Midwives of the Revolution

Explorations, analysis, and reflections on women's health, midwifery, and politics from a feminist, marxist lens


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[Some] Breastfeeding Moms Can Now Do More!

There has been much jubilation this week in the women’s health and lactation (and tech) worlds this week as a brand new “smart” breast pump that will be hitting the market this Spring got the tech world excited at CES 2017. While the Scary Mommy blog and Association of Women’s Health, Obstetric, and Neonatal Nurses were beside themselves with joy over the new Willow breastpump, I believe a healthy dose of skepticism about this type of product is in order.

What’s the big idea? It’s quiet and discrete–you can wear it under your bra, it’s wireless, and it has some cool tech features. It’s being pitched as a way to multitask while pumping. Imagine easily commuting, going to the movies, making dinner, or cleaning the bathroom while pumping! Great for busy nursing parents, right?!

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Willow has a beautiful design,and if such technology was developed and made available in order to actually improve working parents’ lives, including, say, being a covered benefit under state Medicaid programs that would actually help working class and poor women meet their breastfeeding goals, that would be great! And, you know, if it came with gains for our side like the Fight for 15 movement is fighting for, it would be even more meaningful.

Don’t get me wrong–as a supporter of human milk for human babies and a former (and possibly future) pumping and working mama, I am for easing the burden of expressing milk when needed. For instance, as a nursing mama, I did bring my electric pump to the opening night of Star Wars: Force Awakens last year–went straight from clinic to the movies and plugged in during the previews and opening credits! This pump would have indeed made my expression of milk easier. The critique that follows is more about lower wage women than about professional workers such as myself that could likely afford the Willow. In regard to the Willow, we must consider the following not just about our own potential personal use of the pump but about what it represents.

  1. Moms are under pressure more than ever to Do More. You’ve heard that cute phrase “mother’s work is never done”? Or perhaps are familiar with the concept of the “second shift” of women* having two jobs–one (usually under-) paid at work, then going home to be mainly responsible for housework and childcare? With the devaluing of care and women’s work generally, nursing mamas are producing even more value for the economy by making food for their infants that doesn’t have to be paid for (unlike artificial milk for babies, which can be exorbitant but is paid for by programs like WIC). This product allows the pumping parent to Do More while pumping. Sure, that may be convenient and beneficial for many mamas struggling to feed their children, whether working outside of the home or not. However, it strikes me that this product is a symptom (not a creator) of the general societal expectation for mamas to be Super Mothers. In this time of neoliberalism and very few social resources that would actually help parents raise healthy children like, say, socialized high quality daycare/other childcare, postpartum in-home nurse care, excellent local public schools, accessible healthy food for families, walkable safe neighborhoods, paid maternity leave (for at least 12 months like a civilized county) etc.–mothers are still expected to Do Everything to raise healthy children by: breastfeeding in spite of all odds, prepare homemade meals for our kids every night, and sacrifice everything to be the right kind of mother who balances career and parenting. No such standards are ever applied to men/fathers because Sexism.
  2. willow-working-mom

    Ah, the working pumping mother! She’s so efficient and beautiful and productive! You hardly notice she’s a working mother! Makes you wonder if the manufacturer looked at the federal laws on pumping before launching this marketing campaign, or if they are directing it to capital. 

    Let’s be real. While mothers who can afford it (see point #3, below) would likely benefit from a pump like this to get more done at home–though most pumping moms I know do most of their pumping while at work, except exclusively pumping mamas–the real and direct beneficiary of products like Willow are the corporations that don’t really want to support their employees’ right to undisturbed pumping time on the job that is (for now) guaranteed under the Affordable Care Act. Makes you wonder if the creators of Willow have just been waiting for the ACA to be closer to repeal in order to promote this product. In every circle of breastfeeding parents I have been part of, there are constant questions about workers’ rights to pumping time. Many people resort to working through pumping time (though not as discretely as they would with the Willow) because it’s just not practical to take proper breaks to pump (I myself usually did charting while pumping because there’s always charting to be done, and the extra charting time lessened my time staying late). This will only get worse if nursing protections are lost with the almost inevitable upcoming ACA repeal. Bad news for maternal and child health–and workers’ rights. But here’s Willow, and ready to accommodate your upcoming loss of rights! Wouldn’t you like to see your midwife while they express milk for their child?! Or have your latte prepped by a properly productive multitasking discretely pumping barista? Or groceries rung up by a pumping cashier?

  3. Retailing at over $400, plus and astonishing $0.50 per single-use milk storage bag, Willow will be cost prohibitive to the vast majority of working mothers. For a product that will make it easier to make pumping parents work through their pumping session, the least capital could do is subsidize this product. In a rational world, corporations would be made to bear the burden of the cost of such a product, rather than consumers. Sure, eventually, Willow would benefit under the current ACA requirement for health insurance to provide lactation benefits. But until then–or after, if/when ACA is repealed under the next Administration–Willow will be a privilege of a small minority of wealthier professionals who can afford it. I wouldn’t consider Willow a “game-changer,” as it’s being touted, unless and until it is free to all pumping parents who need it in order to meet their breastfeeding goals.
  4. Finally, one question about this product that I’ve seen raised by lots of mamas on breastfeeding forums has to do with the actual science of milk production. Willow claims that it senses letdown and then switches to expression mode (not far off from Medela’s technology), but many pumping parents have expressed (um, sorry) concern that it can be hard to actually produce more milk while focusing on things other than nourishing the baby you love. That’s why many people don’t like pumping–you are always having to measure your output against your baby’s nutrition needs for the next day, and for many, the pressure of making enough makes this a stressful rather than satisfying process. The pressure many of us feel to pump enough in our stressful parenting and working lives does more harm for milk production than good. Some may feel better getting things done while pumping rather than staring at the pump as it fills up, but I question the physiologic good of hooking a mama up to a pump so she can be disconnected from the thing her body is doing (expressing milk) while her mind can be focused on doing something else. This seems to suggest that our nursing bodies are just machines for milk output. Most of the writing I’ve seen on increasing milk production (and I have ear a lot of it while struggling with it personally) suggests focusing your mind on your body and your baby–prety much the opposite of what Willow encourages. I am reminded of the pumping women in Mad Max: Fury Road, who I swear must have all been taking domperidone–making milk for the society and able to do little else. They needed Willow to up their capacity as contributors to the patriarchy!

    fury-road-pumping

    Imagine a post-apocalyptic world with human milk a major source of sustenance and Willow at the ready to integrate pumping people into other productive endeavors!

  5. I hope the next phase of the women’s and reproductive justice movement will fight for paid maternity leave, and more collective solutions to infant nutrition and maternal health than are currently on offer under capitalism, and more specifically, neoliberalism. I hope we will be fighting for more leisure time for workers, so that we could start to imagine technology not to benefit the bosses and the war on women, but solutions for the common good and public health. Willow seems to me a symptom of a particularly American problem, whereas a society that actually values maternal-child health and in which mothers and workers actually have rights, would produce, say, workplace-based nurseries where nursing parents can feed their babies on demand and not be shackled to a pump during the workday at all. Or, say, hospital-grade pumps you could just hook up to (BYO parts), and more lactation lounges at your workplace or public locations like cafes, libraries, bars, etc. De-stigmatizing and promoting breastfeeding is not about individual decisions to nurse or breastfeeding in public, but must be part of changing the infrastructure of our society, and fighting sexism at every step, so that women’s reproductive work (pregnancy/parenting/nursing) can be separated from her life in a healthy, holistic way (yes, nursing parents and other mothers do need to get out of the house/be away from their nurslings sometimes).

    Some of these solutions exist in social democracies, and many of them have not yet been won anywhere, to my knowledge. Let’s not lower our horizons to hoping a product like Willow will lift busy nursing mamas from our drudgery, but use this as a way to vision a better way to integrate the needs of nursing dyads into society.

    *I am using “mother” and “mama” and “women here for linguistic ease. I do recognize that not all breastfeeding parents identify in these ways, and I seek to honor that in my writing. Most of the theoretical work about social reproduction and the second shift focuses on the care work of “women,”  and sexism has generally underpinned the war on mothers specifically. In the framework and sense of solidarity that I would like to put forward here, I do generally refer to women/mothers, because an attack on women and mothers generally underpins the war on parents of all genders, including gender non-conforming and trans* parents. I hope that as the movements for reproductive and gender justice grow in the coming years, they will help us develop more useful and inclusive language that helps capture the shared and also distinct experiences of sexism, misogyny, etc. of gendered oppression. And I hope you will read my piece with understanding and generosity toward my linguistic limits.


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Reflections on Birth and Immediate Postpartum Life

Well, this is now six months late…but I’m a new mom! And a full-time working nurse-midwife! I’m finally ready to dust off the keyboard and start blogging again! So, to kick it off, here’s a post I started right after the transformative experience of welcoming my baby into the world and finally polished off this week. It was fresh when the birth smells were deliciously enveloping my newborn, and fun to revisit now. Enjoy.

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My daughter is now just over a week old. The heat of late summer has broken,  and the kids are back in school at the elementary school across the street. Her umbilical cord stump has just detached, and my bottom and other muscles are gradually returning to normal. I’m generally following the advice I so emphatically dish to my patients: sleep when baby sleeps. Now, I’m taking a breather and making note of what this whole birth thing was like.

Empowerment: I made labor and birth affirmations so I could hear my own midwife voice assuring me during challenging times. My partner drew on this principle several times during labor a few times by asking what I would say to a patient at that phase, when needing reassurance or guidance.

One of the inspirations I had in the week before birth was to make myself affirmations to look at when things got hard during labor. I had been thinking of turning to my friends who had had natural or home births and asking for advice I could use to prepare. While I did receive some good advice (both solicited and not) from such sources, it started to feel strange to me — after all, I’ve attended dozens of births as a student and as a certified nurse-midwife: I know what to expect! Granted, many of the births I’ve attended since beginning professional practice have been in a highly medicalized environment, and few of my patients choose unmedicated birth — fewer have the resources for prepared childbirth.

Yet, I knew the chief thing for me to be successful was not just hearing positive birth stories — and I have read and viewed many — and connecting with the friends and family who were there at my Blessingway, provided beads for my labor necklace, or who were lighting candles for me both near and across the country during my labor. Even having the best labor team possible — which I was fortunate to have — was not a guarantee that I would be okay. No, what I needed more than anything was to be able to hear it from the most authoritative voice I know, my own from my heart as a midwife and my own strength as a woman. For what good is a labor team if the mama isn’t the most willing and capable member?

Though I didn’t look too consciously at the pictures I created, they helped promote a good birth environment — my support team would recite the mantras I had written: Ya mero! Fierce mamas believe in you! You are going to get huge! Yes, yes you can. Trust your body, and so on…And more than anything, I was grateful for the opportunity to make them in the days I was “overdue” and making my nest and heart ready for my baby.

The days after birth, I kept reliving the experience. I was so exhausted and overwhelmed with love and sore in ways I never thought possible. Tears would flow every time I remembered how I felt when my little girl was wet and warm and just screaming her little head off, fresh out of the birth canal on my chest. I had heard and taught women about the “baby blues” on countless postpartum rounds. This was more like a spiritual high, of connection that nourished the parts of me that had been longing for this moment of readiness for years.

I also woke up this week in a panic, realizing that I am probably at high risk for postpartum depression. So I called up my doula, who had mentioned that she does placenta encapsulation, and I ordered up an edible form of the afterbirth to ward off the very real possibility of falling prey to the dark side of new mama life.

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Tree of life: placenta print

I had been hearing about placenta encapsulation for a few years, and knew it hadn’t been studied much. Searches in scientific literatures brings up little of substance, mostly concluding that more research needs to be done. But I also knew that loads of mamas and midwives swore by its powers. I had been planning to plant the placenta in the garden, but when I had a major panic thinking of returning to a very challenging work environment just 10 weeks after the birth, I thought why not give this a chance? Most mammals eat their placentas (seemingly more for survival reasons relating to evading predators), and the power of the oxytocin and progesterone gave me hope it would do more good than harm to try it out. So my lovely doula came over and picked up the placenta a couple days after the birth, and generously returned two days later with a beautiful jar of the capsules and extra home-made herbalist goodies.

In spite of my fears of impending depression, I mostly can’t help but think about how lucky I am to have experienced the birth I did, and how well this network of birth and postpartum support is setting up my little family for a bounty of love, patience, and joy. I had one of the most highly skilled midwives in my area at my birth, who worked with me through a fairly long labor and helped me achieve a normal birth. In almost any hospital, I am certain I would not have had such a nice outcome. Being denied freedom to move and oral nourishment, while being strapped into continuous monitors, I imagine my baby and I would have become very stressed, and a surgical birth would have likely ensued.

Since even before deciding I wanted to be a midwife, I knew home birth would be for me, and now having done it, I feel so strong and powerful as a mama, but also even more convinced of the importance of preserving normal, natural birth. At no point would drugs have helped my labor. At every point, my preparation and support team — my mother, partner, doula, and the midwife assistant — helped me more than any drugs normally administered during labor could. Every laboring woman deserves this type of set-up. How much better for me and my baby (therefore also for public health) that neither of us was too stressed physically during labor, so that we could have such a good, non-interventive birth?!

I know that not every laboring person desires unmedicated birth, but if given the tools and support, it seems many more might at least feel they could make that choice. It seems likely that this could be so helpful in lowering our national rates of surgical births, now more than a staggering one third of all births.

Yet birth is only the beginning. After bringing new life into the world, you have to keep sustaining it! And protecting it for many years!

People have asked me how pregnancy, and now how birth, has changed me as a midwife, but I think that piece, the postpartum and parenting piece has been the most humbling as a women’s healthcare provider. Now, I have pushed this baby out into the world, and now I am responsible for her. I am lucky that I have experience with babies and that I feel so confident in caring for her after this magical birth experience. But if it weren’t for my mother staying with us the first week, the meal train organized by other parent friends, and living in a supportive community, I don’t know I would feel capable of doing hardly anything this week! And I have mamas I care for who have hardly any such support — single mamas, teenage mamas, and mamas with unhelpful or unavailable families. It hardly makes sense to leave new moms alone as a society to figure out recovery from birth and caring for a vulnerable newborn baby.

And then there’s breastfeeding! What a major

BFing linocut

Image borrowed from Rachel Epp Buller’s book cover Have Milk Will Travel

commitment! And I knew it was something I wanted to do, and in fact had literally had dreams about for years. But then doing it is another thing all together. So far, so good. I love how it feels to snuggle this little person and I love how cool it is that my body is making the only food she needs now. I also love how my midwife and doula prepared me to deal with the pain in my nipples the first few days, with ointment, exposing them to air, and the homeopathic medicine. But again, how humbling to have worked with dozens of women to initiate the process immediately postpartum, and then realize how hard it is in real life to keep it up, all hours of the day and night. And a crying newborn. How much patience and calm it takes to keep on loving and caring for a needy newborn. No wonder, with such little support from friends, family, and healthcare providers, so few women in this country actually do commit to breastfeeding for any length of time.

I guess that’s it. Just sharing my thoughts on being a new and breastfeeding mama of a beautiful baby girl that I’m head over heels in love with! And of being a transformed midwife with a new appreciation for birth, the yoni, midwives, doulas, and mothers of all kind everywhere and of every time.

 


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Why You Should Choose a Nurse-Midwife for Your Pregnancy/Primary/Well Person Care

When I started on this path, I was in my mid-twenties. None of my close friends had ever continued pregnancies or chosen to parent. This is partly why midwifery had never occurred to me as a career at that stage in my life — none of us were in that place in their lives. But now that we are approaching “AMA” or “advanced” maternal age, or the ripe old age of 35 (haha), many of my friends are now starting families (or trying to). Lucky for them, they now have a midwife friend! 

So, this is an open letter to all my baby-making (and aspiring baby making) friends and family. 

My basic advice/message is:

Choose a nurse midwife for your pregnancy care!*

Here are 5 reasons why many pregnant people should consider using a certified nurse midwife (CNM) as their prenatal care provider and birth attendant.

1. Client education and counseling

Nurse-midwives aim to spend time with our patients and get to know you. We want to know what is important to you and meet you there. If you want a provider to listen to you and to openly and without judgment respond to your concerns about pregnancy and birth, you have a pretty good chance of finding this in a nurse-midwife.

2. Supporting physiologic processes

This is a hallmark of midwifery care. Take initiation of labor, for instance. A midwife will take a holistic approach — to ensuring your due date is correct, to providing physiologic means of helping you go into labor on time, and choosing not to admit you to the labor and delivery unit until you are really in labor. All of these are part of an approach that supports the pregnant person’s ability to have a baby when it’s time. It may also mean helping you push your baby out to minimize trauma and tearing of the perineal muscles, and certainly avoiding cutting your muscle to make room for baby’s head or shoulders (episiotomy). 

3. Evidence-based practice (EBP)

From my first semester in nursing school, EPB was drilled into my brain. I can’t tell you how many papers I wrote about EPB…but I’m glad I did, because it instilled in me a drive to provide care that is based on rigorous review of current evidence and is patient-centered. What does this mean? A good provider (social worker/doctor/physical therapist, etc.) draws upon current research and literature reviews to determine how they practice. I am very proud that this is a centerpiece of nurse midwifery education and culture. Not that seeing a CNM is any guarantee of this, but it certainly something that most CNMs should be familiar with. The CNM professional organization put together this fabulous resource compiling data about how we use EBP – Midwifery: Evidence-Based Practice. Our practice is not (or at least should not be!) based on expert opinion, tradition, convenience, fear of malpractice lawsuits, or other provider-centered philosophies — but rooted in solid evidence and a patient-centered approach. 

 

4. Labor support!

The best midwives will support you while you’re in labor — not just leave you to labor on your own and then show up at the end to do the delivery. In some busy practices, that may not be possible, so I always encourage pregnant people to find out what their provider does. Midwives are trained in labor support, meaning they can help keep you active and can provide comfort measures that can help you out throughout the process. Unfortunately, many physicians do not (but should!) receive training in normal birth, and often do not know what to do to promote your comfort during labor other than offer drugs. Midwives understand that labor is hard work and can support moms through it. 

5. Greater chance of normal birth

According to a recent survey of research on midwifery, you are more likely to experience the following when getting care with a certified nurse midwife: 

• Lower rates of cesarean birth,
• Lower rates of labor induction and augmentation,
• Significant reduction in the incidence of third and fourth degree perineal tears,
• Lower use of regional anesthesia, and
• Higher rates of breastfeeding. (Newhouse, Stanik-Hutt, White, et al, 2011)

These are not reasons you should not use a nurse midwife

1. I want an epidural

If you choose to have your baby in a hospital, your nurse midwife can still order you an epidural, if that is the anesthesia/analgesia option of your choosing. 

2. I want to have my baby in hospital

No problem – the vast majority of midwife-attended births are in hospitals. You may not even realize it, but there may be midwives at your local hospital. 

3. Midwives don’t know enough stuff

So you may have heard that terrible slam Bill O’Reilly made about advanced practice clinicians (APCs, formerly known as mid-level providers, yech!) — worried that the increase in care by folks in these professions aren’t qualified be good healthcare providers. (Yeah, I know, my readers are big O’Reilly fans.) “Lenny from community college” couldn’t possibly be my provider, he said of physician assistants! (See the response from the American Academy of Nurse Practitioners here.) Even so! Many people don’t know what training we receive. O’Reilly’s ridiculous comments (among thousands he’s made over the years) aside, becoming a CNM is no joke. I’m proud to say that I have attended many community colleges throughout my education, but I also will report that CNMs are required to have a bachelor’s degree, be a registered nurse, hold a master’s degree, pass a rigorous certification exam, and become licensed through the state they live in as both a registered nurse and an advanced practice nurse. We are very well prepared to take care of people when it is within our scope of practice.

4. I want someone I can see always, not just when I’m pregnant

No problem! Loads of midwives work in settings where they can provide well woman, gynecologic, family planning, and even primary care. It depends on how the midwife’s practice setting works, but in many cases, you may be able to see your CNM across the reproductive lifespan. 

5. Doctors know best

Haha, I know no one reading this blog would think that. But I really ran out of reasons why you should not see a midwife. 

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So…if you are low risk (not diabetic, chronically have high blood pressure, etc.) you may be a great candidate for working with a midwife! Get out there and FIND A MIDWIFE!!! And if there isn’t one in your area…well, shoot. Maybe you should get on the path to become a midwife, or tell someone you know who would make a great CNM to get on that path. We need more great women’s health providers. If you are feeling the call…better answer!

 

Reference:

Newhouse RP, Stanik-Hutt J, White KM, et al. Advanced practice nursing outcomes 1990-
2008: a systematic review. Nurs Econ. 2011;29(5):1-22

*Or your well person/family planning/gyne/primary care. More on “women” later…