A Doula Journey

Panama City Lamaze on Facebook!

2011-01-29T14:56:00.002-06:00

In the interest of networking and helping more couples find information, I have launched a Panama City Lamaze Facebook page. Look me up : ) I'll keep an up-to-date class schedule there.

Latest Childbirth Class Dates

2010-09-09T05:00:00.002-05:00

Here is the current schedule for childbirth classes.
September 20 - October 25, 2010
and
November 1 - December 13, 2010
(We'll skip November 22 for Thanksgiving week)

We will cover everything you need to know for a normal birth and any interventions you might face along the way. Breastfeeding, baby care, and postpartum mommy care will also be hot topics. My classes provide fun, evidenced-based information on:

-Pregnancy - how to survive it
-Labor - how to make it work for you
-Birth - how to believe in it
-Postpartum - how to recover
-Breastfeeding - how to make it easy
-Baby Care - how to love them
-Mommy Care - how to love you

Classes are:
-2 hours a session
-6 sessions for a complete series
-6:30pm - 8:30pm
-provided with wonderful snacks
-taught by a DONA certified birth doula
and Lamaze certified childbirth educator

This will not be your typical birth class, I can promise you that. We will have lots of fun and enjoy learning how to birth beautifully. Email me if you would like more info.

Busy Birthing

2010-09-08T22:23:00.002-05:00

The past few months have been busier than usual. I attended 2 births in May, 2 births in June, 3 births in July, and 3 births in August. The last 3 births were back to back on a Wednesday, Thursday, and Friday. Each call was around 2 am as well. I was concerned about the births overlapping, but reality was a bit wilder than my imagination.

Thankfully all have been well even though there have been small and big problems. Most ladies have gotten the birth they wanted, but some had to adjust to what their labors became.

This summer has been a wild ride! Now I'm looking forward to the birth of a sweet friend's little one around Thanksgiving, but in the mean time, I'll be teaching several Lamaze sessions. I just finished a group set of classes with the nicest moms to be, and I can't wait to hear their birth stories in the coming weeks.

Childbirth Classes

2010-05-19T05:00:00.001-05:00

Here is the current schedule for childbirth classes. We will cover everything you need to know for a normal birth and any interventions you might face along the way. Breastfeeding, baby care, and postpartum mommy care will also be hot topics. You may see the following flyer in your local OB soon:

Childbirth Classes

Providing fun, evidenced-based information on:
-Pregnancy - how to survive it
-Labor - how to make it work for you
-Birth - how to believe in it
-Postpartum - how to recover
-Breastfeeding - how to make it easy
-Baby Care - how to love them
-Mommy Care - how to love you

Classes are:
-2 hours a session
-6 sessions for a complete series
-6:30pm - 8:30pm
-every Monday from Jun 28 to Aug 2, 2010
-provided with wonderful snacks
-taught by a DONA certified birth doula
and Lamaze trained childbirth educator

This will not be your typical birth class, I can promise you that. We will have lots of fun and enjoy wonderful snacks. Email me if you would like more info.

Sonday v2.0

2010-05-18T22:56:00.004-05:00

A few weeks ago I got to attend my first birth since the birth of my third child last summer. This was such a blessing as I got to shadow Ms. Kathy Barker, a fabulous doula and former Labor and Delivery nurse.

It turned out that this labor would need lots of support. The little one was posterior which made the labor and birth a lot tougher. It was also very similar to how labor and birth had gone with my little guy last year. This was a little emotional for me being informed of just how hard the mom was having to work. It was wonderful to see just how strong the mom was and how it all fades away soon after the sweet baby boy is placed on the mom's chest.

It's good to be back and awaiting laboring mom's calls. The final countdown has begun for another little one who is due any time now. "The happiest days are those when babies are born" - My favorite Gone With the Wind quote.

Childbirth Classes

2009-11-19T22:07:00.006-06:00

Everything is coming together for my first set of childbirth classes. We will cover everything you need to know for a normal birth and any interventions you might face along the way. Breastfeeding, baby care, and postpartum mommy care will also be hot topics. You may see the following flyer in your local OB soon:

Childbirth Classes

Providing fun, evidenced-based information on:
-Pregnancy - how to survive it
-Labor - how to make it work for you
-Birth - how to believe in it
-Postpartum - how to recover
-Breastfeeding - how to make it easy
-Baby Care - how to love them
-Mommy Care - how to love you

Classes are:
-2 hours a session
-6 sessions for a complete series
-6:30pm - 8:30pm
-every Monday from Jan 4 to Feb 8, 2010
-provided with wonderful snacks
-taught by a DONA certified birth doula
and Lamaze trained childbirth educator

This will not be your typical birth class, I can promise you that. We will have lots of fun and enjoy wonderful snacks. Email me if you would like more info.

Good Cause

2009-11-05T07:17:00.003-06:00

For my day job I work at the Navy base on the beach. Every year they have a Christmas party for children in the community who are less fortunate. They have many fundraisers for it, one of which is a silent auction.

This year I have donated a birth and postpartum doula package that includes 2 prenatal visits, labor & birth, and 20 hours of postpartum help. Bidding started yesterday and goes through November 16. If you would like for me to bid in your name, please let me know. There is no minimum.

This is a win-win for everyone. You get services and a tax write-off, I also get a tax write-off, and the kids get a great Christmas!

Healthy Birth Practices

2009-11-04T21:41:00.008-06:00

Lamaze and InJoy have partnered to make some great free videos discussing the how-to's and importance of preparing and planning for a healthy birth. This is the first video in the series, and along with some great comfort measures footage, there is the testimonial of a couple who switched their providers at 27 weeks of pregnancy. I would encourage you to seek a care provider you can agree with on your birth plan and not to ever think it's too late to switch. I, personally, switched at 35 weeks with one of my pregnancies.

If the embedded video doesn't work, here's the link.

Mastitis

2009-11-03T22:06:00.005-06:00

I've dealt with this illness more than I ever wanted to and may be starting a new round. Mastitis is a breast infection and kellymom.com will give you all the details you need. I didn't know about the commom symtoms (red, painful areas on the breast, fever, body aches) with my first and so nursed through double mastitis and nearly lost my determination to breastfeed along with my mind. With my second I knew what it was and got treatment the next day.

With my third I got it sooner than I ever have. At 11 days postpartum the tenderness started. By the next day the fever and aches were in full swing. My lactation consultant said that due to my weakened state (from the large postpartum blood loss) my body was more succeptible to illness. I was also more likely to get mastitis since I'd had it before. I spent every minute I could in bed to recover, but again it was almost my undo-ing with breastfeeding. I actually dreamed about feeding my baby table food and then cried when I woke to my newborn for whom table food was months away. We made it though and within a week were almost back to square 1.

Last night I started to feel that familiar tenderness again. The only "no-no" I've done in the past few days is attempt to sleep on my stomach for less than an hour. I was tired, my back hurt, and I'd already tried sleeping on my back and both sides. It made sense to me in my exhaustion although I haven't slept on my stomach in over 5 years from when I was pregnant with my first. Now I'm uping my fluids and trying to keep the affected side well-emptied. Fever hasn't showed up yet...

Lamaze Classes

2009-10-23T17:56:00.002-05:00

My newest adventure (besides the 3 month old) is becoming certified to teach Lamaze childbirth classes. I attended the international Lamaze conference earlier this month, and it was so cool to see some of the my birth heros. I got to hear Penny Simkin talk (author of "The Birth Partner" among others), and she was beyond awesome!

So, soon I will be doing my student teaching for Lamaze. I'm thinking in the January timeframe. If you are interested (and due in the February - March time frame) please let me know. Lamaze is not just the breathing method of old but is more of a point of view on birth, and that is that "Birth is normal" It doesn't advocate for a certain type of birth, but rather for us to be informed consumers of maternity services.

I took the Passion for Birth training whose goal is to "stomp out boring childbirth classes" so I can guarantee a much different experience from the stereotype ; )

The birth

2009-10-12T14:53:00.002-05:00

So I'm going to try to dust off the cobwebs here and tell about the birth. It threw me for a bit of a loop but we are all happy and healthy and for the most part recovered.

I was due June 25. I had hoped that my little one would show up somewhere between when my first two had been born at 37wks4d and 40wks1d. I also knew that my little one wasn't quite so little. I had been measuring big as usual and with previous 8 lb and 9lb babies, this one just felt huge.

When I was still pregnant on June 30 we set the induction date for July 8 when I would have been 41wks6d. I was convinced this baby would have to be evicted. I went for an ultrasound and monitoring on July 2 at 41 wks. Baby and placenta looked healthy. I was dilated to 5 cm, but had been slowing dilating over the past few weeks so I still wasn't convinced. I asked for my membranes to be swept (for the third time) trying to help my body along. Contractions started again but, as they had several times before, stopped within a couple of hours.

Around 6pm we decided to go out to eat. As we left contractions stirred up again, but I tried to ignore them as they often showed up at dinner time and went away around bed time. (I'd had many bouts of contractions since 37 wks) They were mild and didn't really demand any attention so out we went. During dinner they stayed 7 to 8 min apart but were still mild. I would just need to straighten up during them and then go about our meal in between.

After dinner I didn't want to go home because I didn't want to start focusing on what was or wasn't happening so we went to a few stores to walk around and entertain the kids. We got home around 9:30 and got the kids to bed. I wanted to get on my birth ball and see what would happen. It seemed to help, but I was so tired I just had to lay down. The contractions were still 7 to 8 min apart but were beginning to mean business.

Around 10:30pm I started asking my husband to take over timing them and to provide counterpressure during. This was the first time I'd ever used counterpressure during labor (and the first time I'd had back pain in labor) and it was wonderful! I still kept trying to sleep but wasn't having much luck with the contractions and bathroom trips.

At 1:00am I asked my husband about going for a walk. Thankfully due to one of the many false starts my mom was here and stayed with the kids who were none the wiser to what was going on. As soon as we got to the corner, the contractions went to 4 min apart. After going a couple blocks from the house with that pattern I suggested we go walk at the hospital's parking lot given my dialation earlier in the day and fast labor I'd had with my second.

We got to the hospital around 2am. We walked around it many times making pit stops at the bathroom in the ER as necessary. We would walk until a contraction built up and then face each other to sway or stand still or even dangle a little as the feeling passed. After a few were 3 min apart I suggested we move upstairs so I could get the checking in stuff done before I hit transition.

We got up to the maternity floor around 3:30am. It took awhile to be checked in. I was wondering why when it was the middle of the night and Friday had originally been offered for our induction since so few were scheduled. I was checked and found to be 6 and sent to a room. Now some ladies would have felt defeated to hear 6 after that much labor and rightfully so, but I was so glad because FINALLY - this is it!

Contractions were much stronger now, but stuck around 4 min apart again. Around 6am I realized how high my fatigue level was and that I still needed to have enough energy to push this big baby out. I asked my midwife about breaking my water as it had gone well with my second. She agreed and at 6:45am clear fluid flowed.

I had been feeling that my body was on the verge of hitting transition and with the membranes ruptured transition I did. It seemed like immediately I had to go to the bathroom. I went and did several contractions on the toilet, but they didn't feel right. I got back on all fours on the bed and still felt sort of "pushy" and started to go with it a little. I was checked and declared "almost" 10 and cleared to push at will (I already was anyway - thanks).

This is when the exhaustion started to factor in and I felt so tired. I was pushing harder than I felt I'd ever pushed before and still felt no progress. My midwife checked and found that my baby was posterior (which I should have seen coming). I kept pushing as hard as I could, but still nothing. I was beginning to think that my midwife would have to use the vacuum to help me, but then when someone else mentioned it she said she couldn't. Since we already knew that this baby was huge, she couldn't help out a head that might end up with a stuck body.

At this point I lost it. I knew it was all on me to get this baby out and I was scared of the concequences of not doing it myself. In the next two pushes I found strength I didn't know I had and suddenly he was crowning. He eased the rest of the way out and was placed on my chest. He pushed up and looked around. The nurses teased that he didn't need a crib, he could walk to the nursery. Others said that's not a baby, that's a toddler!

He was big and beautiful, but like his siblings wasn't taking to nursing very well. I kept trying to get him to latch, but began to feel gushes of fluid. When I told my midwife she took one look under the sheet and had me lay down. Now she has a poker face, but my husband didn't. His eyes went big as saucers at the amount of blood he saw. I gave the baby to him and my midwife and the nurses began to work on me to stop the bleeding. The medications they gave me put my uterus into contractions almost worse than transition. I couldn't take it anymore and asked for pain meds. They gave me demerol and I went into a strange state of still feeling everything, but not really caring for about 1 to 2 hrs. During that time I heard them weigh and measure my baby. He was 11 lbs, 22 in. His sugar was low so my husband gave him formula with a syringe.

We both looked like victims for a while with his bruised face and my extreme paleness. It took a while to recover from my postpartum experience. I think it was the biggest surprise to me as I felt the hardest part was getting him out. I had asked for no routine pitocin after the birth and now (hind-signt being 20/20) I realize that was the wrong choice for me for this birth. Everything else was great though and again we are all recovered now. I have a new respect for twin moms going through birth back to back.

Thinking about birth plans

2009-05-27T21:43:00.004-05:00

As I get close to my own labor and birth, I realize that for the first time I want to write a birth plan. I haven't before because I had heard naysayers telling of the bad luck ladies with birth plans have. Well now I realize how superstitious that is and how silly as well.

I also feel that I should write one this time since things will be a bit more complicated/interesting. My son has been actively asking to go with us to see his brother born. Neither myself nor my husband initiated these requests, and since he asked so many times we feel this is something that is very important to him. I have begun telling him of some of the logistics of birth to prepare him, but I feel I should also prepare our caregivers for him using the birth plan. Here's what I have so far:

If all is well and healthy, these are my birth preferences:

For Labor:
-Hep Lock
-Clear Fluids for energy and hydration
-Intermittent Monitoring – If continuous is required, prefer wireless transmitter
-Freedom of movement and use of the shower/tub
-Pushing in positions of my choice
-No offering of pain medications – I will ask if desired
-No other labor augmenting medications
-No AROM

For Birth and Immediate Postpartum:
-Vaginal delivery in semi-sitting, side-lying, or hands-and-knees on the bed
-No episiotomy
-Baby on mother’s chest, skin-to-skin
-Allow cord to stop pulsing before cutting
-Delay newborn exam until after first breastfeeding or perform on mother’s chest
-No routine use of pitocin or similar unless hemorrhage evident

For Postpartum:
-No circumcision
-No bottles or pacifiers

Notes:
This is my third birth, and I’m very excited to have my son who is 4 years old wanting to attend. He will have a family friend to watch him and help him while I labor and birth. If at any time there is an issue that you feel should not be discussed in front of him, please let me know. If there is an emergency, please use the code of suggesting they go get donuts so that he will not be exposed to the urgency.

My husband will be my labor partner and has supported me through a natural birth before. We look forward to taking this passage together again. If at any time you feel one of our birth choices has been overcome by events, please let us know.

Disclaimer: These are my preferences, and I would never think they should apply to anyone else unless they chose them. Birth choices are very individual and should be treated as such.

Also, some might think the donut suggestion silly, but it's very important to me to avoid saying anything scary around my son should it occur. He also LOVES donuts and being a rare treat (and with Krispy Kreme right in front of the hospital) it would be an easy distraction to get him out of the room fast. Hopefully, we don't have to use it of course. If I labor at night, I won't be waking him, but I'm so excited about the potential for him to witness the birth of his brother.

The Danger of Third Trimester Ultrasounds

2009-05-13T21:24:00.004-05:00

Two weeks ago I had an appointment for an ultrasound to get a better look at my little one's heart. They weren't able to see it well enough at the mid-pregnancy scan or the one a month after that. I knew going in that the ultrasound would reveal a larger than average baby since both of my previous children were and are larger than average. In fact as a family we are above average for size so why would I expect anything different for this baby? He measured two weeks ahead which seemed to concern the sonographer. I reassured her that it was normal for us and went on my way. Some ladies don't have that privilege.

Recently in discussing a friend's sister's pregnancy I was told how the sister's baby was measuring ahead for dates so the doctor was inducing based on the "new" due date. This is very dangerous.
1.) Ultrasounds in the last trimester can be off by 10% in either direction and because of this they are a poor estimator of gestational age/size.
2.) Ultrasound for estimate of gestational age is best used before 14 weeks since we all tend to grow at a similar rate in the first trimester compared to later.
3.) Even the American College of Ob/Gyns states that a large for gestational age baby is no reason for induction.
4.) Would you change your child's age based on how fast they were growing? If your 1 year old was the height of the average 18 month old, would you change their birth date? Of course not. Sure they may be the same size, but the 18 month old will likely have mastered many more skills.

The same is true for infants. We all grow differently starting in the womb. We are very similar in the first trimester, but begin to change soon after. That's why we have percentiles attached to the size measurements to compare growth to that of the rest of the population. If babies are forced out when (or in contrast kept in until) they met the 50% for size of a 40 week fetus you have a lot of development that may or may not have occurred based on the true gestational age of the baby. And those last weeks are crucial.

Many times the only concerns for an early baby are if the lungs are developed enough, but the baby must do more than breathe. Early babies (even 37 weekers) commonly have trouble breastfeeding because of the effort and skill it takes to eat and breathe during nursing. If you have a scan in your last trimester, please resist the urge to change your due date based on the measurements. Those last weeks of pregnancy that are so hard to get though are just as necessary for the baby's development as they were in the beginning.

Unexpected

2009-04-22T21:16:00.003-05:00

As part of my doula training I sat in on the local Lamaze class with Susie Sizemore, CNM and Kathy Barker. I loved it so much (and we all get along so well) that I keep attending and even helping out here and there when one of them is absent. At the end of each session Susie sets up an email list so everyone can share when their little ones arrive with the class. We were still getting birth emails from the class before the most recent one so I wasn't expecting any of the recent grads to be headed to the hospital so soon.

On Thursday April 16 around 7pm I received a call from Kathy that a couple from our most recent class had called her from the hospital needing support. Kathy wasn't going to be able to make it and wanted to know if I could. I hurried home from our grocery trip and got things together. I arrived at the hospital around 8pm.

The couple was already settled into a room, and the labor seemed to be going good and strong. The mom-to-be had chosen an epidural, and it was placed around 9pm. This allowed her some much needed rest as she'd had a couple of nights prior of almost no sleep. Around 6am things were starting to point to her being near complete. A little after 8am a healthy baby girl was born.

This little one was a champion nurser too, and I told the mom that she was making breastfeeding look easy. It was beautiful to see the beginning of a family and so sweet to see how smitten the dad was with his new little girl.

Sonday

2009-04-12T22:46:00.004-05:00

Last Saturday night I had be asleep about an hour when the phone rang. I must have been in a deep sleep fog because until I looked at the clock I thought it was around 4am. It was 10:45pm instead. This was a birth that I was very excited to attend. It was my first homebirth!

I quickly got dressed and got to the family's home about 11:30. We'd already had a "dress rehearsal" earlier in the week, and I was a little concerned that the mom might wait until she was definitely sure labor was in order before making the calls. My concern was that the midwife from Tallahassee's Birth Cottage was over 2 hours away. From listening to the mom on the phone I could tell that contractions were more serious this time and when I arrived they were getting fairly close together at around 4 min or so with good duration.

The contractions had picked up to 2-3 minutes apart when the midwife called to say that she'd been stopped for speeding. With homebirth not being quite so common here, the police officer was a bit confused as to why a midwife was proceeding in the opposite direction from the hospital for a birth. We found out later that she had held the phone up to the officer so he could hear the mom in labor in the background to which he replied, "Just go". The midwife arrived at 1:30am. A healthy baby boy arrived at 1:59am! It was nice that we had all met each other a few days prior since we got so little time for introductions before the little one introduced himself.

It was wonderful to see how relaxed things were even with how rushed the midwife had to be to get all her precautionary stuff set up. The labor and delivery had several little quirks that as you read the medical studies you see that the typical hospital reaction isn't always necessary or even helpful. All these quirks (including the labor stall earlier in the week) were allowed to play out and everyone was healthy.

One of the neatest things is that the mom said she should have known that things weren't going to pan out earlier in the week. All her sons have been born on Sunday!

A new baby girl!

2009-03-29T21:57:00.003-05:00

Four weeks ago (I've got to get better at keeping up with my blog) on Feb 28 I got the call from a couple in labor. It was around 8am on a Saturday, and I had just been thinking about what I needed to get done that day. Of course all of that would have to wait with a new little one on the way.

This couple was the first couple I've worked with to attend Bradley classes. Bradley is a childbirth education method that focuses on husbands helping their wives through labor and goes through great detail of the labor and birth process along with postpartum in 12 classes. (For a list of local Bradley instructors, check out the resource page)

I was very excited to see how well prepared this couple was for their labor and also how involved the father wanted to be. The most fascinating aspect of the labor was that the mother's labor would slow when the father was absent (like for packing and parking the car). It speaks to the truly involuntary side of labor and how the mother's comfort level can totally change the labor dynamic.

I can't emphasize enough how important it is to find a comfort person or object to help keep your subconscious at peace during labor. Most of our labor hormones are controlled by our "unconscious" brain and if it feels threatened, i.e. in an unsafe place to birth, it can slow or even stop the labor process. For some ladies, it's their partner - but for some it's a certain smell, music, object, or even an action like brushing hair or massage.

For this couple it was each other, and it was so beautiful to see. I arrived at their place a little after 9am. We moved to the hospital around 10:30am. At 2:30pm their baby girl was born into her father's hands (yes he even caught their baby!) Their little one had the most precious lip quiver to her cries, and all the staff commented on how she would use it to wrap her father around her finger.

Congrats to the new family!

I'm certified!

2009-02-25T21:10:00.004-06:00

I got the call from DONA today telling me that I'm officially a DONA certified doula! I'm so very excited and can't wait to order official business cards with CD(DONA) on them! In a couple of weeks I'll be listed on the DONA website and in a few more I should get all of my official paperwork. Woo Hoo!

Newborn Tips/Gadgets

2009-02-23T21:57:00.003-06:00

Recently I've been asked about what stuff worked for me with my little ones. "Stuff" being gadgets and other techniques to keep babies calm.

My number one recommendation for anyone would be "The Baby Book" by Dr. Sears! It is the closest thing to an owner's manual you'll get for a baby - 2 year old (and beyond). It's like having a pediatrician on your bookshelf for when those late night sicknesses set in and you question "Should I call?", "Should I go to the ER?", "Should I give them medication?", "How much medication?" This book has saved me several co-pays and is a lifesaver having the dosages for common infant medications based on weight. (You can also view the dosage guidelines at Dr. Sears website) It also gives realistic information on baby sleep and on the family bed. I believe co-sleeping is a personal choice, and Dr. Sears supports that when safely practiced.

Gadgets that I've liked:

- Sling - great for carrying baby and much less bulky/heavy than the infant car seat - I have a ring sling and a Moby wrap. Both are great at different stages.

- Medela Pump InStyle Advanced - this pump rocks! If you're returning to work and want to breastfeed, this pump will more than pay for itself in the money you save on not buying milk substitutes. I've used mine for two kids for a total of over 2 years of daily use - not one problem, still good as new.

- Play mat - my kids never went for the bouncy seats, but they loved the activity/play mats with the dangling toys and tags on the mat - usually kept their interest just long enough for a quick shower

- Swing - oh, how many hours of sleep were saved by the swing!

- Diaper Champ - takes plain kitchen trash bags and only requires one hand to use it - awesome!

- Noise Machine - helps drown out the everyday interruptions for the little one and is something they are conditioned to when they are born - think about how much "white" noise they've heard in utero from your heart, lungs, and um... other organs

- Cornstarch-based baby powder - we've avoided many rashes simply by using baby powder. The creams never did much for mine and actually seemed to hurt them if they were a little raw. Powder made all the difference.

I'm sure I'll think of more when I post this. I almost wish the edit feature had a limit so I wouldn't want to fix things so often.

Circumcision Decisions

2009-02-03T21:36:00.003-06:00

Today we found out we're having a boy! I'm very excited for my son and daughter to have a little brother soon. However the next thing I thought was "now we have to have a discussion".

When we had our son, I was more involved in preparing for labor and registering for baby gear than I was in researching evidenced-based care for myself or him. I pretty much left the decision of circumcision up to my husband since "I don't have one". I'm now a bit embarrassed and ashamed that I didn't attempt to learn more about the procedure.

Our son was circumcised when he was less than 2 days old, which is the common time frame for the hospital-based version of the procedure. I could not ignore how wrong I felt when they came to take him away. I did know enough to ask the doctor to use anesthesia, which frighteningly is not standard. I did not know the reality of the complications that we fortunately avoided that day. I also did not know the reality of the complications that could arise afterward such as adhesions which we were not successful in avoiding.

When I was pregnant last time (and before I knew it was a girl) I started reading the history and research behind circumcision and was surprised at what I found:

The US circumcision rate is currently over 50% (and declining) while the rest of the world is around 10%
The US rate was relatively the same as the world rate in the mid-1800's at under 10%
The US rate climbed sharply through the late 1800's and early 1900's based on "studies" that said circumcision cured various issues such as bed-wetting, epilepsy, and masturbation
The American Academy of Pediatrics declared in 1971 that routine infant circumcision had no medical indications, i.e. no medical rationale/benefits - this was reaffirmed in 1999
The studies done in Africa that concluded "circumcision helped prevent AIDS" did not include factors for the sexual behavior of the men in the study.
The difference in the amount of infections from the control (uncircumcised) and experiment (circumcised) group of the Africa study was in the 20s. Both groups had new infections, the experiment group just had 20 or so less. Is that true prevention?
Newborn circumcisions are usually done by obstetricians in the US - not pediatricians. Why is that? Are pediatricians trying to signal an important discrepancy to new parents?
Anesthesia is not routinely used. Is that humane?
Penile sensitivity is affected by circumcision - a reduction in sensation by as much as 4 times
Female circumcision has been held up by a US court as torture and a reason for sanctuary for a foreign immigrant. Is male circumcision that different?
Religions that promote male circumcision are about offering a blood sacrifice. Christianity does not promote blood sacrifices since Jesus' crucifixion was the final blood sacrifice for all Christians.

I write all of this to emphasize how important this decision is - one that shouldn't be made lightly. I have already told my husband that we have to have a long talk about circumcision soon. The more I research, the more valid my feelings seem for that day almost 4 years ago when my son was cut.

Woo Hoo!

2009-01-31T14:26:00.002-06:00

I just finished compiling my birth doula certification packet! I've done:

Application
Fee
Proof of Required Reading Form
Proof of Childbirth Class Form
Proof of Breastfeeding Class Form
Doula Training Class Certificate
Client Confidentiality Release Forms X3
Labor Forms X3
Evaluations by OBs/Midwives X3
Evaluations by Nurses X3
Evaluations by Mothers X3
Birth Essays X3
Resource List
Purpose and Value of Labor Support Essay
Signed Code of Ethics
Signed Standards of Practice
Self-Assessment Test
Website release form

It's so big and now I have to go get a huge envelope for it, but it's done! In two months I should be able to add new credentials to my name.

What was Eve's curse?

2009-01-24T15:14:00.004-06:00

For many Christian woman, the Genesis story is not a favorite during pregnancy and birth. When Eve is punished for disobeying God, many current English translations have the verse the following way:

Genesis 3:16 "To the woman he said, 'I will greatly increase your pains in childbearing; with pain you will give birth to children. Your desire will be for your husband, and he will rule over you.' "

This is not something you want to hear when you're in the middle of a countdown to labor as you are in pregnancy. However, when I first read Dr. Sears The Birth Book I was struck when he said the original Hebrew does not translate directly to this interpretation. In the original language the amount of effort women were to use in labor was to equal the amount of effort the men would use in cultivating the land and providing for their families. Now in times before machinery and fertilizers, this would be quite a lot of effort, but not out of the question as we sometimes perceive childbearing labor now.

I found an even better explanation of the original meaning of the Hebrew text in this article from Birthing Naturally. I highly recommend you read the whole article, but this author gives the following translation of the verse:

"I [God] will have authority over your labor and fertility. With (toil) work you will have children."

This translation makes much more sense to me as a Christian, and I hope it will encourage others too.

Maternity Leave from Maternity Care

2009-01-15T22:56:00.002-06:00

I've been considering lately what kind of maternity leave I would take from doula tasks given the upcoming birth of my own. For my day job I usually work up until labor since it's mainly desk work and then return at 8 weeks. Given the intensity of doula work during labor I don't think that's a reasonable plan for me or my clients.

Right now my plan is to take mid-May through September off of doula duties for my own healing and our families adjustment. Depending on how things go I might lengthen or shorten the leave, but 4 months seems to be sufficient right now. We'll see when this one gets here.

I find out February 3 what this little one is. I almost feel more excited to know this time than the first two. Maybe it's because I have a glimpse of either way... No matter the results though, we'll be happy of course.

Busy, Busy, Busy

2009-01-01T22:34:00.002-06:00

Well the last of the Christmas decorations are back in their boxes. The only things left are the needles from the tree that need vacuuming. Oh and of course the Christmas candy. Not a good idea to go down an aisle of chocolate with 50% off signs when you're pregnant.

Yes, doula is as doula does. I'm expecting my third little one this summer. My oldest seems to understand, but the youngest is of course clueless. We are looking into a homebirth this time. I was very sure I wanted a homebirth for my next one.... until I found out I was pregnant. Now, I have a little bit of the jitters, but it will all work out I'm sure. We will be meeting with a homebirth midwife in a few weeks to find out all the particulars.

I also attended my fourth birth on December 16. This birth was special because it was for a woman I work with and who I'm actually filling in for while she's out. It was getting interesting it the last few weeks because we met everyday for work issues so I couldn't ignore the fact that her due date was approaching. With the other births I could distract myself with work so that the last days of the pregnancies didn't seem so immediate. Although I do think it helped the couple because we got to talk about pregnancy and birth-related issues a lot more than has been possible with other couples.

It turns out that this couple would need the extra preparations. Their baby settled into a posterior presentation for labor and birth (where the back of the baby's head is towards the back of the mother). This can cause labor to be much more intense for the mom and birth (pushing) to take a lot more time and effort as well. Many posterior babies will eventually right themselves for an easier presentation, but their little guy fell into the small percentage that didn't. The mom did great and so did the dad in coping with the situation and asking for what they needed from the hospital staff to achieve the birth they desired. Baby arrived in the early afternoon, and everyone was healthy and happy.

I've been studying more since this birth about posterior babies and how to maneuver them into more preferable positions. Spinningbabies.com has some great exercises for moms to try before and during labor to encourage baby into the anterior position (where the back of the baby's head is towards the front of the mother).

Now that I've attended all of my certification births, I need to focus on finishing up my reading and writing up the birth reports to send in my certification packet to DONA. I just never thought that I would complete the birth portion of the requirements before I completed the reading. I have one book to finish which I'm about half way through. I hope to complete everything this month.

Number Three

2008-11-26T23:05:00.004-06:00

Every birth is different. This one was no exception. On the afternoon of November 17 my husband called to say that one of the players for his softball team wasn't going to make it since his wife's water had broken. I quickly called their doula Kathy as I was to be her back-up in case she needed me. It turned out that Kathy had another client who was a bit overdue that had also started labor that night so I was indeed needed. I contacted the couple and found that contractions were still elusive so we all decided to wait until things were more interesting.

They called back at around 3:45am to say that meds to induce contractions were about to be given and now seemed like a good time for some more support. I arrived at the hospital at 4:15am, and contractions were already starting to get intense. We did lots of rocking, walking, massaging, and praying. Around 1:45pm a new little one arrived. It was facinating to see his eyes opening and looking around before he was completely born.

This birth touched me quite a bit more since I've known the couple for almost five years now. It was awesome to see how well they worked together as a team with the rises and falls of labor. I was so blessed to be a part of their birth experience.

Congratulations to the new family!

Round Two

2008-11-01T22:59:00.004-05:00

When I attended my birth doula training at Amazing Births in Boca Raton, Lorie McCoy made the statement that "Every birth is different. Every birth teaches you something." After attending my second birth, this is so much more meaningful to me.

Thursday October 30 around 2:30 am I received a call from another new-mommy-to-be. Her due date was November 8, and she hadn't been having much Braxton-Hicks contractions so I really didn't expect to hear from her so soon having spoken with her the night before. However, her water had broken a little before midnight. Contractions had followed around a hour later and were now around 5-7 minutes apart. I said I would be right over.

I got there around 3:00 am. Mom-to-be was doing well on her birth ball, and Dad-to-be was quickly packing for the hospital. I was surprised at how advanced labor seemed to be and as signs of transition started creeping up, I asked if they felt ready to move to the hospital. We got to the hospital around 4:00 am. There were some minor setbacks to the couples birth plan upon admission, but they took it all in stride and did so well with the situations as they changed. At 6:30 am on the dot their little one was born.

It was such an awesome experience, and I'm so glad they chose to share it with me. Way to go, guys!

The Beginning

2008-10-19T21:50:00.003-05:00

My husband woke me at 6:20am this morning. I grumbled at him at first saying that we don't usually get up this early for church, and I wasn't going to work today. (The work statement was justifiable since this was to be my first day off in October.) I'm not sure if his words of "You had a phone call...." or his tone of voice that was almost teasing me with information that he knew I wanted to hear woke me up more.

It was of course THE call. The first "I think I'm in labor" call from a mommy-to-be. I quickly called her back (I had been in my daughter's room who still likes a sleeping buddy so that's why hubby had taken the first call). Things sounded promising so I quickly headed over to their place by 7am.

Early labor was well established and active labor soon followed. We got to the hospital around 10am. Things moved very quickly after that and a healthy baby arrived just before noon. The mom totally rocked and did so awesome with her labor. I don't think I could have dreamed of a better birth experience to start my doula career. It was so cool to work with the couple and help them find their own path through the labor process.

I want to write so much more, but in the interest of privacy for the new family I will only add that this was the best "day off" I've had in a long time! Congratulations guys!

Consumer Reports on Birth

2008-10-16T22:29:00.005-05:00

I was very excited to read Consumer Reports evaluation of labor practices. I was even more intrigued when I read that most of there recommendations come from the recently released "Evidence-Based Maternity Care: What It Is and What It Can Achieve" which was co-authored by Carol Sakala and Maureen P. Corry of the nonprofit Childbirth Connection. There's a common misconception in our culture that most of our medical practices were extensively tested and proven before they became main-steam maternity care.

The biggest example of this not being true is continuous electronic fetal monitoring in labor. It was thought that the baby's heart rate would show signs of distress so that emergency measures could be taken to improve babies' outcomes in cases such as cerebral palsy. Before any studies were completed, the technology spread to labor wards nationwide. Unfortunately, there has been no significant change in babies' outcomes since continuous EFM became standard for most hospital births. What has significantly changed is the rate of instrumental and surgical interventions in birth due to uncertain EFM readings.

For more examples check out Consumer Reports Maternity Quiz.

Birth in the media

2008-10-06T22:29:00.004-05:00

Scripted birth scenes usually involve a lot of rushing, yelling, and general panic. Birth reality shows typically edit to only show the most intense sections of labor and of course the actual birth. Both of these create the image that birth is an emergency in a majority of cases that must be attended to swiftly. Neither of these assumptions is true.

However, there is a great birth reality show focused on a midwifery practice in Miami, FL called House of Babies. It airs on Discovery Health Channel at 6 am eastern time, Monday through Friday. I have just discovered this show that was originally filmed in 2006. The first episodes I watched showed peaceful, low-stress, natural, birth center waterbirths. I realize that this is not a goal for many women, but I think we could all benefit from the exposure to birth as a natural process rather than an accident waiting to happen.

"It only takes a push"

2008-10-01T23:17:00.002-05:00

This past weekend some gracious friends of ours called to ask if we were interested in swapping childcare for a date night each. We watched their little one on Friday while they watched our two on Saturday. (I know, I know, but they volunteered!) So we finally went to see the new Batman flick that so many people have been raving about, and well... we didn't think that much of it. It was the first "blockbuster" in a while to have a decent script so that was nice.

The line that hit me most was "Madness is like gravity. It only takes a push." I find that to be very true especially in the postpartum period. With the huge crash of hormones, most women are near the edge. Add to it a colicky baby or an unsupportive family and a few go over. Add both and few can hold on.

In reading about the postpartum period and how other cultures treat it I find that the U.S. is very different. Mothers in other countries are commonly expected to take the first month or more to only care for the baby. Family and friends step in to care for the mother and household. Baby blues are not considered normal in this setting.

For the U.S. though this is not so. Here we value independence and view it as a sign of success. Too often this leads to isolated families and even more isolated new mothers as the new fathers return to work within days of the birth. However, the best success might be found in interdependence instead.

Panama City Pregnancy and Parenting Resources

2008-09-26T22:40:00.010-05:00

As part of my certification to become a DONA certified birth and postpartum doula I am required to list at least 30 local resources from 45 different categories. I plan to update this post as I find more, but here's what I have so far:

Abused women shelters and support groups
Salvation Army Domestic Violence & Rape Crisis Program
Hotline numbers: 1-800-252-2597 or (850)763-0706

Addiction services and support groups
Bradford Health Service - (850) 522-5932
Chemical Addictions Recovery Effort (CARE), Inc

Birth Centers
The Birth Cottage in Tallahassee, FL

Birth Doulas/Labor and Birth Support
Kathleen (Kathy) Barker
Robyn Smith, CD(DONA)

Breastfeeding pump and equipment supplies
Target and Toys R Us actually have a great variety of supplies for purchase

Child abuse protection agencies

Childbirth educators
Susan (Susie) Sizemore, CNM - Lamaze Method; Panama City, FL
Kathleen (Kathy) Barker - Lamaze Method; Panama City, FL
Stefanie Werner - Bradley Method; Niceville, Destin, FL
Larissa & Ted Timper, AAHCC - Bradley Method; Niceville, FL
Shayne Slingluff, AAHCC - Bradley Method; Dothan, AL

Childcare options
First Baptist Church, Panama City
St. Bernadette Childhoood Development Center, Panama City Beach

Children's hospitals
Sacred Heart Children's Hospital

Chiropractors, Massage Therapist, Reiki Practitioners

Community services and programs
Pregnancy Resource Center of Panama City

Cultural/Multi-cultural resources

Early intervention programs for babies and children with special needs
Early Education and Care, Inc
Florida State University Center for Autism and Related Disabilities (CARD)

Family doctors/Pediatricians
Rubina Azam, MD, 625 W Baldwin Rd Unit D, Panama City, FL
Ingrid J Rachesky, MD, 2550 Jenks Ave, Panama City, FL
Zoe Family Care Clinic, 817 Ohio Ave, Lynn Haven, FL

Health Food Stores
Lemon Tree Natural Foods 2921 Hwy 77 Panama City, FL
Mount of Olives Health Food Store 734 W 23rd St Panama City, FL
Olive Leaves 634 W 23rd St Panama City, FL
Olive Leaves 360 S Tyndall Pkwy Panama City, FL
Herb Shop 302 W 23rd St # B Panama City, FL
Florida Health Foods 416 Harrison Ave Panama City, FL
Herb Shop 11208 Middle Beach Rd Panama City Beach, FL
Nature's Way Healing Foods 7137 W Hwy 98 Panama City Beach, FL

Hospitals/Minor Emergency Services
Bay Medical Center
Gulf Coast Medical Center
Sacred Heart Health System

Incest/sexual abuse support groups

Infant massage classes and services

Lactation Consultants
Carole Buhrows, RN IBCLC 625 W Baldwin Rd Unit D, Panama City, FL

La Leche League/Breastfeeding groups
Breastfeeding Support Group - Meets on 1st and 3rd Thursday of the month at First Baptist Church Panama City, FL led by Cheryl Repel, RN with Healthy Start
La Leche League - Meets in Niceville,FL; Contact Sarah Leatherman

Libraries/infant programs
Bay County Library - Book Babied and Terrific Tots

Maternity/nursing clothes
Bellies & Babies, Pier Park, Panama City Beach, FL
Motherhood Maternity, Pier Park, Panama City Beach, FL
Kohl's, Panama City, FL
Ross, Panama City, FL
Target
Wal-Mart

Midwives - Home birth
Jill Welch, LM, CPM
Suzy Martincak, CNM - Coming Soon!

Midwives - Hospital birth
A. Dale Gauthier, MSN,CNM - Coastal OB/GYN
Tammie Mott, ARNP-C, MSN, CNM, WHCNP - Emerald Coast Obstetrics & Gynecology
Susan (Susie) Sizemore, CNM/ARNP - Emerald Coast Obstetrics & Gynecology

Mother's centers/parent and child centers

Multiple birth groups/associations

Naturopathic/homeopathic services/stores and clinics

New Mothers/Fathers/Parents groups
MOPS - Mothers of Preschoolers - Hiland Park Baptist Church Group

Obstetricians
Coastal OB/GYN
Emerald Coast Obstetrics & Gynecology

Online resources
Breastfeeding - Kellymom.com

Parent's Anonymous/support groups

Parenting Classes
Pregnancy Resource Center of Panama City

Parent and women's bookstores

Perinatal loss support groups/bereaved families support groups

Play groups
meetup.com -Local groups include StollerFit, Attachment Parenting, and more

Postpartum exercise/mother and baby exercise/yoga classes
Advanced Therapeutics Yoga with Sarah Woods, Panama City, FL - Private and Group Classes
Firefly Yoga Studio, Panama City, FL - Prenatal Yoga Classes
Prenatal Yoga Classes at Healthplex, Panama City, FL

Postpartum depression resources and support groups

Postpartum doulas/postpartum support
Kathleen (Kathy) Barker
Robyn Smith, CD(DONA)

Single parenting groups

Support groups for parents of children with special needs
Emerald Coast Autism Society

Teen parent support groups/educational services
Pregnancy Resource Center of Panama City
House of Grace Maternity Home

VBAC/CA support groups
International Cesearean Awareness Network (ICAN) of Tallahassee; Contact Megan Morsey

Well Baby Clinics

Intervention

2008-09-15T07:16:00.004-05:00

As part of my birth doula training I am to attend a childbirth education series as a non-expectant parent. For my series I chose to sit in on a Lamaze class done by Susan Sizemore, CNM and Kathy Barker (which I would highly recommend to any expectant parents).

Lamaze has six care practices for labor and delivery.

These six care practices represent "evidence-based care," and means that they are "using the best research about the effects of specific procedures, drugs, tests, and treatments, to help guide decision-making."

This past Thursday's class was on care practice 4: No routine interventions. Interventions are anything used on the mother or the unborn baby that alters the birth process. They can be as simple as restrictions on eating and drinking and as complicated as epidural and/or episiotomy.

Susie brought many of the items used in interventions for the class to examine. It was shocking to see the epidural needles up close as was the internal fetal monitor that is inserted into the baby's scalp. After looking at all these tools for labor, it's not hard to see why many ladies are concerned about the labor process and what will happen during it.

Interventions have become rampant in labor and delivery. It important to realize that we have a lot of technology in US births that has either become outdated or was never really proven effective in the first place. For some great information on what is useful and what isn't, I highly recommend The Thinking Woman's Guide to a Better Birth by Henci Goer. In this book Ms. Goer outlines the beginning of some of our practices and the changes to our maternity care as the interventions became common place. She references every fact to medical studies and provides a synopsis of all the studies she used in an extensive appendix to the text.

Some quick facts that I wish more women knew:

Limiting food and drink in labor started when anesthesia was a tricky practice and general anesthesia even more so. New techniques on protecting airways under general anesthesia make this intervention unnecessary. (How many car accident victims have empty stomachs anyway?)

Use of IV fluids was started to counteract the limiting of food and drink and the lowered blood pressure effects of epidurals. Did you know that the amount of IV fluids in labor can alter your baby's birth weight and that when this extra fluid is lost it could cause great (and possibly false) concern over the success of breastfeeding?

Continuous electronic fetal monitoring was started with the hopes of preventing birth injuries to the baby due to distress and/or loss of oxygen. Did you know that conditions such as cerebral palsy have not decreased since continuous electronic fetal monitoring was introduced? Did you know that C-sections have greatly increased? Did you know that intermittent monitoring has be proven to be just as effective as continuous monitoring?

Episiotomy was thought to protect the mother and baby from birth injuries. Did you know that more injury is typically caused by an episiotomy that would normally occur with a natural tear?

All of these interventions have their place in labor, and when used appropriately are truly effective and help to promote a better outcome for the mother and baby. It's important that you speak to your provider (OB or midwife) about what interventions they use and what the indications are for them to be used in your labor. If you don't like what you hear, it's never too late investigate other providers. (I switched mine at 36 weeks)

Postpartum Training

2008-09-08T21:36:00.004-05:00

I just got back today from my DONA Postpartum Training. My trainer was Betsy Schwartz, and she was awesome! I highly recommend her if you're looking to become a postpartum doula.

The neatest things to me were watching Dr. Christina M. Smillie’s Baby-Led Breastfeeding and the What Babies Want documentary (both of which are on my "to-buy" list for the library).

Baby-Led Breastfeeding shows Dr Smillie with patients and their new babies. (Most babies were 4 weeks and younger.) Dr Smillie has the mothers place the babies semi-naked in the center of the mothers naked chest and then wait for the baby to initiate breastfeeding. It's amazing to see the babies as they wiggle, crawl, and dive for the breast and then latch themselves. I did not have that experience with either of my kids and maybe it was because I did not realize just how much a newborn can do.

What Babies Want is a documentary with many different professionals talking about how much the infants knows even before birth. The most powerful story to me was of the one year old twins who replicated how they played in the womb using curtains. The main message of the video is that everything we do in pregnancy, birth, and beyond affects our child in some way.

Of course the focus of the weekend was how everything we've experienced before, during, and after pregnancy or adoption affects how well we recover and transition to becoming parents and how postpartum doulas make this transition smoother. My hope is that more families would realize how wonderful, special, and yet, fragile this transition is.

Birth Services

2008-08-30T22:58:00.006-05:00

As a birth doula my focus is to support the mother through pregnancy, labor, and birth. This starts with prenatal visits and phone calls and culminates with constant support and attention through labor and birth and the immediate postpartum period. Services offered are:

Prenatal visits (at least 2)
Phone and email support throughout pregnancy
Access to the Lending Library
"On call" during "due month"
Labor and birth support (via phone, in-home, and/or in-hospital)
Labor positioning/coaching
Massage/Relaxation tips
Birth Plan advocate
Help with initial breastfeeding
Postpartum follow-up visit (1)
Sounding-board for any issues the the family needs to discuss
Reference to professional help if necessary

There are specific tasks I will not perform as they violate the Code of Ethics set by DONA, International which include: blood pressure checks, cervical checks, or fetal heart tone checks. This Code of Ethics was set by DONA to focus the doula on the physical and emotional needs of the mother and partner as opposed to the clinical needs which are assessed by nurses, midwives, and doctors.

A birth doula is not meant to replace the mother's partner, nurse, midwife, or doctor. A birth doula enhances each of these roles by attending to the mother's comfort and relaxation. Having a doula during labor and birth has been shown:

to result in shorter labors with fewer complications
to reduce negative feelings about one’s childbirth experience
to reduce the need for labor-inducing drugs (pitocin), instrumental deliveries (forceps and vacuum), and surgical births (cesarean)
to reduce the mother’s request for pain medication and/or epidurals
to reduce the likelihood of postpartum depression
to increase the likelihood of successful breastfeeding
to increase self-confidence

If you have any questions about birth doula services, feel free to email me.

Postpartum Services

2008-08-30T22:30:00.005-05:00

As a postpartum doula my focus is to "work myself out of a job". This is done by helping the family in the transition stage that begins with the birth of the new baby (or babies). Services that aid this transition are:

Baby care tips for bathing, diapering, sleeping
Help with breastfeeding
Access to the Lending Library
Help watching the baby while the mother attends to her needs (showers, naps, etc)
Help watching older siblings while the mother attends to her or baby's needs
Help tending the home and cooking to allow the mother to rest and recover
Help showing the family how to support the mother while she recovers
Sounding-board for any issues the the family needs to discuss
Reference to professional help if necessary

The duration of my help is determined by the needs of the mother and her family and can be on the order of a few hours to a few weeks. Pricing depends on the level of support needed. If you have any questions about postpartum services, feel free to email me.

Bestfeeding

2008-08-24T22:07:00.002-05:00

I'm sure you've heard "Breast is Best", but I've learned some interesting facts that I wanted to share. The World Health Organization is recognized as an authority on promoting health care practices for all people. In 1991 WHO launch the baby-friendly hospital initiative. It's primary focus was to protect and promote breastfeeding. There are ten steps a hospital must follow to be declared "baby-friendly":

"1 - Maintain a written breastfeeding policy that is routinely communicated to all health care staff.
2 - Train all health care staff in skills necessary to implement this policy.
3 - Inform all pregnant women about the benefits and management of breastfeeding.
4 - Help mothers initiate breastfeeding within one hour of birth.
5 - Show mothers how to breastfeed and how to maintain lactation, even if they are separated from their infants.
6 - Give infants no food or drink other than breastmilk, unless medically indicated.
7 - Practice “rooming in”-- allow mothers and infants to remain together 24 hours a day.
8 - Encourage unrestricted breastfeeding.
9 - Give no pacifiers or artificial nipples to breastfeeding infants.
10 - Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic"

The baby-friendly hospital initiative is now 17 years old. How many baby-friendly hospitals and birth centers do we have? 65 as of July 2008. To clarify, that's in the entire US not just Florida. Florida has 2: Cape Canaveral Hospital in Cocoa Beach and Morton Plant Hospital in Clearwater. Now admittedly birth centers are at a disadvantage for this certification as funds are limited for most of them, but I don't think funds should be an issue for most hospitals.

Another disturbing fact is that in 1981 the WHO established the International Code of Marketing of Breast-milk Substitutes. This codes states (in summary):

"- No advertising of breast-milk substitutes and other products to the public
- No donations of breast-milk substitutes and supplies to maternity hospitals
- No free samples to mothers
- No promotion in the health services
- No company personnel to advise mothers
- No gifts or personal samples to health workers
- No use of space, equipment or education materials sponsored or produced by companies when teaching mothers about infant feeding
- No pictures of infants, or other pictures idealizing artificial feeding on the labels of the products
- Information to health workers should be scientific and factual
- Information on artificial feeding, including that on labels, should explain the benefits of breastfeeding and the costs and dangers associated with artificial feeding
- Unsuitable products, such as sweetened condensed milk, should not be promoted for babies"

Based on my recent maternity stays, the US is failing that one too - miserably. If I hadn't educated myself using sites like Kellymom, I'm not sure my kids would have been breastfed more than a few weeks.

I want to believe that the formula companies are just trying to get their name out and are not intentionally sabotaging new mothers. However, not too long ago a group of women from Jacksonville, FL filled out some consumer surveys from formula companies as an experiment. They wanted to see what marketing they would receive based on their answers. Those that said they were exclusively formula-feeding got next to nothing. Those that said they were formula and breastfeeding got coupons. Those that said they were exclusively breastfeeding got coupons and several free canisters of powdered formula.

The Birth Survey

2008-08-18T21:37:00.005-05:00

As I collect local resources for my list for certification, I've begun thinking about how I would provide the OB/GYN practice information. I could use the two practices I've experienced, or just copy the yellow page listings. However, I that wouldn't help me as a doula or anyone else for that matter. My inner statistician has been yearning to do a survey of the local providers.

The Coalition for Maternity Services has been working hard to advocate for mother-friendly maternity services. Their latest effort is The Birth Survey. The goal is for any woman who's birthed in the last 3 years to fill out the survey and let others know what kind of service they can expect in their community. We review many trivial things in our life from hotels to movies to restaurants. It's time we started informing ourselves and each other of the state of our local maternity services.

I'm still going to attempt a local survey. I'm not sure of the response I will get. I would like to send a survey to all practicing OB's and midwives in the Panama City area and also ask the two local hospitals for a day survey.

For the OB's and midwives I would like to ask them to think of their 10 most recent births in answering the following questions:

How many had C-sections?
How many of those C-sections were scheduled?
How many were induced labor? (Pitocin or vaginal inserts)
How many had augmented labor? (Pitocin or Breaking water)
How many had epidurals?
How many had instrumental deliveries? (forceps or vacuum)
How many had episiotomy?
How many high risk pregnancy/births were there? (placenta previa, multiples, premies, etc.)

For the hospitals I would like to ask the nurses to keep a day tally on a Tuesday and a Sunday of the same questions. Why Tuesday and Sunday? With a large amount of labors beginning by induction, Tuesday has become a popular day to be born. On average there are over 11,000 babies born in the US everyday from Monday through Friday. But on the weekend that drops to around 8,000. Being that there would likely be differing amounts of folks in maternity care on those days, I'm guessing that there might be differing outcomes.

Neither of these questionaires would provide a statistically significant measure of the current state of maternity care in Panama City, but it would be a glimpse.

Lending Library

2008-08-13T22:29:00.004-05:00

As a doula I'm required to read several books for certification. As a pregnant person and parent I've acquired several additional books as well. Here is the list of books and videos I have available for loan to prospective and new parents:

Fertility:
Taking Charge of Your Fertility Toni Weschler

Pregnancy:
Pregnancy, Childbirth, and the Newborn Penny Simpkin, Janet Whalley, Ann Keppler
Prayers for Expectant Mothers Angela Thomas Guffey
What to Expect When Your Expecting Arlene Eisenberg, Heidi Murkoff, Sandee Hathaway
Essential Exercises for the Childbearing Year Elizabeth Noble
Girlfriends Guide to Pregnancy Vicki Iovine

Birth:
Guide to Childbirth Ina May Gaskin
The Birth Partner Penny Simpkin
The Birth Book Dr William Sears, Martha Sears
Gentle Birth Choices Barbara Harper
The Labor Progress Handbook Penny Simkin, Ruth Ancheta
The Thinking Woman's Guide to a Better Birth Henci Goer
Natural Childbirth the Bradley Way Susan McCutcheon
Pushed Jennifer Block
The Doula Book Marshall Klaus, John Kennell, Phyllis Klaus

Breastfeeding:
The Ultimate Breastfeeding Book of Answers Jack Newman, Teresa Pitman
The Breastfeeding Answer Book La Leche League Nancy Mohrbacher, Julie Stock
Adventures in Tandem Nursing La Leche League Hilary Flower

Postpartum:
Misconceptions Naomi Wolf
This Isn't What I Expected Overcoming Postpartum Depression Karen Kleiman, Valerie Raskin
Nurturing the Family The Guide for Postpartum Doulas Jacqueline Kelleher
Mothering the New Mother Sally Placksin

Parenting:
The Baby Book Dr William Sears, Martha Sears
The Discipline Book Dr William Sears, Marth Sears
The No-Cry Sleep Solution Elizabeth Pantley
What to Expect the First Year Heidi Murkoff, Arlene Eisenberg, Sandee Hathaway
What to Expect the Toddler Years Arlene Eisenberg, Heidi Murkoff, Sandee Hathaway
Caring for Your Baby and Young Child Birth to Age 5 AAP
Potty Train Your Child in Just One Day Teri Crane
The Vital Touch Sharon Heller
Multiple Blessings Betty Rothbart

Videos:
Orgasmic Birth
The Business of Being Born (available via Netflix or Blockbuster as well)

The Postpartum Period...or Epoch?

2008-08-10T21:48:00.005-05:00

I've begun reading Mothering the New Mother by Sally Placksin. What struck me most in the first chapter is that there doesn't seem to be an agreement on how long the postpartum period lasts. Some in the medical field feel that it is as little as a few days to two weeks. However, most doctors agree with six weeks since that's when your girly parts should be back to normal pre-pregnancy size (Note: Just because your insides are back where they started doesn't mean your outsides will be too). This only means internally you are recovered but not so much emotionally or hormonally for that matter.

My daughter is 15 months this week. I was just thinking a few days ago how it seems that the disequilibrium is subsiding, and we are on a more even keel lately. She is more self-sufficient, and we are more practiced in refereeing two kids. Her newborn weeks are such a blur in my memory and what I do remember is more my thoughts than any particular event. Memories of my son's early weeks are much the same. I remember laying in bed one night thinking, "What have I done?" Sure I loved my son fiercely, but I was so very tired from lack of sleep and unnerved by the uncertainty of what would be asked of me next. I remember that I felt a little more confident around 6 weeks and that the confidence grew with time.

I'm not sure when I stopped feeling "postpartum" and started feeling more like a mom, but it definitely took more than six weeks. Ms. Placksin interviewed several new moms in her book to get their take on how long the postpartum period was. Some answered 6 weeks. Some answered 3 months. One answered "12 months depending on how long you deny your feelings". A lot of "feelings" can be affected by support. According to Ms. Placksin,

"Basically, your needs as a new mother would seem simple to define: rest so you can heal; gentle education and reassurance as you gain confidence in your mothering skills; nourishing food and drink for yourself; a relinquishing of practical chores to someone else so you can withdraw into yourself and your baby; knowledge about what is going on with your body and spirit; some realistic images and guideposts about the range of feelings other women have experienced postpartum; a place to "debrief" and talk about the birth itself and your emotions; and most especially, some mothering for yourself, so you can feel protected and honored and continually replenished at a time when many women say they feel as if they are forgotten, peripheral, or 'running on empty'."

These are the needs must be addressed by partners, family, friends, or postpartum doulas to help moms recover and learn to mother to their best ability.

Organic Family Planning

2008-08-06T21:33:00.004-05:00

While reading a post and comments on this site I was reminded of the very first book I bought for information purposes. Sure I'd bought books before, but never to actually learn about something. It was either required reading or ..... well I guess I never had another reason.

In Oct 2003 I was seriously contemplating what to do about "the Pill". I'd been on the pill since I was 16. But now I was beginning to realize that everything we put in our body to change it can have a side-effect and I was worried about a big one - cancer. My mother had recently been diagnosed with breast cancer. Her mother, my MawMaw, had recently passed away due to breast cancer that metastasized before it was removed. Her mother, my great-grandmother, had also died from complications of breast cancer. Both my mother's and my MawMaw's cancer had been the kind that was highly reactive to estrogen. I researched the web for studies on whether hormones in the pill could influence my already high risks. For every study that said they were ok, I'd find an older study of older pills that said they weren't.

Being a statistician by education I didn't just take the studies' word for it. I reviewed their numbers along with their conclusions. My conclusion, our current "Pills" haven't been in use long enough for my comfort to say anything conclusively about their long term side effects. I stopped taking the pill that month and haven't looked back.

I bought Taking Charge of Your Fertility by Toni Weschler in Feb 2004. My cycles were never "normal" before the pill and were not getting there anytime soon. This book finally taught me what was really going on during the "monthly" cycle. Maybe sex ed has changed in the 15 years since I took it (GASP!), but all they told us about was the 28 day cycle. If you asked about "longer" cycles, well then that meant you were pregnant! Talk about freaking a kid out!

I learned more though than how to use my cycle signs for pregnancy. I also learned how to use them to avoid which is called Natural Family Planning (and no it's not the same as the rhythm method). I also learned that breastfeeding (with no supplementation and/or sleep training) was a natural child spacer for a good majority of the population.

Is this method 100% effective? No, but I'll give you a hint - None of the other hormonal methods are either under typical use. Plus it has no side effects! And the Catholic Church likes it too! (Disclaimer: I'm Christian, not Catholic, but I know some cool people who are)

On the site I referenced above one of the commenters talks about how many people today are very conscious of getting organic food to avoid chemicals and artificial hormones but think nothing of using artificial hormones directly on themselves for birth control. Another agreed and said that Natural Family Planning should be relabeled as Organic Family Planning for mass appeal.

If you're interested in finding out the real story of our insides, check out Weschler's Taking Charge of Your Fertility. You won't be disappointed.

Two weeks ago

2008-08-03T21:29:00.004-05:00

Two weeks ago today I completed my doula training class. I wish I could go back.

In early June I asked my midwife what doula certifying agency she would recommend. She said DONA, International was the only one she would go with. I started searching for classes in Florida, Georgia, and Alabama. There were no classes in Alabama, few in Georgia, and tons in Florida.... South Florida. I talked it over with my husband, and we decided that we'd make a mini-vacation of it. A nine hour car trip is not exactly a good idea with a 3 and 1 year old, and especially not with a screaming 1 year old. Still in late June I sent in the deposit for my classes in Boca Raton with Rae Davies (If you're looking for a doula instructor, Rae should be it!) I was concerned with how close to the training it was and that I might be late to the game. It turns out that some did not sign up for the class until days before it began, and I'm so glad they did.

We had a full room of folks with such diverse backgrounds, but all with the goal of making a difference and supporting women through one of the most blessed events in our life. The first hour of class we shared our stories of how we decided to become a doula. I was so touched with how many referenced praying or feeling lead by God. It was the most spiritual experience I've had in many years, and several noted the presence that was felt in the room.

The icing on the cake of the training classes was the location, Amazing Births in Boca Raton. My greatest hope is that Amazing Births could open a sister shop here in the Panama City area. They offer many techniques, products, and services to promote a natural, healthy pregnancy, birth, and postpartum. Boca Raton is truly blessed.

There has already been one new mom and baby attended to by one of my classmates. Here's to many, many more!

Genital Disparity

2008-07-28T21:26:00.002-05:00

I know you're probably thinking "spellcheck sinks another blogger", but no I mean "Genital" and not "Gender". Bare with me as this may be a colorful post, but I have a point I promise...

Today at work I was in a meeting discussing an activity to be performed by some co-workers. The co-workers were complaining that the activity was too fatiguing and should be shorter. I reminded them that I had done the same activity for the same amount of time while 20 weeks pregnant so they should be fine for a time or two. To this one replied, "I know, you think we're all a bunch of (insert derogatory reference to female genitals)." I returned him a shocked look. Not so much because of his vulgarity, but because it hit me just how ingrained in our society is the idea that the female organs are weak, inadequate, etc. I started thinking about how many references can be used against a person in relation to either sex. I realized that I cannot think of one male term that denotes a "weak" person nor a female term that denotes a "strong" person. I've ofter heard people say someone (male or female) needed to "grow a pair" but never a female analogue.

It's interesting to me how we've indoctrinated this philosophy of female organ weakness. In Ina May Gaskin's Guide to Childbirth she remarks how readily we accept that the male genitals can enlarge and shrink with no issues while we treat vaginas like cheap girdles that won't survive the stretching of childbirth for which they were designed. (I would directly quote Ms. Gaskin, but I've loaned my copy out to an expectant mom.) I would highly recommend her book if you are a pregnant mother even if you don't consider natural childbirth an option for you. I plan to do a more thorough review of this book in the future, but I will leave you all with this for now. I read this book 3 or more times while pregnant with my daughter, and it was this book that first demonstrated to me just how wonderfully our bodies are made to birth and gave me the confidence to become my own birth advocate.

What is a doula?

2008-07-26T08:48:00.006-05:00

So maybe I should have started with this post instead...

Doula is Greek for "woman of service". A birth doula acts as a continuous labor support to the laboring woman (and her partner if needed) assisting with coping skills, labor positions, and labor techniques. A postpartum doula supports the new mother with new baby care, breastfeeding, and light housekeeping.

A doula does not replace or replicate what partners do for the laboring woman, but they can enhance it by allowing the partner to focus solely on the woman's emotional needs while the doula focuses on the physical needs of laboring or recovery. A doula is not a medical provider and does not replace or replicate what midwives, nurses, or doctors do for the laboring woman either, but they can enhance it by supporting the mother in making informed decisions about her and the baby's medical care.

Who should have a doula?

DONA's goal is "A doula for everyone who wants one." I believe that a birth doula is most useful in first-time births, natural births and VBAC's (vaginal birth after cesarean), but every birth can benefit. I believe that every mom should have a postpartum doula. We all need help in those first weeks with a new baby whether it be from family, friends, or a doula.

Becoming a Doula

2008-07-25T22:54:00.000-05:00

Why am I becoming a doula?

I keep asking myself that question when I try to figure out the logistics of how I would leave work or my family at moment's notice to go support a laboring woman and her family. It doesn't make logical sense.

When I was pregnant with my son I had a slight fear of birth. The story of my own birth was a bit scary, and truthfully few "good" birth stories are told to pregnant ladies. I saw the value of avoiding interventions, but I also didn't trust myself or my body to know what to do. My son's birth deserves a post on it's own, but the short and sweet is that their were plenty of interventions to get our healthy baby boy here.

Two years later and pregnant with my daughter I had re-processed much of my ideas. In raising my son I frequently tried to think how the mommy-baby relationship would work in a more primal setting where the world of "mommy wars" didn't exist. In doing this I realized that for humans to have survived so long without medical interventions, our bodies must actually know how to birth a majority of the time.

The biggest turning point came when I read a clarification on the Genesis story of "Eve's curse". Many translate her punishment (and that of all women) as being sentenced to suffer in birth. However, a truer translation is that Eve would have to work in labor and birth. That made sense to me. So I sought God's will in all of this and started reading several books on natural childbirth. Overall, my goal was to trust my body this time as part of God's good creation.

In the past few years I've met many expectant ladies in real life and on the internet. The majority does not seem to really believe their bodies are capable of intervention-free birth. This is why I want to be a doula. To support women in learning to trust that birth is normally not a medical event unless we make it so.

Do I believe that all intervention is unnecessary? Absolutely not!

Do I believe that we are intervening far too much in the US? Yep

Do I believe that everyone is giving true informed consent to interventions used in their birth? After reading about side-effects to the procedures used in my son's birth and comparing them to my experience, No

I'm starting this blog to chronicle my journey. My name is Robyn, and I'm seeking to become a DONA certified Birth and Postpartum Doula.