Thursday, April 27, 2006

Our Yellow Wallpaper

Several weeks ago the New York Times published an Op/Ed piece on Bed Rest. From the essay:

Over a century later women are still prescribed the equivalent of the rest cure for obstetrical complications, but now it is recommended before birth. It is a standard means of treating just about any pregnancy-related problem in the United States. Women at risk of preterm labor, women with too much or too little amniotic fluid, women with placenta previa (where the placenta implants on or near the cervix), women with pregnancy-induced hypertension, women whose fetuses are judged to be growing poorly, women with multiple fetuses and women with chronic health problems are all likely to find themselves on bed rest. Indeed, doctors prescribe it for about one in five of all pregnant women, or around 750,000 women a year.
She goes on to describe her own frustrating, numbing account of bed rest. Then she comments on the near absence of research on bed rest's efficacy.

Who doesn't know someone put on bedrest? But is it helpful? Certainly anyone who has spent days, weeks or months confined to a horizontal position for the benefit of her fetus knows it is no picnic. And no amount of loaned novels, DVDs or craft projects makes the time pass pleasantly.

The editorial refers to a short story, The Yellow Wallpaper, by Charlotte Perkins Gilman. Written in 1892, it is a fictional account of Gilman's own bed rest. That it was prescribed to deal with postpartum depression makes the account all the more wrenching.

If a physician of high standing, and one's own husband, assures friends and relatives that there is really nothing the matter with one but temporary nervous depression -- a slight hysterical tendency -- what is one to do?
Remember, this was written more than 100 years ago. For many women, little has changed.

I don't feel as if it was worthwhile to turn my hand over for anything, and I'm getting dreadfully fretful and querulous.
I cry at nothing, and cry most of the time.
Of course I don't when John is here, or anybody else, but when I am alone.
And I am alone a good deal just now. John is kept in town very often by serious cases, and Jennie is good and lets me alone when I want her to.

The story is only 17 pages long. I recommend anyone who works with, or has an interest in postpartum women read it. It's a study in what NOT to do.

Tuesday, April 25, 2006

Six degrees from doulicia #2

Nothing so fun today as the first time I tried it. Though I did pass through some interesting writer (read: Author) blogs on my way to this.

Also, last night I had a dream with Tommy Lee Jones in it. Longtime readers may know that his appearances have special meaning to me. I woke up this morning hoping our surgery from last summer is holding strong.

This is getting too self-referential. I gotta go!


Monday, April 24, 2006

Baby Time

A few months ago I wrote about how mothers' perceptions of birth are unique and no one should presume to know how a woman feels about her own birth. The client who was the subject of the first few paragraphs of that post -- the woman who had a beautiful birth in my eyes, but who experienced the birth negatively -- had her second baby last week.

I was there.

She arrived at the hospital in active labor and was 3-4 centimeters on arrival. An hour later her water broke and, as you'd expect, contractions became a lot more powerful. By the time they got her in a room, drew blood, and monitored the baby, she was a VERY uncomfortable 6-7 centimeters.

This labor was tracking very similarly to her previous one, including the rupture of her membranes and ensuing back labor.

She had said ahead of time that she'd be willing to try going medication free, which she did at her first birth, but she did not want to be engulfed by pain again, the way she was the first time. The midwife and I coaxed her into the jacuzzi. Unfortunately, its jets weren't working well and she was not able to get any relief for her back labor. She came out of the tub and announced she wanted an epidural.

She was eight centimeters. It was 30-45 minutes since her last check. She was cruising. The midwife and I exchanged glances. We both suspected that if she held out another half hour, she'd be pushing.

On the other hand, she looked and sounded exactly like she did in her past labor. The labor whose memory made her cry weeks later. No one was going to tell her she had to face that again.

She got the epidural and was understandably relieved. She felt better. She could think and be aware of her surroundings.

Yes, the epidural slowed labor. Yes, it lowered her blood pressure and the baby's heart rate dropped (nothing a little oxygen and some ephedrin couldn't help). Yes, her uterus hyperstimulated when she rolled her nipples to pick contractions up three hours later. And, yes, she sat in bed almost six hours waiting for her cervix to open the last few centimeters.

But, she delivered her healthy baby vaginally. And she volunteered that this labor was "so much better than the last one." She felt very positively about the way things went.

This is why we doulas have to remember that we work FOR our client and in service to her wishes. I might have preferred she have the baby naturally and quickly. But that was not what she wanted. It was her birth and she had the power of directing it.

Thursday, April 20, 2006

Food for Thought

Sometimes I come across something totally unrelated to my blog but nonetheless related to my many ancillary interests. Or else, something so unusual or interesting, I need to put it somewhere, lest I lose it.

This post is a collection of such random pieces. First, I followed a link from Milliner's Dream to a slideshow of sculptures by Ron Mueck. They were so grabbing that I googled him and spent a good 20 minutes seeing what else I could find. A sample show of his works is visible here.

Then there is this project by an art student at UM. I have no idea what it's about but again, I spent nearly 1/2 hour exploring it. (note: to interact with the pages, you have to click the "INFECT" link. It does not literally infect your computer, but rather takes you to the table of contents, which somehow describe a fictional genetic mutation -- or cosmic disturbance? -- that infects life on earth.)

For a total time waster, how about virtual paper dolls? For those of you who never had the Barbie style head (or whatever you called that thing that you could put makeup on and style the hair of), go to the "Makeups" section. There you can change the hair, eye and lip color of such notables as Charlize Theron and the Olsen sisters.

For beauty, enjoy these photos of individual snowflake crystals.

Tuesday, April 18, 2006

Weekend Photos

I have another client due any day now. My second repeat client. I'll keep you posted.

In the meantime, here are photos from our weekend bike trip to the Arboretum, which has an installment of daffodils. They run nearly a mile, angularly through the landscape, twenty-thousand of them. They were nearly all blooming. I'm sure they're still at the peak if you live nearby and want to see them.

And though they are less showy, I tend to be partial to naturalized Scylla, as shown here. Does blue get any better?

I also got going on my next knitting project, inspired by some gorgeous skeins of Artyarns Supermerino 108 that were on sale, 1/2 price at my favorite LYS. I am using Style Your Own Kids Knits to concoct a crew (or maybe roll) neck pullover sweater with a ruffle bottom.

This is for another friend who adopting a baby from China. If it turns out anything like I hope, it will be just too sweet!

Monday, April 10, 2006

As I go, so goes my blog

In other words, it's been WAY too busy lately and my posts reflect that. My housekeeping (such as it is) reflects that. My "productivity" at work reflects that. And so on.

Anyway, in the past week I did accomplish completion of my third official knitting project, the hooded cardigan for a friend who is adopting a baby from China. Her shower was Saturday at 11:00. At 11:00 I was home, frantically sewing a section of border I'd neglected the night before. This after taking the sweater and five buttons with my to my son's karate class at 10:00.

Anyway, here is the finished project, frantically snapped at 11:02:

It was still damp from blocking the night before. And I learned for future reference that I should take close-up shots of details I want to remember, like the buttons (little six-petaled flowers) and my sleeve-to-shoulder seams, which I pleased with for a first outing.

I tried blowing up a section to show the details, but it's not the best:

I also got a photo of me scanned and uploaded. It's by far my favorite photo of myself as a doula. Mainly because of the context. This was at a birth where the woman got an epidural in early labor and then sat, and sat, and sat -- about 16 hours of sitting -- while her cervix crept open.

We killed time all kinds of ways, including my demonstrating some of the non-birth uses for an exercise ball. I said it was great for stretching one's back, and proceeded to demonstrate. At which time my client's mother snapped this picture. She said, "I can't wait to show my friends what we paid a doula for." We all laughed very hard. And a second time when the photo came back and we agreed, as the image shows, that a doula plays a very important role at birth. wink.

Sunday, April 02, 2006

My sliding scale

Last weekend a doula sister asked to get together on short notice. She was feeling a little stressed and unsure about whether she had established appropriate boundaries for her services, especially in the postpartum time.

Doulas have boundary challenges. The work we do is intimate and emotional. Clients sometimes become friends. Friends sometimes become clients. Births turn complicated. Our personal passion for birth becomes intertwined with making a living.

Since many of us work in complete or partial isolation, it is very difficult to know if one's own services approximate a norm. There are standards of practice, which DONA and other certifying organizations have. Those are helpful in certain instances. But when it comes to issues like what to charge clients, whether to count babysitting as postpartum care or a service meriting separate pay and at what point to call in a backup doula on long labors, there are no definite answers. I know there are e-mail groups and chat rooms for these things. But please feel free to post here if you have comments thoughts.

In the interest of openness, I thought I would share my fee scale. Doula fees vary a lot across the country, being highest on the coasts and in wealthy communities. Ann Arbor, where I practice, is a wealthy community. Yet like all wealthy communities, there are also unwealthy women here. My fee scale attempts to make services available to everyone at a level they can afford. It's not perfect, but I feel better about it than the flat $550 fee I used to charge.

I use a sliding scale based on household income. I don't ask for any documentation, but let women tell me where they fall.

<$35,000: no fee, just coverage of my babysitting expenses, if applicable, up to $50
$35,000-$50,000: $350
$50,000-$65,000: $550
$65,000-$85,000: $750
over $85,000: $950

I have only had a few clients in the $350 range and none at the extreme high and low range. Most are at the $550 or $750 level.

This includes a minimum of two prenatal and two postnatal visits (with an additional visit at no fee if the client or I feel it is necessary) and continuous support during labor, birth and the first couple hours postpartum.

I have heard a few other doulas in the area charge flat fees of $500 or $650, so I think I'm in the right range. On the other hand, I never want cost to prevent a woman who needs a doula from getting one. That, of course, is balanced against the significant investment, not only of my time, but of time away from family, emotional energy, sleep lost (and commensurate decreases in productivity at work and home).