Belly Tales

A friend with a colicky baby has suddenly begun to swear by this method of colic massage. First decent sleep she’s gotten in weeks, apparently! Who knows, maybe it will work wonders on your own colicky baby too. Check it out.

So, my birthday is just around the corner, and I spent part of today updating my wishlist on Amazon, just in case anyone wanted to check it out (you never know, after all). While there, I noticed that just about every book on my list was a pregnancy or childbirth book. Funny, that.

I love it when I’m reading a pregnancy book on the subway or bus and someone gets up the nerve to politely ask me when I’m due, and then I have to explain to them that no, I’m not pregnant, but yes, I really do enjoy reading pregnancy books, for fun. Sometimes if I tell them I’m a student midwife, it suddenly makes sense. Sometimes they’ve never heard of midwifery before, or thought that midwives were an 18th century thing that doesn’t exist anymore, and then I get the pure joy of teaching someone something new. Either way, it almost always leads to a good conversation. People should talk to each other on the bus or subway more often.

Anyway, I thought I’d put my top five pregnancy/midwifery wish list books up here, so all of you can see what I hope to be reading in the coming months (hint hint).

	Birth As an American Rite of Passage By Robbie E. Davis-Floyd. I’ve been told this book is a lot like The Woman in the Body, by Emily Martin, which I adored.
	Recreating Motherhood By Barbara Katz Rothman. People have been telling me for years that I’ve got to check this woman out.
	Testing Women, Testing the Fetus By Rayna Rapp. A friend asked me my opinion on amniocentesis the other day, and I realized I really didn’t know enough about it to have a clearly defined opinion on it, so, first step: read about it!!
	Taking Charge of Your Fertility by Toni Weschler. I’ve been told that this is the bible for all things fertility and conception related, which certainly means I’ve got to check it out. and finally…
	Obstetric Myths Versus Research Realities by Henci Goer. Always good to know what the research reality is.

Three cheers for summer reading!!

“We have a secret in our culture, it’s not that birth is painful, it’s that women are strong.”

—Laura Stavoe Harm

I have a friend who’s pregnant with her second child right now. Her first labor went very quickly and easily for her—she got to 4 cm dilated without even being aware that she was contracting in the first place. With second babies, labor tends to go even more quickly and easily, so my friend and her husband and doctor are all concerned that she might not make it to the hospital in time. She has very strict orders to head in as soon as she feels anything, but just to be on the safe side, in case she accidentally does have her baby in the car on the way there, she asked me to put together an emergency car birth kit for her. I don’t think she’ll need it, but as she said, she’d rather be safe than sorry, and it would ease both her and her husband’s minds. So, I thought about what instruments and necessities are on the birth table at the hospital, and I trolled around a few homebirth sites and looked at what comprises a normal homebirth kit, and this is what I came up with: (Read on …)

It’s summertime! The weather is warm, the t-shirts and skirts have been dragged out of the depths of my closet, and school is officially on hold for the next three months, which means I have a lot more time to play around on the internet, and go for walks, and eat ice cream, and most importantly, write tons of posts for this website! Aren’t you all in luck? (Granted, I’m not entirely sure that anyone is reading this website yet, but hey, it’s fun to have an imaginary audience.)

Anyway, amid all my ice cream eating and internet-surfing, I stumbled upon the 2002 labor intervention statistics for hospitals in the New York metropolitan area, courtesy of the New York State Dept. of Health, and nicely summarized on the Choices in Childbirth website. So, without further ado, here are the 2002 cesarean section rates for the major NYC hospitals we all know and love:

Allen Pavillion… 28% (16% Primary, 12% Repeat)
Bellevue Hospital… 19.8% (13% Primary, 6.8% Repeat)
Beth Israel… 22.4% (15.1% Primary, 7.4% Repeat)
Columbia Presbyterian… 33.8% (22.5% Primary, 11.3% Repeat)
Harlem Hospital… 24.9% (15.1% Primary, 9.8% Repeat)
Jamaica Hospital… 25.3% (16.5% Primary, 8.8% Repeat)
King’s County… 23% (17.9% Primary, 5.9% Repeat)
Lenox Hill… 31.5% (21% Primary, 10.5% Repeat)
Maimonides… 18.9% (12% Primary, 6.8% Repeat)
Metropolitan Hosp… 22.8% (11.9% Primary, 10.9% Repeat)
Mt. Sinai Hospital… 26.9% (18.1% Primary, 8.8% Repeat)
NY Downtown… 13.3% (9.0% Primary, 3.3% Repeat)
NYU Medical Center… 26.4% (19.1% Primary, 7.3% Repeat)
Roosevelt Hospital… 27.0% (19.4% Primary, 7.6% Repeat)
St. Vincent’s… 26.1% (19.7% Primary, 6.5% Repeat)

These statistics usually aren’t that easy to find—it’s a pain in the ass to look them up or request them from the Dept. of Health, and few (if any) hospitals will volunteer their own cesarean section rates during the hospital tour for expectant families. Why? Because these CS rates are all embarassingly high. According to the World Health Organization, “countries with some of the lowest perinatal mortality rates in the world have cesarean section rates of less than 10%. There is no justification for any region to have a rate higher than 10-15%.” (see below for full citation¹).

Most hospitals in NYC are averaging 22-25%. Some hospitals even go as high as 31-33%. That means that more than 1 in 4 women at those hospitals end up with a cearean. Those are terrible odds. Cesarean delivery is the most common surgery performed in the US right now. Is anyone else distressed by this? Can’t we do better than this?

¹WHO, 1985. Appropriate Technology for Birth. Lancet, 2(8452), 436-437).

I’ve been writing a lot of activist, news-focused, political posts lately, so I thought I should borrow a page from Monty Python: and now for something completely different!

Birth is an awe-inspiring thing. It’s one of the few moments in a person’s life when the constructs of our reality crack wide open and we come face to face with Divinity, in whatever form that takes for us. It’s miraculous. It always has been. Despite all of our technological advancements and NICUs and amniocentesis and IVF, we still don’t truly know why it works, or how it happens. Sometimes babies who shouldn’t be alive live; sometimes babies who look perfectly healthy and medically sound die. There is so much of it which is still out of our hands, and which will always be out of our hands.

I have always been fascinated by myth and folklore, by the roots of things, and where things come from. Naturally, other culture’s myths and birth stories and legends are a treasure trove for someone like me. So, a friend and I put together a list of the Gods, Goddesses and Saints which people have been turning to for centuries to guide them through labor and bring a live, squalling baby into their arms. I know of several modern women who have drawn solace and support and strength from these ancient Goddessses. Who knows: perhaps these Gods and Goddesses are watching over us still. (Read on …)

Here’s a newsflash: In a sytematic review of the literature in this month’s JAMA, researchers have recently found that routine episiotomy offers no benefit to women, and may in fact do more harm than good. Reuters picked up the article here.

I have never understood routine episiotomy, and in my work as a nurse, every time a doctor picks up the bandage scissors to make a cut (even the smallest of cuts), I find myself internally wincing. Sadly, that amounts to a lot of wincing in the course of a work week. According to Reuters, one-third of all women in the U.S. have an episiotomy during childbirth, although some doctors and hospitals perform the procedure on as many as three-quarters of all women giving birth. Three quarters of all women! True, episiotomies can be life-saving in rare cases of shoulder dystocia or true CPD, but how often do those cases occur? An episiotomy is a deep muscle cut, inevitably weakening the pelvic floor (as was pointed out in the above systematic review). Often even the smallest of episiotomies is extended during the course of delivery, growing from a small cut to a large 2nd or 3rd degree laceration, which then requires extensive suturing. There’s no reason for routine episiotomies. If a woman’s perineum is properly supported and protected during crowning, and if the baby is delivered s l o w l y, and with care, it’s possible to keep her from tearing at all—or if she does tear, it’s a superficial tear, rather than a deep muscle cut; harder to repair, true, but infinitely better for the strength and integrity of her pelvic floor. It’s a rare thing to see a doctor being that patient on a consistent basis, although it certainly does happen from time to time. (I can think of one doctor on my unit, for example, who has a nearly perfect intact perineum rate, but in the way she practices I’d say she’s much more like a midwife than a doctor.)

Change is slow, and it takes a long time for medical practitioners to learn new habits and skills. If an OB has been cutting routine episiotomies all his life, he may never change his practice. But having a review like this come out in a magazine as important and influential as JAMA is a step in the right direction. For years doctors were taught that episiotomies were necessary more often than not. Now, thanks to “new” research like this, maybe doctors will eventually be taught that episiotomies are never necessary, except in true emergencies. One can only hope.

I wrote last week about the alarming trend of pharmacists refusing to fill prescriptions that they didn’t agree with. Thanks to the good folks at NARAL, you can now write to some of the nation’s biggest pharmacy chains and let them know exactly what you think about this.

In my never-ending quest to provide this journal with the coolest links in the world, I most recently stumbled upon Hip Mama, an informative online parenting zine with a decidedly wicked feminist/activist streak. In other words, just my kind of zine.

While purusing the site and getting the lay of the land, I read a fantastic interview with Lorig Charkoudiana, a Maryland woman who organized a nurse-in at her local Starbucks after being asked by the manager to either cover up or go to the bathroom because she was breastfeeding. What a brilliant idea!!! The nurse-in received a ton of positive media attention, and spawned several other Starbucks nurse-ins around the country. You can read Starbucks’ adequate but not quite commendable response on Lorig’s new website: www.nurseatstarbucks.org. You can even even organize your very own nurse-in. And not just at Starbucks. There’s a whole host of US companies which could stand a major revamp of their current (or nonexistant) policies on breastfeeding.

Breastfeeding is the healthiest food you can feed your baby. This isn’t news; the AAP and the WHO have been telling us this for years. But how often do you see a woman breastfeeding in public? Sadly, I only see maybe one or two women a month breastfeeding in public. Some months go by where I don’t see a single breastfeeding woman at all. Given that there are 11,018 babies born in the US every day, shouldn’t we be seeing thousands of breastfeeding mothers in the course of a single month? According to the CDC, in 2003, 70.9% of all women were breastfeeding their babies at the 7 day mark. 36.2% of all women in the US were breastfeeding their babies at the 6 month mark. Even if that rate is nowhere near the 50% breastfeeding goal of Healthy People 2010, that’s still a lot of women. What I want to know is, where are all these women doing their breastfeeding? In their homes? In private places? In bathroom stalls? In broom closests? Why don’t we see more breastfeeding women out and about, going to Starbucks, grocery shopping, reading books at Barnes and Nobles, breastfeeding in taxis, in restaurants, in parks, on buses? Why don’t we see more companies making it easier for breastfeeding women in the first place?

The thing is, breastfeeding is a difficult undertaking in its own right. Babies don’t always latch well, and even if they do latch well, they don’t always suck. Nipples are sometimes inverted, feeding schedules can be so demanding that they can seem like a derranged experiment in sleep deprivation. The whole process is hard enough to accomplish without social taboo heaped on top of it. Breastfeeding women need our support. Maybe more mothers would breastfeed in the first place, or breastfeed for longer, if it was something they could do in public through the course of their day without having to feel self-conscious about it or, let alone stared at or banished to a bathroom. Newsflash 2005: breastfeeding isn’t shameful. It’s not a bodily function. It’s not something that needs to be hidden or covered up. It’s a baby eating lunch, or dinner, or an afternoon snack, whatever the case may be. I certainly wouldn’t want to eat my lunch in a bathroom. Why should a baby have to?