Unlonely

Thirteen years ago today:



How could we have foreseen that thirteen years down the road we'd have traveled to Costa Rica together, weathered turbulent law school years, aborted a wanted pregnancy, become parents to two amazing boys, and be pursuing interests in childbirth and urban planning?

At the time we just knew that nothing had ever felt so certain, so comforting and so fortuitous as being together. I'm happy to say we still feel that way, even though we now know each other through and through and have been at our worst around each other. Are there moments we want to head-butt the other? Of course. Have we hurt each other's feelings? Yes. Would we change things about each other if we had the power? Duh!

But we still feel like there is no other person we can imagine or would want at our sides as we learn and grow through life.

Couldn't Be Prouder

The Center's new website went live last week. There are still parts being filled in but most of it is done and it is gorgeous! If any of you need websites, Pilcrow is the place to go. It's the same designer who created this blog's lovely look (and she has a fun blog, too!).

You forget how much you once didn't know

Some months back I interviewed with a prospective client. She was very nice. I appreciated her interest in doulas and what they can do for laboring women. Her first round of questions, however, had to do with epidurals: Should she get a doula if she knew she wanted an epidural? Would doulas work with her if she wanted an epidural? How soon can one get an epidural? If you have an epidural and need a Caesarean delivery, do you have to get general anesthesia?

That was her segue into Caesarean questions: Do you get put completely under for Caesareans? Could her partner come with her to the surgery? How long do you have to labor before they give you a C-section?

As I answered her questions, I tried to bring in a more normal view of birth. One in which there were a variety of strategies for coping with pain, and a majority of situations that ended in vaginal birth.

She seemed to appreciate the information and confessed at the end of our conversation that she was very scared about birth. The two things she knew about -- epidurals and Caesareans -- were the result of her cousin who'd recently experienced both.

I left the interview astounded and disappointed. How could a healthy, educated woman have such a narrow perspective on this profound process?

Let me tell you my own story of ignorance and good fortune. When I was pregnant the first time, I did what I'd seen other pregnant friends do: purchase What to Expect When You're Expecting. That right of passage, and a friend's gift "The Girlfriend's Guide to Pregnancy" were all I had to prepare with. They were scary. We all know how What to Expect is a month-by-month account of what can go wrong and what benchmarks you're falling short of. I don't remember much about Girlfriend's Guide other than the author was constipated and advised partners to present new mothers with jewelry after the birth.

I took the recommendation of a friend and signed up with one of the well-regarded OB practices in town and was on my way.

Until a box of hand-me-down clothes arrived from a sister-in-law. Enclosed in the box was a used copy of Natural Childbirth the Bradley Way. My life took a whole different path.

I like to believe that I would have found "normal" birth on my own. But I remain thankful to my sister-in-law for introducing me to an alternative approach to birth. I could well be the case that but for that, I'd have learned the hard way about medicalized birth.

For similar reasons I think the increasing popularity of doulas is important. Perhaps the main users of doulas are women who already are educated about birth and are doing all they can to improve their chances of a satisfying one. On the other hand, the woman I interviewed with was not seeking a doula to help enforce a birth plan. Rather, she'd heard of doulas and thought they were as much a part of the process as a a Quad Test, an ultrasound, and, well, an epidural.

When women at that stage of their birth awareness are connecting with doulas, I have a lot of hope. It gives us a chance to plant a few seeds, whether we're hired or not, about ALL that birth can be.

Six Degrees from doulicia

The "rules" are here.

Today I found myself at Bitch, Ph.D. And while I enjoyed the site, I really seems like I'm only a degree of separation from that site. I mean, I could easily link to it.

So I played again and landed at Ben Casnocha: the Blog. This is more like it. Ben is fascinating. He is a self-proclaimed 18-year-old entrepreneur. I had no idea what an entrepreneur was when I was 18 (coincidentally, I was that age the year Ben was born) . Ben has apparently been one for six years already.

If he is telling the truth, he has read P.J. O'Rourke and Francis Fukuyama recently.

Is anyone else just a little afraid of Ben Casnocha?

Finished Object (what's that smell?)

I haven't JUST been combing the grad library stacks and visiting parades, you know. I've also been knitting. I fished the ruffle pullover I started a few months ago. Considering it was only my third knitting project ever, I am pleased with how it turned out.



After all, I didn't know the liabilities of variegated yarn, hence the change in "pattern" at the armpits, when I started a new ball of yarn.

I also wasn't aware of the "sale yarn" trap*. This was 50% off, so I bought it. Five little 50 g. skeins. No project in mind. No sense, really, of what average projects take. When I finally settled on a pattern, I had no idea how close I was cutting it. When all was said and done and the last seams sewed, I had about 30 inches of yarn remaining. Hence the roll-neck collar instead of another ruffle!

After I finished my photo shoot with the sweater, I saw our nightly visitor searching for insects in the front yard. This is one of two babies that visit nightly, usually with their mama. In case you can't quite tell from the photo, it's a skunk, heading for our neighbors' shrubs.

*My second Yarn Sale tale of woe -- I may be a little slow on the uptake -- is also my first experience with mail-order yarn. I have longed for Brooks Farm Yarn since February. Every few days I visit their website and gaze longingly at the colors. It was their mention of a possible visit to the Michigan Fiber Arts Festival that first alerted me to the fact that such events exist (yes I'm going). Imagine my excitement last week when their "Widows and Orphans" section had items in it for the first time. Not only that, but the description for the various skeins would say "Only 7 skeins" or "Only 4 skeins." I misinterpreted that to mean that they were selling only these quantities of yarn per order. "7 skeins for $27!" I thought. So I bought an order of 7 and an order of 4, all for $54.

Imagine my disappointment yesterday when my order arrived in a small envelope. "It's the first of several shipments," I reasoned. No. The envelope contained one skein of the first color and one skein of the second color -- 500 yards each -- and my packing slip confirming this was the entire order. What am I going to do with 1 skein each of mohair/wool yarn? 4 hats? 2 scarves? Yawn.

Of course now there are only 6 skeins of the first color and 3 of the second available at the Widows and Orphans site. I could add to my stash. But not for another $27 each.

BEWARE THE YARN SALE.

You Be Me for a While and I'll Be You

When I was in the Graduate Library stacks tracking down The Woman in the Body, I did my usual trick of perusing nearby books.

In doing so I found a fascinating book on intersex conditions (a.k.a. hermaphrodism). It was more a compendium of photos and explanation of genetic conditions than anything. Written in the 1950's, it covered some the more common XY chromosomal variations, such as Klinefelter Syndrome (Men with XXY chromosomes) and Turner's Syndrome (women with only an X chromosome), as well as conditions such as androgen insensitivity (XY genotype but female or ambiguous genitalia). I apologize if I have mischaracterized these conditions.

Sexual ambiguity is extremely interesting. Long before Middlesex brought an intersex protagonist to the Pulitzer Prize, academics were examining how conventional ideas of gender and identity are challenged by secondary sex characteristics. Natalie Angier devotes a chapter to it in her book Woman. Biologist Anne Fausto-Sterling made it the subject of her book, Sexing the Body.

Fausto-Sterling asserts as many as one baby in 100 is born with ambiguous genitalia. "Ambiguous genitalia" includes not only signs of the syndromes mentioned above, but simple structural variations in XY individuals. The clitoris can be long enough to resemble a penis, for example.

I read this statistic before I became pregnant with our second child. During that pregnancy I kept thinking, "What do we do if...?" Likewise, as a doula I now ponder how to be helpful to parents whose baby has genitals that defy easy characterization. If this ambiguity occurs in 1-2% of births, as Fausto-Sterling suggests, one does not have to work long as a doula before encountering it.

It seems that for many intersex individuals, immediate surgery to conform their physical appearance with one gender or the other is not the best course of action. Adults whose gender was surgically determined for them often feel misassigned, or uncomfortable with the notion of being labeled as one gender or another. The surgery, indeed the very need to KNOW a gender, is totally indicative of our discomfort with that ambiguity. We are a two-gender system.

I suppose the best way to support families whose child has some intersex or sexually ambiguous characteristics is simply to encourage them to learn about it. Refer parents to physicians, therapists, etc. who can answer their questions and deal with their emotions. This type of consultation and counseling fall outside the doula's standards of practice.

But doulas can help parents prepare lists of questions to ask. We can encourage parents to read about adults who were surgically assigned a gender and others who were not. We can be a safe place for parents to share fears and disappointments. As with any unexpected situation that presents itself to new parents (heck, to any of us), there will be an adjustment period that may include grieving the loss of the "expected" outcome, social discomfort at not fitting cleanly into cultural norms ("Is it a boy or a girl?") and confusion/ignorance about the situation's long- and short-term impacts (or lack of them).

And, of course, help them see that their child is so much more than a gender. It is a person, their person, their baby. Laying skin to skin, belly to belly with its parent, its gender is utterly irrelevant.

Client Load Update

I haven't had any births since April. This is largely by design. I'd had a busy winter and wanted a break for May. I knew June would be busy with the end of school and a trip to my in-laws'. I was open to a last-minute July client, but none came along. I thought I'd take an October client and have that be it for the year.

So I interviewed with and was hired by a couple due mid-October.

Then the friend of a former client contacted me about a late August birth. I said I couldn't be her doula -- we were taking vacation at the end of August and then there's the start of school for my kids and me at work -- but that I'd meet her for tea to talk about doulas generally.

Well, we've all had it happen. I totally clicked with this woman and her partner. They are very interesting. They are very informed about birth and yet laid back (both rare in first-time parents). They run marathons. By the end of our tea we were hugging goodbye and saying how sad we were that it wouldn't work out to pair up. I suggested they talk to T$ and said I'd be more than happy to be on-call for them any time T$ wasn't available. Now I'm not even sure how it occurred, but I am their doula and T$ is backing me up the week I'm out of town. It will be hairy, but I couldn't be happier.

As all that was happening, I heard from the man who has been doing some consulting with the Center for the Childbearing Year. He is a magnificent person -- everyone at the Center holds him in such high regard -- and now he is expecting his first child. He wanted to talk about my being his doula. They are due in mid-October. I said "sure" reflexively -- What an honor! -- and then realized I'd already committed to the other October clients. I've talked with both parties and they're okay with my being on call for them at the same time. These things work out, right?

A month ago I had lunch with a former client who's now a friend. She announced she was six weeks pregnant. I didn't ask, but I think that makes her due in January. If she'll have me, I'd love to be there.

And then last week I got a call from a friend who also was generous enough to let me be her doula when I was seeking certification and still learning my way around birth. She, too, is pregnant again. Her due date, if all goes well, would be in early March.

So it appears I have the next year laid out for me already. Exciting on one hand, but it also means I'll be saying "no" to all inquiries from here out for a while. I realized that with the few births I take each year, I could actually be pretty full with repeat clients if they have babies every 2-3 years and use me for future births!

Vera Drake

Last weekend I finally got around to renting Vera Drake.

The movie has been out for a year or more, so I'm guessing anyone who really wanted to see it would have already. If you haven't seen it and think, "well if it's fodder for doulicia, I may want to," let me give you this teaser: It is a Mike Leigh movie (think lots of dialogue, low-key pacing...) it concerns women and reproduction in the 1950s. It provides yet another example of humanity versus clinicality (?) in female care. 'Nuff said.

**now the spoilers**

The plot of Vera Drake unfolds very nicely. We see sweet, gentle Vera going her daily rounds. She works as a house cleaner. She stops in to visit and tend to several invalid relatives. She returns home to provide all the staples of a happy home: dinner, hot tea, love.

Only much later does the film reveal that occasionally her daily rounds occasionally include visiting "young girls in trouble." She scrubs her hands with a brush, grates carbonic soap into warm water, and uses a syphon to pump the liquid into women's wombs. With a tender smile and a pat she explains that in a week or two, bleeding will start. Off she goes. She doesn't charge women anything and leaves them with a pot of tea for comfort.

At the same time as this revelation is happening, the daughter from one of the homes Vera cleans gets raped. She can afford a more "professional" resolution to her ensuing pregnancy. And so we watch her move from physician examination to psychological examination (where she fabricates a crazy aunt and her own suicidal thoughts --is it really fabrication? -- to legitimize her need for an abortion) to her return home.

The movie focuses on Vera's ultimate arrest. Abortion is not legal. She has been breaking the law for roughly 20 years, we learn.

The arrest and trial were wrenching. What I keep thinking about, however, is the quality of care Vera provided and how it compared to the alternative. She cared for women in their homes, with friends and family present, and with empathy for the pregnant women. Though she is ultimately caught when one of her clients becomes infected and nearly dies, it remains unclear whether this was Vera's only sick patient or just the only one she is aware of. It is true that Vera did not sterilize her equipment between uses.

By comparison, the medical establishment separated the woman from her family. Indeed, by requiring "reasons" for the abortion (whether real or invented), it effectively woman from herself. She could not be wholly herself and get the treatment she desired.

Abortion issues aside (though I'll go there someday, I promise), one can compare the abortion situation in Vera's day to the homebirth situation today. Our homebirth midwives provide the personalized, wholistic (and thankfully more sterile) care. Our medical institutions often require the isolation of the laboring mother from her support structures and her true self.

Vera Drake made me think of homebirth midwives who are put on trial for illegally practicing medicine. In both the movie and real life the medical profession applies a double standard: it is both suspicious of lay-practitioners' technique and also less skilled at doing the same task in a humane way.

OB says US C-section Rates Could Be Lowered

Did you hear about this study? Apparently the Chair of Obstetrics at Cal-Pacific Medical Center led an examination of some 41,000 births at Sutter Health hospitals in Northern California. What did they learn?

"This Sutter Health study is the first of its considerable size to clearly show how two very common hospital practices are important contributors to Caesarean birth risk," said Elliott Main, M.D.

Doulas, mothers, childbirth educators: what would YOU guess are the two common hospital practices that contribute to Cesarean birth?

Induction, you say? RIGHT!

Active management of early labor? RIGHT AGAIN.

Two for two. Anecdotal experience has informed us of what the doctors were able to prove by examining labor histories.

"First-time mothers often go straight to the hospital as soon as their contractions start," said Dr. Main. "Our study shows that women can reduce their risk of an unneeded Caesarean birth if they are admitted into the hospital only when they reach active labor, when their cervix is at least three centimeters dilated."

Steering clear of an elective induction of labor also helped avoid higher rates of Caesarean births. "Some women may like the idea of scheduling their delivery date, but inducing labor in first-time mothers should be done only when it's medically necessary and not for convenience," added Dr. Main.

I think I'm going to print copies of this article and give it to my clients. They really don't get that connection between a seemingly small intervention and the cascade it can cause.

Incidentally, the survey found out one more thing that probably won't surprise the "alternative" childbirth community:

Our study finds that infants born in hospitals with higher or lower Caesarean birth rates had the same outcomes," said Dr. Main.

I'd love to provide the link to the full study. Alas, it's available by subscription only in the July 2006 issue of Obstetrics and Gynecology.

Recap of the Fourth

The parade, in quick recap:

1. Ring of Steel Theatrical Combat (chicks with sticks)


2. The car in which my eldest got his first haircut


3. The committee for peace (by far the largest entry, taking up nearly a city block with a band on a wagon, walking drummers, a 20-foot dove of peace and decorated pets)


4. 1/4 mile of police motorcycles, fire trucks, hazmat vehicles, ambulances and a "mobile command center," whatever that is, all with sirens blaring


5. Old-fashioned bicycles (here being photographed by the fearless and clueless man who felt at home single-handedly stopping each entry so he could take its picture in that slightly-bent-kneed position older men tend to use)


It was all swell. We saw lots of folks we knew and brought home several pounds of candy. Alas, the Bomb Pops were distributed by one overwhelmed man who took to periodically dropping an entire box off. The box that was closest to us was across the street amid a dozen kids. They did not heed his suggestion to "share with them" (pointing across the street to us. Oh well. No complaints.

Then we went home and played outside for the afternoon. And, I got the photo that has to be our Christmas Card cover this year:


Precious, aren't they?

A doff of my hat

I finally faced reality and removed Red State Moron's link from my blogroll. The site had been MIA for several weeks. Before that, it had been reduced to a weekly link to Grand Rounds. I have been worrying about its author for months, since an enigmatic post alluding to personal issues.

I finally found the answer (of sorts) here. The "moron" himself wrote:

As for the web site formerly known as Red State Moron, I have neither the grace nor savvy of Medpundit who at least wrote a final post. I simply had to discontinue the life support (read weekly acknowledgement of Grand Rounds), and let it go. I am a physician. My writing (such as it is) has not improved since college. Maybe with enough time....

And yeah, the personal issues are a struggle. Still. I remain a father, a son, a friend (to those who can tolerate my enigmatic ways), and a physician. And that is enough for now. I just had to recognize my limitations. 'Cause ya know, "A man's got to know his limitations".

For those of you who didn't visit his blog, Red State Moron gave every impression of being the thoughtful, pro-woman, pro-birth doctor (in maternal-fetal medicine no less!) that we doulas wish we could encounter more often than we do. I was deeply touched that he linked to this blog (and Milliner's Dream's) in his "Obstetrical Colleagues" category. It really is the highest compliment this blog has ever been paid.

I am sorry to hear that RSM is still dealing with personal issues, but so happy to see that he is continuing his work with pregnant women.

Please join me in thanking him for his reflective, informative posts and contribution to the realm of reproduction.

Between two worlds

Tomorrow is Independence Day and Saturday was Canada Day. Here I am wedged between the two holidays with a work day half over.

We celebrated Canada Day with Bookworm and her family. We both share a fascination with and envy of Canada, so it was only fitting that we spend the day together drinking Mooshead and Labatt's.

If you weren't aware of Canada Day, let me refer you to Yarn Harlot for reasons to celebrate it next year.

Tomorrow will be the traditional Fourth of July parade here in Ann Arbor, which the kids have been awaiting and discussing for weeks and weeks. I wrote last year about the reasons why I love the parade. I can add a new one this year: I have it on good authority (I work with one of the parade organizers) that Washtenaw Dairy will be giving away 1000 Bomb Pop popcicles along the parade route from their 1950's era ice cream truck.

You can not know the reverence my younger son has for the ice cream truck. It has only come down our street twice this summer, but that has not stopped him from developing an obsession with its tinkling "turkey in the straw" tune and side-panel menu. Each night after dinner -- not unlike Linus in "It's the Great Pumpkin Charlie Brown" -- he waits in the front yard for the ice cream truck to come. Suddenly, he freezes, cocks his head and raises a hand to silence the rest of the world. Then he shouts, "THE ICE CREAM TRUCK!!!" And begins looking up and down the street for it. Invariably it comes close -- the music gets louder and louder -- but never appears. And still, my son is calmed, just by hearing it in the vicinity.

So. We will be at the parade tomorrow, you can bet.

Happy Fourth of July everyone.