My Manic Energy

Maybe it was sleeping in until 9:30 yesterday (my parents took the kids overnight). Or maybe it was happiness over the last birth. Whatever the reason, I've been thick with manic energy lately.

At one point yesterday I had laundry in the washer and dryer, the dishwasher running, two pots of soup cooking, bread dough rising, and yarn piled on the kitchen table as I planned my Knitting Olympics project (photos to follow soon). I even practiced a few Kegels for good measure.

Despite all that, I was fretting about all that wasn't getting done: job applications, an agenda for the fundraising committee at the Center, reading the usual pile of notes that came home from school with my son Friday, and all the projects at my regular job.

Let's home my next client (due in a little over a week) delivers while I'm still riding high and not after a crash!

With Three Days' Distance

A few years ago I had a client who very much wanted to have a natural birth. It was her first baby and she had the closest thing to a "textbook labor" that I've seen. Twelve hours start to finish. Contractions that became steadily "stronger, longer and closer together. Spontaneous rupture of her water in transition. The urge to push two hours later.

She changed positions frequently, vocalized as the contractions got stronger, and never once asked for pain relief. She did so well and the birth went so smoothly that I could not wait to meet with her afterward and share in her elation.

I went to her house and all was well. We admired the baby. We commiserated about stitches and perineal soreness. She aired the usual frustrations with sleep and nursing. Then I asked her how she felt about the birth. She burst into tears. She apologized for crying and said, "I just can't think about the birth without remembering how awful it was. It hurt so bad. I never thought anything could be so painful."

It was a good reminder that birth experiences are individualized and highly subjective. Who was I to say she'd had a "good birth." Even though it was what she'd wanted ahead of time, and even though she had a loving spouse, fabulous midwives, and a supportive doula, her memory of the experience was traumatic.

Keeping this in mind, I was prepared to hear second-guessing and regret from my most recent client when I visited her over the weekend. We talked on the phone the day after the birth and at that time she said the labor was horrible and that while she was glad she didn't "cave" for an epidural, she wished she could have more of a sense of accomplishment about it. She said that if she had it to do over she might have gotten an epidural.

When we met face to face two days later she volunteered that she was so glad she had gone natural. She said she can still remember that it hurt, but the exact nature of the pain has faded. She said that having gotten an epidural with her first child, she would have been very disappointed to have gotten one this time around. Especially since the time at which she wanted one was only a few hours from when she delivered. She said her only regret was that she hadn't gotten a prostaglandin gel earlier in the week, to get her cervix more primed for the induction.

She was radiant. It was evident that she now had the sense of accomplishment she wasn't feeling immediately after the birth.

Which was something of a shock to me. I confessed that I'd been having some guilt pangs about not mentioning the epidural option to her when she was slogging through her 'teenth hour of labor and was so exhausted. Of course that's one of my rules: let the client suggest an epidural, not me. But still, sometimes I start feeling cruel... Anyway, she just laughed at the thought of my wanting her to get an epidural while she was so resolved against it in her own mind, even in the thick of labor.

Time can change our thoughts about birth, for sure. But not always. The client I mentioned at the beginning of this post is expecting her second child in the spring. She has asked me to be a doula again and is using the same midwives. But she hasn't made up her mind yet whether she wants to try going natural again. Her memories are still too crisp.

Birth debrief

The induction ended. Well. I don't know which was more significant. The ending or the ending well! Of course I'm kidding, but I suspect the mother, at least in the moments after delivery, shared those sentiments.

Actually the labor itself wasn't so bad. It was the preceeding 14 hours of chemical induction that set the tone for the whole experience. For some reason they start inductions at night at this particular hospital. So at 9 p.m. the mother was tucked into bed with prostaglandins on her cervix and told to rest. Like that's gonna happen.

But she gave it her best shot and got maybe 2-3 hours of sleep. In the morning she had made no cervical change, so they switched to pitocin. After six hours on pitocin, again with no cervical change, she asked for a break. She asked them to stop the pitocin so she could sleep.

At that point, however, her body had taken over and her contractions continued with the same frequency and intensity. Over the next six hours she made steady progress, working so amazingly patiently with each contraction. Finally she asked to have her water broken and the caregivers complied. Twenty minutes later her son arrived, robust and healthy, after three pushes.

Every birth is a learning experience and this birth gave me more insight into why some midwives never induce labor. For though this baby was technically 10 days overdue, he did not have signs of being a late baby. He has some vernix on him. His placenta was very healthy looking (I even asked the midwife to show me what calcification looked like, since I haven't seen many "old" placentas, and she couldn't find any). And after watching hour after hour of exhaustion and pain that the mother went through with the induction, it was pretty clear that her body could have used some more time to get ready for labor. She endured it so well, and without an epidural, which was her goal, but much of it seemed unnecessary; given another few days or a week, how much more quickly would it have gone?

I don't feel like I'm making myself clear. Let me try again. I am extremely proud of this woman and the effort she gave. I am in awe of her determination. Knowing what she has inside her, I wish she could have been allowed to get a better labor, which I believe would have happened if she wasn't induced.

The other thing I learned at this labor was just how quickly a mother can go from transition to birth. She was seven centimeters when the midwife broke her water. After watching a few contractions, the midwife left to check on another patient. Then the nurse left to run down the hall for a second. And no sooner was the room empty than the mother had a contraction where she said, "I'm pushing. I can't help it." I said "O.K. I'll call for the nurse." I pushed the call button and said we needed the nurse. The mother pushed again, this time a hard whole-body push. She said, "The head is right there!" And it was. At least three centimeters of scalp.

I pressed the call button again and said, "We need the midwife in here!" The midwife walked in during the next push and was able to talk the mother through a slow delivery of the head, followed by the rest of his body. It was so fast. In one picture you can see the nurse arriving and putting a glove on, but the baby's already resting on the mother's belly.

Quite a nice, memorable ending to a grueling 26-hour induction.

And now for something completely different

Let's talk about men in drag. Men dressed as women. I love it. There can be something quite sexy about it, with the right person. Or it can be the funniest durn thing you've ever seen. I suppose, going deeper, and especially for men who make a living dressing as women, in less than high-end clubs, there is probably a lot of psychological turmoil and sadness. But given my psyche right now, I'd rather focus on sexy and funny.

Without further ado, I present my list of the Top 10 cross-dressed/transsexual men:

10. Milton Berle



9. Dana Carvey as The Church Lady



8. Will Ferrel as Janet Reno



7. Terence Stamp in Priscilla, Queen of the Dessert (If I was 20 years older...)



6. Boy George



5. John Goodman as Linda Tripp



4. Eric Idle as any woman



3. Billy Crudup in Stage Beauty (Meow!)



2. Barry Humphries as Dame Edna



1. Tim Curry as Dr. Frankenfurter (Damn!)

inDUCtion

Nothing special about the "DUC," I'm just trying to write in the voice of GOD. Imagine the DUC syllable reverberating and you'll know what effect I was going for.

All of which is really irrelevant to my point: my client is getting induced today. She is 41 weeks and a few days. This is exactly what happened to her last pregnancy. Her uterus just doesn't like to let go of its charge. So send good thoughts her (our?) way.

One weird thing: they're having her come in in the evening. Why on earth you would start an induction in the evening, virtually guaranteeing a sleepless night, is beyond me. I'm used to inductions starting in the morning. But I've never had a flat-out induction before. All the ones I've been at have been because the woman's water broke and then she didn't have contractions. So in that sense, the time her water broke is driving the timeline. Here it's completely arbitrary and the hospital wants her to come in tonight.

So that's what we'll do. Hopefully I can give a baby report tomorrow. In the meantime, I'll put up a post I've been saving for just such an entertainment lull.

Another doula reaching out to disadvantaged women

After yesterday's post raving about Loretha Weisinger, subject of A Doula Story (buy your copy now), I felt a universal message was being directed at me when I saw this story about a doula who helps drug addicted mothers through birth as inmates.

I continue to struggle with finding some greater good in my doula work beyond satisfying my birth addiction and helping the already entitled upper middle class.

Doulas hangin' out

My client is now a week overdue and getting very impatient (as only those who've gone a week past their due date can understand). But she still has her humor and seems to be bearing up well. It probably helps that her first child arrived on a similar timeline.

Last Thursday I went and saw T$. After squealing in disgust at her cameraphone pictures of her leg wounds [the one where the bone came through the skin is especially gorey], we did what any doulas would do to relax: watched birth-related television.

First we watched the episode of Bringing Home Baby she'd taped because our colleague Hannah was in it. And thought the show's producers chose NOT to focus on the postpartum doula story line (even though that is why the mother, a doula herself, chose to let them film her babymoon), we noticed that Hannah nontheless was always there in the background, pitching in when needed, giving space when that was what was called for. Isn't that about what a doula does? One thought: it was telling about the state of U.S. postpartum recovery that even with a doula mother and a postpartum doula friend there, the mother was up and about in nearly every shot. No camping out in bed for days with all visitors coming to her turf. She was washed, dressed and awake in most shots. Now if a doula mama can't find (or make) time in her recover, even with a doula on hand, can we expect more from all the other new mothers? Still, hurrah, Hannah, for your happy time in front of the camera. And despite what you said on your blog, I thought that aside from looking tired in a few scenes, you looked great! (and I confirmed you are the person I thought you were!)

Next we finally watched the documentary A Doula Story. I have been itchy to see this for nearly a year, since the film premired at the San Francisco film festival. What an inspirational woman. Once a teen mother herself, she now provides prenatal education, doula care, and postpartum support for single teen mothers on Chicago's west side. There are girls who are wise to the street and resigned to their plight.

Loretha (the subject of the film) says they got pregnant because they weren't able to open their mouths. If they are going to be mothers, they need to learn they have a voice. So she works with them not only to prepare for labor, but also to plan for the rest of their lives. On one of her postpartum visits, she quickly moves from fawning over the baby to asking whether the mother has registered for GED classes. With another woman, expecting her fourth child, she asks, "So once this baby is born, what are you going to do about birth control?" She accompanies the girls on their prenatal visits and requires them to come with 3 questions to ask the doctor.

And the woman knows how to encourage bonding. She tells the girls that their babies' squeezing of their fingers is a baby hug. She holds a newborn and looks and coos at her, captivating the baby. Then she has the mother call the baby's name. Invariably the baby turns. "That means she knows no one is going to love her and look out for her like you are," she says. She shows the mothers their babies are special and in need of love and holding.

Aside from the fact that T$ was in a cast, it was a great way to spend a few hours.

Breastfeeding at the YMCA Update

Last week the e-mail went around: "Nurse in at YMCA." Women are organizing.

I am probably going to get in some hot water (no pun intended...and of course it's only the kiddie pool that's warm) over this, but here goes:

Let's save our breastfeeding activistism for situations that really need it. The YMCA is very family friendly. Breastfeeding is allowed throughout the rest of the facility. It's not breastfeeding they're prohibiting, it's food and drink. Per the health department.

I am all for protest. And if I was a breastfeeding mother and regularly attended the YMCA, I would be frustrated with the policy. In fact, I might try to contravene it if I was there with an older child and an infant. But I would not attend the nurse in. I fear calling negative attention to an organization that offers so many benefits to the community and is generally so supportive of breastfeeding, may give lactivists a bad reputation. The next time we need to protest something genuinely restrictive (e.g. a ban on breastfeeding on public transportation, for example, or a ban against teen mothers breastfeeding babies during school hours), we'll be dismissed.

If the YMCA protest was called off and no one said anything about it for a few months, my guess is women could return to discreetly nursing on the deck, with their backs to the lifeguards. Down the road a group could even approach the Y's leadership and discuss a possible exception to the rule. I think a resolution that breastfeeding mothers will like is less likely to happen if the harsh light of the media is shined on the issue.

Rounding out my doula profile

When I had my little doula blessingway a few years ago, I asked each participant to bring me a small item I could keep in my doula bag as a reminder of them and a source of strength for me at challenging births. I can still list all the things I got, even though I've never reopened the bundle they're all tied up in at the bottom of my bag. Just knowing they're there is so helpful.

Anyway, in addition to a physical item (a candle, in fact), one of my guests gave me the gift of advice: learn to knit. She was a midwife herself and said that knitting offered here something to do to pass the time at births while still remaining present for the mother. Wise advice I have been meaning to follow ever since.

For Christmas my sister consulted my Amazon Wish List and got me Stitch 'n Bitch, as well as a pair of size 10 needles and a skein of yarn. The rest was up to me.

I'm pleased to report that in the past three weeks I have knitted 27 rows on my little practice patch and am enjoying the process greatly. In fact, rather than casting off and saving it as my first knitting effort, I may keep going and turn it into my first project, a scarf.

At any rate, with a birth looming near (induction scheduled for next Wednesday), I'm happy to know enough what I'm doing that I can take my knitting with me to the birth and not be consulting the book every few seconds.

I'm trying to decide whether I'm up to the Knitting Olympics. I have 22 days to decide (Feb. 10). I'm inclined to try at this point. We'll see. Let me know if any of you are doing it.

When I haven't been on call for six months

Last night because I had the following dream:

I was at the doctor's office with T$, accompanying her while doctors did something to the leg she recently broke. My cell phone rang and my mother was on it saying my doula client called them looking for me and asked me to call her. I said, "What did she want?" My mother said, "Well by the sound of it, she was about to have a baby."

Oh no! I told T$ I needed to leave her there while I went to the birth with my client. But, of course, I'd forgotten where my client lived. More accurately, I couldn't figure out how to get to her house from the clinic I was presently at. Dream geography.

The easy solution? Call her for directions, right? Except that I couldn't figure out how to reveal the address book in my cell phone. What button(s) did I need to push? I tried everything I could think of, but I might as well have been the proverbial million monkeys typing for years until one accidentally produces Shakespeare. I could no more apparate to my client's house than retrieve her phone number. And all the while, I suspected she might be delivering her baby at home, alone.

Tell me dream analysts and friendly readers, could this have ANYTHING to do with the fact that my backup doula is out of commission, I have a client whose due date was Sunday, and I have not been on call since July?!!

I'd ask your opinion of my other dream, the one in which my mother (MY MOTHER!) asked me to give her a foot job, but I don't think I want to know.

Grand Rounds Vol.2, Issue 17

Confession: I haven't had a chance to read it myself, but for those of you who enjoy weekly blog summaries, be sure to check out this week's edition of Grand Rounds.

It was only a matter of time...

...until the breastfeeding debate hit Ann Arbor. A woman was asked not to breastfeed on the deck of the YMCA pool because of a strict "no food and drink in the pool" policy.

I'm curious to see how this shapes up. There are a lot of women I think will come out of the lactivist closet on this one.

Honestly, I can see both sides of the issue. I think pools to have unique health concerns because of the hospitable breeding ground their warm, wet environs provide. A rule is a rule. And the Y has plenty of other places where a mother can breastfeed. Indeed, by the time my children were six months old (the age of the child at issue here), I pretty much worked my outings around their feeding schedule and was able to do most things without having to nurse on site (not that I minded it. Indeed I kind of enjoyed the in-your-face element of public breastfeeding and didn't get to do it quite as often as I'd have liked).

I can also sympathize with the mother. If she's at the pool with her three year old to "get his ya-yas out" as she said, then packing everyone up for a 20 minute nursing session in the locker room is NOT going to go over well. And she can't very well leave a toddler unattended at the pool. Breastfeeding does not leave crumbs or the danger of broken bottles the way other food consumption would, so I don't see that it needs to be classified under the "food and drink" policy.

Moreover, if the goal is to prevent food from ending up on the deck, then prohibit babies altogether. Because no matter where you feed them, they'll spit up where ever and when ever they want. Nursing in the locker room won't remove the threat of food matter on the pool deck.

No doubt the real issue was someone's (the lifeguard's it sounds like) discomfort with the sight or thought of a working breast. That is a cultural issue that county health policies can't address.

Feel Free to Vote

The 2005 Medical Weblog Awards are being democratically decided via polling at MedGadget. I was happy to see Red State Moron included on the list of "Best Clinical Weblogs." You can vote for your favorites in any or all categories. On the other hand, there is not an option for write-in candidates, so it's not truly democratic and may prevent you for voting for your true favorites (go Dr. Deb!).

Back to Grand Rounds

I have been negligent in linking to Grand Rounds lately. Here is Volume 2, Issue 15. Check it out if for no other reason than Dr. Charles's reaction to becoming an uncle.

The First Time Is Different

Anyone who has been through birth more than once will tell you that first labor, delivery and "babymoon" are special. Not always in good ways.

First labors are typically slower to start and last longer. First babies usually take longer to push out the birth canal than subsequent siblings. Mothers' milk takes longer, on average, to come in than milk after later deliveries. And how about that feeling of bringing a new baby home for the first time? "They let me walk out of the hospital with this child and no training?" Thank heavens that only happens once.

The hormonal and physiological changes of labor, birth and recovery apparently are different the first time around, too.

Researchers have recently identified "first delivery" as a risk factor for postpartum psychosis. Fortunately, psychosis is very rare. But if it's going to happen, it is most likely to occur after a woman's first birth.

The cases of postpartum psychosis we are familiar with from the media -- women who methodically drown five children in a bathtub or drive their car full of children into a lake -- involve multiple deaths and evoke an image of an overworked mother pushed to the breaking point.

Unfortunately, this study shows, the more representative candidate will be a first-time mother, possibly one who has had a difficult delivery. But because she does not fit the image we hold from the media, we may be less likely to recognize signs of illness in her, or more easily dismiss signs as non-threatening.

An example that has stuck with me from The Chronicle of Higher Education (subscription only) is the story of a promising professor who killed her first-born child, but whose behavioral warning flags were misread:

Like many couples who have just had a baby, Ms. Ener and Mr. Donagi had a lot on their plates. They moved to a house just a few miles from the campus when Raya was five months old. On the evening of July 4, the couple had a housewarming party, where friends and colleagues danced to Arab music, ate desserts, and watched fireworks overhead. Two days later the family left for a monthlong stay in California, where Mr. Donagi would attend a conference at the University of California at Santa Barbara.

Mr. Donagi says both he and his wife were looking forward to the California sun, to running, and to shopping at organic-food markets. But after they arrived, he says in an e-mail message, Ms. Ener couldn't relax and barely slept. The couple had learned that Raya might have trouble hearing.
Ms. Ener focused on that and a litany of other concerns: Was Raya eating enough? Was the tape attaching the feeding tube to her cheek irritating her? When she spit up, was that normal baby behavior, or did it mean she could not keep down enough food?

Halfway through the couple's time in California, Ms. Langohr, the professor at Holy Cross, came for a visit. Right away she noticed something was wrong. "Mine was convinced Raya was wasting away and in a lot of pain," says Ms. Langohr, who could see for herself that Raya was healthy and giggled when she played.

Ms. Langohr tried to persuade Ms. Ener to return to Philadelphia for psychological help, but Ms. Ener said she preferred to go to Minnesota to be with her family. Mr. Donagi drove his wife and baby to the airport on July 27.

In St. Paul, Ms. Ener's family insisted that she see a doctor, who gave her antidepressants and told her family not to leave her alone. "She would say things that were really off the wall," Ruth Ener recalls. At one point Ms. Ener told the doctor that she had considered jumping into the Mississippi River. But later she reassured her family that she could never commit suicide. It was then that Ms. Ener's brother, Oran, asked her if she had thoughts of hurting her baby. She answered emphatically: No.

Even while Ms. Ener seemed ill, there were times during her St. Paul visit that she appeared almost normal. "She would say, 'Boy, I really sounded wacko when I said that, didn't I?'" recalls Ruth Ener. "She wasn't constantly that desperate, pitiful person. She went in and out of it."

Perhaps that is why, although her family never left her alone at her parents' home, they didn't feel compelled to follow her every move. When Oran Ener stopped by his parents' house to visit his sister and their mother early one August morning in 2003, nothing seemed to have changed from the day before. While he was there, Ms. Ener fed Raya and collected toys for her to play with.

At about 9 a.m., after Oran had left for work, his sister took the baby into the bathroom for a few minutes, then walked empty-handed toward her mother, Marita Ener, who was cleaning the breakfast dishes. In an expressionless voice, Ms. Ener announced: "I just killed my baby."

Marita Ener didn't say a word. "Mine looked so completely out of it, I couldn't do anything but jump up and go into the bathroom," she recalls. She found the baby lying on the floor, blood seeping onto the bathmat. Ms. Ener had slit her daughter's throat with a kitchen knife.

A very accessible book on normal and abnormal postpartum adjustment is Overcoming Postpartum Depression and Anxiety by Linda Sabastian. I did not find its value in the "overcoming" aspect, but more in the labeling and describing different types of behavior.

Without a Net

I could go on reading about women's waxing experiences and thoughts for days -- the things I'm learning (a Sphynx!) -- but it's time to move on.

A few posts back I mentioned that my friend and doula partner broke her leg right before Christmas. Aside from the sympathy aroused by seeing a friend in pain and hugely inconvenienced, her injury has me experiencing a vulnerability I have not experienced since I was a new doula, that of operating without a backup.

I have a client due Sunday and another due the first week of February. This is closer than I usually have clients. If the first goes late and the second goes early, I could have two women in labor at the same time.

In truth I am not without backup support. I have lined up a doula I adore -- a woman my mother's age who is so gentle and nurturing -- to back me up for the January birth. And I am tracking down a doula for the February birth from among several colleagues.

But I do not have the relationship with these women that I do with T$. The arrangement between me and them is strictly a business one. And though as doulas they still are wonderful women to share my birth concerns and joys with. They don't have the history that T$ and I do.

Indeed, the February client is the first woman T$ and I were "double doulas" for. She is the first repeat client for both of us. It won't be right to attend her birth without the other half of my team. And for all the other births that T$ and I did not attend together, we still met each other's clients and kept each other posted on the situations so that the clients really felt shared, even though only one of us really interacted with them face to face.

T$ provided a lot of breast feeding support to a client of mine during a week I was out of town. I was present when one of T$'s clients delivered precipitously and T$ was at a different hospital with a client who was having a version performed.

So in addition to feeling a little exposed without my backup, I have also been relfecting on how fortunate I am to have a partner who not only matches me in birth philosophy and style of interacting with clients, but who also is a friend. I don't think that happens every day.

Cooter Pie

Doesn't that phrase just crack you up? Kinda like the idea of shaving all the hair off your vulva, right?

Or so I thought until I heard about the Brazilian wax.

Don't worry, I didn't just hear about the "killer B," though we in the midwest are admittedly late in catching on to national fads. I was reminded of this severe waxing over the weekend when I read an essay on the subject in the New York Times magazine. The author writes, "Pubic hair is out...this mossy covering is deemed no more than an aesthetic hindrance to the unfettered male gaze."

And the result? "As recently noted in an article in The Wall Street Journal, vaginal plastic surgery is one of the field's fastest growing sectors."

A bald, baby vulva isn't enough. Now it has to be sculpted. Sheesh.

This got me thinking. I have seen a few vulvas in my day, now that I've spent some hours at the business ends of birthing women. I don't remember a one. Vulva, that is. It's hard to explain unless you've witnessed birth yourself, but the focus, even though you're stairing down there, is on the baby's head or its absence. Surrounding terrain just doesn't register.

I can say with confidence, however, that all the women I've worked with so far have had hair between their legs. Not that I was consciously noting it at the time. But the sight of a bare mons and labia would be so shocking, I'm sure I'd not forget it. It would look so incongruously girly on a fertile, powerful woman.

Which makes me wonder if women who hire doulas are less likely to fuss over their pubic hair, or if my sample size is still too small (or too far from the standard deviation -- this is Ann Arbor after all) to mean anything.

Book recommendation

It often takes me a while to read books that I put on my "must read" list. For example, I remember when Expecting Adam got reviewed in the NYTBR. It sounded interesting enough for me to add to my (four-page, nine point type) list. Two years ago a colleague's wife who knew about my birth work recommended it to me gushingly. And now, seven years after its publication, I finally read it.

Let me recommend it to you. It is a memoir about one couple's transformation from Achievers to humble and happy humans. The path it takes is through their second pregnancy, one in which the baby is diagnosed with Down Syndrome while in utero. Their coming to terms with the diagnosis as well as a series of mystical (?, spiritual?) experiences during their son's gestation forms the backbone of the book.

It was a very fast read, in part because I'm such a sucker for pregnancy chronicles. But also because Beck is a talented writer whose story of reevaluating her life's priorities and philosophy hit a deep nerve with me.

Sometime in the next seven years or so, you might try picking it up yourself!

My latest patentable idea I'm willing to share with the world

Would someone please take this great idea and see it through to reality so I can benefit from it? Make bedsheets that have long sleeves, possibly mittens as well, built into them, so that one can hold her book without removing her arms from the warmth of the covers. I promise to buy sets in percale and flannel.