Get Yer Freak On. Doula's Orders.

Today is my May Mama's estimated due date.  Well okay, her original EDD is the 28th, but they pushed it back to today because of imaging.  Which means I'm still considering her to be due on the 28th.

When I talked to her today, she was anxious.  Her last two babies had been born at 39.5 weeks exactly, and going "past" her due date was worrying her.  I reassured her that all babies are born eventually, and besides, as her midwife already said, third babies tend to be the odd ones out.  Old wives' tale, sure, but backed up with years of observation by pretty much every midwife I've ever talked to.

Then, showing my nerd-colors a bit, I reminded her that babies, like wizards, are never late.  They arrive precisely when they mean to. 


We went on to have a good conversation about inducing labor naturally.  And no, I'm not talking about smearing your vag with evening primrose oil or doing shots of castor oil.  I tend to be cautious about those methods when a mama isn't being threatened with medical induction, since they tend to have negative side-effects that are, let's say, unpleasant.

But to simply get things going, I always say, a mama needs to simply have a really good night: get a nice long foot/calf massage, have a half glass of red wine, and have some good sex.  Or as I call it, the Sex, Booze, and Foot Rubs Method.

While the above methods tend to be looked at as mere old wives' tales, there is in fact scientific basis for their use.  And besides, unlike castor oil and assuming we're only recommending a half glass of wine, there is little to no risk of negative side-effects.

Here's why they work!

The Sex

Oxytocin, the so-called "love hormone," is at least partly responsible for three distinct physiological events in a woman's reproductive cycle: orgasm, labor, and breastfeeding.  As a sex-positive doula and lactation educator, you might say that oxytocin is my homegirl.

The female orgasm was once thought of as relatively inconsequential to the reproductive process.  In fact, some fertility specialists have even suggested that orgasm "dilutes" a woman's chance of becoming pregnant.  (I call bullshit.  Also sexism.  But that's another post.)  Au contraire, says a bulk of new-ish research that essentially reaffirms what lay-health workers have been saying for years: orgasm increases your chances of conception.  See, when a woman orgasms, her body releases even more vaginal secretion than she does when simply "aroused," helping to lubricate the sperm's path to the egg.  Additionally, the oxytocin released via orgasm contracts the uterus, lowering the cervix (the "neck" of the uterus) and making the uterus more accepting of a fertilized egg (ever wonder what that tight feeling in your lower abdomen was?).

Sidebar: Oxytocin is also associated
with trust, which helps explain why
women who have good relationships
with their care providers tend to have
smoother labors.

So oxytocin contracts the uterus.  Hence labor.  But the wonder-hormone's job isn't over when the placenta is delivered.  Oxytocin is also responsible for the milk "letting down" during breastfeeding.  See, when a woman first lays eyes on her baby, she's essentially OD'ing on oxytocin, as is baby.  That's the love hormone doing its job.  Baby will hopefully find her/his way to a nipple and begin suckling.  When the nipples are stimulated, oxytocin is released from the posterior pituitary gland, contracting the tiny myoepithelial cells inside the milk ducts, forcing milk out of the breast and into baby's mouth.  That oxytocin release is still doing it's job "down there," helping mama's uterus to clamp down post-delivery, thus reducing risk of excessive postpartum bleeding. 

I mention the connection to breastfeeding because oxytocin is also released with nipple stimulation.  Women who are into nipple stimulation during sex may enjoy it for a number of reasons, but physiologically it's because that burst of oxytocin contracts the uterus (which essentially puts interior pressure on the clitoris and, well, you get it).  In other words, if you're into nip-stim, include that in your labor-inducing sex practice.  Otherwise you can just turn on your breast pump when you're finished doin' the deed, and you will probably get a lot of the same benefits.

If a woman is having sex with a man, his stuff may play a labor-inducing role as well.  Semen contains prostaglandins, autocrine hormones that help to soften ("ripen") the cervix.  A softer cervix makes the fertilization/implantation process more likely, but these hormones work the same when a woman is already pregnant.  The low dose of prostaglandins in semen alone aren't likely to induce labor in a woman who's not yet term (which is why care providers don't warn against sex during pregnancy unless a woman is at risk for preterm labor), but the mild softening in a term mama might just be enough to tip her into labor mode.  As an added bonus, if he's, let's say, "gifted," his penis hitting against the cervix may indeed induce some mild (but not earth-shattering) uterine contractions.

Captain Obvious moment: I generally don't recommend the prostaglandin method if a mama is in a relationship where she's at risk for a sexually transmitted infection.  The last thing she needs is to be infected with an STI right before a baby comes squeezing through her vagina!  If infection is an issue, sex with a condom still contains the benefits of oxytocin and cervical pressure.  Masturbation is a safe and effective alternative for women who don't have a partner (or just simply don't want to engage in partner sex).  Again, oxytocin is stronger than prostaglandins... go team vag!

The Booze

While its use remains controversial amongst even the most alternative midwives, wine in small quantities (a glass or less) is thought to help the mother's body relax through the anxiety that often hinders the body's ability to start labor on its own.  Anxiety leads to the release of catecholamines, the "stress hormone" which interferes with the release of oxytocin.  So while the alcohol itself does not induce labor (it can, in fact, cause vasodilation, which actually hinders labor progress), a bit of wine to "take the edge off" of what ever stress a mama may be experiencing can help things along. 

The Foot Rubs

There are several pressure points in the feet and ankles that, when massaged, may induce uterine contractions.  The first is in the soft area between the achilles tendon and the medial malleolus (the "knotty" bone on the inside of the ankle).  The second is about four finger-widths above the malleolus.  Even if the massage does not actually induce contractions, a nice ankle rub may help with the ankle swelling many women experience as they get further along in pregnancy.

A midwife also once told me that the heel is a reflexology point to the cervix.  In fact, she says, you can often read how effaced (soft) a woman's cervix is by compressing her heel, and can often soften a "tough lip" by rubbing out hard points.  I have no research to back that up, just one midwife's anecdote.

And by now my May Mama has called and said that since I gave her the above information, she's been contracting steadily (but lightly) for the past little while.  So there.  Get yer freak on, doula's orders.

30 Kids and Counting: Race, class, and the scapegoating of the Other

This is yet another issue I was planning on avoiding, but it's gone viral on my Facebook news feed, so here we are.

The story goes that Desmond Hatchett, a Tennessee resident, is the biological father of thirty children.  Thirty children born to eleven different women.  The other part... he has a minimum-wage job and therefore some of his children's mothers receive as little as $1.49 per month. He is pleading with the state for help with his support payments.

I know better than to read the comments below the stories.  I'm not even going to go there.  But the commentary provided by people on Facebook - people I'm actually friends with and tend to respect as intelligent human beings - provided its own source of disappointment.

But first, let's break down a few of the issues in the news article itself.

The headline, TN Man 'Fathers' 30 Kids But Can't Support Any, is in and of itself problematic.  The last line of the article tells us he has a minimum-wage job, so obviously he can support some, especially when they report that his previous partners do in fact receive support payments, however small they may be.  The use of the word "fathers" in quotations, paired with the obviously inaccurate claim that he "can't afford any," reinforces the deadbeat Black dad stereotype.  While Hatchett may not come across as the most sexually responsible person in the world, that he is even showing up in court and willingly getting half his paycheck taken by the state means that he is making more of an effort than, say, a man who dodges the system completely and goes "off the grid" to avoid child support payments (or, say, a man who is physically and financially present in a child's life but is any shade of abusive).

Much of the language in the article itself is racist and demeaning.  The author could have easily reported that Hatchett had children with 11 different partners, but instead chose to use the term "baby mamas" in quotations, clearly an attempt to write off all people involved as irresponsible stereotypes.

The article also lacks any discussion of why this sort of thing happens in the first place, especially in a racial and socioeconomic context.  And no, I'm not talking about the apparently "high number" of sexual partners Hatchett has had (okay, I did end up reading some of the reader comments... d'oh!).  I'm talking about the fact that Tennessee is a state with a long history of abstinence-only sex education (or in some cases, no sex education at all). In fact, the state's legislature is currently pushing a bill that would restrict this curriculum even more.  Additionally, while condom use rates have improved amongst the young African American population, cultural barriers present in lower-income communities persist.  Non-barrier, female-controlled contraceptives remain difficult to access in any community without consistent financial stability, and the state of Tennessee strictly prohibits social safety nets from funding abortion services.  And the results are apparent: Tennessee has one of the highest rates of unintended pregnancy in the country, particularly among young African American women. 

And now for the comments I read on my Facebook feed.

I'll say first that simply posting the article without any discussion of the above points is irresponsible, period.  Desmond Hatchett does not exist in a vacuum, and while his situation is a bit more extreme, his story is not unique.  Countless men regardless of race or socioeconomic status have "accidental children" with previous sexual partners.  We're only hearing about Hatchett because he doesn't have the economic privilege to make his child support payments outside of the public view. 

I have a number of feminist-identified friends who decided instead to take the "men are scum" approach.  But again, ignorance of the race/class factors involved here make their commentary troubling in the feminist lens because really, they're not calling out all men... they're calling out this particular kind of man.  A truly feminist account of Hatchett's situation would not ignore the intersectionality at play here.  Rather, it would push it to the forefront of the conversation.

Another person pointed the finger not only at the irresponsibility of Hatchett, but the "stupidity" of his female partners as well.  The poster even went so far as to muse that several of the women involved might have become pregnant intentionally in order to receive payment (because child support payments are just a phenomenally effective get-rich-quick scheme).

Even more troubling was the friend who simply stated that Hatchett should be "permanently sterilized." To make matters worse, he went on to express complete ignorance of why this is problematic when confronted about it.  Using terms like "personal responsibility" and "individual case," he remained unwilling to even learn about our nation's history of forced and coerced sterilization in lower-income communities of color, but assured me his previous comment "had nothing to do with race."  Right.

The Desmond Hatchett story made headlines first because it serves as an extreme example of a very common issue: the United States has one of the most abysmal records of unintended pregnancy in the industrialized world.  But the perpetuation of shock and "oh my god can you believe this guy" serves a deeper social purpose in that it puts a stereotypical face on the issue.  Thus, we allow ourselves to point the finger at one person or one kind of person (read: not us), blaming a group of irresponsible individuals rather than asking how we as a society may be complicit in another person's actions.  I thought the people I associate myself with were better than that, however, this time it appears I may have been mistaken.

A Matter of Context

Trigger Warning: pregnancy loss

--------------------------------------------------------------------------

I believe I'm going to remember last week as the week of miscarriages.  Really, though, it was just the two.

The first was good news, the second not so much.  The two together provided a stark reminder that the emotions surrounding pregnancy loss are completely relative. 

The first happened to a woman who had contacted Spectrum.  She had become pregnant accidentally and had scheduled an abortion procedure around 5 or 6 weeks LMP.  Having been raised what she called "Uber-Catholic," having an abortion was, to her, the killing of a human being.  But she had no choice.  You hear this scenario played out pretty often when you work with people experiencing pregnancy loss.  Intellectually, the embryo is just that: an embryo.  But when you're supporting a person who has been raised in a certain faith or ideology, there's always this deep-seeded idea that they will be killing a human being.  What the general public needs to know is that, most times, they will still have the abortion.  No amount of belief that the embryo is human, no amount of guilt or shame they feel from their childhood upbringing, and no state-mandated scare tactics can sway them from that choice.  They will terminate the pregnancy.  The difference is, they will have more emotional trouble dealing with it.  That's where I come in.

I spent a number of hours speaking on the phone with this woman over the course of a week.  She came to trust me as a truly non-judgmental ear that didn't shame her for choosing abortion but also wouldn't correct her when she said "baby" or "kill."  She became fixated on the idea that she would feel better about the whole situation if she experienced a spontaneous abortion (the medical term for miscarriage) instead of having it induced.  I don't know whether or not she did something to herself to self-terminate (she mentioned having read the parsley + vitamin C "trick" on the internet), but regardless, she did indeed end up having a miscarriage.  The news came from her voice with absolute joy.  She truly felt like the Universe, God, or what have you worked with her to bring about the event, and in the end she was able to have the kind of pregnancy loss she could not only deal with, but be happy about.

The second miscarriage of last week happened, sadly, to one of my birth clients.  She was 18 weeks pregnant, and without sharing too much of her personal information here, I can tell you that this event was earth-shattering for her and her family.  After hearing the news, I spent the better part of the next couple of days in a kind of withdrawn daze.  The pain she must have been experiencing was unimaginable to me.  After all, 18 weeks is pretty far along: you've become attached to the idea of having a baby.  You may have even thought up some names, or even started to buy clothes.  You've already told everyone that you're pregnant.  As if the loss itself isn't enough to deal with, the fetus and other products of conception are not likely to pass on their own, meaning you'll possibly need a D&C and/or labor induction.  Your pregnancy - once this enigmatic idea of a baby - actually looks like a baby at this point... a very small baby, but a baby nonetheless. Worse still, losing a pregnancy after 16 weeks means your milk is likely to come in once your progesterone levels drop.  In other words, full breasts and empty arms.  It's really more than I care to imagine.

I have heard (mostly young) pro-choice folks scoff at the notion of having a memorial for a miscarried embryo or fetus.  Hell, I might have done it myself in my teen years; after all, if a fetus is not a baby, then you didn't lose a baby.  But listen to enough people who have lost wanted pregnancies - whether to miscarriage, stillbirth, anomaly, etc - and your opinions mature astronomically.  They are no longer as black-and-white as they were when you were a red-faced college freshman shouting at antichoice protestors in front of your local Planned Parenthood, and while you remain as staunchly pro-choice as ever, the entire idea of pregnancy loss is tangled up in a billion shades of gray. 

That's really why "the abortion war" is so damn polarizing.  Social issues are best understood and dealt with when they can be easily boiled down to a black-and-white dichotomy.  But really, no social issue whatsoever can be simplified to that end.  We try, but we fail, and in our wake we do a grave disservice to those most affected by that issue.

The antichoice camp is able to rally huge amounts of support simply because their side really does take the black-and-white approach: their arguments are one-liners and emotion-grabbing images, and they make great headlines.  The prochoice movement fails by merely trying to echo these tactics.  Our arguments are full of holes when restricted to the same style of one-liners and headlines, easily refuted when we don't get into the complexities of pregnancy and women's lives.  Our messages will not be received if we merely keep screaming them louder and louder, and we will not ever attain true reproductive justice until we begin to acknowledge that all pregnancy outcomes - birth, abortion, miscarriage, stillbirth - mean nothing without the context that surrounds them.

Just look at my two clients... one had a miscarriage, and it was wonderful.  The other had a miscarriage, and it was the worst thing possible.

Moments in the Life of a Doula

Very Little Known Fact: May is International Doula Month.  2012 marks my third May as a doula, and let's just say the past few years have been nothing short of inspirational. 

I'm on call for my tenth birth.  Number ten!  Two and a half years ago I never thought I'd get here... my dedication to women's health has never been enough, and I fast learned that it's very hard to "get known" as a birth worker, especially when you've never had any babies yourself.  Still, the clients I have worked for have hired me for my presence, my energy.  And as I get more experience, more mamas are realizing that it's energy, not personal experience as a laboring person, that really matters.

Today I'm thinking about all the babies I have had the privilege to watch come into the world: Lundyn, Sara, Quinn, Aaron, Micha, Madison, Gershom, Amelia, and Sullivan.  All born to totally badass mamas with incredibly unique and wonderful birthing experiences. 

Thinking about these nine phenomenal experiences, I ran through my "stats".  Some prospective clients like to know, for example, your clients' epidural rate, though unlike your care provider's cesarean rate, a doula's epidural rate really hinges more on the way the birth progresses itself and not the actual doula.  Or so I tell myself.  But still, I'm proud of my stats.  In my nine births, I have had:

• Three boys, six girls.
• Three mamas who chose to have an epidural.
• Three mamas induced with Pitocin.
• One cesarean birth.
• Two mamas delivered at Forsyth Medical Center, one at Women's Birth and Wellness Center, and six at Women's Hospital.
• The fastest labor was an hour and a half.
• The longest was well over 20 hours.
• My favorite midwife thus far was Kate Layman, CNM at the birth center.  My least favorite was one of the faculty midwives at Women's who, fortunately, was only on for three more hours after my mama was admitted. 
• My favorite obstetrician was Dr. Grewal, my least favorite a tie between Dr. Marshall and whoever the guy was at Forsyth back in September (not worth remembering). 
• I've really loved all the nurses, but my favorite remains the pediatric nurse at Women's Hospital who helped the mama and I convince the father that circumcision has no real medical benefit.

Like any doula, I've experienced the absolute best of human love, compassion, and forgiveness simply by being there in the room.  I've heard mamas and their partners say ridiculously funny shit, sharing a good laugh between tough contractions.  I've also witnessed families make difficult decisions, seen women break down and sob when their birth plans have gone awry.  Fortunately, my birth clients have all gone on to deliver beautiful, healthy babies despite these roadblocks.  I have many favorite moments that straddle these two extremes... to name a few:

• My greatest learning moment came to me in birth number four.  The mama had been having one back-labor contraction on top of the other for a solid 90 minutes.  It had been seven hours since her last vaginal exam, at which time she was 5cm dilated.  When her contractions "stopped," I told her she was probably complete and would be feeling the urge to push soon.  After an hour of continued back pain and no urge to push, the nurse checked her and found that she was 6cm, at most.  As the baby was being born later that day (after an epidural, a nice long nap, and a marathon pushing phase), I saw that he was asyncletic.  Immediately my education flooded the forefront of my mind... it all made sense: the slow progression, the "fake" transition, the lengthy 2nd stage, even the week of prodromal labor. All textbook signs of an asyncletic presentation.  It was in this experience that I re-learned to NEVER estimate the laboring person's progress, that it's not the doula's job no matter how "clear" it seems to be at the time.
• While DONA would surely frown on this, I've been taught a few midwifery skills by midwives who needed an extra hand.  When a birth center midwife was busy stitching up a mama with a 4th degree tear, she asked me to do the fundal massage.  I'd never done it before, but she told me where to place my hand, what to do, and how hard to do it.  While it certainly went against my "doula instincts" to massage so hard, I now feel like I would be able to do hemorrhage control if I'm ever the only person present who knew how to do it.  Another midwife, during a very long 2nd stage at the hospital, gave me a refresher course in how to catch a baby if I ever had a mama deliver on the side of the road.  DONA teaches a little bit about that, but since we're really not "supposed" to do anything medical, they keep it brief.
• There's a popular one-liner amongst birth professionals about the difference between a doula and a midwife: "Midwives catch babies, doulas catch dads."  While I scoff at the obvious couple-centrism, I actually have caught a dad before.  Seeing how he was an ex-Army medic and current paramedic, no one really thought he'd have a problem with witnessing the birth.  However, the sleep deprivation, low blood sugar, and pure adrenalin of "oh my god I'm becoming a father" formed the perfect storm, and while everyone else was watching his baby crown, he was boarding the express train to the floor.  I caught him, this easily 200-pound man, inches above the ground.  Even Dr. Grewal turned from her obstetric duties to congratulate me on my quick reflexes, and hey, it bought the baby's cord some time!
• Speaking of umbilical cords, I once saw a "true knot" in one, which was awesome. The midwife and I shared a moment of "oh wow awesome!" while the new parents were admiring the new baby.  Because we're birth nerds like that.
• Some of my favorite parents have been the ones who "talk back" to care providers that aren't honoring their wishes.  At a rapid (unmedicated) birth last September, the doctor was trying to tell the woman to push when she didn't yet feel the urge.  Any decent research on an unmedicated 2nd stage will tell you this is a waste of energy, but the doctor obviously had a golf game to get to, so he continued to berate her, saying she "wasn't going to have a baby by just laying there and resting."  At this moment, she looked at him and said, "Shut the hell up, I'll push when I damn well feel like it."  Obviously the urge to push came, and within minutes she was holding her baby girl.  My favorite part about that birth was the dad talking shit about the doctor while he was on the other side of the curtain... whoops!

My favorite moments, however, are present at every single birth: the energy you can almost touch, the families being born, the immense joy in the room.  It's really indescribable, and words just cannot do justice to the experience of being present for the birth of a baby.

On another note, I also spent some time this week being the "phone doula" for a woman who was planning an abortion.  I was reminded of how similar the work is even if the outcome is obviously very different (I've discussed this before).  I gave advice, self-care suggestions, and basically was just there to listen and understand.  Without providing too much specific information about her case, I can tell her that her outlook on abortion is far different from mine.  Which is to say, she's never considered herself prochoice or "pro-life."  She was raised what she called "Super Catholic" and honestly thought she would be killing a human being.  But she was having the abortion anyway because it was her only real option.

By the end of our conversations prior to her appointment, she felt good about the choice she was making.  She had more clarity in her values, she was forgiving herself, and couldn't stop thanking me for being there for her without leading, assuming, judging, etc.

Just like at births.

I've been jokingly labeled as a "truly full-spectrum" doula by friends.  Bad Day Doula, Relationship Doula, Sleep Deprivation Doula, Headache Doula... I may end up being my mom's Hip Replacement Doula by the end of the summer.  What it comes down to isn't some certification, or even training... it comes down to who I am as a person, what I am willing to do for people, and the way I treat them.  The training informs the actions we take in response to our instincts, but someone can't simply be trained to be the kind of person a doula is.

Oh hell, I'm rambling.  I'll just let Boromir break it down for you.  Happy International Doula Month, all!!

So this gay marriage thing...

So I was going to write this long, drawn-out piece on the limitations of confining the entire LGBTQ liberation movement into "same-sex marriage."  I was going to go off about Obama's "convenient" announcement yesterday that he now supports same-sex marriage.  And to stave off accusations of total negativity, I was also going to tie in the silver lining: that NC's Amendment 1 has ignited a movement that is focusing on issues far  broader than "marriage equality," that its passage has turned normal, everyday people from pro-equality voters to activists for complete uncompromising social justice. 

But then I read this piece at Black Girl Dangerous and realized Mia McKenzie says it better than I could ever hope to...

Obama Loves Queers! (Except Not)