Science & Sensibility's Blog Carnival - Success Stories from the Field

The following post is especially written for participation and support in the Lamaze International's Science & Sensibility "Blog Carnival - Success Stories from the Field".  http://www.scienceandsensibility.org/?p=1929

     As a doula, probably the most common thing I’ve noticed among expecting moms (especially first time moms – including myself, 16 years ago) is how much women truly DON’T know about the process of natural childbirth.  Sometimes, we think we do, or at least we think we’ve prepared ourselves for the big event.  Unfortunately for most of us, we’ve been led astray by the very well marketed childbirth books on the shelves at major bookstore chains that don’t promote confidence in the natural birth process, by the entertaining television shows of dramatic birth experiences, and even by our closest friends and relatives who can’t wait to share their birth story (and all of the ‘unusual’ events that might surround it).  Let’s face it, shows that describe women giving birth in their bathrooms to babies they weren’t expecting can captivate our minds, pregnant or not.  And we’ve all heard the story from someone close to us whose birth surely was the longest labor on record and the hospital staff who rescued her from the tragic suffering.  It’s no wonder the epidural rate in hospitals is over 90 percent.

                New mothers looking for doula support usually contact me around the time they are entering their third trimester.  Sometimes I’m fortunate enough to provide prenatal support earlier in the pregnancy.  Some of my most favorite doula experiences were with mothers who hired me during their first trimester.  I felt privileged to have been able to share lots of information and resources I didn’t normally have enough time to provide.  In these cases, this extra time for teaching made all of the difference in the birth outcomes.  Can you imagine if this information was available to all women (and men) before becoming pregnant?  How would we view childbirth if we came into it with some background knowledge that didn’t originate from our friends or TV?

                Most doulas with children of their own will probably admit to having shared a birth video or two with their family and probably have a library of birth books, a model of a pelvis, and numerous posters of the birth process within view.  Our children have probably seen a photo of a placenta and know that breast milk is the healthiest food for a newborn.  My six year-old has bounced across my office on a birth ball more times than I care to count and my ten year-old (a boy) knows the “Welcoming Baby” belly dance and that keeping mom upright helps to ease the baby down during birth.  How is it that our children are more knowledgeable than grown adults who are preparing for one of the biggest events in their lives?  The children had access to, and learned honest information early, before the media and social influences could make an impact.  For more on this topic, read my post “Beyond ‘The Talk’ – Educating a Younger Generation” http://momandlittleme.blogspot.com/2011/01/beyond-talk-educating-younger.html

                As part of my doula/childbirth educator practice and as an expectation (and dedication) to my midwifery training, I’ve committed myself to educating a younger generation on natural childbirth and breastfeeding.  My vision of an entire generation of future health care providers and administrators, law makers, insurance representatives, parents, teachers, (fill in any other profession here) who have all come to expect that birth is a natural process of life and not one that needs to be medically managed is what I imagine as the answer for a nation who needs better maternity outcomes and breastfeeding expectations. Children and young adults who have the opportunity to learn the same information that my children (and the children of other birth professionals) have learned about the process of natural birth will become confident adults who trust in their body; adults who respect themselves and one another; and parents who provide the best start to life for their newborn based on research rather than Hollywood or malpractice insurance guidelines. 

                While testing these new waters, my work begins with small groups of young women and their mothers who are interested in learning about the miraculous, perfect design of their body in an age appropriate, real time manner.  The six Healthy Birth Practices written by Lamaze International are simple steps to providing women with confidence to birth their babies that can also be adapted to a younger audience.  When younger women learn to appreciate their primal ability to give birth naturally, they will confidently approach motherhood and make choices that improve their safety and satisfaction during their childbearing years. 

                As this content is further fined tuned, I hope to offer workshops and webinars, and hopefully adapting the information into the health curriculum of many school districts.  I see a lifetime of work ahead of me, but it will be one that I will look back on with pride.

               

Beyond "The Talk" - Educating a Younger Generation

Over the last four years or so, I've seen my three oldest children go through "The Fifth Grade Talk", and learn topics of "Sex Education" in their school health class.  During this same time, I began my work as a doula and midwifery student.  These events came together about the same time, and it started me thinking.

My oldest daughter is now 15.  By the time she had "The Talk" in fifth grade, she had already experienced childbirth firsthand, as she helped "catch" her youngest sister.  During my pregnancy, my midwife suggested that I include my oldest daughter (who was not quite 10 at the time) in the experience, explaining that this would be a fabulous opportunity for her to learn about her own body, and what's to come in her own development.  I wasn't involved professionally in the childbirth field yet, but I embraced the idea.

She attended every prenatal visit, childbirth classes, read information, and evenutally attended and assisted in the birth.  I regret to this day that I did not have my sons attend that birth.  They were very young at the time, and due to their age, I thought several hours in the hospital while I labored might be too much for them.

She sat with me as I nursed her sister (although she had already seen me nurse both of her brothers a few years before).  The boys often sat with me, too.  They never asked questions about breastfeeding.  In their understanding, that is the way babies ate food.  Period.  And, like most children, I would catch them trying to nurse their stuffed animals. 

The following year, my daughter had "The Talk", but it was not uncomfortable for her, nor was it unfamiliar.  We talked together later that night, and I answered a few of her questions.  Four years later, my son had "The Talk", and the following year, so did his younger brother.  It was interesting for me to listen to the boy's side of  "The Talk".  I would be lying if I didn't admit that I felt like the fact that their "Talk" was led by a male phsyical education teacher and his assistant, a male fifth grade teacher, was a disadvantage to the class.  I found myself having to "undo" much of the information that they learned, particularly what they learned about females.  I found it very troubling that my oldest son told me that he learned that "women get grouchy every 28 days".

This year, my younger son came home from "The Talk", and while he was less eager to share everything they talked about, he was proud to tell me that he and another boy already knew a lot of the information.  (The other boy is the son of a midwife, and mine, the son of a doula).  All of my children have watched birth videos with me, or listened in on a childbirth or breastfeeding class I was teaching.  They've helped me study for my midwifery classes, looked at my books, and have just come to appreciate birth for the natural process of life that it is.  They've seen a placenta and know that encapsulated, it helps some women recover during postpartum.

As a mother, I know that I have raised four children who will expect a natural birth experience when they become parents, and that their children will be breastfed.  It's what they know.  They've seen it first hand.  I didn't go out of my way to teach them.  They've just grown up being exposed to such information.

As a childbirth professional, I know that my children will make those choices because of what they've learned and experienced as children, not because they will sit in on a childbirth class when they are 30 weeks pregnant and suddenly learn to change all of their ideas about birth that society and television has taught them.

It makes me think.  Shouldn't all children know this?  Wouldn't this make a difference in the world of birth and breastfeeding?

I've seen my now 15 year old daughter attend health classes in which she is taught much about how not to get pregnant.  Don't get me wrong - it's important information.  But, it's irrelevant information to my 15 year old who's never had a boyfriend, let alone been in a situation to protect herself from pregnancy.  Sure she needs to know this information - someday - but isn't there more applicable information she could use now?

This past fall, I had a chance to attend a Fertility Awareness Method workshop.  After reading the advertisement for the workshop, not only did it sound like something I would enjoy, I thought it would be good information for my daughter as well.  She had enough background to grasp an understanding of the fertility information, and I was already struggling with the idea that she (and her classmates) were learning so much about "how not to get pregnant" that she might never have a chance to learn about good health "when pregnant". 

She loved it.  She soaked it in, and could apply every single thing she learned about herself as she is RIGHT NOW.  It was all information she can use later either to prevent a pregnancy or achieve a pregnancy.  But she could also use that information today.  She can chart her cycle, and she can apply that information to her overall health.  She can live a healthier life as a young woman.  In school she was learning how to apply a condom (something completely foriegn to her), when she really needed to learn how to find and feel her own cervix (something she learned at the FAM workshop). 

I work with lots of pregnant women who are only now learning about birth.  Its kind of like learning to drive after you already have a license.  Often, I sit on interviews with women looking for a doula, and I feel like I'm educating them about birth for the very first time in their lives.  They come into pregnancy with the influence of friends and family members (90% of whom have opted for a medicated birth), and feel educated on childbirth based on reality shows they have seen on cable TV.  That's not real birth education.  They'll tell me how they want a natural delivery, and they'll sign up for a hospital birth class.  I'll share lots of information with them, and do my best to expose them to natural childbirth.  But for many of them, it's simply not their expectation.  Some don't have the advantage of having lived to expect birth as a natural part of life.  The confidence in birth is not engrained in them.

As a birth professional, I read lots about ways to change birth.  We blame much on hospital interventions and the limit of midwifery care and lack of homebirth support.  Then we turn to current birthing women and expect them to be onboard with all of the information we know about safe birth practices, and to help create change in the maternity care field. 

It seems to me that we need to create an expectation of a younger generation before there is real change.  A younger generation that will become parents, health care providers, insurance workers, and lawmakers. If this younger generation learned more about the function of their bodies, in addition to the development of them, perhaps they would gain that confidence, and come to expect that birth and breastfeeding are a human right.  A human expectation.  A given.  A whole generation "on the same page" when it comes to birth. 

No discussion over whether or not women can breastfeeding in public because this generation would think "Why in the world couldn't a woman breastfeed in public?  How else is the baby going to eat?"  Can you imagine a world that assumes birth doesn't need to be medically managed?  It doesn't seem to be that hard of an idea to grasp, really. 

We've changed lots of things over the years with education.  It takes time, but it eventually works.  Certainly if my own actions as a mother have influenced my four children, then that's four more families who will influence their children, and their children, and soon, that's a lot of people making better choices based on what they've learned from their parents.  I think we just need to include this younger generation in our efforts to promote healthy birth practices and breastfeeding rather than relying on holding the medical community or the formula companies accountable.  (For the record, they're accountable in my book - but it's bigger than them).

So in the past few months I've researched, taken notes, jotted down a few ideas and started strategizing.  I struggle with finding the balance of appropriately presenting this idea as a curriculum.  I sure don't want to glamorize the subject into promoting more teenage parents, and I wonder how that pitch might sound to a high school educator.  But, I waiver back and forth as I hear my daughter's stories of health class and social clubs started at school to promote an individuals sexual orientation, and realize if the schools are offering the subject to the students, then they need to offer the rest of the information.  Perhaps they are as uneducated in birth as the rest of the adult population?

Somewhere I'll find the right approach.  And eventually, a new generation will come to expect the same things from birth and breastfeeding.


   

The History of Breastfeeding Failure in the US

Since the beginning of time, breastmilk has always been the best food for babies, yet today, only half of all American mothers choose to breastfeed.  Those who do, less than thirty-two percent of American babies are still breastfeeding at six months of age.  The American Academy of Pediatrics endorses breastfeeding for a minimum of twelve months and the World Health Organization (WHO) recommends at least two years. 

In the 18^th and 19^th centuries, wet nurses – lactating women who nursed and cared for the infant of another woman - hit the height of popularity. With little oversight, these wet nurses often created mixtures of grains and broth for feeding the babies, instead of nursing.  As a result, babies died, and wet nursing was wrongly blamed.

When the Industrial Revolution turned our attention to science and technology, specialized formulas were prescribed by physicians and scientifically thought to be superior to breastmilk.  So began the relationship between formula companies and the medical community.  As birth moved from the home into the hospital, birthing women were highly medicated and unable to breastfeed during their required two week stay in the hospital, often leading to inadequate milk supply, nipple confusion, and ultimately breastfeeding failure.  As a result, breastfeeding success dropped to an all time low of eighteen percent in 1966, and formula was seen as coming to the rescue. However, it was our own community setting up mothers for breastfeeding failure, instead of formula saving our babies.

In the 1970’s the WHO and UNICEF recognized the decline in breastfeeding was due to political, social and technological reasons.  Formula companies were marketing their products aggressively which led to the development of the International Code of Marketing of Breast Milk Substitutes in 1981.  The United States was the only country of the 119 countries participating, to vote against this code.  While most of the world works to promote breastfeeding as a human right for both mother and baby, the United States continues to fall behind in this most basic human need - infant feeding.

Infant formula is the fourth recommended way to feed an infant, falling behind breastfeeding, pumped breastmilk, and the breastmilk of another woman.  While the FDA recognizes that the “exact chemical makeup of breastmilk is still unknown”, nutritionists at a leading infant formula manufacturer admit that it is “impossible” to create an infant formula parallel to human milk, no matter how well the marketing agencies may try to convince consumers otherwise.  These same nutritionists issued the following statement in the March 1994 Endocrine Regulations – “(It is) increasingly apparent that infant formula can never duplicate human milk, which contains living cells, hormones, active enzymes, immunoglobulins and compounds with unique structures that cannot be replicated”. 

Most consumers incorrectly assume that the FDA closely monitors formula production. The Infant Formula Act of 1980 requires formula manufacturers to include only an insignificant number of mandated ingredients and list them on the packaging.  The WHO and UNICEF continue to report that between one and two million infants worldwide still lose their lives each year due to artificial feeding.

Placenta for Postpartum Recovery

During pregnancy, human mothers need 1000mg of total body iron to maintain oxygen to the fetus, increase maternal red blood cell mass, and allow for normal blood loss during delivery (Bodnar, Cogswell, McDonald, 2005).  After delivery, this requirement declines significantly, and the risk of iron deficiency of the postpartum mother is considered to improve dramatically.  However, this puts many postpartum mothers in a very vulnerable state for developing anemia and fatigue, both of which contribute to postpartum depression. 

While the Centers for Disease Control, the Institute of Medicine, and the American College of Obstetricians and Gynecologists have published recommendations for prevention of postpartum iron deficiency, the US Preventive Services Task Force states that there is insufficient evidence to support the need for screening postpartum mothers for iron deficiency if they show no sign of iron deficient symptoms.  Those symptoms, such as fatigue, decreased productivity, and poor cognitive functioning could all be attributed to mothers who are simply adjusting to life with a newborn.  Most mothers suffering from these symptoms as well as postpartum depression rarely seek medical attention.  Left untreated, the effects of iron deficiency are severe and the damage from it increases over time.

With symptoms of new parenthood and iron deficiency being so similar, and the lack of screening all postpartum mothers, studies by Bodnar, Cogswell, and McDonald, 2005 suggest that the postpartum iron deficiency is “more prevalent than previously thought and that the postpartum period should not be considered a time of low risk for iron deficiency”.  Even more noteworthy is the fact that postpartum depression and stress respond well to iron therapy when available.

Studies by McCoy, Bleiler, and Ohlson examined the amount of iron in whole placentas and umbilical cords and suggested that birthed placentas contain just less than 92% of the 1000mg of iron needed in a pregnant mother.  This high concentration of iron is available to all mothers, custom made by her own body that sustained her and her infant through pregnancy.  This same source, if ingested, could provide the new mother with the additional iron supplies her body needs during her postpartum period to help combat anemia, fatigue, and postpartum depression.  These studies assume that natural iron will be more readily absorbed by the body than a synthetically manufactured supplement.  Postpartum depression, stress, and cognitive impairment in women may be related to the existence of iron deficiency anemia, and all respond well to iron therapy.

Most importantly, as with many areas of childbirth, mothers need to be self advocates for their own bodies, and proactively prepare their bodies for this postpartum period with the resources that their placenta is capable of providing.  Rather than wait for her health care provider to identify her as iron deficient by examining her outwardly expressed symptoms, utilizing her own natural iron resources could provide mothers with the ability to combat anemia, fatigue, and ultimately decrease the chance of developing postpartum depression. 

The fatigue issue has many factors. Fatigue can be the result of poor iron stores, and can also be caused by lack of sleep. While it may be impossible to resolve sleep issues for new moms, placentophagy does help with the fatigue. Traditional Chinese Medicine (TCM) has used placenta to treat fatigue, and a large amount of anecdotal evidence that placentophagy helps increase energy levels. It is difficult to determine whether this is due to the iron content of the placenta, or some other unknown factor. But the research linking fatigue to iron deficiency is a strong case that placentophagy would help fatigue symptoms. Since the studies show that fatigue and iron deficiency are both factors in developing postpartum depression, both of which can be relieved by placentophagy, it is assumed that placentaphagy would help alleviate postpartum depression.

Known as POEF (Placental Opioid-Enhancing Factor), placenta is also an effective pain-management option with advantages over standard narcotics.   Results from a variety of studies have unanimously shown support of the analgesic qualities of ingesting placenta during the postpartum period. 

The placenta (and amniotic fluid) contain opioids, an opium-containing substance that is produced naturally in the brain.  Ingested placenta influences specific opioid receptors in the brain.  The use of placenta also enhances the effects of other pain reducing features, such as morphine. 

Known as “pregnancy-induced analgesia”, the pain threshold of women rises at the end of pregnancy and peaks around delivery.  Pain-threshold returns to non-pregnant levels within 9-12 hours postpartum.  Placentophagy also supports the elevation of the pain-threshold. Using placenta during the postpartum period offers the new mother a natural pain relief option.

In stressful situations, the human brain naturally produces a stress-fighting hormone called CRH.  During the last trimester of pregnancy, the placenta secretes high levels of this hormone, assumed to help support the mother through the uncomfortable stage of late pregnancy and childbirth.  According to research, this hormone is key in combating postpartum depression. 

Immediately following birth, the mother’s brain must now regulate CRH itself without the help of the placenta.  This regulation period may take a while leaving the new mother with low levels of CRH, making her vulnerable and unable to naturally combat the stressful postpartum period.

            In addition to lower levels of CRH, new mothers also experience significant drops in other hormones immediately following birth.  Estrogen and Progesterone which had increased levels throughout pregnancy due to the work of the placenta suddenly drop after birth.  Estrogen supplementation is often used to significantly reduce the symptoms of postpartum depression.

The placenta is also responsible for increased levels of cortisol, another hormone which decreases significantly after birth.  It is believed that this suppresses the adrenal hormones that can contribute to depressive mood changes.  Changes in mood postpartum may also occur because the mother is extremely sensitive to the normal levels of hormones following birth.

Using placenta during this postpartum period helps the new mother gradually become accustom to the decreasing hormonal levels.  Because the placenta is responsible for the secretion of many hormones that help control mood and depression, it only makes sense to continue to offer mother’s bodies the support from placenta during the postpartum period.

An appealing option for placentophagy is through encapsulation.  In Traditional Chinese Medicine, the placenta is steamed and dehydrated.  Once dried, it can be ground and encapsulated for the mother to ingest the same as she did with prenatal vitamins.  It is argued that placentophagy is not cannibalism because the placenta is a timed, temporary organ, and does not remain part of the body.

Citations

Information for this article was gathered from research and writings on http://www.placentabenefits.info/

Selander, J. (2006-2009).  Biological Causes of Placentophagy.  Placentophagy as an Adaptive Biological Behavior.  Retrieved from http://www.placentabenefits.info/biological.asp

Bodnar, L. (August, 2004).  Have We Forgotten the Significance of Postpartum Iron Deficiency?.  American Journal of Obstetrics and Gynecology. Retrieved from http://www.idpas.org/pdf/4111.pdf

Blank. M,(November, 1980). Effects of placentophagy on Serum Prolactin and Progesterone Concentrations in Rats After Parturition of Superovulation.  . Retrieved from http://www.reproduction-online.org/cgi/content/abstract/60/2/273

Ramsey, J. (February, 2009).  Baby Blues – Postpartum Depression Attributed to Low Levels of Corticotropin-Releasing Hormone After Placenta is Gone.  WebMd Health and Pregnancy. Retrieved from http://topnews.us/content/23185-hormone-levels-may-predict-who-gets-baby-blues

Kristal, M. Enhancement of Opioid-Mediated Analgesia: A Solution to the Enigma of Placentaophagia.  Department of Psychology, State University of New York at Buffalo.  Retrieved from http://cogprints.org/180/0/review.html