“There is an impossible expectation placed on pregnant women in our society: that we are supposed to get on with everything and express only a blossoming sense of joy and anticipation, even as the person we have thought ourselves to be is transfigured and reborn. It was an expectation that made me feel I was particularly difficult and perverse, in a specifically female kind of way that I had never felt before, in my ambivalence toward what was happening to me and within me. The suppression of the darkness that is also a part of pregnancy, I think, actually muted the experience of what was wonderful and affirming about it.”

—	Naomi Wolf in Misconceptions

Photovoice project: Giving marginalized populations a voice through photography!

I see some powerful photovoice projects involving marginalized pregnant women in the United States, as well as around the world. This is a project I have been brewing for about a year now, and I would love to see it come to fruition. A community based participatory approach to giving voice to those who aren't heard in our culture and abroad. Most of the women that I have worked with as a doula have had access to healthcare and the means to pay for or access a doula, but there are many who do not have these basic needs during their pregnancies and births. Beyond that the birthing culture and system in the US is failing even women who do have access to care. If we could give them a voice through photography how powerful could that be?? It could also be powerful to give voice to midwives and women birthing at home- to show, and perhaps compare, the way that birth is seen and done in this culture and the other birth options that are safe, effective, and available!

Check out the Video!

Check out the website!

Repost: NYT article on the risks of Artificial Rupture of the Membranes

This is a repost of a New York Times article from 2007 I recently read thanks to another doula. 


By NICHOLAS BAKALAR



A large review of studies suggests that a common procedure in labor, intentionally breaking the water, has no effect in reducing the labor time or assuring the baby’s health.


The procedure, sometimes called amniotomy, involves rupturing the amniotic membranes to speed contractions. The procedure has been in use for at least 250 years, although its popularity has varied.


The researchers reviewed 14 randomized controlled trials involving almost 5,000 women and found little evidence for any benefits. Amniotomy did not shorten the length of labor, decrease the need for the labor-stimulating drug oxytocin, decrease pain, reduce the number of instrument-aided births or lead to serious maternal injury or death.


The report, published Oct. 17 [2007] in The Cochrane Reviews, did find that the procedure might be associated with an increase in Caesarean sections and a reduced risk of a lower reading on the Apgar scale, which rates the baby’s condition at birth. But neither finding was statistically significant.


“We advise women whose labors are progressing normally to request their waters be left intact,” said the lead author, Dr. Rebecca Smyth, a research associate at the University of Liverpool. “There is no evidence that leaving the waters intact causes any problems, and there is not sufficient evidence to suggest any benefit to either themselves or their baby.”



A comment: This is very interesting to read seeing as I have yet to attend a hospital birth where amniotomy (AROM) wasn't seen as necessary, or at least strongly suggested. I've even spoken with some family members who, even after given birth a few times, didn't know that the bag of waters could break on their own because a doctor has always done it for them!


Not only may there be some risks to AROM being a standard procedure, but there are many instances where keeping the bag intact can help a great deal. If the baby is not in an ideal position, keeping her in the amniotic sac can help to have her gently adjust to a more ideal position and ease back labor. It is also less painful for the mother to have the bags intact because it adds a bit of a buffer between baby and pelvis. Not to mention the decrease in chances of infection when the bag is still present.


As with any procedure in birth, it is wise to educate yourself and to talk to your care provider about the risks, benefits, and alternatives. In the end, it's your decision! If there is no medical necessity for a procedure-standard as it may be-you can always say you'd rather not have it done. In the case of AROM, the alternative is so simple: Just wait! 

Many New Faces

It was great to meet so many new people all in one day!


Between the SF Birth and Baby Fair and the East Bay Meet the Doula event, we're both really tired, but it was worth it.


We love talking about the benefits of having a doula with couples still trying to decide of a doula is right for them and Grandmoms who've never heard of doulas! 


Just wanted to put out there that if you are due early in the new year, it's a great idea to start interviewing doulas before the upcoming holidays arrive and things start to get crazy for all involved :-)


We're gearing up for a busy week before Thanksgiving. Hope everyone has a safe and happy holiday week full of things to be thankful for.

Atlas of Birth

An interactive Atlas of Birth from the White Ribbon Alliance.

There are is great disparity in the level of care women receive worldwide. If you look at the United States in the map of the Risks of Women Dying in Childbirth, you notice that we're a different color than the vast majority of Europe, Canada, and Australia. That's because there is a greater chance of maternal mortality in our country than in our GDP counter-parts. This is what we need to remind healthcare professionals and policy makers of. We may think we're #1, but too many women are dying in this country to continue with this ignorance and pride.

Thanks to @Amnesty International for the report (Deadly Deliveries) that has spawned so much attention for the risks in keeping the status quo in U.S. maternal health amongst the media, representatives in Washington, and individuals in the U.S. and abroad.

I hope we see more innovative tools for educating us all on the need to bolster women's rights at home and abroad.

Sunday's Bay Area Doula Events

There will be two exciting birth and doula events in the Bay Area tomorrow!

First up is the San Francisco Birth and Baby Fair at the Fort Mason Center in San Francisco. Doors open at 10:00 am and there will be many opportunities to win prizes, attend free workshops on birth and early parenting, and shop amongst hundreds of local businesses all in one place! I'll be at the SF Doula Group table as well as the speed date-style Meet the Doula event at 2:00. Hope to see you there!

If you're in the East Bay and still looking for a doula or are interested in learning more about doulas, please come to the Birth Ways Meet the Doula night tomorrow at 6:30. Pre-registration is required, but this is a free event for expectant mamas and their partners. The first part of the event is a doula panel with representatives from the birth and postpartum doula community will give brief overviews of the roles and benefits of doulas, followed by a Q&A session.The second half of the event will be an informal gathering where parents can interact one-on-one with local doulas. Please visit the Birth Ways site to register for Sunday's event, or any upcoming Meet the Doula nights.

New Year's Babies

We have availabilities in January and February for new clients! Please call or email to set up an initial interview before the holidays!

Email: empoweredbirthdoulas@gmail.com
Tel: 415.424.4680

Vote for SFGH Doulas!

San+Francisco+General+Hospital+Volunteer+Doula+Program

Click the link above to cast your vote for the SFGH Volunteer Doula Program to receive a $10,000 Changemakers grant! Just think of how many more doulas could volunteer with that grant money...and how many more women will have better birth experiences!

Upcoming Events

Hello Bay Area parents and birth advocates!

Here's an update on the upcoming doula events in the area...

What is a doula? First meeting

Thursday, November 18th

6:30pm-8:30pm

731 Henry St., Oakland

We'll be discussing the formation of this non-profit, the goals of the organization, first steps, fundraising ideas, and the results of the survey. If you are interested in learning more about the organization and would like to participate, please RSVP to empoweredbirthdoulas@gmail.com. If you are unable to make it to the event, but would like to contribute still, you can take the survey via Survey Monkey!

San Francisco Birth and Baby Fair

Sunday, November 21st

10:00am-5:00pm

Fort Mason Center, San Francisco

Emily will be at the SF Doula table from 10:00 to noon as well as for the Meet the Doula workshop at 2:00pm. There will be tons of local birth and baby companies with tables at the event, and loads of interesting free workshops. Go onto www.birthandbabyfair.com to register!

Birthways Meet the Doula Night

Sunday, November 21st

6:30pm-8:00pm

1600 Shattuck Ave. Suite 122, Berkeley

Register here! These events are meant to be small and intimate so only 6 couples can register in any given month. Make sure to register early for this or next's month to ensure your spot. This is a free event.

Hope to see you there!

How childbirth preparation classes for men can improve birth outcomes

Ever heard of tocophobia? It’s a term used to describe the fear of childbirth. Researchers in Sweden have found that when expectant fathers experience tocophobia, it may have negative effects on the birth experiences of their partners.

The study found that many of these men were fearful not only of the process of childbirth, but in their roles as parents as well. There have been some signs to indicate that tocophobia contributed to an increase in cesarean sections, pointing to the need for birth professionals to address these fears with expecting parents.

The since the study, the Swedish Medical University has begun providing childbirth preparation classes featuring the use of psychoprophylaxis (relaxation techniques) for all expectant parents with good results.

Childbirth educators encourage both mother and partner to participate in class discussions to try and address these common fears about labor and early parenting. Educational models such as the Bradley Method, Hypnobirthing, and Birthing from Within place a great deal of emphasis on the partner as a strong yet calm source of strength for the woman in labor by teaching the partner relaxation techniques like massage and affirmations.

Couples are encouraged to take these lengthier courses, independent of the hospital preparation courses to get a more complete training in birth support.

Additionally, hiring a doula can help parents receive one-on-one training in these techniques and a sense of security in asking questions concerning any anxieties in an intimate and supportive setting. Doulas also help the partner to feel comfortable that everything is going well in labor, knowing that the mother will never be left alone and that there is a constant source of guidance and expertise by their side.

For a list of childbirth educators in your area, visit the International Childbirth Educators Association website.

“The power and intensity of your contractions cannot be stronger than you, because it is you. The contractions come from and are YOU. So they can not overwhelm, or be bigger than you, as they are only as strong as you are!”

—	http://birthbuddy.wordpress.com/2008/04/11/what-is-labour-like-useful-analogies/

Walking and Moving in Labor

Love this!

What is a doula? Survey

Not in the Bay Area and able to attend the first meetings? You can be apart of the organization anyway!

Please take this quick survey to help us make What is a doula? an amazing, informative, and inspirational group!

Click here to take survey

What is a doula? The non-profit

I'm excited to be starting the non-profit, What is a doula?--something I've been dreaming of for a long while now.

The organization will serve as a tool to educate the wider public on the role and benefits of a doula, as well as promoting education on options in childbirth.

What is a doula? is still in it's infancy, but you can already follow some of the "makings of..." sorts of things and start to get some great info on resources and options through the What is a doula? tumblr and twitter accounts (#Whatisadoula)!

If you're interested in becoming part of the movement, email me at empoweredbirthdoulas@gmail.com

What is a doula, anyway?

A doula is a non-clinical birth attendant who is there to help guide you through pregnancy, birth, and the early postpartum period by offering physical and emotional support. Doulas provide a range of comfort measures, such as massage, counter pressure, reading affirmations, etc., to support you and your partner in labor.

A doula is there by your side for the entirety of labor, regardless of length and outcome. You have the power to choose your doula, interviewing her in the last few months of pregnancy, and meeting with her two or three times before you are due and usually two to three more times in postpartum. For many women, having this level of support made a world of a difference in their birth experiences.

Studies have shown that women who choose to have a doula present during labor: 

* tend to have shorter labors with fewer complications and interventions;
* request pain medication less often;
* have lower incidence of operative delivery including c-section;
* and have more positive opinions of their birthing experiences.

Having a doula can help ease your tensions and fears around birth, physically as well as emotionally. During prenatal visits and throughout labor, a doula can demonstrate techniques for relieving pain, calming and massaging away tension and fear, and reassuring the mother of her awesome ability to deliver her baby safely. Though many women choose to have a doula to assist them through natural (un-medicated) births because of this strong support, this service is not exclusive to women who have made that particular decision. All women can benefit from a knowledgeable support person who remains with them through the prenatal and postpartum weeks ahead.

Doulas are also great support for your partner, too! Some women are told that doula will replace the partner by making him feel unnecessary. To the contrary, doulas are there to ensure both mother and partner are able to fully participate in the labor and enjoy this amazing experience with the guidance of a professional labor assistant.  Many partners feel that they were able to be fully included in the birthing process and felt better informed of what was happening because of the additional prenatal education and this constant support.  

There are so many choices to be made in the journey to motherhood and doulas are there to educate and empower you to make meaningful decisions that work best for you, your partner, and your baby. 

 In the prenatal visits, doulas educate expectant families of their options, the benefits and potential outcomes of some standard procedures as well as helping discuss the alternatives. They can recommend books, movies, articles, and professionals in your community who specialize in certain areas of pregnancy and birth to help better guide you through your decisions, too. A doula will never make a medical decision for you and regardless of the decisions your choose to make, a doula stays by your side to support you through your birth.

MOM vs. MOM

This past July, my new idol, Congresswoman Lucille Roybal-Allard (D-California), brought before Congress the Maximizing Optimal Maternity Services (MOMS) For the 21st Century Act. This groundbreaking proposal to vastly change the way maternity care is handled in the U.S. has the potential to change the lives of millions of women, making childbirth safer and more satisfying for all expectant moms.


This act has been supported by Amnesty International, who earlier this year released a shocking report on the rising maternal mortality rate and the overall disparity in care amongst racial and socioeconomic groups. The MOMS Act specifically addresses these issues, while promoting an overall change in maternity care to a more holistic model. The bill proposes an increase in midwife-attended births as well as a broad-reaching educational campaign to educate women on their options in childbirth.


Not surprisingly, ACOG has jumped in with a bill with an almost identical name, with similarly worded content that nonetheless, would keep the level of maternity care in the U.S. at its current, dismal status. The bulk of this initative is to focus on research on why there has been a rise in complications in pregnancy and thus the rise in interventions, citing obesity, and poor record taking as some of the main causes. As PushGirl Friday of the Unnecesarean put it, it's, "[b]ecause as we all know, the problem with maternity care in the US is with the women who receive it, not with the care they receive," and if you look at the slew of recent studies regarding these trends--the "Too Posh to Push" meta study in the UK and the flurry of obesity studies--it seems like the obstetrical community really does look to the women first to find the problem. 


Midterm elections are fast approaching and what better time to write or call your representative and tell them that you hope they will support Rep. Roybal-Allard in her effort to reform maternity care. I promise I'll have a template letter written by early next week, but an impassioned phone call will certainly serve more for the cause than any formal letter I can muster. Visit OpenCongress.org to find your local Reps and send them a letter directly from the site!

The 10 month-old fetus

An interesting article from our neighbors up north:

Lobbying grows for the 10 month-old baby

Just how long does it take to make a human baby? Nine months is the going answer, but a small lobby of women believes that it’s more like 10 months and beyond.

Guardian columnist Viv Groskop gave the debate some gravitas with her Oct. 1 story of giving birth to her third child 20 days after his due date. “My first two babies were 15 days late,” she wrote. “But a day shy of week 43? That is virtually record-breaking – and, some would say, slightly mad.”

Generally, a baby is considered full-term when it reaches a gestational age of 37 weeks. A “post-term” baby is one that been gestating up to or beyond 42 weeks...

Read more

I've heard a lot of women tell me that their due date is not what they think it should be, knowing for sure the date they conceived, but they still go along with the doctor's estimates. When they reach 38 weeks, they start being pressured into having their membranes swept or being scheduled for inductions. I have to think that this standard adjustment is part of why I see so many women who are not at all in labor walking to their hospital rooms while I'm attending other births. Are they all considered "late"? And are the ones who are told that they're "overdue", are they at 38 weeks? 42? 40 and 3 days?

I was a three week late baby and was born with no complications and minimal interventions. No one was pressuring my mother to induce when she hit 38 weeks. I know many other people who have a similar story. Interestingly, since becoming a doula, my mother has shared more of her birth story with me than I had previously ever known. After a lengthy talk on due dates recently, she realized that the doctor's due dates for her were most likely off due to a number of factors that she never had the chance to even bring up with her OB when they took out the gestational chart and circled September 2. I was born September 29 without a sign of post maturity...unless my whopping 9lbs 10 oz were solely the result of a few extra weeks.

Are there similar stories out there? This article came from Canada and as far as I know, their induction rate is somewhat lower than ours (which was reported to be 20.6% in 2003, but some smaller recent surveys are showing rates closer to 40%) and it may be likely that the pressure to induce in Canadian hospitals for post-term dates could be even less significant than in the U.S. I don't know of very many women who are allowed to go even two weeks past their due dates in the U.S., let alone to 43 weeks. Am I wrong?

National Health Services Releases Video on Birthing Options

A new birth center in a local hospital prompts a video sponsored by the NHS (UK) to release a video on the various options afforded women in that area. Could you imagine a video like this being released in the US? Where homebirth is seen as a safe and viable option, where one-to-one nurse care is standard, where laboring in a birth tub is the norm, and where midwifery care is given to all low-risk women? Let's hope so!

Mother's Blessing

Jaz and I recently helped host a Mother's Blessing for a friend and it turned out to be a really beautiful, wonderful experience for the mama and all involved. It was a day of pampering Alyx, belly casting, and sharing stories of strength and guidance.

Mother's Blessings can be alternatives to the traditional shower, or supplemental to them. There are some unique traditions to be made up and some long-standing ones to be celebrated during the event. There are no gifts to buy, but the time spent helping the mother prepare for the journey she will soon take is worth so much.

For Alyx's ceremony, we made an intentions banner and left it blank for everyone to fill in with pictures, drawings, affirmations, and messages to mama and baby for labor. Alyx can bring the banner to the hospital on the birth day and hang it in the room for some added cheer and to remind her that although she is the only one that can deliver this new life into the world, she is not alone.

These ceremonies are really about celebrating the journey of motherhood and honoring this mama's entry into the world of motherhood. There are no set guidelines for these events, but some wonderful activities could be cooking food to freeze for the postpartum period, belly casting or painting,  belly henna, giving mama a massage and a foot bath, sharing birth stories, writing and sharing affirmations, making a calming birth playlist together, making a quilt or afghan for mama and baby, or sharing beads or other collected items for a labor necklace. The possibilities are endless! Just get creative and think of ways that you can show the new mama you care!

Article on homebirth from the Huffington Post

"Why Homebirths are Worth Considering" by Melissa Cheyney

Some highlights:

"The answer among the U.S. medical establishment has been to throw more expensive technology at the problem rather than retracing our steps to see where we went wrong. Instead of admitting that something is fundamentally broken with the system, organizations like the American College of Obstetrics and Gynecology continue to endorse the idea that medicalized hospital births are the only safe route for women."

"While maternal mortality rates decreased among our peer nations between 2000 and 2005, they increased by more than 54 percent in the United States during the same time period. The two major differences between the U.S. and other nations, which have superior maternal and infant health outcomes, are that the latter offer universal health care and rely more extensively on cost-effective midwives as a public health strategy."

There is a critique (one of many) of the Dr. Joseph Wax study on homebirths published recently in AJOG, siting faulty research methods and accusing the study of deepening our nations overall distrust of midwives.

It's a good read. Thanks, Melissa!

Afghan Midwifery Training

This was passed along through one of the Bay Area birth doula groups. Please donate if you're able and spread the word about this amazing organization!



Dear Friends,

I try not to send these requests out too often, and appreciate you reading this! As president of Afghans4Tomorrow, and especially when I have an opportunity to help the women and babies in Afghanistan, I hope you won't mind if I tell you about it, and ask for your help too.

We want to provide training for several women who live in Wardak Province (just southwest of Kabul, and heavily controlled by the Taliban) to become Skilled Birthing Attendants in their respective villages. There are no female obstetric doctors in this region, and due to Taliban influence, we are no longer able to find female doctors living in Kabul willing to travel to Wardak to practice. Some women will not go to male doctors, if they are even available. Many instead rely too often on old wives tales, and receive no prenatal care nor have the birth attended by a doctor or midwife or anyone with any training at all.

Afghanistan is one of the most dangerous places to be born, or give birth. A woman dies in childbirth every 27 minutes in Afghanistan, that is 1 in 8 women who give birth. One in five children die before they reach the age of 5.

The formal Midwife Training program in the country is a two-year program that requires the women to live in Kabul for the entire time. We have already trained two midwives and will likely fund more as we find women able to live in Kabul for the two years, which is not so easy.

This program is a way to help bring more skills to the region to help provide safer childbirth and baby checkups to the region now, while we wait and hope for more calm encouraging more doctors to move to the area and while more fully trained Midwives and doctors become available. Our Skilled Birthing Attendant training starts with an intensive 4-week program (to be held in December) conducted by a volunteer American doctor, and is in conjunction with another organization; Mountain to Mountain, who is funding some of the expenses for this training as well as ongoing financial and training for the next three years for the group of women.

Afghans4Tomorrow's responsibility in this program is $20,000, of which we have already raised about $8000. I know things are rough for many of you out there, but if you can't help with a donation yourself, maybe you know someone who would be excited about helping such a program, or know people involved in the Midwife movement that might we willing to share with their friends?

I have attached the actual proposal for those who are interested. I will have more info in the next several days, but feel free to reach out with any questions, and feel free to share this email with anyone you think might be interested in learning about our efforts in helping women to deliver healthy babies in Wardak Afghanistan.

Thanks everyone for taking the time to read this far!

And for those celebrating Ramadan-- Eid Mubarak!

Cheers,Kim

Kimberly O'ConnorPresidentAfghans4TomorrowP: +1 415.282.8281M: +1 415.608.1260Skype: kiminsanfranciscokim@afghans4tomorrow.orgkimoco@mac.comwww.Afghans4Tomorrow.org

First Lady on Breastfeeding

First Lady Michelle Obama spoke to the NAACP a few weeks back on the "obesity epidemic". In it she mentions the low rate of breastfeeding amongst African-American women:

And finally, it’s one thing we can think about, is working to make sure that our kids get a healthy start from the beginning, by promoting breastfeeding in our communities.  (Applause.)  One thing we do know is that babies that are breastfed are less likely to be obese as children, but 40 percent of African American babies are never breastfed at all, not even during the first weeks of their lives. 

And we know this isn’t possible or practical for some moms, but we’ve got a WIC program that’s providing new support to low-income moms who want to try so that they get the support they need.

And under the new health care legislation, businesses will now have to accommodate mothers who want to continue breastfeeding once they get back to work.  (Applause.)  Now, the men, you may not understand how important that is.  (Laughter.)  But trust me, it’s important to have a place to go.  

Breastfeeding has been linked with lower risk of obesity along with several other health factors. 

Hilarious Pregnancy/Motherhood Blogs

Check out The League of Maternal Justice. Pretty hilarious and all-around awesome. Maybe they'll let me join their squad?

Blacktating is another fun read.

Enjoy!

A doctor's take on touch

From the New York Times:

A new patient comes to my office, a healthy middle-aged woman. The medical assistant has already documented her normal blood pressure. Of our allotted 15 minutes, I spend more than two-thirds talking with her.

I ask about her personal medical history, her family medical history. I inquire about her lifestyle: what kind of work she does, whether she smokes, how much she exercises, whether she eats five servings of fruits and vegetables each day. I review her “health maintenance”: whether she’s up to date with her mammogram, Pap smear, vaccinations.

I press into the remaining minutes, counseling about calcium, sunscreen, seat belts. I screen for depression, domestic violence. I remind her about flu shots and colonoscopies. I pull out brochures about healthy diet and exercise, and we talk about ways to squeeze in exercise during her sedentary job.

And then I compliment myself on a job well done. I’ve covered all the relevant screening topics. I’ve touched all the bases of preventative medicine for a healthy woman. And I’ve even managed to finish on time, so I won’t have to keep the next patient waiting.

But my patient has a quizzical look on her face. Is that all there is, she seems to be asking.

In fact, through our extensive discussion (and the initial blood pressure check), we have fulfilled all of the medical interventions that scientific evidence has validated as helpful for a healthy patient. But my patient is clearly dissatisfied. A doctor’s visit is not a doctor’s visit until a stethoscope has probed the inner rhythms of the heart, and a set of medical hands has palpated the belly. Research has shown that patients expect a physical exam.

But is there any research to show that a physical exam — in a healthy person — is of any benefit? Despite a long and storied tradition, a physical exam is more a habit than a clinically proven method of picking up disease in asymptomatic people. There is scant evidence to suggest that routinely listening to every healthy person’s lungs, or pressing on every normal person’s liver, will find a disease that wasn’t suggested by the patient’s history. For a healthy person, an “abnormal finding” on physical exam is more likely to be a false positive than a real sign of illness.

Moreover, a normal physical exam cannot reassure a patient that there is no disease lurking in the shadows.

But does the physical exam serve any other purpose? The doctor-patient relationship is fundamentally different from, say, the accountant-client relationship. The laying on of hands sets medical practitioners apart from their counterparts in the business world. Despite the inroads of evidence-based medicine, M.R.I.s, angiograms and PET scanners, there is clearly something special, perhaps even healing, about touch. There is a warmth of connection that supersedes anything intellectual, and that connection goes both ways in the doctor-patient relationship.

We only have a few minutes left to our visit, but I gesture her up to the exam table. I place my hand on her shoulder and slide my stethoscope over her ribs. As I listen to the thrum of airflow that I’m 99.9 percent sure is perfectly normal, I feel both of our bodies relax ever so slightly.

I ease the bell of the stethoscope around to her heart, and though I know that there is only a small chance that I will hear anything to indicate serious illness, the familiar rhythms are comforting to my ear. As I examine her abdomen, we continue to talk, but there is a perceptible shift in the tenor of our interaction.

The polite but businesslike nature of our initial conversation has melted. No matter how we’ve come to this room, to these postures, to this connection, we are now more intimate. Even if our initial conversation had been marked by frustration or anger, the timbre of our interaction would have softened. It is almost impossible to be annoyed or curt when skin is touching skin.

Perhaps that is the crux. Touch is inherently humanizing, and for a doctor-patient relationship to have meaning beyond that of a business interaction, there needs to be trust — on both ends. As has been proved in newborn nurseries, and intuited by most doctors, nurses and patients, one of the most basic ways to establish trust is to touch.

I cringe whenever our hospital administration refers to the doctors and nurses as “health care providers.” That term always makes me feel like a soft-drink dispenser at Burger King. I’m not a “provider”; I’m a person, a doctor. And my patient is not a “customer” or a “client.” We are not transacting business.

Which is why a doctor’s visit never feels complete without a physical exam. It is a crucial part of the doctor-patient relationship that cannot be underestimated. One doesn’t need a scientific study to prove that.

Dr. Danielle Ofri is an internist in New York City. Her newest book is “Medicine in Translation: Journeys With My Patients.”

Happy World Breastfeeding Week!

Article with great links and fun facts up @The Examiner

Someone give this lady a UN post, already!

From NYMag:

Gisele thinks breastfeeding should be mandatory
The genetically blessed Gisele told Harper's Bazaar it was breast-feeding that helped her maintain her super-hot post-baby figure.

"Some people [in the United States] think they don't have to breastfeed, and I think 'Are you going to give chemical food to your child when they are so little?' I think there should be a worldwide law, in my opinion, that mothers should breastfeed their babies for six months."

Although she claimed her eight-hour labor “didn’t hurt in the slightest,” Gisele prepared herself for the event by meditating and adhering to a strict exercise plan.

“You want to go into the most intense physical experience of your life unprepared? That doesn't make any sense to me. I was ready and I thought OK, let's get to work'. I wasn't expecting someone else to get the baby out of me … I did kung fu up until two weeks before Benjamin was born, and yoga three days a week.'

Ah, so that’s how she did it! Approach your pregnancy with a drill-sergeant-like focus, and you, too, can model swimwear six weeks after giving birth.


After some backlash for the previous comments, this was posted on Gisele's blog:
Since Gisele became mother, the Top model has been outspoken when expressing her feelings about motherhood and life. In a recent interview for the September issue of Harper’s Bazaar UK, Gisele talked about the importance of breastfeeding in the first months of a child’s life. Now, Gisele writes first-hand on the impact caused by the comment.
My intention in making a comment about the importance of breastfeeding has nothing to do with the law. It comes from my passion and beliefs about children. Becoming a new mom has brought a lot of questions, I feel like I am in a constant search for answers on what might be the best for my child. It’s unfortunate that in an interview sometimes things can seem so black and white. I am sure if I would just be sitting talking about my experiences with other mothers, we would just be sharing opinions. I understand that everyone has their own experience and opinions and I am not here to judge. I believe that bringing a life into this world is the single most important thing a person can undertake and it can also be the most challenging. I think as mothers we are all just trying our best.

One more reason not to induce

From the New York Times:

Babies born six weeks prematurely are 40 times as likely as full-term infants to suffer respiratory distress syndrome, a new study reports.

Ten percent of the premature infants experienced the syndrome, the study found, compared with less than half of 1 percent of full-term babies.

In respiratory distress syndrome, the tiny air sacs of the infant’s lungs do not fully open because of a lack of surface lubricant, making breathing difficult. It is one of the most common complications of late preterm deliveries, defined as those that take place after 34 weeks and before 37 weeks of gestation.

The risk of respiratory problems decreased with each additional week of pregnancy, the researchers also found.

Babies born after 36 weeks were only nine times as likely as full-term babies to develop the syndrome, while those born at 37 weeks were at three times the risk. The study, published in The Journal of the American Medical Association last week, is one of the largest and most current to examine respiratory problems associated with late preterm births.

“The pulmonary system is the last system to develop in the fetus,” said Dr. Judith U. Hibbard of the University of Illinois and the paper’s lead author. “Obstetricians need to make every effort not to deliver a baby until 39 weeks unless there is a good medical reason.”

New research on even more benefits of breastfeeding

New article up from the New York Times detailing the latest research in the benefits of breastfeeding.

Researchers at the University of California, Davis are studying the individual components of breastmilk to determine their specific functions. They have found that the sugars in human milk contain a specific microbe that helps line the intestinal walls of an infant and help ward off disease.

This particular strain of bacterium, a subspecies of Bifidobacterium longum, protects infants from others strains of bacteria that would make an infant ill. Humans do not naturally process the sugars, which make up about 21% of breastmilk, but the bacteria is specially designed to do just that.

They have also found that harmful bacteria will bind to the sugars in breastmilk and will then be flushed out of the baby's system as waste.

“Everything in milk costs the mother — she is literally dissolving her own tissues to make it,” said Dr. Bruce German, “Finding that [milk] selectively stimulates the growth of specific bacteria, which are in turn protective of the infant, let us see the genius of the strategy — mothers are recruiting another life-form to baby-sit their baby.”

The research also suggests what breastfeeding advocates have been striving toward for decades, that mother's milk could be extremely beneficial to premature babies. They also suggest it may be good for the elderly.

Dr. David Mills noted that each component of breastmilk may hold biological significance, updating the previous notion that some elements just pass through with no effect. His quote finishes the article: “So for God’s sake, please breast-feed.”

Lessons from a Reservation Hospital

I found an article on this amazing hospital from this past March on the Pushed Birth blog. The Tuba City hospital is small and impoverished, yet it has significantly better birth outcomes than the majority of maternity wards in the U.S. It's cesarean rate is 13.7%, less than half that of the national average and in line with the WHO recommended rate. It also has offered women the option of having a VBAC for decades and with excellent outcomes.

"Tuba City ...with about 500 births a year, could probably teach the rest of the country a few things about obstetrical care. But matching its success would require sweeping, fundamental changes in medical practice, like allowing midwives to handle more deliveries and removing the profit motive for performing surgery," the Times writes.

Doctors and midwives have salaried pay, stripping the incentive to cram more patients in and perform more unnecessary and costly procedures. The hospital receives its insurance coverage from the federal government and as such is more likely to opt for less expensive, and less invasive techniques. At least in terms of birth, those simple and inexpensive methods--massage, words of encouragement, staying at the woman's side for the entirety of labor, encouraging a woman to move, having a tub available in birthing rooms--return significantly better outcomes for the majority of women.

"Birth is a joyous affair here, and the entire family — from children to great-grandparents — often go to the delivery room... Linda Higgins, the head of midwifery at Tuba City, said: 'All of a sudden Mom is surrounded by women, and they’re all helping her and touching her.'

As a result, many young women have already seen children born by the time they become pregnant, and birth seems natural to them, not frightening."

We can learn a lot from this small hospital, both in practice and in the perception of birth in our society. With the change in ACOG statements about the safety of VBACs, the recognition that our cesarean rate has shown no signs of decreasing to the detriment of mothers and babies, and the recent push for legislative reform covering more birthing options, there is hope the methods of the Tuba City hospital are echoed in hospitals across the country.

Read the full Times article here.

Victory for midwives: The Midwifery Modernization Act passed

WAY TO GO NEW YORK!

The Midwifery Modernization Act passed unanimously in the New York State Congress and received Gov. Patterson's signature.

The bill was quickly pushed through the New York State Assembly following the recent near demise of midwifery and homebirth in New York City. The previous piece of legislation concerning midwifery required certified midwives to have the written practice agreements (WPA) with an obstetrician in order to practice in the state. In New York City, the only OBs willing to enter into this agreement were to be found at St. Vincent's Hospital, which shut its doors this past March.

The Midwifery Modernization Act removes the need for a WPA, allowing midwives to practice independently as primary care providers. It recognizes them as the qualified care providers they are and not just as second rate specialists for a fringe movement.

Under the new law, midwives may continue to refer women to obstetricians, gynecologist, or physicians when necessary, but this is on a as-needed basis--just the same as your regular physician refers you to any other specialist. This is the standard of care in countries where midwifery care is the norm for pregnancy and birth related matters and has a record of being a safe and cost-effective means of care. In fact, under this model, countries such as The Netherlands, Sweden, and Norway have better maternal and fetal outcomes than the United States where only 1% of births are attended by midwives.

This is also a victory for mothers in New York who now have more options in deciding where and with whom to give birth, an option that should be available to all women without political barriers.

New Examiner Article Up: Top 5 reasons NOT to induce

The following are some common occurrences associated with labors that are medically induced--through drugs such as Pitocin, Cytotec (or Misoprostol), and/or the artificial rupturing of the membranes (AROM)--as well as a number of common misconceptions. They do not happen 100% of the time, and there may be several medical indicators which suggest induction is the best option for the health of mother and baby. However, the rates of inductions in the U.S. have skyrocketed while our infant mortality rates not improved and maternal mortality rates have actually increased.

This article is not meant to scare any woman out of having an induction, or to judge anyone for having chosen to have one. Instead, this article is meant to be informative, and to urge women to educate themselves on the benefits and risks of non-medically indicated inductions in addition to other options and alternatives in childbirth. If your primary care provider is urging you to induce, make sure to ask him or her what indicators for needing an induction are present and what your options are. Make sure to inform yourself the risks and benefits of induction from more than one reliable source before making a decision. The following may be a useful place to start...

Read the rest of the article here.

Congresswoman Lucille Roybal-Allard (CA-34) Introduces Maternity Care Reform Legislation

I'm going to eventually do a lot of research on this bill and keep my eyes and ears out for any new news on it being passed, but for now I just wanted to pass along the info on this new proposed piece of legislation from Lucille Roybal-Allard (D-CA).

The MOMS (Maximizing Optimal Maternity Services) for the 21st Century bill will seek to address the dismal maternal and infant mortality and morbidity rate in the U.S. in an effort to improve overall maternal and infant care. Seeing as the U.S. is ranked 33rd in the world for maternal and infant health, despite outspending every other country in birth-related health care costs, this bill could not be any more prudent or urgent.

Take a moment to read over the summary of the bill from Congresswoman Roybal-Allard's site and write her, or the Congressional representatives in your area, to show your support for this bill!

I'll post a template letter in the next few days so check back for that!

New Online Pregnancy Video Library from Childbirth Connection!

Wonderful news, expectant mamas! The always wonderful website Childbirthconnection.org has recently been updated to include a pregnancy and childbirth video library.

As a doula and birth advocate, I can tell you that although birthing videos are incredibly valuable learning tools, it is often difficult to find some of the best of them, and even when you do, they often come with a high price tag. So welcome the free, online video library!

Some of the options on the site are full length, others provide edited versions of the full length movies you can opt to purchase. A few others, such as The Business of Being Born, allow you to rent the movie on your computer for 24 hours for a small fee. Each video also directs you to the movie's official web page, making it easy to find even more articles, books, and videos on pregnancy and childbirth.

It is worth seeking out videos that celebrate the event of birth and seek to educate families of their options in childbirth and this new site makes it so easy. The videos featured on the site offer more than worthy alternatives to the TLC-run horror stories that take up a five-hour block of morning television.

ACOG Changes VBAC Statement

Following the recent NIH conference on VBAC (Vaginal Birth After Cesarean) this past March, The American College of Obstetrics and Gynecology (ACOG) recently altered their statement on the safety of VBACs to make them more accessible for the majority of women who have previously had a cesarean birth.

ACOG's previous statement, issued in 1999, stated that hospitals have an anesthesiologist who could be "immediately" available to perform a repeat cesarean section on women attempting VBACs if necessary--a situation which even the largest hospitals in the country could rarely accommodate. ACOG's previous statement, issued after an NIH conference in 1980, suggested only that the necessary staff for an emergency cesarean be made "readily" available, helping to keep the U.S. cesarean rate at a relatively low percentage.

The change in wording in the official statement was prompted by a handful of articles published in medical journals in the late '90s regarding the incidence of uterine rupture in attempted VBACs. Though these articles relied on limited data, ACOG soon shifted it's stance on VBACs, thus being a major contributing factor in the incredible increase in the national cesarean rate over the past decade. 

In recent years, several more studies have suggested that attempting vaginal birth after prior cesarean is most often the safest option for women, backing the original data that prompted the ACOG statement prior to the 1999 change. These studies show that the chances of uterine rupture in labor due to a cesarean scar are below 1%, only increasing above 1% in cases where labor was induced or augmented. It is safe to say that ACOG is finally coming around to meet the evidence-based standards proven not only in the past several years, but in what was originally found throughout the 1970's and 80's.

This change should offer women more options in care providers and place of birth when attempting VBACs, though it may take several years to see this becoming a national trend. It is still to be seen whether or not this changes any stances on VBAC attempts in home deliveries, or for women who would wish to deliver at a birthing center, but this may open those options to women, allowing these practices to come out from the underground networks they are currently forced to transverse due to limited access.

Allowing more women to have vaginal deliveries should also cause a shift in the amount spent on births in the U.S. each year, and hopefully will send the national cesarean rate on a downward slope, edging closer, at least, to the World Health Organization's (WHO) recommended 15% (the U.S. currently has a 32% cesarean rate).

Em.pow.er [em-pou-er] (verb-used with object)

Empower- It's a strong word. It's a word that commands that I straighten my spine and look people in the eyes when I speak it.

A good friend of mine is staying with me this week while she is in school learning to teach English to non native speakers, and so I have been thinking about language and words. Empower- this word in particular has been on my mind lately as I move through life.

I have not been as active as I would like to be as of late, partially out of pure laziness and partially out of a general lack of knowing where to go and what to do in this new, sometimes overwhelming, always exciting city environment. But I found a bikram yoga studio not far from my house that offers an awesome new student discount, so I built up some motivation and showed up for class yesterday, and my, how empowering! For a full 90 minutes my mind could think of nothing but holding the pose, breathing, my focal point, and there was no avoiding the rhythmic thumping of my heart bringing oxygen and nutrients to every cell of my body. As I lay in Shavasana at the end of the 90 minutes, manifesting the most forefront thoughts in my brain: a quick and beautiful birth for my client and the perfect living situation for myself and my roommates, I felt truly empowered. This is the feeling that goes with the word, I thought. This is why our business is Empowered Birth Doulas. This is what I want my clients to feel during and after birth. In fact, this is what we live for- to be empowered! Haha, ok, it sounds rather extravagant now, but it is so true. We live for those moments when we feel our deepest strength and we see what we are capable of. When we are empowered we are confident, we exude strength, and other recognize it.

To empower is to give power or authority to, or to enable. We can empower others and we can empower ourselves, and often we empower others by empowering ourselves. Certain acts can be empowering, especially ones that are difficult. In fact, difficulty and empowerment seem to go hand in hand. We can empower through education, action, and choice. Empowerment does not happen, it is something that comes to us after some very hard work.

I am intrigued by what empowers each of us, and how different people are empowered in different ways and by different experiences. For example, depending on your own life experiences, your decision to receive an epidural in childbirth could be the most empowering decision of your life, while another woman's choice to have a natural childbirth could be equally empowering to her.

So what is it that empowers you, and why? (I ask myself)

To be empowered we have to be open, to be aware of what we believe and to what feeds our souls. I love the potential for empowerment through birth, and I think this is one of the main reasons I was initially attracted to doula work: to empower women. Actually, empowering women in something that I think I will be striving to do for the rest of my life, on a global and local level, through birth and any other means I can. Empowering others is Empowering!

Ultimately, I feel a passion to empower women because I believe in and feel connected to the importance and sacredness of Women's work- to our communities and to the future of our planet. I truly believe that, as Agnes Sallet Von Tannenberg wrote, "If we are to heal the planet, we must begin by healing birth".

And so, Emily and I continue to do our part to heal the planet, one Empowered birth at a time!

Empower: (Em=before, Power= strength, power) to invoke power.

New study on stem cells in cord suggest delayed cord clamping after birth

A recent study published in the Journal of Cellular and Molecular Medicine supports the idea of delayed cord clamping in supplying essential stem cells to infant immediately after birth.

This is one of a long line of recent studies suggesting there are long-term benefits to delayed cord clamping--a practice which takes only minutes of patience and has little, if any, adverse effects.

To read more about this and other recent studies, please visit my article in The Examiner.

Learning CPR

Today I attended a free adult, child, and infant CPR class hosted at a friend's house. The wonderful trainer, Paula, noted that though she has trained doulas here and there, she's surprised at how few doulas seek out CPR training. It seems to her, and to me, that being trained in this area would be part of the general requirements for a doula, but it's not so.

I have been at a birth where the baby needed to be resuscitated just after birth, and I was thankful that I was not the only other person in the room. The midwife and midwife assistant were quick to respond to the baby's obvious slow start in a way that impressed me beyond words. But what if I had been there long before the midwives had arrived and baby decided to greet the world in my arms instead of her's? I took CPR years ago and learned a little about what to do in that situation if there is trouble, but I'm the type that likes to be way more prepared than that!

That situation does happen to doulas every now and again and so we should all be prepared by having infant CPR training. Very often local fire departments will hold free CPR trainings a few times a month. It is easy enough to call up your local station and ask if they offer CPR and First Aid, how much it might cost, and if there isn't training available through them, if there is another local station that does offer it.

And this doesn't just apply to doulas! Everyone could benefit from this knowledge, parents, babysitters, and teachers especially. Sure, we've all watched episodes of Baywatch where someone was given mouth-to-mouth so we may know a few things about CPR via cultural osmosis, but the standard procedures for CPR have changed in the last several months, reflecting new, evidenced-based techniques. Having better knowledge of these changes and getting some practice on a test dummy could literally be the difference when it comes to saving someone's life.

Visit the American Heart Association's site on CPR to learn more! 

Namaste

Hello world!

This is Emily and Jasmiene of Empowered Birth Doulas. We're getting ready to move down to San Francisco and are busy updating our website, making connections in the SF birthing community, and choosing a new logo! Lots of exciting stuff.

Check back here to read about our exciting adventures in starting up our combined practice and keeping up with our education in doula work and massage. We'll advertise any local events that may be of some interest and write an occasional article about something we've come across that we'd like to share.

Thanks for stopping by! Please call again.

Warmly,
Em and Jaz