While I'm on a linking role

I recommend that you mozy on over to Hathor the Cow Goddess and check out her reaction to this article about oxytocin and its potential protection for babies' wee brains! "Is Oxytocin Obsolete?"

"Epidurals Are For Tolerating the Hospital, Labor Is The Easy Part"

What a great quote, from this blog entry about a mom's recent second birth.

Having a natural birth in the hospital is a huge accomplishment! Women really do deserve a trophy for it. A drug-free labor at home or in an independent birth center is (comparatively) easy.

Go Minnie!

According to this article, Minnie Driver is planning a home water birth when her baby arrives. Water is awesome for labor and birth -- it's an effective, natural pain reliever and being semi-weightless helps the mom change positions with ease.


Weighty Matters

Obese Women Gain Too Much Weight During Pregnancy, Study Says

Oh, Lord. Keeping up with the ACOG theme of women being too old and fat to deliver normally, this headline really chapped my hide. Yes, obesity has health risks, and ideally we'd all begin pregnancy in perfect physical form, but really, Dr. Artal, is pregnancy really one of the leading contributors to the obesity epidemic? Women should try to limit their weight gain during pregnancy because they're too lazy to lose it postpartum?

The article harps on the fact that the current guidelines for weight gain in pregnancy state that overweight women ought to gain at least 15 pounds. Considering that that would barely cover baby, amniotic fluid, and breast growth, that hardly seems excessive. I find this especially ironic considering that the obstetrical community, with few exceptions, rarely offers anything in the way of substantive nutritional guidelines to women in its care. Those that do often offer such gems as, "Eat lots of peanut butter!" (Actual quote.) I do have a client whose OB employs a dietician on his staff, and I give major props to him.

In the words of Anne Frye, "Our culture has a tremendous loathing of large, especially fat, women." Her sensible advice is that women of size should cut out junk foods and refined carbohydrates, consume plenty of high-quality protein, vegetables, and whole grains, and walk or swim daily. Doesn't that seem more reasonable?

This attention to the weight gained by obese mothers seems, to me, to be yet another example of a reductive approach to maternity care by the medical community. Instead of "how can we help this person have the healthiest pregnancy and birth possible, given factors X, Y, and Z?" we see more of a "shame the patient who dared conceive outside our guidelines!" If nothing else, it's not an attitude that is likely to win a woman (who likely already agrees that she ought to lose weight) over to the idea of weight loss goals in the postpartum period. I'm not even going to delve into the fact that a high BMI does NOT equal an unhealthy or uneducated patient -- and neither is a low BMI evidence of a healthy, active person!

The sad thing, to me, is that focusing on one part of a woman's health and taking such an alarmist attitude towards it squanders, in my opinion, an opportunity to begin a lifelong dialogue about taking steps to improve one's health, make better choices, and embrace pregnancy as a time to implement positive, permanent health improvements. Remember, folks, this is the same community that used to advise women to smoke during pregnancy to ensure a small baby...


Homeopathy for Mamas

Homeopathy is a field of "alternative" medicine that can be wonderfully effective at treating a variety of illnesses and ailments. It's especially good for pregnant and new mothers to explore because it is safe, natural, non-addictive, and can be used in conjunction with other remedies.

As someone who is relatively new to studying the field, I won't try to write a comprehensive homeopathic guide. However, here are some common remedies for issues in pregnancy, birth, postpartum, and infants. Use these as a starting point, and consult a more detailed guide for treatment recommendations. You'll see that certain remedies (such as Arnica and Chamomilla) come up for a multitude of symptoms -- these are the ones I'd recommend buying before you need them!

As always, consult your midwife or other practitioner for guidance before taking any new remedy.

ComplaintSuggested Remedy
For pregnancy
Morning sickness Pulsatilla, Sepia, or Nux Vomica
AnemiaFerrum Metallicum and/or Calcarea Phosphoricum
ConstipationBryonia, Sepia, or NuxVomica
Groin painBellis Perrennis
For labor
Back LaborCausticum, Gelsemium, Nux Vomica or Pulsatilla
Fast laborAconite
ExhaustionKali Phosphoricum and/or Arnica
Unable to urinateArsenicum, Arnica, Pulsatilla or Staphysagria
Weepy or despairingPulsatilla
For postpartum
HemorrhoidsPulsatilla or Arnica Montana
After pains and sorenessArnica Montana or Magnesia Phosphorica
Baby BluesPulsatilla
For breastfeeding
MastitisPhytolacca, Belladonna, Pulsatilla or Lac Caninum
EngorgementBelladonna or Bryonia
Low milk supply
Urtica Urens or Lac Caninum
Sore/cracked nipplesPhytolacca, Silica or Sulphur
For the little folks
Bumps & BruisesArnica Montana
Bites & stingsApis Mellifica
FeverChamomilla or Belladona
TeethingChamomilla, Calcarea Phosphorica, Hyland's Teething Tablets, or Boiron Camilia doses
ColicChamomilla, Dioscorea, Hyland's Colic Tablets or Boiron Cocyntal doses
EarachePulsatilla, Hyland's Earache Tablets/Drops, or Similisan Earache Drops
Like my table? It's my first, and simple as it is, I still had to issue an HTML SOS to my husband when the table data was floating about in space. *sigh*

Online resources for more information and purchase information.
ABC Homeopathy
Gentle Birth Archives on Homeopathy
Find a Homeopath

Everybody's Guide to Homeopathic Medicines by Stephen Cummings & Dana Ullman
Homeopathy for Pregnancy, Birth, and Your Baby's First Year by Miranda Castro


The NYT on Doulas

The Fasion & Style section(?!) of the New York Times has a piece on doulas this weekend. If you like headaches, check it out. Tempting as it is to deliver a point-by-point response to the article, I'm going to limit myself to a salient few (below), and instead focus my energies on the very valid question of what, exactly, a doula's scope might be, and offer a few thoughts on why doulas are at the receiving end of so much hostility.

Scope of practice: What the heck is a doula?
A doula provides emotional and physical support for a mother before, during, and after she gives birth. She provides knowledge, resources, comfort measures, advocacy, and suggestions to both the mother and her partner. She doesn't provide any clinical tasks or assessments, make decisions for the mother, speak for the mother, or control the outcome of the labor.

One of the biggest problems in defining the role of a doula is understanding what advocacy means in this role. I think it's vitally important that doulas discuss this with their clients well before the birth to ensure that everyone is on the same page about her role. My personal definition is that I don't speak for the mom, but I will make sure her voice is heard. No one can labor for the mom -- she has to do it herself. Likewise, I believe no one can empower the mother -- she already possesses the power to birth within herself, and all we can do is encourage her, boost her confidence, and do our best to help her feel comfortable (both physically and emotionally). One of my biggest beefs with both doulas and their clients is the very false expectation that a doula can somehow save a woman from her labor or her care provider. (And doulas, just like birth plans, are no substitute for communication with your care provider.)

An independent doula works for the laboring couple, specifically the mother, and no one else. A doula in a hospital-based program works for the hospital, meaning that she may be limited in what she can do or say in ways that an independent doula is not. For example, a hospital-based doula might be obligated by her contract to "report" a woman who eats during labor, while an independent doula would not. Ideally, I firmly believe that the doula should be a bridge between the hospital and the laboring mother, not a wall. However, if I were faced with a hostile nurse (and I never have been, seeing as how I'm awfully charming), I will always come down on the side of supporting the mother's wishes. I am most interested in the parents' satisfaction, though it's nice when everyone's happy! (So are all the other doulas whose thoughts I know on the subject.) And if a case were to arise where the parents' wishes conflicted with each other (say, the dad wants her to be on the fetal monitors continuously, but the mom wants to walk and try new positions), I will support the mother.

So, who determines the role of a doula? As the Times already pointed out, anyone can call herself a doula. ALACE, DONA, and CAPPA are three of the biggest certifying organizations, and they all pretty much define the doula's role in the same way. The differences in the organizations would take its own post to explore, but I'd say overall ALACE is the least discouraging of its doulas taking on additional roles, such as becoming a monitrice and checking dilation and fetal heart tones , as long as they understand that they need training beyond the scope of a 3-day doula workshop to do so.

Being a doula isn't rocket science, but I think that training and certifying with the above, or any other fine doula organization, is a good thing. For one thing, saying, "I'm a DONA doula," or "I'm an ALACE doula," means something. A potential client can learn what that organization stands for and make some assumptions from there. I also think that it lends credence to a doula's role as a professional to have some sort of formal training. Finally, I think clients deserve to have recourse if their doula is unsatisfactory, especially if she attempts to perform way beyond the normal boundaries of her role.

Shorter labors, fewer interventions (including cesarean), increased satisfaction... What's not to love?
Often, the doula is the scapegoat for anyone who was dissatisfied with the way a birth played out, whether it's a nurse who had to accommodate intermittent monitoring, or a mother whose birth didn't go as she had planned. Remember, having a doula doesn't guarantee a certain type of birth; also, just because a laboring mom who has a doula is declining cervical checks, that doesn't mean it's the doula's doing!

I'd be remiss in my bloggy duty if I didn't also address the fact that many doulas do step far from the cozy confines of their scope of practice. I have read things on message boards (told by the doulas themselves) that make me extremely nervous for their clients and for the fate of doulas overall. I can easily understand why an OB would feel angry towards a doula who, for example, is dosing the patient with herbs during labor or attempting to cut off conversation about options for managing a complication.

But for the most part, I think the hostility towards doulas stems from the fact that they tend to make things a little harder for doctors and nurses. Supporting women's choices, even when it goes against the standard protocol, is one of the most valuable things doulas do. So if a doula's presence gives a laboring mom the extra support to resist Pitocin, to spend time off the monitors, or the idea to try pushing upright, the good that does the mother is beyond measure. However, the hassle for other care providers may be quite quantifiable: extra hours, extra paperwork, extra explaining to higher-ups of why this labor was handled the way it was. I'd love to hear from some actual hospital L&D folks on this, though. Anyone?

And now, a few responses to the article. First of all, I commend the Times for pointing out that not everyone who bills themselves as a lactation consultant is an International Board Certified Lactation Consultant (IBCLC), which is a highly-trained, experienced medical professional. Folks, you don't have to have any letters after your name to give good breastfeeding advice, but if a new mother is having serious trouble, she needs to be aware that the "lactation specialist" nurse who comes to see her in the postpartum recovery room might not actually know that much about breastfeeding. Hospitals (and all care providers) must start being more transparent about their breastfeeding support.

That said...
  • Using a photo of a doula seemingly palpating a pregnant client's belly for the accompanying image... Why? Not that that is terrible or outside the scope of what is appropriate for a doula to do, but it almost seems like the editors are saying, "Look, here's a doula who thinks she's a midwife or something!"
  • Why throw in lactation consultants along with doulas? The fields are related, but their roles are very different. The article seems to have an agenda of "exposing" the bad behavior/advice of a small percentage of these practitioners. Which leads me to my final gripe:
  • I think, ultimately, few hospital-based birth professionals (and certainly not the author of this piece) understand the role of a doula. They may see the doula talking a woman out of an epidural and perceive that the doula is bullying her client. But often, she is simply fulfilling the role she was hired to perform. The doula Pamela Myers hired was perfectly within her scope to recommend avoiding IV fluids (as long as the mother hydrated in another way like, say, drinking water!), and firmly recommending a shower or bath is a time-tested method of pain relief.

    Walking out on a client who accepts an epidural is, obviously, very poor form. However, the article admits, "In an era of nurse shortages and high Caesarean rates, doulas and lactation consultants can be godsends for many women. Indeed, multiple studies show that a doula’s presence during childbirth leads to shorter labor, less medical intervention and a happier experience." And then adds, "[F]ew women readily admit to doula discord." What, then, is the point of this article?