Thursday, September 29, 2005

Whine Whine Fuss Fuss

Around the time I discovered I was a birth junkie, I embarked on an educational effort, the purpose of which was to satisfy the pre-requisites to a local second-career nursing program. For individuals with a bachelor’s degree, this program awards a B.S.N. in 13 months.

The catch is the substantial list of prerequisites. Fortunately I had taken many of the courses (biology, organic chemistry, biochemistry) as an undergraduate. I began taking the remaining prereqs (Psychology, Anatomy and Physiology, Pathophysiology, Nutrition, Therapeutic Nutrition) at the community college. At the time my spouse started his graduate studies I only needed 2 pharmacology courses and “Lifespan Development” to complete my list.

Now that my spouse is in his last year of graduate studies (a two-year masters program turned into a five-year Ph.D. program), I’ve resumed thoughts about the few remaining hurdles to nursing school.

You can imagine my disappointment when a friend, who recently decided to prepare for the second-career program herself, met with nursing school advisors and was told they would only accept courses that were taken within the last 10 years. This has been their policy, but it did not apply to me when I met with an advisor six years ago; I’d only been out of college eight years.

So now, instead of 3 courses and retaking the GRE (my 1990 scores are too old; they don’t even use the same scale any more!), I’m facing 5 classes I need to complete before I’m eligible to apply to the nursing program.

To me, who has said legal education would work far better in an apprenticeship model, all this hoop-jumping for a profession whose daily demands rely so heavily on job-specific knowledge (i.e. most of what a pediatric nurse learns, she learns after she’s on the job; so, too, for an ICU nurse, or a surgical prep nurse, etc. etc.) is just plain condescending.

I need to learn about drug classes, doses and interactions. I need to learn how the human body functions. A little life-stage development is fine. But do I really need to relearn Krebs’ cycle or what distinguishes an ester from an ether? Do you think nurse midwives could explain the chemistry behind electron transport?

Would the health care system rather have another compassionate and competent midwife in its ranks or a frustrated on-looker whose past education and life experience weren’t enough to qualify her for education?

Wednesday, September 28, 2005

Hometown War over The Chocolate War

Few things get my blood boiling as quickly as censorship.

Imagine my ire two weeks ago when I read about a school board battle brewing in my home town over whether a an English teacher could include The Chocolate War in her freshman class.

First, censorship. Second, in the same hallowed halls I walked as a freshman 22 years ago. It really was too much to bear.

I guess the Milan teacher is in good company. The Chocolate War was the fourth most challenged book from 1990-2000, according to the American Library Association. Why is it challenged? Oh, the usual. Profanity. Masterbation. Violence.

Are these things foreign to thirteen- and fourteen-year old boys? No. Might they be topics that young adults would benefit from the exploration of? Yes.

As one source notes, "One of The Chocolate War's principle themes is the futility of individual protests and resistance in the face of such power structures and, by implication, the importance of collective action." Hmm...any larger implications here for training our next generations of voters?

Alas, last week the Milan School Board voted to remove the book from the English curriculum. It will remain in the library.

Several board members made interesting points. One, a relative of my fifth-grade teacher, said she was concerned that if the vote to remove it from the curriculum didn't go through, somebody could have made a motion to ban it from both the library and the curriculum. So she took the lesser of two evils approach.

Another board member, my sister's second-grade teacher, now retired, voted against the ban (you go, Mrs. Mehringer!). Yet she recognized that it could be extremely offensive and upsetting to some students and she was sympathetic to them.

I am disappointed in the ban. If we do not discuss topics that make us uncomfortable, how will we grow? If schools are prohibited from engaging students in these discussions, then what public forum will?

This is Banned Books Week.

Tuesday, September 27, 2005

News Roundup

Several friends e-mailed to alert me to this article about doulas in the New York Times. It is a nice complement to their article of a week ago that focused on families in the birth room and a great counterpoint to the infamous Wall Street Journal doula article (both of which I wrote about and linked to here). It also shatters the stereotype of doulas as white, middle-class earth mothers who work for white, upper-middle-class, highly educated women.

Actually the most exciting part of the article for me was seeing that PBS stations nationwide will broadcast "A Doula Story" starting next month. I have been itching to see this since I premiered at the San Francisco Film Festival last winter. Hopefully I'll soon be able to watch it from the comfort of my living room (possibly surrounded by a few friends? Yes?).

I suppose if one looks, there's a story about an unplanned home or car birth every day. They aren't exactly news. However, here are two I wanted to highlight. The first involves a woman who came to the U.S. from Haiti to learn to be a doula. She ended up delivering in the car on the highway in Miami. But read how her doula training kept her calm and enabled her to help kick-start her baby.

I am touched by the fact that a woman from a developing country came here expressly for the purpose of getting doula training to take back home with her. This, too, debunks the doula stereotype.

Finally, I read in our local paper yesterday about another baby, delivered in the family minivan en route to the hospital. I feel badly for the siblings, especially the three-year-old, who were in the car. It sounds as though they might have been pretty shaken up by everything. I got a smile out of this exchange between the father and the 9-1-1 operator:

"There's a baby on the seat next to me!''
"Where'd the baby come from, sir?'' asked the 911 dispatcher.
"It came from my mom. No, I mean my wife!'' Carruthers said.

Thursday, September 22, 2005

Have you read your RedStateMoron?

I realize putting links to another blog hardly consists of a legitimate post. However, if you're visiting doulicia for the birth-related content, you should check out these posts at RedStateMoron:

1. The risks of delayed childbearing

2. Infertility on the rise

Both raise interesting issues about how our cultural climate affects our reproductive landscape (and vice versa). Along those lines, you might want to check out a third post on Elective Cesarean.

Wednesday, September 21, 2005

Grand Rounds 52

I was laid up with a cold yesterday and so was not able to link to this weeks Grand Rounds, which collects posts exploring the doctor/patient relationship. Good reading if you have the time to peruse.

Monday, September 19, 2005

Daytime epidurals rock!

Well...they at least appear to be more effective at blocking pain for longer lengths of time than epidurals administered at night. So says a new study (co-authored, coincidentally, by the anesthesiologist Peter Pan!).

Doctors found that the time of day an epidural is administered appears to affect its effectiveness. Part of the usefulness of this information, the doctors say, is that it can be factored into appropriate dosages.

"The right treatment given at the wrong time can be ineffective or create a crisis of escalating toxicity," wrote Dominique Chassard, M.D., and colleagues with Hotel-Dieu Hospital in France in an editorial accompanying the study. "Conversely, even a weak treatment, if given at the right moment, could prove surprisingly effective."

Also nice was that the "related article" that ran right alongside this one, was a feature about how doulas are a "risk-free alternative to relieving pain during childbirth."

Saturday, September 17, 2005

3 Doulicias in one week!

I do not have a very common name and yet in the past week I have talked with two different prospective doula clients who share my name. The funny thing is that we all pronounce it differently, which makes it only slightly less weird to talk to one's self ("Hello, Doulicia? Hi, this is Doulicia returning your call..."). I've been hired by the one due in January and cannot pursue getting hired by the one due in October because things are going to be just too darned busy. Don't think I didn't toy really hard with trying to make it work. Two doula clients with whom I share my name would be too fun!

It was on a night just like tonight...

(Ever seen Pee Wee's Big Adventure? That's the title's allusion)

Three years ago tonight I went into labor for the last time. 11:30 p.m. I woke up to a contraction and less than three hours later, Jamesy Doodle (not his real name) had been born. Though he and his older brother were born four and a half years apart, the similarities between their two births is striking:

  • Both labors were roughly two and three-quarters hours long.
  • Both babies were born in the early morning hours (12:50 a.m. and 2:07 a.m.)
  • Both times I went through transition en route to the hospital (7 cm and 9 cm upon arrival; I know, I know...why didn't I have a home birth?)
  • Both births were intervention free, including my personal triumph -- no I.V., until the episiotomy
  • Both boys had meconium present and therefore took brief detours to the warmer before reuniting with me
  • Both labors had a pushing stage of 40 minutes
  • Both times I was sure I was having a daughter and laughed at the news I had a son
  • Both times, I cared less about the baby's well being in the first moments after birth (even as pediatric residents were sticking tubing down my baby's throats) than about my personal relief at being done with labor
  • Both times I was inwardly pleased at how "in charge" I felt once I was in the hospital: the first time telling the nurse who said I needed to take off my shoes that "if you want them off, you're going to have to take them off;" the second time snipping at the midwife, "Can't you do ANYTHING about this pressure?" (her answer was breaking my water...ahhhh)
  • I spent both labors in virtual blindness, as I didn't open my eyes until I was pushing
  • Both times I was certain that that birth would be my last
  • Both times my husband was my only companion and he gave me all the support and calm that I needed

And yet, as you hear all the time, no two births are the same. And so it was with these.

  • 1998's labor started with my water breaking; 2002's started with contractions and my water didn't break until right before I started pushing

  • 1998's labor found us timing each contraction and my husband secretly alarmed that they were coming every two minutes as we drove to the hospital; 2002's labor found us preoccupied with finding someone to come stay with our boy (3 calls, 3 answering machines -- at midnight?!) instead of the frequency of contractions

  • 1998's labor was practically painless once I started pushing; 2002's labor had back pain right up through my last push and in the breaks in between pushes

  • In 1998 I had no idea what I was doing with breastfeeding and the baby and I worked hard for many a feeding to get into synch; in 2002 the baby went happily to breast as soon as we were reunited and nursed for 25 minutes

  • In 1998 we couldn't get the baby to stop crying for about 10 hours after he was born; in 2002, the baby went to sleep for about six hours after his first feeding

  • In 1998 I was scared to take the baby home; in 2002, I couldn't wait to get out of the hospital

I have such positive memories of both boys' births I occasionally get sad that I won't get the chance to "do" birth again. I have to trust, however, the sentiment behind my first words uttered after my younger son was born: "Thank GOD I never have to do that AGAIN!"

Happy Birthday Mr. Doodle.

Thursday, September 15, 2005

Guests at the Birth, Part II

Yesterday I compared the NYTimes' article on large groups of friends and relatives attending women's births with the Wall Street Journal on doulas.

Today I want to call your attention to one particular area of the same article. It discusses the "financial rewards" for hospitals that are more inclusive.

Childbirth, the most consistently happy event to take place within their walls, can be an alluring marketing tool, especially when an audience is involved. "The more family-friendly a hospital can be during labor and delivery, the more comfortable a family will be coming there for an angioplasty," Dr. Ross said.
I had never thought of birth as a recruiting tool for hospitals' other services. At least they don't give you a take-home bag of trinkets advertising other hospital specialties (say, a box of bran cereal that says, "When it's time for that colonoscopy, remember us!").

Still, this is good reminder to look beyond any altruistic, warm and fuzzy hospital actions to the financial motivation. It is always there.

Wednesday, September 14, 2005

Guests at the Birth, Part I

This past Sunday the New York Times printed a front page article about the increasing number of guests women are having with them during hospital births.

Just a generation after fathers had to beg or even sue for the right to be present, the door to the delivery room has swung wide open. Even the most traditional hospitals now allow multiple guests during labor, transforming birth from a private affair into one that requires a guest list. Like bridesmaids and pallbearers, the invitees are marked as an honored group of intimates.

These honored intimates are not usually doulas or other people trained to support the laboring mother. Indeed, many of them are there precisely because the birthing mother would like them to witness live birth for the first time.

Because women used to be heavily sedated during childbirth, even those who have borne their own children may be strangers to the process. Barbara Covell of Rockville Centre, N.Y., joked that she "went to sleep with the first labor pain and woke up in the beauty parlor." Decades later, her daughter "thought it was important for me to witness the birth of offspring - not my own offspring, because it was too late for that, but a grandchild."

The tone of the entire article was positive. To the degree it portrayed a negative element in the birth crowds, it was that they can interfere with the mother's need for privacy during the birth.

Compare this with the front page Wall Street Journal article on doulas which ran on January 19, 2004, "As 'Doulas' Enter Delivery Rooms, Conflicts Arise:"

There's a new work force entering obstetrics wards. They are often strangers to the staff and unrelated to the patients. They aren't licensed and aren't required to have any formal medical training. And they are sparking protests in the medical community.

The workers are called doulas.

This was the first time doulas were addressed in a national media outlet. It was shockingly negative and hurtful to all of us in the birth community.

You have two groups of individuals. The first is family, friends and co-workers of the birthing mother. The second is a professional labor assistant hired by the mother. Both are known to the mother and unknown to the hosptial. Both are invited by the birthing mother to be at the birth. Yet the article about the former group focuses on how they are welcomed, despite their capacity to complicate things, in the delivery room, while the article about the latter group focuses on how a small, disruptive subset is souring hospitals' reception of the group generally. Why the difference?

How about this hypothesis: A woman who invites her family and friends, who turns her birth into a social occasion of which she may or may not be the center, who worries about hurt feelings and relationship ettiquite is acting in a socially acceptable female way. We are supposed to subvert our wishes for others'. We are supposed to share ourselves, even our most sacred and intimate moments, with others. We are allowed to let others come help, or simply watch us. A story about us in this role -- and medical institutions' accomodation of our wishes -- is a patronizing one, a familiar one to write, an easy one to read.

However, the woman who selects a professional NOT ASSOCIATED WITH THE HOSPITAL to accompany her in labor, who wants an individual to help her advocate for her wishes, who recognizes she may defy hospital and cultural conventions and need some support doing so is decidedly not behaving as women should. To write about women acting in this way is socially uncomfortable. We are not supposed to listen to our inner wisdom, especially when it means establishing boundaries, whether with families or with hospital staff. We are not supposed to have our own expectations or wishes. This can only be bad. Bad for our culture, bad for medicine. The only way to tell this story is as one of conflict, and one in which women are punished for their bad choices.

Monday, September 12, 2005

Book Recommendation

If you have not already read Into the Forest, by Jean Hegland, I cannot urge you enough to do so. Because I find one's enjoyment of the arts is usually inversely related to one's expectations, I hesitate to give more than a tepid recommendation. Yet I so enjoyed it -- and it is so in line with themes of this blog (not to mention this writer's life) -- I have to tell you that if you can't find it at your local library (indeed the only copy in town was buried deep in the stacks of the university library), you can order it used through Amazon for a mere $2.80.

What is it about? I'll leave that to you, wise reader, to determine. Let's just say it's a bit of The Red Tent meets The Boxcar Children (less Henry, Benny and most of humankind) crossed with A Heartbreaking Work of Staggering Genius, all coated with a helping of the Bible's Revelations.

Let me just say it is a reminder that if prostitution is the world's oldest profession, midwifery must be the second oldest. And if society collapses in the future (a thought to which doulicia devotes a not-necessarily-healthy amount of speculation), people will still need (i.e. will give you eggs and firewood in return for) the services of someone who can help them through a home birth. A career beckons...

Bless Their Hearts

A group of English midwives have designed a two-year study to see if the baby's in utero position at the time of labor has anything to do with labor length and outcomes. A few things from the article that caught my eye:

  • One of the study's organizers is quoted as saying, "One of the most common reasons why women have [a Cesarean delivery] is when they fail to progress in natural delivery, ie their cervix is not dilated enough. As midwives we believe that's due to the baby's position in the womb, but that diagnosis has never been formally made."

I did not realize that the failure-to-dilate/malposition relationship is hypothetical. I have always heard it talked about in more certain terms. When a woman doesn't dilate, it's either because the baby isn't low enough to press on the cervix and make it dilate or the baby's head isn't making complete contact with the cervix. Perhaps the midwives will find this is not so (but I doubt it!).

  • Another midwife working on the study said, "I think we've come to the point where if there are problems during labour we think 'Well we can always do a C-section'." The article reports these midwives have a Cesarean rate over 20 percent.
I find it interesting that even the midwives take the Cesarean option for granted. She talks about it not as a life-saving option of last resort but as a familiar and recognized solution to labor problems. I am again reminded of Sage Femme's client who pushed for seven hours. Name one hospital where that woman would not have had a surgical delivery.

  • Finally, the article reported that "the team - which also includes midwife Bernadette Early and the University of Central England's senior midwifery lecturer Susan Dover - urgently need extra research staff to assist them. Ms Webb added: 'We're doing this in our own time, on top of our full-time work, and we need a research midwife and a statistician to help us collate all this information and analyse it.'"
If there are medical researchers out there that can educate me on this last point, I would appreciate it. The article makes it sound like the midwives have organized and launched this study without any funding. From my time in academic institutions, I would be shocked to learn of a major research project that does not have funding. Isn't that how things work? Perhaps only in the U.S.; or not even here. This is why I'm asking for help here.

Still, it is impressive that these women took it upon themselves to learn something that might help reduce the Cesarean rate. If they have organized it without any funding, then it's all the more inspirational.

What can you do to bring down the Cesarean rate?

Thursday, September 08, 2005

Elective Cesarean Poster Child

As reported in USA Today:

"Spears, 23, says she doesn't know the baby's sex (but has a feeling it is a boy), and hopes to have a cesarean section. 'I don't want to go through the pain. My mom said giving birth was the most excruciating thing she's ever gone through in her life.'"

This from a woman with a pierced navel and breast implants (not to mention those rubber catsuits)? Careful what you wish for, Britney.

Seriously, it is so sad that this idol for many young women is saying "birth is so scary I'd rather get a Cesarean." This is what we're up against, birth community. Rock stars. When it's Britney Spears vs. Ina May Gaskin, I'm afraid we're not going to get much attention.

Wednesday, September 07, 2005

Don't forget Grand Rounds

I haven't linked in a while, but this week's Grand Rounds are hosted by a medical student right here in Ann Arbor, so take a gander. It contains posts on a Life Expectancy calculator, as well as Baked Body Parts. Enjoy.

Viagra's role in pregnancy may not be limited to conception

This news is several months old, but I had not heard it until this weekend. In case you haven't either, viagra and related drugs may prove helpful in treating preeclampsia. Is this ironic or poetic?

Well it FEELS like I post every day

I am surprised to see it's been nearly a week since my last post. I guess I have been busy.

The Center for the Childbearing Year (a.k.a. CCY), of which I'm not only a board member but FUNDRAISING CHAIR, is kicking its annual giving campaign in to high gear. In the last week I have met with the Center's Executive Director and a fundraising consultant and, at a separate meeting, the Center's research coordinator and another fundraising committee member. Lessons learned?

1) if someone has given to the organization in the past, we need to approach them to give again.

2) States and cities have many small (and not so small) family foundations, many of whom make charitable donations to groups that work with women, children, "areas of human services" or "health care." In other words, we need to start applying to these foundations for money.

Of course we have also had some interesting side conversations on doulas, birth, etc.

Relatedly, I am working on assembling a slide show of birth photos I've taken. I'd like to use it at fundraising desserts and teas that I'll be hosting as a way to introduce the "audience" (friends) to the Center on an emotional level. If I can figure out how, I'll post it here once it's complete. At the least I'll make it available as a PowerPoint slide show I can e-mail you on request.

I also had dinner with a former classmate who was visiting from out of town. She shared a great birth story: Her sister had a baby last spring. This was her first child, first pregnancy. One afternoon around her due date she got home from work and felt a little fluey. She had some diarrhea and felt nauseated. She laid down on the bathroom floor because the cool tile felt good on her face.

When her husband got home, he was alarmed to see her on the floor and said, "I'm taking you to the hospital." She said, "I'm fine, I just feel a little sick." He insisted that she at least call her OB. She did. The doctor asked if she was contracting. No. Did she feel rectal pressure? No. Was she having any bloody show? No. The OB said maybe it was food poisoning.

The husband made some dinner and came up to invite his wife down. She was now naked on the bathroom floor. Even more alarmed, he made good on his decision to take her to the hospital. He brought her some clothes and helped her down to the car. All the while she insisted she was fine, just a little queasy.

At the hospital a staffperson brought out a wheelchair. My friend's sister was embarassed about all the fuss. "I'm just a little sick" she kept saying, rolling her eyes at her husband.

They took her to labor and delivery. She was completely dilated on admission.

On hearing this news, she went from laid back nay-sayer to panicked first-time mother in a matter of minutes. They began preparations for her to push and she started crying that she didn't know how to do it because she hadn't taken any classes (she was planning on getting an epidural the minute she was admitted!).

Friends, this woman pushed for 20 minutes before delivering a healthy baby boy.

But that all labors were this way. I saw Sage Femme's post yesterday about the woman who pushed (PUSHED!) for seven hours. Look soon for a post from T$, whose first-time doula client delivered this morning after being 10 cm. on admission to the hospital.

More posts today and tomorrow, I promise. As work slows down I'll get back in my groove.

Thursday, September 01, 2005

When the Vagina Stops Being a Recepticle

Last week in the New York Times, a columnist wrote about the trauma some men undergo when they watch their wives give birth (I couldn't link to NYT without paying, so I provided a free link instead). No, they're not traumatized by seeing their partners endure physical hardship. Nor are they traumatized by the medicalization or impersonalization of a hospital birth. They are traumatized by the sight of their woman's, you know, "area" as it bulges, bleeds, cleaves to reveal their child's head and body.

Although no one seems to talk publicly about the problem, Josh is one of dozens of men who have confided to me that witnessing the births of their children has made it difficult for them to be attracted to their wives, at least in the short term. They seem to have trouble seeing them as sexual beings after seeing them make babies.

I have sat with this for a week or so, trying to be understanding. I can't. Frankly, I am repulsed. If a man watches his partner go through birth and somehow sees her as less sexual or less attractive, he had the wrong image of women to begin with.

If the sight of your partner's body arouses you, great. But if your desire to be with her is based on the sight of her, it seems you are missing the boat. At the very heart of a woman's femininity is her procreative capacity. This capacity includes tenderness, vunerability, malleability -- all distinctly feminine virtues, and largely represented by the woman's role in creating new life.

Our reproductive capacity also includes emotions and states that are less easily accepted as feminine. There is a self-reliance, a fierceness, a raw power that is equally a feature of women. We do not show this side often, but doggonnit it's there. And what better example of it then the sight of a woman crowning her baby at the entrance to the vagina?
"Honestly," one man, married for 12 years, told me, "I think one of the main reasons I don't feel attracted to my wife is that I saw her give birth three times. It's like I know too much about that part of her." The mystery is gone.

Honestly? That's unfortunate. I would hope that most women are partnered with individuals who want to know them fully, who would stand in awe of their strength as they bring life out from within them.