Breast Milk Bust in Haiti?

MSNBC is reporting that there is no need for breast milk in Haiti.  Not only that, but it’s not wanted:

“The international Emergency Nutrition Network has asked one group, the Human Milk Banking Association of North America, to retract a press release this week that issued an “urgent call” for breast milk for orphaned and premature infants in Haiti, saying the donations contradict best practices for babies in emergencies.” (emphasis added)

The real kicker is that this is a totally inaccurate statement. Breast milk, even when it comes from another mother, is preferable, according to the World Health Organization (WHO), when it comes to infant nutrition.  Formula requires clean water, something sorely lacking in a disaster.  You can’t even turn on the radio without hearing how it is hard for people to get drinking water.  The ramifications of using formula in this instance is of great public health concern.

Emergencies and breastfeeding was the recent subject of the World Breastfeeding Week Campaign last August.  It prompted the WHO to put out documents discussing the benefits of breast milk in such crises as they are facing in Haiti.

Restriction of Food and Drink in Labor from a Medical Anthropologist’s Perspective

The recent Cochrane review, Restricting oral fluid and food intake during labour, analyzed five studies and concluded that women should be free to eat and drink in labor at will.

Since the evidence shows no benefits or harms, there is no justification for the restriction of fluids and food in labour for women at low risk of complications. No studies looked specifically at women at increased risk of complications, hence there is no evidence to support restrictions in this group of women.

The rationale behind denying laboring women food is that the danger of aspiration and the potentially lethal complication known as Mendelsohn’s syndrome while under general anesthesia is greatly reduced.

Medical anthropologist Robbie Davis-Floyd wrote extensively about the cultural myths about non per os and childbirth in the 1992 book, Birth as an American Rite of Passage. Mendelsohn’s original 1946 article reported several cases of aspiration and subsequent pneumonia, but no deaths. Davis-Floyd cites Baggish’s 1974 study which showed that at most 2 percent of maternal deaths were caused by aspiration under general anesthesia and Scott’s 1978 work that placed the risk of death at 1 in 200,000 women.

So what purpose would denying food and drink to all laboring women serve more than six decades after Mendelsohn’s work and with the great improvements made to regional anesthesia? Davis-Floyd wrote:

According to Feeley-Harnik, “persons undergoing rites of passage are usually prohibited from eating those highly valued foods that would identify them as full members of society” (1981:4). In rites of pregnancy and birth across cultures, food tabus serve the purpose of marking and intensifying the liminal status of the pregnant woman. The pseudo-foods (ice chips and lollipops have no nutritional value) allowed in the hospital are often fed to the laboring woman by her partner as if she herself were the baby, a symbolic process that can heighten her own sense of weakness and dependence.

In a recent article in Birth, Broach and Newton (1988) address the question of why laboring women are still prohibited from eating and drinking in labor in spite of mounting evidence that such prohibitions are medically contraindicated. Pointing out that this custom started in the 1940’s when general anesthesia was widely used for childbirth and the danger from aspiration was therefore higher, they posit that its continuance is the result of “culture lag”—that is, of “culturally patterned behavior that continues to be practiced long after the reasons for doing so have disappeared” (1988:84).

Davis-Floyd views denying food in labor as indicative of the confirmation of a woman’s initiate status as a dependent of the institution.

On the contrary, I would suggest that this custom forms an integral part of the technocratic tapestry of birth in the United States, continuing as routine procedure not because of culture lag but because it serves so well to legitimate and further necessitate the technocratic interventions we investigate here as transformative rituals. To deny a laboring woman access to her own choice of food and drink in the hospital is to confirm her initiatory status and consequent loss of autonomy, to increase the chances that she will require interventions, and to tell her that only the institution can provide the nourishment she needs—a message that is most forcefully conveyed through the “IV.”

Restriction of food and liquids in labor was the subject of many discussions last year following the American Congress of Obstetricians and Gynecologists’ press release that women should be allowed “modest amounts” of water and clear liquids in labor, with physicians defending IV use and telling women to calm down their rhetoric and fight for things that matter.

Distortion of Natural Birth

I was so happy to follow up on Ashley’s Midwife Vs. Medwife post because I really feel as though this will be a little piggy back on the subject. Last night I tuned into ABC’s hit series Private Practice, and during the episode I seriously started to wonder why I continue to watch the show that makes my blood boil.

But what really ate at me was they way they portrayed a mother who was working towards a natural birth. Which made me think about the way that the public views the natural birth community, as well as women who simply want a natural birth for themselves.

They treated this woman in the episode like the butt of all the jokes in the episode until the emotionally charged climax of her birth viewed by perfect strangers that would have been a major HIPAA Violation.  The episode shows this woman with a multi-page birth plan, grinding on the door frame of the birth suite trying to squat to help her labor, joking about how she had been in labor for 3+ days, all of which as a mother who has labored naturally, I found offensive.  The character was essentially the comedy of the episode.

It made me think about the perception the American public is going to get from this message, as well as their views on women who do choose to give birth naturally. Do they think we are all just a bunch of hippies that bite on sticks until we drop a baby out in the middle of a meadow while singing show tunes?  Come on!

The problem is shows like this.
The problem is the myths about who has natural births.
The problem is typical stereotypes.

Where do we start?
How do we start to re-educate and properly educate the public so they don’t think all moms who want to have a natural birth aren’t ding bats like this character was?

I really hope that shows like this, and Grey’s Anatomy, and other medical drama’s take the time to fix the American stereotype of birthing naturally. Women from all walks of life do it!

Just on a side note, the character who was attending this woman’s birth “Dell” a “student midwife” came off as a Student OB/GYN if anything. He had no type of midwife qualities in him what so ever and I think that is another huge slap to the natural birth community. He at best was a “medwife” if that!

Midwife vs. Medwife

I attended a birth this weekend in the role of doula. This was for a client in a city where I am not familiar with the practitioners, so I directed the family towards several midwives and asked them to make sure the midwives aligned with their thinking. The one they picked seemed great and for the most part, did an excellent job at the birth. Throughout their pregnancy they had a fairly normal quality of care – no excessive ultrasounds offered, no scared “you must do this prenatal test” type stuff.

There was one thing that really rubbed me wrong, though. About an hour and a half after the birth the midwife came in to talk about discharge plans. The family had a little boy so she wanted to talk circumcision. After noting that “it’s not medically necessary,” the midwife spent the rest of her chat talking the family into circ’ing their little boy. I had spent MUCH longer counseling them on the pro’s and con’s of circumcision and they were leaning towards leaving their baby intact. With one very convincing five-minute talk about dirty penises and how painless the procedure is, she lost her credibility with me. But more than that, I lost credibility with the family.

How sad that a midwife has been in the hospital system long enough to be stepping towards medwife.

VBAC Conference by the NIH

March 8-10, 2010 will have a consensus conference on vaginal birth after cesarean (VBAC).  It will address questions, including:

• What are the rates and patterns of utilization of trial of labor after prior cesarean, vaginal birth after cesarean, and repeat cesarean delivery in the United States?
• Among women who attempt a trial of labor after prior cesarean, what is the vaginal delivery rate and the factors that influence it?
• What are the short- and long-term benefits and harms to the mother of attempting trial of labor after prior cesarean versus elective repeat cesarean delivery, and what factors influence benefits and harms?
• What are the short- and long-term benefits and harms to the baby of maternal attempt at trial of labor after prior cesarean versus elective repeat cesarean delivery, and what factors influence benefits and harms?
• What are the nonmedical factors that influence the patterns and utilization of trial of labor after prior cesarean?
• What are the critical gaps in the evidence for decision-making, and what are the priority investigations needed to address these gaps?

Going in person isn’t really an option for most of us, but you can also sign up for the webcast online and/or to have the transcripts sent to you when it’s up. I’m sure that there will be a lot of activists there, I can’t wait to hear the guest list.

Reducing Anxiety in Early Pregnancy

With home pregnancy tests, many women now find out they are pregnant much sooner than ever before. This can be good because the mother can start preparing herself for a new baby; she can start eating healthy, taking her prenatal vitamin, making sure she is getting enough folic acid, and she can quit smoking or drinking or taking any medications that would not be acceptable in pregnancy. This can also have it’s downside however, as now women get to obsess and worry and be anxious about their pregnancy during the very early weeks when the likelihood of miscarriage is much higher. How can women reduce the stress and anxiety of early pregnancy?

First, take some time to plan when you will tell people and what you will tell them, and make sure that you and your partner are on the same page. You will need to think about when you will share the news of the pregnancy. Some women like to share the news right away, others like to wait until they are in the second trimester, or have heard the heartbeat, or have had an ultrasound. This is an individual choice and one you might want to give some thought to before deciding. You also may want to think about if you will tell people the exact due date of your pregnancy, and the exact week you are on. Now is the time to think about how you may feel in later pregnancy and if you really want the pressure of many excited friends and family members weighing on your mind – and on your phone, and your email, and your front door – when you are inevitably a few days (or more) past your due date. Some women choose to give a due month or a due time period instead of a due date. If you choose to go this route, you will also need to give out your month of pregnancy and not your week, otherwise people can easily calculate the week of your due date. You might also want to consider whether you will be sharing the names you are thinking of for your baby, and if you choose to find out, whether the baby is a boy or a girl. What you choose to share is up to you and there is no right or wrong choice. It is worth giving a little thought to though before you announce your pregnancy.

The next thing you may want to consider is when you will go to your first prenatal visit and what you will have done there. The latest trend in prenatal care seems to be getting women in as early as possible and giving them one or more ultrasounds in very early pregnancy to determine their dates. It is important to know your dates so that if you go into labor early you will know if the baby is premature and needs special treatment, or if you go past 42 weeks you may need to have special monitoring to assess whether the baby is still doing well enough to continue with your pregnancy. However, there are more ways to date a pregnancy than an ultrasound. If you know the first day of your last period, or if you know the date you ovulated or conceived, then these dates will be sufficient in determining gestational age. As your pregnancy progresses your care provider will also measure fundal height and this will confirm your dates. There is also generally a routine ultrasound offered around 20 weeks to check for birth defects. So, when you combine the first day of your last period or the date of conception along with your fundal height measurements along with the measurements of the 20 week scan if you choose to get this, your care provider should then have a pretty good idea of what the gestational age is. Therefore, you may choose to forgo any early dating ultrasound unless you have some medical indication for one.

It can be exciting to see your baby on ultrasound, but you may want to consider a few things before having very early ultrasounds done. Though I feel ultrasounds are relatively safe, some people worry about the number or duration of them. Having many ultrasounds in early pregnancy when the fetus is still developing isn’t proven to cause any harm, but some women still feel that they may not be entirely safe and choose to avoid them. Some women choose to get just one or two ultrasounds throughout their pregnancy. Other women only get an ultrasound if there is a medical indication to do so. The reason that I might recommend not getting early ultrasounds though is that it often can contribute to anxiety instead of alleviating it. Many women who have early ultrasounds find themselves being highly worried for weeks over findings that were out of the range of average, such as slower growth than was expected or not being able to find a fetus or heartbeat. In most of these situations, any issues work themselves out and later ultrasounds show all is well. Why worry yourself over a very early ultrasound when the discrepancy of how the fetus grows may vary widely at that stage? Of course, if you have any indication for an ultrasound such as cramping, bleeding, or a medical history that might require one, then this is a different situation.

Most women in early pregnancy have one major concern; miscarriage. Pregnancy loss can be a very sad event, and it is understandable why women fear this happening when the chances are much higher in the first trimester. There is no way to prevent miscarriage in early pregnancy, and this lack of control or ability to stop it can really produce a lot of anxiety in some women. It is important for women to aware though that no matter how many times they visit their providers in early pregnancy, or how many ultrasounds you get, there is still no way to prevent miscarriage. Women will need to decide for themselves what may reduce their anxiety or add to it in early pregnancy. Some women will want a lot of reassurance by a care provider, others will not even visit a care provider until the second trimester. Whatever you decide, you may want to factor in anxiety levels when you make your decisions about how you will handle early pregnancy.

Folic Acid

January is a time when we start trying to turn a new leaf.  For women who want to get pregnant, are pregnant or even if you’re just of reproductive age, it’s recommended that you get 400mcg of folic acid everyday. According to the CDC:

There are 3,000 pregnancies affected by spina bifida or anencephaly, which are neural tube defects caused by the incomplete development of the brain and spinal cord. If women take 400 mcg of folic acid daily, before and during pregnancy, they can help reduce their risk of having a pregnancy affected by a neural tube by up to 70%.

Most organizations recommend that you simply take a multi-vitamin or prenatal vitamin.  You can also take a simple folic acid vitamin with nothing else.  In fact, many of our foods are now fortified with folic acid, particularly breads and cereals.  But if you are not interested in supplementing with vitamins, here are some handy foods to help you get your 400 mcg of folic acid for a healthy pregnancy (as suggested by Women.gov):

• Beans and lentils
• Peas (black-eyed peas, chickpeas, green peas)
• Juices (orange, tomato, grapefruit, pineapple)
• Fruits (oranges, cantaloupe, honeydew melon, avocado, papaya, raspberries)
• Soymilk
• Vegetables (green leafy vegetables such as spinach, lettuce, turnip greens, mustard greens, collard greens, and Chinese cabbage; broccoli; Brussels sprouts; asparagus; artichokes; okra; corn; cauliflower; potato; beets; green onions; sweet red peppers)
• Nuts
• Sunflower seeds
• Peanuts and peanut butter
• Liver
• Giblets

How do you prefer your folic acid?

Healthy Eating During Your Pregnancy

I can certainly say, when I got pregnant with my oldest, I thought pregnancy was a free ticket to pig out and live on junk food, but I quickly learned through my reading, that is not the case at all!! Another misconception of pregnancy nutrition is that Mom should be eating for two, nope! Not at all. But one of the most swept under the rug, neglected, and black listed parts of pregnancy is nutrition.

We do not see Obstetric models of care including nutrition counciling, or really taking the time to say skip on this, or add that. You get a sheet of things not to eat and most are sent on their way. Which is one of the reasons I am intrigued to write about this.

According to The March of Dimes, women should be including the following into their diet on a daily basis :

• 6 Ounces of Grains Per Day
  • Slice of wheat bread
  • Wheat Tortilla (6 inches)
  • 1/2 cup of cooked rice or pasta
  • 1 cup of cereal
  • 1 large pancake (about 4 1/2 inches)
• 1 1/2 to 2 cups of fruits per day
  • 1/2 cup of 100% fruit juice (be careful of the amount of sugar in fruit juices)
  • 16 Grapes
  • 1/4 cup of dried fruit
  • 1/2 of fresh, canned or frozen fruit (My best pick would be fresh fruit since you often do not know what canned products are being preserved with)
• 2 1/2 Cups of Vegetables per day
  • 1 Cup raw or cooked veggies
  • 1 Baked Potato (skip or go light on the butter, sour cream, or bacon)
  • 2 Cups of raw leafy greens
  • 1 Cup veggie juice
• 400 Micrograms of Folic Acid
  • Most likely found in your pre natal vitamin
• 5-5 1/2 ounces of Protein per day
  • 1 Tablespoon of peanut butter
  • 1 ounce of lean meat
  • 1 egg
  • 1/2 cup of nuts
  • 1/4 cup of cooked dried beans
• 3 cups of Milk products per day
  • 1 Cup Milk
  • 2 ounces of processed cheese
  • 1 Cup yogurt
  • 1 1/2 ounces natural cheese

It really doesn’t sound like a lot of work does it?

We know the typical things to avoid… soda, sugar, caffeine, raw fish, unpasteurized foods, and make sure to keep your water intake up. This was a big one for me in both of my pregnancies. 6 to 8 glasses of water a day!  That is what I hated most of all and often got dehydrated. Which is something you want to avoid!

Remember, everything you eat, so is your baby!
You want to give your baby the best start at life, so just be picky and careful for your pregnancy.
It will pay off in the end!

Epidurals vs. Unmedicated

I was talking to someone today who was trying to decide if an epidural was right for her in her upcoming labor.  She was well read and still had some concerns on the topic.  But in part of our correspondence she said something that made me realize that she felt it was the epidural or do nothing.  We had a long talk about how women who choose to go without an epidural don’t just sit there writhing in pain until the baby suddenly falls out – they prepare and actively participate.

I explained that if she had any intention of going without an epidural, even a slim chance, that she should find a childbirth class that was designed for women who did NOT want an epidural.  Then she would be prepared, but that if she changed her mind and wanted an epidural she could always have one.  I told her that there were many things that women do to cope with pain in labor including:

• positioning
• movement
• massage
• relaxation
• encouragement
• water
• heat
• cold
• TENS

What would you have told her?