Being an informed birthing woman and finding the right care provider, part I
The photo series Oscar made of me for this week with my parents relates to a post I have been planning out and wanting to write for a long time now, but will have to truncate tonight in order to finish setting up baby’s crib and get to sleep. I want to write about and offer some useful websites and other tools for helping to find the right prenatal and birth care provider. I want to share some thoughts and interview questions for distinguishing whether a provider is, on the one hand, overly intervention-happy and doesn’t fully support mothers’ ability to birth naturally and make choices for herself, or, on the other hand, if the provider is out there and not evidence-based and puts moms and babies at risk by doing too little. At least here in Alaska, there are plenty of folks on either end of that spectrum. How to determine who those folks are and what the risks are may not be so apparent. I think through open dialogue, we can help make this process more transparent.
What does this have to do with my parents? Well, being raised by Bradley Cruz, a pediatric radiologist who is much more critical of the many arrogances of his profession than most in the field, and by Barbara Norton, an RN-turned women’s health Advanced Nurse Practitioner (ANP)-turned Certified Nurse Midwife (CNM) who teaches and advocates on reproductive health issues, I feel that I’ve been blessed with a lot of tools and insight in this arena. By critically taking apart health care systems and health issues at the dinner table, by helping me do my 8th grade biology report on herpes or my persuasive argument in high school speech class on continuous fetal monitoring, by my dad asking for my help with language interpretation or my mom bringing me in to help her create lectures on the c-section rate, aby learning from me about the areas of health research and practice that I am involved in, and most recently, by being available to listen to baby’s heart rate or answer questions about this pregnancy, my parents have gifted me a certain comfort with, access to, and ability to engage critically with health care systems and health research.
My mom in particular has prepared me, over many years, to be excited and realistic about birth, to better understand the options out there, and to be a smarter consumer of information about perinatal and women’s healthcare.
So that is what I intend to share with all y’all (with the hope that you will add to it).
Good night for now.
I determined last night that my uterus is too big or maybe baby is just in too funny a position for me to continue with Zumba. But I am determined to still have fun however I can, even though my body is limited in a way it has never been before. So I was happy when Oscar proposed this morning that we do an obnoxiously-colorful photoshoot with his retro backdrop/lighting and that we accompany it with fun music. I threw on my workout clothes from the previous night and we got down to the Pointer Sisters. I am happy about all the little ways that mi amor reminds me to have levity and grateful for how much we laugh together.
P.S. This is another left-handed drawing. I think they all will be from here on out. And yes, the legs are disproportionately long. That’s because I drew how baby feels rather than focusing on anatomic accuracy. Baby feels like a mess of knees and feet that are constantly protruding out of or changing the shape of the right side of my belly and waist. The other night I sang to baby to encourage her/him to move so we could try to distinguish body parts as they surfaced inside my skin. Seriously, baby thinks my uterus is a 24-7 dance studio or something.
P.P. S. This is my dad’s singlet from college at UNLV, where he went to undergrad on a running scholarship.
Where we come from
Since we are down here in Northern California for Thanksgiving, Oscar took this photo of me in front of the home I lived in as a young child in Vacaville, CA. Home base was right in front of our driveway for our many street baseball games. We ate tomatoes and fresh peaches from the neighborhood until the juices were running down our chests. We climbed trees for walnuts and broke them open with hammers to pull the meat out. We swam, swung from rope swings, built that brick retaining wall in the picture, drew all over the sidewalk with chalk, and got poison oak rashes in the creek behind our house.
And then, when I was 10 and my sister was 13, we moved to Anchorage where we learned how to hike, sled, and ice skate and where we eventually began to identify as Alaskans. I acquired my identity as an Alaskan, as did Oscar, who moved to Anchorage when he was three years old from Bogotá, Colombia. Our children, though, as Oscar pointed out, will be those born and raised Alaskan types—Alasqueños hasta los tuétanos (Alaskan to the bone marrow). As he was observing this morning, one of the biggest contributors to our sense of identity and sense of rootedness in the world is place. And as children, we have no control over the place we grow up in. We, as adults, are choosing for our Colombian-U.S. American children to raise them in Alaska, to raise them with the lessons and hardships and beauty and diversity and worldviews and landscape of our state.
As much as I miss certain aspects of California—Norteños on the radio, delicious fruits and vegetables and nuts, food from everywhere in the world, taco trucks, the redwoods, the ocean, the sun, a bunch of people I love, the golden rolling hills speckled with little green trees and deer, redtail hawks, murals, progressive laws and social movements, Spanish being spoken in so many places—I am so glad that we live in Alaska. When I lived in the Bay Area for two years as an adult, I remember feeling this great sense of loneliness from being surrounded by so many people (in so much traffic) and being so anonymous. Most of all, I missed the smells of tundra and cow parsnip, the color of moonlight on snow, the expansiveness of nature in Alaska, the access to nature, and the solitude.
That is the gift of place that we will give to our children. Knowing the land intimately, and the opportunity to learn from Alaska’s First Peoples their worldviews about the land and about ethics and about how to live. This is something that, in Alaska, we have more opportunity to learn than in many other places.
These are the roots we can provide our kids. What they will call home in their adult futures is not up to us. But I am glad to be able to give them the gift of home that we can, just as I am grateful that my parents gave me these two homelands and that Oscar’s parents gave him the mountains of Colombia and the mountains of Anchorage.
P.S. We are staying with two little girls, five and two years old. They are both in love with baby already and sure that we are having a baby girl.
In childbirth class recently we watched a film that midwife and natural birth author Peggy Simkin created. It showed one contraction at each stage of labor from many different women. Using home video footage, it moved from the slow rocking and hummings of early labor to the rhythmic grunts, moans, words, breaths, and motions of active labor, all the way through to pushing, a few short screams and exclamations, and many a squiggly little baby coming out and being placed at mama’s breast. As we watched it, I didn’t know that Oscar was observing me and the others in the class; I was completely absorbed in the film.
What Oscar told me later meant a lot to me. He observed that some of the mamas-to-be in class leaned away from the film with a look of fear or that they tucked their heads down, as though to hide from it. But a few other women and I did not. Oscar said that I, in fact, leaned forward in my seat. He told me, “You looked like when you are watching Glee, only much more intense.” This, he shared, made him confident that I would do fine in labor.
I don’t think I am inherently any more suited for labor than anyone else is, nor do I have any ideas of myself as some kind of birthing superstar who will have quick labors and meditate so deeply that I don’t feel the pain. Nope, no such illusions here. In fact, I have a good chance of having a whole lot of back pain because, well, I have spondololysis and it hurts even when I’m not pregnant or don’t have a baby’s head moving down onto it. Plus, I am not a very disciplined meditator or positive visualizer and I don’t anticipate that changing profoundly in the next 10 or so weeks. And yet, I agree with Oscar that I will be fine. I am truly excited to give birth, and to do so naturally.
I am confident and excited because I have been blessed with amazing opportunities to prepare myself to lean in to labor with openness, curiosity, and strength, and roll with whatever it brings me. Here are a few of these blessings:
1.) Hearing my friends’ positive, healthy, strong natural birth stories. Some had quick and relatively easy labors and some had much longer or more challenging labors. What all of these women shared in common were the optimism, joy, and strength with which they met every challenge that came their way. I figure: if they can, why not me?
2.) The book “Birthing From Within” and the class we took from Jen Allison by the same name. The approach starts with the recognition that because birth is a natural process for which we all have some internal wisdom, a specific, rigid technique cannot be prescribed and followed. Rather, mamas and their birth partners are encouraged to explore and tame their fears/barriers before birth, to create and advocate for the kind of stress-free environment the mama wants in labor (and develop strategies for how to respond and cope if the environment is not what she wants), and to practice the coping techniques that make sense for them. (E.g. a quiet woman should not be expected to be super vocal in labor and a vocal woman should not be expected to labor in silence; there are great pain coping techniques that either can use.) I love this because it feels realistic and liberating, because it helps Oscar to play a really caring and supportive role, and because it affirms the fact that I have the wisdom of how to give birth already within me.
3.) Prenatal yoga. I cannot sing the praises of prenatal yoga enough. I’ve been taking it at Open Space in Anchorage with Svia as the instructor. The healing environment created by women sharing with one another at the beginning of each class, the mantras and Yogic principles, the breathing and strengthening and stretching, all of it feels like quenching a thirst. But oh, the kriyas! They are the best part. Here’s my uneducated explanation of them: Kriyas come from Kundalini yoga and involve doing the same movement or holding the same position, often with the arms, for a long time. They are hard. Your forearms or shoulders can get to screaming at you something fierce. And in there is the lesson for labor: your mind wants to get in your way and tell you you can’t do it, you can’t hold your arms out at your sides for four straight minutes. This means you get the chance to figure out how to let your body take over for your mind and simply do it. You have a chance to figure out what kind of coping techniques help you turn off your mind’s tendency to suffer unnecessarily and, in the words of poet Anne Sexton, you let “your belief [undo] your disbelief.” Through kriyas I have found how useful smiling, dancing, breath awareness, and non-judgmental awareness/observation with all my senses are. I am so grateful for this practice.
4.) Exposure to birth and midwifery practice. Growing up with a midwife mama who has such a mind for public health and policy, I of course came to understand and care passionately about the politics of birth, the socio-cultural and economic issues involved in birth and the midwifery versus the medical model, the importance of evidence-based practice, the risks involved with interventions and the astronomical rates of inductions and c-sections, etc. as well as the risks with reckless “free births” and midwives who don’t practice within their scope. But also, thanks to my mama, Barbara Norton, I have heard about every kind of birth and reaction to birth. I have also had the opportunity to witness and help out with three, both in the hospital and the birth center. I have seen these women experience pain, cope with it just fine, and get through it to birth beautiful little babies who they and their support people then meet with such joy and pride. I have learned from her that the trick to labor is to shut off the over-analyzing and worrying and controlling mind (and I sure have one of those) so that the body can be in charge, so that you can surrender to the process. (Plus, she says, core muscles and overall health and fitness help a lot too.)
These are some of the things that ground and prepare me, that make me excited about birth, that steel me against the cynics who like to scare women about labor or mock them for feeling optimistic (e.g. the “You have NO idea what you’re getting into” people.) I know that labor will surprise me. I know that I can’t anticipate and plan it all out and I don’t need or want to. I just need to be with providers who I know will make good decisions and treat me with respect, and I need to prepare myself and have Oscar prepare himself so that I can let go of control and do this thing my body was built for. And I believe we’ll be just fine.
The practice of solemn recognition & active gratitude
Just as I made this week’s drawing with my left hand, I am typing with my left hand in an attempt to relieve the nerves in my right arm and hand. I am not one to complain about pregnancy—it’s overall super rad and I enjoy it. But this carpal tunnel syndrome part is rough. All pregnancies have some difficulty or another—or many difficulties—so it is very helpful for employers, partners, friends, and others to be attentive to these pains and helpful in the ways we can be. Not all pregnant women will assert their needs or ask for help; it can be embarrassing and tiring to have to ask for assistance lifting heavy things or cooking or, in my case, writing by hand. I will be making it a point from here on out to ask pregnant friends and colleagues about the kinds of help they might need.
I am also making it a point to be grateful for what I’ve got. Sure it’s hard to sleep when my hand feels like it’s filled with tiny, exploding needles and sure, I’ve got some back issues. But I am so grateful for my health, for my healthy hematocrit and blood sugar, for my core muscles, for having been raised with and exposed to good nutrition and exercise habits, and for having the financial means that make it easier to be at a healthy weight prior to and during this pregnancy. I am grateful to have a supportive partner, a mama who is a nurse midwife, great support networks of friends, a non-hourly job so I can get to appointments, health insurance, the knowledge and access and advocacy skills to get high-quality, competent and warm prenatal and birth care, a licensed and credentialed and beautiful birth center where I can give birth, and much more. When my hand isn’t hurting so much, I have made it a point, per the advice of my best friend, Nihal, to write a nightly list of things and people for which I am grateful; these folks and these blessings appear regularly on those lists.
I am also grateful, as I think about the many thousands dead in the Philippines due to the super typhoon and the many thousands more displaced and scared and stressed, to be alive and safe and in a relatively low-stress environment. As I do my job, much of which revolves around training health care providers to provide patient education, screening, and support on domestic and sexual violence and reproductive coercion, particularly with women of reproductive age, I am often thinking about the kinds of stressful life conditions so many women and girls (and their babies) endure during and around pregnancies. These include food insecurity, job insecurity, crowded and unsafe living conditions, homelessness, refugee status, facing threat of deportation, living in war zones or living through natural disasters. These include having controlling partners who isolate them from support networks, make them tiptoe around under constant threat of violence, beat and rape and strangle them, expose them to STIs, and cause pregnancies that the women or girls weren’t ready for. These conditions include intergenerational patterns of substance abuse, depression, PTSD, the death of a dear loved one, the deaths of loved one after loved one in a dysfunctional community, chronic health conditions such as asthma or hypertension that are exacerbated by stress and by pregnancy, childhood trauma that may be triggered by pregnancy or birth or breastfeeding and may not be well understood or handled by their healthcare provider…unfortunately, the list goes on. I don’t name all of these to be a Debbie Downer, but because it’s my job (and moral obligation) to think about these things and what health and social service systems and all of us can do to help change these harmful conditions and help those experiencing them, and also because it reminds me to de-center my little universe of experience, to count my blessings, and not to wallow in my pains.
The things that prepare us for parenthood
I’ve noticed that as the day of baby’s arrival nears and as we learn more about newborns and breastfeeding, the part of this whole process that is about actually having a little baby in our charge is getting way more real. Initially, there was a lot to learn and experience about pregnancy and the birth process was farther from my and Oscar’s mind. Birth has since come into much sharper focus, and the fact that we will, in just one more trimester, have a tiny little person in our home to care for and lose sleep over has too.
This thought can be a little intimidating. I am not nervous about being a parent in general, but newborns are just so fragile and needy that I have caught myself at times a little scared of the idea that we will soon be responsible for one. Three things have made me feel much more confident and excited about this stage of life and being able to meet those needs. One has been meeting my friends’ newborns and watching them care for their small babies with confidence and joy. Another was watching the DVD of Dr. Harvey Karp’s “The Happiest Baby on the Block,” learning about the different ways to soothe newborns. The other, oddly enough, was a lecture about child trauma at the Alaska Pediatric Symposium this weekend.
Josh Arvidson is the Director of the Alaska Child Trauma Center and an international trainer on the ARC model of trauma-informed care (which is a wonderful model). He gave a talk about what trauma is, how it affects children’s development, and what we can help put in place for children and families to prevent and successfully intervene in trauma. What inspired me was that in order to discuss how abuse and neglect and domestic violence affect children’s development, he told detailed stories about what happens when a child is raised with caregivers who do meet her needs. He told stories about the physiological processes that occur in a three-month-old and her caregiver when her caregiver responds to a hunger cry with an attentive feeding–how this creates circuitry in the brain, how it helps the baby develop positive stress resilience that will serve her when she is three years old and waiting for a sandwich or four years old and struggling to learn her alphabet, how it creates the foundation for learning communication skills and emotional self-regulation.
I am fortunate that in my field of work, I get many chances to learn about early childhood development. Every time I do, especially through such compassionate and neurobiology-informed talks as Josh Arvidson’s, I feel more and more excited to take part in the everyday heroism of so many billions of other caregivers who are building their babies’ brains simply by changing diapers, feeding, and smiling at babies, by responding to their coos, snuggling with them, and putting them to sleep safely. My hope is that when Oscar and I are stressed and sleep-deprived and changing the 15th diaper that day, or when I am spending yet another hour at night feeding baby on my breast, that we will recall with some satisfaction that by meeting baby’s needs and interacting with baby, we are building baby’s brain and affecting the way baby’s physiology and even genes prepare her or him for the world. That we are being the kinds of heroes that every baby needs.
I can’t say I look forward to the sleeplessness, but I so look forward to that glorious opportunity.
The Need to Nest
I am in Sitka, Alaska as I write this, in a gorgeous bed and breakfast with delightful food, surrounded by some of the most beautiful ocean and landscapes I have ever seen, in between days of meaningful and exciting work. And I miss home. Seriously.
There is something about this time of preparing for baby that makes us want to move inward, to protect the young and to be protected, to “nest” in the full sense of the word. I have been feeling this for a while but over the weekend my friend Saagulik, whose baby is four weeks old, helped me articulate and understand this feeling of needing insularity during the pregnancy, birth, and postpartum periods. Nesting includes, of course, the instinct to prepare the physical “nest.” But it is also, I am finding, about wanting to be with my people, my dogs, myself, and my baby as it wiggles around inside me. I want to share space and time with mi Osquitar, my mom, my family members, my close friends, and other pregnant women or new parents. I want to be near those who love and care deeply about babies and children and pregnant women and who have a caring, compassionate nature.
I find that I have even less energy than normal for being around those who are cynical or mean-spirited, or even those who may have their hearts in the right place but who are disconnected from how to listen to and care for others. I find myself being very sensitive to these traits in people and really pulling away and pulling towards home, towards the people who make up a sense of home.
This pull feels instinctual, like a need to protect baby and to protect and prepare for the internal mental space I will need in the birthing process. As Oscar and I learn in our birthing classes how to create a mini-environment of calm, acceptance, and support for the birth process, I find myself wanting to invest in cultivating that space. This reminds me of how I wish we had policies in this country to provide some paid antenatal leave to allow mamas this time for moving inward, but that is another post…
In a more practical sense, I also find that preparing for baby and maintaining my health for baby takes up a lot of time. This makes it hard to find the time to even call and/or see people I do love and who do care for me. There is a very careful partitioning of time that has to happen to prepare for life with baby, and it means being careful and choosy, even for things and people I like—and trying not to be racked with guilt for this. It is practice, I suppose, for making baby and his or her many needs and many diaper changes a priority.
If I had the chance to offer two bits of advice to those who are friends with or work with or otherwise interact with pregnant women or parents of very new children, it would be this:
- Don’t take it personally if it seems that they don’t have much time for you. They probably don’t, and they probably miss you, and they probably feel guilty about that fact. Maybe you can help assuage their guilt about this. Practically speaking, it’s also probably easiest to spend time if you can do with them the things that you both need to do, like grocery shop or exercise, or if you help them with some of the things on their plate, rather than having them meet you for coffee (unless that’s their thing)
- Be extra kind, be extra gentle. Of course, this is true always and for everyone—”the soft animal of your body,” as Mary Oliver says, the tenderness of your and everyone’s soul aches for it, needs it. But to someone who is now carrying inside them or carrying, swaddled on their chest, a tiny, sensitive little person, the kindnesses and cruelties around them have so much more weight. From the scientific point of view, we know that prenatal and early life stressors can have life-long impacts on babies’ health. From the point of view of many mothers-to-be and new parents, they don’t want to be around you if you are not kind. Bite your tongue every once in a while if you need to, and more importantly, look inside yourself or around you for some source of love that will allow you to move from that. We can feel it, and we truly truly appreciate it; I promise.
As you see below, the week 26 post is password protected. Please write me by email or facebook DM or leave me a comment here with your email and I will be more than happy to give you the password. I just don’t want it popping up in a Google Image search. Thanks. Here is a sneak peak:
This week Ash Adams came over and took the pictures for us, which was fun because Oscar could be in them. It was a cold and rainy morning (you can even see raindrops in the photos). We made it as warm and fun as possible.
What makes a baby
My senior year of college, the professor of my “Feminist and Queer Studies” class told us that she and her wife had recently had a baby. When asked which was the biological mother, they would tell people that they both were. What they meant by that, my professor explained, was that there are many ways in which we can biologically contribute to and affect a child. While one partner clearly contributes the eggs and half the chromosomes, plus extra mitochondria, the uterine environment for 9 and a half months, the nutrition and hormones and experiences that make their way through the placenta, and much more, the other partner—and the other people in the pregnant woman’s life—contribute biologically by providing food, emotional and logistical support, love, etc. or, on the other hand, by providing sources of stress and fear, unsafe conditions, and so on. Of course, the same is true after a child is born.
Given what we now know about the effects of the prenatal and early childhood environment on baby’s metabolism, muscular development, organ and brain development, and even how the baby’s genes express themselves (for real—this field of study is called “epigenetics”), along with the vital importance of human relationships for health, this makes sense. The pregnant woman is not the only one contributing to how her baby turns out–her family members, friends, colleagues, boss, etc. all contribute significantly. Ash, for example, contributes biologically to baby when she feeds me yummy cashew cheese or helps us with photos and the baby shower (thereby reducing stress hormones). My mom and dad play a huge role, and not just as the contributors to my genes. And who else makes a difference? The folks running the institutions and governments that make decisions affecting our access to healthy foods, places to exercise, stress over income, sex education in schools, access to health care and other services, etc. So one of the implications of my professor’s words, I think, is this: that the responsibility for healthy pregnancies (and therefore healthy people lifelong and onto the next generation) is diffuse and belongs to many of us. Or to all of us if you count us all as potential community members and voters.
The other implication, and this is where I was starting in reflecting on these photos, is that dads and partners (male or female or trans, dad or not dad) matter. A lot. And yes, I aware that this is not a new insight, just one worth reiterating. I have wanted to include Oscar in these photos because he contributes biologically much more than just his half of the chromosomes. Baby will be born familiar with his voice as well as mine. He feeds me and supports me to get good sleep. And as he remains involved in the process of going to childbirth classes with me and is present and supportive during labor and delivery, he too will get inundated with positive bonding hormones (prolactin being a principle one). I believe that in this way, through closeness and support throughout the processes of pregnancy, birth, breastfeeding, and beyond, the gap between the mother and father, or the mother carrying the child and the other mother, etc. can be bridged. Perhaps in bridging this, some of that pregnancy and birth-related sense of deep understanding about the delicacy and importance of life can be experienced by those around the mama too.
This, unsurprisingly, brings me back to gender and sex
I also wonder if this is one way to bridge the empathy gap between men and women. I reject the notion that men are just less sensitive, thoughtful, caring, empathetic, etc. than women by their genetic code. I believe we are all capable of the greatest humanity when exposed to the right conditions, and that girls and boys, men and women, aren’t so different in these respects. However, one argument that a number of people have posed to me over the years is that men really can’t experience pregnancy and birth and women can, which means that our biology makes us different in terms of our understanding of life. Being pregnant now, I am forced to take this argument more seriously because I am definitely experiencing things that my husband and dad and male friends cannot fathom and that I imagine will affect my awareness of the world in some profound way.
That said, I still have a few issues with the argument. One is that there are many women who cannot bear children or who choose not to or who have not yet done so, and they are no less women than I am, nor do I have any evidence that they are less empathetic or in touch with the value of life. Another is that while it has got to be true that having a person grow inside you and then come out of your vagina and then feed from your breasts does something profound to your understanding of life—and to the levels of the hormone oxytocin that you produce, which help you bond and attach—it is also true that we can bring men and boys closer to this process so that they can understand and experience more of it empathetically and hormonally (Seriously! Studies suggest that men who are present at birth produce more prolactin, which also promotes bonding).
I believe that if we encourage little boys to feel our babies kick in our bellies, to help take care of pregnant and nursing women, to hold and coo at new babies, maybe even to care for baby dolls, and if we let boys into rather than shut them out from the women’s world of pregnancy and birth, we will have much kinder and more connected boys. Likewise, if we continue to evolve our norms to encourage men to have more supportive and informed roles in their partners’, daughters’, sisters’, and friends’ pregnancies, births, and postpartum care, as well as in childrearing, we will see men becoming kinder and more capable of empathy (and less capable of dehumanization and violence).
Yes, the experience of pregnancy is amazing and profound and I am so grateful to be experiencing it. I can only imagine how much birth will rock my world, and how profound an experience breastfeeding will be. But, given the importance of everyone else around me (and everyone who responds to this blog online) to my experience of pregnancy, and in particular the role that Oscar plays, I don’t feel as though this is my pregnancy alone.