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Category Archives: Blech

When your doula is not invited

Years ago, when professional doulas first entered the birthing room, there was mixed reaction.  As expected, some care providers thought they were at best superfluous.  At worst, dangerous.

I remember when I first began working as a doula, I was hurt and surprised by the commentary on midwife and L&D forums.  I didn’t know I was doing anything controversial or threatening.

Now, most care providers speak words of welcome and praise for doulas.  They may not mean it but they understand that patient-as-consumer is becoming the norm.  Some providers really support doulas.  I get many of my referrals from some of the larger OB practices.  I even found one hospital-based practice (not local) that requires doulas for moms planning an unmedicated birth.

So I was surprised when I heard from a fellow doula that she was not allowed to attend a birth with a midwife.  It seems that this midwife uses a pool of house doulas from which her clients can choose.

Why?

I really don’t understand.  Why would a midwife refuse to permit the client’s contracted doula to attend her birth?

I can only speculate.

Fear that the doula will talk about something the midwife is doing?  What is she doing?

Are the house doulas trained in some special way?  Are they answering to the midwife?  Assisting her?  Because your doula should be working for you.

Are the house doulas paying a finder’s fee to the midwife?

Has she had a horrible experience with a doula?

Something else that I’m missing?  Because I’m truly stumped here.

I can’t remember being blocked from a birth before.  I’ve never encountered an OB who said a doula couldn’t attend.  A few times, midwives have told my clients that doulas were fine but not necessary.  Once, at St. Francis, I had a grumpy nurse say that only one person was allowed in the delivery room and that I had to leave.  The dad requested a new nurse and we carried on.

So this one is new.  What do you do when your doula is not invited?  I know it can feel challenging to break up with your midwife or OB.  You can interview the house doulas and ask some careful questions.  Choosing a doula is (or should be) an intensely personal choice.  There is a good chance you won’t resonate with the house doulas.  But maybe you will.  At the very least, this situation would be a red flag.  If the midwife doesn’t “allow” choice in who attends your birth, are there other areas she doesn’t allow choice?

Now, the midwife, admittedly, can decide who is present.  The couple, admittedly, can decide whether to hire the midwife.

This doula, admittedly, can decide who to recommend as a care provider.

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Lost in 120 Hours

It’s been quiet around here.  Any guesses why?

a).  I’m terrifically bored and lack anything interesting to say.

b).  The kids are slave drivers and keep me too busy to blog.

c).  As the only people on the planet who never watched Lost, my husband and I (stupidly) decided to watch the entire show from episode 1 to episode [gulp] 120.

The answer is (c).

Crazy, right?  Believe me, we have regrets but we can only move forward at this point and make the best of it by consuming good popcorn and excellent beer.  This Lost madness has left little time for late night blogging. *

Truly, this admission is the most pathetic thing I’ve ever written on this blog!  Readers are leaving in droves now.

To woo you into remaining and to force myself to follow through, here are some upcoming posts:

  • When your doula is not invited
  • Hiring a doula as protection
  • A review of the Grovia trainer
  • Cedar turns three
  • “I will not have a homebirth.” Oops.
  • My continuing refusal to be a homeschooler

I’m certain you’re all on the edge of your seats.

Meanwhile, my old fallback:

Adoring: Cedar’s lisp.  Especially when she says, “Smell these flowers, mom.”  Flowers sounds like flylersh.

Listening to:  A mix of broadway and I-don’t-know-how-to-categorize Trampled by Turtles.  Norah fancies the first.  Especially Cats.  Cedar will dance and bellow for hours to the second.

Seriously.  Watch that clip.  It makes me fret that the fiddler is going to collapse.

Proud of:  Norah’s art.  She draws constantly.  She still isn’t very interested in reading but her sketches are amazing.

Never Leaving Home Without:  Hmmm, I don’t have many necessities lately.  A map app?  I’ve had some prenatals in unknown territories.

Learning:  for the 15th time, how to thread my sewing machine.  It is pitiful, really.  I only use it to sew rice socks.  Meanwhile, why are sewing machines so complicated?  We progressed beyond the printing press and the butter churn.  Why is the sewing machine still so complicated!  Also, I need to learn to knit again.  I was at a birth recently that very much needed knitting.  Remember, I never produce anything.  I only knit in circles.  Perhaps someone could cast on and get me started again?

Appreciating:  an amazing massage I received from Blissful Massage Therapy last week.  Hot stones, loving hands, and a listening ear.  My body and soul felt serene.  And I felt somewhat selfish when I left as if she had taken some of my stress into her hands.

Nostalgic about:  Autumn.  I realize it will come again soon.  Still I’ve missed it.  And each Autumn, I remember skipping school to drive to Highlands, NC with my boyfriend.  We would drink fancy hot chocolate, window shop, and dream.  We still return each year to buy a single Christmas ornament but it is different now.  And the hot chocolate shop is gone which has left a hole in our lives.

Reading: The Birth House, The Happiness Project, Stalking the Wild Asparagus“I Love You” Rituals, Rootabaga Stories, and a bazillion old books for Norah.

Buying:  building materials for Scott’s workshop remodel.  Wow, wood is expensive!

Drinking:  coffee, of course.

Working on:  organizational structuring and plans for Upstate BirthNetwork.  Norah will be attending a fine arts program which will give me a weekly day in the UBN office to work.  If I could work it out so Natalie would be there, too, then Cedar and Naima will play while the mamas work.

Wishing:  for a shorter commute for Scott.  Miles and miles he drives now that his office has moved to Mauldin.

Giddy about:  my friend who is soon welcoming her Airman home!!

Feeling:  a familiar dissatisfied tug.  A feeling of impending change.  Go back to outside-of-home work?  Sell the house?  Buy a yurt and move to an intentional community?  Go paleo?  Adopt a pygmy hippo?  Exercise?  Paint my toenails?  Put the kids in school?  Try a new recipe?

Missing:  oh, my sister, my baby sister.  I hate when she’s sick and I can’t be there.  It makes me walk about distracted and irritable.  And my nephew turned TWO!  And also, they are healing at that lovely spot in Thailand.  Really, I need to go take care of them.  And eat yummy Thai food.

Grumpy that:  I say “yes” much too much.

*NO LOST SPOILERS!  That would be cruel and too awful to comprehend.

Before the good, the worst.

I’m going to tell you how amazing and better-than-expected flying with my kids was. 

But first.

I need to describe the one flight on which it all fell apart.  The flight on which I was that passenger.   The flight on which everyone saw my breasts.

You read that correctly.

It was the one flight I wasn’t concerned about.  We were leaving Cambodia at midnight on a five hour flight to Korea.  I felt confident the children would sleep.  They were already drifting off during the tuk tuk ride to the airport.  

The seats were three on each side with one aisle down the middle.  Norah was at the window, I had the aisle seat, and Cedar was between us.  Scott had already returned to the US.  My parents were on the flight but seated in a different section. 

Take-off was fine.  The girls drifted to sleep as expected.  I watched “The Help” and had a glass of wine.  A few hours before we were scheduled to land, the lovely folks at Korean Air thought we needed meals.  The girls were curled up in their seats.  Never one to waste food and wanting to be prepared in case the girls woke, I took the food.  It was a bad move.   

Picture it:  three trays down.  loaded with food and beverage.  no wiggle room.

And Cedar is startled awake suddenly screams like her arms are being ripped off.

Good morning, everyone.  Let me introduce myself and my precious toddler.

Cedar is screaming and thrashing and twisting.  She’s slippery when she arches her back and straightens her arms.  Now, I have a emergency preparedness plan for just such an event.  I read it on a travel blog.  Take the child to the bathroom and lock yourself in until the child calms. 

Ok, step one.  Somehow get out from under the food trays.  I stack my tray on top of Norah’s (who is mercifully still sleeping).  I grab Cedar and stand up on my seat.  This perch reassures the other passengers that the child is not being tortured.  I want to make sure everyone can see us clearly.  We stumble into the aisle only to realize we are blocked by the first class curtain on one end and the food cart on the other.  A nervous flight attendant runs to me and asks me to “just wait, miss, until the aisle is open.”  Um, ok.

We wait.  And Cedar continues to scream.  It doesn’t let up.  At all.  I try everything.  Yes, even the rescue remedy.  So I do the one thing I said I wouldn’t do:  I whipped out the boob.  No modesty.  Whipped out.  A phrase I hate and claim breastfeeding moms don’t really do.  I did that.  And you know what?  Even that didn’t work.

Finally, the aisle cleared and I carried/lugged/dragged my thrashing child (trying to keep passengers from getting kicked in the head) to the bathrooms.  Which, don’t you know it, were all occupied.  While we waited, sweet flight attendants showered Cedar with chocolate and candy.  Under normal circumstances, she would have been in heaven.  In her screaming banshee state, it made the crying worse. 

Once in the bathroom, eventual calm descended.  She nursed for a little while with those awful hiccup noises.  I began to pep talk her for the walk back to our seat.  She seemed ready.  I let her open the door.  And we made it three steps before the crying began and we bee-lined back to the bathroom. 

Repeat.

This time, I decided to carry my 29 month old child while breastfeeding down the narrow aisle crowded with recently fed passengers waiting for the bathroom. 

“Why hello there!  Have you seen my breast yet?”  “Did you get a good look at my crying toddler?”  “Yep, that’s my boob there.”  “If I can just squeeze by you?”  “Oops, sorry, didn’t mean to knock you in the head with that.” 

We crawled over and into our seats (the food was still there).  I was terrified to stop nursing the child.  Finally, the uneaten food was removed and we began our descent.  And guess what?  

Norah woke up screaming.  Her ears hurt.  And that made Cedar start crying again.  BOTH.  OF.  THEM.  CRYING.

I was prepared for ears.  But on the previous three (!) flights, there had been no ear complaints so I had to dig for the homeopathic ear tablets and gum.  Norah loves medicine and responds well to placebo.  I told her it was powerful medicine and would work immediately.  She went to sleep within 10 minutes.

And then Cedar went to sleep. 

And because we were flying blessed Korean Air, they did not make me (1) buckle my sleeping children for landing or, (2) cover my boob.  The flight attendant even brought me a hot tea.

In Korea, we headed straight to a playground where (still shaking) I prepared myself mentally to board a 14 hour flight.  I seriously considered calling my friend, Kimmie, who lives in Korea to ask if we could move in with her.

Next up:  how awesome flying with children is!

Dear Public Health and Pediatric Nurses

It is ok for a mama to breastfeed her baby during a painful procedure.  The baby will not die from choking on breastmilk. 

Let me repeat:  It is ok for a mama to breastfeed her baby during a painful procedure.

My first pediatric visit with my firstborn ended badly when the nurse refused to let me nurse Norah during an injection.  I was crying.  The doctor had told me I could but the nurses shut the door and said it wasn’t gonna happen.  One nurse said, “You’ll strangle that baby.”  And she tried to take Norah from me.  Rather roughly.  Yeah, that wasn’t gonna happen.  I left in a blaze of postpartum tears. 

Recently, a mama friend stopped in at the local health department to get a vaccination for her baby.  The nurse belittled her and bullied her about her vaccination choices.  Then told her she could not nurse her baby during the shot.  She would “aspirate that baby.”  Now, this mama had nursed her baby through every heel stick and injection.  He has never cried.  This time he did.  And the mama left in a blaze of postpartum tears.

Really, is this request such a big deal?  Do you really, really think that this activity is dangerous?  Has there been a case of a baby dying from breastfeeding aspiration?  I haven’t been able to find one.  And babies choke on breastmilk all the time.  Especially when mama has a forceful let-down. Maybe mamas with forceful let-downs should not be allowed to nurse.   

I found  this American Academy of Pediatrics statement:   Breastfeeding during a painful procedure such as a heel-stick for newborn screening provides analgesia to infants.

And this study in Canada:  There are no reports of adverse events, such as gagging or spitting up. Compared with the frequency of breastfeeding, vaccine injections are uncommon, and it is unlikely that an infant will associate breastfeeding with painful procedures.

And several others.   

What I did not find was anyone with anything to say about aspiration during breastfeeding.  Where is the evidence? 

I couldn’t believe this was such an issue.  The breastfeeding books I read told me to do it…then I couldn’t find anyone who would support it!  When I finally found a nurse willing to administer an injection while I breastfed Norah, I admit I was a little nervous.  Would she choke?  Nope, she didn’t even cry or turn to look at the nurse.  

So c’mon.  Lighten up on this one.  Be a baby-friendly nurse, please.

Changing the Energy

“PUSH!” 

Except it was spoken in Spanish. 

Which I don’t speak.  And neither did my client.  But the nurse assumed from her dark skin that she did. 

My client was a first time mom.  She had spent most of her labor at home.  Beautifully relaxed.  Quiet.  Intuitive.  She was fully dilated when we arrived and pushing with small “ahhhhs” and grunts. 

When it was discovered in triage that she was fully dilated, the energy went through the roof.  Nurse yells for a precip tray, un-brakes the bed and begins rolling it down the hall.  Instructions:  “don’t push, honey, just breathe through them.”  Flurry.  Another nurse appears and looks at my client with pity, “Sweetie, did you mean to go natural?”  The dad is frightened by all the activity. 

We arrive in a room.  IV antibiotics are started (GBS +).  Belts strapped on her belly.  Blood pressure cuff.  Thermometer.  Dr. Ken Barbie enters. 

Mom asks if she can push in a squat.  Ken Barbie says “no, we need to get this baby out quickly because I don’t know what’s been happening in there.” 

Stirrups raised.  Legs held back.  “You’re having a contraction, can you feel that?” 

She shakes her head “no.”  I mean, she’s been a bit distracted by all the madness. 

“Well you are.  And you need to use it.  So take a deep breath, hold it, chin to chest, pull your legs back and PUSH.  1…2…3…4…NO, don’t let your air out!  Again, deep breath…”

And then the nurse switches to Spanish.

Sigh.  Many of  my clients choose to arrive at the hospital late in labor.  And I am struggling to find ways to lower the adrenaline when we get there.   Literally at a recent birth, the nurse was asking the mom (in between pushes) questions like “Do you have electricity in your home?”  “Is this man the father of the baby and will he be going home with you?”  And sometimes, it doesn’t matter how early we arrive, when a woman begins pushing at the hospital, the energy skyrockets.   I especially love the tray of scary instruments that is wheeled into view.   

Yet, out-of-hospital, this stage is often the quietest.  The mom is focused and serious.  The caregivers may murmur a few “beautiful…you’re doing it” or “push with your body” affirmations but are mostly quiet.  And the moms who are encouraged to “push with your body” don’t often “take a breath, hold it, chin to chest, PUSH!  1…2…3….10.”  They give 5 or 6 small grunty pushes or they breathe their baby down.  Sometimes they skip a few pushes to get some rest.  Often, their own adrenaline causes them to rise up, lean forward.  Rarely does a woman intuitively lie back and pull her legs back. 

I’d love to show L&D nurses videos like this one or this one: 

Instead, many of them are trained in this way.  I realize that most of their patients have epidurals and may need help with pushing but PLEASE remember that most unmedicated women do not need to know when or how to push. 

Norah (5 yrs), who has been helping me write this post, would like to tell everyone that “squatting is best.  I know it is best.” 

 I’d love to hear from other doulas how you change the energy during this stage.

AnMed. Good grief.

The Leapfrog Group, a nonprofit organization that focuses on hospital standards asked hospitals across the US to voluntarily report their rate of non-medical (elective) inductions and cesarean births before 39 weeks. 

Ok.  First let’s define why elective inductions/cesareans before 38 weeks are bad.  The biggest reason is that the babe isn’t finished cooking yet.  Her lungs and brain are still developing.  More of these babies go to the Neonatal Intensive Care Unit (NICU) and more are at risk for health problems.  An early induction also carries a high risk for cesarean birth which increases danger to mama and baby.  Leapfrog also factors the cost-saving benefit to avoiding early inductions here

These numbers do not reflect early inductions/cesareans for medical reasons.  Medical reasons include preeclampsia or premature rupture of membranes.  These are purely elective (convenience–for the parents or the OB, concerns of big baby, tired of being pregnant, etc). 

Would you like to check out your hospital?   

For the local families:

1)  I’m surprised AnMed was willing to admit their non-medical early induction/cesarean rate is a crazy high 67.3%!

2)  I understand St. Francis has a new policy for 2009 that disallows these early births prior to 39 weeks.  Good for them with their 2% rate!  Maybe they will also catch up on the evidence for other things soon too.  Like what?  Oh, maybe like uninterrupted skin-to-skin contact after birth or vertical positions for birth or…the list goes on. 

3)  Not specific to our hospitals but good to know, in general, the average length of gestation for a first time mom is 41 wks 1 day.  So if a baby is scheduled to be born at 38 weeks, that baby is premature.  Whether he meets the medical criteria for prematurity, he had potentially had several more weeks to grow and develop. 

4)  Finally, beware the back-door induction.  The what?  Nancy New-Mommy goes in for a 38 week visit.  Dr. Sneaky Sneakyscrubs checks her and exclaims, “you’re 2cm dilated and 75% effaced!  are you feeling any contractions?”  Nancy says, “well, I have been feeling some cramping.  I think.”  Dr. Sneakyscrubs:  Let’s go do a non-stress test to see what is happening.  Nancy is surprised that the monitor shows she is having some contractions and they seem to be coming every 7 or so minutes.  Dr. Sneakyscrubs returns to say, “Congratulations, you are in labor!  Let’s get you over to the hospital.  We’ll start you on a very low dose of pitocin to help things along.”  Fast forward:  Nancy’s membranes are artificially ruptured, she gets an epidural to help cope with the pain of the pitocin, antibiotics because her membranes are ruptured, more pitocin because the epidural slowed things down, oxygen because baby distressed from the pitocin, and a cesarean for failure to progress and prolonged rupture of membranes.  Was she ever in labor to begin with?

Ladies, if you’ve ever attended one of my childbirth classes, you know my mantra:  Keep your knickers on.  Keep your knickers on at your 38, 39, 41 week OB visits.  There is nothing your OB or midwife needs to know from your cervix unless you need to know your Bishop’s score for an induction decision.  (There is an app for that by the way).

Am I Nit-Picking?

I will get back to birthy posts soon, I promise.

Recently, Norah was participating in a food drive for United Christian Ministries.  Fantastic.  She helped pick out what foods we would donate each week.  We talked about need.  We talked about sharing. 

Then, I realized it was a contest within this group.  The group of kids who brought the most food would win a pizza party. 

A pizza party? 

See, I grew up with stuff like this.  Lots of rewards for good behavior, memorizing scripture, perfect attendance.  I kind of felt that way of thinking was behind us.  That we had a new understanding of social justice.  That the reward was in the doing and the giving.   

Somehow I cannot imagine Jesus, when he sent his disciples out, saying, “whosoever heals the most lepers will get first seating at the marriage supper of the lamb.” 

Actually he said they would be flogged and hated. 

Norah’s group didn’t win the party.  I’m relieved.  Because the people we were collecting cast-off, dusty cans of creamed corn probably don’t get many pizza parties. 

Am I a scrooge about this?  Maybe it is all harmless.  I know I can’t shelter her from shallow rewards and legalism.  But oh how I want her heart to stay tender to the needs around her.  I want to model ways of engaging with people without tidy third parties.

Or pizza parties.