Archive for January, 2008

Introducing the Mid-Columbia Birth Network

In a former post, I mentioned that I’ve been working on starting a non-profit. Actually, I can’t take full credit - me and a few other local birthy-types have been working on this something. It’s part of why blogging has been unusually slow for me.

Back when I first started birth work - you know, WAYYYY back in June - I took a very hospital-friendly stance. I would not stand up to doctors, get in their way, respect their medical opinions. This is still true in many ways, as during a birth is, I still strongly feel, absolutely the last place I should be an activist. If I stand between her and her doctor, I’m just one more person speaking FOR her, telling her what’s best for HER, and she’s just another patient without an opinion or authority to speak for herself for her care. Although I know what a woman’s general birth preferences are when I’m at a birth, I also realize that a lot can change in the middle of it all. And I still think that my kindness and compassion to a woman is my biggest tool to help foster a positive birth memory. If I’m creating tension with doctors and nurses, I’m not doing my job.  My best tools in the room are to help the mother formulate questions they can ask the medical staff to get some answers about how urgent a situation is, what happens if they do nothing, what risks are involved, and what alternatives they have.  I can also suggest they ask about specific alternatives.  I will never talk for a mother.

However.

I’m also learning that there is a big difference in being a pain in the ass in the delivery room and being a pain in the ass outside of it. The more I learn about birth in our country, the more I realize that many things need to change. The United States, for all our wealth and technology, has pretty poor maternity statistics when compared to the rest of the developed world. Case in point - let’s check out the statistics from the World Health Organization in 2007:

Neonatal Mortality Rate (rate of death in the first 28 days of life, per 1000 live births):
The United States ranks behind Iceland, Singapore, Japan, the Czech Republic, Finland, Monaco, Norway, San Marino, Slovenia, Sweden, Belgium, Cyprus, France, Spain, Andorra, Austria, Denmark, Germany, Greece, Israel, Italy, Luxembourg, the Netherlands, Portugal, Switzerland, Austria, Canada, Malta, New Zealand, the United Kingdom, and Belarus. We are number 31. Sure, the point spread isn’t horrible, but just tell that to the families whose child would have lived if it had been born in Iceland or Singapore.

Maternal Mortality Rate (rate of death of a woman while pregnant or within 42 days of termination of pregnancy, from any cause related to or aggrevated by the pregnancy, per 100,000 live births):
1) Ireland - 4
2) Finland - 5
3) Spain - 5
4) Austria - 5
5) Italy - 5
6) Canada - 5
7) Australia - 6
8) Denmark - 7
9) Switzerland - 7
10) New Zealand - 7
11) Qatar - 7
12) Sweden - 8
13) Portugal - 8
14) Czech Republic - 9
15) Germany - 9
16) The former state union of Serbia and Montenegro - 0
17) Japan - 10
18) Norway - 10
19) Belgium - 10
20)Greece - 10
21) Slovakia - 10
22) Croatia - 10
23) Poland - 10
24)United Kingdom - 11
25) Hungary - 11
26) Kuwait - 12
27) Israel - 13
28) The former Yugoslaw Republic of Macedonia - 13
29) United States of America - 14

The Netherlands and France are the only European countries who rank below us in this regard - Iceland doesn’t report maternal deaths, but looking at the rest of their numbers I would highly doubt they rank worse than us. Maybe Iceland doesn’t report this number because it is so low it isn’t even on their radar screen?

Yes, our numbers are still fairly high when compared to countries with poor nutrition and maternal care (Sierra Leone reports 2000 maternal deaths out of 100,000). But there is room for improvement.

We spend the most per person on maternal health care, but our outcomes are not representative of this. What are these other countries doing that we are not?

First off, American populations generally eat less whole foods and living more sedentary lifestyles, highly reliant on their cars to get even a few blocks. This could increase morbidity (general health), raising risk factors for things like preeclampsia, for example.

But sometimes, all that technology at our fingertips is actually getting in our way. We look at a machine to measure contractions instead of looking at the woman. We induce labor, just to be safe, but actually increase our odds of things going wrong, such as a prematurely born infant that we induced too soon or a stressed infant because of the strong, unnatrual contractions caused by Pitocin, Cytotec and other drugs used for induction. We use Cesarean birth far too often, sometimes because we can say that “we did everything we could” and avoid a lawsuit, but outcomes might have been better for that mom and child if her body was trusted that it knew what it was doing. We think of a Cesarean as no big deal any more as they are so common, but it is still MAJOR SURGERY. It leaves a woman with a poor start at motherhood: long recovery times impact her ability to parent, her ability to breastfeed and her chances of postpartum depression.

I’m not saying that all medicine in obstetrics is a bad thing. Far from it. Inductions, cesareans and the like have saved countless lives when things go wrong. I don’t think that OBs deserve all the hate that some midwives and doulas carelessly throw in their direction. They entered the field, most always, with a respect for women and a joy for childbirth.

It is interesting that many of the countries ranked above us heavily utilize a midwifery model of care for normal, uncomplicated pregnancies and births. Many countries give home birth as an option. And their success rates are higher than our own. How do they do it? Less interventions, not more. Every time we use a piece of medical equipment or perform a medical task, we are putting a woman at a risk (albeit small). And the more machines and cords a woman is hooked up to, the more she must remain in bed. Unable to move to cope with the pain. Unable to change positions much to facilitate a vertex (head down), occuput anterior (baby’s face towards the tailbone) position. Unable to use gravity to her advantage during the second (pushing) stage of labor. And cesareans have proven to be more risky than vaginal births, even if it is a repeat cesearean.

It’s hard to work with pregnant women when they don’t know all this information. I want to be a part of the solution, not a part of the problem. I want to help. So please welcome my latest entry in the world of activism. Welcome the Mid-Columbia Birth Network.

www.midcolumbiabirthnetwork.org

And if you live in my area, stop by the TRAC in Pasco at the Kidz and Baby Expo this weekend to say “hello”. If you are pregnant, you’ll get a free rice sock and a foot massage, and a whole lot of local support.

Meet the newest certified doula in town

I just got a phone call from the DONA certification committee…and although I totally tripped all over myself with a few of my answers and was as nervous as you can ever imagine, I’m now a DONA certified doula!  Just in time for the local Kidz and Baby Expo that I’ll be exhibiting at this weekend.

I’d been wanting to do this for so long.  I’m patting myself on the back for having the courage and bravery to follow a dream.

Kristina French, CD(DONA)  :)

Meme time! 7 lists of 8 things

8 things I am passionate about
My kids
My husband
Birth/Breastfeeding
Equality/Human rights issues
Kindness
Learning
The power of travel to solve the world’s misunderstandings
Environmentalism

8 Things I want to do before I die
Be kind to others
Share myself wholly with those I love
See my kids blossom into whatever their hearts tell them is their path
Live for a while in another country (Yes, yes, I shamelessly stole Dan’s answer, but it would have made the list anyway)
Achieve inner peace, if only for a moment
Learn to speak a foreign language (maybe British?)
Learn to play guitar
Write a book
8 Things I say often
I can’t understand it when you use your whiny voice.  Can you say that again in your normal voice?
Stop hitting your brother/sister!
Everybody calm down…
Let’s take some nice, deep breaths… (Actually I say this both as a parent and as a doula)
You’ve already used up all your screen time today. (to Connor)
No, It’s never not okay to play with the chapstick on the carpet. (to Siena)
Let’s all just start over today, okay?
So…what time do you think you’ll be home today?  (To my husband)

8 books I have read recently
Hypnobirthing (Marie Mongan)
When Survivors Give Birth (Penny Simkin and Phillis Klaus)
Birthing From Within (Pam England)
Eat, Pray, Love (Elizabeth Gilbert)
The Doula Book (Klaus, Kennell and Klaus)
The Birth Partner (Penny Simkin)
Ina May’s Guide to Childbirth (Ina May Gaskin)
Pregnancy, Childbirth and the Newborn (Penny Simkin)
(I do read about other things than birth - really I do!  I love fiction…just haven’t had a lot of moments to lose myself in a story lately.  But it’s in the works, once I finish my stack of birth books on the nightstand.)

8 songs I could listen to over and over again
Closer to Fine - Indigo Girls
Aluminum - Barenaked Ladies
Landslide - Fleetwood Mac
American Idiot - Green Day
Silent All These Years - Tori Amos
Revolution - The Beatles
The Distance - Cake
Carolina Blues - Blues Traveler
What’s the Matter Here - 10000 Maniacs
8 Things that attract me to my best friends
Sense of fun
Quick Wit
Intelligence
Sense of humor
Open-mindedness
Introspectiveness
Common interests
Divergent interests

8 people who should totally do this meme
Circuitbeta
Erin
Jennifer


Singlemomleftofthemiddle

Smile
the other Kristina
the other AmericanMum

Reclaiming Our Birth Rituals: Part II

This is part II of this post.

We’ve gone over how our ancestors ritualized pregnancy and birth, saw their laboring mothers as strong, and gave them tools to find their own way through the maze of birth.

So what are our current birth rituals?

Weight obsession. Ask any pregnant mother how much weight she’s gained so far and she’ll be able to tell you to the pound. Not only that, she’ll be able to tell you what she thinks of the figure and probably what she’s doing to keep her weight down and plans to diet/exercise once that baby pops out. Forget the health of the baby - it’s all about “getting my old body back”. In my parents’ time, moms were told to try to keep weight gain to about 15 to 18 pounds - now thought to be a dangerously low amount. Now the optimal weight gain is thought to be about 25-35 lbs. for an average-sized woman. But in reality, weight gain varies much more than this. The first thing a pregnant mom does at her doctor’s appointment is to step on the scale, yet it tells a doctor very little about the health of the mother and baby. What message is this sending Mom?

The Baby Shower. Here in the western world, the celebration of a new baby starts with gifts. Baby clothes, baby gadgets, all this stuff that we can’t live without. The miniature baby things in soft pastel colors ultimately erupts in a celebration: the baby shower. (Side memory: When I was pregnant with Connor, I had two baby showers. I remember thinking before the first one - “I’m not ready to be a mother! I cannot have this baby! I don’t yet have a Diaper Champ!”) The baby shower, as the prominent celebratory birth symbol in our culture, has its merits and its drawbacks. It is wonderful that friends and family all gather together to welcome a child that has usually not come earthside quite yet. Babies can actually sense so much more than we give them credit for in utero, and I suspect that the baby can feel just how much love is in the room when the shower is taking place. But, first of all, why is this celebration all about the “stuff”? Is a baby just an excuse to redecorate a room in your house or to buy new clothes? Do we really need 50 newborn outfits that the baby will grow out of in a week - for every baby in the USA? How much space in our landfills is full of these outfits, and the high chairs, swings, bouncy chairs, etc. that could have been used again? I think it is interesting that most people dread the little games played at these events and want to get right to the gifts. Secondly - and this is my major gripe - it’s all about the baby. Rarely do we see a gift purely for mom, something to help her on her birth journey, or help her relax during precious moments of motherhood. Mom (not to mention Dad - poor guy is usually not even invited) gets lost in the shuffle.

The Wheelchair. On any sit-com on TV that portrays a birth, you always see Mom being wheeled in, huffing and puffing, in a wheelchair. Who is ill? Pregnant women are actually encouraged to walk during labor - gravity and the gentle rocking of the pelvic opening helps ease baby down to the proper position for birth. Not many hospitals still use wheelchairs for admittance, but I know several that still use them for discharge.

The Fear. Sit in a room full of childbearing-age women, and it won’t take long before they start telling birth stories. This would be great if the stories were productive - we need to learn from those around us - but the current ritual is for moms to try and one-up each others’ scariest, most painful, most dangerous birth yet. “My baby’s cord was wrapped around her neck - she almost died!” (Hardly dangerous.) “Thank God for that epidural - why would anyone want to give birth without one is beyond me!” (Teaches that the pain will be unbearable for anyone.) “I just didn’t dilate well - my body just isn’t made to give birth.” (Self-doubt is common in these stories). Still many men (and women) hold a belief that birth is dangerous, that many things can go wrong, and that death is a very real, strong possibility, when in fact it is now extremely rare for a woman to die in childbirth. A woman is set up to have a negative birth experience before her first contraction.

The Hospital Gown. Almost all women don a hospital gown when they are admitted to Labor and Delivery. It is extremely convenient for doctors and nurses - it gives them quick access. But what other messages does it send? There is a subtle, probably subconscious message that the mother now belongs to the hospital. Doctors wear white coats or solid colored scrubs, nurses wear blousey scrubs with prints on them, and patients wear gowns which expose their backsides. We easily know the rank of everyone in the room, and who is subservient to whom. Another possible subtle meaning of the hospital gown is that you are sick and must be made well by the hospital staff. Finally you have given up your identity and appear as any other laboring women that has ever stepped through the hospital doors.

The IV Pole. Most mothers are hooked up to an IV the moment they enter the hospital. For a normal, healthy mother, fluids could easily be taken by mouth instead, by reminding her to drink some water or juice as she labors. The pole is another symbol that suggests Mom is sick and must be treated by those around her. Most of the time we don’t see IVs in arms of anyone but the unwell. It further could be inferred subconsciously that mom is “broken”, and without the hospital staff to treat her, she is incapable of birthing on her own.

The Monitor.  Mom is almost always hooked to a machine that measures baby’s heartbeat and her contractions.  This is in spite of the fact that monitors have not improved birth outcomes.  Doctors, nurses, Dads, and even Moms stare at the parabolas being produced on the monitor strip.  “That was a big one!” Mom is out of the spotlight, and all the attention is now on the machines.  Many women feel neglected.

The Funny breathing. Most brands of childbirth classes teach some sort of breathing as coping mechanisms for birth. I’ve seen and read about all kinds. We see women panting, blowing, and almost hyperventilating when we watch birth on television. Seeing these women huffing and puffing away sends a message to women, pregnant or not: silly breathing patterns are the only tool we have to get through the pain of childbirth besides an epidural (which is far from the case).

The Exams. Cervical checks are done periodically to check for labor progression. Mom knows that if she is not progressing the way the staff would like, she’ll need to get Pitocin, a synthetic version of oxytocin, a birth hormone, that makes birth much more painful than if it were to happen on its own. Or if labor is stalled for several hours, she might end up with a cesarean - a scary prospect for most. These checks often can put fear into a mother, and could potentially slow labor down if Mom feels stressed or on display.

The Stirrups. On television and in most hospitals, we always see mothers birthing flat on their backs, their feet placed in stirrups or being held by Dad and a nurse. But ask any women that has ever given birth what the sensation of pushing a baby out feels like and almost all will answer that it is very much like the act of pooping. Now - girls (and guys) - imagine needing to pass your bowels - but instead of sitting on the toilet, you decide to climb into bed and put your feet up in metal stirrups or have a couple of people hold your legs in the air. What is gravity doing for your ability to get the job done?

The Yelling. Even better, to continue the bowel movement metaphor, invite your spouse in to hold your hand while you lie on the bed with your legs spread in the air and your parts exposed. Don’t forget to bring in about 5 medical personnel in to yell at you. “Push! Push! You can do it! Get mad at it! Put your chin down…not yet…NOW! One! Two! Three! Keep going! Four! Five Six! Yes - good! Seven, eight, don’t stop! Nine! Ten! Okay…take a quick breath…again!” Continue the poop metaphor and add this to the mix. You wouldn’t be able to do it, would you. Sure, most people give birth this way, but they probably give birth in spite of the coaching, not because of it.

The Baby Warmer. Once baby is born, he’s carried for an exam over to a baby warmer, where he’ll usually be dried roughly, suctioned, get APGARS, a few treatments, and over to mom all bundled up. Interestingly, all these things can take place on Mom’s belly, but the warmer is often preferred by the staff. This may send a final message to Mom - that an artificial machine (the warmer) and other people (the nurses) are better at caring for her child.

The Nursery. Still on television and in movies, we see the little swaddled babes all wrapped up in their isolettes, attended by a nurse who holds the baby up to the window so family members can see the new addition. In US hospitals, this is rarely the case - most hospitals now prefer to have mother and child to room together to facilitate bonding and breastfeeding. Yet this image strangely is still all over the media we see. The glass could be seen as a way to keep the germs of the unclean (family members) away from the child, while the clean (the nurse) cares for the baby. It also symbolizes that hospital staff are more adept at taking care of the child’s needs, although mother has been caring for his needs in utero since the beginning.

Next up in Part III: let’s replace these rituals with more productive, positive ones.

Superwoman

We’re curled up together on the sofa - Connor, Siena, and I, enjoying an early morning dose of PBS kids while we shake the cobwebs out of our brains.  Miss Lori comes on, with a gaggle of caped children.  “We’re superheroes today! What kind of superpowers do you have?” she asks the miniature Superfriends around her.  “I can count backwards!”  “I can fly!” come the replies from the kids on the television show.

I lean over to Siena.  “What’s your superpower?” I ask her.

She excitedly lifts up her shirt.  “I have nipples!” she proudly proclaims.

As a feminist-lactavist-doula-mother, I have never been prouder.

(It’s even funnier to know that she actually pronounces the word “nipples” as “hippos”…)

Sorry I’ve been MIA.  Lots of stuff going on…just mailed off my doula certification, finished putting together birth stories for my clients, and I’m in the middle of starting a nonprofit group and preparing for an expo where a bunch of earthy-birthy types and I will be exhibiting together, amidst a not-so-earthy-birthy crowd.  I’ll catch up with you all later.  I can’t imagine it will be much longer…that “Part I” in the last title is haunting me…


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