Who's Gonna Pay If I Leave AMA

So a girl walks into a hospital...

Sounds like the start of a joke, yes?

Let's continue...

So, a girl walks into a hospital 'in labor'. She goes through triage, where they separate her from her birth team for 'a quick few minutes'. The check her cervix, she's 3cm. Her water breaks on the table while they're checking her. An hour later, she's 3cm and her contractions have fizzled. Her birth team still hasn't been reunited with her regardless of  her requests for them.

She notifies her nurse of the fact that she's planning on going home, getting freshened up, meet up with her husband, and they'll probably be back sometime later that evening.

The nurse says they can't leave. She says she's going to leave, even if she has to leave AMA.

The doctor says, that, if she leaves the hospital AMA, her insurance won't pay for her care.

I'm here to tell you that that is a lie.

We have a few possible reasons why they would say this:

1. they don't know any better and really believe this is true. After all, this has been perpetuated as an urban medical myth for quite some time. 
2. they know better but use this as a coercive tactic to keep mom at the hospital. 
3. they know better and have every intention of writing in the file to not bill insurance later so mom is footed with the cost in order to 'pay her back' for not following the doctor's orders. 

The truth of the matter is, I have seen all three as reasons in action. Once, I provided proof that insurance would indeed pay for a clients care even if she left at 24 hours postpartum 'AMA'. He was genuinely surprised and happy!

Many other times, I have seen them back pedal defensively when I bring up the same information with clients who want to leave AMA... getting angrier and more coercive.

And yes, I have actually seen it notated on one nurses file electronically after a mom asked the doctor for the paperwork to leave AMA. The doctor went to the nurse, said something in low tones to her, and left the room. The nurse typed in the notes section, "do not bill insurance as patient is leaving AMA". I called her out on it and the nurse blushed the deepest red. The doctor came back in and blamed it on the nurse, who erased the notes. Later, when mom had birthed and received her bill from the hospital, none of the stay had been sent to her insurance claims department; she called her insurance and confirmed. She called the hospital and they attempted to give her the run around about AMA and insurance declination. She had to have her insurance call the hospital to get it covered.

So, bottom line, yes, insurance will still cover you if you check yourself out AMA. For more information see below:

• http://www.ncbi.nlm.nih.gov/pubmed/22331399
• http://thehappyhospitalist.blogspot.com/2011/05/will-my-insurance-pay-if-i-leave.html
• http://www.amednews.com/article/20120705/business/307059997/8/
• http://www.epmonthly.com/whitecoat/2010/05/will-insurance-deny-payment-if-you-leave-ama/
• http://www.uchospitals.edu/news/2012/20120203-billing.html
• http://patients.about.com/od/atthehospital/fl/Choosing-to-Leave-the-Hospital-Against-Medical-Advice.htm

5 Reasons You Don't Need a Doula

You hear me tell you a lot about why a doula is a great choice in any birthing setting... what I haven't told you in awhile is why you don't need a doula. Let me take this opportunity to do just that. This isn't a long post. It's short and concise - as truth often is - and without explanation. So here you have it. 5 reasons why you don't need a doula:

1. You are strong. You are. You don't need a high pain tolerance or be a marathon runner to be strong, you only need a uterus and a humble respect for it. 
2.  You are capable. You are. Your mind is sound and your body is able, the last part of that equation is to allow those two things permission to do what they need to to give birth. 
3. Your body contains ancient and primal wisdom. Cellular memory, your mother's mother's mother's mother's birthing wisdom and knowledge, they are coursing through every fiber of you.
4. Your body contains immeasurable power. Only a female body can create, grow, and birth. 
5. You have everything you need within you. Tap into that innate wisdom, power, trust, honor, respect, and knowledge. 

This is your birth. 

What Not To Say To an 8+ Month Mama...

"When are you being induced?" (which implies the woman or baby needs it... or that she wants it)

"How far dilated are you?" (which gives no indication of how long labor will be or when you will go into labor, but can sure play with a woman's mind if she has 'nothing for show and tell')

"I can't believe you're still pregnant!" (which, I'm sure, makes her feel stellar..)

"Wow, that's going to be a big baby" (or anything akin to this statement - not productive - way to instill fear into a mama)

"OMG, you're huge!" (only when a woman is pregnant is this considered 'acceptable'.. and trust me, it's never acceptable from the pregnant woman's point of view)

"You haven't had the baby yet?" (well, let's see, if you can't tell if she's had the baby yet just by looking at her, you are either a) blind or b) rude)

"My friend had ____ happen to her and she/her baby almost _____" (yeah, not helpful, or happy, or productive, or educational, or supportive)

In times like these repeat to yourself the age old wisdom of mamas and grandmas:

"If you can't say anything nice, don't say anything at all"

Mother Roasting

sacramentonaturalbirth.com

The Chinese call it zuo yuezi. The Vietnamese, nam lua in. Mother Roasting. The term itself will either conjure up strange mental images of a woman in a stove, or will bring a smile to your face and comfort to your bones.

In the event you, like most women in our Western culture, don't know what Mother Roasting is, it is simply the practice of keeping a woman warm immediately after birth and in the first few weeks following birth. Cross-culturally, it is believed to seal up emotional, physical, and spiritual gateways that have been opened by birth. It is a way of protecting a woman's body, her newborn, and, as a result, nourish her back into being.

Cultural Perspectives

"Many anthropologists interpret the postpartum practices of traditional cultures as ritualistic methods of purifying unclean women after birth. Sometimes this may have been the case, but, in fact, most often these practices were likely done to support the mother in her transition and give her time To rest and bond with her baby (Lang 1987).

When looking at birth from anthropological perspective, it seems that women in traditional societies commonly not only had relatively easy births, but also enjoyed rapid and complete recoveries with minimal complications, especially in regard to postpartum blood loss. Also, rarely were there problems with breast-milk production (Lang 1987)." - Natural Health after Birth: Complete Guide to Postpartum Wellness by Aviva Jill Romm

Worldwide, women in all cultures are encouraged to lie-in during the weeks following birth, allowing other women in their community to take care of them, nourishing, massaging, binding, bathing, and loving on them. They treat the mother with reverence and respect, giving her a safe space to focus solely on her own bodies needs and her babies needs.

This alone, without any pomp and ritual, will help a woman to 'come back to' society quicker, by giving her grace and understanding to take a moment to claim and process the recent events and new life she is entrusted with.

In addition to the simplicity of nourishing a woman during her postpartum period, many cultures have specific practices, and sometimes even rituals, to honor this time. 

Women of Western culture, on the other hand, rarely find themselves given postpartum massage, rarely find their rooms warmed nicely, rarely practice binding, and, more often than not, are offered a cup of ice water and a cold pack for their bottom and are expected to get back to caring for their homes and guests within 3 days.

Practices Worth Considering
MASSAGE

Samhain Birth

Indian mothers are treated to warm oil massages (along with their babies) each day for the first 40 days after birth. Mayan mothers are also given daily warm oil full-bodied massages.

Some of the benefits of postpartum massage include realignment of tissues and ligaments (which can become stressed from the release of relaxin during pregnancy and the birth event itself) and stretching and drawing out of old blood from sore muscles used during the labor and birth event. Uterine massage helps to decrease postpartum bleeding and alleviates discomfort from afterbirth cramping.

Additionally, muscular massage helps to alleviate tension and discomfort associated with the over-worked, tired, or strained muscles used during the act of birthing.

FEEDING

Korean Seaweed Soup. Photo by Damien Maloney

Almost every culture has certain beliefs surrounding feeding mom postpartum as well. Almost all of them include meals that are warm, nourishing, high in protein and iron, specific to healing, or great for lactation.

Ancient Ayurvedic traditions (5,000 years ago) are still played out in many Indian cultures, where mom and baby are given clear broths and warm oiled meats for the first weeks following birth. In China and other Asian cultures, ‘hot’ foods, like boiled eggs, chicken, warm sesame oils, fish soups, seaweed soups, and clear broths and teas are consumed numerous times throughout the day.

In Laos and Thailand, women are served warm meals from other, elder women for the first 7 days after birth. In Mexico and other Latin, Middle, and South American cultures, regardless of the weather, postpartum women will not drink cold drinks if they have the option of consuming room temperature or lukewarm teas and soups.

HEAT
Heat has long been used as a way of strengthening the tissues, nerves, and blood vessels that may have been weakened and be in danger of further, or long-term, stress after birth.

"According to traditional Chinese medicine, heat is highly significant for lie woman who has recently given birth. One of the three major factors considered important for the health of postpartum women is "sparing the exterior". According to traditional Chinese herbalist Andy Ellis, this means protecting against wind and avoiding cold drafts. Childbirth is thought to deplete what in Chinese is called wei chi. The Wei Chi is the body's protective immune capacity, found specifically on the surface of the body and in the lungs. Special herbs protect the woman and nourish the wei chi,  the woman is expected to remain indoors for 1 month after birth." - Natural Health after Birth: Complete Guide to Postpartum Wellness by Aviva Jill Romm

Native Alaskan women were traditionally expected to stay indoors, away from wind and cold, for either one month, if she had a boy, and two months, if she had a girl, so as not to become chilled.

Modern medicine can see that a woman 'cools' after birth due to the loss of heat through baby's body, amniotic fluid and blood loss, and general exhaustion and fatigue from labor. Moxa sticks, incense sticks, a hair dryer, hot water bottles, sauna treatments, warmed rooms, hot oils, or hot hands packets are all acceptable forms of mother heating. 

In the use of moxibustion, an acupuncturist would work on the upper calf, just to the outside of the shin bone (for the uterus); top of the head (for hemorrhoids); four fingers below the navel; on the sacrum; and on the bottom of the foot toward the toes in the indentation. 

In Laos and Thailand, women are treated to steam sauna-like treatments. 

"Many of these terpenes have documented antimicrobial and analgesic properties, and some have also synergistic interactions with other terpenes. The mode of application in hotbed and mother roasting differs from the documented mechanisms of action of these terpenes. Plants in these two practices are likely to serve mainly hygienic purposes, by segregating the mother from infection sources such as beds, mats, stools, cloth and towels. Steam sauna medicinal plant use through inhalation of essential oils vapors can possibly have medicinal efficacy, but is unlikely to alleviate the ailments commonly encountered during postpartum convalescence. Steam sauna medicinal plant use through dermal condensation of essential oils, and steam bath cleansing of the perineal area is possibly a pragmatic use of the reported medicinal plants, as terpene constituents have documented antimicrobial, analgesic and anti-inflammatory properties." - Steam Sauna and Mother Roasting in Lao

In Malaysia, women are given hot stone treatments; rocks are warmed and placed on her abdomen. In other cultures, a hot water bottle or heating pad is applied to the abdomen to help the uterus shrink and become less swollen. 

In other Asiatic and Indigenous Native American cultures, the new father is given the honor and duty to make and keep a fire to be burned for weeks near or under the mother's bed. In Mexico and South Western United States, many Mexican women dress their babies and themselves in layers of blankets, sweaters, hats and scarves whenever they leave their homes. Some will even stuff their ears with cotton to avoid wind. 



BINDING

http://rhythmofthehome.com/

Belly binding, also called belly wrapping, is a common practice cross-culturally. Those in the Caribbean, Spanish, Ethiopian, Asian, and Indonesian cultures all practice, at least historically, the practice of belly binding.


During pregnancy, a woman's abdominal walls separate and her muscles expand. The spine is stressed and often times becomes misaligned. The pelvic floor muscles relax, skin stretches, abdominal muscles separate, and organs move out of the way of the growing uterus. Within hours after birth, as uterine involution occurs, there is a vast amount of 'unused space' in the abdomen, which quickly fills with extra fluid and air.

Belly binding helps to reduce swelling and fluid retention by bringing in the abdominal walls, disallowing the abdomen to distend and thus, fill, with fluid and air. It also works to compress loose skin, draw the abdominal muscles together, encourage proper posture, and keep loose organs in place - facilitating a more comfortable and quicker recovery with less risk of diastasis recti occuring. 

In Conclusion
Mother Roasting is a time-honored tradition that seeks to give women the safe space to rest, recuperate, allow their body to come back into balance, and allow their minds, hearts, and selves to focus solely on their new role as mother and the new life of their baby. Mother Roasting encourages and promotes lactation, healthy bodies, and healthy minds. Perhaps it is time for us to start loving on mothers again.

For More Information:
Steam Sauna and Mother Roasting in Lao
Doctor Berlin
Rhythm of Home
What Is Mother Roasting 
InCultureParent
Korean Seaweed Soup
"After The Baby's Birth", by Robin Lim
"Natural Health after Birth: Complete Guide to Postpartum Wellness", by Aviva Jill Romm

Pelviconscious

I want to talk about butts. Not just butts in general – but the laboring woman’s butt. In pregnancy, the
pelvic inlet is strong and sinewy, protecting baby and holding everything in place. The bones are hard, providing a shielding bowl, and the uterus is protected well.

While in labor, though, the pelvis changes. It becomes soft and pliable, jointed and open. A woman who keeps her posterior open and moving tends to have a shortened laboring time, more efficient dilation, and better pelvic relaxation. Let’s talk about why.

Anatomy, the hard stuff – We women are built with this beautiful basin that protects and holds our

inner stuff, including our growing babies, in and up where they are supposed to be. During late pregnancy and labor, it is our bodies’ jobs to provide a space that can let baby come down into this basin.

Later in pregnancy, our bodies release hormones to help the pelvis to become this ‘more open’ and jointed, mobile basin; these hormones are relaxin and hyaluronidase. Both of these hormones help to soften the cartilage, joints, and ligaments in your body. The result is that your pelvis is no longer a firm bony structure, but a moldable, open, hinged structure that accommodates babies descent.

- Finding that open basin -

Stand up.

Yes you.

Stand up.

Now, reach behind you to grasp your behind. Don't cheat by bending your legs or bending at the waist. Standing up, with your legs at a natural distance together or apart, feel for your sit bones (aka sitz bones or, more accurately, ischial tuberosity) you know, those bony prominences of your tush. Now take note of where they are at, how far apart or close together your hands are.

Now keeping your hands on your sit bones, bend at the waist (keep your knees locked). Feel the difference this simple change in posture made on the space in your sit bones/pelvis? Now we are going to go a step further. Keeping your hands on your sit bones and bent at the waist, now add in bending your knees. How did that change things?

Now take note of what you look like. Beyond 'silly', you should be able to note that you are bending at the waist with your knees unlocked and bent slightly. This is a positive laboring posture, one that will encourage your pelvis to be nice and open.

Labor positions that reflect this openness include:

• hands and knees
• forward leaning
• slow dancing
• belly dancing
• crawling
• walking (to a degree)
• toilet sitting
• kneeling

Anatomy, the soft stuff – Running through the basin of the pelvis is a whole bunch of muscles,
ligaments, tendons, veins, and nerves. As baby grows and your body gets more relaxed and open, your soft tissues automatically begin to stretch and soften. Sometimes, though, just like with a muscle spasm or other tensing of soft tissue, there can be some resistance to this body change.

The “pelvic floor” is actually not one muscle, but several layers of muscles that help to support our internal organs. The first layer of muscle can be thought of as a “compass rose” that runs front to back from the pubic bone to the coccyx (the bulbocavernosis), and from side to side from the perineum to the sit bones (the transverse perineals. (For a detailed, three dimensional video that shows all the major structures of the pelvic floor much better than I could explain, click here. It’s well worth the view.) 

There are three openings along the length of the bulbocavernosis, the urethra, the vagina, and the anus, and the bulbocavernosis snakes around them like a figure eight. The perineum is the area between the vagina and the anus, and it is this area that gets a lot of attention during the birth process. 

The next innermost layer of muscle is known as the levator ani. These have almost a bowl-like shape at the bottom of the pelvis, with a U-shaped an opening for the urethra and vagina, and are the muscles that do most of the heavy lifting of the abdominal organs. When we take a breath in, the thoracic diaphragm balloons downward, pushing the abdominal organs toward the pelvic floor, which in turn moves downward and stretches slightly. When we exhale, the thoracic diaphragm moves upward, followed by the abdominal organs, and finally the pelvic floor. We can accentuate this natural stretching and toning by bringing conscious awareness to our PF’s. But more on this later. - OmMama

- Contraction, aka, getting strong -

Kegels. Yes, everyone should be doing them to make sure that their pubococcygeous muscle is strong, but they shouldn't be doing them to the extent t3hat you can move a small vehicle simply with a contraction of your PC muscle.

Pelvic Clocks. These are awesome for labor, and a great way to tone the pelvic floor more thoroughly. I will let this link tell you a little more on how to accomplish them, this one that has a step by step walk through, and watch the video below for more information.


- Relaxation –

Learning to relax your pelvic floor is equally as important as learning to control/tighten it. One way in which to accomplish this is to learn to breath down into your pelvic floor. Attempt to inhale by expanding your ribcage, not lift your shoulders. Tune into what it feels like in your pelvic floor. Now exhale, again, note the change in your pelvis. And if you are a more visual learner see here.

- Stretching -


Inner Pelvic Stretching will help to loosen any taut or restricted soft tissue. Be sure do both sides evenly and slowly :)... once you have achieved full STRETCH, hold a few seconds, breathing deeply, and waiting for your tendons and ligaments to completely release (they will fight you a little).


The Piriformis Stretch be sure to do both sides evenly and slowly. Once you have achieved full STRETCH, hold a few seconds, breathing deeply, and waiting for your tendons and ligaments to completely release (they will fight you a little)


Your pelvis is an amazing thing! Opening, bending, compressing, expanding - allowing you to protect your baby during pregnancy and bring your baby out of your body during birth. Hopefully, these exercises will help you to become more pelviconscious.  

Of Heroes and Healers

This post is for all of my doula sisters out there, but one in particular. I hope this reaches your heart and you hear my words in love, dear doula-sister.

We work with women. And every woman carries stories that have already been written, as well as stories that have yet to be written. As guardians of women's birthing times, we are allowed the honor of attending this most sacred time - when her-story is engraved upon the woman's heart.

We need be be cautious with the care we give them for that very reason. We are called to be healers and nurturers.. not heroes and warriors. The warrior is the woman. The heroine is the woman. We are the space keepers, the lovers, the honorers, the guides. We are the cupbearers of the court, not the quill and ink of the story. 

We cannot forget what a doula is: a servant, guide, healer, and friend.

We are not called to 'save' any woman from her birth journey, her provider, or her place of birth. We are not called on to be the one who swoops in and saves the day. A woman should look back on her birthing time and see her doula as a loving comfort, a font of knowledge, and a steady hand of care and assurance. She should  never see her doula as the knight in shining armor, the one who rescued her from the challenges that confronted her during her journey, or the torchbearer of her birthing time.

Yes, we can fight along side of this warrior as she slays her dragons, we can even play Merlin to her Queen Aurthur, but we don't replace her power with our own, we don't lead her conquest for her, and we don't save her from her journey.

To do this would be to strip her of her power, her birthing right, her pomp and sacredness. To do this would mean mapping her journey for her, rather than allow her the grace to claim her own land and her own path.

Do you see yourself as a hero or a healer? I hope you see yourself as the latter.

Definitions:
Hero - the chief character of a story admired for courage or noble qualities, typically identified with good qualities
Save - rescue (someone or something) from harm or danger. To spare.
Heal - Cause (a wound, injury, or person) to become sound or healthy again:
Healer - a restorer and repairer.
Guardian - A defender, protector, or keeper.
cupbearer - one of high esteem in the court, trusted servant

CREATING Life

I remember when I was pregnant, some days I felt like a goddess - beautiful, strong, amazing, powerful, curvacious, and sexy... other times, the swelling, backache, heartburn, and nausea was too much to be able to revel in my beautifully voluptuous body! 

Nearly daily, though, I tried to remind myself how sensual and amazing I was! I was creating life! My body was perfectly growing this amazing little person - and I looked good doing it! It can be difficult celebrating yourself and your body when you feel so different - but changing your outlook can change your heart and attitude - which can be a saving grace in those last months of pregnancy! 

Some women have begun pregnancy photography - whether it be sensual, silly, cozy, or abstract. If you choose pregnancy photography, choose a photographer that can capture how you want or do feel during pregnancy. This memento is a literal keepsake of your beautiful form! 

 

Some women have taken to belly casting, a beautiful memento of your pregnant form. A belly cast is a plaster cast of your belly and/or full torso. It can be 'nude' or you can decorate it/have it decorated. It can be hung on a wall, bronzed and used as a centerpiece/bowl or even lined with soft wool and used as a cozy for babies first week of life outside the womb. 

 

http://littlelumpkin.blogspot.com/2008/06/birthing-quilt.html

Some women paint, create pottery, or sketch, reveling in their form and this season of life. Some add words or prose, but all are beautiful works of art that allow women to unfold their innermost self. This artwork can be on full canvas, in sketch books, in clay, or, as the case of the center piece of artwork, on a quilt. 

And others create pieces of wearable art. Pregnancy jewelry is a powerful way to carry your 'talisman of power and beauty' with you at all times. Some women wear jewelry that is pregnancy specific, while others wear jewelry with a saying or a symbol that is meaningful to only them, such as a bead or phrase.

organicmothers.com

No matter how you celebrate your pregnancy, do it!  I know that people have probably told you over and over again to cherish this time, you can never reclaim it, but from one who has BTDT, I can attest that these sentiments are very true. 

If you need ideas for how to start, consider reading a book on celebrating self. A perfect one for pregnancy is called Sacred Pregnancy. Another great benefit of pregnancy art and celebration through creative works is that it translates beautifully into birth art.

http://talkbirth.wordpress.com/2011/05/25/birth-altar-wisdom/

Birth art is a wonderful way to express your needs, desires, delights, and yes, even fears, regarding birth; but art allows it to be done in a positive way that can help carry you through your birth journey.

Blessingway beads are oftentimes held, carried, rubbed, kissed, and worn during birth. It gives mom a sense of centering, and is a beautiful reminder of all of the women holding her space in their own ways.

Other women will make collages or posterboards of phrases of strength, beauty, power, and joy for their birthing time. These posters and collages can be used as a focal point for labor and birth, providing women with affirmations and strength.

No matter how you celebrate yourself - both your pregnant and birthing form, do it! After all, at no other time in her life is a woman more in touch with creation than when she is creating a human life within herself!

Everything's Negotiable

Everything is negotiable... and the flip side? Nothing's truly mandatory.

Want to know the #1 thing that drives this doula absolutely nutty? The statement, "____ won't/will let me."

Why?

Well, let's see, IT'S YOUR BODY!

Sorry, was that offensive? What is offensive to me is the concept that our medical care providers have control over our health care and our bodies. That is simply not true! 

"Many women are not aware that they have the legal right to make their own decisions about caregivers, place of birth, medical procedures, treatments, drugs, or diagnostic tests for themselves and their babies. Childbearing women are encouraged to become informed about their legal rights to make the choices that best meet their needs." - Patient Rights at VBAC

Well, I am getting ahead of myself... so, what are these rights?

• The consent of a competent woman's husband is never required for her treatment.
• Women have a right to have another woman present during a physical examination.
• Women can refuse to be examined or treated by anyone.
• Women have a right to have the father of the child, or another advocate, present during childbirth and delivery.
• Pregnant women have a right to refuse any medical treatment or drug, including a cesarean section, episiotomy, anesthesia, and pain medication.
• A woman has a right to change her mind about any decision made before or during labor or childbirth.
• A woman and her newborn have a right to remain in a hospital up to 48 hours after a vaginal birth and 96 hours after a cesarean section (your goal, however, should be to get mother and child out of the hospital as soon as it is safe for them to be discharged). - Legal Rights of Pregnant Women from ICAN

Remember that no one is responsible for your healthcare but you. As a parent and woman, you hold the ultimate responsibility for the choices that are made during pregnancy, labor, and postpartum, because you are the one who will be raising the child and have to live with the results of the care you have chosen for them and for your own body.

"American parents are becoming increasingly aware that well-intentioned health professionals do not always have scientific data to support common American obstetrical practices, and that many of these practices are carried out primarily because they are part of medical and hospital tradition." - The Pregnant Patient's Bill of Rights from AIM

With this knowledge, women should start making some of her birthing choices that will affect her birth time during pregnancy. The first step would be considering her options. And the next step is making sure that those options are in line with what she hopes for in birth, and then setting in place her advocates (aka birth team).

For some reason, even when women know what they want out of birth, they don't always choose places or people who will necessarily honor those choices. In those instances, whether it was a bait and switch situation, or mom simply stayed with a practice or place that she knew had policies in place that would not support her choices, it is important that she and her non-birth place-affiliated birth team knows what her rights are.

Every woman has the legal right to informed consent or refusal for every medical treatment that is offered. Even if they say it is policy, that you 'have to', or it is 'non-negotiable'. 

The American Medical Association supports this, “The patient has the right to make decisions regarding the health care that is recommended by his or her physician. Accordingly, patients may accept or refuse any recommended medical treatment.”

The ACOG even says that a woman may decline a physician’s advice or recommendation, even during treatment, based on “religious beliefs, personal preference, or comfort.” Women are entitled to “informed refusal.”

Your legal right to make your own choices for you and your babies health care mean that your treatment in your choice of birth place is your decision. Everything's negotiable, whether or not your medical care provider/place would like to acknowledge it.

• What about when I sign that consent for treatment form at sign in? Even after you sign that form, you have the right to refuse any particular part of that treatment. Picture the cancer ridden person who is given the option of amputation or chemotherapy, even though the doctor believes one course of treatment will get better results. Every step of the journey is your right to refuse or accept.
• What about if I already agreed to an IV, epidural, pitocin, cesarean, or nursery stay? At any time during your care, you can change your mind, decline treatment, or nullify any consent forms. 
• What if they challenge me or threaten me? Then challenge them back and remind them of your rights. If it is really important to you, you have legal rights that they must honor. 

You don't have to go in for that scheduled induction. You don't have to agree to a repeat cesarean. You don't have to consent to continuous fetal monitoring, 'mandatory' nursery stay, or 'mandatory' newborn procedures... even bathing and eye erythromycin.

Be aware though, if you decide to decline any treatment recommended by your care provider, you may be asked to sign an AMA (Against Medical Advice) that states you acknowledge you are taking responsibility for your choices.

Before signing that form, though, you can get a second opinion, as you are always entitled to one. This second opinion may not agree with the first care providers opinion and may save you from having to sign the AMA.

For more information on the Rights of Childbearing Women, see here. Remember, your body, your baby, your right to refuse. 

Doulas Do It Anywhere, pt 5

Doulas help women give birth anywhere. We offer support in a home birth setting, hospital birth setting, birth center birth setting, medicated birth setting, and even cesareans.

Again, the definition of a doula:

A doula is not a midwife (unless, of course, she’s certified as both), in that she has no authority to make medical decisions, nor is she credentialed to deliver a baby. She’s not considered on the level of a nurse, either; doulas cannot administer or regulate medicine, operate monitoring devices, et cetera. In fact, a reputable doula will tell you that she doesn’t even have the authority to speak on behalf of the mother should a complication or other medical surprise surface.

But sometimes it’s the unnameable, intangible aspects of the conclusion of a pregnancy that require the most help and planning. And that’s where a doula is indispensable. In addition to the priceless knowledge and experience she brings to the laboring phase and to newborn-care assistance, she’s a wellspring of intimate emotional and physical support. A doula educates the family ahead of time; keeps the laboring mama focused and lucid; instinctively retrieves things she needs, like water or compresses; supports her body while walking through contractions; suggests different laboring positions; initiates massage and breathing patterns; reassures other labor partners; works alongside hospital staff; advocates for the mother; and, afterward, ensures that the new mommy is getting enough rest, is recovering well, and is bonding with the baby.  - Divine Caroline

That said, a doula is definitely a soothing presence in all birth settings, including PLANNED CESAREAN BIRTH.

During home visits, your doula can help you know what options you have for a cesarean birth, options to make your birth experience as mother- and baby-friendly as possible. Doulas also help women to talk with their provider about these options, which is an important step since many of these options are not common-place or commonly requested. In addition, we are helpful assurance during your birthing time:

• We labor with you: If you plan on waiting for baby to decide his/her birthday, we will do the early labor part with you at your home, earlier than we normally would.We will then move with you to the hospital. 
• We 'labor' with you: Even if you aren't planning on letting labor begin before your cesarean, we can meet with you at the hospital before surgery to do last minute emotional mapping, get all postpartum plans in order, and more.
• We can be there for...: Oftentimes, we can be in the OR if it has been cleared with the obstetrician and anesthesiologist. This can be such a benefit because, once baby is born, someone normally can go and be with baby (if it's in the nursery or on the other side of the room) while someone else can stay with mom during repairs.  We also have lots of doula-y tricks up our sleeves to make the experience very personalized and mother-centric.
• We can make memories: Or should I say lasting memories? Oftentimes the medications used during a cesarean can make it difficult for mom to remember all of the details of a cesarean birth. We can use a voice recorder, a video recorder, and/or a camera to take it all, or some of it (the parts you want us to), in. This can be an invaluable thumbprint for your memory of your baby's birth day. 
• We stay late: We wait until you are out of surgery, to help you to nurse, to answer any questions you have, and to help you make a 'be sure to ask later' list for when the medications wear off and you and baby have had some time to rest. If your baby has any extended nursery time, we will wait until you and your partner feel settled in and comfortable letting the 'extra pair of hands' go.
• We refer out: if you need a postpartum doula or a lactation consultant, two very helpful options for postpartum, we can definitely give our recommended and personal best to you.

Women still have many options and needs for a cesarean birth. Whether those needs are emotional or physical, a doula can help a cesarean to be as empowering and mother-centered as possible.

Doulas do it at planned cesarean births!

Doulas Do It Anywhere, pt 4

Doulas help women give birth anywhere. We offer support in a home birth setting, hospital birth setting, birth center birth setting, medicated birth setting, and even cesareans.

Again, the definition of a doula:

A doula is not a midwife (unless, of course, she’s certified as both), in that she has no authority to make medical decisions, nor is she credentialed to deliver a baby. She’s not considered on the level of a nurse, either; doulas cannot administer or regulate medicine, operate monitoring devices, et cetera. In fact, a reputable doula will tell you that she doesn’t even have the authority to speak on behalf of the mother should a complication or other medical surprise surface.

But sometimes it’s the unnameable, intangible aspects of the conclusion of a pregnancy that require the most help and planning. And that’s where a doula is indispensable. In addition to the priceless knowledge and experience she brings to the laboring phase and to newborn-care assistance, she’s a wellspring of intimate emotional and physical support. A doula educates the family ahead of time; keeps the laboring mama focused and lucid; instinctively retrieves things she needs, like water or compresses; supports her body while walking through contractions; suggests different laboring positions; initiates massage and breathing patterns; reassures other labor partners; works alongside hospital staff; advocates for the mother; and, afterward, ensures that the new mommy is getting enough rest, is recovering well, and is bonding with the baby.  - Divine Caroline

That said, a doula is definitely a soothing presence in all birth settings, including BIRTH CENTER BIRTH.

Since doulas roles at a birth center birth encompass both those outlined in the homebirth post and the unmedicated hospital birth post, this is a really short blog post.

But, doulas do it at birth center births!

Doulas Do It Anywhere - pt 3

Doulas help women give birth anywhere. We offer support in a home birth setting, hospital birth setting, birth center birth setting, medicated birth setting, and even cesareans.

Again, the definition of a doula:

A doula is not a midwife (unless, of course, she’s certified as both), in that she has no authority to make medical decisions, nor is she credentialed to deliver a baby. She’s not considered on the level of a nurse, either; doulas cannot administer or regulate medicine, operate monitoring devices, et cetera. In fact, a reputable doula will tell you that she doesn’t even have the authority to speak on behalf of the mother should a complication or other medical surprise surface.

But sometimes it’s the unnameable, intangible aspects of the conclusion of a pregnancy that require the most help and planning. And that’s where a doula is indispensable. In addition to the priceless knowledge and experience she brings to the laboring phase and to newborn-care assistance, she’s a wellspring of intimate emotional and physical support. A doula educates the family ahead of time; keeps the laboring mama focused and lucid; instinctively retrieves things she needs, like water or compresses; supports her body while walking through contractions; suggests different laboring positions; initiates massage and breathing patterns; reassures other labor partners; works alongside hospital staff; advocates for the mother; and, afterward, ensures that the new mommy is getting enough rest, is recovering well, and is bonding with the baby.  - Divine Caroline

That said, a doula is definitely a soothing presence in all birth settings, including MEDICATED HOSPITAL BIRTH.

During those home visits, your doula can help prepare you for early labor, before pain medication is available or a good idea, through teaching you coping techniques and making suggestions for home labor. Your doula can also help you understand the different medications available and the interventions associated with them so that you can make the best choices for your circumstances and desires. Some of the things that a doula does during a  medicated hospital birth include all of the same stuff we do during an unmedicated hospital birth, plus:

• We 'better and best': we will make suggestions along the way in order to minimize risk. There are 'better times' to get an epidural vs. IV pain medication. Likewise, there are 'best' times to get the epidural that you are anticipating receiving.  
• We body work: after the medication is administered, we will still help your body into different positions to encourage baby to rotate through the birth canal. 
• We keep it mother-centered: we help to encourage the hormones of labor to continue, regardless of medication, by setting ambiance and preserving the 'sacred space' of birth. We also gauge the emotions of mom: disappointment, anger, happiness? If she needs to work through emotions, we have an impromptu emotional mapping session. 
• We move it along: we will watch your contractions. If they start to space out, which often happens with epidurals and spinals, we will encourage labor to pick back up through acupressure points, aromatherapy, and massage.
• We stay on task: if a medical emergency does arise, which more frequently does with medicated births, we can  help to prepare you prenatally and during the actual birth event, to be as involved as possible and to ensure this is still your babies birth story/time.
• Breast is still best: we still stay after the birth to help with breastfeeding, which may need more help than otherwise would have.

Anything the doula might do on this list is definitely interchangeable with your other support person (spouse/partner, etc..), so that we can  make a seamless team of support for you where none of your needs, or the needs of your other support person, go unmet.

Doulas do it at medicated hospital births!

Birthing From Love

Birthing From Love

DECLARATION

We find ourselves in a time where the culture of childbirth is at a crossroads. It’s time to choose which path we will take.

AND SO....
We choose the path that empowers, supports, and advocates for childbirth to be grounded in love.
We are loyal to the path that allows women to be empowered by birth and not traumatized by it.

AND SO WE KNOW...
the time has come to dissolve the ideology that has brought us to the point where women live in fear of the birthing process and under the tyranny of scathing judgment about how they bring their children into the world. This oppression of judgment has kept us from seeing the truth about ourselves. We are in this together.

It doesn’t matter where a woman chooses to give birth: in a hospital, a warm water tub, or a sacred hut in the Himalayas—it is time for us to embrace a woman’s choice to birth where she wants to birth.

It is time for us to support women in taking control of their birthing experiences—not the rigid, inflexible control that springs from fear, but the wise, empowered control that’s rooted in love. With that control, giving birth becomes an act of joy, of self-discovery, and of profound self-expression.


AND SO WE DECLARE....
Birth, more than any other experience, has the potential to transform the world. It is time that we support women in experiencing birth as a peaceful, positive, and powerful event.

Birth has the potential to be the most powerful driving force on the planet. The healing of birth will surely change the world.

We must reframe the way we conceptualize birth. We must share this wisdom with the world.

Birth is something to be embraced—not controlled.

Birth is something to be welcomed—not dreaded.

Birth is something to be loved—not feared.

AND SO WE CALL...
To those who know that our world is deeply influenced by the way we bring our children into the world.

To those who are ready for audacious steps towards changing the culture of birth.

To those who are ready to dedicate themselves to all the women of birth who feel like they’ve lost their way to the hurt, the fear, the judgment, the shame, the blame, the trauma.

To those who know we are stronger together.

AND SO WE UNITE...
Although we cannot control the choices of those around us, we have faith that the pursuit of Birthing From Love is a noble, meaningful, and powerful one.

And for the support of this declaration, we pledge to each other our time, passion, energy, and wisdom.

For the love of birth.

Clicking for Breastfeeding

We talk a lot about pregnancy and birth. But, in addition to those very important topics, I love breastfeeding posts. I will literally scour my fellow bloggers sites to find tidbits of wisdom that I absolutely have to share with my readers... so here are my most recently discovered gems.

Nurshable writes a beautiful piece about 'human pacifier's and her feelings on that term. She gives such insight and passion that I was instantly taken back to a time when I, too, found myself breastfeeding my little one 'pretty much straight through the night'. This is a wonderful post on how to change our perceptions on those times when it is sometimes difficult to remember that it is good and positive to breastfeeding on request.

I am not a “human pacifier”. I am what you have a biological and evolutionary need for. I will not devalue your needs by implying that you lack the wisdom and understanding of what those needs are. I will not devalue your needs by becoming frustrated by your refusal to accept something that does not meet those needs. I want you to listen to your body from the beginning, to understand the difference between a healthy need of yours and a pacifying object. To have an understanding that dates back to the beginnings of your time on this planet.. That comfort comes from having your needs met, not from distracting yourself with something pink, pretty and plastic. - Read the rest here.

Bellies and Babies posted a history/art lesson on breastfeeding throughout time and cultures. I know, I know, I snuck myself into this post. But I loved researching and finding all of these beautiful works of art!

From the mythical figure of Philosophia-Sapientia, the personification of wisdom, who suckled philosophers at her breast and by this way they absorbed wisdom and moral virtue... To the Bible drawing parallels between absolute love and devotion, care and comfort as being a woman nursing her child... To the Egyptian goddess Isis, the symbol of motherhood and protection, nursing her son Horus. Breast has always been known to be best! Throughout history, women have been given special time to establish nursing and child caring after birth (such as the lying in time), given special sanction and law to be able to nurse their child on demand in any setting (such as allowance to not make exodus' to birth cities for census), and have been encouraged to nurse. - Read the rest here.

Breastfeeding With Comfort and Joy (which, by the way, I LOVE the book) has a wonderful post on a woman's yearning for her baby after birth. Although it is one of those 'duh' concepts, I love how she presents the information, a plea to hospitals to be more mother and baby friendly, along with great breastfeeding advise.

So I began my search for images of moms and babies skin to skin and/or breastfeeding in the operating room. Recently, with the help of Preparing For Birth, Mother’s Utopia, and Amy Romano of Science and Sensibility, I was alerted to a blog post with a photograph and a mother’s story of meeting her baby in his "birthday suit" in the operating room, and the video below that shows a baby skin to skin with his mom and feeding at birth in the operating room. I posted these and asked for moms’ comments. I am hoping that the images and comments help moms get that yearned-for closeness at birth when possible and that health care personnel become comfortable with the adjustment in procedures necessary to make this happen. - Read the rest here.

BABEs wrote a great post on how to take care of a breastfeeding mama. As mama worries about feeding baby, others should be worrying about nurturing that relationship and loving mama back into health and community.

Share your successful breastfeeding stories and experiences and leave the negative experience or breastfeeding “horror stories” for another person……a new mom is already emotionally full as she processes her birth experience and contemplates motherhood…she is full of desire to be successful at breastfeeding and bonding with her new baby.  Offering stories of challenges may not fill her with the inspiration she needs, especially if she is struggling…..certainly let her know she is not alone even if there are struggles but adding to the list of “what if” and “could that happen to me” worries is probably going to have a negative effect. - Read the rest here.

Banned From Baby Showers recently had a guest post on her blog about her loathing of breastfeeding tents. It was a neat read, I love it when I can read a post and, at the beginning be like 'huh?' and by the end be like 'huh!'. KWIM?

They are bad for breastfeeding moms. They imply you should nurse your baby in them.  In fact, I have been approached at an event while nursing and told there was a breastfeeding tent. I was sitting within eyesight of it. I didn't need to be told.  I have no desire to interrupt my conversation or relocate it somewhere I don't want to be.  Even if I see it as optional, the person who told me about the tent did not.  She thought I needed to be in the tent.This makes the tent more offensive, in my opinion, than the controversial Hooter Hider, or nursing cover.  At least with a nursing cover, I have to pack it in my bag and make the choice to put it on my body.  A Breastfeeding Tent is kinda like having a stack of Hooter Hiders in the corner for "those" breastfeeders.  And empowering someone to walk up and hand me one. - Read the rest here.

Dou-la-la has a phenomenal post (another one of those 'huh's) where she gives another side of the story when it comes to getting off the Medela teat. You have to read it to understand it... and I am not sure how much I can really rally with her, but I must say I totally get her position now and can't disagree.

By way of introductory comments, I first need to hail the revival of Just West of Crunchy, which was rendered out of commission by a terrible crash. Welcome back! Secondly, I'm going to point you in the direction of a Very Important Post: The Problems With Medela. What's that you say? Problems? With Medela? But - they make breastfeeding products! They promote breastfeeding, right? And I love my slick Pump In Style. How can you have problems with them? - Read the rest here.

Dr. Jen talks about good bacteria, the role of breastmilk in immune system development, and that "one" bottle in an amazing post. I can't really even do it justice in a little blurb before quoting her, so I am just going to go onto the quote bit.

In a perfect world, a term, healthy newborn comes into the world vaginally. Again, I want to talk about normal. I know the process doesn't go normally all the time. (And I've talked about this here.) The delivery of that baby close to the anus is critical for immune system development. The healthy, term newborn's gut is sterile (without bacteria) and the bacteria that get into that pristine gut are truly important. During a vaginal delivery, the largely harmless bacteria around the mother's anus are the bacteria getting into the newborn gut. They increase in number, compete for food and space and help coordinate efforts to create a healthy gut for that baby. With the exception of our skin, the gut is the largest immune system organ in our body. Because breastfeeding is normal, what happens to healthy, term newborns who are breastfed is normal. The newborn has a delay in their immune response to bacteria. A delay? To a bacteria? Yup. Normal. After delivery, that newborn gut has many challenges from invaders that may not be friendly. Doesn't seem too smart not to fight back. We all have mechanisms in our body to fight infection. In the gut it's called Gut Associated Lymphoid Tissue (GALT) and it's ready to roll at 19 weeks of gestation. All of the things that make up the GALT are waiting for a specific series of events to occur after delivery, when, if it proceeds normally, will result in a functioning immune system. - Read the rest here.

Timeline of a breastfed baby, written by the Alpha Parent, is a must read for all women intending to breastfeed, their support people, doulas, childbirth educators.. heck, everyone! It is such an easy read, with such positive information, that I have been sharing this post at every opportunity.

However there is a persistent and understandable demand from first-time mothers for information on what is considered ‘the norm’. This is particularly so with breastfeeding, as understanding breastmilk intake is more complex than looking at the oz mark on a bottle. This is a topic rife with large-scale confusion, especially as breastfeeding mothers are in the minority and can often find themselves, and their health workers, comparing their baby with formula-fed babies. Breastfed babies are not the same as formula fed babies. One is fed the milk of its own species; the other is fed the milk of an entirely different species, so it is unsurprising that stark differences can be observed. - Read the rest here.

And finally, for a little more wittiness and humor, check out Modg's 10 Things about Boob Feeding post. She had me snorting my coffee the other morning (yes, sorry Mary, my lovely and guru-like chiro, I was drinking that evil sludge when I was reading it; but you'll forgive me if you click on the link.. promise). It's riotous!

Guess what? It’s world breastfeeding week. That’s where everyone in the world has to find a lactating breast and take a drink. Hooray! In honor of this week of boobs, I wanted to 1) draw you a picture of boobs (and if your boobs are actually that round and symmetrical, I shoot rockets at you. SSSS.) and 2) talk about my experience with breastfeeding and the 10 hidden benefits of breastfeeding that you don’t read about in Lucky Magazine. I know, I didn’t see any in there either. Weird. - Read the rest here.

So there you have it.. my most recent finds on the blog universe. It's a lot of clicking, but I really encourage every breastfeeding mama, mama considering breastfeeding (or preparing to breastfeed), and breastfeeding advocate take a look at these. They are worth the click.