What is Midwifery?

A friend expecting her second baby this coming October recently lamented to me in an e-mail:

…most of the women who go to OBs do not know - or at least believe popular misconceptions - about what midwives do. Every woman would want midwifery care for herself and baby if they knew what it truly was…. All the women I know who used midwives were women who wanted individualized care and somebody to be there to support them through their whole birth experience. Somebody who knew them and who they trusted; rather than a practice where you rotate through providers and get whoever is on call. Some had natural births, some with epidurals, etc. but the most important aspect was that relationship and better care. (Jennifer Harper)

A Pioneer Midwife in Pennsylvania

As a childbirth educator and a doula, and most importantly as a mom of 5 children, I couldn’t help but Continue Reading…

Birth in the News

Recently 3 major news organizations have had articles about birth related issues:  The LA Times, The Wall Street Journal, and Time magazine.  All of these articles have merit, but also have some short comings, which I’d like to address.

LA Times

The LA Times article, Childbirth:  Can the US Improve?, I thought was over all very good.  I liked that it featured a mom who not only had to look around to find a Dr. willing to support her VBAC, but that she successfully birthed a reasonably large baby (8 lbs 11 oz) vaginally.  I thought it dealt with the risks of cesarean and interventions very well, such as the increased risk of “ICU” admissions (that should be “NICU) for babies with planned births–that is, planned inductions or planned cesareans.  They pointed out that when some hospitals institute rules banning “planned” deliveries prior to 39 weeks that are not medically indicated, NICU admissions dropped by 46%.  Amazing.  Here are some of my favorite quotes:

“We’re going in the wrong direction,” said Dr. Roger A. Rosenblatt, a University of Washington professor of family medicine who has written about what he calls  Continue Reading…

You Need to Eat a Peck of Dirt Before You Die

So said my grandmother…so it MUST be true. 

Of course, not everyone agrees with that philosophy.  Yesterday I happened to catch about half of an episode of “The Doctors” that was themed “Is This Really Bad For Me?”  If you believe the esteemed Dr’s, not only is double dipping taboo (which I agree with just on the “GROSS” grounds, but have less bacterial concern); its a serious health concern, right up there with the “5 second rule” and using finger nail polish while pregnant.

Wait…I’m a childbirth instructor AND a chemist, I worked with many of the chemicals that are in nail polish.  And I’ve never heard that you should be concerned about painting nails while pregnant.  In fact, I did it while I was waiting for labor to set in with Katie. 

Not that I think the chemicals in nailpolish are completely safe.  No, I don’t.  Reasonable precautions should be taken by anyone using a product with volatile organic compounds–use it in a well ventilated space.  But quantities do matter.  Even water can kill you if you drink enough of it–and there are traces of cyanide in apple seeds, and yet they don’t kill you if you eat them.  I have trouble really believing the amount of nailpolish one might get on ones skin would result in enough chemicals absorbing into the body to have any toxic effects.

The Dr’s really tore into the “5 second rule”–that is, eating food that has fallen on the floor–even if it only was on the floor for 5 seconds!  They pointed out that studies show that foods that have fallen on the floor have a higher bacteria count than foods that haven’t.  Likewise, they shamed “double dipping” (which again, I do think is gross–spoon some dip onto your own private plate for goodness sake!) due to increased bacteria counts.

So let me get this straight…the same doctors who want us to inject a live virus (certain vaccines) into an infant to develop immunity, are freaking out over what might be on my kitchen floor?

I do wonder if as a culture we have become too “germ phobic?”  I have trouble finding hand soap that *isn’t* antibacterial, and I make it a priority to find that because I’m concerned about antibiotic resistant bacteria.  Many products are now marketted as being antibacterial.  My kids’ elementary school requests that children keep hand sanitizers at their desks to “reduce sick days” (none of my kids have ever missed more than 2 days of school in a single school year even before the hand sanitizer policy). 

Could it be that being exposed to a certain level of bacteria acts like a vaccine, building immunity toward stronger illnesses?  I once had a co-worker who told me that he was glad that his kids caught colds while they were toddlers/preschoolers, because they didn’t get sick often when they hit school age and it was more important that they be ”well.” 

It seems that I’m not the only one that is thinking this way.   Craig Weatherby over at Vital Choices asks if “American children’s overly sterile surroundings and overprotective parents may pose dangers to their health?”  He proposes that “excessively clean environments and lack of outdoor play may be partly to blame for the rise in allergies and asthma in recent years.”  The folks at the New York Times actually suggest that children’s desire to put things–even very dirty things–into their mouths may have an evolutionary advantage.  Immunologist Dr. Mary Ruebush writes in her book “Why Dirt is Good“:

 To read the news headlines or to watch any TV commercials, you’d think that the only thing standing between you and death by some horrible new disease…is the germ-killing power of some miraculous cleaning product.  Actually, what keeps most people healthy most of the time is the amazing ability of your body to keep infection out to begin with….All that cleaning doesn’t protect you nearly as well as your own body can.

Hmmmm…imagine that.  Simply being exposed to a germ does not doom you to illness!  If someone is reasonably healthy, they can fight off most common illnesses.  Which I guess explains why my husband and I both recently got fairly bad colds from our then 5 month old Sophia (we don’t get enough sleep to maintain good immune systems), but none of our 4 older children caught a cold.

Of course we do take what I consider to be “reasonable precautions” around our house when it comes to germ transmission–we aren’t just wallowing in each other’s germiness.

But what are “reasonable precautions?”  Well…despite the dire warnings on The Doctors, the “5 second rule” is alive and well in my house…and its probably more like 30 seconds.  Tight budgets mean that I’m not above scraping meat off my kids’ plates into a leftover container to eat for lunch the next day.  And I didn’t miss a beat when Sean picked up an interesting black item off the sidewalk today and said “what is this Mommy?”  “A dried up earthworm.”  (Don’t worry, he didn’t stick it into his mouth…and just in case you wondered…if you are a guest in my home you will not be served recycled or dropped food.)

BUT…even 5 year old Sean will remind anyone who sneezes near him to “cover your mouth” (with your arm if you don’t have a tissue–you are less likely to touch something with your germy arm prior to washing it than if you had sneezed into your hand), all my kids know to sing “Twinkle, Twinkle, Little Star” while handwashing to get a thorough wash.  And we don’t eat food that has fallen onto dirt…and I certainly wouldn’t eat something that had fallen on a hospital floor–a scenario posed by one of “The Doctors.”  We use separate cutting boards for meats & veggies, and wash hands after handling raw meat.

On a related topic, there is a very good discussion of the whole “Swine Flu” situation over at Mercola.com, and another at Junk Food Science that reveals that the toddler in Texas who died of swine flu had actually been air lifted into Texas from Mexico, and had under-lying health concerns.

Finding the Right Maternity Care Provider

This past weekend I listened as a woman explained that due to her medical condition (epilepsy), her OB had advised her at her first prenatal visit that she could terminate her pregnancy.  I understood that.  For liability reasons her Dr. HAD to make sure she knew that 90% of babies born to mothers with epilepsy are normal, and if that 1 in 10 risk of having problems is too high for her, she had that option.  Fair enough.

But then I listened in amazement as she went on to say that her Dr. reccommended “termination” again at her 2 month visit (apparently she went to her first visit lickety split!), and her 3 month visit, and her 4 month visit, and her 5 month visit…at which point she finally told the Dr. to quit advising this, that she intended to keep the baby even if the baby had deformities.  BTW…her baby was healthy & normal at birth.

I had to wonder what it takes to get a woman to switch care providers?  I mean really, the guy wants to kill your baby, and you are still trusting him to make life and death medical reccommendations for said baby?  Why, even if you were pro-choice (which this woman isn’t), would you continue on with such a glaring difference of opinions?

Unfortunately in America we seem to have bought into the idea that the most important things about choosing a care provider are if they are on our insurance plan, how close they are to our home, and if we like the waiting room decor.  Okay…I might be exaggerating a bit on the last point…but really…the things we take into account really aren’t often important.

I admit…I’ve been guilty of the same kind of decision making.  In choosing my first OB, I just stuck with the GYN I’d seen for about 4 years prior to pregnancy.  I had chosen the practiced based on reccommendations from friends that they were a “Christian” practice.  Let me tell you, as a committed Christian, I often dread having Christian clients who chose their care provider because they are Christian.  Why?  Because they tend to put the care provider on a higher pedestall than they would a non-Christian provider, and don’t question much of what their care provider says to make sure that it matches up with what they personally desire.

And trust me…there is a LOT of variation in practice philosophy amongst care providers (since, as my father used to say, Dr’s PRACTICE medicine–its not really a science so much as an “ideology” where entrenched beliefs often are contradicted by medical research), even Christian ones.  Just looking at the Christian birth care providers I’m familiar with, there are some that:

• will cut episiotomies without consent, 
• state outright that they do not trust vaginal birth and much prefer planned cesareans, 
• will allow women a lot of lattitude in how a hospital birth is carried out–asking her every step of the way if she wants option A, B, or C and avoiding cesarean whenever possible, 
• will attend homebirths with a woman who has had 2 prior cesareans.

Now at a certain point during my first pregnancy I started realizing that the practice I was using was a philisophical mismatch with me, but I didn’t switch.  Why?  Because I felt too busy perhaps?  All I can say is PLEASE don’t follow my example!  It is only through the grace of God that my inaction did not result in my having a cesarean.  Care provider choice does matter.

I do know that many women don’t switch care providers do so out of a desire to “not offend” their care provider.  I had one client who was driving over an hour to see her care provider, knew she didn’t like the practice, and still didn’t switch for this reason.  But here is the thing…as much as a woman may “love” her care provider…her care provider doesn’t love her!  It’s strictly business, and while care providers do have hearts, and their hearts may be saddened if their clients have tragic things happen, they just CAN’T allow themselves to be emotionally involved…to do so with all they see would be too draining. 

Nicole over at “It’s Your Birth Right!!” has written a great pair of posts (Part 1 and Part 2) on “Choosing Wisely.”  She’s been an L&D nurse, and is now a CNM, and has some great insight.  One of her bottom line suggestions that I think is great is that a woman should interview at least THREE care providers before choosing one.  Wow.  Like I said…I didn’t interview my care provider in my first pregnancy.  And even with my second pregnancy I only interviewed one care provider–the one who had been the on-call Doc when my first was born.  Again…3rd pregnancy, I only interviewed one care provider, although this time I’ll use the excuse that I knew I wanted a homebirth, and to my knowledge, at that time I only had one care provider option for homebirth.  Used her again for my 4th birth.  It wasn’t until my 5th birth that I actually interviewed 4 different care providers (and kind of half-way interviewed a 5th over the phone), and chose one.

And guess what? 

She wasn’t covered by my insurance.  And yet she probably cost me less than either of the “in network” providers I interviewed would have cost considering that I would have had a $300 deductible and 20% co-pay for the in network providers. 

She was the furthest away from my house.  Of course after signing up with her I found out she would do home visits for a small fee, and so my appointments literally took only 30-60 minutes of my time, and ALL of that was face time with the midwife, unlike the 2-ish hours I often spent on appointments during my first pregnancy between driving (just 10 minutes from work!), waiting in the waiting room, having vitals taken by nurse, waiting in the exam room some more…then seeing the OB for 5-10 minutes.  Even when I did drive to her office for two visits, I still only devoted a bit less than 2 hours to the visit, and saw my midwife for 30-ish minutes.

Patient vs. Disease

A “facebook friend” is attending the 2009 Reache Conference, and she’s been posting updates periodically.  I think this quote that she just posted is worth spreading around.  She reports that OB/GYN Dawn Russell, MD, in discussing medical education in the US said:

You begin to see the patient as the disease…You are trained to understand, to believe, that no matter how small the risk, it WILL happen to your patient.

How true it is, how true it is.  Instead of seeing a laboring woman as most likely to have an uncomplicated birth, the typical OB really believes that the birth WILL end in tragedy…and thus they are quick to intervene in an attempt to prevent that tragedy.  Which would be okay if the interventions were harmless, but they aren’t.

Dovetailing very nicely with this quote, is one that is found at Rural Doctoring (I paraphrased a bit to make it fit my blog):

I once told a [wo]man I didn’t care if [s]he ruined [her birth with interventions]. “I mean, you’re a nice [woman], we get along, I appreciate your honesty,” I said, “but, let’s face it–if you [need a cesarean] ten minutes from now, I’m going to say ‘Aw, that’s too bad, [s]he was a nice [girl],’ and then I’m going to move on to the next disaster because that’s what I do. I’m a doctor, I got a hundred [girls] like you. So I don’t care. But I bet you do, and I bet your kids do, so think about that. You need to get honest with yourself and quit making excuses…

Seriously…the original quote was in context of the Dr. talking about not caring about a patient DYING…so do you think it is a stretch for me to substitute having your birth end in surgery?  NO!  Most OB’s don’t see any particular value in vaginal birth…their only goal is to get the baby out as quickly as possible, because once that baby is out, it isn’t their liability anymore.  As a mom, OF COURSE you want a healthy baby.  But maybe, just maybe, you assign some value to not having to recover from major surgery while caring for a newborn.  If you do, then you need to take responsibility for choices that will minimize your risk of having a cesarean.

Don’t eat the frozen vegetables!

I have a friend who eagerly anticipated becoming a mother.  She planned for how she would care for her child…and one of the things that was important to her was giving her child home grown vegetables.  She wanted her child to get all of the nutrients of fresh vegetables, and avoid the contaminants that might come with processing.  Unfortunately, she was not able to grow her own garden, but she had some friends with gardens who offered to share their frozen vegetables with her–actually, she didn’t wait for them to offer, she asked them if they’d grow more than they needed and save the veggies for her, even before she had a confirmed arrival date for her child.

When she was finally blessed with an adopted child, she very carefully listened to the instructions from the pediatrician regarding feeding the child.  The Dr. instructed that she should only feed canned vegetables to the child.  Overwhelmed with all the instructions that were being given to her as a new parent, she did not question this bit of advice, but just took it in.  However, as her friends called to congratulate her on her new arrival and ask if they could bring some vegetables over she simply said “the Dr. says he doesn’t reccommend it.  He says that I should feed canned vegetables.”

This is pretty ludicrious, isn’t it?  I mean really, what in the heck is wrong with the frozen vegetables, wouldn’t the less processed homegrown vegetables be healthier?

I actually asked my friend what specifically her Dr. objected to, and she didn’t know.  I gently urged her to find out (because…ahem…you CAN disagree with your Dr. and make your own choices!).  Especially because her BABY was constipated…and we weren’t really talking about vegetables here, we were talking about…

BREASTMILK

Ummm…yeah…”ICK!” right? I suspect that was the objection the Dr. had. Hey, it makes more sense to feed your baby processed cow milk than human milk, right?

If your baby needs cow milk because there isn’t a way to get human milk for the baby, then I’m glad that we have the cow milk. And hey, I’m a self-professed [cow]milk-aholic, so it’s not like I’m in the camp that thinks that across the board, cow milk should not be a human food. But I happen to think that whenever possible, baby humans should drink human milk. Its what God designed for them after all!

Apparently it was not important to the Dr. that babies fed breastmilk are less likely to die , with some speculation that an excess 9,000 babies die each year from formula feeding in America.  That’s not to mention the ear infections, gastro-intestinal illnesses (including constipation!), eczema, and allergies.  And of course, lets not forget, at about $.75 to $1.80 per 6 oz bottle…we are looking at about $1300 to $3300 to buy the formula for a year.

So I encouraged the mom to find out what the Dr’s objections were, to see if she agreed. I don’t know know if she ever did find out–she hasn’t asked me for my milk, and her baby is over 2 months old now. So my extra milk is going to a baby in Philadelphia–I’ve given about 12 gallons so far to this baby (another 2 gallons went to a baby in Oregon in 2002, and my other excess milk was either fed to my toddlers…or saddly, before I was aware of milk sharing, poured down the drain)–thats about $250 worth of formula for anyone who wonders…or about $7000 of breastmilk from a milk bank (yeah, they really have a steep mark up!).

I’m going to hazard a guess here that the Dr.’s primary objection to the donation was the “ick” issue…but if pressed, the Dr. would probably say something about the potential donor possibly having a virus that the baby could catch (that was what was recently published in a magazine, which coincidentally, I found out about AFTER starting to write this post). Which makes no sense really–would the Dr. turn down a blood donation on the same grounds? Well I’ve got my 2 gallon pin for blood donation (being pregnant so often really slows me down!), and a large portion of blood donations go to premature babies…who presumably would be more susceptible to any virus than my friend’s full term baby. If I can be cleared for blood donation (my most recent donation was in January 2009), surely I can be cleared for milk donation!

The Dr. from the magazine suggested that only pastuerized milk from a milk bank was safe, but there are a couple of problems with that suggestion:

*just like blood, milk is a live substance. Pastuerization kills it, thus lowering its benefits. No one pastuerizes blood. Actually, the only reason we pastuerize milk is because the cows used to be dirty *externally* when they were milked. With laser cleaning now prior to milking, perhaps we ought to reconsider the whole pastuerization issue even for cow milk.
*milk from a milk bank, as I mentioned above, is prohibitively expensive, AND milk banks will generally only sell milk to parents who have a prescription for it–which is usually only given to preterm babies
*if a recepient mom really wants to have pastuerized milk, she can pastuerize it herself.

I’m a milk donor. And I’m not going to stop any time soon.  After all, doesn’t my recipient look happy? 

If you’d like more information about milk donation (as a donor or recipient), please visit http://www.milkshare.com or the “Milkshare” Yahoo Group.