Wednesday, November 30, 2005

You Look Just Like....

In finding the link for my last post, I came across this one about celebrity doubles. In high school I was told I looked like Elizabeth Shue. More recently I occasionally hear Hillary Swank (no doubt from her Boys Don't Cry stage!).

Who are you a celebrity double for?

p.s. In rereading this I see that I appear to have no argument with others' favorable assessments of me. While it is always a pleasant surprise to be told you look like someone famous and not unattractive, that does not mean you actually look like said person. So let's agree here that if you reveal your celebrity double identity, no one will hold you to proving the association or qualifying the resemblence in any way (such as I feel compelled to do here). And, for the record, I've also been told I have a "turned up nose" like a Barbie doll, a "snaggletooth" (which I do and which I refuse to let the dentist correct because, as I tell him, it adds character), and a body like a boy's. Doesn't sound much like a movie star, does it?

Variation on the Baby Shower Theme

I saw an article in the paper yesterday about eco-friendly baby showers. I especially liked this paragraph:

At these parties, parents may even request re-gifts, items that have been handed along from one family to the next. Guests present coupons for baby-sitting or homemade meals and offer handmade books filled with sage parenting tips. Presents, perhaps bought from consignment stores, arrive wrapped in reusable materials like baby blankets, or not wrapped at all.

We did not have a baby shower for either son. All their clothes were passed down from friends and family (which made for some amusing photos of our sons in pink flowered playsuits). Friends loaned us a bassinet and changing table. We used my sister's old dresser for the baby's clothes and diapers. Another friend gave me the unused duplicate port-a-crib she'd gotten as a shower gift.

My motivation was practicality over environmentalism, but the result was the same.

Unfortunately, it has been difficult to pass along my younger son's cast offs now that we're exiting some stages of growth. Everyone I know, especially first-time parents, but even repeaters, have multiple showers at which they get a closet full of clothing (all 0-3 months, so you know the baby won't even wear much of it before s/he outgrows it), more toys, stuffed animals and blankets than a crib can hold, and a surfeit of "must-have" items that quickly end up in the trash (e.g. Diaper Genie, Baby Monitor, pack-and-plays, baby wipe warmer).

I have a crib I'd love to give to someone, but nobody wants anything used for their child.

This is probably a phenomenon located firmly in the upper-middle class. Most of the doula clients I have and other expectant parents I know are dual-career professionals who have waited a few years before having children. So they have money to burn and nothing to focus it on.

Indeed, a "green" baby shower is no cheap prospect. Organic cotton is expensive, as are hand-made wooden toys. Don't get me wrong. They're great gifts. But I suspect most gift-buyers go for the 4-pack of onesies over Gaiam's $24 romper, especially outside the college-educated, socially-progressive circles.

For readers who are beyond the baby-shower days but are still looking for cost-saving, earth-friendly or just plain sensible ways to run a household, I highly recommend The Complete Tightwad Gazette, a collection of tips and tricks from the woman who raised four or five kids on $30,000 a year. It is there that I learned a tablespoon of soy flour and a tablespoon of water can be substituted for an egg when baking. It also tipped me off to the idea of stocking up on "leader loss" items at the grocery store, which is why I now buy 20 boxes of pasta when it's on sale for $.80/box.

Anyway, it's always good to be reminded that the status quo is not the only quo in town.

Monday, November 28, 2005

My latest thought

After reading some of the responses to my post about the rising Cesarean section rate and thinking back over many stories and reactions I've heard from women who delivered surgically I had this thought:

Is not the fact that women fear Cesarean delivery before labor and feel sad, defensive or ambivalent toward it afterward the best evidence that it is being overused? I would think you don't have to go far back in history for the near-universal attitude toward surgical birth being one of thankfulness. For in the situations when a Cesarean is truly needed, to save the baby's life or the mother's, what a relief it is to have this option.

And if it were only used today when truly needed, women would not have to second-guess whether they or their doctor "caved" or whether there was something they could have done differently. They wouldn't need to worry that people would question their decision after the birth.

Instead, you would hear that someone had a surgical delivery and say, "Oh how lucky she and her baby are."

Saturday, November 26, 2005

Crazy is as crazy does

You probably have seen by now that Tom Cruise purchased (PURCHASED!) an ultrasound machine so that he and Katie can check their child’s development whenever they want. I don’t do snarky well, so someone else please feel free to comment on the more catty elements of this situation. I will point out, however, that when some women and caregivers refrain from using ultrasounds because their safety is not proven, having amateurs bouncing waves of their baby throughout pregnancy seems irresponsible at best.

And speaking of overzealous lunatics, I saw the movie “Good Night and Good Luck” today. I am not a movie fan in general. They far more often disappoint than reward. Paying full price for a theatre showing is almost always guaranteed to result in my regret.

Fortunately this movie was well worth the fee. It does not bowl one over. Instead, it reminds us that history repeats itself (suspending of civil liberties in deference to political expedience and fear mongering) and that debates over journalistic objectivity as well as the role of television are nothing new.

Wednesday, November 23, 2005

30? Do I hear 30, anyone?

Why stop with a Cesarean rate of 29%? Women, let's get out there and make it an even 30%! While we're at it, let's surpass Brazil's infamous rate and have MORE THAN HALF of us delivering our babies surgically.

I suspect you have already read about the CDC's 2004 birth statistics. The national Cesarean rate rose to 29.1%. On the National Center for Health Statistics' summary page, they put this number in (recent) historical perspective:

"For 2003–04 the primary cesarean rate rose 8 percent, and the rate of vaginal birth after cesarean delivery (VBAC) dropped 13 percent. The primary rate has climbed 41 percent and the VBAC rate has fallen 67 percent since 1996."
With the loss of the VBAC option, women who have 1 surgical delivery are condemned to the same route for subsequent births.

The article quotes several doctors, one of whom blames the rising Cesarean rate on older mothers' wish to preserve their pelvic floor. In Red State Moron's comments section, I shared my personal experiences with this physician. Suffice it to say, I am skeptical that older mothers hold most of the blame for the upward trend.

Another doctor quoted says fear of malpractice is a key factor. I have to agree there. And as Atul Gawande laid out nicely in the November 14 New Yorker, malpractice isn't going anywhere anytime soon.

What the article doesn't discuss, however, is the cultural trend of disempowerment that is happening to women. We are being told our bodies won't labor right and won't work right after labor. AND WE ARE BELIEVING IT. We are being told labor hurts so much we should avoid the pain at all costs. AND WE ARE BELIEVING IT.

I think one of the most important things we can do to help the future of birth in the U.S. is communicate to girls and young women that they can trust their bodies, that their bodies are strong, and that they can withstand pain.

Over the weekend I was pondering ways to convey this message. One thought I had, not surprisingly, given my own experiences, was to get all girls involved in athletics and, for lack of a better term, "body arts" (yoga, pilates, etc.). The goal is not to make them athletes, but to give them familiarity with their bodies and build a sense of trust in it. Let them push themselves and see that they not only survive it, but grow because of it.

I also think anyone who has positive birth stories, should be sure to share them, especially when women congregate around an expectant mother to tell their horror stories. At least provide a counterpoint to the well-trod narrative of popular culture.

Lastly, those of us who have the opportunity to work directy with pregnant women should make sure the women are educating themselves and asking all their questions of their health care providers.

Tuesday, November 22, 2005

Then I Saw Her Face

As a former Monkees fan, I couldn't resist this article about Davy Jones catching his granddaughter. He plays up his role and trivializes the mother's too much for my preferences, but then I'm not his stepping stone...

Sunday, November 20, 2005

Trying to Outsmart the Universe

You just can't do it, ya know?

I refrained from taking any doula clients this fall (September through December). Why? Because in the past this is the time when our family is plagued with colds and flus, not to mention overextension with school and work activities.

So with my months off call, what exactly happened? Nothing. The kids were well. I was healthy. Spouse was healthy. One of my big events at work got cancelled, leaving me with a wide-open October.

I am now jumping back in with doula clients in January, February and April. AND a family trip to Florida in March. What are the odds our good health will continue for another three months? Well the optimists in the crowd can wipe their smug smiles away, because the odds are zippo. Older son woke up this morning with a headache and sore throat. By dinner time he had a 102 fever.

Granted, he might wake up fine tomorrow and the rest of us might dodge his virus. BUT if this is like years past, we are passing through the gateway into WinterIllnessLand, a bleak and demoralizing place that takes weeks and weeks to cross. And that's if you don't get lost and have to double back through, just as you thought you were leaving.

On the other hand, I am coming to trust a little proverb (mantra?) I apply to doula work: This will all work out. When I've had clients in labor and a can't miss doctor appointment or vacation beginning imminently, I tell myself This Will All Work Out. So far it has. I will say that as I ramp up the doula work again.

I will Will it to work out.

Wednesday, November 16, 2005

Women aren't the only ones experiencing discrimination

I was saddened to see this story about a male midwife in Wales who committed suicide, in large part because of workplace harassment. In his suicide note he asked that no one from the hospital where he worked be permitted to attend the funeral.

With no psychological training, I don't have more to say on this, at least not authoritatively. My sense is that suicide is usually the result of deep depression or psychosis (yes, Dr. Deb?). And my observations with my own father is that workplace dissatisfaction can be a trigger, if not the root cause, of depression.

Did his profession's failure to welcome this man cause his death? Hard to say. Did it contribute to it? Undoubtedly.

Tuesday, November 15, 2005

Grand Rounds, Vol. 2, Issue 8


Monday, November 14, 2005


"Mama, your lap is the best band aid of ever." --younger son, for no particular reason, while having a "wake up" with me Friday afternoon.

And people ask why I "need" to work a reduced schedule!

doula weekend

After a few months of distance from doula work, I spent both weekend days back in it.

Saturday I participated in a DONA doula training session, representing the "real doula" perspective to the seventeen or so participants. I had brought my doula bag and thought I'd spend time going through it. I had only about five minutes at the end of my two-hour slot to show off my toys. The rest of the time we talked about building a business, handling difficult situations, what questions are typical in a phone interview, and so on. I had to offer the caveats that I have only been to about 20 births and by no means make a living from doula work. I am never comfortable putting myself forth as the expert on anything. Collaborative sharing, sure.

I had a moment of humility when one of the trainees asked if I had ever encountered the situation she recently did: A Latina immigrant contacted her for birth support. But this woman, in the tradition of her culture, was planning to birth at home with only her husband in attendance. The trainee, a Latina herself, said this is common in many Central American and Carribean countries, particularly among poor women. The difference is that in their home countries, there are relatives or community members who serve as midwives, whether they are trained or not. For women who have transplanted themselves to the U.S., they lose the community base from which to draw support, but not the sense of This Is How Things Are Done.

The doula trainee's dilemma was whether to say no, because she did not want to end up catching a baby, and leave the woman unsupported AND facing health risks, or to sign on as a doula with the knowledge she'd be asked to do more.

I could only point her to the DONA code of ethics, encourage her to talk to the trainer, and point out that she could be a hugely valuable resource for this woman in terms of helping her find affordable care she was comfortable with. The question prompted a lot of discussion among all of us there. For me it was a reminder that I work with very privileged women (i.e. those that can pay) and would like to find a way to reach out to other women, too.

I won't say that my clients don't need, deserve or benefit from doula care. Compared with the kind of client the trainee described, however, my clients have a posh situation: health care, citizenship (!), friend or family support networks, education, access to information. The difference a doula makes for these women is much greater than for someone who hopes to avoid an epidural or wants to make sure her baby spends the first hour on her belly or breast.

An example of this latter woman is the new client I met with Sunday. I am very excited to be working with her. We hit it off well. (She is one of the "doulicias" that contacted me back in September). She got nearly the birth she wanted her first time around except that without support, she finally caved to the nurse's pushing of an epidural, only to deliver her child 80 minutes later. This time she wants a doula to help her through that transition period of self-doubt. I'm more than happy to do so.

I just feel that for every client like her I work with, I should work with a teen mother, an immigrant, a single mother. I keep saying once our financial situation is better I will. And I'm hopeful that it will improve in a year or so. Until then, I can't escape a little twinge of guilt as I sip tea in cheerful sun rooms and talk with clients about lavender-scented oils.

Friday, November 11, 2005

Hush little baby

Today's New York Times had an interesting article on the variety of cultural remedies that can be found for colic in its multi-ethnic, cross-cultural streets. It's worth reading just to see how many strategies women around the world have developed to deal with the nightmare of a child that won't stop crying.

[L]ittle New Yorkers are being comforted with Colombian cinnamon tea, soothed with Egyptian recipes for rosewater and calmed with infusions of anise seed, fennel, chamomile, or "hierba buena," a kind of spearmint plant that Latin American mothers and baby sitters seek out in supermarkets. Others are dosed with "gripe water," the elixir once bootlegged from the former British Empire, and now sold over the Internet in nonalcoholic versions with names like "Colic-Ease" and "Baby's Bliss."

Sure, methods from the heyday of America's machine age are still popular: place the crying baby atop a vibrating washing machine; run the vacuum cleaner full blast near the cradle, or take the wakeful infant on a midnight ride (preferably on a route without stoplights).

But now, with more immigrants in the city than ever before, so too are there more ancient anticolic traditions practiced down the block: Chinese acupressure, Haitian belly binding, Mexican swaddling, Indian oil massage, African cowry shell bracelets. And just as exotic foods from distant cultures enter the city's culinary mainstream, these methods are being examined and tried by the city's natives and nonimmigrant transplants, desperate for any way to stop the screaming.

Removed from the situation, I think it should be some comfort to mothers of fussy babies to see what a universal, normal situation it is. I can remember being in the throes of it, however, and nothing mattered but putting safe space between me and that baby!

Wednesday, November 09, 2005

Tah-Freakin'-Dah!! (or Happy Anniversary to Me)

Continuing in the self-focused vein I've been traveling lately, I decided to call attention to myself yet again by celebrating the one year anniversary of this blog. The effort would have been exclusively literary but in a fabulous coincidence of timing, my friend Julie (a.k.a. Pilcrow Text and Design) agreed to give me a much-needed blog makeover. Julie, by the way, is the person I credit with leading me to my epiphany that I wanted to work with birthing women. How fitting that her hand is present here, too, where I write about and reflect on birthing women. Her knowledge of me and of birth shows in the beautiful design she created. Thank you so very much, Julie.

I also want to acknowledge here Mark Maynard, who was the first person I ever met who blogged and whose blog was the first I ever read. I probably would have found blogging eventually, but it would have intimidated me a lot longer had I not met such an ordinary (I mean that as a compliment, Mark) person who used this medium with such humor, vitriol and complete crudeness.

As much as I have enjoyed writing about birth-related topics, the real fun of this blog has been making contact with those of you who leave comments. Thank you for reading and for occasionally weighing in, and civilly, too.

[Does this sound like an acceptance speech or a swan song?]

Finally, I want to thank my spouse for his enthusiasm toward this very personal project of mine. He has not always felt comfortable with what I've written, particularly in some of the ways I exposed him or our family here, but he has always respected my creative license and privacy. And he may not belive this, but I do take his concerns to heart.

Tomorrow I begin another year with doulicia. I hope you will join me from time to time.

I was Jeff Tweedy's doula!

Not really.

But in the dream I had last night I was. He and his wife had a healthy baby and a great birth.

This was no doubt inspired by seeing Tweedy in concert yesterday evening with my doula buddy and SERIOUS Wilco fan T$ by my side. I suppose it is also an answer to the title question Tweedy sang last night, "(Was I) in Your Dreams?" Mine most certainly was not an answer he could have anticipated!

This is my first ever celebrity doula client dream. I will let you know if there are others. At the peak of my passion for the Detroit Red Wings, I had a dream every few weeks involving one or more of the players. I began recording the dreams and ended up with more than twenty.

So if the celebrity doula dreams continue, we could be in for a fun (or boring, depending on your attitude toward dreams) ride.

And in case anyone is wondering, I am still doing doula work! I took a little break this fall but have three clients due in the winter, the first of whom I'm meeting with this Sunday for the first time.

Tuesday, November 08, 2005

Ashes to Ashes

If you live outside Michigan's lower peninsula, southern Ontario, or northwestern Ohio, you may have the luxury of ignorance of the emerald ash borer. Unless you live in a climate that doesn't support temporate hardwoods, you should expect to hear about it in the next few years.

This invasive insect eats the pulp of ash trees, killing them.

Coincidentally, I have a particular fondness for ash trees. Our first fall in Ann Arbor, over ten years ago, I walked absent mindedly under a tree on Ashley Street (near Doughtey Montessori, for locals). The change in light was so dramatic and brought on a sense of euphoria so strong that I stopped and looked up. The most cheerful, radiant yellow was above and on me, in leaves and reflected light.

I had to do some investigating with my Michigan Trees book to discover that this miracle tree, this font of cheer, was an ash. A white ash, to be specific. From that time on, I hunted for ash trees in the fall, drawn to their yellow core and burgundy periphery. Maples may have the market on fall reds, but nothing beats an ash for multi-hued drama.

Ash trees grow very tall and very straight. Those features make them perfect material for baseball bats. They likewise make for a stately companion in the woods or town. When we bought our house five years ago, I felt it had been preordained when I realized our front yard had a fifty (seventy?) foot tall white ash growing in it.

The emerald ash borer invasion is a recent one. In just a few years Ann Arbor has been robbed of nearly all its living ash trees. In fact, today we vote on a millage proposal to fund removal of all the tall, dead, and potentially hazardous ash trees in town.

We had the ash in my yard cut down three years ago. It was infected with the ash borer and was lined up to fall on our neighbor's house if a strong enough wind came along. The tree was 89 years old, if I counted its rings correctly. Older than the houses in our neighborhood by thirty years. Three years younger than my grandfather (who died that same year).

Our neighborhood is populated with ash skeletons today. They rise a story or two above the old oaks and dwarf the more recent maples.

In my freezer is a hopeful collection of ash seeds that I collected a year ago. If the humidity and prolonged coolness doesn't damage them, I envision planting them years from now when the ash borer has eaten itself out of a habitat in this area. I want to see the colors once more. Return the tree to its home soil.

For now I find myself saying a lot of goodbyes. As I run, as I walk to work, as I take the kids to school. Goodbye young ash. Goodbye old fork-trunked ash. Goodbye Ashley Street ashes that first introduced the species to me.

Grand Rounds Volume 2, Issue 7

Another week's worth of health and medical-related blogging is collected here. Trekkies be sure to check it out.

Monday, November 07, 2005

I am thiiiiiiiiiiiiiiiiis smart!

I went for my flu shot Saturday. The first (and only other) flu shot I received was two years ago. My arm was in serious pain for three or four days thereafter and tender to rotation for another two months. I don't know that the injection was to blame for the extended pain, but I held it responsible.

Anyway, this year I decided to get immunized again. When I went in for the shot, I asked to get it in my thigh instead of my arm. The difference between my running-developed quadriceps and my puny deltoid is significant. The nurse had to check with her supervisor, but was permitted to do it.

IT DID NOT HURT A BIT! I only felt the tiny poke of the needle. No burn of medication, no days of soreness.

I am a genius.

Thursday, November 03, 2005

A Bird in the Hand

Our blogging friend (and bird bander) Bootstrap Analysis has a post today that any backyard bird feeder will enjoy. It's about chickadees, one of my favorite birds to see (and hear) in the winter. I worry about them on cold nights, knowing that their smallness makes them especially vulnerable to the cold, especially when they are inactive.

If you don't have time to read it all, at least visit her page for the great photo and read these paragraphs:

It's hard for me to imagine a worse situation than nets full of chickadees; even dozens of flesh-clamping cardinals or diarrhea-spewing robins seems more appealing. All the bossy, determined fuss you see chickadees express in the field is magnified when they are in the hand. Observe how calmly this bird sits in my net. You can see we'd been through all this before -- I had banded this bird two days previously. Note that it is hardly tangled, an easy bird to remove from the net. Note also the gleam in the bird's eye, as it prepares to launch its assault.

The moment I reach into the net, it will explode in an indignant whirl of commotion, a virtual avian tempest in a teapot. No other species squirms, wriggles, and hangs on to the net so tightly. Most obnoxious is the constant barrage of pecking, with an outstanding affinity for locating cuticles and other soft, sensitive places. I've been bitten by dozens of species of birds, and although not the most painful, chickadee abuse is clearly the most annoying.

Chickadees remain miffed throughout the banding process. It's really astounding how a 10-gram ball of feathers can make life so difficult. Inevitably when you open your hand to release them, they stick around for one final second -- in order to offer one last good, hard peck.


I wanted to share two stories of doctors who "get it" when it comes to birth. I don't have links for either of these because I have witnessed one first-hand and had another shared with me by a friend.

First, there is a family practice doctor (far west of Ann Arbor, alas) who is advocating on behalf of a doula, to add her to the practice staff so she can attend births with the doctor. AND GET PAID BY THE PRACTICE.

Second, an OB/GYN in town is about to beging a research project looking at the effectiveness of many of the traditional pregnancy and birth herbs (red raspberry leaves, black cohosh, blue cohost, etc.). He does not want to debunk them, but rather wants to find out how to standardize use in obstetrical management. Bless his heart. This is a doctor who also spends half the year in developing countries working trying to improve maternal mortality rates.

Tuesday, November 01, 2005

Another argument for insurance-backed postpartum support

Have you seen the article about how many parents secretly confess to putting their babies to sleep on their tummies?

The headline calls it a revolt but if you read the article, it sounds more like the proverbial cry for help.

"Increasingly, however, some new parents are finding that the benefits of having babies sleep soundly -- more likely when they sleep on their stomachs -- outweigh the comparatively tiny risk of SIDS. "

Parents are doing anything to get their babies to sleep. Have we not all been there, mothers? How else can you explain going for a drive around town at 3 a.m. with a howling baby in the back seat. Whatever it takes.

But if what it takes has been demonstrated to be a risk factor for death, why do it? After all, we don't take our infants for those graveyard-shift rides without first buckling them into their car seats.

A major factor of why new parents are so desperate for sleep is that they are not getting the postpartum care they need. My guess is the "tummy sleepers" mentioned in the article are not napping when their babies sleep during the day. They are not taking 4-6 weeks postpartum to rest and recover their strength before jumping into work inside and and outside the home.

Dream a dream of post-partum care provided to all new parents: someone they could schedule to help with child care in the middle of the night, someone to help keep the household running during the babymoon, someone to encourage the mother to rest and bond with her baby.

I suspect in that dream world, it would be easier to deal with a baby who balks at sleeping on her back. The need for sleep would not be so great that it outweighed potentially life-saving advice.

I am curious to know, readers, did you put your baby to sleep on her or his belly in his first six months?

Grand Rounds Vol. 2 Issue 6

Is available here.