I'm Baaaack...

The conference went swell. My presentation was well attended and well recieved. I love doing this (the horrors of flight notwithstanding) and look forward to my next speaking gig in Las Vegas in July. My mother wants to go with me, which will be great. She'll get a kick out of watching me speak, and I'll have someone to film me. (I need some footage for my website.) I got some good feedback after my talk and look forward to seeing my evals for the session. Doing this presentation, and collecting a check for it, makes we want to do it more and more. I tweeked my website since I've been back, and have read two books on building a consulting business. I would love for my speaking to branch into consulting. Meanwhile, back at the ranch, my human baby was cared for just fine, and my business baby also did fine as well. I have to give my son his props- he held down the fort just fine. (Although I confess, I called home twice while I was away, but I called about the business about 3 times a day.) I also had it impressed upon me that I need to finish a book- any book, for the sake of needed promotion.

I'ma leaving on a jet plane...

Headed to Minneapolis this morning- still over my head in overdue reports and articles. I guess I'll be using my travel time to write. I am anxious leaving my baby- not the human one- my husband is excellent with him. I mean my business. I'm leaving it in the hands of my oldest son. I have a total of 5 classes going on while I'm away and have done everything in my power to make sure they go off without a hitch. But I'm still nervous. I don't want my clients to be let down in any way in my absence. I know things will probably go just fine- its just so hard to delegate and let go. I checked the itinerary of the conference. There are about 1200 attendees, I should get about 200 in my breakout session. Send good thoughts my way, that I will positively influence my listeners. It would also be nice if I got more speaking gigs out of this one!

Texas- Its a whole other controversy

Check out this link to Controversies in Childbirth. This looks like a terrific conference and they are still requesting speakers! What controversial topic should I take on? Unassissted birth? Health disparities in birth? How birth practices sabotage successful breastfeeding? Homebirth for grandmultips? Why I turned my back on hospital L&D nursing? Ah, so many subjects, so little time. Unfortunately with an article due and getting ready to leave town, I'll have little time to devote to daydreaming, but I do intend to submit an idea.

Put Your Money Where Your Breast Is

I got some excellent feedback from the LCs last night. Its interesting that my very first official speaking gig for pay (besides the one I did in San Francisco last February) is talking to WIC about breastfeeding. I'll be addressing admin not the rank and file, so my presentation is to those who can facilitate change, yet this will be a delicate balancing act. Some have told me I'll be preaching to the choir, but others have said its a great venue for making converts. I'm sure both statements are true. Its a balancing act, because I don't want to offend them on the formula issue because I want them to hear what I'm saying about lactation. So I included a slide of what I think they are doing right. The suggestions are a little radical- like having an LC in every clinic (LCs are expensive) but as good as peer counselors are, they do not represent professional support. I'm also suggesting that all peer counselors be trained as breastfeeding educators (also expensive). But I have no choice - if we want to make an impact on breastfeeding rates, we have to be willing to invest in those outcomes. The taxpayer is getting a much better return on investment if breastfeeding rates go up, and formula feeding goes down. Past a certain tipping point, there will begin to be a savings.

Breast Conversion

Tonight I give a preview of my breastfeeding presentation to the local lactation consultant group. I look forward to finally visiting their meeting, even more so to give my presentation and get feedback. Our local LCs are the foot soldiers. They labor tirelessly often stretched between hospitals. I hope to gather feedback from them about what LCs have to offer in a WIC office setting. This is one of my suggestions for WIC in my presentation- that they have an LC in every office. I also suggest that WIC offices be converted to breastfeeding clinics. I'm sure that suggestion will go over like a ton of bricks. Then I suggest that they delay offering formula vouchers until six weeks postnatal. That should have them booing me off the stage and throwing tomatoes. Its very difficult to convert someone from bottle-think to breast-think. I'm hoping an evening of hanging out with LCs will be refreshing for my soul and good preparation for next week.

Battle for the Breast

Last night, I attended a meeting for the healthcare foundation board that I sit on. This group has many wonderful pans in the fire, but last night, a proposal was made to start a new initiative dealing with cultural competency. Now before I started researching my breastfeeding presentation, I thought cultural competency was a noble enough goal- now I think it's absolutely essential to making a dent in health disparities. My look at research showed me how minority interaction with the healthcare community can be unproductive and downright punitive without the principles of cultural competency in place. There is a direct link between health disparities or health outcomes and cultural competence. That is why I'm so excited about this new 3 year initiative to fund the exploration of training for safety net clinics. I hope to have an active role in this, even though my term is up next year. What I found, while not directly looking for it, was that black women were less likely to be talked to about breastfeeding from their healthcare provider during prenatal care, were less likely to get follow up support when complications arose, and were less likely to have access to mother to mother community-based support. Failure to initiate or continue lactation has a direct impact on infant health- more so in the black community where health disparities already put black infants at more risk. What I found overall is that the infants most likely to benefit healthwise from breastfeeding, were the least likely to get it. My buddy Charlene has already warned me that I'd have to overcome WIC complacency in my presentation, that "they messed 'em up at the hospital, so what can we do about it now?" attitude. However WIC does see folks prenatally too! I'm gleaning my list of over 55 barriers. I want to shock folks out of their complacency, but not overwhelm them. I want them to see that black women don't just 'prefer the bottle' as some research suggests, but that they have overwhelming odds against them in the fight for successful breastfeeding. More to come on that subject.

Blog Eulogy

I'm so sorry to have to be writing this, but this is a farewell send off to Mama Midwife Madness, a blog I've enjoyed since I discovered blogging 2 years ago. Mama Midwife joins others in a long line of wonderful blogs that have removed themselves off line. Flea, FPMama, Minority Midwife and others, gone, all gone. They become like friends, a glimpse into the world of likeminded others... and when they go, they are missed. Some leave the blogosphere entirely, some just go private. Mama Midwife went private and has graciously invited me to continue reading, but I know the sadness of losing a blog, often without warning and usually because something really bad has happened. Unfortunately Mama Midwife was the victim of blog bullying which can be very scary and very damaging. This all echos my presentation a few weeks back, when I wrote that blogs can have their dark side. Just as you can use blogs to build a reputation, they can backfire when used to call your credentials into account. It makes me wonder what kinds of things can be said about me to make me want to stop blogging. It's hard to imagine such words. One of the reasons I 'divested' myself of affiliations (ie., quit working at hospitals) was to be able to write and speak freely. I use my real identity precisely because I don't have to 'hide out' or worry about 'getting caught'. I don't expect everyone who reads this blog to agree with me, but I do expect respect and common courtesy, which I'm happy to report, so far- I've always recieved. I do try to be objective and listen to dissenting voices. No one is 100% correct nor 100% incorrect so there is something to be learned from everyone. Having said that, I do have a political agenda- I'm not just blogging to blow off steam. I consider blogging a tool in my arsenal for cultural change. It's sobering to think that any of us can be driven off line by the hurtful words of others. Farewell Mama Midwife- the blogosphere will be a lonelier place without you.

Knocking Down Barriers

I've been hard at work trying to finish my powerpoint for the WIC conference in a couple of weeks. (WIC is a government run food program for low income women and children who are nutritionally at risk- the program supplies them with supplemental nutritious foods to round out their diets) The research has been very thought provoking. I've learned so much more about the barriers that have to be overcome for some women to breastfeed. Its amazing. It seems that the babies who would most benefit from being breastfed are the least likely to be. How sad. I hope to have many, many opportunities to give this presentation. From the research, I identified 55 barriers divided into 9 categories ( political, cultural, social, economic, institutional, behavioral, environmental, educational, and relational). I came up with a list of recommendations that cover every level of human intereaction from governmental interventions to community-based, to one-on-one in the workplace. I have still have mixed feelings about this organization. They are an arm of the government, and the largest purchaser of formula. On the other hand they are under federal mandate to increase breastfeeding rates. However, one of the research articles I came across identified being a WIC mom as a factor for being least likely to breastfeed! At least 2 research articles found WIC interventions to boost breastfeeding to be weak or ineffective (though there were other articles that promoted the stregnth of other interventions). In other words, there is much work to be done. This organization has access to the women who need to increase their breastfeeding rates- so this is the organization to join forces with. The idea is to come up with interventions that really work- interventions that truly change peoples beliefs and behaviors. I don't believe that governments lead cultural change, they can only facilitate and encourage that change. Consumers lead cultural change. My desire is to draw consumers to claim and embrace breastfeeding as their own.

Between a Rock and a Hard Place

The Missouri midwifery bill is having a final go at it. This legislative session is about to come to an end, and there's just enough time to get a vote in the state senate. I wish my sister Missourians well. We've gotten to this point many times in the past. So many folks work so hard to get a bill this far. Folks who move here from other states are always amazed at how repressive things are here. Kansas law keeps non nurse midwives allegal, while Missouri law has them out and out illegal. Its a felony offense to practice midwifery (unless you are a CNM) and midwives here have been prosecuted. The fear of prosecution keeps midwifery underground for the most part. You kinda have to know someone who knows someone. All this cloak and dagger mystique keeps options out of the reach of most women. Some women prefer a CNM to care for them- but good luck finding one who does homebirth. Punitive malpractice insurance companies practically guarantee that needed physician back up and collaboration will be unavailable. Women don't have true choices in the hospital setting. Political tyranny limits their choices outside of the hospital. What are women to do?

Decidedly Undecided

I'm reflecting on life as I sit at the computer and watch my toddler feed his oatmeal to the dog. I heard a terrific speaker, Dr. Mom, at a luncheon earlier this week talk about life balance. How when we take something on, we should let something else go so that we don't get overloaded. I know that my life needs an overhaul to support my weight loss goals. While I don't know yet what I'll decide- its nice to have choices. It's good to be in the decision making role. I'm happily muching on an apple bran muffin and glass of water (I've given up drinking milk), and thinking about how this relates to birth. How much of her decision making role does a woman give up when she enters the hospital to birth. Yes, healthcare providers expect you to make decisions- the ones they want you to. Woe to those who desire something contrary to standard protocol. But if you can't say no, does your yes really have much value?

Back to Birth

I met with a fresh, young, lovely couple last week about being their doula. I don't think they will (or should) select me, because I have an out of town speaking engagement one week before their due date. I have to confess a slight anxiousness about returning to birth. I don't know if its too soon, or if I just have to jump in and do it. I do feel the need to work through my issues before I attend anyone's birth. I want to help birthing women, but I'm still struggling with what exactly that looks like