Family Centered Maternity Conference: Bob Monterverde, IBCLC

Bob Monteverde is a lactation consultant at West Penn Hospital in Pittsburgh. Of course the first question he answered was the first question most people ask -- how did a guy become a LC? He recounted his time as a pediatric nurse in the military and some twists and turns with different patients and doctors that led him on his path.

I took away a great one-liner -- "It's not nipple feeding, it's breast feeding." I know a lot of women have flat or inverted nipples and some use shields, some pump first to draw out the nipple, but Bob's "Bob-ism" really reinforced what I knew already about the mechanics of breast feeding. If the latch is correct, the baby will draw out the nipple. The nipple shouldn't be anywhere near the front of the mouth (except in passing of course!).

(this is the type of blog post where I just cross my fingers that my dad doesn't read my blog today. Hi Dad!)

Another neat trick -- there's supposedly a pressure point on the baby's palm that triggers the suck reflex, and if mom or dad massage it while the baby's latched on it can encourage sucking. I wonder if that's why babies tend to do that hand-clasping motion so much, especially when they're nursing?

For me, this speaker reinforced my view that although childbirth and breast feeding are a woman's domain, when it comes to supporting those women, it matters a lot more what's in a professionals heart than what's in his skivvies.

Family Centered Maternity Conference: Manny Vallejo

The first speaker at the conference on Saturday was Manny Vallejo, the director of OB Anesthesia at Magee Women's Hospital in Pittsburgh. I have to say, regardless of whether or not I agreed with everything he said -- I have got to give him serious credit for speaking at the conference. I'm sure many would have seen it as nothing less than walking into the lion's den.

It was extraordinarily informative to see the thought process behind protocols at Magee and to learn that the actual policies the hospital has are not as conservative as many of the orders that doctors impose, as far as nourishment in an uncomplicated, unmedicated labor. A tray of clear food/liquid were fine with him up to 8cm. And who wants a cheeseburger in transition, anyway?

The epidural rate at Magee is 89-91% which elicited a groan from many. He rightly pointed out that the Magee also receives many high-risk women from suburban hospitals who have medical issues that warrant an epidural; but he also pointed out that there are 15 year old laboring girls who are terrified. I wanted to ask, well, how about making sure that mom-to-be has a doula? He did list the variety of analgesia Magee had at its disposal, and at the top of the list were Lamaze, birth ball, doulas, etc., and then gas/air, IV meds, and finally the epidural. He recognizes that other forms of pain relief are appropriate.

He also showed a photograph of a woman in labor, who was on her knees in bed, with her hands against the inclined head of the bed, with two women (nurse?) attending to her. (For those playing along, this is a lot like what my labor with Badger looked like.) I, like many others in the room, saw a woman being guided by her body. He saw a patient in pain, and said something to the effect of, "This is what you don't want to see," and that she probably should've gotten an epidural before this point. There is a difference between pain and suffering, and honestly, perhaps he had more background on who that woman was and how she felt in her labor, but I found it very interesting that he saw suffering where others saw the productive pain of labor.

Oh, and for TOLAC (ahem. not my favorite term.), he thought an epidural should be placed, even if "just in case." Aggravated me on many levels, although I did appreciate that he didn't feel that it needed to be utilized, just the catheter put in place.

All in all, a good speaker and we could've asked him questions all day long. He answered most questions in a fairly transparent way.

Oh, and if you're visiting... say howdy!

Let me know you've come and read the blog! Tell me when you think I'm full of it, or brilliant, or somewhere in between! Or just say hey!

Conference was a success!

I will write more tomorrow, because I'm about to fall asleep, but the speakers (head of OB anesthesiology at Magee Women's Hospital; a male lactation consultant at West Penn Hospital, and an accupuncturist with the UPMC Center for Integrative Medicine, and of course Jan Mallak) were informative, the energy was great, and I think the VBAC panel went well (I really really have a fear of public speaking so I confess it was a blur). It was terrific to put faces to names, meet new friends, and catch up with doulas, midwives, and childbirth educators from all around Pittsburgh and beyond.

Also, check out Heart & Hands Doula Service's new website!

Family Centered Maternity Conference is tomorrow!!!

If you are in the area, come join us tomorrow at Heart and Hands Doula Services Family Centered Maternity Conference. It's at the PPG Chemical Center in Monroeville PA. I am going to be speaking on the VBAC Panel. And MAN am I nervous!

Doctor "believes that women should get an epidural, even before pain starts"

OK, as I have said, hooray for choices in childbirth! But this is just a load of humbug, if you ask me.

Epidurals: Time to stop labouring over 'natural' childbirth

Says Dr Gilbert Grant, director of obstetric anaesthesia at New York University Medical Center:

"...that women should get an epidural, even before pain starts. According to him, much of the information that women receive is incomplete or inaccurate, and that the lucrative “natural childbirth industry” creates fear and guilt about epidurals. He believes that opposition to anaesthesia during childbirth is the result of a deep-seated misogyny: “There is no other situation in medicine in which pain relief is routinely withheld. No man would be asked to undergo an appendectomy, which lasts about 24 minutes, without pain relief, yet the pain of labour, which can last for more than 24 hours, is viewed as something women have to endure.

"Natural childbirth has become a multimillion-dollar industry. The fear of epidurals is promoted by those who discourage their use - and who have a vested interest in doing so."

I guess a few things jump out at me here.

1. The comparison of natural childbirth to surgery to remove something. There's so much in that one sentence that is just mind-boggling. The pain of childbirth does not last 24 hours, in a 24 hour labor. Surely the director of OB anesthesia at NYU Medical Center has heard of a contraction. A contraction does not last 24 hours. They are spaced several minutes apart for the vast expanse of a long labor. It's not constant pain, and the laboring women have time to recover and regroup before the next one. Now, again, surely the good doctor knows mounds more about anesthesia than I do. But isn't one of the purposes behind anesthesia in surgery like an appendectomy, besides the clear benefit of pain control, to keep the patient stationary and not bleeding to death? In the course of a normal labor, which is the apple he compares to the orange of appendectomy, that's not something that's necessary.

2. I'm not saying that there is not an industry around natural childbirth, and I'll believe it's a multi-million dollar industry. But please, do not try to insinuate that it's some avaricious enterprise that's taking advantage of women's fears and charging exorbitant fees. I don't know of anyone who is in this for the money. I sure could be making more money doing almost anything else.

There's also quite a bit further down in the article from Sheila Kitzinger and Michel Odent, which I found balanced this piece.

Shouldn't we stop bickering about whether ALL WOMEN or NO WOMEN should get an epidural? Shouldn't we start thinking about how we can facilitate ALL WOMEN making informed decisions that will leave them with positive, empowered memories of the day they became mothers?

Looking for Babywearing Recommendations...

What was your favorite way to wear your newborn? I never did except for a few brief times I put the babes in the Bjorn (I have to say, I really liked the dummy-proofness of that!) but I'd like to be better versed in a wider variety so I can recommend them to clients.

I love the mei tai but I never ever felt like a small one was secure.

Is a Doula for You?

An article written by none other than the doula who trained me and the founder of Heart and Hands, Jan Mallak!

Is a Doula for You?

Ever wondered who helps you and your husband during labor when the nurse has to attend to another patient’s needs? Or, what happens when it’s a shift change and the new nurse arrives not knowing anything about you or your labor? What if it’s really busy and no one is available to help you to initiate breastfeeding right after the birth? How about who is going to help out when you first arrive at home and probably feel a little overwhelmed about being totally responsible for the baby? The answer to all of those queries is…a doula!

Postpartum Doula... part 3.

Well, looks like I may get to try my hand at postpartum doula work! We're working out the details but it looks positive.

Isn't it fun to see what the universe sends our way?

Penny Simkin article

Great article about Penny Simkin (even if they do misspell her name in the title bar!)

Looking to nature, doula Penny Simpkin practices the art of delivery

Known as the mother of the doula movement, Simkin has trained thousands of these caregivers to provide physical and emotional support for women during birth — the only intervention scientifically shown to decrease time in labor (by 25 percent) as well as to reduce Cesarean-section rates by a third.

"Birth never changes," Simkin says. "But the way we manage it and the way we think of it has. Right now, we're in a culture of fear around birth."

In case you need a laugh

Thanks Megan for finding this!

YouTube: Hahaha

Post Partum Doulas, part 2

My client who had her baby on Thursday expressed an interest in my services as a postpartum doula... but I'm not trained. I am leaning more and more towards taking the training this summer because I feel very sad that this client values the relationship we've developed and I am not trained to continue serving her when she needs it (and recovering from major surgery when you have a 3 day old baby, she very well may need it!).

Ban the Bags

Free Formula Undermines Breastfeeeding

Mothers who take home a formula company gift bag are more likely to stop exclusively breastfeeding their babies by 10 weeks of age, according to a new study in the American Journal of Public Health .

With my Chim, I did get formula from the hospital and I did use it, although we breastfed for the vast majority of the time after my milk FINALLY came in.

With Badger, I got formula just in the mail and I gave it to a food bank. He never had a drop of formula (and for that matter, the little darling never took breastmilk from a bottle either. I think I dumped 500 ounces. Heartbreaking.).

Dyeing Easter Eggs

We just dyed eggs, Chim and I. Badger was aching to get in on the action but I am just not that good of a mother :) Next year, I promise, I'll try to make natural dyes, but I had gotten these PAAS kits last year on super duper clearance and, well, I'm tired. So very tired.

Now, onto the bath with the kids!

Lunch with "New Doula" today!

I had lunch with New Doula today and she's just a sweetheart. Dining with Chim and Badger, who took turns making mischief of one kind and another, is testimony to how great she'll be at mothering the mother since she swooped in and gave me a hand, knowing just what would be most helpful (short of adopting the both of them on the spot, that is. just kidding. mostly!). She's getting clients aplenty and I'm really impressed!

Happy Birthday, Baby Girl G!

Attended my first Cesarean birth (well, since Chim Chim's birth that is!) tonight. Mom E. had been feeling off all day, was having some contractions, and wasn't confident that she'd been feeling Baby move enough, so went in to be observed. Got a call from Dad S. that E was having a Cesarean section and to please come.

I got there as Dad was waiting to go into ER and filled me in -- baby's heart rate went very high and that was the reason they were given for the Cesarean section. I was able to be in the OR as well. Mom was just in a state of shock but excited to meet her baby. When Baby G was born, it was discovered that she had a quadruple nuchal cord -- that explains a few things! Baby was fine, with great APGARS, and just beautiful! Surgery went well. Mom got a cramp in her shoulder from tension and the "Braveheart" posture that she was in during the birth. So I did lots of rubbing the knot in her shoulder.

Welcome to the world, Baby G, on the first day of spring!

Circumcision and STDs

Circumcised men no less likely to get sex diseases

Circumcision does not appear to shield men from the types of sexually transmitted diseases (STDs) common in the developed world, according to new research from New Zealand.

I know this is a sensitive topic, circumcision. I know I breathe a sigh of relief when a doula client says they're having a girl because I don't have to talk about circumcision!!! But I think it's hard to talk about because it's important. This is one "check" erased from the "pro" column in the circumcision debate.

Cloth Diapers in Pittsburgh

This article was in today's Pittsburgh Post-Gazette:
Better for baby? New cloth diapers also kinder on planet, advocates say

The old cloth vs. disposable diaper debate is flaring up again as a new generation of eco-friendly products are starting to toddle into the mainstream.

If I could go back in time 4 years when I was newly pregnant with Chim Chim, I would totally go for cloth. I didn't know cloth diapers were so cute and easy these days. By the time I knew better, I was expecting Badger and I didn't think I could commit to learning a new system while caring for a newborn and a toddler. Again, I should've just done it!

Now, Chim Chim is all but potty trained (her recent adventures in impacted bowels notwithstanding) but Badger probably has another 18 months in diapers, minimum. It's not out of the realm of possibility that we'll have a third child so they may get plenty of use after Badger. Perhaps I should take the plunge now -- what do you think?

The Midwife Center's Let Them Eat Cake

Heart and Hands is donating a belly casting service for silent auction for The Midwife Center's Let Them Eat Cake event.

If you're in the Pittsburgh area, why not attend this fun event, sample some yummy cake, and support this important option for women's health?

And, bid on the belly cast!

3 "R"s -- Rhythm, Ritual, Relaxation

No, not reduce, reuse, recycle, or even readin', ritin', and 'rithmatic (although those sure do come in handy!).

My doula trainer taught me that if a woman in labor has these three "R"s -- rhythm, ritual, and relaxation -- she is most likely coping well with the pain of labor. I have found this to bear true! Most moms in labor that I attend practice various techniques for breathing and relaxation which is really useful for a good part of labor. But almost without fail, she ends up doing something of her own invention, repeating it with every contraction. It's amazing to see, really wonderful. I find that in speaking to the moms after, this part of the labor is fondly remembered, that they impressed themselves when they let their mind stop fighting their bodies.

Anyone want to share experiences or observations?

Women 'unprepared for childbirth'

This has been discussed the past day or two on the blogs hither and yon. Here's one article covering the review of research:
Women 'unprepared for childbirth'

The gist of it is, childbirth educators downplay the pain of labor and women are unprepared for the pain of childbirth.

It's my belief that no matter how well-prepared one is, nothing can prepare you adequately for what labor feels like. I also believe that the typical, default, routine procedures that occur in a hospital birth remove a lot of the natural mechanisms that women laboring may otherwise employ, so that birth is more painful than it may otherwise have been.

In my observations -- the childbirth education I have observed have not de-emphasized pain. The pregnant women I meet realize that there will be pain, and they frequently say in our postpartum meetings that there's nothing that could've prepared them for exactly how it would've been.

What do you think?

Sage Femme has a new home!

Lookie! Sage Femme has a pretty new site! Update your bookmarks!

Post Partum Doulas

I'm in the process of deciding whether or not to take postpartum doula training. I confess I'm not quite sure what the job description is, since it will vary so much. It would be nice to increase my skill set and I'm sure that a lot of the baby care stuff would inform my work as a birth doula in the immediate postpartum period.

Here's CAPPA's definition of postpartum doulas:
A postpartum doula is a woman who assists the new mother, baby, and the rest of her family within the first few weeks after the birth of the baby.

I could probably swing that, eh?


I am totally going to take my omegas after I write this. I promise.

I'm very interested in this research about not only the benefits for babies when their moms are great about getting Omega 3s and 6s, but about the benefits for mom's body and mind.

Omega-3 deficient diet poses risk to infant health

During pregnancy and breastfeeding, fat consumed by the mum is transferred to the developing baby and breastfed infant, and this fat is important for the baby's developing organs.

Xtina and breastfeeding

OK, so I was less-than-generous in my words about Christina Aguilera's elective cesarean. I'll make up for it now in some small part for applauding her for breastfeeding little Max:
Xtina: Breastfeeding is Best

I agree that breastfeeding can be a great way to shed the pounds. Hopefully moms will also be eating really well during this time of their lives, which can surely help not only weight loss (it really is just a number) but overall fitness and health for moms and babies!

Myself? I lost the weight OK each time but after the second... well, this is where "it's just a number" is very true. The number is where it used to be... but that's about IT. Oh well, thankfully I have a toddler attached to my boob half the time -- it helps hide my jelly belly :) Thanks Badger!

Nubain -- informal poll, please?

I saw Nubain in action this past week. From my classes and reading, I had learned that about half the women who use Nubain in labor will have rest between the contractions and be better able to cope with the contractions when the next one comes. The other half would find themselves loopy as all get out.

This link from gives us what the PDR says about Nubain in labor:

The most frequent adverse reaction in 1066 patients treated with NUBAIN is sedation 381(36%).

Less frequent reactions are: sweaty/clammy 99(9%), nausea/vomiting 68(6%), dizziness/vertigo 58(5%), dry mouth 44(4%), and headache 27(3%). Other adverse reactions which may occur (reported incidence of 1% or less) are: CNS EFFECTS Nervousness, depression, restlessness, crying, euphoria, floating, hostility, unusual dreams, confusion, faintness, hallucinations, dysphoria, feeling of heaviness, numbness, tingling, unreality. The incidence of psychotomimetic effects, such as unreality, depersonalization, delusions, dysphoria and hallucinations has been shown to be less than that which occurs with pentazocine.

My client was loopy and it was not a good situation. The other women in the room (nurses, midwives, etc) who had Nubain in their labors ALL felt like that as well. Other doulas have concurred, they see the unpleasant out-of-control hallucinations, dreams, confusion, etc., more often than not.

Any input, kids? If you've had Nubain, what was your experience? If you're a childbirth professional, what have you observed?

Baby P in the NICU.

He should be fine shortly and it doesn't seem to be a serious issue, but please do keep this new family in your kind thoughts!

Baby Boy P's Birth Story

OK -- I started to write the birth story but it's such a peculiar story that I felt I was violating confidentiality.

So the basics: Mom's water broke Wednesday morning, started labor naturally at the birth center but transfered to hospital Thursday morning for augmentation. Baby born shortly after midnight on Friday. No c-section -- a miracle!

Here's what I took from the birth -- as I concluded their birth story:
This birth was a truly amazing experience for me – although I surely wish it had not been so difficult for [client]! I absolutely learned new things and it was amazing to get to work with three of the midwives, plus the student midwife, in the course of one birth. Seeing the effects of Nubain firsthand was certainly a learning experience and I knew so little about amnioinfusion, and had never heard of a velamentous cord insertion before.

More than any of this, though, I am honored to have been part of this birth because I saw a woman become a mom through hard work and force of will, and a man become a dad as he firmly advocated for his wife. I learned that sometimes one can do everything just absolutely correctly – take all the responsible prenatal steps to ensure the safest, most satisfying, birth – but sometimes things just don't fall into place the way we think they will. However, I saw a couple become a family by staying flexible when they needed to be and remaining firm for the things that truly mattered.

Happy Birthday, Baby Boy P!

I was just at my longest, most complicated birth as a doula. I'm very tired and very proud of the brand new mom!

AROM not recommended for shortening of first stage of labor

Amniotomy for shortening spontaneous labor

On the basis of the findings of this review, we cannot recommend that amniotomy be introduced routinely as part of standard labor management and care. We do recommend that the evidence presented in this review be made available to women offered an amniotomy and suggest that it may be useful as a foundation for discussion and any resulting decisions made between women and their caregivers.

I'm glad to see this although I don't think this is news per se. It's still surprising to me when I hear the resident explain to a client "what we'll do" during her uncomplicated, progressing-just-fine labor, including, "And then we'll just break your water." Most of my clients have a strong preference not to have their water broken as a matter of routine if their labors are not stalled out, and the research they've done before labor gives them the confidence to tell the doctor that they don't want their water broken as a routine intervention.

Two Articles on VBAC/Repeat C-section

Our Bodies Our Blog did the hard work here and I'm happy to link to it!
Our Bodies Our Blog: What Do These Two Article Say About Cesarean Section?

Reviewed are an article that I wrote about earlier and an article about repeat cesarean sections.

Ultimately, what these studies suggest is that VBACs get safer in some ways and more successful for women after they have had one prior successful VBAC, and that each successive c-section may result in more complications for the mother.

And no, I'm not going to write about that damn NYT article.

There was an article in the NYT about doulas. It stunk. At first I thought it stunk, then I thought it was OK, but upon further consideration, it stunk. So I'm not going to link to it because the fewer people who read it, the better. Not because it was negative but because it was classless and careless journalism.

Strangers Making Me Happy.

I posted on a message board when someone had a question about doulas. I got a private message:
I have given birth eight times, one of them (the most wonderful) at home. It is so nice to know that such support is offered now. Thank you on behalf of all mothers for making this your life's pursuit.

Isn't that sweet?! Isn't it amazing that someone who I've never met, will probably never meet, can make my day with such a kind thought!

Any Leap Day Babies?

Hmmm??? Any Feb 29thers born yesterday?

As for myself, I am kissing February goodbye and saying, "good riddance." February was NOT my month. Hellooooooo March!