Written on the Body

Thank you, Pink Lady, for sharing your tattoo with us all.

Imagine if all of us depicted our losses on our bodies. Mine would have "the perfect parents" (not literally those words, but some representation of them) and Louis for starters.

What you be on yours?

Birthing Like a Girl

I was reading Linda’s comment to my post about an Expectant Grandparents class and it reminded me of a research presentation I went to several years ago. “Giving Birth Like a Girl,” summarized what U-M professor Karin Martin learned from interviewing women and having them tell their birth stories.

What she found is that the socialization women undergo – to be caretakers, to deflect attention away from themselves, to be deferential, to seek external validation – can conflict with many of the behaviors normal, even necessary for a good birth.

I’ve dug out my notes from her talk and here are a few interesting points:

· Women described their behavior during transition in negative terms and feel badly about it afterward: “Then I got crabby;” “I was really nasty to the nurses.”

· Women looked to their male partners to define their labor experience, both in the moment and afterward. One woman said she was tolerating labor fine, but her husband was so upset she got an epidural for his sake. Another woman kept seeking her husband’s corroboration as she told the birth story (“Right, dear?” “Didn’t I?”).

· Women continued to play “hostess” during labor, not wanting to inconvenience others. Several women talked about how they wanted to ask family to leave the room but didn’t because “they were so excited and had waited so long for this.” Women commented on feeling badly that they were “so demanding” of the nurses and partners. One woman even said that she really wanted to bellow loudly, but she was worried that might scare women in other rooms who wouldn’t know that she was actually feeling fine.

· Even those women who were comfortable running their own labors and were following their body’s lead admitted to some guilt after the fact for being “such a bitch.”

I raise this with my clients in advance of labor. I tell them that in labor they may find themselves acting in ways they might no ordinarily. I assure them the hospital rooms are very soundproof and that they can’t do anything that a nurse hasn’t already seen before.

Of course, the time to address this is long before doula meetings are happening. I think childhood is a good place to start. Teach girls how to listen to their needs, make space for them, and ask others to do the same. Then more of them will grow up to birth like women, or better yet, like the ferocious, primal she-beasts we all house inside.

Midwives "Down Under" Out-Number

In scanning this article about Australia’s Midwife of the Year, I was surprised to see that there are about 12,000 midwives in that country. It made me wonder how the U.S. compared.

The American College of Nurse Midwives’ 2003 annual report (the most recent available on line) listed just shy of 7,000 members. The most recent newsletter from the North American Registry of Midwives (the certifying organization for direct entry or “Certified Practicing Midwives”) recognized their 1000th member.

Even adding together the CNM and CPM figures, we only get to 8,000. Two-thirds the number of midwives in Australia.

What about population? The U.S., at 295 million, has more than ten times as many people as Australia.

Grandparents, Expecting

A few years ago I was at a great birth. A first-time mother’s water broke around 5 a.m. and she had the baby around 11 a.m. She labored at home until around 10:00 when she said “I think we should go now.” Her contractions were every 3-4 minutes, lasting about a minute. Definitely active labor. Only in the car ride did her quiet, low-pitch humming begin to escalate. We began to lock eyes and breathe together through each contraction. She was 9.5 centimeters in triage.

They no sooner got her in to a room than she started pushing. I was set for the 2-3 hour run, but instead 20 minutes later her slick little boy entered the world to everyone’s delight.

At that moment a nurse poked her head in the door and said “there are some grandparents out here that would like to come in.” It was the new mom’s parents. She asked the nurse to tell them that she’d send her husband for them when she was ready for them. Then she examined her son, shared hugs and kissed with her husband, put the baby to breast and began to absorb what just happened.

Soon after she delivered her placenta a different nurse came in the room: “Your parents are out here and they’re pretty eager to see you.” My client smiled and said, “Tell them another 20 minutes or so.” The nurse waited at the door and said, “Maybe one of you could come talk to them? They’re pretty anxious.”

I walked out to the hallway. A short, stocky, gray-haired man approached me as soon as I stepped out the door. “What the hell is going on in there?” he demanded. “They keep telling us we can’t go in. We don’t even know if the baby’s alright. How is my daughter? I want to see her!”

Whoa! Pinned against the wall, I took a breath and calmly explained that everyone was doing wonderfully. The baby was healthy, the mother was radiant. Things could not have gone any better. “But,” I said, “Your daughter is still undressed and is not ready to have guests yet. She wants to see you all just as soon as she has had some time to get herself together.”

They returned to the waiting room. When the new father went to deliver the news in person, he returned with the clan in tow. He offered a weak smile to his wife and said, “I couldn’t hold them back any longer.”

Long story for a short point: it would be useful to provide family with education about childbirth and new parents. Some new grandparents handle their new status gracefully. Others, however, become wrapped in a self-centeredness that rivals that of adolescence. I do not mean this in a vicious way. In fact, I am sympathetic.

New grandparents are befuddled by the hospital practices and birth timelines (“if she’s been pushing for 2 hours something must be wrong!”). They are overwhelmed with the anticipation of access to a baby, and better yet, kin, that they have not had since their own children were born. Yet in their excitement to meet their new grandchild and/or verify the well-being of their daughter/in-law many new grandparentsforget that these are the first moments of bonding for the motherbaby unit and the new nuclear family. And days, weeks later, they also forget that new parents need help with the house, not (usually) help cuddling the baby.

After the birth I described above I went home and began drafting a pamphlet for expectant grandparents, aunts and uncles. Like so many things, it sits as an unfinished draft on my computer’s hard drive.

But I came across this story about a class for grandparents-to-be and it sounded like a great idea. I am wondering whether there would be any audience for that here. I would love to teach a similar course, though with a slightly different focus: how to be helpful to your children when they become new parents.

Better still would be to have a grandparent teach or co-teach the class. They would be someone the audience could relate to and trust better than me, who is the same age as their birthing children.

Course outlines anyone?

The Up Side of Primips

A doula friend and I have a running joke that she always gets the repeat (multiparous)birthers whose labors race along. I get the first-time (primiparous) mothers whose labors are, well, first labors.

Granted, I've had two primips whose labors were under five hours and who spent less than an hour at the hospital before delivering. In general, however, my clients have the 18 or 24 hour labors. I was recently reminded, however, that in addition to their excitement and curiosity about every aspect of pregnancy and birth, first time mothers have another positive element: no other children.

The older I get, the less I like other people's children. When I was in high school, I babysat all the time. I truly enjoyed it. I still correspond with families for whom I used to babysit.

Then I had my own children. Or I just got older and less tolerant. Or both. At any rate, the result is that I now have little patience for other people's children, especially those who wildly disrupt doula client visits.

I recently visited the home of another doula's client. I had agreed to back up this doula during a week that she would be out of town. We got to her client's home and were greeted by a tangle-haired, grubby-faced, barefoot, dress-wearing three-year old. In fairness, my children would probably look like this if they were girls. Her appearance was not the objectionable feature of her presence, of course. It simply added to her feral aura.

During the abbreviated visit -- cut short because it was obvious we couldn't carry on more than a superficial conversation -- this girl helped herself to the items in the other doula's birth bag, hauling out essential oils, CDs and honey packets with reckless abandon. She rolled the birth ball up to me and demanded "bounce me." When I said I was busy talking to her mom, she pressed a palm to each side of my face, the better to turn it toward her, and said again, with no humor whatsoever, "I said bounce me."

Her mother finally asked the girl's father to entertain her. With his assistance we were able to exchange phone numbers and establish the dates I woud be on call. Yet even with the paternal diversion, the girl managed to get in a pull on the other doula's hair and throw a class I tantrum.

This woman ended up delivering with the doula she'd hired. The doula got called to the house four hours before the mother delivered. Short? Yes. Everybody happy? Yes.

But now, poor soul, this doula has to wade into that house for postnatal visits and deal with the daughter who is adjusting to a new sibling, who appears not to know how to respect others, and whose mother certainly won't have time to discipline her now, if she didn't for the past 3 years.

Me, I'm happy to work with parents who are anticipating their first baby, the possibility of a long labor, and a lifetime of effective parenting.

(In fairness, I had a client in the past year whose three-year-old daughter was a delight. She and I drew photos for each other. We had a tickle-monster relationship. When I came for post-natal visits, I delighted in playing with her and having her company while I cleaned the bathroom. Another client's son was no more demanding than any other two-year-old would be. Yet I think this was largely my good fortune and fate is not something I generally like to tempt.)

Imaging Versus Imagining

Two controversial issues in pregnancy and birth imaging are gathering steam.

The first is videotaping of births. Some parents like to have a record of their child’s first moments ex utero. Some birth injury lawyers spontaneously ejaculate when the same record turns up as evidence in a malpractice case. As AMA president John C. Nelson noted, birth videotape is “a potential nail in the coffin from a liability perspective.”

The second issue has to do with “ultrasound boutiques,” which I hadn’t heard of before reading about them on Red State Moron’s post. They use ultrasound machines solely for the purpose of giving you photos or videotape of your baby, not for any medical diasnosis. Here is one that’s in a shopping mall.

In both cases what interests me is not the tension between doctors and patients, but the relationship between families and technology. What do we gain from a live-action record of birth that could possibly surpass our own memories of the event? How many women have been surprised or even shocked to see the mismatch between their recollection of the birth experience and the projected images they see on videotape? I have observed this even with photographs. Some women do not want to see photographs of their baby’s birth for fear those images will overwrite the ones in their memory.

And what in seeing the profile or bas relief image of our child draws us to her or him in a way resting a hand on our undulating belly can not?

This is not a criticism. I wish I had videotape of my sons’ births. If given the option at my ultrasound appointments, I certainly would have wanted to see a 3D image.

But why? What is our relationship to videoscreens that it overrides internal wisdom and connection? Are we letting our visual processing overwhelm other senses? It makes me wonder what the experience of pregnancy is like for blind women. What connections do they make to the growing life inside them and their changing bodies when they cannot rely on sight to affirm and define it?

I wish there were as many options for women wishing to acknowledge their pregnancies through non-visual, or should I say non-technological, means. I don’t even know what forms these options would take. The belly cast is one, visualization is another. What else? How else have you found to connect with, believe in the reality of, and bond to your baby without looking at an ultrasound monitor or reliving the birth on a TV screen?

Cryptogram

Uterus. Heart. Meaning?

For several weeks I have been perplexed by an image spray painted on the sidewalk outside the university building where I work. It is a hot pink uterus with a little hot pink heart next to it. It was clearly created from a stencil laid on the sidewalk and a can of paint -- the sort of system intended for rapid replication of images. Yet this is the only one I have seen in my frequent and varied walks around campus.

What does this image mean? And why did someone go to such lengths to paint it on a relatively minor sidewalk?

I will try to snap a photo of the real thing tomorrow at work, but for now, you can get some idea what it looks like by viewing the image here.

As much as I like answers, I have to say I have a developing fondness for this unexplained uterus + heart icon. It feels like it was put there for me, to remind me as I head in to my other work, that the uterus is always out there, always loved (or loving?) and that someone else feels the same way I do about it.

Fight Fire with Fire

If birth in America is to change for the better, things are going to have to get ugly. Hopefully not in the birthing rooms, but at least rhetorically between stalwart clinicians and more progressive practitioners. A few examples:

First, this summary of the turf lines and attitudes toward midwives, nurse midwives, and unassisted births. Unfortunately the article uses a maternal death to lead in to the story. Other than that, it is pretty balanced reporting on what the various birth attendant classes (MD, CPM, CNM) think of one another.

From Australia, here is another story on tensions between doctors and other birth care providers. Though it's overseas, this scenario does not seem out of place in the states either. Here's a story about a Pennsylvania midwife who has had to close her practice because she can't get authority to write prescriptions.

Finally, there is this response from a maternal-fetal medicine doctor, steeped in condescension and contempt, to the ACNM’s call for Congressional Hearings into the escalating rate of Cesarean births.

This last piece, especially, reminds me that if natural birth advocates ever hope to advocate successfully, they (we) are going to have to make sure our efforts are as professional and scientifically founded as possible. This doctor throws away the American College of Nurse Midwives’ concerns as quickly as a soiled pair of surgical gloves. And blames the patients to boot.

Talk of the beauty of birth or the innate power of women is not going to make ACOG change its standards of care. Nor, unfortunately, will a bunch of women with gauzy skirts and Guatemalan bags get the attention of hospital administrators.

To advocate for woman- and baby-friendly care and a true range of birth options, we are going to have to have statistically significant numbers from double blind studies and hard-as-nails lobbyists to present them. By all means let’s not lose sight of birth’s magic or the voices and wisdom of Earth Mother midwives and doulas. We just can’t afford to be viewed as soft, weak, or fuzzy by an establishment that needs little excuse to dismiss us.

Calling All Doulas (and Prospective Doulas); Calling all Moms

It's finally up on-line: registration for the 2005 DONA conference this summer in Washington D.C. I sure hope some of you friends I've met on-line are planning to go. We could have a doula bloggers (and blog readers) drink together!

And now, a question I've been wanting to ask for over a week: What was/is your favorite item of maternity clothing?

I had one March baby and one September baby. For the March one I loved these floral print, corduroy Laura Ashley overalls. They weren't maternity, but you know how everything Laura Ashley makes is loose in the waist. For my September birth I had black capri pants and a blue gingham 3/4-sleeve button-front shirt that were so summery. Every stitch of maternity clothing I wore (except underclothes) was borrowed. Thank you Robbie, Marnie and Dora-Maria for the items listed above.

The umbilicus gets severed after birth, remember

Before I lose this link, I wanted to connect to it here. It’s an article about how the current trend in protective parenting is leading to prolonged adolescence and increased anxiety among children.

Because I work with college students, I am particularly interested in this analysis and possible explanation. When I compare advising now with that that I did in the early nineties, the differences are stark.

Many students today seem quite helpless, lacking in self-awareness and wholly unable to make independent decisions. They come to me to solve problems that students a decade ago would have done on their own (e.g. trying to track down a faculty member who is not responding to e-mail). More frightening, they look to me, doe-eyed, to make decisions about their schooling and future: “Should I take Algae or Ornithology?” “Would I be better at law school or public policy grad school?” I have had parents accompany their students to appointments with me where we discuss the merits of one career path over another – and the parents totally directed the discussion. A large minority of my appointment begin “I was talking with my parents and we…” or end with “Well let me talk this over with my parents and get back to you.”

I get so enthusiastic when the rare student says, “my parents want me to do X but I really want to do Y and so I’m just going to do it.” I never would have imagined I would be whole-heartedly endorsing someone’s moving to Nashville to break into the Christian song-writing business. But when that particular student finally came to the conclusion (after MONTHS of directionless spinning), I swear I got misty-eyed. Godspeed!

Seeing these coddled, hand-held students reminds me of how my seven year old son comes back from visits to his best friend’s house with the bottle of water they provided for the trip. Or how my two-and-a-half year old will not be allowed to ride the trikes at preschool unless we provide a helmet for him. Do they know he climbs the six foot step ladder into our tree house unassisted?

Last week I ran into Bookworm and her two older children at the local ice cream shop. While she and I chatted, her son spent some of his allowance on a cone. With his first lick, the entire sphere rolled on to the floor. Everyone stared at it for a minute and then Bookworm calmly said, “Well? What do you want to do? You have two dollars left.” My son looked on in awe as this nine-year-old decided – with disappointment of course – that he was going to use some more of his money to get the pleasure of a cone.

Never mind that the shop replaced his ice cream for free. It was reassuring to see a child asked to choose between two losses (money or food) without a parental offer to make things better. Better still was the equanimity with which this boy faced a situation that would provoke a meltdown out of others. I suspect his advisors will enjoy him ten years down the road.

Define Difficult

Oh my! Sage Femme pointed me in the direction of a book Dr. Hooberman has co-written, Managing the Difficult Patient. I don’t know if that’s properly labeled ironic or poetic.

This prompted me to do my own search for Dr. Hooberman. I could not turn up anything else to speak of. Though in the process, I found that someone has already jumped me on my idea of Grading the Docs. Except, of course, this one is for profit. Still, it has a place where people can submit comments on doctors. So if you know someone who should be reviewed, positively or negatively, chime in. Also, it’s not limited to OB/GYN, so think broadly!

Nipples of Steel

I was relieved to hear mothers at my book group comparing nursing experiences the other night. We shared a laugh recalling those first few weeks of nursing when our tender nipples stabbed with pain for the first 30-60 seconds after the baby started sucking. One woman even did a perfect pantomime, complete with bouncing feet, raised eyebrows and her mouth shaped in a tight “O.”

When new mothers call me, frustrated with their nursing experiences, one of the first things they say is “It’s not supposed to hurt!” This is what the lactation consultants, the hospital nurses, or even La Leche League leaders have told them. After we talk a while, it becomes apparent that they are not referring to a chronic issue, but rather an initial "ouch" that fades as the session progresses. A week later, they are fine.

This was my experience with both of my newborn sons. I do not think I had positioning problems or that my sons had bad latches. I think my nipples, which until that point had encountered nothing rougher than a bath towel, were in shock at the repeated compression and stroking they were getting at ninety minute intervals. This seems normal.

Yet I have seen time and again the hospital nurse say to a mother, “Remember, if it hurts, you’re doing something wrong.” Yikes! I have even asked “It’s normal for it to hurt a little at the very beginning of a feeding session, though, right?” and been told “no.”

Finally a lactation consultant explained to me that they don’t want mothers to get it in their heads that they have to endure pain to breast feed. She said many women will go through weeks of nursing, clenching their teeth the entire time, because the baby is chomping on the nipple instead of the areola. I am all for avoiding that!

Always the moderate, I am just asking for full disclosure. Breastfeeding should not hurt for the entire session, true. And once you and the baby are in a groove, the reappearance of pain probably indicates an infection or blockage. But if in the first two weeks your nipples hurt pretty darn badly -- and you find your eyes suddenly squinty and feel the need to revert to those slow, steady labor breaths for a minute or two – it is probably just a little adjustment period while your nipples get used to their new task.

Meme

Courtesy of Bookworm:

1. You are stuck inside Fahrenheit 451; which book do you want to be?
I see from Bookworm this means what book to you want to memorize and thus be responsible for preserving. Tall order. And I’m not much of a memorizer. But I do think Darwin’s Origin of Species is pretty important. If the book has to be a work of fiction, then I’d choose Dr. Seuss’s The Lorax.

2. Have you ever had a crush on a fictional character?
A crush, no. But I had a really warped attraction to Humbert Humbert in Nabakov’s Lolita. There was something titillating about such a perverted man’s cruel attentions to the girl. I AM NOT a freak, but what can I say?

3. Last book(s) you read?
Oryx and Crake, by Margaret Atwood. And that’s about all the post-apocalyptic dystopia I can face for a few months.

4. What are you currently reading?
The Power and the Glory by Grace MacGowan Cooke. I stumbled across it in the library when I was looking for Oryx and Crake. It was published in 1910 and is a lively and eye-opening story about one girl’s descent from the Appalachian mountains to toil in the textile mills of Tennessee.

5. Five books you would take to a desert island?
At least two would be field guides to local flora and fauna. One would be the American Boys Handy Book. One would be an anthology of poetry. And I suppose the one book of fiction I would bring to read over and over would be The Feast of Love by Charles Baxter, because it is set in the neighborhoods around my house and would remind me of home.

Who are you going to pass this stick to and why?
I am guessing, by Bookworm’s blog, that it has to be bloggers who have visited my site. That said, I would like to see responses to these questions from:
Sage Femme, because she has such thoughtful posts and has referred in several posts to books that have influenced her.
PinkLady, because she is being so honest about a hard time in her life and besides, thinking about books might help her think of other ways to deal with her loss.
T$, because although we are friends and back each other up as doulas, we never have talked about books (well, birth-related books excluded) together.

I'm wondering if rules of the meme allow me to tell them I've passed it on, or if the fun is in seeing if they ever do. I think I'll work on my patience and wait.

Copy B: To Be Filed With Employee's FEDERAL Tax Return

Note to doulicia: Next year do not leave your tax materials lying in reach of your toddler's hands.

Iron, Depression and Honesty

Busy at work today; I promised myself I'd be a "good" worker and not get distracted by the internet.

Then I just happened to stumble across this announcement that researchers have linked iron-deficient anemia to postpartum depression.

And that reminded me of this sad illustration of the risks of untreated postpartum depression. (if you can't view the article because it's password protected, let me know and I can e-mail it to you).

Which made me glad to see that doula Kristina is helping her clients talk honestly about their postpartum feelings and fears.

I feel like my posts have been negative lately, which I don't like. I'm trying to look for happy birth news out there. I know it occurs hundreds of thousands of times each day!

Birth and Taxes

I spent the weekend working on our taxes. It’s almost enough to make me quit doulaing. I grossed $3,900 for my doula work last year and spent about six hours calculating the taxes I owe on it!

Not that I object to taxes. It’s just frustrating to have the bulk of our household income be so quick to put through the tax formulas and the small fraction that is doula work to take so long. All for $400 in self-employment tax and half that as a credit (or deduction).

I would prefer to pay a flat rate than to calculate the depreciation of our computer, the total miles driven (adding up those 4 mile round trips to the hospital or the grocery story), the sum of the receipts for disposable food storage containers, chapsticks, and other “supplies” for the business.

On the plus side, I was able to get something of a profile of my doula business as a byproduct of my slicing and dicing for taxes. For example I learned that on average I have five home visits with clients, rather than the minimum four I lay out in my contract. I learned that although half my clients were within walking distance (generously defined) of my home, I put nearly 500 miles on our car in the process of doing doula work (which confirms my instinct to stick to clients closer to home if possible).

What is not reflected is the total number of hours I devote, consciously or not, to this work. Even if I know a birth lasted 13 hours and the pre- and post-natal appointments totaled eight hours, I tend to overlook the phone calls and e-mails, the digging through books or on-line to help clients find information, the shopping, preparation and cooking time for meals, and the hours lying awake in anticipation or aftermath of a birth.

Those moments slip by in small, unremarkable increments, but are what ultimately take their toll on my family. Last night I felt myself catching a cold, so I thawed out some broth and started making soup. My older son walked through the kitchen, did a double take, and then said in a taunting, sing-song voice, “Oh, are you making more soup for another doula client?”

Thankfully I’m not taxed for that time. But then, I’m not paid for it either.

April Fools?

Courtesy of dictionary.com:

fool:

1. One who is deficient in judgment, sense, or understanding.
2. One who acts unwisely on a given occasion: I was a fool to have quit my job.
3. One who has been tricked or made to appear ridiculous; a dupe: They made a fool of me by pretending I had won.

Can we call women who choose Cesarean births for convenience fools? Here's a report from a Florida hospital where Cesarean deliveries exceeded vaginal births last year.

April is National Cesarean Awareness Month.

Grab Bag

Another calm and unexpected home birth reported at this site. What is it with the British?

Actually I have a an idea. I think they cover birth a lot more in their on-line news than I see here. If you go to google news and type in "birth" or "midwife" or any other word, about half the stories that come back have ".uk" addresses. Considering the comparative populations of Britain and the U.S., this says something. Birth just is not as much in the news here. 'Cause I gotta think plenty of Americans are having unplanned home births.

Now to the Friday fun show:

1) Check out this film depicting "Birth Man." It's in Spanish, but the point is not lost! The link comes courtesy of ICAN. April, by the way, is Cesarean Awareness Month. Incidentally, April is also the Month of the Young Child.

2) Let's talk impacted feces. Doesn't this look like it occupies more volume than a uterus with a full term baby? But without nine months to adapt to the situation. This link courtesy of Dr. Andy.

Spouse says if I'm linking to poo pictures, I should get in the bed. I think he's right.