Thursday, July 28, 2005

The Uncertainty of It All

I got a call last night from my client who is due August 7. She is very in tune with her body. Yesterday she noticed a slight backache off and on. Then in the evening, her Braxton-Hicks contractions persisted long past the time when they typically quiet down. Resting didn't help. Bathing didn't help. Could this be it, she wanted to know.

Ah, well. If only I knew!

I empathized with her. I said how frustrating it can be to not know when labor is starting. I explained that if six hours later her contractions were becoming painful, lasting longer, coming more often, then she would be in labor. But if in six hours she was sleeping soundly while her uterus rested, or quietly continued its rehearsal, she would not be in labor.

Somewhere (and oh how I wish I remember where), I once read that the AVERAGE labor starts and stops three times before it culminates in THE labor that delivers the baby. I know the two nights before my younger son was born I had contractions from dinnertime until midnight. But then I'd fall asleep and wake up to a calm belly.

Just as nobody can tell a woman what kind of labor she will have, nobody can guess when or how it will start.

Depending on your point of view, that is the beautiful mystery or the confounding aggrevation of natural labor.

update: my client just called to say she'd lost her mucus plug. So those contractions yesterday were doing something!

Wednesday, July 27, 2005

DONA conference debrief

The conference. Hundreds of doulas in one place at one time. Teen doulas. Old doulas. White doulas. Black doulas. Mexican doulas. Israeli doulas. (DONA International indeed!) Straight doulas. Lesbian doulas. Pregnant doulas. Nursing doulas. Earth Mother doulas. Business-suit doulas. Certified doulas. Uncertified doulas. Birth doulas. Postpartum doulas. Homebirth doulas. Hospital-based doulas. I was surprised by our diversity. Especially when the first national doula survey found the majority of us to be white, roughly 40 years old, college-educated, mothers.

The general sessions I went to were on Preparing Parents for the Postpartum Period, Updates in Anesthesia, Intimate Partner Violence, and the Doula Backlash. The last two were particularly good, though the other two were also informative.

I learned that on average, one in six women doulas encounter working with a general pregnant population is in an abusive relationship. Zoinks! That means I would have encountered three such women if I had a statistically representative population. I don’t think I have had such a population, though I had one client who I’m certain is abused and another who I suspect may be. The presenter gave us great tips for being useful. What I took away was making sure I’m able to, at some point, get every woman alone, to ask her if she’s ever scared or hurt by her partner. I ask about abuse in my general client history questionnaire, but the partner is usually present for this. I also learned what to say when a woman reveals abuse: “Thank you for sharing this. I believe you. You are not crazy. You do not deserve to be hurt. There are safe places you can go when you’re ready.”

“Queen Doula” Penny Simkin closed the conference with a discussion of doula backlash and what we can do to prevent it. I cannot think of a better icon for the doula movement than Penny Simkin. I have to put her picture here so you can see (if you haven’t already) how kind and wise she looks.

When she speaks, even to a full conference hall, you feel as if you’re sitting across the kitchen table from her. She is that informal, personable, humorous and vulnerable. That she still works as a doula blows me away. How lucky her clients are to have her smarts, experience and heart with them through birth.

Enough gushing. The take-home lesson I got from her lecture is to introduce myself in advance of a birth to my clients’ midwives/doctors. I came home and promptly wrote a letter to my current client’s doctor explaining that I’m a team player and carry no agenda beyond facilitating my client’s getting the information and care she desires during the birth. I also put in a business card so that he can refer other women to me if I leave a good impression.

And as to why the doula backlash? There are turf and control issues, of course. There is misinformation and misunderstanding. But we can’t do much about a doctor who wants a woman to just follow his orders with out question. By the time we’re in a delivery with that sort of person, we just need to help the mother through it with as much of her dignity as possible. And we can be there to record and later acknowledge the slights she felt.

We can, MUST, also stay within the scope of our practice. Doulas do not provide medical care. Some nurses and doctors have reported catching doulas in the act of doing a cervical check. Some doulas apparently listen to heart tones or take blood pressure. Some doulas counsel for or against medical procedures. We are not supposed to do those things. It confuses our role. It opens us to liability. It does our clients a disservice.

For the breakout sessions, I attended one on “Latch On,” where I learned that Fentanyl is the epidural drug that causes problems in newborns and that patients can ask their anesthesiologist to give an epidural without it.

I attended “Positions for the OP Baby.” We went station to station trying various tips and tricks. I was pleased to know of most of them, but picked up a few good ideas along the way (2 tennis balls tied tightly in a sock provides bilateral pressure along the spine, instead of 1 ball, which can only be on one side at a time). Here are two doulas demonstrating lap sitting (not to be confused with lap dancing), with a third doula supporting the “mother” with a bed sheet under her arms.

This saves the seated partner or doula from having to bear all the mother’s weight. Note: this is the resting position. During a contraction, the partner spreads his or her knees very wide and the mother slides down into the space below, opening her pelvis nicely.

Penny Simkin gave a breakout session on “Supporting the Mother through Difficult Procedures.” She covered everything from stillbirth to diagnosis of a fetal anomaly to external version of breech babies. Her reminder that frequently in these situations, especially those of loss, “less is more” was helpful. Often our most helpful role is as quiet observer and note-taker and, later, listener.

Lastly, I went to “Birthing with Pride,” a session on working with lesbian, bisexual and transgendered couples. The lesbians in the crowd stressed that the non-birthing woman in a lesbian relationship is not just an analogue for the dad in a heterosexual couple. Non-birthing mothers may have many issues: jealously, equality, redefined identity, etc. Again, great stuff to think about.

The funniest moment was the closing slide of the anesthesiology presentation. The doctor showed this image:

The accompanying text says,

Among the Huichol Indians, the father traditionally sat above his labouring wife in the rafters of the hut, with a rope tied round his testicles. When his partner felt a painful contraction she would tug on the rope, so that he too would experience the pain which would bring new life.

Whether it’s true or not, I think the though resonates with any woman who’s felt labor pain while her partner stood comfortably by.

The conference closed with all the doulas gathering hands around the perimeter of the room and singing “Dona Nobis Pacem.” Something else I learned about doulas? We can really sing!

Monday, July 25, 2005

The Highest Compliment

I'm still digging out from being out of town at the conference, so I don't have time to post about the conference today. Stay tuned.

I just wanted to register my thrill and honor at having my first invitation to be a repeat doula for someone. Actually it's the birth I mentioned here, where T$ and I were "double doulas." The couple is expecting again and has asked us to save the date.

I couldn't be more excited and pleased. For them and for us!

Thursday, July 21, 2005

How many doulas does it take to hold a conference?

I'll soon know the answer. I leave in a few hours for my first DONA International conference in Washington, D.C.

I am terribly excited for the chance to... doulas from across the country.
...hear from DONA founders Penny Simkin and Marshall Klaus.
...walk through the exhibition hall and look for birth bag additions. "The Life of Pi" on the plane and Metro.
...drink a bottle of wine with my sister, whom I'm staying with.

Am I having my usual pre-flight anxiety that the plane will crash? Yes.

Am I missing my boys already? Yes.

Did I have the conversation with Spouse last night that if I am killed in a subway bombing he must be silly with the boys from time to time? Yes.

Then the trip must really be happening. This isn't just a daydream.

I'll be back on-line Monday to debrief from the weekend.

Wednesday, July 20, 2005

Got Art?

Art Fair has erupted on the streets of Ann Arbor. Artists and buyers from across the country have converged in an orgy of consumption on what are guaranteed to be some of the hottest days of the summer. It's a tradition.

Literally block after block is lined with booths selling everything from high end sculpture to tie-died sundresses. In reality "The Art Fair" is three separate main fairs and a few little ones that are held on the same dates in the same part of town. This distinction is lost on nearly everyone, since local merchants and food venders fill up the distance between the separate fairs.

Each year fair organizers thoughtfully set aside the blocks between two of the fairs for county non-profits. This year I served a shift in the Center for the Childbearing Year's booth for the first time. Since I'm also on its board, I helped plan for the booth. I'm proud to say it was my idea to put up belly casts as a way of getting attention. Here is one of the two we put up. Each has the organization's logo painted on the front.

My older son went with me last night to help set up the booth. He got inspired by watching the various booths slowly take shape and by our talks of how to decorate our own space. This morning he came upstairs with two signs for me to post in the booth. If you know how careless he tends to be with his writing and work, you'd know these were earnest efforts on his part:

By the way, I swear I have NOT said a word at home about my bias toward NOT finding out the gender of one's baby. I think this came completely from somewhere inside him, which makes me appreciate all the more what a thoughtful kid he is.

After working in our booth, I had to go to my job on campus. I was surprised to stumble across an exhibit by the Friends Service Committee protesting U.S. involvement in the war in Iraq. They had boots organized by state and with names attached representing the soldiers who wore them and were killed in the war. They filled the grassy plaza at the center of campus.

To go from talking with women about the transformative power of birth to reflecting on the exhibit and the destructive power of war was just about too much for one morning.

Tuesday, July 19, 2005

The next birth-related book I'll be reading

In my constant search to find a replacement to the "What to Expect" product line, I want to check out this recent release. On the one hand, it's written by an obstetrician and its ghost writer edited the Parents magazine website. On the other, Michel Odent blurbs the book.

Is anyone out there a fan of What to Expect When You're Expecting? Two women handed down their dog-eared copies to me when I became pregnant. I thought it was all there was. Thankfully, my sister-in-law gave me her Natural Childbirth the Bradley Way book and Penny Simkin's Pregnancy, Childbirth and the Newborn (check out how the cover mimics What to Expect, hoping to "trick" women into buying the better book!). My path to doulahood had begun.

Incidentally, another woman gave me a subscription to Parents magazine. It probably took me five or six issues to realize how upset it made me each month. All the "Health and Safety" updates were just more ways in which I could inadvertently be screwing up my kid. And each month they featured a family whose pregnancy or child was facing some rare and tragic disease. No matter that they ended on an up-beat note. Did I need to know about other ways in which my child could die or disintegrate?

As a result of my experiences with Parents magazine, I have worked hard to keep doulicia mother-friendly. Yes, there are weird and rare ways in which pregnancies can end, births can go awry and children can die. Do we need to be reminded of that? Dealing with the routine and normal challenges of pregnancy, birth and parenting are fodder enough.

Monday, July 18, 2005

What we can learn from dolphins

My persistent complaint about parenthood is how tired I always am. I expected to be exhausted when I had a newborn (though who can anticipate the depth of that fatigue?). I could not have imagined that seven years later I'd still be punching my pillow in the morning and fantasizing about just ONE night of uninterrupted sleep and what the dollar value of that night was to me. But that's how it is.

So naturally I was drawn to this article: Sleepless in SeaWorld: Some newborns and moms forgo slumber. Forgo slumber ain't the half of it. Both mother and baby Orca whales and dolphins don't sleep for about a MONTH after the baby is born. This from animals who usually sleep 5-8 hours a night. Can you imagine?

Humans hallucinate when deprived of sleep. Not a good thing in a new parent (ask my spouse, who on our third night post-birth, dozing off with his pinkie in the wakeful newborn's mouth, was certain people were trying to jimmy open the window and spirit the baby away).

But with these aquatic mammals, apparently, no sleep is exactly what is needed. Is this because they need to remain on alert for predators during the baby's most vulnerable days? Is it that the babies need more oxygen initially and to sleep is to drown? The scientists don't seem to have any answers yet. The fact that their observations were made with captive animals raises the initial question in my mind whether wild animals behave similarly.

At any rate, this seems to lend credence to my stoic New England mother-in-law's famous quip when she visited us two weeks postpartum: "Nobody ever died from lack of sleep."

For newborn dolphins and Orcas this appears to be true.

Friday, July 15, 2005

The Network Expands

I was on-line sending out executive committee minutes to the board from our meeting today at the childbirth non-profit I volunteer for. Friends be warned: I am chairing the fundraising committee. You WILL be asked for money. But hopefully in a way that lets you see that your contributions (because why WOULDN'T you contribute? multiple times?) really make a difference in women's lives.

Anyway, too tired to post, I quickly skimmed my comments and was surprised to see a few new names around here. Being a midwesterner, and a sensitive person even among us open-hearted folk, I do not want to offend current visitors (those whose blogs I've put permalinks to, as well as e-friends like PinkLady, Linda, Melissa, anonymous and others I'm too tired to page back through and find).

But when I checked out Mrs. Coulter's profile I saw that's she's a frustrated intellectual -- and a feminist to boot. That last revelation was from her comment on an earlier post here. Anyway, I hope we continue to hear from the frustrated intellectual feminist mother of a precocious one-year-old because I'm guessing you have LOTS to say.

And THEN I saw that the Milliner's Dream is, among other things, a doula! I can't add her right now, but I'm so happy to have another doula blog to visit. Especially since West-End Doula seems to have gone on hiatus (hint, hint) .

Maybe in the morning I won't be as giddy. Fatigue does that to a person (just ask dearest spouse who returned today - halleluja - and fell asleep at 8:30 after being up since 11:00 p.m. yesterday, local time). But at any rate I wanted to welcome Mrs. Coulter and the Milliner's Dream. And remind the rest of you that your thoughts and comments are what make blogging both fun and thought-provoking.

Thursday, July 14, 2005

The unraveling (or Single Mothers of the World, I Salute You)

Tomorrow, my husband returns from nine days of academic conferencing in Europe. Oh joyous day!

I cannot fathom how single mothers function. I have such respect for them. It's only been a week and I am exhausted.

Mornings are getting myself and both boys fed and packed for day care/camp/work. After working a full day, I pick up the boys from day care/camp and go home to a hastily prepared dinner. Between dinner and the boys' bedtime I try to get the kitchen in order and get as much of the next day's dinner prepared in advance as I can. Though the older boy gets himself ready for bed, I still have to move the younger through the potty, diaper, pajamas, toothbrush routine. Then one-on-one reading to each boy, goodnight songs, hugs and kisses, requests for water and then my firm and exasperated ultimatum: "Not another word. See you in the morning."

It's 8:30 by then. I try to take care of business (return phone calls, do work for the non-profit board I'm on, touch base with my doula clients) and address the most pressing of household concerns: does the older son have clean underwear for tomorrow? are any bills overdue? is the cat litter box overflowing?

Before I know it, it's 10 p.m. For whatever reason, the older boy is waking up early this week -- 5:00 early -- so I try to get to sleep quickly and clock at least seven hours' sleep. Except that my brain is so busy I can't sleep. I've even tried our doctor's suggestion of keeping a notepad beside the bed to write down "to dos" on. My list grows as I supposedly empty and quiet my head but the buzz goes on.

My sanity at this point is hinged to the promise of my husband's imminent return. I hope never to be deprived of that promise.

Not to mention, it is my spouse, my parter in this life path, that makes me feel like an individual, rather than some generic servant. He appreciates the parts of me my children aren't even aware of or couldn't care less about. He makes me laugh and forces me to think and helps me lighten the freak up.

Well I'm going on about 6 hours' sleep this morning; before I completely dissolve in sentimental and desperate tears, I'll stop.

I expect my next post will be back to the more standard doulicia fare.

Tuesday, July 12, 2005

My Day in Court

My brief legal career is not without its highlights and near misses. I almost took a deposition one time, but the opposing party never showed. I "third-chaired" (i.e. from a bench at the back of the chambers) a state supreme court appeal to enjoin construction of Comerica Park and preserve Tiger Stadium. I even stood before a judge when I got sworn in to the state bar.

The only time I actually presented before a judge, however, was when I was still a law student. Through the Women and the Law clinic, I represented a minor seeking judicial bypass to Michigan's parental consent for abortion law. It was a whirlwind process.

A group of us went with our advisor to the local Planned Parenthood building. Our advisor said we would be paired with a pregnant teen and given 20 minutes to interview her. The interview was our chance to learn a) why the girl felt an abortion was the right option for her, b) why she could not get a parent's written consent to her abortion, and c) her plans to prevent future unwanted pregnancy.

Two teens were seated in the lobby when we got there. A third entered holding her boyfriend's hand soon after. The clinic director walked me to one of the seated girls and said we would be working together. She showed us a conference room and then left. I was alone with this pregnant girl and my yellow legal pad. I couldn't stop thinking with a mixture of saddness and awe, "She has a baby growing inside her."

The girl was fifteen. I didn't know how to begin. Even though she was ten years younger than I, her pregnancy intimidated me. She knew things I didn't. I wanted to ask about those things. Instead I asked why she felt she couldn't get one of her parents to sign an abortion consent form. "My mama would kick me out," she said quietly to the table.

As I'd been instructed to do, I explored this a little bit. "Are you sure? Sometimes your parents are more understanding than you expect. Do you have an aunt or someone you could tell who could help explain things to your mother?" "They'd kill me if they knew I was like this. My sister got thrown out for it."

I tried a different tactic. "Does your father live at home? What about him?" "Don't know," she mumbled. I was confused. "You don't know if he'd sign?" She glanced up at me. I couldn't tell if she was scared or annoyed. "Don't know where he is."

I had no doubts that I was hugely out of my league. I was just a student. And a sheltered one at that.

Finding out her reasons for an abortion was easier. She wasn't speaking to the boy who'd gotten her pregnant; he had a new girlfriend now. She didn't want to get kicked out of her house. She wasn't ready to be a mother. She volunteered that she didn't want to put the baby up for adoption because she thought she might be too sad when it came time to let it go.

I asked what she might do in the future to prevent pregnancies. "Not do it again," she said, like a scolded child. Trying to be realistic without being condescending I asked whether she could think of something else, especially since it can be hard to say "no" in the heat of the moment.

Without any pretense of sincerity she said, "O.K. The pill." I explained that she would need a prescription for the pill, which Planned Parenthood could help her obtain. Then our time was up.

Our advisor then drove us around the corner (how convenient!) to Juvenile Court. Someone from PP had driven the girls over. We reunited outside the judge's chambers and went in as a group.

The things we were to stress to the judge were the reasons the girl wanted an abortion, why a judicial bypass was her only safe route to getting one, and her plans to prevent the situation's recurrance in the future.

My client was called first. She and I went to the desk and stood before the judge. I nervously presented my client's case and concluded with a request to bypass the parental consent requirement. The judge thanked me. Then she did a wonderful thing.

She addressed herself exclusively to my client. I can't capture the balance of firmness and kindess she used, nor her frank but respectful words. But she said something along the lines of "You have gotten yourself in a bind. That is unfortunate and I am pleased to hear that you have given considerable thought to making sure it does not happen again. I do not want to see you back here in the same situation next month or next year. In coming here today you have shown courage and maturity. You are taking a long view of what is best for you. And for the child you are carrying. I do not like to see young women like yourself pregnant. I do not like sending you off to get an abortion. But I also do not like to see young women throw away their education and their lives with an unwanted pregnancy. You are in control of your body and your future. You have demonstrated that today. I hope you continue to do so. Do you understand me?"

The girl said "yes ma'am."

The judge continued. "I will sign an order permitting you to get an abortion without your parent's consent. You have shown me that you are thinking like an adult in making this decision. I am confident you will continue to act responsibly. Good luck to you."

We thanked the judge and returned to the back of the room. The judge repeated this process with each of the girls, talking to them from her seat of power about their own strength, their own capacity to control their circumstances.

It was a pep talk disguised as legal dicta.

This is the closest I ever got to being the kind of lawyer we see on T.V. My presence in the court, however, was just a courtesy, an excuse for me to get some experience before the judge. The hearing was clearly for the benefit -- on so many levels -- of my client.

I haven't thought of that day in quite a while. I was reminded of it today reading Dr. Charles's account of a teen birth. It is the other side of the coin, what my client might have experienced if she hadn't gone before the judge. Who is to say which path was better?

Monday, July 11, 2005

Why know the gender sooner...or at all?

You've probably read by now that for $275 women can find out the gender of their baby as early as the fifth week after conception.

Why would women want to know the gender of their baby so early? Well check out the advertising:

Knowing the gender of your unborn baby helps prepare for your baby’s birth: you can decorate the nursery, choose your baby’s name, and make gender-specific purchases during your pregnancy.

Those are the important "preparations" to make for birth, aren't they? The decorating. The registering at Baby's 'R Us. It's such fun it's almost like a game! Just look at the box:

Those aren't hoola hoops, silly. Those are the symbols for male and female. Which will it be? Whooeee! Spin the dial and run off to the mall. Prepare for birth!! Miscarriage? Shhhhh -- don't spoil the fun.

Ethicists worry that early gender revelation could prompt sex selection among parents. Not the gender you want? Abort! Take another spin next time.

It is a legitimate concern. Already we have books and medical practices dedicated to ensuring that you get one gender over another. If it is that important to you, why not test the fetus early on and see if it fits with your needs. Interestingly, notice that if the product's name was a truer rhyme than GenderMentor (does gender need mentoring? Can a test serve as that mentor?) it would be the GenderMender, which might be closer to reality if it is used to abort babies of unwanted gender.

Family planning aside, however, what really bothers me about this -- and about determining the gender of a baby before birth in general -- is the frequency with which it is motivated by consumptive, not paternal desires. Few women say "I wanted to learn the gender of my baby so I could start bonding with a son or daughter instead of an it." They say, "I wanted to know what color to paint the baby's room" or I wanted to know whether to keep my older son's clothes.

It comes down to things. It reduces the baby to a set of purchasing instructions. If girl, then flowers (or baseballs -- whatever). If boy, then natural wood with blue plaid flannel.

I suppose this happens anyway. For many parents, even those who don't know the gender, it is important to choose "Pooh" over "Noah's Ark" for the nursery theme and begin fetishizing each nightlight and reading lamp purchase.

I'm about to run over the top into a complete indictment of Western capitalism, so I'll stop.

It is fun to lose oneself in anticipating the baby. I know that first-hand. And just because expectant parents focus on material preparations doesn't mean they aren't preparing internally, too.

Let me just say that a baby's needs are few: love, food, warmth. They are the same whether that baby is a girl or a boy. Our efforts to satisfy them-- and the basis on which we do so -- says more about our own needs than our children's.

Thursday, July 07, 2005

Where ignorance is bliss...

What books do conservatives wish you hadn't read? According to Human Events Online, The Feminine Mystique among others. The publication asked 15 conservative "scholars and public policy leaders" to identy the 10 most harmful books of the last 200 years. Here they are:

1. The Community Manifesto, by Karl Marx and Friedrich Engels
2. Mein Kampf, by Adolf Hitler
3. Quotations from Chairman Mao, by Mao Zedong
4. The Kinsey Report, by Alfred Kinsey
5. Democracy and Education, by John Dewey
6. Das Kaptal, by Karl Marx
7. The Feminine Mystique, by Betty Friedan
8. The Course of Positive Philosophy, by Auguste Comte
9. Beyond Good and Evil, by Friedrich Neitzsche
10. General Theory of Employment, Interest, and Money, by John Maynard Keynes

It's an interesting question. Can books BE harmful? I want to think about what books, if any, I would put on such a list.

News Roundup

For once the U.S. is more progressive than a European country when it comes to birth! We have male midwives, whereas Switzerland is in a tizzy over their first. His presence is seen by some as a threat to the previously all-female profession.

I’m of the opinion that midwifery has always been a women’s profession and it should stay so. Men should stay out of it," said Lucia Mikeler Knaack, head of the Swiss Midwives Association.

One of Mikeler’s main arguments is that only another woman can really understand what women go through during pregnancy and childbirth. Some women might feel more comfortable being examined or looked after by another woman, she says.

Added to this is the fact that there would always have to be an additional female midwife on shift to deal with patients who are uncomfortable being looked after by a man.

Mikeler admits that her view is not shared by all members of the association.

Some health care professionals have welcomed male midwives as a step towards equality, and argue that being able to deal with mothers and babies is a talent that doesn’t depend on the sex of the midwife.

It is possible to agree with both points of view. I think the ability to deal compassionately and competently for mothers and babies can be found in both genders. For that reason I have no objections to male midwives, or doulas for that matter.

Just because men may be good at it, however, does not mean they should have access to the profession. It is true that midwifery is a historically female profession. It was (is?) an arena of power for women in a culture dominated by men. Its practitioners (in the U.S. at least) have been persecuted, first as witches, then as illegal practitioners of medicine. That midwifery has survived at all is testament to women's solidarity and individual women's strength.

I don't know the history of midwifery in Europe, but I suspect it is similar. In that context, I appreciate midwives' reluctance to welcome men into their circle. I wouldn't have a problem with it myself, but I can understand the resistance.

In a wholly unrelated item (except for some possible subliminal misandrist inclination in me that drew me to both of these), a South African woman has invented a tampon-like device that latches, talon-like onto the end of anything put in the vagina. It's intended to be a rape deterrant. And, because it has to be surgically removed, it could help identify rapists.

Critics are calling it a return to the days of the chastity belt. But wasn't it the husband who had the key to the belt? The anti-rape device has a slightly different power balance, see.

I haven't seen what the device's product name is. Any suggestions?

Wednesday, July 06, 2005

Preeclampsia: blame the placenta, treat with fish? vegan diet? antioxidants?

I have been learning a lot about preeclampsia at RedStateMoron's blog these past weeks. Did you know that it's caused by placental detrius in the bloodstream? Me neither. I thought its causes were unknown. What is more, there appears to be a genetic predisposition toward preeclampsia for which doctors may soon be able to screen.

For anyone who has preeclampsia, however, the question turns toward treatment. The axiom that "the only cure for preeclampsia is delivering the baby" is little consolation when the condition sets in at 25 weeks' gestation. Even later in pregnancy, preeclampsia can turn the hopes for a vaginal delivery into an emergency Cesarean in a matter of hours.

Ina May Gaskin's birth records from The Farm show a preeclampsia rate of 0.39% -- as compared to the national rate of roughly 5% -- which The Farm residents (and a few researchers) tout as the benefits of their vegetarian/vegan lifestyle. Renowned French obstetrician Michel Odent advocates eating lots of "fish from the sea." Lately a lot of attention has been given to the role antioxidants may play in preventing preeclampsia.

Can any one treatment be "the one?"

Again, RedStateMoron has a helpful perspective on placing faith in simple answer.

My wholly unqualified guess is that, as with so many things, there is a genetic predisposition which may or may not be triggered depending on a variety of things, diet among them. Finding a "cure" for preeclampsia will probably involve tailoring treatment (drugs, diet, surgery) to each individual. Nothing new here. That is the nature of pregnancy and birth -- and good medicine.

Tuesday, July 05, 2005

Independence Day in a Nutshell

One of the best things about having kids is that they give me an excuse to do things I might otherwise get sideways glances for doing on my own. Like hanging out in the children's section of the library. Or sitting and watching construction workers demolish and replace pavement. Or going to parades!

Yesterday was my favorite of all parades (that I've been to -- I still hope to attend the Drag Race one day): the Ann Arbor 4th of July Parade. Yes, it has the usual scout troups and police cars. But it also has such lively and though provoking entries as Veterans for Peace, the Ring of Steel Theatrical Combat Troupe (who swordfight on the back of a flatbed truck) and the Ann Arbor Area Committee for Peace (pictured below). Missing this year -- or perhaps they are just a sub-group within the Committee for Peace -- was the group protesting the School of the Americas. They always have grandmothers dressed as skeletons.

At any rate, the parade combines festiveness with leftie politics and free speech in exactly the right way to highlight the freedoms we have in the United States as well as our reponsibility to do something good with them.

My older son is getting a little too old for parades, though not too old for the candy that's thrown. My younger son had quite a thrill at it. He waved at every vehicle that went by, clapped for every animal and politician, and stood in awe of the fire and police departments' truck horns and sirens. Here they both are curbside sucking on the spoils of the parade.

Later in the day the boys organized an impromptu concert in the driveway. I was appointed "announcer/singer;" the little guy was "the audience;" my older son was "martial arts dancer" as well as event organizer. If you have not seen "My Country Tis of Thee" sung through an MSU megaphone to toddler flag waiving and seven-year-old performance art, you're really pretty culturally deprived.

That this concert took place in the rain only heightened the gravity of our mood. My older son took seriously the fact that his little brother was being less than diligent in keeping the flag dry and off the ground. "Do you know that you're supposed to get rid of a flag once it's dirty?" he asked me. "Our teacher read us a book on proper care of the American flag. And do you know how you're supposed to get rid of it?" I said I seemed to remember that burning it was the thing to do.

He said, "You're right. And that's why you always see people burning it on T.V."

Let freedom ring.

Monday, July 04, 2005

About those postpartum visits...

By far the piece of my doula practice that I feel least comfortable about is my postnatal visits.

My standard package of services includes a minimum of 2 prenatal and 2 postnatal visits in addition to providing support throughout labor and delivery. The prenatal visits are easy. I take a history on the mother, find out her hopes for the birth, learn what she and her partner expect of a doula, discuss postpartum support plans, etc. etc. Usually these visits run over an hour, sometimes they approach two hours. I have scheduled third meetings with some clients to give us more time to cover everything from breastfeeding to relaxation.

The birth pretty much takes care of itself. What to do is obvious.

But then the baby is born and everything changes -- at least for me. I no longer feel part of "the team." I see a new family and recognize that they need an insulated space in which to integrate their birth experience and their new child(ren) into their previous lives. I see new parents who have not slept in a day or two or three and who just need to curl up together in a big bed with the baby and not get up for a week.

On the one hand, the need for a doula is never higher than in this critical postnatal period. The doula can help insulate the family, provide food and other needs so the family can cocoon, offer assistance or reassurance that recover and breastfeeding are proceeding, and encourage the mother to rest and limit visitors.

On the other hand, much of this happens only if the doula takes a leading role in the post birth periord. I am not that kind of person. I always think "This is not my show" and am reluctant to interfere or be overbearing.

Add to my reservation the sudden influx of family, many of whom look at me as if I've wandered off the street into their daughter's delivery room, and I lose all gumption to assert myself. Moreover, when I know a lot of family and friends are visiting the new parents at home, I don't want to further limit the family's private time by adding my visit to their list.

My own experience with the postpartum period was that I pretty much wanted to be left alone. I had my husband to take care of me. I didn't want to see anyone else. In deference to that, I try to leave it in the mother's court to dictate when and whether she'd like me to see her.

But often, despite my phone calls and e-mails, mothers have problems and do not call on me. When I saw one mother six weeks postpartum, said "oh, that's right -- I didn't tell you I got a uterine infection at 3 weeks and had to go back into the hospital." Another told me when I called 5 days postpartum that she'd been having a horrible time feeding for the past two days and was at her wits end.

I hear these things and reprimand myself that if I'd worked harder to cultivate a bond with these women they might have called on me. Or I second guess the intervals between my contacts to them; should I have called every day?

In the end it's a balancing act. The new parents' fatigue, privacy and bonding time often stand in opposition to services I can offer that I believe would help.

Ultimately I defer to the family but keep myself -- perhaps annoyingly so -- within easy reach. I visit or call every 2-3 days in the first two weeks. I always ask if there's anything I can do. If they no, I suggest a few things they might not have thought of (grocery shopping? walk the dog?). If they still say no, I urge them to keep a list for the next day of things I might do to help.

Still, short of moving in, I have to recognize that I can't "make it better." There is a certain hardship that comes with new parenthood. It is unavoidable and it is part of the rite of passage. I can't be at every feeding. I can't help them dodge middle of the night feedings. I can't take away the alternating feelings of elation and shock that accompany the suddent and complete responsibility for a helpless new life.

The best I can do is be ready at the fringe and come in when asked. And make sure they know I'm there if they aren't asking.

As I'm sure is apparent from this rambling post, I have guilty feelings about my clients who delivered two weeks ago, and whose home I have only visited on two separate half-hour occasions since birth. They are having a tough go and I'd love to do more. But every time I call, they decline my offers. I jokingly remind them that they've paid for this as part of their fee and that I am happy to clean bathrooms or bring food.

Then I think of myself in the same position seven years ago and remember that as much as I wanted the six weeks of massages, baths and family-prepared food that is part of Indian culture's postpartum period, I was determined to get through my babymoon on my own. I took pride in that. I have to honor that desire in others, much as I wish it was moderated.

Friday, July 01, 2005

Breastfeeding and Exercise

The Journal of the American Dietetic Association announced in its July issue that moderate exercise in lactating women does not compromise the quality of their breast milk, so long as women consume enough long-chain polyunsaturated fatty acids. These fatty acids are found in "vegetable oils, seeds, nuts and fatty fish like salmon and tuna."

But what about immunity passed through the breast milk, you ask? Doesn't exercise effect that? Well a group of researchers asked just that question two years ago and found that while levels of immunoglobulin A were lower in the breast milk of women who exercised to exhaustion, they were not significantly lower in women who exercised moderately (e.g. 30 min, 3x/wk.). Not surprisingly, however, the women who exercised did have healthier cardiovascular systems than those women who didn't. And at no cost to their nursing babies.

And if you are worried that the lactic acid from your workout will spoil your milk's flavor, think again. Scientists gave pre- and post-workout breast milk to babies. The babies accepted both batches equally.

My point? Breastfeeding mothers should not let concerns over their baby's health, comfort or nutrition keep them from exercising.

Now the bouncing is another story. Thankfully they make articles to address that.