A Feminist Perspective on Breastfeeding

“Breastfeeding and Work; Let’s Make It Work.” What comes to your mind when you hear the 2015 World Breastfeeding Week’s slogan? Most Americans think of women working outside the home who juggle nourishing their babies at their breasts with the demands of a boss. This calls to mind breast pumps, bags of frozen breastmilk, and bottles left for daycare providers; mothers striving to provide the very best both financially and nutritionally for their families. If you are a politically progressive American, “breastfeeding and work” may evoke images of paid maternity leave, perhaps even as long as some European countries, which provide 1 to 3 years! If you are a woman working in an office job perhaps this slogan sets you dreaming about pretty, private, lactation rooms with cozy chairs, baby photos, relaxing music, a clean sink to wash your pump parts, a refrigerator for storing pumped milk, clean counter space and electrical outlets to plug in your double, hospital-grade, hands-free, electric pump. Or you may be one of the many women yearning for a long-enough break from running a cash register, working the sales floor, making motel beds, tending the sick, picking vegetables, or flipping burgers to drain your full breasts often enough during the day to keep your body producing enough of a milk supply to match your hungry baby’s growing needs.

These are all valid dreams and desires, but as a community lactavist and modern feminist I have a broader vision; a vision better for all of humanity.

Who decided what IS work and what ISN’T work? Men did. Our modern chauvinistic culture decided work was what men did away from home. Therefore, women weren’t working when they stayed home and raised children. Anyone who has raised children knows this is ludicrous. Raising babies into well-functioning, happy, healthy adult human beings is incredibly demanding work. The hours are ridiculously long. Your job description changes every few months. Your day is filled with multitasking, negotiating, and strategic planning. Safeguarding the next generation, assuring the continuation of the species, is arguably the MOST important human endeavor. Regardless, men deemed raising children as less important than making money; therefore, what women did was NOT work.

Sadly when the women of the women’s liberation movement fought for the right to work outside the home they adopted the male paradigm for themselves. Imagine all those career-minded women in their pant suits. Secretaries might wear skirts but any woman who hoped to climb the corporate ladder donned the female equivalent of the coat and tie. Even Hillary Clinton perpetuated this stereotype through much of her last campaign. The 1960’s feminist reasoning went like this. We want to compete in the professional world. The professional world was designed by men for men, therefore we will pretend we are men. We will pretend we don’t grow babies, we don’t birth babies, and we don’t make milk to continue to grow babies. Many of the feminists of the time, such as Gloria Steinem, DIDN’T have babies. Others, like Betty Friedan had children who were older by the time they spearheaded a cultural revolution.

The “Mommy Wars” are a direct outgrowth of this acceptance of the male construct of what is and isn’t work. The media plays into big corporations’ hands when they keep the conversation about women judging each other; “working” mothers versus stay-at-home mothers. Giant formula makers are happy the conversation stays away from the damage we are doing to the long-term physical and mental health of human beings by feeding milk proteins designed for baby cows instead of baby humans.

Purely from a science perspective the verdict is in. Breakthroughs in epigenetics, the human microbiome, gut health, and evolutionary biology all point to the same conclusion; formula feeding is a major health risk in our society, but no one is talking about it except people directly involved with lactation education. We desperately need to make a cultural shift if we want to truly deal with the obesity epidemic. Or tackle lowering our rates of heart disease, autoimmune disease, breast and cervical cancer in our country and much, much more. Studies link all of these health issues to artificial human-milk feeding.

That shift starts by valuing women’s abilities to nurture and sustain life. Acknowledge that women have brains, and uteri, and breasts that lactate. We are the crucial link between the generations. This most important ability needs to be supported by every level of society if we want the human race to thrive. We need to support not only the women who are pumping behind closed office doors, but also the women who need to pump during a break from picking strawberries, and the women who are working at home to raise kids, and the women who are nursing their children while they take calls for their in-home business, and the women who are taking their babies to work. We need to tell all mothers through our laws, through our media representation, through changes in our language, through our politics, and through our economics that all women who are providing breastmilk for their children are doing important work for all our futures. I want us to move beyond the Mommy Wars, to move beyond normalizing breastfeeding, into a culture that values and supports the significant contribution every lactating woman is making for our country, our world and our species.   

Jennifer Stover is the education chair of the Central Coast Breastfeeding Coalition, based in San Luis Obispo, CA. She has been a La Leche League leader for 5 years and a certified birth and postpartum doula for over 20 years, and founder of the Birth & Baby Resource Network.

Classic Hospital Bed Meets Ancient Wisdom

So you have read Ina May's Guide to Childbirth and plan to birth in an active, upright position. Bravo! You have taken the first step in reclaiming your birth instincts. As a first time mother you have chosen to do a "homebirth in a hospital." You took classes, hired a doula, and crafted a birth plan. Being well educated when labor began you did not rush to the hospital with the first contraction. Instead you listened to your doulas suggestions of eating, showering, baking, gardening on hands and knees, rocking in a rocking chair, swaying on a birth ball, dancing, cuddling, hanging within your partner's loving embrace, climbing up and down your stairs, and going out for a walk or two or three. 

At last the time has come to drive to the hospital. You climb in the car and instinctively know that leaning back in that bucket seat while you sit to ride to the hospital is NOT going to be fun. Each contraction is intensified without being more productive. You are so glad to be able to get out of the car. You get on your feet and instinctively lean forward, drop your knees a bit and sway gently with the contraction that hit as soon as you stood up. Strong but doable you tell yourself. 

Next stop the emergency room doors and waiting for a wheel chair to take you to your room. Now they want you to sit in a chair and wait for a chair. The idea of not having to walk sounds inviting as your labor hormones are coming on strong and making you feel drifty but the actuality is something very different. Labor sensations while in a wheel chair moving forward causes your head to swim and you grip the arms of the chair causing tension through your neck and back intensifying your pain. The pressure of the seat on your bottom causes you to lift one cheek and list to one side. Too late you realize walking would have been much better than this. You traded in your feelings of competency and confidence in exchange for a quicker way to access the privacy of your birth room because you have a strong desire to be away from the bright lights and staring eyes of strangers. 

You finally arrive at the room where you will meet your baby face-to-face and there it is; the bed. It's presence dominates the room. Next to it stands all the technology money can bring to birth; fetal heart monitor, contraction monitor, computer, read out screens, audio controls, blood pressure reader, oxygen saturation tester, IV pole with computerized medication administration box attached, in other words, all "the machines that go beep". Still it is the bed that seems to suck the life out of your idea of an active birth; an instinctual birth. Your nurse cheerily asks you to pee in a cup and climb into the bed. So after all that walking, and sitting, and rocking, and kneeling what should you say or do?  

U.S. mothers are faced with this dilemma every day or more likely night. How should you handle this moment. It will be the opening moment in the long negotiation of your birth. If you have already had a baby and experienced that moment what DID you do? How do you feel about it now? Would you do it again?

This is the theme for July's Positive Birth Movement; the hospital bed's impact on your birth. PBM started in Great Britain and is spreading around the world. I am proud to be the SLO facilitator. We will be discussing the topic of labor beds from many different angles at my coffee & conversation in July.

It is important for modern American women to fill their mind with images of many possible birthing positions. Positions that can be done in or out of a hospital bed. How many different positions do you see portrayed in this short film? Notice how many different ways one may "squat". How deep the squat is, how far apart her feet are set, whether or not she is rounding or arching her back, pushing her feet against something or someone, or pulling on something all make the physics and body mechanics different.  <iframe width="560" height="315" src="https://www.youtube.com/embed/0J5xlBmJHTI?list=PL197D9817EDD8A137" frameborder="0" allowfullscreen></iframe> 

For anyone to make the general statement that squatting causes babies to descend too rapidly or causes tearing isn't educated enough about squatting to see all the many nuances that can be obtained. <iframe width="560" height="315" src="https://www.youtube.com/embed/Q3wbuDSio74?list=PL197D9817EDD8A137" frameborder="0" allowfullscreen></iframe>

Many of our doctors and nurse midwives are comfortable with mothers moving into a variety of laboring positions but once the mother is in the pushing phase still desire to take over and control the process by moving her into positions they, the care providers, are most comfortable in regardless of the mothers instincts or desires. In which of these birth positions do you think your care provider will be comfortable catching? Which ones will he or she have ever done? <iframe width="560" height="315" src="https://www.youtube.com/embed/HiCgDlxdmPI?list=PL197D9817EDD8A137" frameborder="0" allowfullscreen></iframe>

In many ways I see the pushing phase of labor as the final frontier of the struggle I have been part of for so many years; the struggle to return birth to the birthing woman. As a doula the hospital labor bed represents the Berlin Wall that stands between women and their innate abilities. It is long past time to “Tear down this wall!” 

What a VBAC Calculator Shows

This morning I noticed this intriguing post in our local ICAN group's Facebook page:

I know this isn't an active group, but this is the only one of my groups where it seems appropriate to post this. Does anyone know where I can find info about the VBAC rates for home births and hospital births? I found this cool VBAC calculator, but it doesn't account for birth setting.https://mfmu.bsc.gwu.edu/PublicBSC/MFMU/VGBirthCalc/vagbirth.html

A Vaginal Birth After Cesarean calculator? Really? So I decided to try it.

It is always important to know who you are playing with so I investigated who created this calculator. OK it says it is based on data collected from an article "Development of a nomogram for prediction of vaginal birth after cesarean". A nomogram? Huh? That is just a geometric way of looking at multiple variables. The data set came from the Maternal-Fetal Medicine Unit Network. Here is their mission statement: "The MFMU Network conducts clinical studies to improve maternal, fetal and neonatal health emphasizing randomized-controlled trials. The aims of the Network are to reduce maternal, fetal and infant morbidity related to preterm birth, fetal growth abnormalities and maternal complications and to provide the rationale for evidence-based, cost-effective, obstetric practice." They are a network of university based hospitals. These teaching hospitals are where the births happened that form the statistics to base this calculator upon.

First the questions they ask to help them calculate are telling. They want your age and body mass index. Don't know your BMI? Don't worry they'll calculate it for you. They want to know if you have a "proven pelvis". What's that? It is a woman who has either had a vaginal birth before or after a cesarean. In other words at some point a baby "fit" through. They want to know if your cesarean was for lack of progress dilating, lack of progress moving the baby through your pelvis or some other reason. Other reasons could be twins, breech, high blood pressure, fetal distress, maternal fever, etc. They just lump all the other reasons into one category. Most distressing to me are their questions about race. They break it down by African-American, Hispanic and all others lumped together. What the hell? What on earth should race have to do with it?

So here is what I found when I did some calculations.  I kept all other factors the same except the one I was looking at. Trying to compare apples to apples. Let's look at age first.

Age 
They obviously feel age matters. I changed the age from 18 to 30 to 35. 
I had between 7% to 10% less chance of successfully VBACing at 30 than at 18 years old. The low end reflects women who progressed on their predetermined schedule. The top end reflects women who fell off the time chart plus were heavier. At 35 it drops again. Now I have 10% to 15% less chance depending on the other factors. Ugh! Obviously age is NOT something you can do something about or can you? How many 35 year-olds do you know? I have worked with many and some have the physical health of a 40 year old while others could pass for being in their twenties.

Weight
By adding 70 pounds to a white woman with no previous vaginal births and allowable progress during labor/pushing she has lowered her chances of VBAC success by 12%. If she had a "failed" labor the numbers move down to 16% because of the additional pounds alone. This may make some sense because weight can cause confounding health issues, such as high blood pressure.So if you want to VBAC stack the decks in your favor by starting at a healthy weight. Oh wait! If you want to avoid that first section be a healthy weight before you get pregnant and then work with someone who knows about pregnancy nutrition to stay on track.

Arrest of Labor
This is defined as absence of progress. So of course one must FIRST note that progress is a very subjective animal. The good news is this calculator says if you had a surgical birth for arrest or "failure" either during dilation or pushing your chances are only 9% to 12% less than the woman who didn't. As a doula I know it is critically important to look at WHY you stopped progressing or weren't progressing fast enough. Was the baby in a poor position? Was this a failed induction? Why were you induced? Too long past due date? How far was too long? Baby "suspected" of being too large? How large was he or she really? Induced for other health concerns, blood pressure, diabetes, etc.? Perhaps your water broke and labor didn't start quickly enough so you were given labor initiating drugs. Did you have an epidural? At what point in the labor? I can't stress how important it is to obtain ALL your records and to go over them with an experienced doula or midwife. Perhaps your "failure" to progress was actually THEIR failure. 

Race
Here is where they doubly fail women. Be prepared to get angry.
I went back and changed only race as a factor. So let's look back at the age issue WITH race added in. If I am a 30 year old woman of color I had a 10 to 16% less chance than an 18 year old. While a white 30 year old has a 7% to10% less chance.  And at 35 I as a white woman would have 10% to 15% worse odds but as a woman of color it plummets to a 21% less chance of success. Excuse me? What about race with weight? If I am a 30 year old white woman with healthy weight, no vaginal births and no "failure" the calculator predicts I have a 80% success rate in their hospitals. That same woman of color? 67.2%! That is a difference of about 13%. If  I am 70 pounds heavier I have a 16% worse chance of success than my white sister. 

So now I compared the best case scenario; 18 years old, healthy weight, no arrested labor c-section, vaginal birth before and after surgical birth, White to Black or Hispanic. Shockingly the numbers say a woman of color automatically gets 4% worse chance of birthing vaginally. That my friends is systemic racism in its most insidious form. It is in how they are treated from the moment they are in their doctor's offices until the moment they are discharged from the hospital. I have witnessed this unequal treatment. Every time it has angered me. Usually it appears to anger me more than the woman trapped in it. Perhaps because she has only her own experience to compare, whereas I can compare her to the white women I have supported. But here the numbers are; in black and white for all to see. A disgrace.

I did not intend for this to be a post about race. I started in thinking I was going to check out this calculator and compare hospital stats with homebirth stats. But the numbers took me a different direction. Here are two links for those of you who wish to compare homebirth and hospital birth numbers. They were posted by Terri Woods of SLO Doula Connection  in response to the ICAN query. She rightly warns that homebirth midwives automatically risk out a variety of complications and so it isn't exactly apples to apples. Still it is worth noting that out of 1,354 VBAC women 87% were successful. There is no way for me to do a straight comparison because I don't know anything about age, weight, reasons for prior sections or if they have had a vaginal birth either before or after their surgical birth. 

Science and Sensibility looks at the MANA homebirth study 

Outcomes of Care for 16,924 Planned Home Births in the United States: The Midwives Alliance of North America Statistics Project, 2004 to 2009

Planning to VBAC? Hire a doula. Plan a home birth. Hire a midwife. Get healthy and stay healthy. Finally question, question, question; especially if you are a Black or Hispanic woman. 

Consumer Reports: Cesarean Births

“How you deliver your baby should be determined by the safest delivery method, not which hospital you choose.” 

I couldn't agree more with this statement. Consumer Reports is beginning to tackle the issue of our disproportionate cesarean rate. The World Health Organization has determined that NO region, area or country should have a higher rate than 15% rate. Currently the US has a rate twice that and California's is even higher. The rate is "up 500 percent since 1970. All those C-sections have not translated into substantially better outcomes for mothers and babies. The infant death rate in the U.S. is higher than that of most other industrialized nations. And the maternal death rate actually increased slightly from 1990 to 2013, according to an analysis published May 2, 2014, online in The Lancet medical journal."

So What? 
Why should we be concerned? C-sections are safe right? Usually when they are done it is because they are safer for mom, baby or both, than a vaginal delivery right?
"A C-section—the second most commonly performed surgical procedure in the country, requiring a 6-inch incision in the abdomen and a second through the uterus—is major surgery, and thus takes longer to recover from than a vaginal delivery and also carries additional risks." 

Consumer Reports is also concerned that hospitals within a few miles of each other with similar populations can have such drastically different rates of surgical births. "And unfortunately, it’s usually much easier to find a hospital with a high C-section rate than a low one." 

Our Local Hospitals
To earn top marks a hospital had to have a c-section rate of between 5-9.5%. None of our local hospitals earned this ranking. Twin Cities comes in at the next best level between 9.5 and 11.5%. French is in the average zone at 11.5-15%. Both Marian and Sierra show up in the next to lowest ranking with between 15-21%.

Hey That's Not Fair 
You may be thinking Sierra Vista should have a higher rate because they have the high risk mothers. Consumer Reports tried to correct for this. "To level the playing field, the measure controls for some things that affect C-section rates, such as not including multiple gestations and breech births. However, this measure does not account for all differences in patient characteristics (such as chronic illness) that might affect the C-section rates of an individual hospital." So yes their rate should be higher because the high risk moms with chronic illness appropriately deliver there. The question is how much higher? Both Sierra and Marian are just a few percentage points away from being given the worst rating.

“We think it’s time those hidden numbers are brought to light,” said John Santa, M.D., medical director of Consumer Reports Health. 

Well said! Pregnant consumers and their families deserve this information in order to make true informed choices about their births.

Quotes were taken from the following 3 articles by Consumer Reports.

What Hospitals Don't Want You to Know About C-Sections:
Very good in-depth article with an excellent section on things to do to avoid a surgical birth.

Hospital Ratings; Avoiding C-sections: 
Their statistics

Safety Scores:
Finding your hospital's score.

More Research and Reading

What to Reject When You are Expecting
Good list of prenatal and during labor procedures to avoid

My Birth Statistics
Comparing my stats with our local hospitals

Dear Anatomy & Physiology Professor

Yesterday I finished a 12 week anatomy and physiology 2 part course. At the end I posted my professor a note in the discussion area.

I have enjoyed both Anatomy classes and have learned lots of information valuable for the various things I do. I am a birth doula, birth educator, La Leache League Leader, parent educator and more. I do have some ideas about the labor and birth chapter which I meant to contact you about. I'll still try to do that before the discussion areas get closed. 

Thank you,

Jennifer

The professor responded, "I'm glad you enjoyed the course and look forward to your input!"

So I spent a considerable amount of time yesterday going carefully through her lectures and formulating my response. I posted it into the discussion area as I had no other way to connect with her. I found out this morning that she took it down and sent me this reply, 

"To Jennifer,

Thank you for the information.  I am not able to keep that type of post up in the Discussion Area, but I read it carefully and copied and pasted it into a Word document for further review.  I am looking forward to checking out the references you included.  I think the pendulum has swung some on medication during childbirth.  When I was having my children (my oldest is 33 and my youngest is 18), women were encouraged to avoid medication if possible, while women in my mother's generation were significantly medicated.  Now, it seems that epidurals are used almost routinely, rather than reserved for special situations.

http://americanpregnancy.org/labornbirth/epidural.html

I think it's very important for women and their partners to learn as much as they can about pregnancy and childbirth, understand the pros and cons of different types of pain relief, think about their ideal situation for labor and delivery, and then discuss their wishes and concerns with a physician who comes highly recommended and who they trust.  

Thanks again for the info!"

I couldn't agree more. Women should learn all about the pros and cons, safety and risks of ALL medical procedures before they give birth but NOT in an anatomy and physiology class. In an anatomy and physiology class they should learn how a woman's body works without any outside interference. How her musculoskeletal, integumentary, sensory, hormonal, chemical and nervous systems work in concert to bring a baby into this world. 

Here is what I posted on the discussion board:

I have some thoughts about the sections in your lectures which cover normal vaginal birth. Let me explain my background. I have been a doula for over 20 years. In case you aren't familiar with this profession, a doula supports couples during the entire birth process and into the early postpartum period as well. I have been at over 100 births. Some have happened in homes and birth centers, but the majority of my clients have chosen to birth in a hospital setting. I have seen lots of babies come into this world vaginally and some via cesarean section. Along with this I am a birth educator and La Leche League Leader. La Leche League International has been educating and supporting breastfeeding women for over 50 years. They have the most up to date information and studies on lactation, breast milk, and breastfeeding. As a Leader I am trained to support mothers who desire to breastfeed through facilitating meetings and providing one-on-one support.

Throughout your classes I have been impressed with how well you explain the body's systems both anatomically and physiologically. The more I know about the human body the more amazing its abilities seem to me. I am very passionate about women, birth and families. It is very important to me that women are given accurate information about their body's birthing and breastfeeding abilities. Unfortunately in our culture women know very little about birth and what they are told is not at all from an anatomical and physiological stand point. Instead it is heavily mixed with cultural beliefs with no regard for science. Unfortunately I believe your section on birth is skewed in this manner. Women need to know how we were designed to give birth. If they then choose to use medical and pharmacological props or interventions that will be an educated cultural choice. As this is an anatomy and physiology course, I am hoping you will consider taking a more physiologic approach to how you present birth to women. Please understand I am NOT advocating women should birth without skilled help at the ready. How much they use or need that help will depend on their unique situation. I want them to learn what their bodies are capable of doing. 

Here is what I have learned from watching women, keeping up with the latest science, and opening my mind to see past our current birth culture. Women are designed anatomically to labor and birth in upright positions. Left to their own instincts it is very rare indeed for a woman to choose to lie down to birth, especially on her back. Imagine a woman choosing to lie flat on her back to defecate or urinate. Most un-medicated women will choose to stand, semi-squat, full squat or be on their hands and knees. Unfortunately all of your graphics clearly show the supine position. This position is brought about through the use of pain medication and for doctor and hospital convenience. It is considered normal only because of cultural influences on the physiologic birth process. Anatomically it flattens the pelvis and doesn't allow for the sacrum and coccyx to move out of the way of the descending head. It also immobilizes both of the illiac bones making it harder for them to spread laterally giving the additional space needed for the baby. You mention the doctor placing the woman in a semi upright position but as long as her bottom is against the surface of a bed she will be hampered in her abilities to birth unassisted, but unassisted is what we are anatomically and physiologically designed to do.

In your course you say the doctor will tell the mother when second stage has begun. But anatomically when a mother is un-medicated she does not need to be told when to begin pushing. When the baby descends to a certain point in the pelvis he naturally triggers the fetal ejection reflex in mom. Just as when you need to vomit you know you are about to vomit. No one needs to tell you it is time or how to do it. No one needs to say how long each vomiting session should last. This is exactly like the 2nd stage of labor. The mother, even a first time mother, will spontaneously begin to push with her diaphragm and abdominal muscles. She will not be able to help it. She will not be able to stop herself. She will naturally tend to push 3 times during each contraction for approximately 6 seconds. This amount of time works physiologically for the baby. When a mother is pushing she tends to hold her breath to bear down. This breath holding reduces the available oxygen to the baby. Six seconds is an amount of time that babies tolerate well. Longer than that can cause a drop in oxygenated blood with a corresponding rise in fetal heart rate as they physiologically struggle for homeostasis. 

The un-medicated mother will know when she is crowning from the burning sensations she will feel. Most mothers stop pushing and cry out. This releases the vaginal muscles and allows for the last stretching. I agree with you that it can be helpful for a provider to gently put counter pressure on the head to keep it from coming so quickly mom’s vaginal tissues tear but this is not how the system was designed. It was designed for the mother to birth like other mammals, without assistance. Further there have been many studies done that show that an episiotomy does not keep a woman from tearing. As a matter of fact they all agree that a woman is more likely to have a 3rd or 4th degree tear if she has an episiotomy. Currently most doctors only do an episiotomy if the baby's heart rate is dropping into the danger zone. In this situation it can be life-saving.  

When the baby's head appears the supine or semi-reclined position necessitates a care provider to hold the head so the head doesn't flop backward, hyper extending the baby's neck. When a mother births in a squat the head stays perfectly in line with the body as it hangs down. In your lecture you say the doctor will rotate the baby's shoulders but most babies rotate without any assistance. It is part of the anatomical fit between mother and baby that causes them to sort of cork screw out. It is only if their shoulder is stuck under the pubic bone that this doesn't happen. Finally rather than a doctor needing to catch the baby as you suggest, the mother is capable of reaching down and catching the baby as it pops out after the body rotates into position. I have witnessed this. 

As to the physiological process, you mentioned the hormones oxytocin and prostaglandin but equally important in the process are dopamine and endorphins. This combination of dopamine, endorphin and oxytocin is the same combo released during orgasm which causes intense pleasure and a feeling of floating. In labor this powerful chemical combination changes the laboring woman's perception of the pain allowing her to endure much more than she would otherwise. On top of that she is chemically driven to bond with her new baby as soon as he or she emerges. This is a very important feed-back loop which pitocin and an epidural disrupt. It has consequences for the next phase, mothering the baby outside the uterus.

The latest studies all show conclusively that immediate skin-to-skin contact is what we are physiologically designed for rather than taking the baby away even briefly and presenting it back to mother as a wrapped bundle. The mother and baby should continue to be considered one biologic unit. They share bacteria, hormones, body fluids, antibodies, fats and proteins. A neonate has no ability to self-regulate. He does this through his mother. Hearing the mother's heart beat and feeling the rise and fall of her breath regulates his heart rate and respiration. It keeps the levels of adrenalin and cortisol at their appropriate levels; enough to cause the baby to be hyper alert without causing him physical stress. Science has proven babies should not be taken away or wrapped in blankets. This is part of the WHO Baby Friendly Initiative. Their goal is to have all babies go immediately onto their mother’s abdomen or chest unless they need life saving measures. Normal suctioning doesn't count as life-saving. If needed this can be accomplished quite easily on the mother while baby remains skin-to-skin. They are to stay this way undisturbed for the first 2 hours of life so that all of the above sharing and regulation can occur. If you haven't watched a video on delivery self-attachment yet you will be amazed! We are much more like other mammals than we have given our babies credit. When un-medicated, undisturbed, and left skin-to-skin with mom they move themselves into position and find the nipple, latch on, and begin feeding. I just attended a conference where I was blown away by the latest info about epigenetics and breastfeeding. Breastmilk contains, histones, lepten, and microRNA, which all pass to the baby. They attach into their genes and change how the genes are expressed. This is an important further step in passing on genetic information from one generation to the next.  

The third stage is more easily accomplished if baby stays with mom. This triggers further oxytocin release, especially if the baby latches and begins to nurse, which stimulates the placenta to fully separate and then keeps blood flow to the amount which brings mom back to homeostasis. She loses the extra blood she created to maintain the pregnancy which she no longer needs. There is no need for "a little bit of pitocin" as you have taught unless the mom actually IS bleeding too much. Again our physiology is miraculously designed to take care of most contingencies. Only when it is not able to do its job successfully should we vary from this amazing design which you clearly have so much respect for.

Finally I want you to imagine what would physiologically occur if the mother and neonate were all alone immediately after birth. What would the mother do? Would she immediately clamp and cut the umbilical cord as you have stated the is done in our hospitals? Highly unlikely. Therefore what is supposed to occur? As you detailed so well, the baby's circulation and respiration have major changes that need to happen. These will generally take place quite peacefully without any gasping or stress to the baby. There is significant pressure around the baby's chest when it is squeezing through the vagina. When the baby is born there is therefore a significant drop in pressure which causes air to try to rush into the lungs. Also there are nerves in the skin of the neonates face which, when exposed to air for the first time, trigger him to breath in. This is why babies can be born under water and not drown. They do not attempt to breathe until their face is lifted out of the water. Further as long as the cord and placenta are intact and still pulsing the neonate continues to receive oxygenated blood from the mother through the placenta. The cord is covered with a substance called Warton's Jelly. When the air hits the cord it dries this out and triggers the cord to slowly stop pulsing. Meanwhile inside the baby his body is working to close the foramen ovale and reroute the blood. Most cords will pulse for 5 to 10 minutes after birth and placentas stay adhered to the wall for anywhere from 15 to 30 minutes. This gives the baby buffer time. I don't believe in this scenario there is a fall in blood PH, but I could be wrong. This also gives the mother/baby system time to bring their blood exchange into homeostasis with the neonate receiving exactly the right amount of blood. If you clamp the cord too soon you will leave 1/3 of the fetal blood in the placenta. This blood is needed by the neonate for many reasons. They are discussed in one of the links below. 

Thank you for listening and thank you for expanding and deepening my knowledge of the human body. I'm very glad I took this class. If you wish to ask me further questions about labor, birth or breastfeeding please email me at jenniferstoverdoula@gmail.com.

A standing unassisted birth video: https://www.youtube.com/watch?v=zFMHB4RqpjI  

An MRI study of Pelvimetry in 3 positions:

http://www.ajronline.org/doi/pdf/10.2214/ajr.179.4.1791063

Further explanation about up right positions: http://www.givingbirthnaturally.com/birth-positions.html

Discussion of labor hormones and how catecholamines disrupt the natural hormonal cascade:http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1595201/  

Fetal Ejection Reflex: http://www.wombecology.com/?pg=fetusejection

Delayed cord clamping: http://www.scienceandsensibility.org/?p=5730

The requirements for a hospital to become Baby Friendly certified:http://www.babyfriendlyusa.org/about-us/baby-friendly-hospital-initiative/the-ten-steps

Importance of skin-to-skin contact: http://www.medscape.com/viewarticle/806325

Breast Crawl video: https://www.youtube.com/watch?v=zrwfIcPB1u4   

I hope dear reader you found this information helpful to you. Please feel free to share it with others. You can link to this blog or share it via Facebook. Even copy and paste it into an email or on your own web site. Please remember to attribute it to me.

Listen to National Experts: What the Birthing Women of San Luis Obispo Need to Think About!

These posts originally appeared as my Food for Thought series on Facebook. I wanted to provoke the women of San Luis Obispo county into thinking about their birth and parenting choices. By quoting directly from books I wish to stimulate discussion and encourage women to seek out information and become more educated. My hope is you will empower yourself through this process.

“Our lives begin to end 

the day we become silent about things 

that matter.”

~ Martin Luther King, Jr. 

from his unforgettable

 "I Have a Dream" speech

Doctor or midwife: How to choose which is right for you.

Baby Bonding and Attachment: Getting Parenting off to a good start.

Induction and Due Dates: What you need to know to keep anyone from scaring you into a decision.

Understanding Risks: Learning more so you can choose the risks you are most comfortable taking.

Parenting in Labor: Things to know about the decision to use pain medication.

Labor & Birth: Things to remember about normal labor and birth.

A Positive Cesarean Birth

Approximately 10% of women will truly need to give birth to their babies via surgery. For most of the women in this country this is far from a positive experience. Their babies are born behind a screen and then are moved to a plastic box, called an isolette, far enough away the mothers can't really see them. Once they are checked over and determined to be breathing ok, they are wrapped up so only their tiny faces are visible and given to their dads sitting next to the mothers' heads. The mothers who are lying flat desperately want to at least see their babies' faces. The dads try to find a way to accomplish this with their floppy newborns. Mothers crane their necks trying to catch a glimpse of their babies' gaze. They are biologically driven to look deep into their babies' eyes and connect. In just a few minutes dads and babies are whisked away to a nursery. All the other normal biologic functions which kick into gear as soon as the mothers have given birth are disrupted. These are called claiming behaviors. We are meant to smell our babies, kiss our babies, touch our babies. We are meant to look them over from head to toe and to count each tiny finger. And of course to put the baby to our breast and begin the breastfeeding relationship. Our senses and our babies are heightened at the moment of birth. We are both exquisitely aware of each other. We are meant to connect on a deep emotional, biological, chemical level; a connection which will last a life time. But for most mothers around the world having cesarean babies they get none of these. By the time they get to really see their babies they have been washed and dressed and are deeply asleep; too sleepy to breastfeed for  hours.

For a different perspective on the cesarean birth experience please watch this video. Then talk to your doctor, your midwife, your doula, your husband, and your hospital. You and your baby have a right to the most natural positive birth possible. You can make this happen!

Get Inspired

"Never doubt that a small group of thoughtful committed citizens can change the world; indeed it is the only thing that ever has." Margaret Mead, woman, daughter, wife, mother and controversial cultural anthropologist.



Inspired? Join the Birth & Baby Resource Network or International Cesarean Awareness Network. You can find the info about meetings in the side bar under Meet Me or go to my Labor of  Love Virtual Rally event page and find out the next step.

I am a Community Lactivist

I believe in breastfeeding both for the healthy growth of a child and the healthy growth of a mother. When a new mother breastfeeds she learns to watch and listen to her child's cues. These simple facial expressions, body movements and vocalizations which trigger our innate response to nurture are the start of a life long conversation...

See community lactivism in action and read more about why as a doula and La Leche League leader I support breastfeeding women.Here. 

Speaking for Midwives at SLO's Historic Celebration

This is Nora Lewis the certified nurse midwife who caught my son at Sierra Vista Hospital in 1990. That birth changed my life forever and set me on the path to becoming a doula. When it was over I had many hurt and angry feelings and a million questions. After being part of many women's births over the years I have grown in my understanding of what occurred during my own labor and have come to a new perspective and deep appreciation for my midwife. Working side by side with many different midwives has given me a great respect for the women who answer the midwifery call and dedicate their professional lives to helping women all around the world. I was honored to give a speech about midwifery at the Birth & Baby Resource Network's historic celebration for the International Day of the Midwife and I was very grateful to be able to publicly thank Nora Lewis for her courageous stand with me that long ago August day.
My Speech.

Midwifery; a David and Goliath Tale

The story of midwifery in America is a classic power struggle for women’s rights, respect and choice; a tale of the clash of women’s culture and values with the male dominated spheres of science, medicine and finance. It is an ugly story laced with racism and class war fare. This struggle continues to walk the halls of political power and sits in insurance industry board rooms today.
It began as the eighteenth century was drawing to a close and the science of medicine was on the rise. Men for the first time began to move deeply into the privacy of the birth room, a place that in most cultures around the world is traditionally populated almost exclusively by women. This slow and determined encroachment into what had previously always been a woman’s world began the battle.

Before men became involved American midwives had always held a place of respect within their communities. Their skill at helping women during the birth process was of vital importance to all in the community. Women were encouraged to stay mobile as long as possible during the birth, the pain of the process was recognized but not believed to be insurmountable, the passage of time was noted but there were no standardized graphs labors had to abide by, and women utilized up-right physiologically sound positions for pushing a baby out.


When male doctors took over this all changed. Pain relieving drugs were used as an inducement to have doctors attend women’s births. These medications changed the balance of power forever; stripping the woman’s innate abilities. She became an object to practice medicine upon; someone who needed her baby delivered to her like a pizza instead of using her own physical power to bring her baby forth. Soon untested scientific “theories” blended with necessities created by using pain medications and women were routinely being cut and babies were being pulled out with forceps.

As the prestige of the medical profession rose, so did their power. In the end it came down to dollars and cents. In order to corner the market doctors began a campaign to stamp out midwifery. First they created a belief that birth was a medical event which could only be safe if attended by a physician. Doctors traveled in the upper circles of society. They convinced bankers, lawyers and other prominent society men to avail themselves of the best that the science of modern medicine could offer for their wives by using a physician. Men controlled the medical schools and women were not allowed to attend so female care providers slowly began to die out. In the early twentieth century not satisfied yet, they convinced the government to begin a propaganda campaign slandering midwives as dirty, illiterate, and ignorant. Eventually only poor women or newly arrived immigrants were still turning to midwives for care.


Meanwhile another huge shift in health care in our country was taking place. Hospitals were on the rise, with their bureaucracies, standardizations, schedules and sanitization of birth. Women were told it was best when labor began to leave their homes, where they had some control, and travel to a hospital, where they had no control. Hospitals lead to the immediate separation of the newborn from its mother and scheduled feedings. These disruptions in the process along with the drugs created babies who could not suck effectively, needing to be force fed from bottles. Soon the women of America thought their bodies were so defective they couldn’t even breastfeed their own children. Meanwhile the practice of midwifery was outlawed in most states.


But it’s hard to hold good women down. It is hard to stop women from answering the call to serve women; especially women in need. In the 1920’s nurses began to step forward to get additional training in the skills required to help low income women, the rural and urban poor. These were women who couldn’t pay doctors and hospitals, therefore providing them care did not threaten the medical establishment’s monopoly. They eventually founded specialized nurse midwifery schools and associations. From this branch was born the certified nurse midwife. In the 1960’s couples living on communes had turned their backs on many forms of the “establishment”. These female rebels began to birth their babies at home with the help of other women in their communities. The daring women who answered this call eventually became highly trained homebirth midwives. It took courage to be a midwife, to practice midwifery without a license. Not only could you lose everything, your home and your practice, you could be thrown in jail. In our county one traditional midwife was brought up on charges and convicted in 1982. Over time this branch of midwifery also adopted standards for training, created associations and worked hard to become legal once again. In California the legal battle culminated in 1993 in the creation of a system to license out of hospital midwives but it took 4 more years for the first group of midwives to be licensed by the state medical board.


All midwives are still fighting for the right to work as autonomous, respected members of the birth provider community. Whether they are CNMs who have made the choice to work in a doctor’s practice under his supervision because even if they could find a company willing to cover them medical malpractice insurance is prohibitive, or the LMs who can’t get insurance company’s to reimburse their clients for basic care the struggle continues. The California Medical Board is currently reviewing whether to change the language in the regulations governing LMs to allow them to order the life saving medications and tools they need to attend birthing women. And so the struggle continues.


This year on May 5th, the International Day of the Midwife, the women and their families who have been cared for so well for so many years by our community’s midwives will gather in Mission Plaza to honor 41 courageous, tireless, and caring professional women. The Birth & Baby Resource Network along with the co-sponsors of this year’s Birth & Baby Fair wish to invite you to join us at 10:30 for this historic event in the annuls of San Luis Obispo women’s rights.


Participate in BBRN’s on-line Midwifery Project at: www.bbrn.org.
Learn More about the History of Midwifery:
A Midwife’s Tale; Martha Ballard her Diary by Laurel Thatcher Ulrich
Motherwit; an Alabama Midwife’s Story by Onnie Lee Logan
Listen to Me Good; the Life Story of an Alabama Midwife by Margaret Charles Smith
Birth Matters; a Midwife’s Manifesta by Ina May Gaskin
A Short History of Midwifery: from Midwife Info an independent internet resource 
I am a Midwife, a movie trailer by the Midwives Alliance of North America
Fiction with Midwifery themes:
The Midwife's Apprentice by Karen Cushman
The Red Tent by Anita Diamant
Midwives by Chris Bohjalian

A Midwife's Story by Penny Armstrong and Sheryl Feldman

Understanding Risk

Whose Risk are We Talking About?

"We must never underestimate the power fear of litigation holds over obstetricians. In my experience, as a motivational force it over shadows their desire to lower the maternal mortality rate." 

~ Dr. M. Wagner

The "Risks" of Home Birth: Why haven't we heard about this? 

"We now have good, solid scientific evidence that makes clear that planned home birth attended by a midwife is a perfectly safe option for the 80 to 90 percent of women who have had normal pregnancies...This study is by far the largest scientifically valid study of planned home birth ever conducted...In summary this prospective, highly reliable study, which followed the course of more than 7,000 pregnant women planning home births attended by CPMs (Certified Professional Midwives), collected data on more than 5,000 who intended home birth at the initiation of labor. Among these women, the obstetric intervention rates were far below the rates reported in low-risk hospital births. The combined intrapartum/neonatal death rate (babies dying during labor, birth or shortly following birth) was as low or lower than rates reported for low-risk hospital births. And the maternal mortality rate was zero." ~ Dr. Marsden Wagner Born in the USA. 

When I looked up this study I found that 12.1% of the women ended up needing to be transported to the hospital but many of the transported women still didn't need a cesarean. Of the total low-risk home birth women in the study only 3.7% needed a c-section. How does that compare with our hospitals? Visit my Hospital Statistics post to find out.

If this study was published in the Boston Medical Journal in 2005 (six years ago!) why don't more people know about it? Why isn't the whole medical community talking about it, trying to understand what this means about how hospital-based birth is conducted? Why aren't they trying to understand the lessons that can be learned from home birth and how to incorporate those lessons into their practices? To read more about this study visit the Boston Medical journal web site. 

Which Local Hospital is the Safest?

Why would the same OBs who delivered babies at Sierra Vista for years, before they had a Neonatal Intensive Care Unit, now being telling women that French Hospital is unsafe because they don't have a NICU? They never told women in the past they needed to go out of town to a hospital with a NICU to safely deliver their babies. Just saying??? Did you know both hospitals have special baby respiratory therapists at births as a safety precaution? Did you know the same pediatricians and neonatalogists will go to either hospital if a baby arrives in need of their services? 

Hospital Versus Home Birth: Accepting the fact of risk

"If the obstetric tribe says that out-of-hospital birth is not "safe", the implication, of course, is that a hospital birth is safe, which is not true. Newborn babies die in hospitals every day, sometimes because someone made a mistake. When the obstetrics establishment implies that this doesn't happen, the family naturally feels deceived when it does happen." More from Marsden Wagner's 'Born in the USA'.

One of the hallmarks of a good out-of-hospital midwife is that she explains that there are risks to birth and is clear that the parents need to be willing to accept those risks. The reality is with life comes the risk of death no matter where you are or who you are. 

I am a Community Lactivist

I believe in breastfeeding both for the healthy growth of a child and the healthy growth of a mother. When a new mother breastfeeds she learns to watch and listen to her child's cues. These simple facial expressions, body movements and vocalizations which trigger our innate response to nurture are the start of a life long conversation.With support the new mother comes to trust her baby's ability to know when they have a need and what it is they need. As she learns she can meet these needs through breastfeeding she gains confidence both in her mothering abilities and her baby's abilities. As she learns to let go of the need to quantify these abilities through weighing, measuring or lines on a chart she starts down the path of mothering wisdom. This path can teach her to relax. It can teach her to rely more on her child's wisdom than on professional experts. It can teach her she is more a witness to her child's life unfolding than a director. She is more an access to the resources needed  for her child to play their unique heart song than the leader of the band. Breastfeeding can be the key to a new way of parenting for life.

It is because I believe this in my heart that I am a Community Lactivist. I express my commitment to all the breastfeeding mothers out there by being an active member of several organizations that support breastfeeding in our community; La Leche League, Birth & Baby Resource Network and Central Coast Breastfeeding Coalition. I am proud to say San Luis Obispo has a very high breastfeeding initiation rate. Unfortunately like most of the country there is a steep drop off from the second week to two months. We have lots of support groups and resources in our community and yet women still can't seem to make it through the challenging first six to eight weeks and into the months of breastfeeding bliss. As Lactation Consultant Julie Merrill said at Thursday's Farmer's Market, "It breaks my heart to see so many babies in strollers with bottles." The Coalition has just printed a new breastfeeding resource brochure full of places, people, books and web sites mothers can turn to for guidance and encouragement. Look for their green and white cover around town, at your doctor or midwife's office and baby stores. 

This baby wants all new mommies to have this brochure!

Stepping out of the shadows

Breastfeeding mothers need our support. We need to step out of the shadows and take a stand that breastfeeding is normal; formula feeding is abnormal. Babies need to feed when they need to feed and mothers need to feel comfortable attending to those needs; even in public. This is a national health issue. By continuing to pay money to formula companies we are draining our economic resources, environmental resources and our nations future health. Don't be blinded by the "Well I was formula fed and I turned out ok", way of thinking. Look around you we have an obesity epidemic, while cancer, diabetes, and heart disease run rampant in our nation. We are overly dependent on antibiotics and medications. While these may not be the direct result of formula feeding the studies clearly indicate that all of these could be lessened if we only chose to breastfeed for the first few years of our children's lives. I firmly believe some day we will look back on these years of our nation suckling at the teat of the Nestle Corporation and compare it to the time of America's romance with cigarettes.

Our bodies grow smarter healthier babies.

August is National Breastfeeding Awareness Month. If you see a mom nursing her child, give her a thumbs up and a friendly smile. Each day she chooses to breastfeed she is giving her child a wonderful gift and performing a patriotic duty.

We gave a new meaning to "flash" mob at SLO's popular Thursday night Farmer's Market.An special thank you to Robyn Berry Photography.

Lactivistas come in all ages.

Educating the public on the benefits of breastmilk.

Demonstrating the miraculous work our breasts were perfectly designed to do.

Every baby deserves a booby!

Learning one generation to the next.

 Thank you to the mamas who chose to bare it all last night to demonstrate what breasts were actually designed to do.

Inspiring a new mommy.                BREASTFEEDING It Rocks!

 

Read about how I managed to juggle working and breastfeeding here.

This month's La Leche League meetings:

Monday, August 13th at 10 am:

Santa Lucia Birth Center 4251 S. Higuera Street in San Luis Obispo
Topic: Nutrition and Weaning

Monday, August 27th at 7 pm:
Santa Lucia Birth Center
Topic: Baby Arrives

Look for Los Osos meetings to start back in September!