The Nipple Natzi and the Prayer Warrior

I stopped by my son's place yesterday afternoon to drop off a copy of The Womanly Art of Breastfeeding to my daughter-in-law. She was in tears when I arrived. They both complained that the baby wasn't having bowel movements and that when they took him to the pediatrician earlier that morning for a weigh-in, he had lost 14% of his body weight. I encouraged her to read the book for some practical info and that I would take her to an LLL meeting next week. Meanwhile my mother comes by to bless the baby with her holy oil. She lays hands on my daughter-in-law as well and prays for peace and healing. It was really quite lovely. (My mother is a holy woman and a prayer warrior) I suggested two things. First, (a technique I actually learned from my mother, which she learned from hers), an ivory soap suppository to stimulate him to move his bowels. They gave me a little bar of soap which I cut off and carved a small chunk into a little fingernail sized bullet. I coated it in olive oil and inserted in his rectum. I then held him upright and massaged his back in downward strokes, soothing and talking to him. About 5-10 minutes later, out comes the soap suppository followed by a huge meconium stool. Next, I evaluated his suck to see why he has so much trouble latching on and staying on. I don't expect to find anything amiss since they've seen the lactation consultant twice at the hospital. But I find he has a short tongue, tongue-tied, and may need his frenulum clipped. I've seen shorter, but I do think its impeding his ability to maintain a good latch and suck. I tell them my findings and suggest they discuss it with the LC and pediatrician on Monday when they return. In the meantime, I tell her to attempt the breast at every feeding, followed by pumping and if needed finger feeding (which is what they've been doing). I tell her how important it is for her to empty the breast and make sure he gets that hind milk to overcome a possible calorie deficiency. I make an extra suppository for him in case they need it. I also encourage her to use lanolin on her one sore nipple and expose it to air to hasten healing. (She said the breast shield she was given at the hospital had cut her nipple- I had never heard of that happening.) When I leave, she has gotten him on the breast in a football hold and they are happily nursing away. It was nice leaving them smiling.

Breast is still Best

My Toastmaster's group ended its meeting yesterday with a baby shower for one of our members who is expecting twins. Everyone was encouraged to bring a children's book for the new mother-to-be. I gave her Henci Goer's, The Thinking Woman's Guide to Childbirth, a book that somehow stood out amongst the Dr. Suesses and Richard Scarrys. Each gifter had to explain their book selection, so I had an opportunity to talk about my work with birth. It felt good to have an audience for my ideas, and get their feedback and answer their questions. On another note, I also met with my Breastfeeding Committee yesterday. (My secondary passion after birth) We are a committee of the Maternal & Child Health Coalition (www.mchc.net), a health advocacy group. The BF committee is devoted to increasing breastfeeding initiation and duration rates in our metropolitan area through professional education and support. I'm so excited about our latest project for this year's World Breastfeeding Week. (August 1-7) (www.waba.org) We are bringing Kathi Barber to town, founder of the African-American Breastfeeding Alliance, and author of the book, The African-American Woman's Guide to Breastfeeding (www.aabaonline.com). I hope it's different where you live, dear reader, but our breastfeeding rates here are in the toilet, and worst of all for African-American mothers who nurse at the lowest rates of anyone. I always thought this a great irony since African-Americans tend to suffer most from the disease processes that are impacted the most by breastfeeding (think diabetes, obesity, etc.). Surely I can't be the first one to figure this out. Why hasn't there been an outcry within and without the African-American community or the healthcare community to promote breastfeeding? Why is it the folks who stand to benefit the most have the lowest rates? Still the silence continues. Our entire group is excited to bring Kathi to town to talk to healthcare professionals that work with at-risk populations. We are also sending all the hospitals in town that do deliveries, (all 19 of them) samples of our breastfeeding crib cards that we developed and the "eat at moms" onsie that we developed and trademarked, and are encouraging them to have some event at their facility to mark World Breastfeeding Week. This is truly our big event of the year and I like making the most of it. Meanwhile, sadly, my daughter-in-law is struggling with getting her breastfeeding established. They came home from the hospital yesterday, and I got one call in the middle of the night, and another early this morning. I hope she hangs in there with it. I'll visit later today to see how I can help. I plan to take her to an La Leche League meeting next week. Keep your fingers crossed for them.

Going My Way

I've been pondering why I feel as strongly as I do about birth issues, and why I have chosen to devote my life to this particular cause. Its not like tackling world hunger, or environmental causes like the ozone layer. Its not trendy or sexy, or even on the radar screen of common causes, at the moment. But for whatever its worth, it's my cause. I visited my friend, Dotty's church yesterday, and she showed me one of her Bill Gothard wisdom books. (These are christian homeschooling "manuals") It had an entire chapter devoted to myths about birth and breastfeeding. I heartily agreed with everything I read. I also realized others have said what I am saying and have said it better. It was a terrific reminder that birth is God's plan, not ours. The supreme designer of birth made our bodies to accommodate the rigars of birth. How did we get to this place? A place where epidural rates exceed 80% and cesareans are inching upwards of 33%. This is such madness. Everything within me screams that this is wrong. It reminds me of that scene from The Posiedon Adventure (the original, I haven't seen the remake yet). Our heroes encounter a group of ragtag survivors, slowly trudging toward what they think is certain safety, but what actually is certain death. However they cannot be convinced, and continue on to thier ill-fated destiny. The harrowing voice of a one our heroes calls out behind them, "You're going the wrong way, they're going the wrong way!" The sound of her distressed call fades as they disappear from sight. I suppose this is my job, a sentinel posted by the way, calling out to all that will hear me, "we are going the wrong way."

Why Women Can't Give Birth

Well, I just spent the last 24 hours with my son and his wife as she delivered her first child, (my son's third). Gabrielle Gregory was born yesterday at 5:32pm and weighed 8 lbs, 13 oz. He is beautiful and healthy. I am joyful and grateful at his being here, and yet feel a deep sense of loss. Gabrielle, like my son's other two children was born by cesarean. Here's how it happened. I got a call from them early Friday morning at about 3 am. I had just been dreaming that they were about to call me, so when I heard the phone ring, I woke right up and answered it. My son told me they were still at home and asked me to come over. When I arrived a little while later, the doula was already there. My daughter-in-law was having good ctx about 5 minutes apart and sitting on the birth ball. I thought this doula was fabulous. I had known her for a long time, but had never been at a birth with her. She is also a massage therapist so has a fine understanding of anatomy and physiology that she uses as she helps the mother adapt to the changes and sensory experiences of labor. Throughout the long day, I saw her use movement, repositioning, aromatheraphy, music therapy, verbal encouragement, counter pressure techniques, hydrotherapy, massage, homeopathy, and other tools in her arsenal of care. We were at their house about an hour before my daughter-in-law stated that she wanted to go to the hospital. Her ctx were so good and steady that I was hoping she would be dilated to 5 or 6. Her ctx had started about 8pm the previous evening, but I didn't want to be overly ambitious about a first time mom. I had reminded them repeatedly to pace themselves because first babies take a lot longer. The doula at one point pulled me aside and asked if I were willing to check her [cervical dilation]. I had thought of this just the other day, and decided that it was not something I was comfortable with. It was important to me to maintain my mothering role and not put on any other hats if I could help it. I told the doula this, but would do a check if they insisted. They never asked me to. So, an hour later, we headed to the hospital, about a 20 minute drive away. When we arrived and she was checked, she was dilated to 3. My heart dropped. My number one rule for a good birth experience had been violated. Don't arrive at the hospital too early. Getting there at 5-6 would have been better. But we were there now, so they immediately got back to the process of laboring. After a few minutes of monitoring (baby looked good) they went back to the birth ball and my son and the doula took turns giving counter pressure and massage. I hung back and observed giving encouragements here and there. It was strange for me to be in this setting in this role. It was important to me to hold my boundaries. This was not my birth. The doula told me later that she thought my son needed me there for him, more than for his wife. I think she was right. Several times throughout the day, I was asked for my opinions. I think he thought that my being a nurse would offer them some protection or special insight. It was an honor to be asked to be present at this sacred occassion. I offered opinions only when asked, and had to tread more carefully as the day went on. After two hours, my daughter-in-law was dilated to 4, and asked for an epidural. We had discussed the slippery slope of interventions, previously, but she said she felt as if she couldn't continue laboring the way she was. Her request caught me by surpise. We had used practically all the therapies mentioned above in those two hours. We were all working together as a team so well. Hearing her ask for the epidural was like hearing that it wasn't enough. Her midwife immediately granted her request. The midwife was a lovely and supportive person, several times during the day she came in and simply sat with us. However, I never saw her say or do anything that a physician wouldn't say or do (except for the sitting of the labor) throughout that long day. I could not pinpoint any difference in practice. Before the epidural could be placed, she need an IV placed (of course). She would now be confined to the bed, place on the fetal monitor continuously, and have her vital signs monitored every 15-20 minutes. After the epidural was in, a bladder catheter was placed to measure urine output, (and because she could no longer go to the bathroom). Her labor stalled. (Surprise, sursprise.) After another two hours, she was still dilated to 4. The midwife offered to break her water (the gravest error yet in my opinion) "to speed things up." The baby was OP (sunnyside up) and the head asynclitic (sideways) (we found this out later) so to my way of thinking, removing the cushion of fluid would only inhibit the ability of the baby to reposition itself. But this all occurred while I was out getting breakfast and when I returned, it had already been done. I sighed and sat back down. Time passes and she is dilated to 5. More hours pass and she's still dilated to 5. The midwife does sit her upright in the bed, and later positions her from side to side in an effort to reposition the baby. The midwife and nurse won't try the in-bed positions the doula and I suggest because her legs are too numb to hold her up. They have a point, our positions do require some use of her legs- hers are completely numb. More hours pass without change and her cervix has begun to swell. The midwife tells them they can try a pit augmentation, but my son says no. She already has a good ctx pattern every 2-3 minutes and he doesn't want to risk taxing the baby. (We knew this because the midwife had earlier put in an internal monitor.) Her other option was of course a cesarean. After the midwife and nurse left the room for us to powwow, I told them they had a third option of doing nothing and giving themselves more time. The midwife agreed to give them another hour. It was evening by this time. I had to leave again to pick up my three girls from a birthday party. I was glad to have to go (a cowardly thing to say, I know). I knew when I got back the cesarean would be over and done. It was a foregone conclusion from the time they broke the water, maybe even from when they did the epidural. I had seen this whole scenario played out 1,000 different times as a L&D nurse. My daughter-in-law fell right into a typical delivery. I really thought that teaching them childbirth ed myself, getting them a doula, and encouraging them to select a midwife would make a difference in their birth. It made no difference at all in how things played out. I realized then, as I returned to the hospital and they were rolling her back to her room from the OR, that birthing women themselves have to want a change, and are in the best position to make the change. My wanting things for her, made no difference at all. She had to want it for herself. My daughter-in-law knew she didn't want a cesarean (they told me she cried when the midwife came back and told her time was up and they were out of choices) but she didn't know what she wanted instead. How could I explain to her that she would have had an entirely different labor if she hadn't had the epidural that began the cascade of interventions and robbed her of her ability to reposition and be mobile in ways that could have made a real difference in the baby's positioning. I don't think she failed. I think the system has failed her. As they wheeled her back to her room, I thought of a whole generation of women who would not know the experience of vaginal birth and the impact it would have on the next generation of women. I felt almost doomed. I only perked up after a private conversation with the doula in which I could see my role more clearly. I have to write this book and make my documentary on birth. I stopped being a doula, and an OB nurse, and a childbirth educator and I stopped pursuing midwifery as a vocation. None of those was ever a good fit for me, but I am beginning to see my place in the grand scheme of things. My role is in advocacy and policy change. I feel powerless at the bedside. I'll never be an insider. I've been inept at causing change from within. Perhaps my book and film can help women internalize the need for change. At this point I feel it's all I have to offer to the cause.

Writer's Boot Camp

I've spent the last 48 hours putting a plan into place to finish my book. Here is what I've come up with. My two precious hours will be spent thus: 30 minutes of walking, 30 minutes of some combination of the following: blog writing/poetry writing/journaling/prayer/meditation and one blessed hour per day for working on my book. (Before I spent the two hours doing whatever struck my fancy the most- which was usually blogging and journaling.) Its not much, but I intend to jealously guard my time. I've also put a support system into place. I've asked my friend Drew, a published poet, (drewdorsey.com) to resume our little writing exercise. He sends me several titles a week, and I make them into poems. I've also asked my friend Barbara, also a published writer, to be my accountability partner and inquire weekly as to how my book is coming along. I'm compiling a list of women's magazines to query about a book exerpt and my story on homebirthing. I've also gathered some preliminary info on the Mexican retreats. I was watching Oprah's show on Monday about her weight loss boot camp. She said something that struck me. She said it doesn't take will power, but simply making a decision and then taking action to support that decision. Thats what I have done this week. I hope it works as well with writing as it does with weight loss.

Planning my Work and Working my Plan

My, oh my. Life has such limitless possibilities. I'm sitting on the balcony of my room of a local waterpark resort. My husband and I brought the children here for a few days of R&R. The kids have been staying up late, enjoying the cartoon network that we don't get at home (because we refuse to do cable). Everyone is still asleep, just like at home, because I like to have at least 2 hours of quiet time to myself every morning. I just spent my early morning hours catching up on my friend's blog. She's a NewYork author and speaker (just like I want to be when I grow up, except for the New York part- I'm happy where I am). Victoria and I met years ago when we were both homeschooling moms here in KC. I remember when she was writing her first book, now she's about to publish something like her 14th or 15th. I try to get a front row seat whenever she is in town for a presentation. I feel so priviledged to have witnessed her journey. She now travels nationally and internationally promoting her books and giving her talks. (check out her website for yourself at www.victoriamoran.com ) My, my, my, and here I sit, trying to wrangle out my first book. Her blog is so full of her now glamerous lifestyle hobnobbing with the rich and famous. I'm not envious, so much as impatient to see my own dreams come to fruition. I was reading an email this morning from another friend, Michele, who lives in San Miguel de Allende, Mexico. San Miguel is where I have gone two years in a row now, to participate in a three day pilgrimage through the mountains (a life altering event). Michele sent pictures of her retreat center and it just got my mind ticking. I've been trying to think of ways to link my business to San Miguel. I'd love it if it became a second home, in fact. It suddenly occurred to me that I could set up week long retreats that involve both education and vacationing. One of those learning vacations I heard about when I attended my travellers group meeting last week. I just have to figure out, a) what I have to teach, that folks would pay big bucks to learn, and b) the logistics. A will be the harder of the two. Should I teach to other healthcare professionals and offer continuing education credits? Could I offer a retreat on a more fun or frivolous topic? Could I set up a medical missions project and combine it with safety training or language learning? I have a lot of thinking to do. Of course, I always have to ask, how does the new baby fit into all this. One of my life goals is to travel. One of the reasons both my husband and I were looking forward to all the kids being gone is so that we could finally, at long last, do the travelling that we really have wanted to do. I know everything is falling into place. The quickest way to become a recognized "expert" in anything, is to write a book. I'm working on that one. I also want to become a presenter. I'm continuing to hone my presentation skills through involvment with my Toastmasters group. (I even took private lessons last year.) I've spoken at several conferences now (not for money, but for experience. I do have some connections and trusted friends of whom I can ask advice, and ones who have been where I want to go. I know how to create and or take advantage of opportunities. I'm still sharpening my niche, which I think is really important. What do I lack? Courage and belief. One cannot do the work I seek to do without a deep and abiding faith in his or herself and a willingness to step out in faith and conquer their own fears. My mind is so full of doubt. (Will people listen to what I have to say, why should they, who made me an authority on the topic, what validates my knowledge and experience?) Even at 43, I still feel like that little girl in pigtails sitting alone in the grass making flower wreaths. I don't take that as a bad thing. All my alone time cultivated my creativity and taught me how to entertain and motivate myself. But my desire is helping me to overcome my fear. I want what I want and I want it bad. Now I have opportunity like I have never had it before. I own my own time. That in itself is an amazing gift. Twenty-four hours everyday to make my life count for something. I can't let having a baby throw me back into chaos and the tyranny of the urgent. I may never have the opportunity of time, the way I do now. I must make it count. I have to take a step of faith and bring my goals to fruition. I have to complete what I have started. But how? Thats the working part of making and implementing a plan.

The Courage to Embrace Change

I think I'm ready to tell our families about the pregnancy now. I've been so conflicted about it and so afraid of what our parents will say. (I know I sound like a wuss, we are after all 43 and 47 and married) I know that some of them will still give us a hard time, but I know I can handle that, that together we can handle any negative feedback. I asked my husband what he'll say if his mom says something negative. He said, she'll say what she'll say, it won't change anything. He's right of course. We love one another and we're having a baby. So what. We didn't plan it. So what. We're still having a baby. We'll still love him or her and one another. This baby will be embraced by our whole family- eventually. I know I just need to bear the initial reactions of others. They'll need time to get used it, just like I did. Heck, I needed 3 months to get used to the idea! I need to allow others time to process this as well. I understand that part of other's reactions is concern for our family. We are stressed and overloaded. We did just recently downsize our lifestyle by moving to a smaller home, and will have to do so again to adjust to the loss of my income from my second job. Hey, I don't even know where we'll fit a crib in this new house, we certainly won't have a nursery! But we will have a home with a sane wife and mother and plenty of love to go around. I keep telling myself, this a blessing. As time goes on, it starts to feel more and more like one. I sat in a board meeting today, feeling my belly and smiling to myself. I completely spaced out during the financial reports. I'm beginning to have moments of terror where I think, "what will I do about _____ after the baby comes." Then I think, I'll just adapt how I do this, or I'll take the baby with me, or I'll have to modify my lifestyle, or even, I won't be able to keep doing this. Whatever needs to happen, I'll make it happen. I won't pretend anymore that my life won't change. A baby changes everything. I want to open my arms wide and welcome the change. After all, it's the next phase of my life- and I do fully expect my life to get better and better. I expect me to get better and better. I'm ready to embrace this phase of my journey.