© Erica Hagerman

This is where the real action happens and when most dads experience their transformation of becoming a father. I remember being a little kid and my dad telling me about when I was born. His face was full of amazement as he recalled my birth. Most of the dads I talk to share a similar feeling while describing the birth of their children. Even for the toughest pregnancies and births, dads recount sublimely wonderful moments of holding their children for the first time.

Quite a bit has changed since our dads had kids — and the the most dramatic shift has been the attitudes about dads at birth. We are no longer expected to stay in the waiting room, wring our hands and wait for the doctor to proclaim the gender of the new baby. Today, dads are getting involved in every aspect of the birth of their children and we are showing up at the births with high value. Women making empowered birth choices are asking for their partners to take a starring role in their support while giving birth. Many of the families I work with now tell me that they couldn’t imagine not being together every step of the way.

What does it mean to be a dad showing up with high value at the birth?

It means a willingness to allow the powerful force of procreation to move freely. A woman’s body knows how to give birth. You provide the environment that allows a woman to feel safe, where she can move with the contractions. Advocate for this kind of freedom. Amazing things will happen.

How do I create an environment in which a woman feels comfortable and free to birth?

Since you will have already talked about your birth plan in detail with your partner, you’ll already know which kind of environment helps her feel safe. In the birth time, put your focus and attention on the birthing mama. I remember my wife, Andrea, asking that nobody move during the contractions when she was in transition. She told me later she could feel the air pushing against her when people were moving through the room and hearing people talk was bringing her out of her concentration. She needed absolute stillness, total silence. So I stood there and breathed with her. And our birth team was able to do the same because we chose birth attendants that were in line with our birth philosophy.

What if we’re in a situation where the birth attendants don’t share our philosophy?

If you find yourself in a situation where interventions are being suggested that don’t seem necessary, then take action. The birthing mama needs you to step in, ask questions, and get involved. Unnecessary medical interventions in a hospital setting can start a cascade that can turn a normal birth into a c-section very quickly. The C-Section rate in the United States is a whopping 32%. Are we to assume that ⅓ of all births require major abdominal surgery? I think not. The tremendous work of the modern, gentle birth movement is likely to make that number decline considerably over the next generation, and you are part of that movement when you advocate for safe birth choices. If you are choosing a hospital birth, then you have the greatest opportunity to present knowledgeably about birth and to hold fast in your birth vision. Stand tall and congruent in your decisions to get whatever it is that the birthing mama requires to respond to the procreative force within her.

What if we are choosing to birth at home? What can I do to be present and supportive?

Choosing a home birth means you will be involved in the midwifery model of care, in which a birthing mama is given plenty of freedom to birth in her own way. This is why many families are choosing it. Over the months of the pregnancy, you will have formed a close relationship with the midwife and the doula, and this is the time when you all come together to be a powerful support team for the birthing mama. Your support could look like breathing through contractions with her, organizing the birth pool and managing the water, offering physical assistance through the labor in different positions, or organizing food for the birth team and birthing mama. Being present is simply about keeping your attention and focus on her needs as she goes through this amazing process.

*This is part two of a four part series: Pregnancy, Birth, Postpartum, and Breastfeeding.

www.implementingdesignism.org

Polycystic Ovarian Syndrome (PCOS)* is an endocrine disorder estimated to affect more than 1 in 10 women and is the leading cause of female infertility. The root cause of PCOS is thought to be insulin resistance. It is a close cousin of diabetes, sharing many of its increased health risks.

PCOS also raises the risk of cardiovascular disease, and is associated with higher rates of depression and anxiety, as well as endometrial cancer. Symptoms often first appear during adolescence, but too frequently, women go undiagnosed for years.

In recent years there has been an incredible surge in PCOS communities online. PCOS needs to be brought into the public health spotlight. Women’s health suffers because the vast majority of people aren’t aware that this prevalent disorder exists, and even when women seek out medical advice, their doctors may treat the symptoms without diagnosing their cause.

Some women have only one or two symptoms. Others, myself included, may experience almost every single one on the list to varying degrees:

• Irregular or absent menstrual cycles
• Obesity/unexplained weight gain/difficulty losing weight
• Infertility or recurrent miscarriages
• High cholesterol levels
• High blood pressure
• Excess or abnormal hair growth and distribution (hirsutism)
• Pain in the lower abdomen and pelvis
• Multiple ovarian cysts (often only seen on ultrasound)
• Skin tags
• Acne
• Acanthosis Nigricans (dark, velvety patches of skin)

I was diagnosed with PCOS ten years ago at 26, when I was ready to get pregnant. I’d suspected something wasn’t quite right for several years. My periods were never remotely close to regular. As a teen, I averaged 6 to 8 cycles per year. Doctors told me I would “grow out of it,” and at 19 I was told that The Pill would help regulate my cycles. It didn’t.

I now know my sporadic cycles are a common symptom of PCOS. My last semester of college, I experienced my first spurt of sudden weight gain. I was underweight as a teen, but at 21 gained 20 pounds in the course of a semester. Over the next two years 20 pounds turned into 60. I felt like I’d completely lost control over my body. It became alien, and I began to view it as my enemy.

By the time I was 24, I decided to stop taking The Pill, thinking it might be the weight gain culprit. Then I didn’t have a period for 7 months. I made an appointment with an OB/GYN who prescribed Provera on my first visit to jumpstart my menstrual cycle. The only thing she said about my sporadic cycles and the weight gain was that we should check my thyroid, which came back normal.

When I asked if I would have trouble getting pregnant, she said,

“We’ll have to wait and see. It would help if you lost some weight.”

Words women with PCOS hear too often, without receiving a thorough evaluation or referral to the appropriate specialist. I still feel angry when I recall how casually my concerns were dismissed.

Fast forward a couple of years. Due to a job and insurance change, I switched to a new OB/GYN. By this time, my husband was within sight of earning his Ph.D., and we’d begun talking about trying to conceive. After learning that the university Student Health Services provided pre-conception counseling, we made an appointment. I will be forever grateful to the nurse we saw that day for tipping me off that the symptoms that had gotten progressively worse through my 20s had a name. While reviewing facts about increasing chances of conception, she came to a card in her education kit that named the four most common causes of infertility. PCOS was one of them. I asked her to explain what it was, and as she talked the light clicked on. We discussed my own history, and she immediately said I should be evaluated for PCOS. After having a miscarriage at 6 weeks, I was referred to a reproductive endocrinologist. I was finally in the right hands.

In “A Patient’s Guide to PCOS,” Dr. Walter Futterweit states that women with PCOS experience early miscarriage at three times the normal rate. Under the care of a reproductive endocrinologist, I conceived and gave birth to my first daughter, following a second miscarriage that occurred at 8 weeks. My younger daughter was a very welcome surprise, as I managed to get pregnant without any fertility drugs or other medication after regaining control of my health and losing weight.

The journey that led to the birth of my two gorgeous girls was far from straight. They are my Hope and Grace, middle names that honor their great-grandmothers, as well as the gifts they are to us.

My goal is to raise awareness and prevent other women from suffering from undiagnosed health issues and infertility, potentially going without answers for many years. We must educate our daughters and other young women in our lives about their bodies and normal cycle lengths, for our menstrual cycles are an extension of our health, and an abnormal cycle may be the first sign of PCOS.

In my next article, I plan to cover information about testing, what doctors to seek out for accurate evaluation, treatment options, as well as the importance of nutrition and exercise.

*Please note that PCOS is referred to as both polycystic ovarian syndrome and polycystic ovary syndrome in medical literature.

To Learn More about PCOS or Take a PCOS Quiz:

• The University of Chicago Center for PCOS
• The Polycystic Ovarian Syndrome Association
• PCOS & Teens
• PCOS Quiz for Teens
• A Patient’s Guide to PCOS by Walter Futterweit, MD (This book also includes a PCOS quiz.)

© Vicki Elson

A baby born in a tree!

A baby beamed out of her mother’s body!

A baby born to Arnold Schwarzenegger!

I’ve looked at hundreds of TV and movie birth scenes to discover exactly how the mass media distorts birth.  I found that Hollywood routinely exaggerates fear, danger, and speed, like in this common motif:  the minute a pregnant woman’s water breaks, there’s a mad rush to the hospital. Cars screech around corners and run over pedestrians, or, worse, they get stuck in traffic.

None of this would matter if it didn’t accumulate in our subconscious minds, affecting the way we feel about labor when it’s our turn to have babies.  But a lifetime of exposure does indeed seep into us.  That can affect our minds and even our bodies during pregnancy and birth.

Hollywood makes women look silly, nutty, desperate.  Moms look helpless and in need of immediate rescue.  The scariest birth scene ever was an episode of “E.R.” directed by Mimi Leder.  A loveable woman who wanted natural childbirth soon discovered, like many TV moms, that her body was unreliable.  But her doctors were even worse.  With an insanely unrealistic set of medical mistakes, they managed to, um, kill her.  That one was a double whammy for the pregnant women who made the mistake of watching it.  It won an Emmy.

Hollywood takes footage of a normal birth and adds a gratuitously terrifying narrator:  “The most DANGEROUS journey in life…the four-inch trip… DOWN the birth canal!” and “Here on a classroom floor…a lot can go wrong!”

I even heard about a mom who gave birth squatting, but the reality-show camera crew didn’t make it in time.  So they made her re-enact the birth — lying flat on her back, working against gravity and sound physiological positioning, just because that’s what the director thought audiences should see.

But the laboring mother isn’t always the star of the show.  Her partner often upstages her with the rough time he’s having. He (it’s always a he, except for once that I know of on “Friends”) gets his fingers bitten or crushed by the laboring mom.  Or she threatens to do an instant vasectomy, or she jams his video camera into his eye.  Sometimes, his struggle to get to the hospital on time is the focus of the episode — say, crawling through ventilation ducts with Bruce Willis.

When ordinary natural normal childbirth does make it onto the screen, it’s in the olden days – say, a Native or a pioneer woman.  Or it’s a wacky woman giving birth in a remote lagoon, or swimming with dolphins.  Or it’s an alien lady enjoying painless, sweat-free reproduction with her android pals looking on.

How can pregnant people de-program themselves and cultivate healthy, realistic expectations?

Be careful what you expose yourself to.  Online births can be inspiring, or terrifying, or just plain stupid (a college student “birthing” a basketball might light up your search engine).

Fill yourself up with confidence-building imagery and information.  Take a childbirth class.  Watch “Birth Day,” a short film that captures midwife Naoli Vinaver Lopez’s robust grace and joy as she herself gives birth.  Read informative, honest books like Pregnancy, Childbirth and the Newborn by Penny Simkin, or the excellent new Pregnancy & Birth Edition of Our Bodies, Ourselves, and the treasured fear-buster, Ina May’s Guide to Childbirth by the pioneering midwife Ina May Gaskin.

“Laboring Under An Illusion: Mass Media Childbirth vs. The Real Thing” is a film I made for just this purpose, juxtaposing 100 TV and movie births with real births, so you can judge for yourself what’s realistic and what you might want for your own birth.  It’s pretty funny, and it’s got lots of clips from filmmakers whose mission is to inspire and encourage you.  You might find that you want to see those films in their entirety.  See the trailer at www.birth-media.com.

I’m alarmed to discover that my film is being well-received all over the world.  It won a couple of awards here in the USA, which delighted me, but why do I get fan mail from places like Singapore and South Africa?  Apparently, we are exporting our culture so far and wide that my critique of mass media is relevant all over the place.

I suppose Hollywood might wake up and stop scaring the daylights out of pregnant women.  In case they care, I launched “Reel Childbirth,” a script consultancy to help them out.  But I’m not holding my breath.  It’s up to pregnant women and those who love them to balance distorted media with responsible information.

Go find people who are not afraid of labor.  Find people who have had labors they feel good about, and find out what they know.  Soak up their wisdom, and turn off the TV!

Now! Enter to win your own copy of the DVD “Laboring Under An Illusion: Mass Media Childbirth vs. The Real Thing”, regularly $19.95.

a Rafflecopter giveaway

© imagerymajestic

If you’ve ever been pregnant, you know how you rely on your favorite fetus-nourishing foods.  You know how you cherish your collection of pillows and your comfortable bedding.  You choose your shoes and clothing carefully for comfort and self-expression.  You know how nice it is to get the kind of exercise that feels good – the pool at the Y, the yoga class, the long walks.

Incarcerated pregnant women miss all these things, and they miss their sweethearts and their older children too.  When they go into labor, they are transported under guard to the nearest hospital.  Most are shackled before, after, and sometimes during active labor.  An armed corrections officer (CO) is present for every minute of labor, birth, and postpartum at the hospital. And then the new mothers go back to jail, alone.  For all mothers, giving birth has the potential for being traumatic.  But for incarcerated mothers, giving birth is inherently traumatic. 

Each year in the U.S., 40,000 pregnant women are incarcerated.

The Prison Birth Project was created by two community-spirited young moms, Marianne Bullock and Lisa Andrews, to serve a small number of these mothers. We are a reproductive justice organization working to provide support, education, and advocacy with women and girls at the intersection of the criminal justice system and motherhood in our regional women’s jail.

The average incarcerated mom is likely to be inside for a nonviolent offense.  She is much more likely than the average American to be poor, illiterate, mentally ill, sexually abused, addicted to drugs – and African American or Latina.

The unintended consequence of the failed “War on Drugs” is that now more than 1% of the adult population of the United States is incarcerated.   It’s a huge industry.  The number of women in jail has increased 832% in the past 10 years alone.  (No, that’s not a typo.)

PBP offers advocacy, friendship, peer mentoring, and leadership development.  We organize with incarcerated people around policy change.  Our three main programs are childbirth education, doula services, and mothers’ groups.

Childbirth Education Classes, which we offer weekly, are a little tricky in jail because there are issues (like custody, or survival) that overshadow everything we ever thought was important to teach pregnant people.  Sometimes the best “classes” are just being together.

Also, we never know for sure if we’re going to see a woman only once or if we’ll see her every week for her entire pregnancy. It doesn’t matter.  Any respect and kindness – and food – that we offer isn’t wasted.  If you’re interested, I’ve written a suggested class plan. You’ll also find some short handouts: what I think pregnant women need to know if you only meet them once, and a postpartum guide specifically for incarcerated moms.

Doula Care starts with prenatal visits.  We try to help laboring moms feel more in control.  We try to create a “bubble” that consists of the mom, her family (if they’re present), and her doula.  We help CO’s and hospital staff create a friendly atmosphere, but we try to let the mom decide who gets to be in her bubble.  It feels odd that we doulas are allowed to touch her, but her close family members are not.  We try to channel their touch, and offer suggestions for how family can participate in ways that are allowed under Department of Corrections protocols.

Of all the women who have ever received PBP’s doula services and then been released, very few have returned to jail. We believe that doula care is stopping a cycle of violence and trauma to mother and baby during delivery, and helping women to have the tools to make healthier choices. Other prison birth programs report similar decreases in recidivism.

In addition to doula care, we offer full-spectrum reproductive care.  This might include pregnancy options counseling.  We serve as adoption support and as abortion doulas – as controversial as that is, we feel that all women deserve services that will lower their chances for further traumatization.  We help women with custody issues and interactions with the Department of Children and Families.  We offer support in the courtroom.

Mothers’ Groups are available for ALL mothers at the jail.  So far, more than 75 moms have participated in “Mothers Among Us,” PBP’s peer-led support group. MAU offers a safe place to be real and honest about the full spectrum of mothering experiences.  Both participants and facilitators are reclaiming their resiliency and strengthening their core selves.

PBP is dedicated to having incarcerated and formerly incarcerated women fill at least half of our positions of leadership.  We are training women to lead MAU groups.  We are exploring offering childbirth educator and doula trainings inside.  We are hoping that others will offer similar services at jails, prisons, and re-entry programs nationwide.  An article in the upcoming issue of Midwifery Today will include some suggestions for those of you who wish to serve these families in your own communities.

©Kate Donahue at Portland Doula Care

The January 11, 2012 Slate.com article “The Truth About Epidurals: Are they really so bad?” by Melinda Wenner Moyer concludes with this paragraph:

“Women shouldn’t cave to pressure from either side.” [Of the 'mommy wars' between natural birth advocates and pro-epidural advocates] “They should make informed decisions based on their goals and priorities. I aspired to have a comfortable birth even if it meant being surrounded by nurses and doctors and tubes and incessant beeps; other women may trade pain for a more intimate birthing experience. Each choice comes with its own benefits and unpleasantries. My unnatural childbirth left me with a memory that does not involve intolerable pain, and that’s exactly what I wanted.”

I’m concerned about this piece for a number of reasons, but the most significant are summed up in this paragraph, so I’d like to start here.

I agree that women should make their own best and informed decisions. I object to the continued polarization of “us” and “them.” I also disagree with the characterization of the options as choices between benefits and “unpleasantries.”  This minimizes the fact that we must weigh benefits and risks when considering birthing options. This includes risks to babies as well as ourselves. Thus, while the decisions very well may be based on “goals and priorities” I would argue that the highest priority must be the health and well-being of the mother-baby dyad. Reducing the choice to that of comfort vs. an “intimate” experience ignores that many women choose natural birth not because of the “experience” but to minimize risk.

Intervention was introduced for a valid reason and, when used appropriately, has the potential make a difficult birth better. That does not mean every intervention is appropriate for every situation. When used inappropriately, every intervention has the potential to also cause problems. This includes epidurals and other labor drugs. To suggest otherwise is disingenuous and a huge disservice to those trying to make an informed decision.

Wenner Moyer mentioned studies in her article, but failed to cite them. I did not find her references, but she was correct in her assertion that the evidence is “inconclusive.” The vast majority of studies do say that rates of surgical deliveries increase due to a multitude of reasons involving epidurals. A handful suggested otherwise.

The Cochrane Collaboration, the largest independent collection of available medical studies, encapsulated in A Guide to Effective Care in Pregnancy and Childbirth, states:

“In women with epidural analgesia, both the first and second stages of labor are longer, and oxytocin use, malrotation and cesarean sections are more frequent.” (Enkin, et al p. 291)

The Cochrane Collaboration last updated in 2011 states:

“The review identified 38 randomised controlled studies involving 9658 women. All but five studies compared epidural analgesia with opiates. Epidurals relieved labour pain better than other types of pain medication but led to more use of instruments to assist with the birth. Caesarean delivery rates did not differ overall and nor were there effects of the epidural on the baby soon after birth; fewer babies needed a drug (naloxone) to counter opiate use by the mother for pain relief. The risk of caesarean section for fetal distress was increased. Women who used epidurals were more likely to have a longer delivery (second stage of labour), needed their labour contractions stimulated with oxytocin, experienced very low blood pressure, were unable to move for a period of time after the birth (motor blockage), had problems passing urine (fluid retention) and suffered fever. Long-term backache was no different. Further research on reducing the adverse outcomes with epidurals would be helpful.” (Anim-Somuah, Smyth & Jones, 2011)

Cesarean rates did not increase overall, but the risk of cesarean section for fetal distress was increased. The experience of very low blood pressure often leads to fetal distress which leads to surgical birth. If a complication can be directly attributed to the epidural, and it leads to emergency surgery, is the surgery then considered due to a medical complication instead of the epidural, even though the complication would not have occurred in the absence of the epidural? If a study does not compare natural birth to medicalized birth, how can any conclusions be drawn about how the interventions impact a birth?

And does it matter if the research is possibly tainted by special interests anyway?

Dr. Marcia Angell, the Editor of the New England Journal of Medicine, said in 2009:

“It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor of The New England Journal of Medicine.” (Angell, 2009)

When looking at the evidence in trying to make a decision as important as that regarding the long term health of our children, this should lead consumers to ask: Where is the funding for a coming from and who is performing it?

Who loses revenue if tools like epidurals are used sparingly? I hear a lot of disparaging remarks about natural birth advocates, but what do they have to gain by questioning the safety of labor drugs?

Wenner Moyer suggests that we compare the objective evidence with “…the reassuring words of obstetricians and anesthesiologists who tout epidurals as being completely safe.” What makes her think that her doctor or anesthesiologist is making a recommendation on scientific evidence anyway? Reading the summary of ACOG recommendations for suspected fetal macrosomia (big baby) 2/3 of obstetrical recommendation not evidence-based. (Chatfield, 2001) A Guide to Effective Care in Pregnancy and Childbirth reveals this is hardly unusual.

If we are only asking “Do epidurals effectively reduce or eliminate pain?” and “Is there 100% consensus on safety?” Wenner Moyer’s article addresses those questions. That is also providing that the only thing one is concerned about is whether the mother will end up with a surgery that has a 5 times greater mortality (death) rate than natural birth. But what about other consequences of epidurals, like the increased risk of maternal fever, slowed labor, augmentation, vacuum or forceps assisted delivery, and perineal tearing? (Childbirth Connection, 2011.)

If the debate is framed in such a way as to present the only choice as excruciating pain or “completely safe numbness”, it would seem illogical to opt for natural birth as opposed to “risk-free” drugs. Except that isn’t being honest, there is no such thing as a “risk-free” drug, and these extremes aren’t our only options.

When women are confident that they are fully capable of making the best decisions for themselves, because they made their decisions on the actual events specific to them and not an imagined potential reality, they tend to feel good about their choices. Becoming a mother comes with enough challenges without having to deal with ones that might have been avoided. One of the best ways to avoid the pitfalls is to take an independent childbirth class and educate yourself fully on your options.

References:

AIMS. (Alliance for the Improvement of Maternity Services): Drugs not FDA approved for obstetrics http://www.aimsusa.org/ObstetricDrugs-NotApproved.htm

Angell,M., 2009. Drug Companies & Doctors: A Story of Corruption. The New York Review of Books. http://www.nybooks.com/articles/archives/2009/jan/15/drug-companies-doctorsa-story-of-corruption/

Anim-Somuah M, Smyth RMD, Jones L., 2011. Cochrane Supparies: Independent high-quality evidence for health care decision making. Epidurals for pain relief in labour. http://summaries.cochrane.org/CD000331/epidurals-for-pain-relief-in-labour

Chatfield, J., ACOG Issues Guidelines on Fetal Macrosomia, Am Fam Physician. 2001 Jul 1;64(1):169-170. Retrieved from http://www.aafp.org/afp/2001/0701/p169.html

Simkin, Penny. “Best Evidence: Labor Pain | Labor Pain :: Childbirth Connection.” Childbirth Connection: helping women and families make decisions for pregnancy, childbirth, labor pain relief, the postpartum period, and other maternity care issues.. N.p., 30 June 2008. Web. 7 Feb. 2012. http://www.childbirthconnection.org/article.asp?ck=10183#epidural.

Enkin, M., Keirse, M., Neilson, J., Crowther, C., Duley, L., Hodnett, E., Hofmeyr, J., A Guide to Effective Care in Pregnancy and Childbirth, 3rd edition, 2000. Oxford University Press, USA.

Wenner Moyer, M., 2012. The Truth About Epidurals: Are they really so bad?  Posted Jan. 11, 2012, at 3:28 PM http://www.slate.com/articles/health_and_science/medical_examiner/2012/01/the_truth_about_epidurals.html

© Erica Hagerman

“In this postmodern era, we have gone beyond the unconscious, anesthetized births of the 1940’s and 1950’s, the systematic elimination of lay midwifery, the demise of breastfeeding, and even ‘natural childbirth’ to an enormous range of options and historical shifts. These include the presence and active involvement of fathers during pregnancy and at birth.” (Davis-Floyd & Sargent, 1997)

Women are making empowered birth choices, and they want their partners there to support them. Men might not know how to get involved, or might feel anxious about the process because it’s not happening in their bodies. Yet the pregnancy is a vital time for bonding between the couple and preparing for this new life to enter the family.

Making empowered birth choices means taking responsibility, educating yourself, and holding a vision of what you want your birth to be — together. Write that vision down. That’s your birth plan. Think about who will be there, what kind of food you’ll be eating, if you’ll have a birth pool, if your older children will be there. Allow the birth plan to evolve as the pregnancy progresses.

If you are an expectant mom and you want your partner to be more present and involved, you can help him understand the importance of his role by asking him questions about his ideas of birth and becoming a father. Have a conversation about what matters to him, and what concerns he might have.

If you’re an expectant father, congratulations! You’re already a dad. Every bit of care and attention that you offer to the pregnant mama is also for the baby inside of her. Here are some ways to be proactive in your approach to getting involved.

What can I do?

• Understanding the pregnancy, birth, and postpartum process is key.
• Go to the childbirth education classes
• Talk to other dads
• Be present at the appointments with the birth professional
• Get one-on-one coaching
• Read blogs books, and watch videos of births that embody the birth you want

Self-Care

• Physical exercise: get your heart rate up at least 3 times a week. Every day is even better
• Meditate on becoming a father: what does it mean to you?
• Eat healthy, nutrient dense food and drink
• Drink an alkalizing beverage such as water with lemon, green drink
• Get the right amount of sleep for your body
• Think positive thoughts about the birth and becoming a dad

Make it easy on yourself.

Connect with your birth professionals. This is your opportunity to ask questions, speak up about concerns, and create a bond with them so that you can all be on the same team supporting the birthing mama.

*This is part one of a four part series: Pregnancy, Birth, Postpartum, and Breastfeeding.

Reference:

Davis-Floyd, R.E. & Sargent, C.F. (1997). Childbirth and authoritative knowledge: Cross cultural perspectives. Berkely, CA: University of California Press.

© Robyn Roche-Paull

Body Modifications are a group of practices that include branding, scarification, tattooing, piercing, and other body art.  Body modifications have been around nearly as long as breastfeeding. Archaeologists, historians and body art practitioners note that tattooing and body piercing have been performed, in one form or another, worldwide for over 5000 years. However, within the last 20-30 years body modifications have experienced an explosion in popularity, with people both young and old getting body mods of various types.  More than 20 million Americans, half of whom are women, have one or more tattoos and up to 30% have piercings, and many have both (DeBoer, Seaver, Angel, & Armstrong, 2008).  This surge in body modifications shows no signs of slowing down in the near future.

Many women today get tattoos and piercings as a form of self-expression or to commemorate a special occasion or life event (Caliendo, Armstrong, & Roberts, 2005).  For whatever reason, women today have or are getting body modifications in greater numbers at the same time that many are also becoming mothers.  Along with the rise in body modifications, breastfeeding has seen resurgence in popularity as well.  With breastfeeding rates climbing worldwide it is not surprising that many new mothers, who either have body modifications or who may be contemplating them in the future, might have questions as to the safety of breastfeeding. So what’s a hip, tattooed or pierced and breastfeeding (or soon-to-be) mom to do then?  Is there breastfeeding during or after tattooing and nipple piercings?

Nipple piercings, while a favorite among body mod fans, require patience and are not without risk.  Nipple piercings can take up to a full year to heal completely, with infections and rejections the most common problems. If you are contemplating getting your nipples pierced and also want to have a baby, it is best if you plan the piercing at least 12-18 months before you plan to get pregnant. This allows the piercing time to heal and create a fistula, or channel, before the bodily and hormonal changes that accompany pregnancy occur.  It also will allow for removal of the jewelry during breastfeeding without the worry of the channel closing up. The nipple(s) must have time to heal and cannot have any saliva enter the open wound and the jewelry must stay in place during the healing period, something that is next to impossible to achieve with a young baby to feed frequently.

Many women who already have nipple piercings are concerned about their ability to breastfeed in the future. Breastfeeding is not generally affected by established nipple piercings.  Human nipples have between 8-12 nipple pores therefore it is unlikely that a well-healed piercing will block all of the pores.  However, there has been some recent research pointing to a few reported cases of abnormal milk production in women with nipple piercings due to possible duct obstruction (Garbin, Deacon, Rowan, Hartmann, & Geddes, 2009).  Often women find that when they do remove their jewelry for a feeding that milk leaks out the piercing, this can be problematic if the flow is too fast for your infant.  Be proactive about preventing or reducing any engorgement and be on the lookout for blocked ducts or mastitis, all of which may be exacerbated by nipple piercings (Armstrong, Caliendo, & Roberts, 2006).  It is best to remove your jewelry for each feeding, to reduce the risk of your baby aspirating or choking, although some women do nurse with flexible PTFE barbells in place (Angel, 2009).  Removing your jewelry also reduces the risk of latching-on problems, damage to the inside of your baby’s mouth or the passing of bacteria from the jewelry to your baby.  If you chose to keep your jewelry out permanently until your baby is weaned, be aware that even a fully healed piercing may close and some women have noticed nipple pain in a previously pierced nipple while nursing (Wilson-Clay & Hoover, 2005).  You can keep the piercing open by inserting an insertion taper on a regular basis.  If the channel closes completely wait at least three months post-weaning before re-piercing  (Armstrong, Caliendo, & Roberts, 2006).  If you face any problems with breastfeeding be sure to contact your local LLL Leader or an IBCLC for help.  For problems with your piercing you should be seen by a qualified piercer.

Tattoos are a permanent form of artwork etched into the flesh and are not without risk as well.  As with piercings, local and systemic infections are the most prevalent risks of tattooing. Already present tattoos, on the breast or elsewhere, do not impact breastfeeding. The possibility of the ink migrating into the mother’s blood plasma and then into the milk-making cells of the breast, is next to impossible. It is however, possible to have allergic reactions to the tattoo inks, which are not regulated by the FDA (FDA, 2008).  Many, if not most, professional tattoo artists will not knowingly tattoo a woman who is currently breastfeeding or will actively discourage a new mother from doing so. It is felt that the body needs time to heal the tattoo and that is harder to do so when the body is producing milk, it also lessens the possibility of any infections from being passed on to the baby (Hudson, 2009).  A newborn baby is far more vulnerable to any possible changes in breastmilk than a nursing toddler.  Going to a professional tattoo shop following Universal Precautions also lessens the risk of any infection that might be acquired.

Tattoo Removal It is estimated that 20% of those who get tattoos later regret the decision and wish to have them removed (Armstrong, et al., 2008). Tattoo removal is now accomplished with the use of Q-switched lasers. The laser works by producing short pulses of intense light that passes through the skin to be absorbed by the tattoo pigment. The laser energy causes the tattoo pigment to fragment into smaller particles, which are picked up by the body’s immune system and filtered out. The particles are considered to big to pass into breastmilk.

Whether you are contemplating a tattoo or getting your nipples pierced it is very important that your tattoo artist or piercer follow Universal Precautions. Professional tattooists and piercers will follow all universal precautions such as sterilization of the tattoo machine and piercing implements using an autoclave, single-use inks, ink cups, gloves and needles, bagging of equipment to avoid cross contamination, thorough hand washing with disinfectant soap and the wearing of gloves when performing the tattoo or piercing (Armstrong, et al., 2006).  Any jewelry that is to be inserted should be kept sterile before insertions as well.  It is important to screen the tattooist and the shop carefully, checking with the local health department for local laws and regulations. Reputable body artists support regulations and legislation to keep their customers safe and to legitimize the profession.  The Association of Professional Piercers and the Association of Professional Tattooists both have a wealth of information on safe body modifications and what to look for in a practitioner.

So go ahead and make a statement with your piercings and tattoos, just follow the rules and make sure your piercer or tattoo artist does too.  Body art and breastfeeding are not mutually exclusive, and both are beautiful.

References:

Angel, E. (2009). The piercing bible : the definitive guide to safe body piercing. Berkeley, Calif.: Celestial Arts.
Armstrong, M., Caliendo, C., & Roberts, A. (2006). Pregnancy, lactation and nipple piercings. AWHONN Lifelines, 10(3), 212-217.
DeBoer, S., Seaver, M., Angel, E., & Armstrong, M. (2008). Puncturing myths about body piercing and tattooing. Nursing, 38(11), 50-54.
FDA, U. S. F. a. D. A. (2008). Tattooing & Permanent Makeup  Retrieved September 10, 2009, from http://www.fda.gov/Cosmetics/ProductandIngredientSafety/ProductInformation/ucm108530.htm
Hudson, K. L. (2009). Living canvas : your total guide to tattoos, piercing, and body modification. Berkeley, CA: Seal Press : Distributed by Publishers Group West.
Wilson-Clay, B., & Hoover, K. (2005). The breastfeeding atlas (3rd ed.). Manchaca, Tex.: LactNews Press.

© Robyn Roche-Paull

When I work with mothers that are serving in the military, I hear time after time about the many challenges that they face from the moment the pregnancy test comes back positive to when they finally ‘hang up the horns’ from pumping. Some of these obstacles are what any employed mother might face, but others are definitely unique to the military culture or other non-traditional workplaces such as police, firefighting, construction, airline pilot, or long distance trucking, just to name a few.  Here then are a few of the more common challenges that can trip up even the most diehard and gung-ho of military mothers (and others) including:

Time to Pump: From working the flight schedule, either as ground crew or as a pilot, as a firefighter with no schedule at all, or as an air traffic controller with a console that must be monitored nonstop; mothers in the military or other non-traditional workplaces face the hardships of not having time to pump or not being able to pump on a steady schedule.

Place to Pump: Mothers in military find themselves in some pretty unique situations ranging from pumping in the back of an aircraft, or under a poncho while on the firing range, to shipping milk home from the sands of Afghanistan.  Creativity becomes paramount in finding suitable places to pump with a modicum of privacy!

Hazardous Materials exposure: Some mothers face the added dangers and stress of having to work around or with hazardous materials such as jet fuel, ammunition, oils, solvents, or paints in order to fulfill their job duties.

Deployments/Training/Traveling: Deployments lasting from a few days to 12 months or more are the name of the game while serving in the armed forces and can mean the difference between premature weaning or not.

Supervisor/Co-Worker/Rank Issues: Not surprisingly many of the non-traditional jobs are in male-dominated fields.  It will come as no surprise that many women in these jobs have unsupportive supervisors and/or co-workers who harass them and feel that the breastfeeding mother is getting something ‘special’ when requesting time to pump.  Also, rank issues between enlisted and officer all can combine to make breastfeeding difficult to say the least.

Uniforms: Uniforms are a fact of life in the military and para-military professions.  Not only is breastfeeding or pumping nearly impossible in certain uniforms, there also aren’t any regulations governing whether a mom is even allowed to breastfeed or pump while in uniform.  There are bullet-proof vests and other types of gear that can have an impact on breastfeeding and pumping to consider as well.

So given these seemingly insurmountable obstacles, how do mothers go on to be successful at breastfeeding? More importantly, how can you overcome these and other speed bumps so that you too can breastfeed your baby for as long you desire?

The key lies in attitude, information and support.   Your attitude is probably the biggest determinant of your success at breastfeeding in the military. All of the mothers I have helped have had the attitude that breastfeeding was just going to work, period. They also have a gung-ho, can-do spirit and a good dose of perseverance to boot. There was no trying, or thoughts that it might not work out. These moms went into it believing in themselves, their babies and their breasts.

As with most things related to breastfeeding, having the proper information allows you to make good choices and plan ahead.  While it is vital to your success to know the basics of breastfeeding and pumping, it is more important to know the regulations and policies of your service or workplace regarding breastfeeding and pumping. Have a plan written up before you speak with your supervisor or HR personnel, including when, where and how often you’ll need to pump. Know whom you need to talk to…who are the ‘gatekeepers’ at your workplace? Do you need to speak with the Training Officer or Logistics Officer, what about your Occupational Health representative if you’ll be working around HAZMAT?  Speak with your immediate supervisor or other gatekeepers BEFORE the birth of your baby.  Being an informed mother regarding your rights as a breastfeeding mother in the military can go along way towards making breastfeeding a success for you.

Last but certainly not least is lining up your support even before the baby arrives.  Call on your local IBCLC or La Leche League Leader for information on the basics of breastfeeding and any problems that might crop up.  Attend breastfeeding classes on base, and check out your local New Parent Support Team.  Talk with the baby’s father about his role in breastfeeding, he’ll be your biggest support after the baby is born!  Speak with co-workers and friends that have successfully breastfed while on active duty and think about starting or joining a breastfeeding support group.  Above all don’t be afraid to ask for help, the military is a 24/7 job and so too is breastfeeding.  We all need a helping hand and some encouragement to keep going when the going gets tough.

The same basics of breastfeeding apply to breastfeeding in the military or other non-traditional jobs including:

MILK SUPPLY: Your milk supply is dependent on how often milk is removed from your breasts, whether it is by a pump or your baby.  You should aim for at least 8 pumping sessions or breastfeeding sessions (or any combination thereof) in a 24 hour time period. Remember the saying “You must REMOVE milk to MAKE milk”. Whether that means you can only pump twice while at work but you manage 6-7 nursing sessions during your off-hours; or you can pump 4 times during the day and breastfeed 4 more times while at home, you need to aim for 8 in 24, if at all possible.  Consider co-sleeping and reverse-cycle feeding to boost your milk supply.  Mothers whose babies breastfeed during the nighttime hours have increased milk supplies due to the higher levels of prolactin (the milk making hormone) during the night hours.  By allowing your baby to sleep near or with you, you can more easily facilitate breastfeeding during those precious night hours.  Babies may take matters into their own hands by reverse-cycle feeding, that is breastfeeding heavily during the night hours and sleeping a lot during the day, which also means you don’t need to provide as much breastmilk for the daycare the next day!

PUMPING: Your pump is vitally important to the success of your breastfeeding while in the military or similar job speciality. If you don’t have a high quality, reliable pump your milk supply may falter due to the pump not being effective or pumping may be painful for you.  Do yourself a favor and spend the money on a new double-electric pump from a reputable manufacturer (and preferably one that abides by the WHO code).  Hygiea makes an excellent pump for working mothers that are WHO code compliant.

HAND EXPRESSION: Learn hand expression. You never know when the power might go out, you’re sent on an unexpected overnight TDY, or a pump piece breaks.  It happens, and knowing how to hand express will keep your milk supply intact and your milk flowing until you can get back home or the power returns.  Mothers have also found that hand expression combined with using a pump yields more milk.

BREASTFEEDING: When at work give bottles, when at home give the breast.  Breastfeeding is about more that just the milk, by using bottles ONLY while at work, you put the BREAST back in breastfeeding and help to cement that wonderful bond between you and your baby. It also helps to keep your milk supply up as your baby is the best pump available, and the skin contact and snuggling with your baby boosts your milk-making hormones too.

It is NOT all or nothing!

Whatever amount of breastmilk, for whatever amount of time that you can provide to your baby is wonderful.  While we would all love to give 100% of our breastmilk, 100% of the time…some times and in some situations it just isn’t possible.  Do the best you can for your baby, no one else has to walk in your (combat) boots!

Give yourself a big OORAH for breastfeeding, no matter if it’s 6 weeks, 6 months or 2 years! Breastfeeding in the military is not an easy task to accomplish, and any amount you can give your baby is to be celebrated. Remember, you are giving the breast for baby and country!

© thefeministbreeder.com

My husband Evan and I welcomed our first child, Liam, in November of 2009, one of the first parenting decisions we made was to use cloth diapers. Evan and I are known among our friends and family as champion penny-pinchers, so our decision was no surprise to anyone. To diaper a baby from birth to potty training, it costs approximately $1500 to use disposable diapers, compared with about $300 for prefold diapers and covers (and for more comparisons, click here). For families that can’t spend that much at once, or for people like me who shudder at the thought of spending that much money on anything, there are a number of strategies and resources to reduce the cost of cloth diapering even further. My goal is to help other families find the most cost-effective way to diaper their kids.

Strategies for Savings

Versatility: One of the best questions to ask yourself when trying to diaper on a budget is, “What diapers will give me the most use for my money?”  Depending on your individual needs, the best bet for you might be prefolds, which can be reused as rags once their diapering life is over, or one-size pocket diapers if you have multiple kids in diapers at the same time.

Sized vs. one-size: When buying cloth diapers on a budget, an obvious strategy is buying one-size diapers or covers that can be adjusted to fit infants through toddlers. With one-size diapers, there is no need for new diapers or covers as baby grows – just adjust the snaps!  One-size diapers are also a great option for families with multiple children in diapers, making it easier to find a diaper that fits. However, sized diapers tend to provide a better fit for very small newborns and larger toddlers who are still in diapers.

Is it a good price? When you think you find a great deal, particularly on-line, do a quick search and compare prices to other retailers. This is especially important when purchasing used diapers.  Is the price of the used diaper enough to justify the wear and tear?  I’m pretty stingy when it comes to purchasing used diapers, and I usually require a pretty sizable markdown.  Always remember to figure in shipping costs!  A great deal isn’t so great if shipping costs make it more expensive than purchasing from a local retailer.

How many diapers will we need? One easy way to blow a diaper budget is to buy more diapers than you actually need. We figure a diaper change about every two hours. If you have access to a washer and dryer to wash diapers every other day or so, you will need about twenty-four diapers and five to ten covers.

Affordable Options

Prefolds or flats and covers: Hands down, the most affordable option is using prefolds (rectangular flat cloth diaper with an absorbent center pad sewn in) or flats (large, square diapers made of a single layer of birdseye cotton that can be folded in a variety of ways to fit babies of different sizes) and waterproof covers. 

Seconds and discontinued items: Many manufacturers and retailers sell “seconds” (slightly imperfect but fully functional items) and discontinued products at deep discounts. Cloth Diaper Clearance is an example of a retailer that specializes in these products.

Cloth diaper registries: Creating baby registries on-line is a common way to let family and friends know what your need. Diaper retailers now offer this option too! We created a registry with diapers, covers, wipes, a wet bag, and a diaper pail that family and friends could access and order from online. When asked about your baby registry, share the link and let folks know that this gift would mean a lot!

Finding Used Diapers

Craigslist: CraigsList.org is local, allowing you to save on shipping, and giving you the opportunity to inspect the diapers before purchasing them.  The easiest way to find cloth diapers is to go to the “Baby and Kids” section of “For Sale” and do a search on “diapers.”  You’ll get a lot of other stuff, but this is the best way to catch all listings for cloth diapers.

DiaperSwappers.com: Since my son outgrew his first batch of covers, all of his covers have come from DiaperSwappers.com.  DiaperSwappers.com is a community forum organized by types of diapers and accessories that you must join (for free) in order to purchase diapers directly from the seller. In addition to being able to snag great deals, DiaperSwappers.com is a great place to find unique items at a great price.

Re-diaper.com: Unlike the person-to-person sales and trades, Re-diaper.com serves as a middleman, buying used diapers from families and reselling them.  Re-diaper only buys and sells name brands, like BumGenius and FuzziBunz. Some of the benefits of using Re-diaper.com include ease of use, consistent ratings of the condition of the diapers, and being able to combine multiple items in one shipping order. However, you can’t haggle or trade on Re-diaper.com, like you would be able to do on Craigslist or DiaperSwappers.com.

Local retailers: Check out any local retailers that carry cloth diaper supplies – they may offer used diapers at a deep discount.

Local consignment: Be sure to check out local baby and kids consignment sales, rummage sales, and thrift stores – they occasionally have cloth diapering supplies.

How “used” is it?: When considering used diapers for purchase, this is an important question to think about. How much life is left in the diaper? Do you have the skills to repair any rips or weaknesses? If you have to replace elastic, snaps, or Velcro, do the cost of those components outweigh the savings of purchasing a diaper? There are no hard and fast rules for this, and you’ll need to use your best judgment with each purchase.

Making Your Own

Resources abound online for making your own diapers, including many free patterns and instructions for creating diapers and covers from recycled clothing, like t-shirts and wool sweaters. The Mothering.com forums have a forum dedicated to resources and patterns for making your own diapers.

Cloth Diaper Assistance

If your budget doesn’t allow for the upfront cost of purchasing cloth diapers there are resources for free cloth diapers for families who demonstrate need. Re-diaper.com’s Cloth Diaper Loan Program and Giving Diapers Giving Hope provide free diapers, or diapers for the cost of shipping. Visit their websites for information on applying.

Anne-Marie Lindsay

One year ago, my partner and I decided to have a child. Because I have suffered from anxiety and depression for as long as I can remember, and have managed my conditions with medication for over five years, I knew I had to educate myself before we started trying to conceive. I spent many months trying to “taper” my medications, but it became clear that I was not going to function without them. I was going to therapy twice a week, but even so, I began having such frequent panic attacks that leaving the house became terrifying, and I was fired from a much-loved job for not showing up often enough. It was bad. I knew I could never function as a mother, feeling that way. My tedious journey down the rabbit hole and into the world of perinatal mental health has finally produced a decision that my partner and I feel confident will promote the best possible health for me and any fetus I eventually carry, as well as our family as a whole.

Reliable Sources of Information about Medication and Pregnancy

These are shockingly difficult to find. If you can find one, I highly recommend consulting with a perinatal mental health expert — a psychiatrist who specializes in treating women who want to become pregnant, are pregnant, or have had children. The specialist we consulted was expensive ($400 an hour was our discounted rate), and our insurance only reimbursed us later. Even if you think you cannot afford it, call a women’s mental health center and tell them about your situation. They are remarkable people who tackle perhaps the most difficult aspect of psychiatry; they want to help.

Why is it so difficult to treat a pregnant woman with, for example, a severe anxiety disorder? Because there is no clear, clean, scientific data about the safety of medication during pregnancy. By this, I mean that it is considered unethical to run a drug trial on pregnant women in order to find out what will harm a fetus. The only studies scientists can do collect what is called observational data. They ask women to tell them about any medications they took during pregnancy and about the health of their babies. One such study recently found a link between SSRI (a common class of antidepressants, including Prozac) use during pregnancy and an increased risk of pulmonary hypertension in infants. We cannot know from this study, however, whether the SSRI use caused the increased rates of this serious illness. Because we cannot measure depression with a blood test, we cannot know how many women in these studies were successfully treated. They may have both taken SSRIs and also have experienced major depression. As KJ Dell’Antonia explains in the New York Times parenting blog The Motherlode,

“… other research suggests that untreated depression during pregnancy has its own risks, including pre-term birth and low birth weight. Given that, how should a pregnant woman and her doctor weigh the competing risks? The answer to that may depend on whom you’re talking to.”

Dell’Antonia talks to a Dr. Ariela Frieder, psychiatrist at the Montefiore Medical Center, about using research to make a decision. She says that,

“the problem [with research] is always that you cannot separate the risks of the severe depression itself with the risks of the medication. And the risks here are still small. Women who have lived with severe depression know how hard it is to live with.”

Do you trust the animal studies that show few problems when pregnant rabbits and rats are given 150 times the dose of whatever you’re taking? My OB does. Do you sift through the observational data and mull the one or two cases of clef-lip and palate that point to a potential risk for your future child? My specialist psychiatrist does. The scariest part of this journey may be that the answer to any and all of these questions is: it’s up to you. I have so often wished for a definitive answer. All I ever hear, even from the expert is,

“So, now that you know [insert information here] what do you think you want to do?”

Ms. Dell’Antonia discovers precisely what I learned after talking to experts and reading material similar to the experts I talked to and the material I read. She concludes her piece with this statement from Dr. Kimberly Yonkers, perhaps the most famous researcher in this field:

“There’s not a one-size-fits-all answer, … that advice still stands. No generalizations apply. Treatment decisions must be made on a case-by-case basis. A case-by-case basis that’s a new struggle for every patient, every time.”

What You Can Do

You may end up disagreeing with your OB or disobeying a direct order from your general practitioner. You may have to find a new psychiatrist. But you’re the one who has to live with your decision, so get informed and do the best you can. Then, assemble a team of professionals and loved ones who support that decision. No matter what.

My psychiatrist said at the end of our first meeting,

“You’ll be at a higher risk for some problems, but that’s not the same as a high risk. It really remains quite low, and they’re risks that already exist for the general population. The problem is, if you are the family with the child who has developed a birth defect or other problem, those statistics disappear. It won’t matter that the risk was small. You should ask yourselves now, ‘If something goes wrong, can we handle knowing that our decision may have contributed to that?’”

My husband and I feel strongly that we will be able to remember that there is always a risk that something will go wrong. We will remind each other that something could happen no matter how perfect a pregnancy I have. We will remind each other that, for us, un-medicated depression and anxiety pose a greater risk to the health and safety of our family than any risk posed by my medication.

Resources for Patients

The Organization of Teratology Information Specialists — This is a wonderful organization devoted to helping women make educated decisions about what we put in our bodies during pregnancy. There is a toll-free number that you can call to talk to an expert, for free, about your medication and any risks it may post to a developing fetus. That number is: (866) 626-OTIS, or (866) 626-6847. Note: If you are pregnant and taking medication, please participate in one of their studies as well to do your part in helping gather more information.

Motherisk – Information on specific medications.

The Food & Drug Administration For Women – section for information specific to women.

Emory University’s Women’s Mental Health Program

Columbia University, The Women’s Program

UCLA’s Mood Disorder Research Program

Massachusetts General Hospital’s Women’s Mental Health Program

Pregnant on Prozac — by Dr. Shoshana Felman. I found this book extremely helpful, which was a relief because it is the only book that thoroughly covers how to plan for pregnancy when you struggle with mental illness. My mother found the copy I sent her extremely helpful, as well, in trying to understand my journey. I even emailed Dr. Felman and received a response to my question within two days.

Depression in Pregnancy – article from Dr. Hale’s Infant Risk Center at Texas Tech University Health Sciences Center.

For Health Care Professionals

ReproTox is a database available by subscription to health care providers. Each article contains a summary of all available scientific data on any given medication or potential teratogen (chemical potentially toxic to fetus). My psychiatrist and I have found its articles extremely helpful!

MommyMeds smartphone app from the Infant Risk Center