Hear me roar

After a few weeks of caring for her precious first-born baby, my friend Fig declared, "Motherhood is blood, sweat, and tears. Rinse and repeat." Are you nodding and chuckling at the same time? Fig's good at inducing the chuckle-nod. She's so witty. And right on.

So I've been thinking, of late, about how I focus so much on the intense physical challenge of labor (some, including me, call it "pain") that I have sort of neglected to give attention to other physical "pains" associated with bearing and nurturing children. For example...

* The cramping associated with ovulation and/or menstruation is painful for some women.
* PMS can cause painful bloating, headaches, etc.
* Love-making is painful for some women.
* Some women experience round-ligament twinges and/or cramping in early pregnancy.
* Morning sickness can range from mildly bothersome to excruciatingly miserable.
* Some pregnant women suffer with back pain, sciatic nerve pain, joint pain, etc.
* Preterm labor pains keep some women on bed rest for weeks or months.
* Then there are the after-pains (I think they get worse with each birth... wowza!).
* Some women endure general perineal tenderness, pain from perineal tears/episiotomies, or cesarean section wounds.
* Breastfeeding hurts like the (toe-curling) dickens in the beginning, being compounded initially by painful breast engorgement, painful milk let-down, and more intense after-pains due to the uterine contractions produced by suckling.
* The muscle strain from carrying around a 5 to 10 lb newborn can lead to sore arms and/or sore backs, especially with a first child.
* Once an infant has teeth that introduces a whole new kind of potential pain during breastfeeding.
* Back pain can continue and intensify from carrying increasingly hefty babies and toddlers.
* Rinse and repeat.

(And that's not even getting into the emotional pains we endure.)

The other day a first-time pregnant woman I love told me she's pretty sure she'll get an epidural 'cause she's (and these were her exact words) "such a pansy." I couldn't help myself... I rushed toward her, grasped her face in my hands, and said, "No! You're not!" This woman has endured excruciating menstrual cramps every month for over a decade followed by miserable morning sickness for the last couple of months... and she thinks she's a "pansy!"

Look at the list above, ladies. Take a good, long look at it. Do you really think God would entrust those challenges to a bunch of pansies?



Nope.

We are women. We are strong. We can push ourselves to our absolute limit and somehow find the strength to push some more. And then rinse and repeat.

Don't you dare call yourself a pansy. 

 (Photo by Fife Photography, Fall 2005)

Dolphins and Birth Plans

While I was in California a few weeks ago, we hit the beach. Almost as soon as we got there, we saw something swimming several yards out in the water. At first I didn't know what it was and sort of screamed (thinking shark), "There's an animal!" Once it became clear it was a pod of dolphins, I had to smile to myself, reminiscing.

I used to be mildly (or... very) obsessed with dolphins as an adolescent. I had dolphin figurines, dolphin stuffed animals, dolphin posters, dolphin videos, dolphin stationary, dolphin everything. I did book reports about them, dreamed of swimming with them, toyed with becoming a marine biologist because of them, etc.

I was reminded of that adolescent dolphin fascination again this morning.

Years ago, my sister saw Marsden Wagner's Creating Your Birth Plan at Overstock.com for cheap and, knowing my passion for all things birth-related, she told me about it. I had never heard of the book itself, but I knew simply because it had Marsden Wagner's name on it that it was a book worth having. So I ordered it, and it has basically been collecting dust on my bookshelf ever since.

About 2 weeks ago we got word that my sister-in-law is pregnant after years of infertility. I'm ecstatic for them. And, naturally, I'm feeling protective of her and wanting to do all I can to ensure that she has the best birth experience possible. So I was perusing the birth books on my shelves about a week ago, contemplating which one(s) I should lend to her first, and I pulled out Creating Your Birth Plan, thinking it might be a good one to start with (especially since it has an M.D. in the by-line). As I flipped through the book, however, I realized that I'd probably better read it before I lend it out to anyone, just so I know what I'm sharing with people.

(I lent her Penny Simkin's Pregnancy, Childbirth, and the Newborn and The Birth Partner instead. Her husband's currently in physical therapy school, so it seemed fitting to start them off with the words of a fellow PT.)

So I've been skimming through Creating Your Birth Plan off and on over the past week or so. This morning I lingered on p. 176 where Dr. Wagner shares some fascinating details about dolphin birthing. Here's an excerpt:

At its physical and emotional best, support for women in labor has always reminded me of dolphin birth. When a dolphin gives birth to a calf, several female dolphins swim in a circle close to the laboring mother. Slightly farther away, another larger group of all the remaining females in the pod circle around the laboring dolphin. Then, even farther away, all the male dolphins in the pod circle around her. The entire collective comes together to protect the laboring dolphin and her emerging calf from intrusion and harm. A woman giving birth to a baby thrives when she's at the center of a circle of love.

This prompted me to do a google search and discovered that there are actually places where women give birth in the water "assisted" by dolphins.

A Russian male midwife, Igor Charkovsky, says this about the practice: "Dolphins have an affinity with the baby in the womb and are automatically attracted to pregnant women. They sense when a woman is about to give birth and gather round. They give both the mother and child a sense of protection and safety" (source).

I've been mulling over the topic of birth partners in preparation for writing something for the book, so this dolphin stuff feels relevant. And it has reminded me, yet again, how crucial it is for women to have supportive people around them as they give birth. The people we invite or allow to be with us can make or break our birth experiences. I recently encountered a 2005 study indicating that there is a strong correlation between patient satisfaction with care provider and lower cesarean rates. And Penny Simkin's research has demonstrated that the women with the highest long-term levels of satisfaction with their birth experiences were the women who had positive memories of the way they were treated by their care providers. Which brings me back to birth plans.

I think writing a birth plan is a helpful exercise. But I think most women do it too late in the game. A birth plan will do little to help you if the care provider and place of birth you have chosen have a practice style totally incompatible with it. In my opinion, the time to write your birth plan is before you ever choose a doctor or midwife (which is why I toyed with giving my sister-in-law Marsden Wagner's book now). I can't stress enough how important it is to choose the right provider--someone who will support and respect your birth preferences and shares your personal philosophy of birthing. You'll know you've found the right provider when you know you don't need to give them a copy of your birth plan when they arrive to catch your baby. Birth plans, at their best, aren't for labor day, they're for doctor/midwife interviews. Unfortunately, most women don't approach the doctor/midwife selection process this way. Hence, there are far too many battles in the labor room where peace and joy should prevail and far too many cruel jokes among doctors and nurses about "those women" with birth plans. Alas.

Given how protective I feel of my pregnant and laboring loved ones, I suppose it's no surprise I grew up with such an affinity for dolphins. I wish I could circle protectively around them throughout their pregnancies and births as the dolphins do. Maybe if I ever start an official doula business, I'll have a dolphin logo? That would be cool.

For them I could

Sometimes I feel like it's inevitable. I'll probably end up a midwife, in the end. But most of the time I don't really look forward to it. It terrifies me to imagine holding the lives of women and babies in my fallible human hands. I don't really want to be a midwife. But I've been thinking lately of some facts and figures that just might be enough to propel me forward on the path toward midwifery.

First, my cousin-in-law, Liz, wrote a blogpost discussing the book Half the Sky. She shared a couple of excerpts that have been reverberating through my skull ever since:

In much of the world, women die because they aren't thought to matter. There's a strong correlation between countries where women are marginalized and countries with high maternal mortality. Indeed, in the United States, maternal mortality remained very high throughout the nineteenth century and beginning of the twentieth century, even as incomes rose and access to doctors increased. During World War I, more American women died in childbirth than American men died in war.... 'Women are not dying because of untreatable diseases. They are dying because societies have yet to make the decision that their lives are worth saving.' (p. 115-116)

"More women die in childbirth in a few days than terrorism kills people in a year." (Jane Roberts, letter to San Bernadino Sun, qtd. on p. 146)

Then, last night, my brother-in-law watched a PBS segment on maternity care in rural Peru. He thought I'd be interested, so he passed along the link to me. Last year, CNN reported that Peru's pregnant women were "dying at scandalous rates"(source). Yesterday, PBS shared some of the solutions that are being implemented to reduce the mortality rates in Peru's remote areas. The segment starts with this intro:

High in the Andean Mountains of Peru, far from the modern conveniences of a city, generations of indigenous women have given birth at home, their only help from family or a village midwife.

The longstanding tradition of childbirth at home wasn't a problem for most women. But, in that small percentage of cases where complications developed at the end of a pregnancy, in a remote rural area, you could be days away from the nearest medical facility on foot, even multiple-hours' drive.

(Screenshot from the PBS segment)

I've been studying childbirth for the past seven years, but most of my reading and research has revolved around maternity care in the U.S. Although we still have a long way to go here in the U.S., our risk of dying in childbirth is far lower than the risk most women of the world face. I think I could feel content remaining a doula/birth activist if the rest of the world didn't exist. But it does exist.

The World Health Organization puts things into persective:

Every minute, at least one woman dies from complications related to pregnancy or childbirth – that means 529 000 women a year. In addition, for every woman who dies in childbirth, around 20 more suffer injury, infection or disease – approximately 10 million women each year.(Source)

Far too many women die simply because they lack "skilled care during pregnancy, childbirth and the first month after delivery," according to WHO.

While I don't feel compelled to become a midwife for my fellow American sisters, I do think I'd be willing to shoulder the risks inherent in midwifery in order to help save the lives of women in places where maternal deaths are excessively common. For them I could do it.

Unfortunately, those who are able to help these women often lack the ability to communicate in indigenous languages. I have a deep love for languages and have always wanted to learn to speak more of them. I've also always wanted to travel to Africa, South America, and other far-off places. I couldn't think of a better reason to fulfill those dreams. Someday down the road... I hope.

A Year Ago Today

Happy First Birthday to my little April Fool.

At this moment a year ago, he was still squirming around inside my belly, and now look at him...Happy Birthday to you, my little first-home-born baby boy! I love you more than I ever could have dreamed I would.

For all the nitty gritty birthing details, see here.

To learn more about why I chose a home birth, see here.

To read about my midwives and their training, experience, and stats, see here.

Ask Busca: Iron and Vitamin D suppplementation for infants?

Ali, a nursing student, asked:

[The teacher of my nutrition class said] that babies who are breast fed will likely need an iron and vitamin d supplement. This makes absolutely no sense to me, because breast is supposed to be best, so why would anything need to be supplemented. The teacher said because the baby stops living off of it mothers iron stores at four months, and so that is why, but do they not get enough from the breast milk. I would just think that if the mother was eating healthy that the baby would not need to be supplemented on anything.

Busca's (excessive) babble:

Thanks for your question, Ali. So sorry it has taken me nearly 6 months to finally give you a response! I'm not a doctor, nurse, dietician, or nutrition expert, but I do love to dig around and see what I can find to help my readers out. So here's what I dug up in regard to iron and vitamin D supplementation...

Iron Supplementation

I knew kellymom.com would probably have something to say about it. And, indeed, she does. In fact, she has so much great info over there, that I'm just going to direct you to her site where you will find just about everything you could possibly want to know on the subject of iron supplementation. Here's a brief excerpt:

Healthy, full-term infants who are breastfed exclusively for periods of 6-9 months have been shown to maintain normal hemoglobin values and normal iron stores. In one of these studies, done by Pisacane in 1995, the researchers concluded that babies who were exclusively breastfed for 7 months (and were not give iron supplements or iron-fortified cereals) had significantly higher hemoglobin levels at one year than breastfed babies who received solid foods earlier than seven months. The researchers found no cases of anemia within the first year in babies breastfed exclusively for seven months and concluded that breastfeeding exclusively for seven months reduces the risk of anemia.

The original recommendations for iron-fortified foods were based on a formula-fed baby's need for them and the fact that breastmilk contains less iron than formula (doctors didn't know then that the iron in breastmilk is absorbed much better). Also, a few babies do have lower iron stores and will need extra iron at some point. . . .

La Leche League recommends that babies be offered foods that are naturally rich in iron, rather than iron-fortified foods. . . .

Note: Additional iron intake by the mother will not increase iron levels in breastmilk, even if the mother is anemic. Iron supplements taken by mom may produce constipation in baby. Anemia in the nursing mother has been associated with poor milk supply, however.

Learning about baby-led weaning really changed the way I saw iron supplementation. My first two daughters had iron-fortified rice cereal before 6 months of age, but my son was exclusively breastfed without any supplementation for 6 months. Afterward, he simply ate whatever offered foods he managed to get into his mouth. But I never worried about his iron levels.

Vitamin D Supplementation

As for Vitamin D, there was a recent news article on the subject that caught my eye and prompted me to finally tackle your question. USA Today reported on a couple of studies published in the journal Pediatrics related to infants and vitamin D. Nicolas Stettler, a pediatrician interviewed in the article, acknowledges, "Because humans originated in equatorial areas with year-round sunshine, babies in the distant past wouldn't have needed to get vitamin D from breast milk," but, according to the second study from Pediatrics, 58% of infants today have deficient vitamin D blood levels. It also reported that "Getting lots of sunlight helped raise vitamin D levels in moms, but not in their newborns." (It was unclear to me whether they meant that the mother and baby were both exposed to sunlight or whether they meant that sunlight didn't improve the vitamin d levels of breast milk.)

I have to wonder when I hear that breast milk is "low in Vitamin D," whether that really just means that mothers themselves have been low in Vitamin D for decades leading researchers to conclude that breast milk is always low. I've read elsewhere that Vitamin D supplementation will increase the Vitamin D content of breastmilk, so I think that's worth exploring. Maybe breast milk isn't inherently low after all?

I am partial to Vitamin D expert, Michael F. Holick, who has been researching Vitamin D for more than three decades. The home page of his website has some great info on Vitamin D:

Vitamin D is not a vitamin but a hormone. It is unique in that it is made in the skin as a result of exposure to sunlight. Photosynthesis of vitamin D has been occurring on earth for more than 750 million years. Some of the earliest life forms that were exposed to sunlight for their energy requirement were also photosynthesizing vitamin D. Both children and adults have in the past depended on adequate sun exposure to satisfy their vitamin D requirement. It is well documented that at the turn of the last century upwards of 80% of children in the industrialized, polluted cities of northern Europe and northeastern United States suffered from the devastating consequences of vitamin D deficiency rickets. The skin has a large capacity to make vitamin D. Exposure of a person in a bathing suit to a minimal erythemal dose of sunlight, which is typically no more than 15-20 minutes on Cape Cod in June or July at noon time, is the equivalent to taking 20,000 IU of vitamin D orally. It is now well documented that in the absence of any sun exposure 1,000 IU of vitamin D3 a day is necessary to maintain healthy levels of 25-hydroxyvitamin D in the circulation. An analysis of the NHANES III data has demonstrated that neither children nor adults are receiving an adequate amount of vitamin D from their diet or from supplements.

Holick is a strong proponent of sensible sun exposure. And so am I. I feel fortunate that I live in the Valley of the Sun where my children and I can go outdoors at any time of year most days and receive more than enough Vitamin D in ten minutes to keep our levels adequate. Even so, during times of the year when the weather keeps us indoors more often, I have mixed safe amounts of liquid vitamin D into my kids' yogurt or juice to keep their immune systems functioning and prevent illness.

(Getting a few minutes of backyard Vitamin D at lunchtime in February)

The American Academy of Pediatrics is opposed to exposing infants to direct sunlight. Personally, I think their recommendation is counter-intuitive. Human beings have been living with the sun for thousands of years (and without chemical sunscreens). We even took my newborn son outside for a few minutes every day (at my midwives' recommendation) because of his slight jaundice. Even after his slight yellow tinge had disappeared, I still took him with me outside in the early April morning sunshine while I watered my vegetable garden. He absolutely loved it. As soon as the sun's warm rays would fall on his face, his facial muscles would relax and take on a look of total peace and serenity. He always turned to face the sun no matter where I put him. And my instincts told me it was good for him. My gut tells me newborns need a few minutes of sunlight every day, just like the rest of us.I love the sun. I really think that human beings need regular sunlight exposure to survive. I don't generally use much sunblock on myself or my children unless we are in the sun for an extended period of time. I remember asking our pediatrician about the safety of sunscreens for infants when my first daughter was about 6 months old. He encouraged us to use hats, clothing, and shade rather than chemical suscreens. At the time, I was slow to take his advice and continued to use sunscreen. As I learned more about Vitamin D and safe sun exposure, my sunscreen use has decreased dramatically. Now we rely on hats, clothing, and shade to prevent sunburn (as our pediatrician recommended all those years ago). We all try to wear shirt-style swimming suits to keep our backs and shoulders protected. When we do use sunscreen, I focus on the areas most likely to sunburn--the nose, cheeks, ears, tops of feet, etc.While I wouldn't advocate spending large stretches of time in direct sunlight, I do advocate spending a few minutes every day (sunscreen-free) with some of your skin exposed to the sun, even babies. In places where sunlight is minimal in winter months, I also advocate taking Vitamin D supplements. I'm convinced that widespread Vitamin D deficiency is largely responsible for the "cold and flu season" phenomenon.

So what am I trying to say with all this Vitamin D babble? Yes, babies need vitamin D. How they get it is a personal decision mothers should discuss with their pediatricians. Personally, I'll echo what the Vitamin D council has to say:

Infants and children under the age of one should obtain a total of 1,000 IU (25 mcg) per day from their formula, sun exposure, or supplements. As most breast milk contains little or no vitamin D, breast-fed babies should take 1,000 IU per day as a supplement unless they are exposed to sunlight. The only exception to this are lactating mothers who either get enough sun exposure or take enough vitamin D (usually 4,000–6,000 IU per day) to produce breast milk that is rich in vitamin D. Formula fed babies should take an extra 600 IU per day until they are weaned and then take 1,000 IU a day, as advised below.

Children over the age of 1 year should take 1,000 IU per every 25 pounds of body weight per day, depending on latitude of residence, skin pigmentation, and sun exposure. On the days they are outside in the summer sun, they do not need to take any; in the winter they will need to supplement accordingly.

I hope that helps!

Speaking of loving the sun, this is one of my new favorite songs. I was introduced to it over our Spring break trip to CA when I attended a prenatal yoga class taught by my book collaborator, Felice. Love it! It's definitely going on my next birthing c.d.