The Inheritance

I've decided to write the speech about my grandmother. She is 90 years old and since she won't be around much longer, I've been reflecting on her life and legacy. My inheritance won't be anything temporal or as temporary or as tacky as money. My inheritance is the ability to tell a story. My grandmother is a storyteller, and a midwife, and a homebirther. I follow in her footsteps. There was so much yet I wanted to learn from her, herbal remedies, how to "put up" jellies, how to pick greens- but I'm afraid I've lost my chance. I have a hunger for her stories. I want to gobble them down whole. I collected them one at a time, like plucking daisies from the ground. I wanted to discover her through her stories. I intended to write them down. I still want to tell her stories. I'll start with this speech.

I had lunch with Valtra yesterday (the African-American lactation consultant). She asked me to collaborate with her on a book about lactation in the African-American community. I'm thrilled and honored. I haven't done a collaborative project in years. I think we'll make a fabulous book together and the title is fabulous. (Unfortunately, I can't tell yet). She's working on the outline and I'm fishing for a publisher. Yet another adventure begins. We're hoping to get it written in about six months.

Amazingly I've been meeting my writing deadlines this week, even though I've been teaching CPR classes out the wazzou (I've always wondered how to spell that). I've turned in one article on workplace safety and completed two more proposals. I have now have two birth articles left to write by Saturday. This week has been a killer- up at the crack of dawn to teach 8 hour classes, then up till midnight every night writing. So this is my life, my legacy, and my inheritance.

Writing Frenzy

This week marks several deadlines for articles and proposals. On top of those, I'm competing in a Toastmaster speech competition and need a really great idea for a speech. I compete to keep my speaking skills sharp and I learn so much from the other contestants. It is an international speech contest that starts at the club level, moves up to area, then division, then region, then national, then international. I've made it as far as division, which is also my goal this year. It is a 5-7 minute speech on any topic. My goal is to make my audience laugh, and cry in that 5 -7 minutes. It really takes two weeks of practice and the club contest is in a week and I haven't been able to narrow my topic yet. What I need is simply a good story, one that packs a wallop. As soon as I get it written, I need to practice, practice, practice. The speech that got me to division last time was one about my grandfather. It was an unforgettable speech. Here's hoping my muse will show up soon.

Pissed Poet

Okay, now I'm pissed. I've been eagerly awaiting the doula retreat going on this weekend in my city for our local doula group. This group has grown and evolved so much over the years of existance and I'm really proud of all that it has accomplished. However, a few days ago they sent out an emailing stating that only non-mobile babies are welcome. Josiah is definately not non-mobile. So now I have to decide whether or not to attend, because I was really looking forward to going and having him with me. I don't want more time away from my baby. I've tried so hard to be a good role model. When Jo was an infant I took him everywhere- even uptight business ladies meetings- and I bore the all those "I can't believe she brought a baby to this meeting" looks. I bore it because I wanted to live by my conviction that moms and babies should be together (that's what all the birth people keep saying right?) Now we're being ousted by the very people who should understand and welcome moms and babies together. I'm really miffed. I already had to bow out of women's art night because they came up with the same stupid ass rule. No more relaxing evenings with my charcoals in one hand and a yummy hor'dourve in the other. What is with this? Even the birth community thinks babies need to be relegated to the care of 'caregivers' I thought I was the ultimate CAREGIVER for my son. But everywhere we try to go- I'm told he's not welcome. He still spends time in my office with me (when not with his dad) I've even taught classes with him, I've taken him to out of town speaking gigs with me. I'm not going to that fucking retreat without him- I have to stand my ground on this one. It's not that I'm clingy and needy. I spend nearly everyday out of his presence when I'm at work. It just that outside of work time I really want to be with him. So what's wrong with that?

Warrior Poet

A beautiful blanket of snow is slowly covering the city. I have no less than 4 articles and 3 proposals due in the next two weeks. 1) an article on birth choice for KC Wellness magazine 2) an article on workplace safety for KC Small Business 3) an op ed piece for the Kansas City Star on birth options 4) an article for the Maternal Child Health Coalition newsletter on our first African-American lactation consultant (take a bow Ms. Valtra Brown) and 1) a proposal for a Conscious Woman presentation on the relationship between lactation and infant mortality. Check out the conscious woman website. They feature national high quality speakers that you can hear without leaving your home. I'm very excited to be working with them. Meanwhile the local CNM (certified nurse midwife) group denied my proposal on homebirth for their upcoming conference (no shocker there, they prefer to go in the other direction toward medicalized subjects-maybe I just wanted to annoy them) However, they will be showing Ricki Lake's new movie the night before the conference- so I'll attend that, see and be seen, and chew that fat with some of the new midwives graduating from our local CNM program as well as some of the more established midwives who are cordial to me. I also have two other proposals due by March 1st, 2) to the ADA (American Dietetic Association) and 3) to the professional nursing education conference on the topic of blogging as an education tool for student nurses. I must really be turning into a writer/speaker. Elsewhere on my agenda: I'm rejoining a second Toastmaster group, the Earlybird Toastmasters who meet at the crack of dawn on Monday mornings, and I'm joining a nonfiction writer's group who meet on Tuesday mornings. I met with the earlybirds many years ago and got my speaking chops there. I can't wait to join them again as the group has grown and features many professional speakers who I hope to have mentor me. The writer's group is new to me and I'm just hoping to get some encouragement to grow some gonads to get this book published. I'm not sure what will happen once the book is out there, and I just want to keep it close to me still- crazy huh- like being pregnant and now wanting to let go of the prenancy and give birth. I actually get this way with all my pregnancies, I always hope I'll be pregnant just a little longer... Anyway- plenty of writing to keep me busy and off the streets and running around saving birthcenters and such. I got all pumped up watching GI Jane last night and stangely enough, I do feel like a warrior- a warrior poet. Will I draw blood or just rhetoric?

Will Advocate for Food

Happy post V-Day everyone. I've chucked my letter to the editor in favor of an editorial on the loss of birth options instead. I'm pitching an op ed piece on the birth center closing and how that impacts birth choices for local women. I'm also putting together a comprehensive midwife listing to pass out to women as they contact me. My first interview for doula work went well. They were an older, well-read, and enthusiastic couple who will have a great birth no matter who they go with, because they've done their homework and are willing to do what it takes to get the birth they want. Couples like that will do fine no matter who attends them. The wife was Russian born and thought our ideas of birth were wacko (I couldn't agree more). The husband had just read the book "Pushed" (I haven't even read it yet- don't want it to influence my own writing just now) and had the keen insight to asked me why the women's movement hasn't taken this issue on? (I could have kissed him!- he was so insightful). It was a very good visit- but truthfully, couples like this don't really need me. The couples that do, usually can't afford me or think I'm wacko. What's an aspiring birth activist to do?

A Crushing Blow

Sage Femme, the only free standing birth center in my metropolitan area, has closed this week. This is such sad, sad news for me. It was only in October that I discovered this hidden jewel. This is such a disservice to the women of my community. This comes on tails of my recieving about 5 calls so far this year from women looking for midwives (mistakenly thinking that I am one-possibly because of this blog or my website- though I certainly don't claim to be a midwife on either.) Of those five calls, two were women looking for a "woman of color" to attend them in birth. I had the depressing charge of informing them that there are no midwives or doulas of color in our area (to my knowledge- and I do try to keep up with who is doing what where). With the closing of Sage Femme (due to financial concerns) and the calls that seem to continuously come, I had to rethink things. My decision to resume doula work is my pitiful attempt to give women some choice. But what they really need is a birth center. In a city where we already don't have enough midwives, the loss of our lovely little birth center is grave indeed.

Quick Update

I've just updated my website. (Just click on the link in the upper corner) All that's missing, of course, is a plug for my book. I've been procrastinating looking for a publisher- not sure why. But I have been very busy working on getting speaking gigs. One notable change to my life- I've recently decided to do doula work again- homebirths only. My year and a half birth fast is about to come to an end. I interview with my first potential clients tomorrow night. I do want to get back into birth- but only on my own terms- so this is what I've come up with. I'm also writing a lot and have two to three more articles in the works. Life is good, when you allow yourself to be who you are.

You Go Girl

The need for certified midwives
By DEBORAH SMITHEY
Special to The Star

Smithey
Man-made and natural disasters can occur at any time, as evidenced by Sept. 11 and Hurricane Katrina. Missouri should be prepared for weather, epidemic and terror-related disasters.
What if hospitals are overwhelmed by casualties, disease or infection? Many first responders are not prepared to deal with the special needs of pregnant women and infants. Where will women give birth during the next disaster?
FEMA strongly encourages each state to prepare an out-of-hospital scenario for such conditions. During Katrina, babies born unassisted in the Superdome and on the third floor of Salvation Army Corp Community Centers opened our eyes to the need for a better plan.
The Trust for America’s Health reports that Katrina overwhelmed the institutional facilities we often depend on for health care. In addition, doctors and nurses were forced to perform without the technology on which they heavily rely.
Women and infants are disproportionately and adversely affected by disasters. Missouri women generally expect to give birth in hospitals; 99 percent of births occur there. But during an emergency, hospitals may not be immediately accessible. In the case of pandemic flu, hospitals may not be safe.
Certified Professional Midwives are trained to work in homes and other out-of-hospital settings. Many midwives serve the Amish and Mennonite communities, and are accustomed to working without electricity or other modern conveniences.
Yet their statistics are as good as or better than those of doctors working in hospitals with the same-risk population.
In February 2006, the National Working Group for Women and Infant Needs in Emergencies was formed to ensure that the health care needs of pregnant women, new mothers, and infants are adequately met during and after disaster situations.
Certified Professional Midwives should be part of Missouri’s disaster preparedness plan. There are approximately 1,400 CPMs in the United States. Experienced, community-based certified professional midwives are scattered across the state of Missouri. But because of our current laws, they are not eligible for licenses, but rather are criminalized because of an archaic law.
They are licensed in the majority of other states, and many already include them in their emergency disaster plans. I urge all Missouri policy makers to ensure pregnant and birthing women and their newborns are safely cared for when the next disaster strikes.

Deborah Smithey is president of the Missouri Midwives Association. She lives in Stockton MO.

(This article appeared in yesterday's Kansas City Star and was submitted by my buddy Debbie Smithey. We actually discussed this topic of disaster preparedness for pregs and infants at the breastfeeding conference. What better way to ensure a food source for infants in a disaster, than mother's milk? )

More Street Cred

I just recieved the latest edition of "Birth Project" a publication out of Michigan, with my article in it! My article is called, "Consumer First, Patient Second" and is about birthcare advocacy. Since the article can't be accessed from their website, I'm reprinting it here for now, but do check out their website. It's a very nice publication with very thought provoking articles.

Consumer First, Patient Second
Finding the right care provider for your pregnancy and birth
By Sherry L. Payne RN BSN

I had a long conversation with my friend, Pam, the other night. She is in her final month of pregnancy, with her first baby, who is in breech position. Her physician is suggesting a cesarean. If attempts to turn the baby are unsuccessful, she will consider a homebirth in order to avoid the surgery. I urged her to let her doctor know her thinking. Woman are often unwilling to have a frank discussion with their caregivers about their wants and desires. I reminded my friend that she selected this provider (or group of providers) and that she is paying them to be competent partners in this process. During a crisis is not the time to start doing things behind their backs but tell them exactly what you plan to do and why and listen to their feedback (but take it with a grain of salt- they don't have the final say- you do). I think this approach is important because it preserves the integrity of the relationship. Physicians and midwives are not mind readers. They need to know and understand what type of care clients desire, or what they don't want and why. Otherwise they'll just continue to think women are happy with the care they are getting.
Think about this question: What is the role of your pregnancy and birth care provider? Is it to manage your pregnancy, labor and birth for you? Is it to take care of you during pregnancy and birth? Is it to deliver your baby for you? Is it to ensure that you have a healthy baby? May I make the audacious statement that all these things are in your own power to do. When I hear statements like, “my doctor won’t LET me do that” or “my doctor says I can TRY that and see how it goes” it tells me how out of balance the care provider is with the care receiver. It is not the proper role of any physician or midwife to tell you how to have your baby (or where, or when). Receivers of health care must adopt a more pro-active consumer role in their own healthcare delivery. Nowhere is this more obvious in healthcare than in obstetrics where as a labor and delivery nurse, I have seen care providers of all types routinely bully, control, and dominate their patients. Your care provider should be a competent guide through the process. He or she is not your daddy. They can’t tell you what you will or won’t do throughout your pregnancy, labor, and birth. They can suggest what they think is best, but the final course of action should be up to you.
This does not mean that a caregiver does not have the right to define their parameters for care. If a midwife only wants to take vegetarian mothers as clients, that’s her prerogative. If you happen not to be a vegetarian and really want this midwife to care for you, then you have a choice to make. The same is true for physicians. If their parameters of care include routine epidurals, episiotomies for all their patients, routines IVs, etc. then that is their place of comfort in giving care. If you don’t want any of those things, you’d be much better off finding a different physician than trying to convert this one to your way of thinking, because you’re asking them to take themselves out of their comfort zone to care for you. It’s important that as consumers of healthcare, women understand the pressures that come to bear upon care providers.
Consumers greatly underestimate the role litigious threat has had on healthcare. One of the reasons obstetrics has become so defensive in practice is because the threat of a lawsuit hangs heavily over their heads. Now some medical lawsuits are well deserved, others frivolous, yet taken together their impact has changed healthcare, and not for the better. Obstetricians are more likely than physicians in any other specialty to be sued for malpractice. This alone has changed the way they approach birth- the way they approach you. Midwives don’t get sued nearly as much, but they are still confronted with the ever growing threat. If you think your relationship with your caregiver is built on trust- well, this may be an idea whose time has passed. Trusting patients is a luxury most physicians find they can no longer afford. Many malpractice attorneys and nurse-attorneys make their livings teaching healthcare professionals how not to get sued. It boils down to defensive practice. This translates into taking all precautions, ordering all the tests, acting the moment something appears amiss. If all else fails, there is always the ultimate medical intervention for a birth at risk- perform a cesarean section. This, among other reasons, is why the cesarean rate has risen to 30% and above. Birth has not suddenly become more dangerous, the practice of delivery babies has.
This is why it is so important to know your own philosophy of birth AND your care provider’s philosophy of birth. It will be far more productive to find a caregiver that agrees with your philosophy of care than to try to convert someone because you like them. Don’t just hope you’ll be the exception or that things will go well- you won’t be and they won’t. Liking your caregiver is not sufficient criteria for choosing him or her.
As consumers you’ve got to do your homework. Get referrals from friends and family, asking them WHY they think this person is so great. Listen to their birth stories- do you want yours to mirror theirs? Google them and find out about them, go to those rating sites and see if someone has left comments about your particular caregiver. Ask your caregiver directly for client testimonials or references. Ask directly for their cesarean and induction rates. (If they won’t give them to you, that’s a red flag). Your ultimate goal should be to find the caregiver, be it physician or midwife, OB or family practice, that is right for you.

Sidebar
Questions to ask your potential care provider
What is your philosophy of birth? (They may have it in written form-even better.)
What are your practice protocols? (What do they do routinely for every patient?)
How many births do you do a month? (Will they be available for you?)
Do you attend your own patients or do I get whoever is on call for your practice group? (This is more the rule now than the exception.)
Will I have an opportunity to meet all the physicians and or midwives in your practice?
Will they abide by any agreements made by you and I?
Which settings do you practice in? (Hospitals, home, birthcenters, etc)
How do you feel about ____________________ (epidurals, episiotomies, routine IVs, or conversely birth balls, squatting, or loud verbalizations – you’d be amazed by how many providers think the birthing woman should be quiet)
What are your parameters for inductions? (What medical or non-medical criteria do they use to decide?)
How available are you (or your staff) for questions between and during appointments?

US Breastfeeding Committee Conference II

More about the sessions I attended last week at the conference:

Presidential candidate, Mitt Romney took an ass-kicking at this conference. There were two (2) sessions that blasted him on Ban the Bags campaigns! Apparently he blocked BF coalition members in Massachusetts from making legislative change via perinatal regulations. It seems ol' Mitt was courting Big Pharm at the time to bring jobs to his state. This of course, only made them take the campaign national. Our committee is now considering what role we will take in Ban the Bags in our city. (For those who aren't familiar with Ban the Bags, its an effort to stop hospitals from their long held practice of giving free diaper bags to the women who birth there with lots of formula in them- even to breastfeeding moms. Research shows this practice can undermine breastfeeding.)

I attending a couple of sessions that gave me great ideas for two of our committee projects:

One session called the Breastfeeding Cafe, gave me ideas to enhance our annual World Breastfeeding Week event. We are planning another breastfeeding fair and I'm excited to borrow some of the ideas I learned from the cafe, such as adding infant CPR and infant massage to attract folks to our event. Thanks, ladies from Utah.

Another session focused on awards for workplaces that support lactation. I got lots of food for thought on our own annual lactation support awards. We give one to an organization, and one to a community member. Good ideas on setting criteria, and what the actual award should be and in what setting it should be awarded. Also some good ideas on getting press.

The best part of the conference was the sharing room. This is where each coalition could set up a booth to showcase what thier state was doing. So many great ideas. I'm really excited to share all this great stuff with my committee when next we meet. I'm so glad I was able to attend.

Next year, I'll put in a proposal to present! So much is happening in KS and MO on the breastfeeding front and our little committee has worked so hard.

Speaking of presenting, I made some great contacts for CIMS (Coalition for the Improvement of Maternity Services). I'm hoping to speak at their 2009 conference. I got in a couple of proposals for MANA (Midwives Alliance of North America) and ADA (American Dietitic Association), so I'm keeping my fingers crossed for those. I also put out a proposal to my nursing school, to speak at their annual Scholarship Day, about healthcare and blogging. We'll see how that one goes. I'd love to share about the role blogging has in healthcare and how blogging builds community and shapes healthcare culture.

If anyone knows of other upcoming conferences in 2008 and 2009 that focus on birth, laction, or healthcare consumer advocacy, I'd love to hear about them.