So where does the Bible say that childbirth is meant to be excruciating…or does it REALLY say that?

Genesis 3:16 states:

To the woman He said, “I will greatly multiply your pain in childbirth, in pain you will bring forth children …”

Or at least that is what the New American Standard Bible (NASB) says.  Most modern versions of the Bible have a similar rendition of this verse.  The “truth” of pain in labor is so ingrained that the average reader will think nothing of the difference found in the King James (KJ) version:

Unto the woman he said, I will greatly multiply thy sorrow and thy conception; in sorrow thou shalt bring forth children.

Is this difference significant?  And which version is more accurate?

To get to the bottom of this issue, perhaps a look at the original Hebrew text will help:

Hmmm…well since I took Spanish, not Hebrew in school (and I barely remember my Spanish), that isn’t going to help me much, I don’t know about you.  So I use a handy tool called the “Blue Letter Bible“–which, BTW, is where I got that text above.  Its a handy website that allows you to view multiple versions of the Bible, concordances, commentaries…and a word for word translation from the original Hebrew and Greek texts.

The Blue Letter Bible shows that the first phrase is “‘ishshah ‘amar rabah ’itstsabown herown”  The key words here are “‘itstsabown and herown,” which are translated as “‘I will greatly multiply your pain in childbirth” in the NASB and “greatly multiply thy sorrow and thy conception” in the King James.

‘itstabown is a word that is used to mean pain, labour, hardship, sorrow, toil. It occurs two more times in the Old Testament.  It occurs one verse later in Genesis 3:17:

NASB: in toil you will eat of it [the ground]

KJ: in sorrow thou shalt eat of it all the days of your life.

It also occurs a few chapters later in Genesis 5:29:

NASB:  Now he called his name Noah, saying, “This one will give us rest from our work and from the toil of our hands arising from the ground which the LORD has cursed.”

KJ: And he called his name Noah, saying, This same shall comfort us concerning our work and toil of our hands, because of the ground which the LORD hath cursed.

Only one of the 3 interpretations of “‘itstabown” is translated as “pain,” the one referring to women–and only in newer versions of the Bible.  Interestingly, its also the only one that is translated as “sorrow”–in the KJ.  The others refer to toil-work-which no doubt childbirth is work.  Sometimes hard work will result in pain…but only in extraordinary circumstances would work be expected to be so painful that the pain would be described as “greatly multiplied.”  Is ”sorrow” an appropriate translation here?  It doesn’t appear so to me considering that it is not used in the other passages. 

But is this passage even talking about childbirth?  The KJ uses the connector work “and” which sets up the phrase to have two separate subjects, where the NASB and many other versions use “in,” reducing the number of subjects to one.  Moreover, there is the question of whether this passage is referring to “childbirth” or “conception,” two distinct events, which brings us to…

herown which is a masculine noun which is used as “conception” or possibly “pregnancy.”  In addition to the use in this verse, it is also used in Ruth 4:13 referring to Boaz and Ruth conceiving Obed, and in Hosea 9:11 where 3 distinct Hebrew words are used to describe conception-herown, pregnancy-beten, and childbirth-yalad.

The question of the “and” vs. the “is” can not be conclusively determined since the Hebrew language often leaves out such words, but I think it is pretty clear that this phrase is talking about conception, not birth.

Does it really make sense that God would have cursed women to experience conception as “pain,” especially multiplied pain?  I think not, which leads me to believe that “and” is the correct word here. Eve was told that due to her sin she would have to toil-or work more, and also she would conceive more.  Why would she need to conceive more?  I have read a theory that it is because with the harder life people had to live after being kicked out of the Garden of Eden, more children would need to be conceived to ensure adequate population.  Interesting…I don’t have any theories of my own.

Of course we aren’t out of the woods yet…there is still the second phrase!

‘etseb yalad ben

This translates to “in pain you will bring forth children” (NASB) or “in sorrow thou shalt bring forth children” KJ.  The key Hebrew words here are ‘etseb and yalad.

Well, we already mentioned yalad above…which was used to refer to childbirth in Hosea 9:11.  It actually has a very complex meaning, being used a total of 498 times in the Old Testament, the vast majority of which do refer to labor and childbirth.  So this one clearly is referring to childbirth, not conception.

But what does ‘etseb mean? Other than the use in this passage, it is used 6 times in the Old Testament. One is in Proverbs 15:1 where it is translated to “grievous” but in context could also mean ”emotionally hurtful.”  One use is as “sorrow” in Proverbs 10:22. Proverbs 5:10 and Proverbs 14:23 use it to refer to work. The use in Proverbs 127:2 is translated as sorrow in some versions, but work in others–I think work makes more sense in the context. The final use is in Jeremiah 22:28 where it means “idol,” which seems not to fit the context, unless you consider that an idol is a man-made object–a result of work or toil. 

So the count there is one use as grievous/emotionally hurtful, 1-2 uses as sorrow which is an emotional pain, and 3-4 uses that refer to work. 

So how should it be interpretted in Genesis 3:16?  Well obviously physical pain is not the connotation that is given to it in other verses.  I think any of these definitions could fit.  Labor can be emotionally hurtful to a woman who considers the difficulty of life she is bringing a child into…but I don’t think this is the over-riding emotion women are feeling in labor, do you?  I think that the use as “work” fits better.  So I would translate the second phrase differently than either version, I would translate it as “with work you will bring forth children.”

In any case…I really don’t think there is any indication that the Bible declares that childbirth is meant to be excruciating as a result of Eve’s sin.  In fact, if you read carefully you will find that Adam and Eve are never cursed…the serpent is cursed and the ground is cursed.  Adam and Eve are given consequences for their sin…not a curse.

Oh, and for Dr. F who told me I would be begging for drugs…I’ve had 5 babies now, and never once have I felt even remotely close to begging for drugs.  I have had clients who have had particularly difficult births where the availability of an epidural was definitely a blessing.  But I think we do women a disservice when we tell them that labor is *meant* to be terribly painful.

Yoplait sparked controversy with a "mail in the lid" campaign. Yoplait had promised 10 cents a lid, but consumers would pay nearly four times that on the stamp to send one in. That’s money that could have just been given directly to breast cancer research. Second, Yoplait dairy products were made using artificial bovine growth hormones (called rBGH), which are thought to increase the risk of breast and colon cancers.

If you are on Facebook perhaps you remember the bra color statuses?  And the purse locations?

Its back again.  And I’m annoyed.  Really. Not with the person who sent me the e-mail asking me to post “I’m going to Columbia for six months” in the name of breast cancer awareness…but with the whole pink-washing of our culture that has been going on since the pink ribbon debued in the early 1990’s and led to the New York Times dubbing breast cancer “this year’s hot charity” in 1996.

I will not participate. 

Why? Well first of all, unlike the bra color and purse location ideas…this one requires me to post a lie in my status.

But really, beyond that, is “awareness” really necessary? In America at least, you would have to have been in a coma for the past 15 years to not be “aware” of breast cancer. 

Breast Cancer Action’s Karuna Jaggar echoes these concerns.

In the beginning, the pink ribbon campaigns were part of solving a visibility problem, but today the pink ribbons are blinding us to the real issues,” Jaggar says. “The issue is no longer awareness, the issue is understanding the root causes of the disease. Awareness is often channeled into screening and mammography, with no recognition of the limits of mammography. Mammography is a tool, an important tool, but it is not the solution to the epidemic. It detects cancer after it has already occurred. Even women diagnosed early may die of the disease, and too often do.

A controversy brewed when high fat food was used to promote breast cancer awareness.

Many corporations have jumped onto the breast cancer awareness bandwagon not because they want to save lives…but because research has shown them that if they market themselves as supporting a cause that people believe in, 50% of consumers will purchase their product over a similarly priced and quality product that they had previously prefered.  So pink ribbons get slapped on products resulting in a minimal donation to breast cancer charities, or the products themselves contain chemicals that may contribute to health problems including breast cancer.

Heart disease kills more women than breast cancer. While 1 in 8 women will be diagnosed with “invasive” breast cancer in their lifetimes, 1 in 3 women will die from heart disease. Can we get some awareness for that?

Breastfeeding can reduce a woman’s chance of getting breast cancer significantly (a study of Chinese women who breastfed for 6 years showed a 63% drop, several studies found a “dose response relationship,” meaning the longer you breastfeed, the lower your risk. I’ve breastfed for 10 years, what reduction does that give me?)…can we get some awareness of that? No, the American Cancer Society (ACS) says that promoting breastfeeding as a way to lower the risk of breast cancer is “impractical,” and they under-report its protective effect. 

Good diet (espeically optimizing vitamin D levels) and healthy living can help reduce the risk of breast cancer…we don’t hear about that…why? 

Delaying motherhood past the age of 30 increases the risk of breast cancer, but women are not told to consider this when deciding the best time to start a family.

Having an abortion* (and here) may more than triple the risk of developing breast cancer…we don’t hear about that…why?

Smoking increases the risk of developing breast cancer…why was my neighbor told that her smoking had nothing to do with her diagnosis?

Why is it that in 1995, before the start of the mass “awareness” push, approximately 44,000 women died of breast cancer in America, but in 2011 just under 40,000 died…hardly a huge drop for the massive amount of money that has been poured into the “awareness” campaign. Was any of that drop even due to “awareness?” The ACS said that a 10% drop in breast cancer cases between 2000 and 2004 was due to reduced use of hormone replacement therapy.

Why does the American Cancer Society (ACS) website not include ANY information about breast cancer prevention on its page about breast cancer?

I believe that the answer to all of these questions is that the ACS and Susan G. Komen are too busy being in the pocket of companies producing mamography machines and drugs to treat breast cancer to do much about promoting prevention.

Breast Cancer Awareness Month is October, its January now…can we move on?

* It is important to note that medically speaking, a miscarriage is termed “abortion.”  Some studies do not differentiate between spontaneous abortions–what the public generally calls a “miscarriage,” and induced abortions–the use of medication or a medical procedure to end otherwise viable pregnancies.  Miscarriages, or spontaneous abortions, do not seem to have the same effect of raising breast cancer risk.  It is also important to note that in denying a link between abortion and breast cancer, the ACS is using an analysis from 2003 and has not updated this analysis in the light of newer research.

My review today is of Denise Austin’s Fit & Firm Pregnancy.  Denise has written 10 books on fitness and was in the longest running exercise program on TV.  I first discovered her program on Lifetime in 2000 when I was pregnant with my second daughter, Katie.  I used her program to help in loosing 60 lbs after Katie’s birth. My kids love her Fit Kids DVD. So I had high expectations for this DVD.

The DVD starts with the intro before the main menu, and you can not skip this intro to get to the main menu without watching it.  I guess you could use this time to lace up your shoes and make sure all your necessary equipment is ready.  Denise recommends watching the whole DVD before exercising along with it…which of course I didn’t do. 

The DVD has 5 major menu choices, “Breathing & Core Awareness,” “Cardio Workout,” “1st & 2nd Trimester Toning,” “3rd Trimester Toning,” and “Postpartum Reshaping.”  Each major menu choice has the choice to go directly to that workout segment, or to a description of that portion.  I didn’t look at any of the descriptions, just went to each work out segment.  I didn’t realize at first that near the bottom of the screen there was an option to “play all,” which I assume will play all of the work out segments continuously instead of having to keep going back to the menu which disrupts the “flow” of the workout a bit.

The “Breathing & Core Awareness” section is a brief 5 minutes that includes instruction on breathing and kegel exercises.  She also talks about proper posture in pregnancy, explaining how a pregnant woman’s back curves more during pregnancy, and advising women to tuck their pelvis under to straighten the back.

I could not disagree more with this advice! Katy Bowman from the Katy Says blog is rolling over in her grave.  Okay, not quite because she isn’t dead…but she would be aghast…COMPLETELY.  Tucking under the tailbone to straighten the back?!?!? Seriously? Well I suppose if you are planning a cesarean birth that is okay…but if you are planning a vaginal birth, don’t do it. A pregnant woman’t back is supposed to curve more…it is part of pulling the tailbone out to make more room for the baby to fit through the pelvis.  The increased curvature of the spine is also coming from the rib cage shifting backwards to re-align the mother’s center of gravity so that she doesn’t fall forward from the increased weight of her belly.

Okay…now that I got that off my chest…LOL!

The Cardio workout includes Denise Austin (who isn’t pregnant…I think she was about 46 years old when she shot the DVD for release in 2006) with 4 extremely cheerful pregnant women.  Someone must have been reminding them to smile…a lot.  There were no specific instructions given to modify the program for different points in the pregnancy, just a mention that you should modify it according to your comfort level.  One of the women in the back row was modifying the program, but with a total of 5 women on screen at most points, it might get difficult to focus on following her. The program was mild, and included patterns I recognized from some of her other DVD’s.  There seemed to be a high ratio of walking forward 4 steps, then walking backward 4 steps.  Sophie thought it was very fun to run circles around me while I was doing this, especially when I would walk foward 4 steps, V-step (which Denise calls “go wide”), then walk back 4 steps and V-step.  Denise’s cueing is not as good as Leisa’s in yesterday’s review, for example, “tap it out” means two different things at different points in the workout, but since the patterns are fairly simple, they would be easily learned after doing the routine 2 or 3 times.  I did notice that she wasn’t good about balancing right and left side activities.  For example, for a while she was doing 4 steps forward then a right kick, then 4 steps backward and a left knee raise.  She never switched this around to left kicks and right knee raises.

There are two different toning segments, one for the 1st and 2nd trimester, and one for the 3rd trimester.  For either segments viewers need a chair, handweights, a mat, and pillows; and for the 3rd trimester segment a towel is needed.  In the 1st & 2nd trimester segment Denise seems to base her modifications of the exercises more on issues of balance and fitness level.  In the 3rd trimester segment she recommends reducing the hand weight size down to 3 lbs, but I used 8 and 10 lb hand weights in my 3rd trimester with several of my babies, and I know women who use more.  Please weigh in if you know why the weight of the hand weights should decrease during the 3rd trimester!

The toning segments were very good overall, with focus on muscle tone, flexibility, and proper form for getting down onto the floor and getting back up.  However, I was surprised that she recommended doing standard “lay on your back crunches” in the 2nd trimester, something most pregnancy exercise guides discourage.  She did exercises with the women laying on their backs in both toning segments, each time cautioning that if a pregnant woman starts to feel dizzy she should just roll over to her side. 

There was an amusing faux pas at the beginning of the 3rd trimester toning segment.  In the segment Denise does two exercises that use the towel–one requires it to be placed behind the mother, while the other requires it to be placed in front of the mother.  She had two pregnant assistants with her for this segment, and obviously they did not know how she was going to start the segment because one started putting the towel behind her, and the other started putting it in front of her…but then it became obvious that Denise was doing an exercise with no towel!  So both women tried to nonchalantly move their towels out of the way.  It would seem that this should have been editted out, but it wasn’t.  Unfortunately, I think this example is a telling feature of the whole DVD.  It seems somewhat sloppily put together…as if Denise’s heart wasn’t really in it, but she was just doing it because someone told her “look, you haven’t done a pregnancy video in 20 years, and that one is REALLY looking dated, you really should do a new one.” You can trust me that it really looked dated, I used to have it…black and white striped pants and big 80’s mall chick hair as she was going to her OB to get pregnancy exercise recommendations…

Bottom line…as much as I like other Denise Austin products…I do not recommend this one.

I’m off to the library tomorrow…I’m wondering what treasures I’ll find there!  Do you have a pregnancy workout DVD that you’d be willing to lend me to review?  If you are local, I’ll pick it up from you.

The package description lets you know that this workout includes 20 minutes of Salsa Dance, 20 minutes of Yoga Fat Burn, 6 minutes of Labor & Delivery Prep, and 8 minutes of Prenatal Stretch and Relax.  Bonus features that I discovered once I put the DVD in my player included an “Easing Labor” segment that displayed a lunge, forward lean, and squat that could be helpful in labor and a “Bonus Stretch” segment that focused on lower body stretches. I found the menu to be well laid out, including an option to choose exercise tracks rather than having to use the fast-forward feature as would be needed with the prenatal yoga DVD from yesterday. I have a 2003 version of the DVD, but it was re-released in 2008.

This DVD also includes an introductory segment explaining what will be required in the work out, and safety precautions.  Leisa reviews ACOG guidelines on exercise and stresses that it is important to be hydrated before, during, and after exercise.

The exercise starts off with the Salsa Dance segment, which is upbeat and fun, though the hand movements would take me a couple times to get completely correct.  Leisa is somewhere around 8 months pregnant with her second child at the time of filming (and “all belly”), and she is joined by two women in their first trimester on her right, and two in their second trimester on her left.  Leisa is very cheerful and encourages pregnant women to be confident in their bodies.  She reminds participants regularly to modify exercises as needed to be able to talk while exercising, and she also reminds participants to drink often.  Her “cue-ing” is very good even with her avoiding the use of “left and right,” which allows the participant to decide if she wants to be a mirror image of the instructor (my preference), or if she wants to match right to right, left to left.

The yoga section is more intense than on the previous all yoga work out, though it was simple enough for a beginner and did not involve any complicated postures.  During this segment she instructs participants on deep abdominal breathing rather than shallow chest breathing, which earned her more points in my book.  In this segment she did offer a few modifications to the poses to accommodate the growing abdomen and balance challenges, but she also noted that modifications should be based on physical ability and even a woman’s daily comfort rather than arbitrary trimester divisions.

The Labor & Delivery Prep consisted of standing and squatting abdominal exercises, and some pelvic floor exercises.  As my notation on yesterday’s review, research has shown that doing pelvic floor exercises during an exercise class does not lead to measurable benefit, however that may be because the limited amount of exercise is not enough.  Leisa recommends doing 10 sets of 10 pelvic floor contractions per day. A yoga mat, a pillow (I really would love to have the purple pillows used in the DVD…I love purple!), and an optional yoga ball were used in this segment.

The final segment, Prenatal Stretch & Relax, is accompanied by very soothing music, and was very relaxing.  A yoga mat, pillow, yoga strap or towel, and an optional yoga ball were used.

Over all I liked this DVD a lot for a beginning exerciser or for someone who wants a moderate workout. As a bonus, it can also be purchased as a 2 DVD set with a post-natal work out. On an intensity scale of 0 being sitting on your couch and 10 being running a marathon, this workout measures in somewhere around 6.

What did you do to stay fit during pregnancy?

Today is a gentle start with Prenatal Yoga with Shiva Rea .  The description for this DVD includes an approximate run time of 70 minutes and says

Focussed on helping you feel comfortable, relaxed and fit during pregnancy, this workout will increase your energy and stamina, and build strength, flexibility and balance….The gentle stretches help reduce fatique, tension and tightness, while promoting relaxation and improved circulation.”

So, set to work on my own resolution to exercise more, I popped this DVD in, and let it go.  There are two choices at the main menu, one to start the exercise program, and one called “interview.”  I assume this is an interview with Shiva Rea, I did not watch it.

The exercise segment started with a very good intro explaining the program and introducing Shiva and the 2 models who appeared with her in the program.  Each woman was intended to be an example of how the exercises should be done in a specific pregnancy trimester, and each woman wore a single primary color leotard to help her stand apart.  Shiva performed the 1st trimester exercises, while appropriately pregnant models displayed the second and third trimester modifications.  The introduction explained that the exercise program is divided into segments that can easily be utilized as stand alone programs, or all of the segments can be combined for a longer work out.  A relaxation segment is at the end, and it was recommended to be used every time the program is used.  The introduction lasted approximately 4 1/2 minutes, and could be easily by-passed by moving ahead one “track” on the DVD.

I have done some yoga before as a part of a longer aerobic program, but I have never done a full aerobic class, so I didn’t know quite what to expect.  In my case, I really would have liked a more vigorous workout, which this was not.  I think this program would be a nicely calming activity to do at the end of a day.

Right away I have to admit that I was getting annoyed by Shiva’s pronounciation of “exhale” as a very exaggerated “ex-ale.”  Since “in-hale” and “ex-ale” was virtually all that was being said near the beginning of the program, I was a bit concerned that I would be anything BUT relaxed by the end.  But I did find that as the program continued I focussed less and less on the mispronounciation.  There were also some other small annoyance points near the beginning, but I really don’t think I would have noticed them if I hadn’t been hyper-focussed on every detail to write a review.  We moved through a series of very simple yoga positions that I was familiar with, and at times my 3 year old Sophie joined in on the fun.

Over all I felt that the program, which ended up being about 50 minutes of yoga, could be beneficial for developing flexibility, though I’m not so sure about the “strength” claim from the product description beyond a bit of strength from the squats (the benefit of the short pelvic exercise set is probably minimal at best).  It certainly could be very calming and meditative.  I was a bit confused about why there was a perceived need to modify the exercises for 2nd and 3rd trimester, as I have previously done all of the exercises fully in my third trimester.  Particularly I wondered why a woman in her third trimester would be advised not to perform the squat position, but rather sit on a chair, and why a woman in her third trimester was advised at one point not to raise both hands over-head, but rather to just raise one hand at a time (but then later when a very similar stretch is performed the third trimester model raised both hands).  At one point I actually stopped the DVD and “rewound” it because I thought Shiva said that women in their 3rd trimester had limited flexibility (which is exactly opposite of the truth–in the third trimester women have increased joint flexibility, though may be more cumbersome due to the expanding belly), but what she really said was that women in their “3rd trimester or with limited flexibility” should make a particular modification.  In the end, I felt her “trimester” modifications really should just be suggestions for women who feel their balance or flexibility does not allow them to do the exercises as shown by Shiva, which could mean that a first trimester woman just starting out would be using the third trimester modifications, while a woman who has been doing the work out all along may easily do the unmodified postures at 40 weeks.  Of course I’m not particularly flexible, and I could perform all of the positions without using the modifcations.

The relaxation segment was only about 5 minutes long, I was hoping for more like 15 minutes.  Different positions were advised for the 3 trimesters-laying prone propped on blankets and pillows for the first trimester, side-lying with a maternity pillow between the legs in the second trimester, and side-lying with the top leg propped up on the chair and lower leg under the chair for third trimester.  I immediately thought the first trimester position looked to create an uncomfortable arch in the back, and sure enough, when I tried to mimic it I found it very uncomfortable.  Similarly, I wondered about the comfort of the third trimester position and I did find that the raised leg rested uncomfortably on the front edge of the chair.  The second trimester position was comfortable, but I would more recommend the “runner’s pose” advocated by The Bradley Method, where the top leg comes foward of the bottom leg, producing a slight forward lean to the hips and shoulders.

You will need a folded blanket and a chair to do this workout, and possibly a yoga block and yoga strap.  On an intensity scale of 0 being sitting on your couch and 10 being running a marathon, this workout measures in somewhere around 3.

What did you do to stay fit during pregnancy?

It’s New Year’s Eve Day and so the internet is awash in what else…an article that intends to instill fear in breastfeeding mothers who just wanted to enjoy a toast to the New Year…

“Mother Kills Son While Breastfeeding Him Drunk” reads the headline…which is of course eye catching.  But the story its self is full of holes.

The story contends that the mother drank a liter of Port, which resulted in her blood alcohol content being 2.5%.  Most people are unconscious at a blood alcohol somewhere between 0.3-0.39% and death comes around 0.5%. How was this woman somehow still able to breastfeed her baby with a blood alcohol level of 2.5%?  And would one liter of Port really have given a woman a blood alcohol level that high?  By my calculations using a chart on Wikipedia, a woman weighing 120 lbs would actually need to consume more like 5 liters of port to get a 2.5% alcohol level.  That’s some serious drinking…

Assuming there was a typo in the article and the woman had a lower blood alcohol level…lets say even 1%…her baby would need to take in about 12 oz of milk to end up with a blood alcohol level of 0.4 (extrapolating from the Wikipedia chart for an 8 lb baby). How many two week old baby’s take in that much milk?

I suggest that something else was done to that baby to result in a 0.4% blood alcohol level…like giving the Port directly to the baby.But the resulting discussions have led to many recommendations to “pump and dump.”

For the average woman who has a couple of drinks, there really is no need to pump & dump in my opinion. The amount of alcohol her baby would get in her milk is miniscule. I’m not alone.  Dr. Jack Newman, renowned for his expertise in breastfeeding, has said:

Reasonable alcohol intake should not be discouraged at all. As is the case with most drugs, very little alcohol comes out in the milk. The mother can take some alcohol and continue breastfeeding as she normally does. Prohibiting alcohol is another way we make life unnecessarily restrictive for nursing mothers.

La Leche League recommends against pumping and dumping because it doesn’t work.  You will simply make new milk that has alcohol in it.  Once the alcohol is cleared from your blood stream, it also clears from any milk that was already in your breasts.

In one Facebook discussion a mother mentioned having used alcohol detection test strips specifically made for breastfeeding, and being surprised at how little she needed to drink to get a positive result (I do get the impression that it took her at least 3 drinks to get a positive result)

The test strips are…well…a marketting ploy in my mind.  The description of them uses phrases like “alcohol concentrated in breastmilk” and “recommended feeding guidelines” [for alcohol concentration in breastmilk].  But alcohol does not “concentrate” in the breastmilk, it is in the same concentration as it is in the blood.  Further, where are the “recommended feeding guidelines” coming from?  Neither La Leche League or The American Academy of Pediatrics say anything about recommended maximum alcohol concentration in breastmilk. 

The strips test positive for alcohol at 0.02% alcohol, while admitting that it takes at least a level of 0.03% alcohol level to have any impact on the baby. To put this amount in some perspective…wine has about 12% alcohol, so its like putting about 1/100th of an ounce of wine in a 5 oz bottle of milk. Of course they don’t tell you that the impact on the baby is only short term…the baby will nurse more frequently for a few hours, and take in less milk (because mom is making less milk–so it is kind of debatable whether the impact is due to the alcohol directly, or due to the mom’s lowered milk supply which was caused by the alcohol), but then will make up the missed milk intake during hours 8-16 after the mother has stopped drinking alcoholic drinks.

So my thoughts?  Enjoy a glass of champagne or two tonight.  And once you get back to your baby, don’t feel guilty about breastfeeding.

What do you think is a safe policy on alcohol consumption for a woman who is breastfeeding?

First a disclaimer…Erin mentions trying out these methods of labor induction starting at 34 weeks.  I sincerely hope that this was a typo on her part; while recent research has found that up to 50% of women attempt to induce their labor, hopefully you are not trying to induce a premature baby!  More and more research is pointing to the importance of getting to at least the 39th week of pregnancy. So please, I know it gets uncomfortable, but unless you have some health issue that really makes induction necessary, hang in there!  Once your baby is born you would walk through fire to save her…I’m just encouraging you to waddle through 15 bathroom trips a day for a bit longer. 

1.    Eating spicy food. The story goes that eating a spicy burrito will get your whole digestive track moving and doing the Macarena, and your cervix will want to join the fun.

Almost 11% of women studied reported trying this method, but I’m with Erin  that I’m not really sure that eating spicy food is effective at all.  They way I’ve heard that it might be effective is through irritating your intestines.  When your intestines are irritated you produce oxytocin to contract the intestines and push the food along…and if you are pregnant you probably also know what else oxytocin does, right?  LOL!

2.    Walking.

While this is the most commonly used method to attempt self induction with over 43% of women who attempt self induction using it, it is SO not worth the effort in my opinion. I did a LOT of it after my water broke with my second baby and I was trying to avoid a chemical induction (which turned out to not be such a bad deal).  It did NOTHING but give me sore calves.

But when walking can be effective is when you are 4-5 cms dialated and having irregular contractions that aren’t really strong enough to get you dilating.  In my 3rd labor I had a bit of a battle with my midwife about this because I had been taught in Bradley Method classes that you should NOT move during contractions, and she was trying to send me out for a walk (at 2 a.m. in February to boot!), and she was telling me to walk as fast as I could through contractions.  I finally did it…and guess what?  It worked!  And it worked again with my 4th baby.  I’ve had it work for a few clients as well.

3.    Sex. The gist of this method—which I’m sure was “discovered” by a man—is that sperm on the cervix can help spur it into dilating.

23% of women who try to self induce try this method…because what got you into the situation will get you out of it, huh? But as of 2007, the Cochrane Database reported that there was not any high quality research to demonstrate if this method works.  The reason this method is thought to work is because semen contains prostaglandins, and prostaglandins can soften the cervix.  Of course human semen has a lot less prostaglandin in it than the amount used in a Cervidil or Prepidil induction, so unless you are almost ready to go into labor on your own anyway, it is unlikely to actually put you into labor.  But research does show that women who regularly have sex with the same man are less likely to have premature babies (interesting, huh?).

Now here is the real trick…female orgasm releases not only beta endorphins that make you feel good…but oxytocin is what cause the orgasmic contractions…and going back to the spicy food example…you all know what oxytocin does to pregnant women, right?  Yeah…I think I dilated my first 3 cm in my first pregancy that way.  Not that it made me go into labor…but that was sure fun. :-)  Research has found that while most women do engage in man on top face to face sex even in late pregnancy, the women who are most sexually satisfied in late pregnancy tend to use “woman on top, face to face” positions, but I’ve also been involved in internet discussions with a large number of women who report liking woman on top facing away from the man… If you want some inspiration, check out this blog (trust me, its safe…though not “work safe,” KWIM?)

4.    Castor oil. Castor oil makes your bowels move.

Yep, this goes back to the oxytocin as well…and like Erin warns, will leave you in your bathroom for a long while.  I do know a couple of women who have successfully used this method.  You can now get orange flavored castor oil that is a bit more palatable, and I’ve heard that blending it into a smoothie or milk shake to disguise the taste is a lot more effective than trying to mix it up in orange juice–which it quickly separates out of.  Ultimately though, a 2009 study found it was not effective.

5.    Nipple stimulation.

I find it saddly ironic that in Erin’s post she says that most doctors don’t recommend nipple stimulation because it is … effective.  HUH?  Actually, the research is a bit mixed, with the Cochrane Database reporting that it is indeed effective in 40% of women who use it (causing labor to start within 72 hours, so this is hardly a fast method), but an individual study I pulled up finding that it was not effective.  I’ll lean with Cochrane as being the more reliable source. 

Contrary to what many doctors seem to fear, the Cochrane database reported no cases of hyperstimulation (contractions too close together) in the study population.  While I’ve had numerous clients who were able to borrow a hospital pump (a common means of nipple stimulation, but it can be done manually as well) to try stimulating contractions; I actually did have an OB tell a client of mine that she could only pump for 1 minute intervals while on the monitor, then I think she wanted her to rest for 10 minutes.  But that is not going to be effective.  To be effective, a woman needs to pump for 20 minutes each hour, pausing the pumping when she feels contractions.  I’ve had several clients successfully use this method to augment a labor that is at 4-5 cms, but is just not getting going.  Interestingly, the Cochrane database reports that women who used nipple stimulation were significantly less likely to have a post partum hemmorhage.

6.   Acupressure.

Okay, here is the thing with acupressure…you have to be REALLY serious to make it work.  I’ve actually never seen it work in my clients, and the research on it is non-existant.  I know of a point in the skin between the thumb and forefinger that you need to squeeze REALLY hard for 5 minutes or more (it will also work to bring on your period a few days early), or a spot on the inner ankle about 3 finger widths up from the ankle bone, or a spot on the roof of the mouth that can be accessed by thumb sucking or sucking on a round lollipop.

7.    Raspberry leaf tea.

Well, unfortunately, this one is unlikely to do it for you.  Raspberry leaf tea (make sure you don’t get the Celestial Seasonings berry tea like I did the first time I shopped for it–that’s not the right thing) works to produce mild contractions that simply tone your uterus, getting it ready for the big event much like a weight lifter will lift weights for months getting ready for a competition.  Most midwives are okay with women starting to drink up to 4 cups per day starting at about 32-34 weeks  Some midwives suggest drinking 4 cups rapidly when labor starts to help speed it up, but like acupuncture, there is no research to support this.

8.    Begging and pleading with God for mercy. I guarantee that God will eventually hear your pleas and put you out of your misery.

Well…okay, I wouldn’t have used those words because I like to be more positive about pregnancy…but as I stood crying in the hallway of my church at 38 weeks 5 days with my 5th baby, I guess I would have.  :-) 

This is the point that I often refer to as the “transistion point” of pregnancy.  You know how in labor you hit transition and it is at this point that you feel discouraged, like you can’t do it anymore, and that you just want “it” to be over…no matter how?  Well I firmly believe that the emotions of labor (excitement in early labor giving way to seriousness and “down to business” in active labor, turning to discouragement in transition…) are often played out in pregnancy.  I’ve seen it in myself…I hit that transition point of pregnancy where I am begging with God…and the next day I’m in labor.  I’ve seen it in clients…spending hours on the phone with them encouraging them that no, they will NOT be pregnant forever…only to get a call 5 hours later that they are definitely in labor.

So if you are are at that “transition point” of your pregnancy…by all means…try my “Dinner and a Date” method of labor induction.  Have fun!

I Got Stuck in the Jacuzzi, and Couldn’t Get Out, So I Had a Natural Birth!

On Thursday, I went to my doctor for a last minute appointment. I was nine days overdue with Mikaela. At my appointment the week before, the physican’s assistant I saw said if I hadn’t had the baby by Thursday, they would want to induce me, and I should go to the hospital. I had lots of questions though, and insisted on another appointment before going to the hospital. At that visit Dr. Lamb explained to me their procedure for induction: a treatment of Cervidil overnight, Pitocin in the morning, and breaking my water later if necessary. We asked her about all kinds of possibilities, including delaying the induction. She explained why they don’t like people going past 41 weeks, but was willing to see if there were other openings for the induction. We also talked about stripping my membranes in the office as a fairly safe and non-chemical method of starting labor. She checked my cervix; I was a tight 3 centimeters and 70% effaced.  I asked her to strip my membranes.  She said if it worked it would probably take between four and six hours, but could take up to twelve.  She said if we went home and wanted to reschedule the induction, to call her and she would see what she could do.  The afternoon passed, and nothing happened.  It came time for the office to close and I didn’t know what to do so I just didn’t do anything.  We went to dinner at my husband’s parents’ house, and as we were leaving, I broke down in tears.  I did not want to be induced.

Nonetheless, we showed up at the hospital at eight that night.  The nurse checked us in, and said we would be with the only male nurse on the OB floor.  I asked for a female nurse, and she made a big deal about it.  When she took us back to triage, though, the male nurse had a female nurse helping him, so she would look in on us.  At that point, however, I was far too upset to go through with the induction (the nurse had made me so uncomfortable, and I was already stressed to begin with).  We were assigned our room in triage, and I went in and cried hysterically.  My husband said it didn’t feel right and went out to tell the nurses we were going home.  The female nurse came and asked me what was going on.  I explained to her how I felt about the induction; she re-explained the same thing Dr. Lamb had, emphasizing that my OBs were notorious for starting their patients on very low doses of Pitocin, and increasing it gradually.  She left us with the question of when would we want to be induced if Mikaela didn’t come on her own; we didn’t really have an answer (I had been thinking the full 42 weeks).  She told me Dr. Lamb was in surgery and asked if I would at least be willing to be hooked up to the monitor until we could meet with Dr. Lamb.  I said that would be fine.  So my husband and I sat there, reading The Hobbit, when suddenly I had the strongest urge to go to the bathroom.  The nurse came and unhooked the monitor, and I tried to go to the bathroom.  I came out and got back on the monitor.  Not long after that, she and Dr. Lamb came back in the room and asked me if I knew I was having contractions!  I said not really (I just thought I had to go to the bathroom).  However, the longer I was on the monitor, I realized that they did have a definite peak.  They were about two to four minutes apart, but definitely minor.

We talked with Dr. Lamb once again about all our concerns, namely that if I had to have Pitocin, I would have to have an epidural.  She again talked about the low doses.  She offered to check my cervix again, and I let her; I was three centimeters and 80% effaced, so no significant progress.  Since I was having contractions, she was willing to let me go home.  If it turned into full blown labor, I would call her.  If not, we were to show up at the hospital at 7 am to get started.  We went home excited, hoping that something would happen that night.

All that really happened was a sleepless night!  I had contractions off and on, but nothing too bad.  We got up early, and I went for a short walk to try to get things going.  We ate breakfast and were on our way.  At the hospital, we were assigned a LDR room right away, and I realized we were there until we had a baby.  The nurse who was assigned to us was there for twelve hours, and said hopefully she’d be able to be with us for our delivery.  She loved working with patients who wanted to have natural births, and we were so grateful she was our nurse.

Rocky (our nurse) hooked me up to the monitor, and saw that contractions were about what they had been the night before.  She started my first dose of antibiotics for GBS (ouch!), and once she thought things looked good, she let us go on our way.  We walked the halls for 45 minutes until she wanted to check up on me again.  When we got back to the room, Dr. Lamb was there.  She checked me, and nothing had changed from the night before.  She said since I was contracting, Cervidil wouldn’t really do anything for me anymore.  She didn’t mention Pitocin, but did talk about breaking my water.  She had a few surgeries that day, so was going to stop in around noon and two to see how things were going.  My husband and I spent the rest of the morning and early afternoon doing whatever we could to try get labor going; we walked a lot, used the birthing ball, got on hands and knees, and did lunges.  Around 11, I started getting really hungry, so I sneaked some snacks.  At noon Dr. Lamb checked in just to see how we were, and said she would be back at two.  At two she came back and immediately pulled out the tools for breaking my water; I was so scared!  I asked her to please check my progress first, and that if I was progressing, to not break my water.  I was still only three centimeters, so I told her to go ahead and do it (though I was scared out of my mind).  I had to stay on the monitor longer this time to make sure Mikaela and I both were doing ok with having my water broken.  About two contractions into it, I could totally feel the difference.  After I got off the monitor, I went on hands and knees.  And then, I threw up my snack.  I was glad it was only my husband and I in the room so no one knew!  I vomited twice, and once I got my wits about me, we decided to try the same coping techniques. 

We hit the halls again, but this time, it was much harder to walk.  I had to stop with each contraction and lean on the railing and really try to breathe through it.  Nothing seemed very comforting, so sometime before four, I asked Rocky if we could get in the Jacuzzi.  She filled it up for us, and we slowly made our way there.  At this point, Rocky had had a second patient, and she gave up that patient to be with us.  It’s so good she did, because I really lost my focus while I was in the Jacuzzi.  The contractions were so painful, and I kept telling my husband I couldn’t do it.  Later my husband told me it was hard for him to hear that and he was starting to think it was too much for me.  I tried to stay relaxed, but often the contractions made me start to cry.  Rocky reminded me to take slow, deep breaths and try to picture my favorite place.  The first time I really looked at the clock since having my water broken, I saw it was almost five, and I couldn’t believe how fast the time had gone.  Still, with many of the contractions, I told myself if I wasn’t at least five centimeters dilated the next time Dr. Lamb checked me, I was going to get the epidural.  During this whole time, my husband was totally incredible.  He got a cold compress and kept wiping my face and shoulders with it; it was the only comfort I had at that point.

At one point I really thought I had to go to the bathroom, so Rocky got me a bed pan.  I stood up to try to go, and was in too much pain to try it, so I immediately got back down in the water.  I asked Rocky if Dr. Lamb would be able to come to the Jacuzzi room to check me, because I didn’t want to leave until I knew what I was.  A little after six, Dr. Lamb came in.  It took a lot of effort for me to get out of the Jacuzzi because standing up made me contract again.  Finally I got out, and when she checked me, I was nine centimeters dilated!  My husband said there was such a look of relief on my face.  I knew I was going to have this baby, and naturally.  Dr. Lamb calmly said I could get back in the Jacuzzi, but that if I did, they would have to start bringing things into the room for the delivery!  I said that I was OK with going back to the room at that point. 

Rocky wheelchaired me back to the room between contractions.  Now I really had to go to the bathroom, so I went real quick, stood up, turned around, and threw up again.  Rocky said to my husband that she wouldn’t be surprised if that got me all the way to ten!  Dr. Lamb came in not long after we settled down again and checked me.  She said that I was ten centimeters, and asked if I felt the urge to push.  I said I felt like I needed to go to the bathroom, and they said that was pretty much it.  She left the room, and I got on hands and knees and slowly figured out how to push.  After a while my arms were shaking, so Rocky got the birthing ball and put that on the bed and I leaned on that.  I pushed through a few more contractions like that, but wasn’t very comfortable.  So Rocky suggested lying on my side, and I tried that.  My husband held one of my legs and Rocky held the other.  Now I was figuring out how to push, and a few contractions into being on my side, Rocky said she saw hair and I had to stop pushing until Dr. Lamb came in.  I didn’t feel like I could stop pushing!  I had to keep my legs closed for two contractions—definitely worse than actually pushing.  I asked where Dr. Lamb was, and as Rocky went to call her again, Dr. Lamb came back in the room.  Rocky was supposed to get off work at seven, and at 6:40, I begged her not to leave me.  She said she would stay until I delivered, and I am so grateful she did.  She really coached me through the pushing, counting to ten, making me take a breath, and push again.  When I tensed up in my face, she told me to relax.  She told me what I would feel as the baby crowned.  She and Dr. Lamb both told me I was doing a good job pushing, but it didn’t seem like I was making much progress with my pushes.  Finally when I started pushing to Rocky’s counts, I really started making progress.  She said I would feel burning, and boy was she right.  But at that point, it didn’t even matter.  I just wanted to get the baby out, and knowing she was right there was so motivating.  So I kept pushing, and our little girl was born at 8:07 pm.  Holding her in my arms was the most incredible experience ever.  There were no issues with meconium, and Dr. Lamb and the entourage of nurses who were now in the room were all familiar with what we had on our birth plan.  So Dr. Lamb waited until the cord stopped pulsating, and my husband got to cut the cord (Dr. Lamb said the cord was really short, which is why despite all my pushing, she came out so slowly).  I was able to have immediate skin-to-skin contact and was able to nurse within the first hour.  They even brought in things for her bath and the nurse showed my husband how to bathe her.  He did the entire bath.  I didn’t even know it was an option, but I’m so glad she offered!

Overall, labor was definitely the most painful and intense experience of my life.  I had been so nervous about being induced and some of the choices we made, but ultimately, I feel like God really blessed us throughout the whole process.  Dr. Lamb was so great with us, and we had the best nurse ever.  My husband was so supportive and comforting.  Initially when it was over, I felt like having another natural birth would be really hard; however, now I believe I would do it again.

I can not find data specifically on how many births are attended by CNM’s in the Lehigh Valley, but I can make some estimates. At last count, the five hospitals that have LDR’s in the Lehigh Valley have just six CNM’s to attend hospital births.  There were 9181 hospital births in the Lehigh Valley in 2009.  For those six CNM’s to attend a total of 10% of hospital births, they would need to attend approximately 153 births per year per midwife, about 13 per month.

Let’s take a bit of time to look at how this would work out. 

The average prenatal visit in the midwifery model of care is approximately 30 minutes, and with each client having approximately 14 prenatal visits during her pregnancy and one post partum visit, that would work out to approximately 1147.5 hours per year in prenatal and post partum care.  If the average midwifery client needs 8 hours of labor assistance and post-partum checks in the hospital (my guess based on doula clients…I really don’t know what the average amount of time would be.  I can tell you that I guessed what I thought was a LOW amount of time.  The very first birth I attended with a CNM attending, she and I both spent over 24 hours supporting the client), that would be an additional 1224 hours per year for the midwife.  So far we have 2371.5 hours per year of work.  This does not include the time spent doing GYN care, paper work, or attending continuing education.

If we assume that the typical midwife takes 2 weeks of vacation time per year, 2 weeks worth of holidays (the typical white collar worker gets 10 paid holidays in a year), and 1 week of sick days; that leaves 47 weeks per year that the midwife is working. If we divide 47 into 2371.5 hours, we find that this works out to work weeks that are 50 hours long…and remember again that this does not include any time for doing GYN care, paperwork or attending continuing education–all of which are things midwives do.

So that leaves me with only 3 conclusions that I can draw:

• CNM’s attend significantly fewer than 10% of hospital births in the Lehigh Valley, or
• CNM’s in the Lehigh Valley are not working from within a “midwifery model of care.”  That is, they are not providing longer prenatal visits where they can advise women on healthy pregnancy, thus reducing the need for interventions.  They are not “labor sitting” with their clients, which has been shown to be one of the primary benefits of midwifery care during labor, leading to reduced intervention rates and increased maternal satisfaction with the birth.
• CNM’s in the Lehigh Valley are working insanely long hours–80 hours per week perhaps.

Note that these same conclusions can be drawn about a CPM or other type of midwife who has a high client load.  In the case of many of them, they work insanely long hours which means that they may neglect their own health or their families.

I suspect that there is a mix of the first two explainations happening with CNM’s in the Lehigh Valley.  I definitely believe that fewer than 10% of hospital births in the Lehigh Valley are attended by midwives.  But of those midwives who do attend hospital births, I think that there are some that seek to provide the midwifery model of care, and others that don’t.

So who are the midwives who are doing births at hospitals in the Lehigh Valley?

Dr Alessandro Boschi at St. Luke’s Allentown has two midwives on staff, though a nurse who answered the phone at St. Luke’s has said that they aren’t “like traditional midwives who will labor with you.”  Dr. Boschi’s practice is in Lehighton.

Andrea MacLaren from Pocono Midwives and Associates in Stroudsburg attends births at St. Luke’s Bethlehem.

OB/GYN Associates of Lehigh Valley Health Network (LVHN) have 3 midwives who attend births at Lehigh Valley Hospital Cedar Crest.  However, in the case of this practice, women can not opt in or out of midwifery care.  The midwives rotate primary call along with the OB’s for low risk women.  If a low risk woman attending this hospital arrives in labor when one of the midwives is on call, she will be assigned to the midwife whether she wants a midwife or not.  Like Dr. Boschi’s practice, the midwives are not laboring with the women because they usually have several women who are laboring at the same time. I’ve also been told that these midwives only take call during daytime hours Monday - Friday, which would greatly reduce your likelihood of actually having one be on call for your labor.


Sacred Heart Hospital in Allentown and Easton Hospital do not currently have midwives who attend births.

Out of this scarcity, many Lehigh Valley women have been turning to the Hackettstown Midwives in New Jersey, home birth midwives or two birth centers in the Reading/Pottstown area. 

Laurice Dunning of Lehigh Valley Midwives and Associates attends homebirths, but she is currently doing that without OB back up. 

There are a few CPM’s and non-credetialled midwives who also provide homebirth services to women in the Lehigh Valley, however none are located in the Lehigh Valley, but rather are a significant drive away.  I live on the west end of the Lehigh Valley, and the closest homebirth midwife to me is a 50 minute drive.  For women on the east end of the valley, they can find a midwife who is about 30 minutes away, another who is about 45 minutes away, then the ones that I would drive at least 50 minutes to could be close to 1.5 hours from them.

Interestingly, Lehigh Valley Health Network (LVHN) had an article about midwives in a recent edition of their “Healthy You” newsletter.   I view the piece as little more than a puff PR piece, and not a serious effort to encourage women to utilize midwives.  Why do I view it that way?  Well rather than going to one of the midwives in their network (the 3 at OBGYN Associates) who actually provide prenatal care and attend births to get quotes, they got quotes from a midwife who works in the LDR triage unit at the hospital. So women who want a midwife for their birth might try contacting her, and be frustrated in their efforts.  If they had really wanted to promote midwifery care they could have, at the very least, mentioned the midwives at OBGYN Associates since they are employees of LVHN, but they didn’t even do that, leaving it up to the woman to seek out a midwife.

*These numbers are estimated using the CDC Wonder 2005 data.  The CDC Wonder data reports on birth attendant for the birth.  Certified Nurse Midwives should not be the reported birth attendant for cesarean births (though they are for about 250 cesarean births in PA, and about 4500 cesarean births nationwide), so I estimated a 25% cesarean rate for CNM attended births to determine what percentage of births are attended by CNM’s.

After several e-mails back and forth, the couple decided to hire Doula Dianne, and settled on a price.  Rossi told Doula Dianne that he would have his business manager send her a check, and soon she received a check, drawn on a foreign bank.  This was not unexpected, since Rossi and Jeana were not in the country.  What was unexpected was that the check was written for a figure that was significantly greater than the agreed upon fee.  Rossi reassured Doula Dianne that his business manager had just made a mistake in writing the check, and since Jeana’s due date was coming soon, he asked that Doula Dianne just cash the check, and send him a refund.

Doula Dianne was a bit skeptical, but she took what she thought were prudent actions.  She deposited the check in her bank account, and waited for it to clear before writing the refund check.  After 3 days a teller at her bank assured her that the check had cleared, so she wrote the refund check and mailed it to an address in America, where the recipient promptly cashed it.

What the teller apparently did not know was the foreign checks often take up to 2 weeks to clear, and a bank will often “clear” the check as a courtesy to their customer after only 3 days.  So while the money was appearing in Doula Dianne’s bank account, the check had not cleared yet.  Much to her horror, Doula Dianne learned after her refund check had cleared that the check had actually not cleared, and the money was deducted from her account balance.

Doula Dianne has contacted her local law enforcement offices about this scam.  In addition to the check that she already deposited, she was also sent a fake Western Union money order, so she has also contacted the post office about mail fraud.  Unfortunately I know from experience with my husband’s business being scammed with a stolen credit card that the “business” usually has to take the loss, and law enforcement will not make significant effort to pursue what they see as a “small” crime of only a few hundred dollars.  Unfortunately for Doula Dianne, that amount of money is a significant amount of her income since her family income has taken some hits in the economic downturn we’ve been through.  To be sure, most doulas find doing their taxes a bit on the depressing side as they see their expenses eating away at their income, and realize that their work is truly a labor of love that does not leave them much profit.

Unfortunately it does seem like the individual (or group) who orchestrated this scam against Doula Dianne has also been contacting other doulas with the same scenarios.  It has been discussed on the DONA Facebook page and the “All Doulas” discussion boards.

Doula Dianne would like to talk to other doulas who have been victims of this same scam.  You can get her contact info by e-mailing me at jenn@knittedinthewomb.com .  While I hope on the one hand that not many of you have need to contact me, on the other hand I hope that enough of you have been scammed by this same individual (or group) that a law enforcement agency might take seriously the idea of pursuing this crime.