FYI - Breastfeeding Certifications

You know those letters after a doula's name that don't necessarily have to do with being a doula? Often those are credentials from different (but related) organizations and may indicate a specialty in a number of birthy areas: childbirth education, massage and bodywork, breastfeeding support, placenta encapsulation, nursing, etc.

There are many credentials that revolve around lactation, which can often be confusing when an already-exhausted family is searching for the right kind of support. Each of the below certifications qualifies one to offer a certain level of breastfeeding support, however, the IBCLC is the only credential that is qualified to provide clinical assessments and address the full scope of lactation challenges.

The following list lays out what each certification means, how one certifies, and the scope of practice associated with each.

IBCLC - International Board Certified Lactation Consultant - This is a clinical credential that requires several thousand hours of required study, education and training culminating in a once per year international exam given by IBLCE. IBCLCs must rerecertify every 5 years, and every 10 must retake the exam. These clinicians work in hospitals, birth centers, out of their homes, and in private practices. They perform complete evaluations and assessments of both mother and infant and create individual plans of care, working hands on with all breastfeeding challenges as well as more complex health issues.
*Sidenote: I took the IBLCE exam this past July and am waiting on my results, which will be mailed in October.  Fingers crossed! :)

RLC - Registered Lactation Consultant - This credential is used in conjunction with IBCLC within the United States.

CLE - Certified Lactation Educator - CLEs have completed a 20-hour course on breastfeeding support and completed approximately 25 additional hours of out-of-class coursework which culminates in a certificate of completion from CAPPA. CLEs are trained to teach breastfeeding classes and answer basic breastfeeding questions, however, they must refer out to IBCLC for more complex cases and are not trained for hands on consults.

CLC - Certified Lactation Counselor - CLCs have completed a 45 hour course of education, culminating in a certificate of completion, sometimes after completing an end-of-course exam, from The Center for Breastfeeding. They are trained to counsel on normal breastfeeding situations and troubleshoot minor challenges, however, they must refer out to an IBCLC for more complex cases and are not trained for hands-on consults.
*Sidenote: I completed this course as a stepping stone towards the IBCLC. I highly recommend it for any doula or childbirth educator who wishes to hone in on their lactation support skills, or anyone who's considering sitting for the IBLCE exam.

CLS - Certified Lactation Specialist - Similar to CLC, CLSs certify through Lactation Education Consultants by attending a 45-hour course and completing an end-of-course exam. They are trained to educate, support, and counsel mothers on normal breastfeeding situations, however, are not qualified to perform hands-on consults or administer clinical plans of care.
*Sidenote: I know of several doulas who have spoken very highly of this course as a supplement to their doula services, or as a stepping stone to the IBCLC.

BEC - Breastfeeding Educator Certification - Those who hold a BEC have completed an intensive course of study with Birth Arts International. Prospective BECs complete a lengthy in-classroom or self-study course on the science of lactation, anatomy and physiology, pedagogy, sociology, medical terminology, and counseling. They must also complete 600 hours of supervised lactation support in varying clinical settings in their communities.  The BEC certification is community-specific and qualifies students to teach, support, and educate the public on breastfeeding and related issues and policies. 

BC - Breastfeeding Counselor - A relatively new organization, Breastfeeding USA certifies mothers to lead free, highly accessible support groups for breastfeeding mothers. They answer questions regarding normal breastfeeding situations, offer tips for troubleshooting challenges, and refer out to IBCLC support when indicated. 

LLLL - La Leche League Leader - La Leche League International is the oldest breastfeeding support organization in the country, now offering support groups all over the world. LLL leaders receive a multitude of training in normal breastfeeding situations, offering tips for troubleshooting challenges, and know when to refer out to IBCLC support. Offers mom to mom support in a casual and accessible environment. Many IBCLCs started as LLL Leaders.

WIC Certified Breastfeeding Peer Counselor - WIC CBPCs are employed by state WIC offices and provide support to breastfeeding mothers who qualify for WIC at no additional cost. While the requirements vary state by state, WIC Peer Counselors are mothers who have breastfed themselves and have completed comprehensive study in breastfeeding management, counseling, cultural diversity, and education.

Our Foreskins, Ourselves

A number of people have asked me my opinion on the new American Academy of Pediatrics statement on infant circumcision, released today. But y'all know I'd have my opinion out there even if I hadn't been asked, so here it is:

• The background: It appears the AAP has taken the same body of evidence they've used for the past 13 years plus one new study and somewhat reversed their stance. Despite the hype that the AAP now "recommends" routine circumcision, what the AAP has done is take into account one new study on HIV transmission and is now saying that "the benefits may outweigh the risks." While this is a stone's throw from actually recommending routine male circumcision, it's close enough, and future parents will take it to heart.  Sidebar: The AAP is now the only major pediatric association in the world that does not clearly oppose routine infant circumcision.
  
• While they have added a single study on HIV transmission, the study they are actually referencing cites VOLUNTARY male circumcision, as in, by choice at an adult age, in areas of the world where HIV rates are astoundingly high. This has led to the idea that circumcision at birth somehow protects men from contracting STIs later in life. However, among industrialized countries, the U.S. ranks high in both STI transmission rates (including HIV) and percentage of boys circumcised at birth. In other words, we don't even have correlative evidence to back up this claim. Of course STI transmission is a big concern to me personally, but I don't see how removing a functional part of a boy's penis at birth is going to somehow protect him from contracting an infection later in life. To address this issue, I'd advocate instead for a) comprehensive sex education in schools, b) more funding for youth programs that encourage and increase access to safer sex practices, and c) a society that isn't so sex-negative that things like condoms and penises can't even be discussed in a frank and honest manner.
  
• Regarding the "penile cancer" risk: Penile cancer is extremely rare. When it does occur, it usually manifests in what we call the "foreskin" of the penis. So by removing the foreskin at birth, a male infant will grow up to be less likely to develop a cancer that he was already unlikely to develop in the first place. By this logic, we should also be removing the breast buds of baby girls. Think about it... breast cancer manifests in the functional breast tissue, the basis for which is present at birth. And seeing how breast cancer is far more common than penile cancer, we should be taking every possible precaution. We'll do it when they're two days old, so they won't remember it. We'll use anesthesia, so they won't feel it. And if they want to have kids later in life, well, they can just feed their babies with infant formula. And besides, women can still get some sexual pleasure without their breasts being involved. (See how ridiculous this sounds?)
  
  
• This is just speculation, but... given the fact that more and more insurance companies (and Medicaid) is seeing infant circumcision as a cosmetic procedure, they tend to not cover the costs. Perhaps the AAP is changing their position so they can continue performing the procedure regularly (cough cough cha-ching cough cough). Again, just speculation.

At this point, the sex-positive person in me wants to rail on and on about the sexual implications of removing the nerve-rich foreskin at birth, but instead I'll let Laci Green break it down for us:



Further Reading:
Doctors Opposing Circumcision: Commentary on American Academy of Pediatrics 2012 Circumcision Policy Statement (pdf)
Intact America
The Whole Network

A Letter To The Guy Who Catcalled Me In Front Of The Harris Teeter

Or, A Day In The Life Of A Female Body Living Under Patriarchy

Dear Potential Rapist,

You watched me approach the store entrance while lighting your cigarette. I made eye contact with you and possibly ventured a smile, something my Southern nature tells me to do when passing by even the strangest of strangers. You clearly took that as an invitation, nodding, raising your eyebrows, and saying something to the effect of, "Hey there you lil' gorgeous thing, what you lookin' for this afternoon? A good time?"

I wanted to turn to you and respond that I was lookin' to buy some groceries so my partner and I can eat tonight. Tell you that my polite nature is not an invitation to harass me. Then I wanted to ask what you thought would come of it. Did you think I would jump into your car with you? Have mad anonymous sex with you because you're clearly just that hot? Or does harassing random women do enough for you? Does it make you feel like a big man, worthy of respect in a society that offers you little based on your race and socio-economic status?

But I said none of these things. Instead I averted my eyes, dropped my gaze, and hurried into the store where my every move would be caught on security camera.

See, I'm a pretty strong person. I generally stand up for myself and others without blinking an eye. I regularly assist women through long labors without hardly sitting down, let alone sleeping. I have held my own in arguments on complex and controversial topics ranging from abortion, queer lib, rape culture, etc. I've even used my body as a human shield between abortion patients and groups of people who very possibly want me dead.

But you forced upon me the kind of vulnerability from which even the strongest of women are so often unable to recover. As much as I would have loved to turn around and tell you what's what, the threat of further verbal - or worse, physical - harassment turned me into little more than a timid schoolgirl, and I was silenced. So if that was indeed your goal, congratulations.

When I exited the store, you were still there.  My heart skipped a beat as you stood up from the bench where you had apparently been sitting, waiting. A thousand different thoughts flew through my head at once: would someone really attack a woman in broad daylight, and if so, would bystanders respond? Do I remember the defensive maneuvers I learned in RAD almost a decade ago? Could I take you myself, or will I need to scream for help? And finally, I wish I was wearing better shoes. 

I then considered my knee-length skirt and form-fitting tank top and wondered if your good-for-nothing defense attorney would be able to argue that I was asking for it. Imagined the people who would question why I made eye contact with you in the first place. Recalled every last email my mom has sent me with tips for avoiding an attack. Wished I hadn't scoffed at them.

I walked across the shopping center faster than usual, covertly using storefront windows to see if you were following me (a trick most of us have learned by necessity). You weren't there, but I only breathed a sigh of relief when I got into my car, closed the door, and immediately locked it like I always do.

In a way, I think I should thank you for not letting me go a day without a stark reminder that rape culture exists. This wasn't the first time this has happened to me, and it won't be the last. Young women aren't taught that these things might happen to them... we're taught that they will. And it's a survival mechanism, a societal bandaid that helps us prepare for and avoid potential attacks without ever really asking why these things happen in the first place.

But let me not pass judgment. It's quite possible you've never truly raped a woman in your life; your predatory activities could very well begin and end with street harassment. But I (and whoever else you've catcalled) don't know that. To us, you and all men are potential rapists, and your decision to make unsolicited comments about my being a "gorgeous little thing" doesn't exactly help your case.

See, you may never have stopped to consider how your actions are perceived. And in many ways, you will never fully understand the impact of them. To you, street harassment may at worst embarrass us, gross us out, or make us roll our eyes while giving you a funny story to tell your guy friends later. You need to know, however, that rape culture exists in a continuum. You do not need to physically rape a woman in order to make her afraid of being raped... we're socialized to view you as a potential rapist, and any action that seeks to sexualize, objectify, or threaten us without our consent may be perceived as a precursor to the worst possible end. 

Something to think about.

Sincerely,
Your Potential Victim

Friday Musing: Something To Think About Edition

When I went to urgent care after stepping on a sharp metal object in the driveway (thanks dear!), I was told I should take a round of antibiotics.  The doctor was nice enough, informing me that the antibiotics would interfere with my contraceptive method, and therefore I should use a backup method for the next month.

It was nothing I didn't already know, and yet I left thinking, "That's not the way I would have phrased that."  Okay, I say that a lot.  Obviously I'm the kind of person with certain ideas about how health care should and should not be.  But I really mean that here... that is not the way I would have phrased that.

Last week, the Affordable Care Act went into effect, giving women specifically increased access to health care and support.  While the health care bill has obvious short-comings, women's health advocates celebrated the accomplishment, primarily the new contraception without copay rule that will benefit many (but not all) women using birth control.

Don't get me wrong... increasing economic access to a range of birth control methods is awesome.  It absolutely should be lauded as a great accomplishment for sexual health.  But what's left to battle over are the other barriers.  Social stigma, attacks by religious institutions, and a lack of access to education all shape our society's relationship with birth control, not to mention a common issue that is very often overlooked completely: lack of partner support.

Because it's so hidden, it's difficult to gauge how many women are in relationships that impede their ability to use consistently effective birth control.  Birth control sabotage is particularly common in abusive relationships, the idea being that a person is less able to leave the relationship if she is kept in what amounts to reproductive slavery. Abusers don't always covertly sabotage contraception to force pregnancies on their partners; intimidation, threats, or simple unwillingness to use a condom all create significant obstacles that mere co-pay free contraception is not about to remedy.

Given its potential to go unreported, health care providers need to be able to create a plan of care that can work with or around a patient whose partner is unwilling (or just refuses) to play an active role in safer sex practices.  Today many reproductive health clinics (such as Planned Parenthood) staff providers who are able to do this, helping patients choose a method that cannot be sabotaged or, in some cases, even detected by an intimate partner.  But many general health practitioners - particularly those from "the old school" - fall short of even recognizing this as a potential issue.

So back to my doctor's health counseling.  "You should use a backup method for the next cycle" isn't at all inaccurate.  It's actually good information, clearly stated and with little room for confusion.  However, his counseling in no way acknowledged the fact that using a backup method might be out of the question for me. 

What if he phrased it, "You should use a backup method for the next cycle, is that going to be a problem?"  To be sure, the majority of his patients would have said, "No, that's not going to be a problem," and maybe wondered why he thought it might be.  No harm done.  And the ones who would potentially have a problem would be given the opportunity to say so, possibly receiving advice to prevent pregnancy or even some resources to help them change their situations. 

Health care providers need to be at the forefront of these conversations.  We entrust them with our confidential information, knowing our intimate details are protected by law and by their oaths.  They need to be able to first see if they can help patients get out of abusive situations, but they also need to know that getting out is not always possible, and therefore working within those situations to reduce harm may be the best conceivable option.

Women who wear the hijab are being oppressed by the patriarchy. Ima rock this corset now.

It started out innocently enough: the Facebook page for a mainstream feminist group featured an image of Team USA fencer Ibtihaj Muhammad, the first American woman to compete in an international competition while wearing a hijab.

You know where I'm going with this, don't you?

Oh yes, it happened.  Before I even clicked "view all comments," I knew what I'd find.  And sure enough, I found it:

•  "That's awesome.  Too bad she feels the pressure to cover though.  Damn patriarchy."
• "Good for her! But I can't get past the covering. Poor woman."
• "I hope she wins gold!!  And can be empowered enough to stop having to cover!!!!"

It's really the defining trait of liberal/reformist feminism: privileged Western white ladies having clear-cut ideas about what does and does not constitute oppression, never taking issues of race/class/ethnicity/gender identity into the equation, all the while failing to see where or how they specifically fall into the role of oppressor themselves.  And they just can't shut up about the hijab.  I mean, the second comment says it all, "I can't get past the covering."

I actually engaged that specific commenter in a private conversation, because I do that sometimes.  I've become more particular about who I will engage in deeper-level conversations about privilege and oppression, because let's face it, when you go into an argument with a rabid antichoicer about the morality of abortion, it's just never going to be productive.  But seeing how this particular woman was at least a feminist, I figured what could be the harm.

And it was good.  We had some decent exchanges of ideas and both came out having earned a slightly different perspective on some things.

Then I clicked on her profile.  She had a few photos public, and the ones I could see featured a person, I'm assuming her, dressed up in a corset, fishnets, and heels.  Don't get me wrong, she looked amazing.  If I'd been out and seen her walk by, my reaction would have been one of "hot damn she looks good."  And I'm not one of those feminists who thinks that donning a corset sets women's liberation back three or four decades... while I don't own a corset myself, I have been known to occasionally rock some sexy stuff that would make Andrea Dworkin cringe.

But you must understand that this person made some very scathing comments about how a woman's decision to wear a hijab can never be free of patriarchal influence.  She was very clear about that, even echoing one of my personal favorite talking points: we don't live in a vacuum. It's beyond me, really.  Here's this intelligent woman expressing her discontent with another culture's patriarchal standards while at the same time proudly playing into a centuries-old standard of her own.

I mean obviously it goes back to intersectionality.  There are tons of feminists who believe that they never "buy in" to patriarchal standards with their appearance, but a woman who simply covers her head and hair because of religious tradition has zero autonomy in the matter.  It goes back to our deep-seeded racism and Islamaphobia that, admit it, exists in the majority of us on some level, which is deeply problematic.  For one, it's ignorant: few people who criticize the hijab actually know why it's worn. We're told, mostly by American-based media, that such coverings are required by law in all those mean evil Middle Eastern countries and that's bad.  We pretty much leave it at that.  Secondly, it assumes that we in the United States live in a post-patriarchal society where we've "moved past" all that sexist stuff.  Putting on a vintage-inspired apron and baking cookies for your boyfriend doesn't mean the same thing that it meant 50 years ago... goodness no, the systematic oppression of women - at least in our forward-thinking society - is a thing of the past.  (That's post-feminism, baby!)

Lastly, it's paternalistic.  Liberal/reformist feminists continue to buy into the idea that privileged Western white ladies need to be the ones to "save" other women (Muslim women specifically) from themselves.  This is nothing new... white feminists have been doing this since feminism was feminism. (If you haven't read White Women's Rights by Louise Newman, that should be added to your reading list.  Like now.)  Co-opting the neocolonialist language of our government, these women assume that liberation is something that needs to be given to the women of the world, not something they can achieve for themselves in a way that will jive with their cultures.  Worst of all, no one even attempts to ask Muslim women whether or not they feel oppressed by wearing a hijab, and if they do, they question one or two women of color to gain the appearance of inclusitivity by means of tokenism.  

So my feminist friend "feels bad" that Muslim women are "pressured" to don "unnecessary and uncomfortable articles of clothing" because of patriarchal rule.  I'm picturing the modestly-dressed Muslim women of the world peering at her Facebook pictures, thinking much the same thing.

Overheard at Urgent Care

While awaiting my Tdap injection at urgent care today, I overheard a troubling conversation.  This specific care center has curtains instead of doors closing off exam rooms, so I was able to hear the situation fairly clearly.

A woman had come in with what I understood to be a very serious GI infection.  She had a fever of 103* and was experiencing nausea, chills, and severe dehydration.  After an initial consultation with the doctor, it was advised that she immediately commence a regimen of a certain antibiotic.  She said she'd first have to see if that medication was on the $4 prescription list at Wal-Mart's pharmacy; a quick call by a staff member on her behalf confirmed that this specific medication was not on their $4 prescription list.  The doctor spent a few minutes discussing with her alternative treatment options that would involve a higher dosage and more side effects on top of being less effective, but may be on the pharmacy's low-cost prescription list regardless.

At this point the LPN came in to get my Tdap authorization form, so I was unable to really hear what was going on in the room across the hall.

However, by the time I left the situation had gotten worse.  I'm not sure exactly what they discovered, but it seems no effective medication could be found for a price that fit her budget.  She said she would take the prescription slip and get it filled when she got paid.  On Tuesday.  The doctor became very stern and told her that this specific infection can become fatal very quickly.  It needed to be treated immediately, so beginning on Tuesday was out of the question.

By the time I left, they had made a plan of action: the woman was to be admitted to Moses Cone so that she could be treated today without having the immediate funds to pay for it.  This will end up costing her (and her insurance company) thousands more, however, it appeared to be the only way this woman would be treated in a timely manner, possibly saving her life.

I'll admit I don't have all the information here.  Part of me thinks if I'd just walked over and handed her $4, she'd have been able to get her medication today and avoid admission to a hospital.  But maybe not.  Like I said, I wasn't an active part of the conversation, this was just what I overheard.  And given how helpful the staff at the urgent care was being, my guess is that they'd thoroughly explored all other options before referring her to the hospital for treatment.

This is our health care system, folks.

The Humorless Feminist

Yeah, that's right.  I'm weighing in on the Daniel Tosh clusterfuck.

See, when one speaks out against the use of sexism in comic routines, they risk being labeled "one of those feminists without a sense of humor."  The humorless feminist stereotype has been a cultural archetype since the radical feminists of the 1970s first spoke out against using women's disenfranchisement to make a joke. 

Many people continue to tell themselves that rape jokes are not only okay, but they're also funny and don't do anything to perpetuate rape culture.  We've somehow come to allow ourselves the privilege of invoking gender oppression for the sake of humor, all the while telling ourselves that sexism, misogyny, sexual assault, and partner violence are things of the past (or at least don't exist in our own social circles).  However, in a country where 20% of women report being sexually assaulted, where the gender wage gap still exists as prominently as it was decades ago, and where our government continues to legislate our bodies and sexualities with ease, how can even the most light-hearted jab not reaffirm our society's commitment to gender discrimination? 

This kind of humor has really become popular in self-described "enlightened" circles.  Maybe a person fancies himself a feminist and supports the right to choose.  He probably condemns wage discrimination and treats his female friends and partners as equals.  He may have helped organize Take Back the Night events, and he may speak loudly about the importance of consent.  From this, he may feel he's "earned" the right to make a rape joke or two; after all, he would never rape anyone, so what could really be the harm?

What he doesn't realize is that the women in his extra-enlightened, uber-sex positive and politically radical social circle are just as likely to have experienced sexual assault as the women in the repressed circles he and his friends love to scoff at.  That means that, for every rape joke he tells, 20% of his female friends are forced to hear the worst thing that's ever happened to them turned into a mechanism for cheap laughs.  Worse yet, the ever-present stigma of being a sexual assault victim means that these women are unlikely speak up, lest they become labeled "humorless feminists" who allowed themselves to be raped.  Even the playful jabs of "bitch make me a sandwich" smack of regressive social norms and help to maintain the constraints of male dominance.

Not wanting to be left on the sidelines of social clout, women themselves often become complicit in the maintenance of rape as an acceptable source of humor.  For us, it's even harder to unpack.  After all, haven't we, the clear majority of sexual assault victims, also "earned" this right?  We face the threat of sexual assault every single time we work late and have to walk to our cars alone.  We worry about stopping for gas late at night.  Our hearts skip a beat when we're in the shower and think we hear someone in the house.  We're warned from early childhood about getting into cars with boys, accepting alcoholic beverages at parties, wearing clothes that show too much skin, dancing a certain way, etc.  Why not take this horrendous reality and laugh the weight off of it once in a while, if only while in the company of other women?

I struggled with this one for a while, then I finally realized that, at least in my experience, the opportunity to make a rape joke never really comes up in all-woman gatherings.  It's not that we were censoring ourselves: the compulsion simply isn't there.  From this I can only conclude that jokes about sexual assault exist almost exclusively in rooms where male privilege dominates, and let's be real, male dominance exists even inside groups of anti-sexist wingnuts.

And yet we refrain from speaking up against it, lest we become "the oppressors" ourselves.  How dare we police someone else's god-given right to free speech?  I mean what is this, Nazi Germany?  This is perhaps the most frustrating (and most difficult to refute) accusation, the one that probably silences us more than anything else.  By turning the language of oppression against us, we become the bad guys while they continue perpetuating rape culture under the guise of "freedom of expression."  And with that, we continue to be silenced.

Let me get one thing straight: I have a phenomenal sense of humor.  It's actually a bit warped, which makes some people uncomfortable.  I use the word "fuck" a whole lot.  I enjoy incredibly raunchy jokes, especially those that take an ounce or two of intellect to fully appreciate.  In proper circles, I can make a whole group cringe, laugh, then cringe some more as they add my side-splitting anecdote to their own humor arsenals.  Best of all, I can do it all without having to use sexist or racist language.  That's the opposite of having "no sense of humor." 

My question is, how bad is your sense of humor that you have to turn to years of social injustice to get laughs?  How bad is your vocabulary that you have to use sexist slurs to make a point?  And how lacking in whit are you that you have to use one of the worst possible things that can happen to a person just to make a joke?