MANA Musings

I am so glad I was able to attend MANA this year. It's always a privilege and I learn so much and meet old and new friends. Highlights include:

• Meeting Jenny Joseph and getting an introduction to her model for prenatal care. I would love to bring this model to KC- have some ideas in the works for my FIMR board. I've got to get her here.
• Participating in a white privilege game. Its where everyone stands in a line and takes steps forward or backward depending on their socio-economic and racial factors. I was at the tail end, by a mile. I can't wait to do this exercise with my nursing students. I found it quite powerful.
• Being near sea and mountains- as a child of the midwest I hardly ever get to do both at once. Taking my little rental car on a coastal tour was a wonderful experience.
• Vegetarian meals served at the Asilomar Resort were fabulous.
• Getting to room with Morningstar and Alison, a midwife from San Miguel de Allende, Mexico.
• Seeing Diane Paul of Sage Femme and witnessing more of her birth videos.
• Bird watching- saw some new ones I haven't seen before.
• Seeing so many midwives of color- there are more and more every year- good to see the next generation answering the call.
• Conference bookstore: purchased two new books, a purse, a pair of earrings, gestational wheels for my students and a host of souvenirs for my kids
• Favorite session: At your cervix: the ethics of how we teach pelvic exams
• Most transcendent session: Morningstars session on using storytelling to teach instinctual birth
• Most practical session: Using social media to promote better birth care
• Goal for next year's MANA: do a presentation from my newly published book

MANA Faces

Photos from Monterey Bay

MANA Update

MANA has been wonderful, as usual, and has gone quickly, as usual. I've attended sessions on, teaching cervical exams in a humane way, using social media (like this one) to expand business or advocate for a cause (like I'm doing now), cultivating cultural sensitivity, and using storytelling to teach instinctual birth. I will use all of this new knowledge in teaching my nursing students, and in furthering my work at home with lactation, infant mortality, and humane maternity care. I'm off to have breakfast, stroll the beach (dip my toes in the ocean/bay one more time) and visit the Red Tent which is always a treat. I will also listen to Ina Mae give her keynote address this morning- which starts right about now...

Rebel with a Cause

I'm here in Monterey California at MANA 2009 sitting on white sand beaches, in temporate weather, contemplating my role in materal infant health in the United States. What mark will I leave on future generations of mothers and babies? I came here to see and hear my heroes in the cause, only to hear how overwhelmed they sound and defeated they sometimes feel. Still I must take up the charge. Morningstar's book, "The Power of Women" is making it's debut here at the conference. I make a solemn vow to myself, that next year, I'll be sitting at the author's table. People have begun to approach me about 'my work'. So far my work has been verbal and written, now I feel the universe telling me its time to get some skin in the game. I have an idea for a pilot program, to increase utilization of prenatal care for high risk women. I have to secure funding from somewhere, and I have to coax the powers that be to partner with me. Now that I sit on the FIMR board, I can use it as a jumping off place. I've been offered a leadership role on the Health Commission. There are lighthouses here- beacons of light and hope to ships lost in dark and dangerous waters. How do I shine a light on the darkness of infant mortality?

Doctor Dick

Okay, Even though I would run screaming from the facility if a physician handed me the following document, I still find something refreshing about his or her honesty. Most docs just say, "sure okay, we can try that" and then when labor hits they do whatever the hell they want.

A healthcare consumer posted this on another blog. She stated her plan to find another physician. Good for her.



DR. ________ "BIRTH PLAN"

Dear Patient:
As your obstetrician, it is my goal and responsibility to ensure your safety and your baby's safety during your pregnancy, delivery, and the postpartum period. My practice approach is to use the latest advances in modern obstetrics. There is no doubt that modern obstetrical advances have significantly decreased the incidence of maternal and fetal complications. The following information should clarify my position and is meant to address some commonly asked questions. Please review this information carefully and let me know if you feel uncomfortable in any way with my approach as outlined below.* Home delivery, underwater delivery, and delivery in a dark room is not allowed.* I do not accept birth plans. Many birth plans conflict with approved modern obstetrical techniques and guidelines. I follow the I follow the guidelines of the American College of Obstetrics and Gynecology which is the organization responsible for setting the standard of care in the United States. Certain organizations, under the guise of "Natural Birth" promote practices that are outdated and unsafe. You should notify me immediately, if you are enrolled in courses that encourage a specific birth plan. Conflicts should be resolved long before we approach your due date. Please note that I do not accept the Bradley Birth Plan. You may ask my office staff for our list of recommended childbirth classes.* Doulas and labor coaches are allowed and will be treated like other visitors. However, like other visitors, they may be asked to leave if their presence or recommendations hinder my ability to monitor your labor or your baby's well-being.* IV access during labor is mandatory. Even though labor usually progresses well, not too infrequently, emergencies arise suddenly, necessitating an emergency c-section. The precious few minutes wasted trying to start an IV in an emergency may be crucial to your and your baby's well being.* Continuous monitoring of your baby's heart rate during the active phase (usually when your cervix is dilated 4cm) is mandatory. This may be done using external belts or if not adequate, by using internal monitors at my discretion. This is the only way I can be sure that your baby is tolerating every contraction. Labor positions that hinder my ability to continuously monitor your baby's heart rate are not allowed.* Rupture of membranes may become helpful or necessary during your labor. The decision as whether and when to perform this procedure is made at my discretion.* Epidural anesthesia is optional and available at all times. The most recent scientific data suggest that epidurals are safe and do not interfere with labor in anyway even if administered very early in labor.* I perform all vaginal deliveries on a standard labor and delivery bed. Your legs will be positioned in the standard delivery stirrups. This is the most comfortable position for you. It also provides maximum space in your pelvis, minimizing the risk of trauma to you and your baby during delivery.* Episiotomy is a surgical incision made at the vaginal opening just before the baby's head is delivered. I routinely perform other standard techniques such as massage and stretching to decrease the need for episiotomies. However, depending on the size of the baby's head and the degree of flexibility of the vaginal tissue, an episiotomy may become necessary at my discretion to minimize the risk of trauma to you and your baby.* I will clamp the umbilical cord shortly after I deliver your baby. Delaying this procedure is not beneficial and can potentially be harmful to your baby. * If your pregnancy is normal, it should not extend much beyond your due date. The rate of maternal and fetal complications increases rapidly after 39 weeks. For this reason, I recommend delivering your baby at around 39-40 weeks of pregnancy. This may happen through spontaneous onset of labor or by inducing labor. Contrary to many outdated beliefs, inducing labor, when done appropriately and at the right time, is safe, and does not increase the amount of pain or the risk of complications or the need for a c-section. * Compared to the national average, I have a very low c-section rate. However, a c-section may become necessary at any time during labor due to maternal or fetal concerns. The decision as to whether and when to perform this procedure is made at my discretion and it is not negotiable, especially when done for fetal concerns.

Spawn of the Devil or Angel of Destruction?

Josiah turned 3 last week. While he is cute and adorable, inquisitive and intelligent, we seem to be experiencing a greater volume than normal of broken electronic major appliances in our home, lately. It seems in the last couple of months he has broken our TV (poured water over it to 'wash' it), our computer (kicked it over in a fit a rage, hasn't worked since), lost an IPOD (last seen in his pudgy little hands), broke the IPOD port on our CD player, and has been implicated in the malfunction of several cell phones. We went to look at computers yesterday, and will budget for a replacement TV next month. Has he been sent to us as a plot by Satan to break all our stuff? Well even if that turns out to be the case, he's still a lot of fun to have around. His vocabulary increases every day, he's spoiled rotten, and still insists on sleeping in bed with us or one of his siblings. Potty training is optional, right? He's still in the throes of a Batman fetish, and insists on being Batman for Halloween. Later today we head to a local pumpkin patch so he can pick out some pumpkins. Despite how expensive having him around is turning out to be- we couldn't be more thrilled. Thankfully, he hasn't broken anything today.... wait... what was that crash???