a wanna-be doula

Yesterday, one of my dearest friends and closest neighbor gave birth to her second child, a little boy.  She and I got to know each other when we were each pregnant with our first baby, back in fall of 2003.  We were each sold on the idea of natural childbirth, and we were both hoping for drug-free, intervention-free birth experiences.  We even took our childbirth classes at the same place, Blossom Birth, but at different times!  Our girls were born exactly five weeks apart, and to this day they are one of each other’s best friends.

As my friend’s pregnancy progressed, we talked a lot about birth and thoughts about a second child.  As the time for her birth drew closer, we talked more about actual childbirth, and I was able to answer some questions she had.  Since I first had Lyd in fall of 2003, I’ve learned a lot about childbirth as well as the postpartum time.  I feel very strongly that I want to become a doula, both a Birth Doula who acts as a labor coach to assist the mother (and father) through the process of childbirth, and a Postpartum Doula who assists the new mother after the birth with breastfeeding and is an expert on newborns.

I had hoped to obtain some doula training this year, but with my husband’s extra-busy schedule, that was not able to happen.  Depending on what happens with our family in the coming year, I hope to be able to try to pursue some training again.  As I talk with pregnant women, I realize that this is where my passion lies.  I love talking to pregnant women, I love to be around new babies, and I love helping people prepare to welcome a new baby into their home.

Today as I went to the hospital and held my friend’s new baby (Oh! What an amazing smell new babies have!), I was reminded of just how passionately I feel about new moms and new babies.  THIS is what I want to do.  Maybe I won’t always want to be in this field, but right now, it is definitely what I want to do.

I’ve promised my husband – and my children, even though they don’t realize it – that I won’t actively work as a Birth Doula until my children are older.  Being a Birth Doula requires the ability to be on call at any hour of the day or night, and I can’t do that while I have small children at home.  However, I am holding on to hope that I will get to witness a few actual childbirths between now and my actually becoming a Birth Doula.  I was hoping that it would work out to be at my friend’s childbirth, but circumstances happened otherwise.

But being a Postpartum Doula – that I could theoretically do right now.  For this kind of doula-ing, you set up appointments with families, and there’s no running off in the middle of the night.  It’s a lot more predictable, and I could do it while still having small children at home.  Being a Birth Doula seems more exciting and dramatic, but Postpartum Doula is no less important, and probably just as rewarding.

We’ll just have to see what the new year brings.  Hopefully I can make something happen in the Doula Training department.  It would be such a thrill for me!

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affirmations of love

As parents, you pour so much love and care and attention into your child — and you really get so little affirmation back.  The first smiles are greeted with delight, and the first time the child raises their arms up to you asking to be held are great moments in parenting.  “Finally!” we think.  “My child loves me!”

At 15.5 months, Curious J is finding new ways to demonstrate that she loves us.  Lately, when we’re giving her hugs, she will sometimes pat us on our back, the same way that JJ and I often do with her when we’re giving her a hug.  This evening while I was nursing her, she gently patted my face in that same manner.  It was so beautiful to see her trying to hug me like that.

In another first, tonight, for the first time, as I put her down in her crib for the night, she waved goodbye to me with her chubby little hand.  I never wave goodbye to her at nighttime, so her actions were completely unsolicited on my part.  It was so wonderful to have her communicate something to me that was an emotion rather than a need.  And, of course, it was so cute! 🙂

I still can’t stop smiling.  It’s wonderful to be loved by my baby.

less is more when it comes to maternity care

I recently found this article from the L.A. Times.  The author of the article, Jennifer Block, previously wrote an amazing book entitled Pushed: The Painful Truth about Childbirth and Modern Maternity Care.  Like the movie The Business of Being Born (which I reviewed here), it takes a hard look at the maternity care system in the United States today and shows that it spends too much money and does not provide good care for mothers and babies.

The United States ranks at the bottom (41st place) of the world’s industrialized nations in regards to both infant and mother mortality rates.  This means a mother and her baby are more likely to die in (or soon after) childbirth here in American than in practically ANY other industrialized nation in the world!  How can this be?  We’re so MODERN here!  We have fancy machines at birth, we’re surrounded by doctors and nurses, our care is the best, right?

Wrong.

Study after study after study proves that when LESS machines are used in birth, when doctors are LESS involved, when LESS medications are given to mothers, and when LESS time constraints are put on labor – the result is MORE healthy babies, MORE healthy mothers, and MORE instances of successful starts to breastfeeding.  Less is more in childbirth, yet Americans in general don’t seem to believe that, and certainly not when it comes to childbirth.

The most cost-effective, health-promoting maternity care for normal, healthy women is midwife-led and out of hospital. Hospitals charge from $7,000 to $16,000, depending on the type and complexity of the birth. The average birth-center fee is only $1,600 because high-tech medical intervention is rarely applied and stays are shorter. This model of care is not just cheaper; decades of medical research show that it’s better. Mother and baby are more likely to have a normal, vaginal birth; less likely to experience trauma, such as a bad vaginal tear or a surgical delivery; and more likely to breast feed. In other words, less is actually more.

This topic becomes even more interesting when you consider the implementation of nationalized health care.  In most contries of the world with nationalized health care systems run by the federal government, midwives handle the majority of the births.  The high-risk births (about 20%) are attended by obstetricians, who are best able to handle the problems that go with these births.  But the majority of births are low risk, and those births are handled by midwives.  These countries spend far less on maternity care, yet they have far better outcomes for mother and baby.

There was much talk about “health care reform” in the last election.  Maternity care is a prime example of an area of health care that is badly in need of reform.  The good news is that reforming maternity care would dramatically lower costs!  Consider this quote from Block’s article:

Currently, just 1% of women nationwide get midwife-led care outside a hospital setting. Imagine the savings if that number jumped to 10% or even 30%. Imagine if hospitals started promoting best practices: giving women one-on-one, continuous support, promoting movement and water immersion for pain relief, and reducing the use of labor stimulants and labor induction. The C-section rate would plummet, as would related infections, hemorrhages, neonatal intensive care admissions and deaths. And the country could save some serious cash. The joint Milbank report conservatively estimates savings of $2.5 billion a year if the caesarean rate were brought down to 15%.

If nationalized health care does indeed become part of the United States under the Obama administration, will midwifery become the new standard of care for Americans?  Will birth centers become more prevalent?  Most birth centers today have a hard time keeping their doors open.  Because they support hand-on, low technology births, they don’t bring much money in, and they have a difficult time staying open.  Furthermore, many insurance companies won’t cover births that occur outside of a hospital setting.  (Nor will insurance companies cover doulas, as I have unfortunately discovered during my last two births.  Grr.)  Will the evidence-based best practices be implemented on a national level, not only for their cost-saving measures but also for their greater health benefits?

I’m not an Obama supporter, but I would be very pleased to see him instigate such practices.  And if anyone can get people on board to make change happen in this area, he can.

—–

An interesting side note: Last month I had my yearly OB-GYN checkup.  After the requisite poking and prodding, I got dressed and met my doctor in his office.  I offered him my copy of The Business of Being Born, explaining what the movie was about.  He was glad to receive it, and said he would happily watch it with his wife (who is also an OB).  We talked about the waste that happens in obstetrics today, and he mentioned something interesting.  Apparently all pregnant mothers are now recommended to be screened for cystic fibrosis early in their pregnancy.  It’s a blood test, like the others, but it’s another test that has to be run, and another test for which insurance now has to pay.  My OB thought that this test wasn’t worth it, as he’s seen only a handful of CF babies in his 20+ years of obstetrics.  He said, “It’s another test that costs insurance companies money, it’s another test for the mother to worry about, and it’s really not necessary.”  He then added, “If Obama made me the OB czar, I would get rid of all the prenatal testing, save for the 16 week blood test and the Level 2 ultrasound halfway through the pregnancy.  Pretty much anything that’s significantly wrong with the baby can be discovered one of those two ways.  That would save a lot of money while still giving doctors and mothers adaquate information about the baby.”

Ah, yes, Americans’ obsession with medical tests!  Another way that waste could be cut out of the health care system!  (Don’t get me wrong – I know people with CF, and I’m not saying your disease isn’t important enough to test for.  But, from a practical and monetary perspective, it’s just not that common enough of a disease for the entire general populace to be tested for it.)

Frankly, if all of this waste WERE cut out (and I’m sure there’s similar instances of waste in other medical fields), perhaps health insurance would become more affordable and there wouldn’t be this great health insurance debate going on right now!  We wouldn’t need to even consider getting the federal government involved, because costs would be under control.

Oh, well.  One can always dream, right? 😉

Comments, please! What to feed a 13-month old?

Help!  Please read and comment!

So, last night I wrote about how my daughter, Curious J, and I are going through a rough patch.  I don’t know what to do about her constant, all-day fussiness.

Today, during another difficult mealtime, it occurred to me that the problem may be food-related, specifically, not enough food.  Because at lunch, she frantically downed a 4oz bottle of breastmilk straight from the fridge.  It was a leftover bottle prepared for her to have while I was at work yesterday morning, and I only meant to give her a few sips to wash down her food.  But she swizzled it down so fast that I didn’t feel right taking it away from her.

As we watched her down this bottle in less than 5 minutes flat, I wondered aloud if I should perhaps introduce some formula into her diet.  (She’s never had a drop of formula – call me a breastmilk purist.) I can’t pump anymore, and frankly, I don’t want to either.  I’ve still got about 50 or so ounces of breastmilk frozen in my freezer, and they are slated to be used when I’m at work.  However, I’m desperate enough to consider all options, including trying formula, although I feel like a bit of a failure if I use formula.

My husband agreed with me about at least considering formula, and he remarked that when our older daughter was this age, he seemed to remember her eating more “baby-ish” food and not so much table food.  I do feed Curious J a lot of table food, and while she likes to try most of it, she doesn’t really like to eat it beyond a few bites.  Perhaps I should listen to my baby; perhpas she’s just not ready for lots of “real” food yet.

Unfortunately, neither of us remember real clearly what we fed our firstborn when she was one year old.  We’re at a bit of a loss.  I do remember steaming big batches of fresh green beans, chopping them up in my food processor a bit, and spooning them into empty plastic Gerber food containers, freezing them for later use.  I know I made applesauce.  I know I made a few large batches of a pear sauce/butternut squash combo which I also ran through my food processor.  I remember putting spaghetti through the blender for a bit to make it into small pieces, and Lyd really liked that.  I also remember cooking up small noodles and sprinkling them with shredded cheese, which is Lyd (and Curious J’s) favorite for a long time.  But I don’t remember anything more specific than that.

So, WE NEED HELP.  I am asking for comments, or you can email me, if you prefer.  What do you feed an almost 13-month old child? How much table food, and what kinds of table food?  How much breastmilk/formula?  How much “baby-ish” foods?  And what do you feed your 13 month old for breakfast?

If you would be so kind as to give us your thoughts, I would be most appreciative.  I am getting ready to feel guilty for being a horrible mother, but at the same time I don’t want to let my pride or guilt get in the way of my child’s happiness and comfort.

Thanks.

Babywise by Gary Ezzo and Robert Bucknam

On Becoming Babywise: Book One

by Gary Ezzo and Robert Bucknam, M.D.

First of all, I should state that my edition of this book is copyrighted 1998, and I know it’s been revised and updated since then, so bear that in mind.

Ah, Babydumbwise.  I saved the controversial book for last.  If you click on the link above, you’ll go to the amazon.com website, where you’ll see 2/3 of the people give the book 4 or 5 stars, but 1/3 of the people give it 1 or 2 stars.  Some parents swear by this book, other parents claim this book promotes child abuse.  You’ll have to read it and decide for yourself.  I’ll give you my opinion, however, because this is my blog ;).  Here goes…

There is some good advice in this book about putting baby on a schedule and tips on how to incorporate your baby into your life, rather than having your life completely revolve around the baby.  That said, most of the good advice in here is stated far better in other books, and while, yes, you can’t revolve your life around a baby, at the same time a new mother’s life should revolve around the baby, especially in the first weeks of life.  That’s the best way to promote bonding and attachment, as well as to firmly establish the breastfeeding relationship, which can take up to 8 weeks to really feel comfortable (says Emily as she frantically waves her hand in the air and says, “That was me!  Eight weeks!  With Baby J!  And I had already successfully breastfeed Lyd before that!”).

I didn’t read this book until my first daughter was no longer an infant, past the age range of this book.  I had already been introduced to attachment parenting (AP) by then, and while I still don’t consider myself a full-blown attachment parenter, I definitely use some AP ideas in my own parenting.  However, what struck me instantly on reading this book is how the author creates straw-man arguements between Babywise parenting and AP.  Babywise parenting is All Good, and AP is All Bad.  The picture the author draws of AP is not a true picture at all, and if I had heard nothing about AP before I read the book, I would be completely biased against AP.  So, reading the author’s stupid analysis of AP biased me against the book, because I know that’s not what AP is.

The other problem with Babywise is that not all babies take to a schedule the way Babywise thinks babies should.  Neither of MY daughters have!  So, if I buy into the teachings of this book, then if my baby doesn’t fit the Babywise mold, the problem either lies with me, that I’m just not doing it right, or the problem lies with my baby, that something is wrong with her.  I don’t like either of those assumptions.  I don’t need ANY MORE GUILT as a parent than I already am dragging around with me, thank you very much.  I can create all the guilt I need BY MYSELF; I don’t need any book telling me that I’m parenting “wrong.”  Secondly, I resent the assumption that something is wrong with my child if she doesn’t fall neatly into the pattern laid out in the book.  NOTHING is wrong with my baby!!  She is just fine; she is her own person!  Stop making me feel bad about my baby!

There.  Got that off my chest.

Now, I can, more calmly, go on to say that there are some nice ideal schedules in this book that might be useful to a new mom, especially for a woman who has not grown up around babies and infants.  But at the same time, you have to be willing to adapt to your baby’s needs regardless of what the schedule is.  This book pays lip service to being sensitive to your baby’s needs, but the whole tone of the book says that you should not let your baby push you around, and you have to be the parent in charge.  When you consider that this book is written for the parents of infants 0 – 5 months old, that’s a little strict, in my opinion.

Now, if Babywise works for you and your child, great.  More power to you.  But the danger with this book, and why some people are so vehemently against it (besides the points I yelled out above) is the book’s idea of a parent-directed feeding schedule.  The author encourages the parents to decide when their child eats, rather than doing “demand feeding,” an AP term, which the author apparently assumes means that AP’ers only feed their baby when s/he shows hunger cues.  If it weren’t for the book’s parent-directed feeding philosophy, then parents wouldn’t know that they should feed a child, even when that child is not displaying hunger cues.  Where does the author come UP with this nonsense?  That is so NOT what attachment parenters do!  Anyway, the author says that when the baby wakes up, s/he should be fed, then should have some waketime, and then back to bed for a nap.  This routine takes place over 3 hours.  (This routine in itself isn’t bad, and if it works for you, great!)  Parents are encouraged not to feed their babies in-between times, and to definitely not nurse their child at naptimes or even (God forbid!) nurse the baby to sleep.  (What??)  Unfortunately, there have been parents who have followed this schedule too strictly and have allowed the baby to nurse only at specified times, which meant the mother’s breasts didn’t get the stimulation needed to build up a good milk supply, which meant the baby didn’t get enough to eat, and when the baby was finally taken to the doctor, it got a “failure to thrive” label.  Now, that’s not likely to happen to most people, and in fairness to the book, it does lay out criteria that you can use to make sure your baby is growing adaquately, but it serves as an example of the authoritative tone in this book, a tone of This Is How You Should Parent.  Personally, I don’t buy into the idea that there’s only one right way to parent a baby.

Like I said, there are some good tidbits of advice in this book that I have used with my girls.  The “eat-wake-sleep” schedule worked well with Lyd, although she did it on a 2-hour schedule, not a 3-hour schedule.  However, it did not work with Baby J.  I tried and tried to get her to do that routine, and it just never worked.  When I finally gave up, and did what she wanted, which was an “eat-wake-eat-sleep” schedule, she finally developed regular naps and became a much happier baby.  But she followed a 3-hour schedule, whereas Lyd did not.  So, you have to be willing to know your baby and work with your baby, not try to force your baby into doing it the “right” way.

Beware, another rant coming on here.  In the chapter “Facts on Feeding,” the author says that feeding schedules have an impact on sleep schedules.  Not true.  I’ve read a lot of research on this, and no other doctor out there (that I’ve come across, please prove me wrong) says this is true, with the obvious exception of the fact that a hungry child won’t sleep well.  But, to suggest that when you put food in your child’s belly is a main factor in whether or not your child sleeps well at night is bogus.  Read Healthy Sleep Habits, Happy Child if you want to learn the facts on babies and sleep.  And that author, whose life work has been to study sleep in children, says that most babies don’t begin to establish regular sleeping schedules until at least 8 weeks, and many don’t establish them until 3, 4, 5 or even 6 months.  He also says that feeding and feeding schedules have NOTHING to do with sleep habits.

Speaking of sleep, the author promotes letting your baby cry themselves to sleep, even from a young age.  While I have done that with both of my babies, I wouldn’t dare do it in the first three months of their life at least.  I think I started doing it with Lyd around 5 months and with Baby J around 6 months.  In many health and sleep professionals view, it’s highly ill-advised to let a baby younger than 3 months cry it out.  If babies are crying at that age, it’s because they need something.  Little newborn infants just don’t have the capacity to be stubborn or rebellious at that age.  And to insinuate that putting a baby to breast when it’s fussy isn’t always the best idea — well, maybe it isn’t ALWAYS the best idea, but it’s a pretty sure-fire idea to have at your disposal.  To suggest, even mildly, that a mother NOT do that is to insinuate that breastfeeding isn’t always good enough.  It’s part of the subtle attacks on breastfeeding that are peppered all over this book.

Finally, while this book does promote breastfeeding in the first months of a baby’s life, it also says that the nutritional value of breastmilk declines after six months, which is simply not true.  The nutritional value changes, but it certainly doesn’t decline!  To be fair, perhaps this is a fault of the 1998 version, and newer versions don’t have this false fact.  But although the book says that “breast is best,” there are many subtle statements in the book that create the idea that a bottle is just as good.  And another false fact stated in this book regarding feeding and sleep is that “It is not what goes in the mouth as much as when it goes in.”  This is SO false!  Breastmilk IS digested faster than formula; it’s supposed to be that way.  Now maybe you’ll be a lucky one and your child will sleep through the night early despite being breast-fed, but that’s certainly not every mother.  And to insinuate that there’s no difference between the two is going to potentially set a mother up for failure.  Either her child won’t get enough to eat and will be hungry and fussy much of the time, or the mother will give up breastfeeding and start feeding the baby formula, making the baby “settle down,” and the mother will think that she just wasn’t meant to breastfeed.

Like I stated earlier, if this book worked for you, great.  But I’m thankful I didn’t read it with my first child, because my parenting experience would have been very different.  I have gleaned some good tidbits from this book, but I found those good tidbits floating amidst a sea of lousy advice.

And as for the author, Gary Ezzo, apparently he’s … got issues.  The American Academy of Pediatrics and breastfeeding professionals have many concerns about the infant feeding advice promoted in Babywise.  Read about those problems at http://www.ezzo.info/  He apparently has had problems with his church, too, and has been publicly denounced.  So…

There is good advice in this book, but you can find that same good advice in far superior books.  Read it if you feel the need, but, like ANY book, don’t follow it blindly.  Read, research, and make your own decision that works best for your family and your particular baby.

For stories of people who initially thought Babywise was a good idea, but then had problems with it later, read here.