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Monday, January 31, 2011

Book Giveaway and Other Cool Stuff!

I've discovered the best way to beat the winter doldrums: go shopping!

I pre-ordered a copy of Ina May Gaskin's new book Birth Matters, which is due out in March. When my FaceBook fan page reaches 250 "likes," I'll give away this book to a lucky fan! (If you pre-order your copy before March, will give you a discount price.)

The UK version of
Ina May's book, from
Pinter & Martin LTD.
The first thing I noticed about this book was the cover: the British versions feature a photo of Ina May next to a nekkid kid, umbilical cord clamped, little doinky in full view of the world in all its newborn glory. In the US version of the book, this portion of the photo is cropped - perhaps to preserve this child's dignity, or because it's perceived as child pornography in the eyes of discerning US censors (or perhaps they're a little uneasy at the sight of an intact penis). Whatever the case, it almost seems like they're heading Ina May off at the pass - the title of the book is, after all, "Birth Matters: How What We Don't Know About Nature, Bodies, and Surgery Can Hurt Us." (emphasis mine.)

My next purchase was inspired by Birth Without Fear's blog post on Peggy Vincent's Baby Catcher. So far it's an easy, thought-provoking read and I can't wait to really get into it. I love her description of her own labor: wracked with pain and trying desperately to adhere to the advice of the Lamaze pamphlet ("the little blue book of lies") and her own humiliation, even as a childbirth educator, in asking for drugs during her labor. Vincent chronicles many of the births she's attended throughout her years as a midwife, and one thing is for sure: birth stories never get old!

I also picked up a copy of Marsden Wagner's Born in the USA, which I've been meaning to check out for some time. I haven't had much of a chance to really delve into it, but the introduction caught my eye over morning toast:
"Much of what is in this book will come as a shock to women and families in America. There are two reasons for this. The first is that accepting that our present maternity care system is as abusive as documented here is a hard pill to swallow. No society wants to believe itself capable of putting its most vulnerable members - pregnant women and their babies - at such risk. The second reason is that the American obstetric profession has managed to keep a big secret from the public for fifty years."
Right on, Dr. Wagner.

I also snagged a second copy of Tina Cassidy's Birth, just in case. Perhaps for a future book giveaway, perhaps to lend to someone who needs to read it. Come fall, I'm seriously considering suggesting this to my book club - I chickened out last time and wished I hadn't. Why? Because I was concerned that for some women, it might highlight the vulnerability they perhaps experienced while pregnant and laboring, maybe even bring back memories of past bad birthing experiences. While I want people's eyes to be opened, if they're not as birth-nerdy as me, they might take it as an affront to the choices they made while laboring, and I don't want it to end up that way. (But mostly now, I think the word needs to get out, so if they have issues with reading it, let the chips fall where they may.) If we do read it, I'm really interested to see what kind of discussion comes out of it: especially since I think women who otherwise don't discuss such intimate details with each other flow like Niagara Falls when it comes to discussing their births of their babies.

And because I just couldn't help myself, I stopped over at Barnes & Noble and picked up a copy of Swedish photographer Lennart Nilsson's "A Child is Born." I remember seeing photos that this miraculous photographer has taken over the years, and even caught part of the Discovery show's TV special on it. Unbeknownst to my husband and I, the very process of fertilization was taking place in my body, almost as if it were being orchestrated with the broadcast. We found out about two weeks later that we were pregnant with our first baby.

When I  gleefully brought the book home to show my husband, he cried. (He tends to be a very emotional guy as it is; when it comes to babies, he's a big ball of blubbering mush.)

Nillson started taking pictures in utero in the mid 1960s, including well-known photos of pregnancy on a cellular level - which astounded everyone (as it should!). Also included in the book are wonderful photos  - mostly emphasizing normal birth. One image shows mom pushing on all fours; and while analgesics are mentioned, nearly all of the photos of laboring mothers are free of IV tubing and monitors. The book does extensively cover preemies, and shows beautiful shots of moms (and dads!) in skin-to-skin contact with their babies, including plenty of images of babes at their mama's breast.

The book has been updated several times since its first publication in 1965, to include advancements in medical technology like IVF. There is also quite a bit of coverage devoted to artificial insemination, and interestingly enough only one page is devoted to cesareans. Among the reasons listed for them is "fear of childbirth," which in some ways is true, while in other ways isn't. I think the photographs are more representative of the normal birth culture in Sweden, where I assume most, if not all, of the photographs are taken. In this blog post, a dad talks about the process of midwives assisting throughout the pregnancy and birth and why he and his wife feel it's superior to giving birth in the US. He also mentions that Sweden's cesarean rate, not surprisingly, is around 17 percent.

While perhaps some of the text is out-of-date (the cesarean rate in the US is reported to be between 20 and 25 percent) that can easily be overlooked due to the amazing photographic content. While at first I was hesitant to buy this book, I thought of my kids and how soon they would be wondering, Where do babies come from? I figure this is a good place to start: with pictures of normal pregnancies and normal birth. When they're ready to be intrigued by naked boobies and body stuff, I want this to be the book they turn to.

Tuesday, January 25, 2011

SF Circumcision ban: Be careful what you wish (vote) for

Could government involvement
make your parental rights go up
in smoke? 
It seems that whenever California disagrees with the safety on something, they ban it. First incandescent light bulbs; then it was the toys in your child's Happy Meal. Now the City of San Francisco is engaged in battle over whether circumcision of male newborns should be illegal. If the legislation were to pass and you violate the ban, you could be jailed.

This is not meant to turn into a debate over whether the act of circumcision is right or not, as both sides of the argument, in their own eyes, have a very valid point. This is a debate over whether an entity other than the parents and the doctor - in this case, a city government - should be allowed to have a say in what you do with your child.

In this case, it seems that Lloyd Schofield - the guy who is bringing the debate to the forefront - thinks it does indeed take a "village to raise a child." Should that village have a voice in your parenting decisions if this issue is on the ballot?

I think that if this measure passes, it could be a mixed victory for circumcision opponents.

Whether you think it's right or wrong, it's really not your decision to make. Whether it's for cleanliness issues, a matter of religion or just because, when it comes down to whether it should be done or not is not a decision the public at large should have a say in.

In certain cases, it is definitely not recommended - such as when the baby's health is compromised. If the parents aren't aware of the dangers, it should be a joint effort of parents and the doctor to be educated on the risks and potential benefits, and the doctor should say up front, "Your child has this condition, and if you're considering circumcising him, perhaps you should reconsider."

When you talk about banning something like this, it is essentially ramming the ideology of one group down the throats of those who don't agree, and if the shoe were on the other foot, you can bet that wouldn't go over too well.

Take, for instance, the birth of Ruth Light, whose parents are currently engaged in endless court battles to regain full custody of their daughter. Ruth was born in a breech presentation at home, and experienced a brief shoulder dystocia, but was otherwise declared healthy and recovered from it. Her parents, being cautious and wanting to make sure she was well, took her to the hospital after her birth, where the physician declared that she was fine.

However, somewhere along the way a well-meaning, perhaps uninformed hospital worker decided that Ruth's birth problems could have been avoided had she been born in the "safety" of a hospital via cesarean, and children's services were dispatched. Ruth was removed from her parents' custody as a result.

Compare the home birth debate to the circumcision debate for a moment: one side says it's safe, and presents few complications when managed well. The other side says it's dangerous, presents complications that could result in death, and should be outlawed.

In both cases, there have been studies that declare it reasonably safe. And there have been studies that say it's dangerous and should be avoided at all costs. Which one should we believe, in either case?

Ultimately, yes - it's a human rights issue on one level, I'm not going to argue with that. But it's also a parents' rights issue, and as the caregivers responsible for that child, they are going to make choices on behalf of their children that could affect their lives, whether perceived as great or small. Atheist or Christian, meat-eating or vegan, we make choices for our kids every day, and dismiss them as just merely decisions that we make in raising our children the way we see fit. The choice not to vaccinate? Perceived as dangerous by some, there are currently laws on the books - as mandated by the government, in certain states - to have your daughter receive the Gardisil vaccine. Considering there have been reports of injury and even death regarding the vaccine, should you be forced by the state to vaccinate your child anyway? Or should you exercise your parental authority on behalf of your child?

Ultimately, whether you like the idea or not, you can't stop people from doing what they want to do. I'm guessing that any parent could simply locate a doctor outside the San Francisco city limits and get their child circumcised, if they felt that strongly about it. This same type of legislation could be used against parents, essentially weakening or severing altogether their authority to make decisions for their children.

Given our currently litigious society and the escalating role of government in our lives, and I can see this getting out of hand very quickly. In some ways, the Orwellian aspect of it has already taken over: forced c-sections, VBAC bans, pregnant women kicked out of bars because it's potentially risky to their unborn child (even though the mother in question didn't consume alcohol). (Let's not forget that some medical authorities consider it safe to drink wine occasionally while pregnant - are we going to publicly shackle women who adhere to this idea?) Where do you draw the line? Who's kid is this, anyway?

Why not outlaw formula feeding because it's dangerous and unhealthy and is inferior to breastmilk. After all, some babies have died from it - whether from contaminated water or from the very product itself. Piercing your infant daughter's ears? Doesn't matter if it's for religious or cultural reasons, it should be outlawed because it's for vanity reasons, can cause infection, and is not medically necessary. How about co-sleeping, because some people think it's dangerous? How about banning epidurals because they could potentially harm the baby? We could go on and on.

Those Happy Meal bans were instituted because the city wants McDonald's to put in healthier foods. Does that mean it'll soon extend to limiting parents' right to take their kids to McDonald's? Should we limit them to one visit per family per month in an effort to force them into healthier eating? Or how about we place them under house arrest and jail them if they don't feed their kids all organic, nutritious food once they're in the privacy of their own home?

Regardless of where we stand on the issue itself, I just wish people could see that involving government in the matter is not necessarily the best course of action. Beating someone over the head with your argument will not effectively convince them to rethink their stance so much as it will perhaps make the other side look like a bunch of crazy zealots. Nor will it help to infringe on the religious views of parents who circ for those reasons (separation of church and state, anyone?). A wide-scale education campaign, perhaps - starting in your obstetrician's office - is perhaps a kinder, gentler idea that will win more parents over and leave more little boys intact.

More reading:
'Intactivists' to San Francisco: Ban Circumcision 
San Francisco Circumcision Ban Unconstitutional, Professor Says
The 'Crappy Meal,' from Comedy Central: meant to be funny, but an interesting look into what the city can and can't force people to do

Monday, January 24, 2011

What birth stories can tell us (if we listen)

Every birth story is important, and we need to listen
carefully: What does it tell us about ourselves? And
of our past and present birth culture?
Photo credit: Jennifer Lasseter
Every so often, I talk to women who's birth story - or in this case, lack thereof - stick with me and really have an impact, whether for their joy or their profound sadness. I think of these women and wonder, if in a different time and place, things would have turned out much differently for some of them.

Mary, an elderly lady with whom I used to attend church, told me a fascinating if not altogether creepy story of how her doctor intentionally turned her first child breech in the womb, resulting in a breech vaginal birth. I wondered how poor Mary fared and if she ever questioned the "expertise" of her seemingly odd doctor, considering that probably nearly all the women Mary knew had babies who came out head-first. It's a wonder that she went on to have two more children after that.

Later at one of my OB visits while pregnant, I mentioned Mary's doctor to my OB, who dismissively said, "Yeah, that sounds like Old Dr. So and So." No word on what his crazy theory was supposed to mean or what results it was supposed to yield, other than making for an unnecessarily painful, most likely difficult and probably traumatic birth.

Another friend, Andrea, didn't have a birth story so much as she had one taken away from her: she confided in me that she had been diagnosed with bipolar disorder and depression. She was married for fourteen years and has struggled off and on in relationships. Her doctor told her that because of her bipolar disorder, she should never become pregnant. She reluctantly followed her doctor's advice.

Maybe Andrea's doctor was right; maybe not. I do know some perfectly competent mothers who are bipolar and manage with proper medications, monitoring and support. I can't help but wonder what Andrea's doctor's goal was: to keep her from "breeding" and passing on her "defective" genes? To somehow "spare her" the trials of motherhood?

Sandy, the mother of two grown sons, gave birth to her second son - on the heels of his older brother almost exactly a year later - and didn't want or feel she needed any pain medication. Sandy got into the delivery room just in time for the baby to crown, yet the nurse was adamant on giving her pain medicine.

I've had this post mostly finished in draft mode for months, and something sparked in me when I read a recent blog post from Birth Without Fear, who recounts the story of Zelda from Peggy Vincent's book Baby Catcher that unfolds much like Sandy's. Zelda was a black woman laboring on her own terms, vocalizing and doing great - until she is forced onto a bed and given pain medicine that she neither wanted nor needed. What is the real point here? Were doctors teaching us a lesson? Saving us from ourselves, that surely birth must be painful for everyone (because either I say it's so, or I make it so) and you're no exception?

Judith, who had just delivered her first baby and was determined to breastfeed, was given hormone medication to take after her birth - which was actually quite common then. Later she realized the nurse had given her pills to dry up her milk, even though she had made it quite clear her plans to breastfeed. How is it that someone makes that decision for you, without even asking your permission? Sorry, but this still happens today - "Take this pill," without so much as an explanation. Hang a bag of Pitocin after birth in order to shrink the uterus, even though mom is successfully breastfeeding, no questions asked, no reason given. Before you know it or can even object, it's done.

Even in the not-so-great birth stories, they're still important - in helping us understand the rocky history of "modern obstetrics," as well as putting things into perspective. While straps were often used to tie down a patient to force them to comply, those straps have turned into IV lines and lead strips for EFM today. The tethers that were once present at birth to quiet a patient have now been replaced with epidurals. A quiet patient is a compliant patient, and when mom isn't hollering, yelling or vocalizing through the pain, hospital staff doesn't have to hear her or deal with her.

Our culture's tenacious hold on birth ignorance is stronger than any leather strap or dose of narcotics, and it's these people that need to hear these birth stories the most. We need to read between the lines, and educate ourselves: why was grandma's birth story so much different than mom's, or mine? How was it the same, and what needs to change? As we see in Zelda's story, the endless empty excuses and outdated ideas blend with modern medicine. The shackles are still there; they just look a lot different.

More reading:
Pushed: The Painful Truth about Childbirth and Modern Maternity Care, by Jennifer Block
Born in the USA: How a Broken Maternity System Must be Fixed to Put Women and Children First, by Marsden Wagner
Birth: The Surprising History of How We Are Born, by Tina Cassidy

Friday, January 21, 2011

Under Pressure: Pushing Kids to the Limit

Yesterday we received an intriguing article in the mail from my father-in-law: author Amy Chua writes how Chinese mothers are "superior" in their efforts to parent children who excel at everything they do and far surpass their Western counterparts.

There were no shortage of responses, including Hanna Rosin's article "Mother Inferior." While I normally don't agree with Rosin (like her ideas on breastfeeding that I mentioned in my previous post) I think she was spot-on here. The children of "Chinese mothers" also chimed in, sort of exchanging battle scars about their childhoods and being raised under the thumb of a parent who relentlessly sought perfection.

Some of my FaceBook friends know that recently I've been trying to survive a spate of outbursts from my 4-year-old daughter, that exploded into a public full-on fit with screaming, yelling, and generally mopping the floor with herself the other day. Looking back on that episode after reading Chua's article, I figured we could go one of several ways: public humiliation (for both of us) in the form of a spanking right then and there, or resign ourselves to the relative peace of the ladies room; or coddling gently, prodding and giving in to Princess's endless list of wants in order to get her through the day. Since we were in the mixed company of parents who I know spank and others who coddle, I wondered silently to myself what they were thinking: Because I'm such a strict disciplinarian, my kid would never do this in public, or Because I'm my child's friend, she would never do this in public. In many ways, I think Chua's article about American parents is somewhat right, in that our society tends to place a lot of emphasis on "Everybody wins!" rather than teaching children how to cope with loss, losing, and generally just not getting their way. Not every outburst and tantrum has to end with a congratulatory ice cream sundae with cherry on top "because you were sitting still for three whole minutes!" Can we not achieve a happy medium here somewhere?

Since I'm not Chinese, I can't really relate to the cultural differences she refers to. I suppose that some of my own shortcoming as a person - take, for instance, my inability sometimes to finish tasks - could have been prevented if my mother stood over me and forced me to finish, regardless of my feelings about it. As a result, I try to instill in my son more discipline overall than I have. I do some graphic design work on a weekly basis, and yet every time procrastinate almost until the last minute. Therefore, when my son comes home, homework comes first before television and fun. I don't remember my mom taking a similar stance with me (which doesn't mean she didn't), but it seems that when we're adults, we indulge ourselves in ways that we often weren't able to as children.

Chua rattles off a list of things her children were not allowed to do, some of which, in the eyes of probably all Western parents, are extreme: no sleepovers, no television, no playdates. Her children were required to play a musical instrument, and it was to be either piano or violin. (Is there absolutely no merit whatsoever in knowing how to play the oboe or the flute?) It sounds as though they were not able to make any decisions regarding their own lives, and thus establish their autonomy. To me, it sounds like a living nightmare: forced to be creative because someone wants you to, not because you want to be. You may be able to create beautiful music, but more along the lines of a finely-tuned robot; not someone who has a clear passion for doing so.

Rosin makes this point in her rebuttal: she knows people who were drilled ad nauseam in music, and thank their parents for instilling that drive and determination in them. But they hate music as a result. Can't play it. Can't enjoy it. At least not without it dredging up a lifetime of unhappy memories at the same time. Rosin mentions Andre Agassi and his autobiography "Open," where he says, "I hate tennis...hate it with a dark and secret passion, and always have." Where's the joy in that? If you're an expert at something, but hate every minute of it, what's the point?

In her article, Chua states, "Nothing is fun until you're good at it." By who's standards, I want to know. Because my definition of "good" might not be the same as yours, and it sounds like from her standpoint, nothing is fun, ever.

Chua categorizes Western parents as if they're all sloths who don't care much for their kids' success, and sort of take a willy-nilly approach to ensuring a future for their children. I don't know if she's attended a high school football game, where angry parents take to the field when their children fail to live up to the standards of perfection some of these parents have. Much yelling, swearing, hat-throwing and general bad behavior takes place at a number of these events, leaving the student athletes no doubt embarrassed and ashamed. We've all heard tear-jerker stories of American parents who will relocate their entire family or drive 500 miles a day so that their child can practice ice skating at a rink three states away, all while working four jobs and yet trying to maintain a sense of normalcy in their child's life.

Chua obviously has not heard of Western parents who so overschedule their children in music lessons, sports, and other extracurricular activities that they have little time to do anything else, including enjoy their childhoods. Every minute is spent planning, performing and shuttling between one event and the other. I've noticed now that most sports teams practice at 6 p.m., right smack in the middle of dinner time. When does family time take precedence? When do we have down time to just do nothing and relax?

There's also the typical model of the American workaholic, who spends much of his or her time on the road, working, earning a living for the family but not really spending much time with them. I know several families like this, and while it's great that dad makes a very good living, he isn't even home to see his family enjoy it or put it to use.

When I graduated from college and entered the workforce, I took a number of jobs and eventually got good at them - but never really enjoyed what I was doing. So much of that was typical of the American mindset: that you should get a job at 18, get married and work at that job the rest of your adult life to earn a living for your family, regardless of whether you liked it or not. When I got married and could afford to do so, I wanted to be picky about the job I chose. I wanted to do something I loved, not something that merely made me a living to get by. My mom later told me how much she learned from that example - that being happy is more important than living the typical boring daily grind, and that life's true passions are what should drive us.

Do Chua's daughters have a passion for music? Probably not. Will they be concert pianists and performing in front of thousands in ten years? Probably not. Chances are, the way it's being driven down their throats they'd probably prefer to burn a piano than play one. So will their experiences matter in the end? Who knows.

And speaking of the Olympics: while Chua maintains that academics are key in the Chinese parents' model, and athletics take precedence in the American parents' one, I can't help but recall during the last Olympics (or two) stories of Chinese parents living in remote, isolated villages, who sent their children away for years, sometimes the duration of their childhoods, to train. And then train some more. To the point where their team and coaches were their new family. Where's the love in that? While "loving" your child enough to work them nearly to death or send them away to the Big City to learn is one thing, you essentially do it at the expense of any hope of a parent/child relationship.

Or how about the Chinese gymnast who was the best in her sport - but underaged? The team cheated and won the medal, of which they were finally stripped years later when it was revealed what they had done. At what length will you go to be the best?

(Perhaps this drive for perfection at any cost can explain China's long history of human rights violations against their own people. And not surprisingly, as I read the response article from the Chinese daughter, an article titled "Can the US teach China how to be a better global player?" shows up in the sidebar.)

Something sparked in me when I read the opening list of demands Chua made of her children when it came to academics and socializing. I immediately thought, How can these kids be happy, fulfilled or even close to normal?

It turns out, they often aren't. A quick Google search reveals that Asian-American women aged 15 to 24 are the most likely out of all ethnic groups to commit suicide, and it's not any wonder why after reading Chua's article (which doesn't mention this at all - perhaps her book does?). Apparently older Asian women are often prone to suicide and depression as well. There's no telling now how Chua's daughters will feel about their upbringing, or if they'll follow the same steps their mother took in raising their own children. But one thing's for sure, as Rosin points out: all the strict rules in the world won't make your child perfect. She also wonders, is success more important than happiness? Would you rather be wealthy and successful and miserable, as many people are? Or would you rather be mediocre, by someone else's definition, yet happy?

It's no secret, though, that many American teenagers lack severely when it comes to academics. In my opinion, it's a blend of apathy on the part of students and parents, exasperated teachers who are struggling to fill in the gaps, and lackadaisical teachers who think every kid learns at the same pace and try to force them into that box. Tenured teachers, both good and bad, tend to be more protected by the system and in some cases, it can just enable mediocre teachers who are burned out to stay for the wrong reasons.

While I do think some parents could improve in that department, I don't think Chua's solution is any where near the right answer.

In parenting, it's a mixed battle for many of us. Not every battle is won, and some are carried out rather badly on both our parts. I don't think any parent has ever walked away from such a fight without regretting a particular decision at some point. And I can't help but feel sorry for Chua's daughter during the horrible tongue-lashing she received from her mother over practicing the piano. The dishrag dad piped up briefly on his daughter's behalf, and then subsequently backed down when mom boasted her eventual success at getting her daughter to perform the piece properly - only after she received the equivalent of a verbal baseball bat over the head to do so.

You have to wonder, then, what kind of wife she makes when she engages in verbal warfare with her children? Does she ever stop to think how she would feel if her husband spoke to her like that? Sometimes when things get truly heated, I have to remember the age-old rule: Don't say to your kids what you wouldn't want them to say to you. Sometimes it comes back to bite you in the ass, and in a big way.

What happens, if parents like Chua wind up with a kid who just doesn't "get it," and never will, for whatever reason? Is there any room for failure there? While there is the stereotype that Chinese children have higher aptitude than their Western peers, I wonder - because Chua doesn't address it - what happens to those who don't? (Given China's track record on population control and forced abortions of females, I'm not sure I want to know.)

In her article, Rosin says that Chua admits in her book that she is "not good at enjoying life." No kidding. And you're raising kids that won't know how to enjoy it, either. Ever heard the expression "Stop and smell the roses"? It's hard to enjoy the innate beauty of something when you're forcing it to perform at your every whim and command.

In the end, Chua writes, "By contrast, the Chinese believe that the best way to protect their children is by preparing them for the future." Who's version of the future, I wonder - theirs or yours?

More reading:
Thoughts from the Daughter of A Chinese Mother, by Julianne Hing
The Tiger Cub Roars: Amy Chua's daughter speaks out

Thursday, January 20, 2011

Cultural Shifts in Breastfeeding Trends

In light of FaceBook's recent take-down of pro-breastfeeding content, I wanted to post some historical photos of women breastfeeding - namely in public places with other people around - to illustrate that not long ago, breastfeeding was considered a normal, healthy practice.

(These photos are in addition to the ones I have posted on my fan page as part of the "Girls on Film: Breastfeeding Through the Lens" series. To see it, click here.)

A nurse stocks the refrigerator with infant
formula made with PET brand evaporated
milk. From
Jennifer James of posted an interesting array of old photos of women breastfeeding. Many of them take place in public settings, in the company of friends, family and strangers. Among them are pictures of hospital staff stocking refrigerators with infant formula, and James notes that the rates of breastfeeding began to decline sometime in the 1930s. "It all started in the hospitals with their insistence that mothers did no[t] instinctively know how to care for their own babies," James writes. She adds that PET brand evaporated milk was being marketed heavily to hospitals in order to make the formula, much like formula brands are hawked today. 

During the shift from home birth to hospital birth, we already know that your finances often determined where you gave birth. Poorer people still tended to give birth at home and were thus more likely to breastfeed. Those with enough money to do so began having their babies in hospitals, where formula feeding was more encouraged. Because of companies that marketed evaporated milk to prepare formula, I'm sure that's where the connection that James makes comes in: We can tell mothers they don't know enough about feeding their babies, when in reality we just want to tout our product as being 'superior' to breastmilk.

A migrant worker living in
Depression-era squalor. 
Because of the changing cultural (and economic tides), I am going to go out on a limb here and suggest that initially breastfeeding was thought - much like having an unmedicated birth - to be something only the 'poor people' did. James makes this point in the following caption featuring a woman photographed by famous Depression-era photographer Dorothea Lange.

James writes: "I believe there was a brief window in history where poor, rural mothers were afforded a level of breastfeeding freedom that their city-dwelling cousins didn’t have. Indeed, this was before the milk industry rushed in and changed infant feeding habits for mothers all across the country."

Perhaps the most famous photograph that Lange took was that of migrant worker Florence Owens Thompson, mother of seven and considered an "iconic image of the Great Depression." However, other images from that same photo session reveal the mother breastfeeding one of her children.
Later Thompson and her family revealed how embarrassed by the images - and their poverty - that they were. (They never received any royalties from the image that Lange took, nor did they even know that their mother was the model for the well-known print until nearly 40 years after its release.) While the idea that formula companies were to blame for aggressively marketing their product and essentially destroying breastfeeding relationships in women, their poorer counterparts had no choice but to breastfeed. In one piece I read, Thompson replied that because of their poverty, they "couldn't afford not to."  

In my family, it's written in my grandfather's baby book (born in 1927) that he was breastfed for a year. By the time my mom was born in 1948, her mother nursed neither of her two children. Judging from the stories I hear from other women, it seems like there is a persistent attitude of "You can't nurse your child,"  which translates into "So you shouldn't bother," that carried on well into the 1970s. A friend's mother told how she was given hormones, much to her dismay, to prevent milk from coming in (a common practice, often done without the mother's knowledge). Another woman, who had five children during the mid-1950s and 60s, never nursed any of them because she "couldn't." I never asked why.

In this photo from James' blog post, you see a child in a "Skinner box," a contraption designed to help in raising the child with a temperature-controlled, humidity regulated box. Aside from that - the sight of which no doubt makes attachment-parenting advocates cringe - is the image of the baby with a bottle in its mouth. We've moved on from the active role of nursing to the idea of propping the baby's bottle in his mouth so we as parents can move on to more important tasks.

This photo reminds me of my mom, who was about the same age as this baby and often left in her crib at night with a bottle in her mouth. As a result, she has had a lifetime of dental problems.

The image of the Skinner box and the ideas behind it remind me of the technology-driven 1950s, where inventions were cropping up to make our everyday lives easier. While babies who were "raised" in Skinner boxes were not kept in them 24/7, there still was this idea of separation from mother and child when it came to parenting, that I think gave way to the idea that touching, loving, coddling and nurturing your child was passe and spoiled kids.  Like some people think today, the idea of formula feeding no doubt seemed more appealing because you could multi-task - and it's just too much of a pain in the ass to have to feed your child while shopping, or out and about, under the watchful eye of those who think breastfeeding in public is "gross." (I've actually heard women say this was a major reason why they chose not to breastfeed, because of what other people thought about it.)

Despite my own mother not being breastfed, my mom nursed me for four months. I asked her once why she stopped, and she said it seemed like I wasn't getting enough. I'll have to ask her sometime if she remembers any aggressive formula marketing that seemed to make mothers feel like they were broken or inadequate, or tout their product like a miracle food that could eclipse Nature's own. Interestingly enough, breastfeeding was not something mom and I talked much about, but I was adamant about nursing my child when I became pregnant.

Fast forward to the counter-cultural revolution. While there has been a resurgence of natural birth and breastfeeding movements since the 1970s, the idea that "breast = sex toy" remains. A lot of people blame the formula industry for increasingly aggressive tactics, which plays a large role. But I think with the more open sexual culture, the more normalized the idea that breasts were for pleasure. While we've always had porn and erotica, the increase of sexual freedom and greater access to adult entertainment seems to further cement in our minds that breastfeeding is "dirty," sexual, or gross. With even greater access to porn and adult images today on the internet, as well as the problem of child pornography, breastfeeding has been the unfortunate victim of people who can't separate the two. Even my internet filter won't allow me to access a Wikipedia article on breastfeeding because it blocks it as "nudity."

The resurgence of the feminist movement likely did more to hurt than help breastfeeding, as more and more women were finding success in the workplace. Like we see today, they either couldn't or wouldn't breastfeed because of expectations about returning to work soon after childbirth, and the idea that it somehow tethers them to their children and the confines of staying at home. Some women, like Erica Jong, assert that more attachment-style parenting, breastfeeding and stay-at-home motherhood is a prison. Writer Hanna Rosin asks, "is it this generation’s vacuum cleaner—an instrument of misery that mostly just keeps women down?"

While the age-old "breast vs. bottle" debate still rages, I can't think of anything that defines me more as a woman than breastfeeding my children. 

Timeline: A Brief History
1867: The first commercial infant formula, "Liebig's Soluble Food for Babies," was introduced by German chemist Justus von Liebig
1907: The "percentage method" of infant feeding was made popular, which involved mixing "cow's milk, water, cream, and sugar or honey" in an attempt to reproduce what physicians thought breastmilk was most like. Up until this time, sanitation problems had already led to the illness and even deaths of some babies because prepared food had been mixed with contaminated water, thus necessitating another shift in feeding trends.
1920s: Evaporated milk was more widely and cheaply available, and studies suggested it was healthier than breastfeeding - even though many formula- or milk-fed infants at the time exhibited signs of scurvy, rickets and bacterial infections. The studies, apparently, "were not supported by modern research."
Late 1920s: Similac, named for "similar to lactation," was introduced. Mead Johnson invented and marketed Sobee.
1950: Over half of all babies were fed infant formula.
1956: The La Leche League is formed.
1959: Enfamil was invented by Mead Johnson, combined with "marketing campaigns that provided inexpensive formula to hospitals and pediatricians."
1970s: Over 75% of America's babies are fed infant formula.
2000s: Infant formula is heavily marketed in hospitals and doctors' offices (with free samples), despite regulations that forbid it. About 50 percent of the infant formula sold in the US is subsidized by the government for low-income mothers.  "In surveys, over 70% of large hospitals dispense infant formula to all infants, which is opposed by the AAP and in violation of the code." - Wikipedia

More links:
Bring Back the Leaky B@@b on FaceBook

Saturday, January 8, 2011

Gettin' Your Baby Fix On, Similac-Style

Similac: Good to the la$t drop
A recent blog post by Amy West at Just West of Crunchy has brought to light Similac's attempts to further market their product - Abbott Laboratories has launched Night Nurse Nation, whose FaceBook fan page is specifically geared towards night-shift nurses.

The moderators of the fan page posted this thread recently: findings suggest babies who die of SIDS have "significantly lower levels of Seratonin." No mention of breastfeeding and how that can greatly reduce the risk. I suppose it would be a conflict of interest for them to drop that bomb - why, then, would anyone want to buy their product?

Shockingly, breastfeeding as a way to reduce risk doesn't appear anywhere in the article, either. (Isn't it ironic that they'd pick this article? It appears that a few people who left comments aren't buying it, either: I don't know if they're nurses, birth/breastfeeding advocates or what, but one woman said, "The greatest risk for SIDS occurs when babies are NOT breastfed. Period." Wait...listen for it: can you hear the pin drop?)

Another commenter felt, as I did, that the findings were inconclusive: what about Pitocin? Mothers who use antidepressants such as Zoloft? Another reader remarked, "Abbott Nutrition has no business getting in bed with Night Nurse Nation."

In Amy's blog post, she included a photo of RestFull, a product made by Enfamil designed for "bedtime feeding." From the descriptions I've heard, it's designed to keep babies' tummies full longer. Supposedly it's "thick" - honestly, it sounds like sludge.  I couldn't think of anything scarier or more ridiculous: not only is it like "gassing up" your car before a long trip, but it's almost saying, "That stupid ol' breastmilk - your baby's going to starve on that stuff!"

Recent studies have shown that formula-fed babies do wake up just as often as their breast-fed counterparts. So, even though breastmilk is easier to digest than formula, it doesn't mean that formula feeding will lead to fewer sleepless nights. (So, does that mean Enfamil will have to retract their claim - or perhaps pull their product - because of false advertising?)

As a graduate of the Bad Sleepers Club, I can tell you from my experience that it doesn't have anything to do with it. My oldest - my first, most perfect child LOL - was exclusively breastfed and slept through the night at four months. I was in heaven, ecstatic to tell my grandparents over the phone that their grandson was already sleeping through the night! Yippee!

Fast forward to his Princess Cranky Pants sister - or even to his baby brother - and neither of them slept through the night consistently until at least 18 months. All were exclusively breastfed for the first six months before the introduction of solids. And with Little Tater Tot, we're still perfecting it at nearly two years old (I say that in my best ass-dragging, I've been awake all night voice.) So don't tell me that formula will make my kids sleep. Every child is different.

Aside from all that, my post really isn't meant to reiterate Amy's, or even to go into the whole formula marketing debate. She does mention one thing that piqued my interest - about seemingly well-intentioned nursery nurses who want the mother to "rest" so they can feed their babies. Maybe they buy into the whole "formula will make your baby sleep longer" theory, or perhaps they ignorantly think breastfeeding is a waste of time. It's not unheard of for nurses to openly knock it and discourage mothers from even trying, perhaps because their own experiences with breastfeeding might have been less-than-perfect.

I have a different theory: that there is some kind of "baby fix" thing going on.

There is something special about feeding a baby. I often wonder if some people are jealous of breastfeeding moms because of the special mother-baby bond that is created. Perhaps they couldn't nurse, didn't want to, or gave up too easily and feel defensive about their decision, yet have regret at the same time; I don't know. Especially if the baby is bottle-fed, it seems like there is never a shortage of grandmas, aunts and others clamoring to feed your baby. Some even react with hostility towards breastfeeding moms because they feel they can't participate in that aspect of the baby's care.

I once heard the story of a mom who's mother and grandmother were so insistent on feeding the baby a bottle that they did so behind her back, even though the infant was breastfed. Therefore when it was time for the baby to nurse, she refused the breast.

A friend of mine who is in her 70's told me that when her sons were babies, her husband adamantly told her he didn't want her breastfeeding. His reasoning was that he wanted to take part in feeding the children, especially at night. He was a psychologist - I'm still wondering if there were deep-seated territorial issues the man had over certain aspects of parenting or something. I kind of looked at her and thought, Have you ever heard of a breast pump?

Some nurses feed your baby without asking. They did this with my youngest because his 'sugars were too low' - "We just do it, we don't ask," I was told by the nurse (as if she was expecting a fight). I was ticked, though, because if something was abnormal or wrong with my baby, I would expect her to tell me about it. And hey, breastmilk is nature's perfect food - how about putting him to the breast and seeing what happens with his supposedly bad "sugars?"

With my second, I staggered into the nurses' station in the middle of the night to get my daughter for a feeding. I don't even know why I did it; something in my internal clock (I could always tell right before my milk was about to let down) told me to go get her. I'm sure I looked a wreck, but the nurse asked me, "Wouldn't you rather me give her a bottle so you can get some rest?" I kind of looked at her like, "Why the hell would I do that? She's breastfed." At one point they wanted to take the baby back to the nursery so I could sleep, and I said, "Why? She's going to be waking me up all night long while I'm home - I might as well get used to it."

While I certainly never got any rest while in the hospital, I also fail to see how skipping a nursing session is going to help a new (or any) mom who is learning how to nurse, and can just result in painful, engorged breasts.

Amy West is cautious about how aggressive formula marketing and some nurses' persistence about bottle feeding in the hospital will encourage parents to use it solely in order to get more sleep, perhaps further undermining the new breastfeeding relationship. That still doesn't explain why my nurse would approach me about formula feeding after I've already successfully breastfed a child for a year and a half, other than she maybe just wants her baby fix. It seems that with some people, they get very territorial and protective of their 'right' to feed your child, as if it gives them some kind of control or a role in The Most Special Job Ever that normally is reserved for the mother. Aside from the obvious nutrition your baby receives at each feeding, there is the comfort aspect - the ability to provide emotional nourishment as well is a very intimate relationship that some people get very defensive about wanting to take part in.

While the formula marketing push certainly doesn't help, I think it's also rooted in psychology - I would venture to guess that some nurses (hopefully all!) get attached to their 'babies' and want to interact with them on some level, too. I just wish they'd find a more productive way to do it than sticking a bottle in their mouths. Rather than push formula, they should encourage parents, telling them that sleepless nights won't last forever, but to enjoy those nighttime feedings, however tedious they are - because you can never get that time back, and someday will probably miss it.

More reading:
MomBlog Network: SIDS and Enfamil "RestFull Formula: Yes, the Connection Exists"
The Case for the Virgin Gut - by Ann Calandro, RNC, IBCLC

Tuesday, January 4, 2011

The Obstetrical BS Series: "He's the doctor ... you have to listen to him."

When I was 22, I visited the Dreaded Gynecologist for the first time. I was young, naive, and totally stupid when it came to seeing the OBGYN. My doctor proceeded to tell me two things: That doctors should always put gloves on before examining you, and that they should always tell you - or ask - before they did something to you.

For some reason, people would never tolerate having someone aggressively approach their genitalia in any situation - but because you're at the OB's office, whatever he does to you is suddenly okay.  It's like your care provider has free reign over your body parts, and it's just too bad if you don't like it.

While we should be able to trust our physicians, I'm no longer under the delusion that I necessarily can. As a result, I've become increasingly skeptical when hearing "emergency" birth stories and in dealing with my own OB.

Many people are under the impression - especially when it comes to labor - that doctors are always well-meaning, know what they're doing, and are doing whatever it is to you because it's necessary. I'd like to say that were always true. Unfortunately, largely because a lot of people are totally uninformed about birth, they don't know what's truly necessary and what isn't. Sometimes even when you are informed, it doesn't make a difference and you get railroaded into something terrible. I hate to say it, but that aspect of birth advocacy really depresses me.

Because of that lack of information, and the blind trust in the physician to be overseer in all aspects of our care, some people think that mothers who consider their experience 'less than perfect' are going to extremes when making claims of birth rape or assault. They think you're exaggerating, that you are being dramatic, that you care more about the "experience" (gah - I hate that description) than a "healthy baby!" Fervent anti-natural birth advocates like Dr. Schizo often make those claims, as do those diehard women who run in her circles. To say that a healthy baby doesn't matter to any pregnant woman is utter BS. But to some of us, the process of getting there means more than to others, and can greatly shape our definition of "health" both for mother and child. I hate how those "anti" people tend to completely disregard the emotional and physical well-being of the mother in favor of the baby, as if it means nothing. How can we even consider for a moment that mom's overall emotional and physical health don't play a role in how she cares for her newborn?

Many times I've run across comments like, "Just listen to your doctor, he knows what he's doing," or "You are not a doctor and you can't possibly know anything." Totally downplaying mom's (completely relevant) fears and concerns as if she's some kind of idiot. When she dares to question the doctor, suddenly she's treated with disdain, as if to say, "How could you" One mom, when confronted with the comments of a knowledgeable labor and delivery nurse, basically said, "You're not a doctor, and I won't listen to you." That degree and white coat mean so much to some people that they're totally willing to overlook huge red flags, like My doctor treats me like sh!t, belittles me, makes me feel like my concerns are meaningless, and doesn't treat me like a human being.

Our often well-meaning, completely birth-stupid culture devalues mom and her individual labor and birth needs, essentially seeing her as nothing but a vessel - an incubator who holds that baby in for 10 lunar months and suddenly ejects it in any way possible, whether she likes it or not. Then they either turn around and accuse you of being uninformed, or being selfish - even though your baby is no doubt just fine.
OB:  “If I’d known the baby was so big, I would have done a cesarean section.”
Mother:  (holding her just birthed baby) “I wouldn’t have let you!”
OB:  “It wouldn’t have been up to you.”  (Courtesy My OB Said What?!?)
So, mom is perceived as selfish and superior because she would have had the audacity to question her doctor. And her doctor is basically implying that he would have done a cesarean without her permission. Many women called it as they saw it, except this one:
"u ladies need to be a little less sensetive, hes an OB.. part of their job description is to come into contact with female genetalia.. birth rape? give me a break.. i have had 5 kids, and have suffered some pretty traumatic birth experiences ((ie. heamorraging and having the OB use her hand to mannually remove the clots from my uterus))… but thats birth, its dirty, its hard, and its not pretty… if ur not ready for that, then adopt, or buy a puppy…get over yourselves…."
So in other words, even if your vagina was forcefully entered into with a hand, fingers or other tool, or even the mere suggestion was made of doing something without your consent, you're just supposed to get over it. Because he's the doctor.

Yes, an OB's job is to come into contact with vaginas and whatnot. But it's the contact part we need to examine: did he ask first? Did he tell her what he was planning on doing before he did it? Did he preface it with a comment that suggests her rights were completely irrelevant to him, as the above post suggests? (As a side note, I bet you ten bucks that the second commenter's "traumatic birth" was likely due all or in part to her overzealous physician. What say you?)

Further down in the comments section, another poster mentions how yes, it's assault; but it would be awfully hard to prove in court. Of course it would, because we have a whole generation of sheeple who think the doctor is always right and only does what's good for you.

Awhile back I read the comments of a mom who was nervous about her doctor inducing her with Cytotec. She was planning on standing her ground if the doctor insisted on using it, but "didn't want to make him mad." I nearly swallowed my teeth.

As usual, the old "He knows what he's doing" crap came out. And while I was happy that she had done some reading on Cytotec and the concerns surrounding it (more than likely because she's used to hearing about Pitocin and this sounded different, thus prompting her research), I'm sure she had no reservations whatsoever about Pit and didn't question that one iota.

Your OB is not the boss of you. He is not God. He is not your dad. He is a medical advisor, and you are free to seek another opinion regardless of what he says. Yes, sometimes unpleasant and painful things must be done to us for the safety of ourselves and our babies, but he or she should do so with compassion, dignity and respect. And if he's not giving it to you, then you need to demand it, because it's your right.

Do not let anyone tell you to disregard or ignore your feelings of inadequacy, spiritual, emotional and physical pain, and other complications that might be hard to concretely identify but you know they're there. You are not just a holding tank for this child; you are a human being with feelings, emotions, and rights.

Monday, January 3, 2011

Do you need a doula?

When most people think of labor support, they conjure up images from movies and sitcoms: the idea of nervous dads and meddling mothers-in-law, in a scenario of total chaos where everyone freaks out so much they pay little attention to the laboring mother. I've talked to a few people who, if they even know what a doula is, think they're a waste of money and would never hire one, because they have their husband, after all. This is really quite unfortunate.

I'm not downplaying or underestimating dad's role as labor coach. Some dads are terrific - rocks of strength and support for their laboring partner. Some are not - quivering, uneasy blobs of jelly who hit the floor the moment the first real contraction hits. And some are on the fence - they want to support their partner in labor, but often fall prey to the hospital staff who sometimes use fear and scare tactics to get mom to comply.

This is where a good doula comes in. Perhaps not just to support mom, but both parents in labor.

A few days ago a most disturbing blog entry was posted on My OB Said What?!?. A mom was going over her birth plan with the OB, and requested no pain medication. The OB responded, "That's okay, we'll just get your husband to sign the release and give you an epidural anyway."

I can't think of anything more repulsive.

I'm not even going to join the "at least they were honest" crowd, because regardless of whether it's a bad joke or not, it's downright despicable. And clearly it's obvious that this doctor willingly uses dad as a pawn to manipulate the mother into things that she doesn't want and might not even need.

Some OB's, in discussing birth plans or other details with the female patient, will completely overlook mom and make eye contact with dad instead. As if he's her overseer; her boss, her daddy, if you will. This is why it's so important for both parents to be on the same page about birth wishes. And if they're not - if dad is on the fence - I strongly recommend a doula, who will help both mom and dad in the process.

This is another reason why it might not be a good idea to have dad, or another family member, as labor coach: they love you, they don't want you to suffer or be in pain. If dad, or mother-in-law, or whoever, is quavering even a little bit, that fear comes out and someone will tap into it: whether it's an overbearing nurse or a doctor who just wants to get it over with and move on to someone else. Having a neutral third party there, if doctors and nurses are unsupportive or blase about mom's birth plans, is essential.

I also recommend hiring a doula if you you have no labor support. Mothers whose partners are deployed, or where family is far away, could greatly benefit from having a doula. Think of all the inductions that take place simply because mom is waiting for parents, grandparents, sisters, etc. to roll into town. Just because of this perceived lack of support, mom now puts herself at greater risk of cesarean section and a whole host of other potential complications, and for what? I often think that if women and their loved ones knew what an induction entails, and the complications that could - and often do - arise from them, they would never want you to go through all that just for their sake.

If you desire a natural, normal birth like the woman mentioned above - with no induction unless absolutely necessary, no Pitocin and no epidural - then hiring a doula is probably the best thing you can do. While there's definitely no shame in asking for drugs if you need them, you should not buy into the illogical farce that you absolutely need drugs to get through labor, because you might not. It's the doula's job to remind you of that, much to the chagrin of the OB. While some hospitals are completely supportive of natural birth, many are not, and those women who truly want that experience might find it hard to combat aggressive nursing staff or the idea that they are stupid, uneducated or ill-informed because they recognize the risks of pain meds and want to forego it if they can.

Mothers who are attempting a VBAC or twin vaginal delivery would likely benefit from having a doula as well, mainly because women in these situations are finding increased pressure to perform a cesarean because the medical establishment sees these scenarios are increasingly seen by the medical establishment as "dangerous" or impossible

Another group of women who could benefit tremendously from a having a doula are teen mothers. There is already so much negativity and bias towards young mothers while they're pregnant that it often makes it very difficult for them to find support while in labor. Their youth, coupled with the possibility of being completely uninformed about the birth process, as well as their rights and choices in childbirth, can make it a disastrous situation that no doubt ends with more primary c-sections. Not to mention it further embeds a very abnormal view of birth in their minds, which is hard to erase or change.

Yesterday I had a wonderful conversation with a friend whom I am going to lobby hard for this year to become a doula. She has been the labor support person at almost all the births of her grandchildren, and attended nearly two dozen births while working as a crisis teen pregnancy counselor. She told me one interesting story of a young mother who was in active labor, and the nurse wanted to give her Pitocin.

ML showed up at the birth and the nurse demanded to know who she was. Nurse Ratched then told her that the patient needed to be put on Pitocin, and ML demanded to know why. "What do you know about Pitocin?" the nurse asked defensively. In other words, How much can I get away with telling you before you'll realize I'm giving you a load of crap?

The nurse explained that they needed to free up more beds on the L&D floor, to which ML replied, "This girl is already in active labor. Go speed up somebody else's contractions."

As far as ML is concerned, I think she'd make a great doula. She is compassionate, caring, and yet outspoken. Even if you don't know the ins and outs of something like a doctor or nurse would, just asking questions - "Why do I need to do this?" - makes a world of difference. And if they can't give you a good answer, chances are you don't need whatever they're selling.

ML affirmed my opinion that teen mothers - who are already in a position of vulnerability - are often the scapegoat of frustrated care providers who are out to "teach them a lesson" because they got pregnant so young. No one needs that care and support more than someone who is not that far out of childhood herself.

Studies have shown that doulas can actually decrease the rate of epidural use and cesareans (although they most certainly can attend you if you do have a cesarean). Although I kept an open mind about pain relief when I had my VBAC, my doula was - literally - a focal point for me while in labor. She talked me through it, was supportive and focused on me, and I focused on her. It was literally like having an extra person there to guide my husband in his support for me, too, so that the care and attention he paid me was more productive and meaningful. (In other words, he didn't look at the monitor and say, "Looks like another contraction is coming!" like he did during my first labor, God bless him.) Following the doula's lead can encourage other family members who might be present not to contribute to the general freak-out factor when they see how things can progress normally, without such a sense of urgency.

Unfortunately, some doctor practices forbid the use of a doula, which in a strange way I find sort of comforting. Not only does it tell you that perhaps your control-freak doctor might not be the right fit for you, but it effectively admits that the doula can be a symbol of peace and calm, yet power all at the same time. Because of her neutral advocacy, she is there to remind you that yes, you can do this! and provide mother-focused care that the OB might not, which means you just might get the birth you want and deserve.

More recommended reading:
Doulas of North America (DONA)
Statistics on doulas and how they can help in labor
He Ain't Creepy: He's My Doula