nutritional information, and referrals to outside resources. I found in my postpartum period that making one phone call took too long, and if I had to make two it never happened.

Finally, here is a short but sweet story about a boy who assisted with the precipitous delivery of his baby sister.

Happy Monday.

Thursday, August 25, 2005

Lesson Learned: Never get your astronomy tips from e-mail

For MONTHS I have had this weekend marked on my calendar with the word "MARS!!!" Why? Because in May my boss circulated this provocative e-mail to us staff:

The Red Planet is about to be spectacular! This month and next, Earth is catching up with Mars in an encounter that will culminate in the closest approach between the two planets in recorded history. The next time Mars may come this close is in 2287. Due to the way Jupiter's gravity tugs on Mars and perturbs its orbit, astronomers can only be certain that Mars has not come this close to Earth in the Last 5,000 years, but it may be as long as 60,000 years before it happens again.

The encounter will culminate on August 27th when Mars comes to within 34,649,589 miles of Earth and will be (next to the moon) the brightest object in the night sky. It will attain a magnitude of -2.9 and will appear 25.11 arc seconds wide. At a modest 75-power magnification Mars will look as large as the full moon to the naked eye. Mars will be easy to spot. At the beginning of August it will rise in the east at 10p.m. and reach its azimuth at about 3 a.m.

By the end of August when the two planets are closest, Mars will rise at nightfall and reach its highest point in the sky at 12:30 a.m. That's pretty convenient to see something that no human being has seen in recorded history. So, mark your calendar at the beginning of August to see Mars grow progressively brighter and brighter throughout the month.

Share this with your children and grandchildren. NO ONE ALIVE TODAY WILL EVER SEE THIS AGAIN

Well? Wouldn't YOU mark your calendar, too?

In a lather of excitement I sent a reminder notice to my father (a.k.a. The Great Spoiler*) and sister (a.k.a. Couldn't Care Less). My father's reply was a consolation for having gotten suckered by an out-of-date, but still circulating, message. The hyped encounter occurred two years ago.

Damn. Balls. Shite.

*The Great Spoiler has revealed these things to me through the years, among countless others:

1. Halley's Comet would not have streaked through the sky like Mary Chapin Carpenter sings in "When Halley Came to Town;" it would have appeared as a bright stationary object.

2. "Have you ever seen a vole? I have one here in this bucket. See him? [poke poke] Of course he's dead."

3. "Remember Buckey? The Squirrel that ate peanuts from your sister's hand? He fell from the power line and broke his leg. I put him out of his misery."

4. It was wrong for me to have freed our neighbor's turtle from the 5 gallon bucket he was desperately trying to climb out of for hours on end.

5. The [insert migratory bird species here] that I just saw, he's been seeing for weeks.

6. "So, what do you think? You like it? Do you know blutwurst means blood sausage? Here, have some more."

7. The [insert butterfly species] that I just saw, he's been seeing for weeks.

8. The [insert bird, plant, insect species] that I saw in Costa Rica? That's nice, but he doesn't believe in contributing to the global warming problem just so he can travel to see exotic species. He finds pleasure enough in the organisms outside his front door.

9. The beautiful new bookshelf in my son's room could tip over and crush him if he ever tried to climb it.

10. My personal best 5K race time is more than ten minutes slower than the world record. Huh! Isn't that interesting?

o.k. enough therapy for today.

Wednesday, August 24, 2005

Depression and "Successful" IVF

Women who birth a healthy baby conceived through in vitro fertilization are uniquely at risk for postpartum depression, Australian researchers say (sorry for the FOX link; the journal the research was published in, Fertility and Sterility, is members-only access).

Without access to the journal article, I am left to wonder to what causes the researchers attribute the increased depression frequency. The story I link to above says, “Mothers who conceived through IVF and other forms of assisted reproduction were more likely than other moms to be older, have multiple births, and have difficult deliveries that ended in cesarean sections -- three other suspected risk factors for postpartum depression.”

In that case, it is not the process of IVF that triggers the depression, but a set of birth circumstances (multiples, advanced maternal age, etc.) that are more often associated with IVF. Then this is neither new nor surprising in my book.

If, however, they found that the process of undergoing IVF itself created a unique emotional/hormonal situation that predisposed mothers to depression, that IS news, though it is still not surprising.

As someone whose first pregnancy loss tainted my two subsequent pregnancies, I can attest to the fact that any pregnancy glitch can shake your confidence in the whole reproduction process. For women who use assisted reproduction, there are the additional psychological issues of physical competence. The process of becoming pregnant is often long and depressing in itself. Many women with infertility issues are subjected to enormous doses of hormones to suppress and stimulate ovulation and to make the uterus more hospitable.

I would be more surprised to learn that women who endure this regimen are NOT depressed at the end of it, whether or not they have a healthy baby to show for their efforts.

Monday, August 22, 2005

Get your bottle while supplies last!

Friday, August 12, 2005

Back in a week. But first, a birth.

Quickly: My client had her baby yesterday. Hurrah. Great birth; only a shot of narcotic to get the birthing mother through a 26 hour first labor. Her daughter, at 7 lb. 1 oz. cutie, was welcomed into her mothers' arms at 6:18 last night. The non-birth mother's family shot out of their seats in the waiting room when T$ and I went out to tell them the baby had been born. All but the grandfather were thrilled to have a girl. He was consoled that she has a Russian name. He is a Russian immigrant. (Coincidentally, his daughter, the non-birth mother, and I studied Russian with the same professors, a few years apart, at MSU. Small world.)

Check out T$'s blog for more details. We revived our "double doula" act to much buzz around the hospital.

I have have more reflections on the birth but will wait to unload them until a time when I'm not trying to wash four loads of laundry, brief the house sitter, and pack for a week in northern Michigan.

I am taking to read:

Daughter's Keeper by Ayelet Waldman
Cry, the Beloved Counry (for our book group) by Alan Paton
Songs of Enchantment by Ben Okri

Be back soon.

Wednesday, August 10, 2005

Honorary Birth Support Dream Team Member #3

It's been a while since I've added anyone to the roster. If you wish, you may read about members #1 and #2.

Member #3 is of a different ilk altogether.

It has been 25 years since Terry Fox ran his marathon of hope to raise money for Cancer research. I hope I am not the only person who remembers this young hero (twenty-five years! I'm getting old!). As a Canuckophile and a runner, I really can't be more inspired.

Though he never accompanied a woman through labor, I think he knew something of the courage and endurance involved.

Tuesday, August 09, 2005

Bunk Beds and Frozen Peas

If the decreased frequency of my posts lately hasn’t already given me away, let me state now that things are a little crazy for me right now. We’re leaving Saturday for a week’s vacation which means this week I’m frantically trying to wrap up all the summer projects I ignored in lieu of posting to this blog in the last 2 months.

And my client who was due Sunday still hasn’t delivered. She’s at 2 cm, 80% effaced and the baby’s at zero station. She’s been contracting for periods each day. So she could go into labor at any moment and I’ll lose a day’s work. Still, I’d prefer that to her delivering while I’m on vacation. She and her partner are very cool; I think they’re set up for a really nice birth.

In my head things have been busy, too. It began a week ago Sunday, my husband’s and my 12th anniversary coincidentally, when we put up bunk beds ($20 at a garage sale!) in the boys’ room. Our youngest will be 3 in a month, so it was time to move him out of his crib.

I was alone when I took down the crib ($100 with mattress at a garage sale 7 years ago). Who knew that act would bring me to tears? I was surprised to find myself getting choked up as I untied my homemade bumpers from the rails. Wasn’t it just a few months ago I was setting it up for the first time, for my now-seven-year old? And had it really been two years since I set it up for the second time, with the same sheets and skirting and stuffed sock monkey?

There will be no third time to assemble the crib. My husband got a vasectomy yesterday, you see.

We agreed it was the right thing to do. We do not, at 36 years, with the prospect of dual employment for the first time in our married lives on the horizon and two healthy sons whom we adore and who adore each other, wish to start back over with a newborn. This balance we have now, it is a good thing.

So good, in fact, that it honestly outweighs the undeniable attraction of a new family member to meet and love, of another pregnancy to revel in and birth to achieve, of the heavy lids and milky lips on a baby that’s nursed itself into oblivion.

But recognizing that you do not wish to have any more children and taking a [mostly] permanent step to ensure it are two different things. I hate closing doors. I would rather continue our married life using birth control on a day to day basis until those days carry me safely into menopause. Let the sum of our daily reproductive decisions add up to zero, rather than start with an empty set for the rest of our lives.

The vasectomy won out for several reasons, most of them based in pragmatism and comfort. For me, however, there was the one additional reason. No birth control is fool proof. It is one thing for my present family composition to outweigh the benefits of an imagined pregnancy. It would be another to weigh it against an actual pregnancy. I would neither want to bear another child, nor lose another one.

Saturday, August 06, 2005

My meagre stats

Looking at T$'s blog and her tally of birth stats so far, I thought I'd check in, too.

17 births so far

15 vaginal deliveries
2 Cesarean deliveries (1 scheduled, 1 unscheduled)

10 delivered with CNMs (including 1 whose baby was delivered by an OB by Cesarean section)
6 delivered with OBs (including the other Cesarean section)
1 delivered with a family practice doctor

10 had natural deliveries (1 with a family practice doctor, 9 with CNMs)
7 had epidural anesthesia (including the two Cesarean births, of course)

All breastfed after birth, but 4 stopped breastfeeding by 2 months' time because of breastfeeding frustrations/complications. All of these women had either long epidurals ( 20, 9 and 8 hours respectively) or a Cesarean delivery.

The remining 14 clients, all of whom breastfed until at least nine months, had natural births or shorter-duration epidurals (3 and 5 hours respectively) with the exception of the client with a scheduled Cesarean.

Obviously a sample size of 17 means nothing. But this data is dramatically different from the 25% Cesarean section rate and the 90% epidural rate at area hospitals.

Thursday, August 04, 2005

Life at what price?

Stuck in a traffic jam yesterday I was nearly brought to tears by the story of Susan Torres, the woman who was on life support for several months so her fetus could develop. How tragic. A 26-year-old mother, pregnant with her second child, suffers a stroke from metastatic melanoma. Her family decides to keep her alive so that her second child gets a shot at life.

Whenever I hear this kind of story I am so thankful for all that I have, and all that I have avoided in life.

I can't imagine the woman's husband, getting a daughter the same day he loses his wife. And what of the two-year-old whose mother has been brain dead for months. Did he go visit her? How will he understand the events of the past few months.

Reading about this story on-line today, however, made me also get a little angry. The woman's medical costs were tens of thousands of dollars a week. People around the world donated to help offset the family's expenses.

Nice sentiments, but if one really wants to help infant outcomes or mothers in a bad position, think of what $400,000 (the amount they received in donations) could do for basic prenatal care in, say, Guatemala. Or the Sudan.

And though the baby is doing well, prematurity bring with it considerable risks. There is also a minor chance that the baby will develop cancer from exposure to the mother. This is a baby born into grief and without a mother.

Obviously I am not in a position to answer. But there are many reasons to say that the fetus die along with her mother could have been as generous, and no less heroic, an action.

Saying No

I hate turning down a doula potential doula client. When they contact me they invariably have some tidbit, in addition to their gravid state, that makes their situation seem espeically compelling.

In the past 2 weeks I've had to decline interview invitations from six women. One was a Lebanese immigrant (I haven't worked with an international client yet), two were attempting VBACs (I haven't worked with a VBAC client yet), two were using a nurse-midwife practice I love working with, and one was a nineteen-year-old single mother (I haven't worked with teen mothers yet).

Fortunately there are many other doulas -- and skilled doulas at that -- in the area. So I am always able to refer them elsewhere.

It's not their care I worry about. It is my own missed opportunities. Each phone call or e-mail is a potential relationship with another amazing woman from whom I can learn something. Passing on such an opportunity is difficult.

I remind myself that women will continue to have babies and my schedule will get more flexible with time. As my boys get older and my spouse finishes grad school, the need for me to be available at home will diminish. And though I still won't be able to say yes to every contact, I look forward to saying yes more often.

Tuesday, August 02, 2005

A difference of degrees

I was surprised to read in the latest ACNM newsletter, an update on the Doctorate of Nursing Practice degree development. I had never heard of this. I did a little searching around and learned that advance practice nurses have an several degrees available to them:

1. M.S. or M.S.N or M.S.N.P. (Master of Science, Master of Science in Nursing, Master of Science in Nursing Practice): masters degrees and training as a nurse practitioner

2. Ph.D. (Doctorate of Philosophy): doctoral degree, the traditional preparation for research and academic posts

3. DrNP or DNP (Doctor of Nursing Practice also known as the Practice Doctorate in Nursing): "Graduates will be experts in designing, implementing, managing, and evaluating health care delivery systems and will be prepared to lead at the highest clinical and executive ranks."

The first two of these I'm familiar with. Nurse practitioners have their master's degree. Nursing scholars often have a Ph.D. in addition to their master's training.

But what of this "Practice Doctorate?" Case Western Reserve University's web site best explains the reasoning for the DNP:

The Doctor of Nursing Practice degree (DNP) is a practice doctorate, similar in concept to practice doctorates in other professions such as medicine (M.D.), law (J.D.) and dentistry (D.D.M.).

Individuals with practice doctorates are the most highly educated and qualified practitioners in their fields. Instead of focusing primarily on research and teaching, like those with Ph.D.'s within their fields, those with practice doctorates use their education and expertise in leaderships roles on the front lines of their profession.

I have to say I'm having a hard time seeing the vacant niche. What does the DNP offer that nurses couldn't get through Masters training? Aren't nurse practitioners already "the most highly educated and qualified practitioners in their fields?"

If one wants more clinical training than a nurse practitioner, it seems medical school is the appropriate next step. If one wants to enter management and administration, Public Heath programs offer tracks in Health Management and Health Administration.

Admittedly I have a bias against credentialling. I recoil at anyone but a physician referring to herself as "Doctor." This includes a friend with her D.P.H. and another with a Ph.D. I am offended by the listing of credentials in any setting other than the most conservative of professional venues (e.g. business cards).

The DNP looks to this outsider like nursing's attempt to legitimize itself relative to doctoring: "We can be 'doctors' too." And while I'm sympathetic -- nurses get far too little credit for what they do and know -- I think there is nothing wrong with proudly brandishing one's "CNM, M.S.N." credential when the need arises.

If there are nurses out there, especially DNPs, who can shed light on what the DNP degree provides that one can't find elsewhere, I would sincerely like to know. I suspect there must be some "value added." Otherwise Columbia University wouldn't proudly proclaim its status as the FIRST such program in the country. Please also correct any misinformation I put up about the other degree programs. This is a first, and admittedly less-than-expert, take on the matter.

--doulicia B.A., J.D., CD (DONA)