Muscle Rub Liniment

As part of my on-going herbal course, I decided one of my formulations should be a muscle rub for that post-run soreness.

I used a formulation I found in my studies from Herbal Healing for Women by Rosemary Gladstar. She calls it a “Goldenseal/Myrrh Liniment.” I altered it slightly, to meet my needs.

I began by mixing the four powders it called for. (Amounts are in the text, and for copyright and respect, I will not list them here.) I bought my herbs from Mountain Rose Herbal, and highly recommend them. These are the herbs used: Echinacea Purpurea, Cayenne, Goldenseal Leaf, and Myrrh Gum.

I mixed the ingredients in a pint-sized canning jar, and they filled very little of it.

Finally, I filled the entire jar with 100 proof Vodka.

I gave the jar a good stirring until it seemed all the powders were well dissolved. 

I then let it sit for a few weeks. 

Overall, I was pretty happy with it's use. It's certainly messy, and even stains a little (I used a rag/washcloth to rub into my calves), but the massage alone helps. 

Valerian Tincture

Valerian Tincture

I’m catching up on my herbal coursework through Birth Arts, so the next few posts will probably be herbal-related. It’ll still be fun. I decided early on in the course that I needed to drastically decrease my stress levels. I’m still working on that, but there are many better days. As one of my stress helps, I decided to do a simple, a valerian tincture to help me sleep. Valerian is commonly used to aid sleep and relieve stress.

I order my herbs from Mountain Rose Herbal (highly recommend) unless I’m growing them, and my Valerian came from MRH. I also used 100 proof vodka. 100 proof gives the best balance of alcohol and water (in my humble opinion) which is why I use it.

I initially tried this tincture in a small dropper bottle. I’m not sure what possessed me to do so other than the fact that it used very little herb and it would be the size bottle I planned to use for the finished product.

It didn’t work out well.

I filled the entire little bottle with the Valerian, which became pretty tightly packed. Then I added all the  vodka I could. (Yes, you can fill a bottle twice when it comes to herbs). I allowed it to sit for at least six weeks (I don’t have the dates written down now) and attempted to strain it. I couldn’t get the Valerian out of the bottle and got the equivalent of 10 drops of tincture from the bottle. I tossed it.

When I tried it again, I used a half pint canning jar, like you’d use for jelly. This time I decided to fill it about ¾ of the way full. I was afraid of using a good bit of my Valerian and not being able to get it out of the jar again. I again used the 100 proof vodka and filled the jar. I shook the jar well as I added the bottle (capping it of course) to get as much vodka as I could throughout the Valerian. I then allowed my working tincture to sit in a dark place. I shook it in the first couple of weeks daily or so, and as the Valerian swelled a bit, found that I didn’t need to shake it very often at all.

I started this on December 30, 2010.

On March 12, 2011, I got ready to drain and strain it. I had wanted it to sit at least six weeks, but had to find a time when it didn’t matter than my hands smelled like gym socks to strain it. (Good valerian has a very gym socks kind of smell.)

I started by getting out another half pint jar. I’ve found it easier to strain into a similar jar and then rebottle into a dark bottle than it is for me to strain into the dark bottle with dropper. This way I can use a large mouth funnel with my wire strainer, which works well for herbs of this size. I strain slowly, allowing the tincture to drip out, and I sometimes coax a little more by pressing lightly with a spoon. This is not a time to be rough and forceful, but to allow the tincture to come out on its own.

In the end, I was left with this much: 

A much better amount than the first attempt.

Unfortunately, Valerian is a very bitter, strong herb. It truly does smell like dirty gym socks. I hate to say that I haven’t used it, but based on those pugent odors I have not. I feel I would need to add some things to it and use less Valerian to be able to get a treatment I could take.

Update on Life

Yes I know, the blog has been quite quiet. And I’m sorry about that.

And I’m not sure it’ll get better any time soon.

Today I go for my second nursing orientation, and I start classes August 22. The program is a 2-year RN, so needless to say, I’ll be very busy with school for awhile. Each semester has three nursing classes, five weeks a piece, one right after another. Each semester except the last I’ll have a couple of additional classes: Anatomy, Physiology, etc. that will keep me busy. I’ll also be tutoring this year and am considering a nursing externship for later seniority in the local system. Last spring I took Nutrition, Math Reasoning, and Life Span Development. Over the summer I crammed and took Microbiology and Chemistry. I’m thankful I did so, as it’ll certainly help me coming workload.

So, where does this leave Healthy Mama Childbirth?

I’m still here, but I will probably not be taking any doula clients for the time being. I’ve found that as I look at EDD and on-call times, I don’t feel that I’d be able to provide the support necessary to be a good doula. I’m saddened as I turn down clients, but I know that it is best so they can get the support needed in this area.

I am still taking childbirth education clients and will be offering another Prepared Childbirth Series in the fall. I also still take private clients for flexible scheduling and course offerings.

I plan this year to begin lactation-related education online in preparation for the Pathway 1 IBCLC exam requirements. I had considered IBCLC previously, but thought it out of my reach since I wasn’t in the healthcare field. However, now as I find myself in nursing school, it’s back on the table for consideration. I’m also hoping in the near future to go through doula certification, though it’s certainly on hold until I can take clients. I’ll still be available to local doulas as a backup and hope to continue to be active in the local birth community.

I’m also honored to be the chapter leader of our local ICAN – ICAN of Greater Charleston WV. Please visit http://ICANGreaterCharlestonWV.weebly.com for more information about meetings.

As for the blog, I’m leaving it open, but please understand that I have little time at the moment to really devote to entries. I’ll do entries as the mood takes me (I hope), but regular updates – which were not often as it was – cannot be expected.

:-D Much love and happy birthing!

Co-sleeping, a failed account? Part Two

Our night-time sleeping was very different from our naps. While he would refuse to nap longer than twenty minutes in a place other than mommy’s arms, he refused to sleep there at night.

Well, let me back up…

Like I said before, at about a month old he started having trouble sleeping at night. Cutting dairy really helped, but the biggest fix at that point was to co-sleep. We have a king-size bed (best investment ever), so instead of him sleeping in the Arm’s Reach, I just had him snuggle. Most of the time, I slept on my right side, with little man snuggling there between me and the co-sleeper. Sometimes, he slept between my husband and me, but with my husband’s sleep apnea, I was more comfortable with the other set-up.

While little man co-slept with us, I was amazed at how our sleeping patterns worked together. Even just having him in the room accomplished this. Babies have shorter sleep/wake cycles than adults, allowing them to wake, eat, and keep getting the calories necessary for growth. Short sleep/wake cycles may also have a protective effect in regards to oxygen levels and adjusting to life outside the womb.

The difference in sleep/wake cycles is what makes parents so tired with new babies, but here mothers have an advantage. Having baby in the room allows these sleep cycles to be synced: beneficial for both mama and baby. Some research suggests this may be protective against SIDS. And for the mother, the added benefit is waking more easily rather than from a deep sleep.

For us, here’s how it worked. Little man would feed and drift off to sleep snuggled in my arms. I’d drift off around the same time. A couple hours later, I would wake. My deep sleep cycle was shorter in response to his, so most of the time I felt pretty good. I would look down at little man, who was still asleep but begging to root around and stir. This gave me time to get ready for feeding. He would then feed and re-settle, much of the time never fully awakening. I would then drift back off as well. This synchronization may be part of the reason breastfeeding mothers get more sleep than formula feeding mothers.We had this great set-up until little man was about three and a half months old. He started by feeding. Then he would arch his back and squirm. He would touch and explore my face. He’d coo and squeal, discovering his own voice. As cute as it was, he was starting to go from tired at the beginning of the night feed to wound up by the end. Eventually he would drift off, but he was fussing more during the drift off period. Sometimes we would have to give up for a bit and try again later, as late as 11pm.

One night, probably a week or so after this change, I cleared out the Arm’s Reach. After he fed, I scooted him over into it. At first he fussed, but after a few nights, it was getting better. If the fussing seemed to be “sleepy-time fuss,” I let him be. If it was “I need mommy, I’m scared!” fusses, I’d pull him back over and snuggle. For awhile our sleep routine came to be starting out in bed, then the Arm’s Reach for part of the night, back in bed for the rest. I tried my best to read his cues and let him sleep where he seemed to settle the easiest. After a few weeks I noticed he was spending less and less time snuggling with me in bed and more and more time sleeping contentedly by himself in the Arm’s Reach. Along the way he had realized he was definitely falling asleep snuggled with a warm mommy, but he could coo and be cute and “fight it” a little longer by himself.

Knowing the independent part of his personality, this all doesn’t surprise me too much now how easily he self-weaned from co-sleeping. At the time I was surprised and even a little embarrassed. Co-sleeping was an important part of my nurturing parenting philosophy, and I felt I must not have done it right for him to have weaned so early.

But for us, this was exactly right. He was ready and let me know in his own way. Around six months he settled into sleeping in the crib at night since he was able to crawl out of the co-sleeper. I attribute his good sleeping habits now to the security he had sleeping then. Falling asleep at a young wasn’t scary; he wasn’t hungry, cold, or wet; and he knew mommy would be right there if needed.

Recently, we got to co-sleep again. We went to the Columbus Zoo, and little man was having trouble sleeping in the hotel room. My husband suggested we have him in bed with us, so we decided to try. He took his sippy, coo’d, explored my face, and drifted off with me sleeping on my right side again. It was uncomfortable, as a sleeping toddler is much more mobile than a sleeping two month old. But it was beautiful and I loved it. I miss our nightly snuggles, but I’m glad I listened to what he was ready for.

Co-sleeping, a failed account?

 I was so fortunate that prior to pregnancy I had learned about many safe sleeping practices, one of which was co-sleeping. In the end, we just decided we would “go with the flow,” and that crying out wasn’t an option.

I highly recommend that approach.

However, I really expected our co-sleeping story to be different than how it actually played out. I’ll go through our story and talk a little about why I think it worked for us.

Around the time my son was born, we were staying with our pastor and his wife (fun stuff like our new home not being ready on time necessitated that). At the same time, my husband’s mother and grandmother were in from Mexico.

It was a hard way to start out with a new baby. I was in an unfamiliar environment, with a slight pressure to perform. (Side note: I love my husband’s family, and the pressure didn’t come from them but from my own self-consciousness). My husband and I were sleeping is separate twin beds so I could recover from surgery and little man slept in a Pack N Play at my feet.

Not my ideal set-up to be sure, but necessary at the time.

Little man was swaddled for the first week, but after that we simply had light blankets covering him. We stopped swaddling because he started to hate it, probably as his startle reflex was calming down. He slept at naps and at night, which was unexpected.

By the end of his birth month, we had moved home. My husband’s family was still to be with us a few more days as we settled in. We put up our Arm’s Reach Co-sleeper with our King-sized bed.

Elias was still doing fine with our set-up of alone naps and nights until right before my husband’s family. He was starting to be more restless at night a bit irritable during the day. Where he had previously been a greater napper, sleeping three hours at a time, he was now cat-napping twenty minute sessions.

Finally, one night he literally refused to sleep. At 2am we had him in the car, trying to lull him done. He gave in but was up as soon as we were in the house. That night we pulled the swing into our room and let the rocking work its magic.

The next day I starting cutting dairy from my diet. I also held him for naps. He would nap without me holding him, but he napped much longer in my arms. At night, I started cuddling with him in our king size, using the Arm’s Reach as a table.

Later, I discovered Elizabeth Pantley’s No Cry Sleep Solution. I had heard of it, but at this point I finally bought it. I was desperate for something to help him sleep without me, but refused to try “crying it out.” We had seen a crying fit from him on the six hour drive from Washington D.C., and the pain and terror he was in was not going to “work.”

Pantley simply confirmed to me that all was actually ok with our sleeping situation. When he cat-napped, he wasn’t getting adequate sleep, making night times more difficult. I charted his sleeping habits and made my decision.

We’d keep going with the flow.

I started keeping track of his eating and naps (I kept a note pad on the armrest of the recliner) and continued to hold him for every nap, for the entire nap, until he was five and half months.

People thought I was crazy. I got nothing done during his naps.

Around five and a half months, we started trying the crib for naps only. I would rock him while he ate and then laid him down when he was fully asleep. At that point, being fully asleep was key; generally about ten minutes after he appeared to be “asleep,” he was ready to go down.

It worked. Within a few days, he was comfortable sleeping in the crib for naps. Night time was another story…

Should We Have ONE Certification Organization for Doulas?

There’s been some talk lately (nothing new really) about having one national organization for certifying doulas. While it seems like it could be a nice idea, I have some concerns.

First, the good…

In terms of recognition, one doula organization could do some great things. Marketing and awareness for the consumer could be broadened. Recognition in media outlets may increase. We may gain respect as an industry – think of the recognition achieved by being an IBCLC as opposed to a lactation educator, etc.

Recognition for the consumer would be wonderful. With more women aware of doula care, it’s certainly possible many more women would be interested in exploring this in their own birth. If I fully embrace my idealist side, I’d even go so far as to say birthing practices would change en masse and we may see a turnaround in our cultural birth practices.

However, I think have one organization would certainly have some negatives. These negatives have the potential of out-weighing the positives.

Personally, I’m hoping to begin doula certification within the year. I’ve gone back and forth about doula organizations to certify with throughout my pursuit of this career. There is the possibility of doing a DONA training in our area in the fall; otherwise, I’m generally looking at doing distance learning or traveling three hours or more.

However, I’ve never been totally comfortable with certifying through DONA. I’ve had it recommended to me many times before (I’ve even blogged about deciding to certify with them). But it seems to be such an impersonal organization. I don’t want to join an organization simply because it is “premier,” (which is very true of DONA, and I certainly respect that), but there needs to be something more. Maybe I’m missing something, and more consideration will certainly follow before I make any decisions.

That little tangent discussion of DONA will be relevant later; I’ll come back.

I think for some, the biggest issue with having one certifying organization would be in the possible restrictions placed on its members. Most commonly, the restriction doulas complain about is involving “free birth” or unassisted birth. For me personally, I’m not sure I agree with having a doula (a trained support professional) at an unassisted birth, and I’m not sure I would take a client planning unassisted birth. However, there are doulas who would like to serve women and families in such capacity (I can think of one I know personally who is skilled in this area). And I think they should be allowed to do so (and encouraged! If you have such expertise and feel called to serve in such a way: do it!!)

I’m a little concerned that having one doula certifying organization would in some way “medicalize” the profession. Doulas are non-medical professionals, and I feel they should remain so. Doulas who are student midwives/midwives’ assistants walk a fine balance, and I don’t know how they juggle the two. But for the majority of doulas who are not in that situation, medicalization would harm the profession. I’d be afraid of “protocols” and “standard practice” and other such generalized guidelines that might interfere with the personalized care doulas are “famous” for. Doulas are uniquely available to hands-on at all times, without having to stop and chart or do a particular procedure. While many doulas do chart their notes, they typically wait until the birth is finished and the family is settled before hurriedly scribbling.

I’m not saying that I am afraid a certifying organization would begin to require doulas to do medical tasks. However, I do think that unfortunately some families already feel that doulas are part of the medical team, particularly in assisting the midwife. This assumption may cause them to not look further into the possibility of doula care. So many believe that doulas are only for homebirth, possibly stemming from that assumption of assisting the midwife.

So what should be done?

I honestly don’t know.

Back to my concern about DONA, one of the great benefits of the current situation in having multiple organizations is that there are many different philosophies. A common piece of advice for new doulas trying to pick a certifying organization is to “see which philosophy fits you best.” Losing this could be detrimental to the profession.

It also allows some to study and become experts in doula care and choose not to certify. There are a number who go this route, and they should be allowed to continue to do so. I think that families are able to interview doulas and decide for themselves who best to serve them, whether or not they are certified. I would be concerned that simply one organization would attempt to push out “rouge” and “uncertified” doulas.

Me, I’m choosing to certify. I do think that for me, especially among nursing professionals, having certification will be one step in showing my skills. But for all the other doulas out there, I don’t know that any one person/organization should be making that same call.

How do you feel?

Common Sense Labor Practices - the Walsh argument

It looks like I’ll be finished reading Denis Walsh’s Evidence-based Care in Normal Labour and Birthing soon. I’ve really enjoyed it.

One thing I really like about this book is the underlying theme of using common sense to return to normal labor and birth. The author seems to come back to this idea at least once in each chapter, but I think it is best displayed in the argument surrounding the following topic: Movement in Labor and Birth.

Why is it that we seem to need randomized clinical trials to show us that moving and using gravity in upright positions would be good for birthing?

I was really struck when I was reading about this concept. Well, duh. Of course, even those promoting natural birth do forget about this. We try and try to prove that this works, but why is that we must prove something so common sense? Are we that far away from good birthing practices?

Quite simply: Yes. [insert a number of choice words]

As a culture, we have truly become a nation that absolutely relies on medical intervention. It’s pervasive. We go to the doctor with flu symptoms and find ourselves getting chest x-rays, bloodwork, and antibiotics (Let’s not forget that the flu is a virus. Antibiotics are for bacterial infections, not viruses). Our child gets a bad bump on the soccer field, and he’s in the ER for a CT scan (see this article).

Recently, we took my son to the doctor (not our pediatrician), for a suspected ear infection. Fortunately, he didn’t have one, but the doctor offered us a prescription for something just in case. When I declined, he replied that was fine, and that he offered because some people feel unsatisfied if they come to the doctor and don’t get something, even if nothing is wrong.

Novel idea, I know, but if you’re not sick, you don’t need something.

And this is much of what Walsh is arguing. If not sick, which pregnancy and labor should never be considered pathologies, then why are we doing randomized clinical trials to prove that natural labor needs natural things? (The same argument can then made against IVs, routine AROM, monitoring…)

I’m not making a new argument of course. I’m simply reiterating what many are already saying.

Pregnancy, labor and birth are normal the vast majority of the time. They require normal, common sense things. If they cease being so, then we’ll call for something else. Don’t do anything just to say that you’ve done something.

Preventing ALL Death and Injury?

I’m currently reading Denis Walsh’s Evidence-based Care for Normal Labour and Birth. In my reading this week, I was struck by the chapter called “Fetal Heart Monitoring in Labour.” I understand that fetal heart monitoring is not proven beneficial, though it continues to be in widespread practice. I was familiar with much of the information presented, but the following reference caught me off guard.

Walsh discusses a number of studies and reviews throughout the book, and in this particular case, the review being discussed brings up one (of many) possibly disadvantages for continuous electronic fetal monitoring. Walsh quotes directly, as will I, the following: “[it] shifts staff focus and resources away from the mother and may encourage a belief that all perinatal mortality and neurological injury can be prevented.” (Reference below).

Can I just stop and say “WOW”?

Of course, it makes perfect sense. This attitude is pervasive in western culture. All death should be prevented until natural causes in old age. All other death is negligent and/or preventable by future technologies.

Again, WOW.

I come from this culture of course, and I struggle constantly with the idea. Late last year, my dad was diagnosed with prostate cancer. His prognosis was very good: he was (and is) in excellent health, and it was caught very early. He had surgery and has thus far done well without any other treatment.

My mother, of course, panicked with this diagnosis. Current research suggested to her that even with surgery and complete removal of the tumor, it only extended my dad’s life expectancy ten years. She was distraught.

Let’s put the above in perspective. This year, my dad will be 66. Ten years is 76. My dad (due to good health) probably had a previous life expectancy of 80.

Was surgery helpful? Certainly. Would my dad have died sooner without it? Yes, probably. He has a genetic risk for prostate cancer, so his cancer was likely vigorous. Does he have cancer now? Nope, not as far as we can tell.

Should my mom still be concerned about his life expectancy? Nope, not in my opinion. He will die eventually anyway.

That’s heartless sounding of course, but it’s true. Some of us will die from cancer. If we cure cancer, it’s likely some will die of other causes, beyond the “natural.”

My point is, as a culture, we are terrified of death. We string ourselves out at the end of life, struggling for each breath in some sterile hospital, without being allowed to die in dignity and grace surrounded by family and friends at home.

Unfortunately, birth is no different. Birth is a symbolic act of life beginning in another (though I would argue the life began long before, it just needed constant care in a different environment before birth). It is logical that once life begins, it will certainly eventually end. And as much as we would like to, many times we cannot prevent it, not should we.

I do not believe there will ever be a time when NO women and NO babies die in childbirth. That would be like saying there will never be any more SIDS or miscarriages. As tragic as these things are, they happen. They are a part of the life cycle.

Therefore, we need (as much as possible considering the culture we’ve been raised in) to attempt to lose this idea of preventing all perinatal mortality and injury. It will likely never happen. Our focus should be on healthy normal childbirth so we can recognize when it goes astray. When it goes astray from normal, we should focus on doing what we can, WITHOUT CAUSING FURTHER INJURY OR HARM to either the baby or the mother. After that, we should focus on supporting and counseling the family through a difficult life event.

Reference: Alfirevic, Z., Devane, D. and Gyte, G. (2006) Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour. Cochrane Database of Systematic Reviews, Issue 3.

Baby fever and putting it off...

I have baby fever. It’s unfortunate that right now we can’t have another, so I’m going to lament and have myself a pity party.

As some may know, in January I decided to apply to nursing school with a local two-year R.N. program. Nursing had been in the back of my mind as an eventual pathway to midwifery, but I hadn’t truly considered it for awhile. The decision to apply was very much spur-of-the-moment, and to be honest I can’t remember all the reasons my husband and I considered when we made the decision I should apply. A primary concern of course was financial stability: we’ve struggled our entire married life, and I was not going to reenter full-time public school teaching unless I had to. (We did consider it, and I’m thankful my husband said he’d rather we struggle a way longer than put me through that). My husband is also going for nursing, though he’s not starting the program this fall with me. We felt that since I have a bachelor’s degree, I would get through the nursing program faster than he would. Then I’d be able to do a three day a week/full-time thing while he finished up the program himself. Three days a week would give me enough time home that I would still feel like a full-time mommy, at least as much as I am now working part-time and going to school part-time.

Of course, going to school full-time and then trying to find a job is really difficult pregnant and/or with a new baby. Not impossible, but…

I’ve considered the fact that I could probably take time off from the nursing program. Legally, I’m allowed a semester off (R.N. programs have some special requirements due to accreditation), though I’ve been told by the program director that I’m not allowed any time off. I could fight him on it, but I wonder if it’s worth it. I don’t want any difficulties going through, and I want to be finished and move on with my life. I also get his perspective; they’ve had a lot of concerns about the program’s accreditation with people not passing/dropping out. Rumor has it that of the latest class in the hospital partnership, only about half are making it to next semester. That’s got to be nerve-wracking as a program director to be staring accreditation worries in the face.

Also, I think about what I’m going to be looking at with my next birth. We want a large family, and I’ve already had one cesarean. I don’t want to have another and I’m really considering my options to ensure a VBAC this time. Out-of-hospital birth certainly seems to be the best option, but is it an option for me with my medical history? If I’m risked out of midwifery services, do I “free-birth?” (probably not, but it’s been on the table). How do I manage a hospital VBAC fight while struggling with clinicals? (and a family?)

Apart from the next birth, what about the next postpartum: I want to do everything I can to have a healthy postpartum transition this time around. Fewer stressors would equal reduced risk for me developing postpartum depression again. I was switching from working full-time to mothering full-time at the last birth, so being settled and having less life change is ideal.

Having a great start breastfeeding is also key in my mind: not being able to get out to find the help we needed was a huge factor in our failure to continue breastfeeding. Little man needed specialized care, and that simply did not get met. I would like to not battle with returning to school and pumping; arguing to pump at work seems to be a much easier battle.

So yeah, we’ve decided to avoid for the time being. Neither of us is very happy about it. We both have baby fever to the extreme, and the little man is not very little anymore. He’s talking now, and it’s really obvious that he’s a BOY rather than a little baby. It’s hard also when I consider that by the time I’m done with school, he’ll be almost FOUR. We had hoped to get them close together, so it’s a bit of a blow for us. Of course, we know that conception is not controlled by us, so I guess we’ll see if anything else comes up.

Until then, I’m burying myself in my birth studies, focusing on being the best nursing student, mothering my little man, and being a wife to my fabulous husband. These next two years (or so) better fly by.

Breastfeeding Presentation - A little encouragement for me and other birth professionals

Hello all! I have been in a terrible hiatus lately as I over-prepared for my presentation. (Background: I'm now a pre-nursing major - officially nursing in the fall - and had a breastfeeding presentation for my nutrition class).

But right now I'm pumped at how the presentation went! I wanted to just share my thoughts, and I hope you'll find them as encouraging as I did.

Before the presentation, I was nervous about a number of things. I had a lot to talk about and not a lot of time. I knew this was probably one of very very few changes these pre-nursing and nursing majors would have to learn about breastfeeding, and I was determined to do it right. Besides the issues of a couple group members (yes, group project love), I had the issues of talking about breastfeeding without anyone shutting down because they felt guilty or didn't agree. I had a textbook that stated formula feeds once daily at three weeks were no big deal and didn't even discuss the supply and demand principle. 

I had already come up against nervous nursing types before the presentation. We had asked at the beginning of the semester if we could have someone come in and demo breastfeeding for the class - we were shot down. While the professor was supportive, the dean was concerned about repercussions and denied the request. When the class learned of this, I got some fun comments - "Someone would do THAT?!" "I would be so embarrassed." etc. The typical. 

My response: I knitted a breast hat for the baby doll and a breast model for our display. I also was lucky enough to be able to order to very cool breast model from Childbirth Graphics. 

Our group had divided up the work, and I had taken the overview portion of the presentation. About a month before the presentation, one group member had a family emergency and dropped, so I took her part as well. In the end, my topic list was the following:

• breast anatomy/physiology
• latch
• positioning
• oxytocin
• prolactin
• supply/demand priniciple
• maternal nutrition (calories and nutrients, tandem nursing, loosing weight, increasing supply, placentophagy).

And yes, you read the last one correctly. I was going to talk placentophagy (eating the placenta) to a bunch of nurses.

Needless to say I skipped breakfast that morning.

But....despite all this, I was very encouraged afterwards!

I started with the current recommendations (WHO and AAP) and compared the Healthy People 2020 Goals to the US and WV 2010 rates. I got some shocked looks that it was that bad - yes, it is that bad. (for reference, WV has a breastfeeding initiation rate of 52%, national average around 75%, goal of 82%.)

We talked about the breast, and I explained how latch works, how latch has to be effective to initiate supply and demand, how to tell a bad latch, how prolactin works, how oxytocin works, how you can use that information to understand how to increase suspected low supply, how demand at the breast is essential for supply, etc etc etc. A lot of nods, some lightbulbs going off about - maybe why it didn't work for them/someone they knew. I talked about maternal nutrition, about how much weight loss was average, how much typically began to effect supply, some considerations with what might be lacking in diet and what supplements were probably not necessary for the infant/mother, what things a mother might take to increase supply, and why some eat the placenta. 

Yes, placentophagy got some gasps, but I told them that I wanted to address the topic so they could gasp now rather than with the mother who asked for her placenta. Also addressed that some mothers may want the placenta for other reasons besides encapsulation (culture respect) and they needed to be ready to deal with such a request. 

I didn't get stoned afterwards.

In fact, I got a lot of questions and comments afterwards. "What about breast reduction - how does it effect?" "See, I had that problem too, that makes sense now." And on.

I'm so pumped about the feedback with this presentation; I can't even convey. I'm not naive enough (quite) to think that it's a huge impact - one class out of many, and many won't even make the nursing program in the end. However, there are a least a few nurses out there who know a little more about breastfeeding and who might be a little more supportive. Yes, unfortunately there are a lot of nurses out there who seem to know nothing about natural birth and breastfeeding. But there are those who do care...

And it's got to start somewhere right?

Some thoughts on my scar - Cesarean Awareness Month

I've been thinking about my scar more often in the past few weeks - I guess it's part of the healing process. So, this weekend when I came across this post on Facebook from ICAN - "Today's CAM task: For those of you who have had a cesarean, find a quiet spot today, and touch your scar. Spend a few minutes with it. If your scar could speak, what would it say? Be gentle with yourself" - I decided it was time to put those thoughts into words here. Pictures do follow at the end, so be aware that they are not graphic, but raw and personal. 

My scar is hideous. There are days I hate it. It's disfiguring and I will never be rid of it.

I was totally unprepared for the pain and numbness - both emotional and physical. No one ever told me I would lose feeling from my belly button to my pubic hair line. I didn't know that through the pervading numbness, my scar would sometimes be painful, even tingle. 

I didn't know that some days I would hate my cesarean so much I could cry, while other days I'd acknowledge that under those circumstances, I'd probably do it all over again.

I can't handle the way my skin hangs in relation to the scar. My scar itself is tight, but all the numb skin and tissue is loose. It's embarrassing that my stomach hangs lower on the right side than on the left. I'm disheartened when I think that diet and exercise seem to do little good when the numbness seems to affect the ability to tone and tighten.

The scar itself seems to testify the disregard the surgeon must have had in repair. The right side of the scar is fading like a stretch mark; it's thin and light. The left side is raised and angry, and it extends out farther to my hipbone than the right side does. Sometimes my underwear seems to catch on my scar; sometimes I nick it shaving. 

And yet...

I know the fire and passion I had for birthing and women's health rights before my surgery - it's shameful in comparison now.

Surgical birth, recovery, emotional healing - they have given me the experience and empathy I never could have hoped to have had before. I'm ashamed that this is what it took, but grateful to be here in these convictions.

Please go to: http://sites.google.com/site/healthymamachildbirth and click on the ICAN chapter link for more information about a support group coming soon.

June Class Series - Prepared Childbirth

Healthy Mama Childbirth is pleased to present a June 2011 Prepared Childbirth Course.

The course will begin Tuesday June 7 and run each consecutive Tuesday of the month of June (June 7, 14, 21, 28) from 6pm - 9 pm at Perrow Presbyterian Church in Cross Lanes, WV.

Class topics:
...Class 1: The Third Trimester
Class 2: Regular Course of Labor
Class 3: Variations of Labor and Common Procedures
Class 4: New Baby Care and Postpartum Adjustment

This course is regularly offered for 120.00, but the June series is offered at half price! A 20.00 deposit is due at registration. Please contact healthymamachildbirth AT gmail.com for registration.

More information:
The Prepared Childbirth course is a full four week course designed for women and couples in the latter half of pregnancy. The course is suitable for women and couples in a first pregnancy, as well as those needing a refresher course.

The course focuses on presenting pregnancy, labor, and birth as normal parts of life rather than as times of illness or caution. Because of this, "typical" labor is presenting as a baseline for all other discussions of labor and birthing. However, participants will still become competent in the variations of labor.

Additionally, hospital procedures and interventions will be discussed in terms of benefits and risks, particularly in how they may affect the course of labor. High-risk mothers will also benefit from this focus on "typical" labor in light of how their experience may differ. Birth center and homebirth clients will also see how their choices affect what they can expect during labor.

Class content is presented in a variety of ways in order to meet the needs of adult learners. Participants can expect lecture, handouts, group discussions, guest speakers, displays, role play, physical models, rehearsal, demonstrations, relaxation, and review games.

Class Goals:

* to facilitate an appreciation that birth is a normal and healthy event
* to enhance communication between families and caregivers
* to provide means for partners to support birthing women
* to assist in creating a positive birth environment beginning in pregnancy
* to assist families in achieving a healthy pregnancy and birth
* to facilitate informed consent
* to enhance communication between the woman and her partner
* to assist individual values clarification, regarding your needs and wants for pregnancy, labor, birth, and postpartum

A little late, but better than never: A short analysis of the BMJ exclusive breastfeeding attack

Yes, it's late. But I recently needed to look at studies and analyze them, and this was one I looked at (turned out I needed something else, but that's beside the point.) 

The article is here for reference: http://www.bmj.com/content/342/bmj.c5955.full

I will refer to the full-text of the article, which is free. I will also refer to the citations used by the authors.

The article starts off with an odd statistic. It states that although the WHO recommendation is six months of exclusive breastfeeding, that 65% of all European Union states and the United States "elected not to follow this recommendation fully." This appears to sound as though those nations disagreed with the recommendation; however, the citation for the claim is simply an article on breastfeeding rates rather than policy. For the record, the American Academy of Pediatrics agrees with WHO and recommends six months exclusive breastfeeding. While the nation may agree it is best, and many women may try to follow the recommendation (initial breastfeeding rates are high), actual six months exclusive rates are low.

The article continues by attempting to discount the systematic review the WHO recommendation is based on - "the review included 16 eligible studies, seven of which were developing countries." This seems to be a primary point throughout the article (and many others that attempt to discount exclusive breastfeeding through six months) that while breastfeeding exclusively for six months is best in poor developing countries, it is not so for developed countries (because we have scientifically engineered stuff that is supposedly better than natural).

Breastfeeding adequacy is questioned later, as the authors cit a study by Wells and Reilly and state that "many mothers who exclusively breastfeed would not support their infant's energy requirements to six months." Unfortunately, no further information backing this up is given (unfortunately for them!). The study cited is actually only a hypothesis proposed for developing countries and the authors Wells and Reilly would like further studies to see if this hypothesis is true.

Later in the article, low iron levels are looked at. The authors cite a study that found lower iron levels in United States infants breastfeed exclusively for six months as opposed to four to five months. However, when I looked up this citation, the study also found that the differences were "statistically insignificant." The other studies cited here are ones linking iron deficiency to low cognitive performance and development; a valid point if the difference in iron levels had been significant and of concern.

The article then addresses food allergies, citing a study that found introducing gluten prior to three months and after six months increased the risk of gluten allergy. The authors claim this justifies introducing solids between three and six months. Unfortunately (for them), when i looked at this citation, the study only included infants deemed "at risk" for such an allergy, rather than infants as a whole. The authors the article then state that exclusive breastfeeding to six months is directly challenged by this evidence of higher risk for celiac disease. 

The article's purpose is to demonstrate the need for randomized trials regarding breastfeeding rather than the current observational studies. Some may argue this is unethical, particularly in light of the author's own statement that early feeding practices directly influence the rest of a child's life. 

Of particular interest, the article ends by addressing competing interests. While none of the four authors received "external funding in connection with the preparation of this manuscript," three of the four "have performed consultancy work and/or received research funding" from infant food and formula companies in the last three years. I think that is particularly telling in light of the article's flaws.

Thoughts on the birth battle

Recently I have been becoming more and more disgusted watching the arguments in the birthing world. I'm sad part of me is less "green" about it all, because I certainly like the hopeful, optimistic me. 

Part of this stems from my entering nursing school (well almost - I'll know by April if I'm accepted) in an effort to continue down my path to helping birthing women while trying to support my family. I feel like a spy in my classes with nursing majors, like I'm trying to figure out how the brain works to so blindly trust the medical model at the expense of common sense, mamas, babies, and families.

My conclusion: In many ways we're all guilty of the same blindness.

Both sides of the birth war use the same methods of guilt and anger, the same self-righteous attitude. 

Before I get hate mail, let me be clear that I am certainly on the homebirth, breastfeeding, unassisted if you want it side. 

But we're not free from the negatives - the failure to see some options as appealing to others even we will feel they're dangerous (so hard!). And to be honest, I don't know what we do about it - if anything.

It is absolutely true that we often make women feel guilty for not breastfeeding.

Mothers should feel guilty about not breastfeeding - just as they should feel guilty about giving a child a Coca-cola and a donut instead of milk and a banana.

But how do we prevent that guilt from turning into defensive rationalization and inability/refusal to change? How do we communicate with love, empathy, and understanding?

I think we have to start with these assumptions - we do not know all the reasons a mother may choose to do "X" and she is not at the same place we are.

The second assumption, to me, is the hardest and the most important. We can talk until we're blue in the face about the risks of not breastfeeding (which as a note is proven more effective than presenting it as the benefits of breastfeeding - study) but without long-term cultural change we are not going to get there with everyone.

I hate this.

The idealist in me wishes I could help everyone, save every mama and baby from a bad birth, but I can't. No one can. We can try our damnedest and then we just have to hope. Things may not change now, but down the road these seeds may sprout and bloom. We just have to keep planting and watering and weeding. 

Breastfeeding Misinformation begins with Doctors and Nurses

As some of you may know, I have recently gone back to school. I've applied to a local RN Associate Degree program and am working on related coursework. One of my courses this semester is Nutrition and Diet Therapy, and as part of the course requirements, we're presenting group projects. Yes, pregnancy nutrition was taken by the time I got to sign up, but I managed to snag breastfeeding.

I started by scanning my textbook (which is required as we're primarily presenting the text information and supplying research to compliment). I came across this gem: "The adjustments [of breastfeeding comfortably] are easier if supplemental formula feedings are not introduced until breastfeeding is well established, after at least 3 to 4 weeks. Then it is fine if a supplemental bottle or two of infant formula per day is needed." [Contemporary Nutrition: A Functional Approach]

I had a few choice words and then set out to find the research to disprove it. I'm presenting that here.

First - The statement goes directly against current breastfeeding recommendations. WHO states that "exclusive breastfeeding is recommended up to 6 months of age, with continued breastfeeding with appropriate complementary foods up to two years of age or beyond" (Citation) American Academy of Pediatrics goes this far: Supplements (water, glucose water, formula, and other fluids) should not be given to breastfeeding newborn infants unless ordered by a physician when a medical indication exists.” and “Pediatricians and other health care professionals should recommend human milk for all infants in whom breastfeeding is not specifically contraindicated and provide parents with complete, current information on the benefits and techniques of breastfeeding to ensure that their feeding decision is a fully informed one.  When direct breastfeeding is not possible, expressed human milk should be provided." (Citation) Healthy People 2020 Targets are exclusively breastfeeding through 3 months - 46.2% and exclusively through 6 months - 25.5% (Citation)

Second: Formula Supplementation has been linked to early breastfeeding cessation: “Partial breast-feeding (supplementing more than one bottle of formula per day, measured at 1 month postpartum) was associated with shorter breast-feeding duration. This latter effect was minimized by frequent nursing (seven or more times per day), despite formula supplementation.” (citation) 

And finally: “Clinicians who recommended formula supplementation or who do not think their advice about how long to breastfeed is very important may be sending signals that exclusive breastfeeding is not something that mothers should value highly. In addition, our results indicate that many clinicians do not feel confident in their skills to support breastfeeding and may have limited time to address the issue during preventive visits. As for mothers, experiencing problems with the infant latching on or sucking seems to be a risk factor for not exclusively breastfeeding.” (Citation - I found the full article through Ebscohost and cannot link it directly. You can comment/email me for the file and I will be happy to supply it.)

I'm excited to use the information I've found to disprove such a fallacy and educate other nurses. Let's hope they listen...

Modern Medical Birth Control - Risks

 Sometimes people wonder why I go through all the trouble of charting to avoid pregnancy when women have so many other birth control options. 

I just wonder why they put themselves through medical birth control methods. 

Let's look at the risks of some of the modern methods. By the way - It concerns me that I had to do extensive searches on each website to find this information. Some even hide the full side effects from the FAQs portion of their site.

Hormonal birth control pills and patches

Taken from the pdf file (download here) for OrthoTriCyclen - "The use of oral contraceptives is associated with increased risks of several serious conditions including myocardial infarction, thromboembolism, stroke, hepatic neoplasia, and gallbladder disease, although the risk of serious morbidity or mortality is very small in healthy women without underlying risk factors. The risk of morbidity and mortality increases significantly in the presence of other underlying risk factors such as hypertension, hyperlipidemias, obesity and diabetes."

OthroEvra (the patch) contains almost identical wording. 

Seasonique (the three-month no-period pills) -  "Vascular risks: Stop Seasonique if a thrombotic event occurs. Stop Seasonique at least 4 weeks before and through 2 weeks after major surgery. Start Seasonique no earlier than 4 weeks after delivery, in women who are not breastfeeding. (5.1)
• Liver disease: Discontinue Seasonique if jaundice occurs. (5.3)
• High blood pressure: Do not prescribe Seasonique for women with uncontrolled hypertension or hypertension with vascular disease. (5.4)
• Carbohydrate and lipid metabolic effects: Monitor prediabetic and diabetic women taking Seasonique. Consider an alternate contraceptive method for women with uncontrolled dyslipidemias. (5.6)
• Headache: Evaluate significant change in headaches and discontinue Seasonique if indicated. (5.7)
• Uterine bleeding: Evaluate irregular bleeding or amenorrhea."

Depo-Provera Shots - "Thromboembolic Disorders: Discontinue Depo-Provera CI in patients who develop thrombosis (5.2)

Cancer Risks: Monitor women with breast nodules or a strong family history of breast cancer carefully. (5.3)

Ectopic Pregnancy: Consider ectopic pregnancy if a woman using Depo-Provera CI becomes pregnant or complains of severe abdominal pain. (5.4)

Anaphylaxis and Anaphylactoid Reactions: Provide emergency medical treatment. (5.5)

Liver Function: Discontinue Depo-Provera CI if jaundice or disturbances of liver function develop (5.6)

Carbohydrate Metabolism: Monitor diabetic patients carefully. (5.11)
----------------------------------ADVERSE REACTIONS---------------------------
Most common adverse reactions (incidence >5%) are: menstrual irregularities
(bleeding or spotting) 57% at 12 months, 32% at 24 months, abdominal
pain/discomfort 11%, weight gain > 10 lbs at 24 months 38%, dizziness 6%,
headache 17%, nervousness 11%, decreased libido 6%. (6.1)

To ensure the patient is not pregnant at the time of the first injection, the first injection should be given ONLY during the first 5 days of a normal menstrual period; ONLY within the first 5-days postpartum if not breast-feeding; and if exclusively breast-feeding, ONLY at the sixth postpartum week."

Mirena (IUD device) (This was by far the most difficult to find information on. While others listed their "prescription inserts" with a bit of searching, Mirena asks that you talk to your health care provider for a full list of possible side effects) - "Call your healthcare provider right away if you think you
are pregnant. If you get pregnant while using Mirena, you may have an ectopic pregnancy. This means that the pregnancy is not in the uterus. Unusual vaginal bleeding or abdominal pain may be a sign of ectopic pregnancy.
Ectopic pregnancy is a medical emergency that often requires surgery. Ectopic pregnancy can cause internal bleeding, infertility, and even death.
There are also risks if you get pregnant while using Mirena and the pregnancy is in the uterus. Severe infection, miscarriage, premature delivery, and even death can occur with pregnancies that continue with an intrauterine device (IUD). Because of this, your healthcare provider may try to remove Mirena, even though removing it may cause a miscarriage. If Mirena cannot be removed, talk with your healthcare provider about the benefits and risks of continuing the pregnancy. 

Life-threatening infection can occur within the first few days after Mirena is placed. Mirena may become attached to the uterine wall. If embedment happens, Mirena may no longer prevent pregnancy and you may need surgery to have it removed. Mirena may go through the uterus. If your uterus is perforated, Mirena may no longer prevent pregnancy. It may move outside
the uterus and can cause internal scarring, infection, or damage to other organs, and you may need surgery to have Mirena removed.
Common side effects of Mirena include: Pain, bleeding or dizziness during and after placement. If these symptoms do not stop 30 minutes after placement,
Mirena may not have been placed correctly. Your healthcare provider will examine you to see if Mirena needs to be removed or replaced."

 

Essure - permanent placement of coils within the tubes - "The most frequent adverse events and side e ffects reported as a result of the hysteroscopic procedure to place the Essure micro-inserts were as follows: cramping (29.6%), pain (12.9%), nausea/vomiting (10.8%), dizziness/lightheadedness (8.8%), and bleeding/spotting (6.8%). Hypervolemia occurred in <1% of cases. During the rst year of reliance on the Essure micro-inserts for contraception (approximately 15 months after micro-insert placement), the following episodes were reported as at least possibly related to the Essure micro-inserts: back pain (9.0%), abdominal pain (3.8%), dyspareunia (3.6%). All other events occurred in less than 3% of women." A number of women had to undergo a second surgery because the initial surgery failed to properly place the devices or they became dislodged."

Tubal Ligation - difficult to find direct information since this is not a device or pill, but a procedure. Some general information may be found at webmd - "Minor complications include infection and wound separation. These affect about 11% of women after mini-laparotomy, and 6% of women after laparoscopy.³ Major complications include heavy blood loss, general anesthesia problems, organ injury during surgery, and need for a larger laparotomy incision during surgery. These affect 1.5% of women after mini-laparotomy, and 0.9% of women after laparoscopy. Although fewer complications occur with laparoscopy than with other kinds of tubal ligation surgery, these complications can be more serious. For example, on rare occasions, the bowel or bladder is injured when the laparoscope is inserted. The general risks of surgery are greater if you have diabetes, are overweight, smoke, or have a heart condition."

I encourage women to embrace their fertility. I wonder why so many doctors (and women) feel that loosing a period - and therefore fertility - is a fine or even good thing (think about those "unnecessary period" commercials). Fertility has long been feared by some men and now by some women.

I've heard it said that bottles were invented by men to separate the woman from her child. Don't allow men to separate you from your fertility.