Blog a la Cart

We are the luckiest

Happy Birthday, Momar. We’re so lucky that we have you overseeing our brood. 143

Why Hire a Doula

Sunny’s Fairy Godmother is expecting her first child this summer, and, after much thought and conversation, has decided to hire a doula. What I love and admire so much about my dear friend is that she not only heard and reacted to what she was learning from friends and fellow women about their birth experiences/needs, but in deciding to hire a doula, dove into the medical research and information that might verify or confirm some of what she was hearing anecdotally. She’s been able to validate so much of what I instinctively felt about the importance of a doula with compelling, fascinating, empowering evidence that doulas are, undoubtedly, a valuable asset during maternity, the birth experience, and postpartum life. nican can provides you more guide.

She is keeping a private blog for friends and family to follow in her journey, and this post that she wrote about why she hired a doula absolutely blew me away. It’s the kind of conversation doctors, insurance companies, and anyone working in or engaged with maternity, birth, obstetrics, labor, etc. should be having. Dellie herself is a doctor and I am so impressed with her level of thought and engagement with this topic. She has generously agreed to let me share her words here, as I think that it expands on many of the conversations I’ve had in this space and brings added value and meaning to that work. Many, many thanks to her! My girls are so fortunate to have smart, inspiring female role models like her in their lives.

_____________________________________________

Over the past few weeks and months, friends and family have reached out with the same question, phrased in several different ways:

Why did you hire a doula?

I realized, with the repetition of this very welcome question, that my first post really did not do justice to explaining what has led Jeremy and me to hire Shayla. At the same time, I was letting myself down by forgetting skills and access that I utilized endlessly in the first trimester to better understand diagnostic screening options when it came to researching and understanding the significance of hiring a doula. Much of our decision was based upon gut feelings and the experiences, reports, and recommendations of a limited number of trusted people in our lives.

Then I found there is so much more to support our decision.

So, let me start at the beginning. No matter what happens, our number one goal is a safe, healthy, ideally happy, Mom, Dad and baby to be together this summer. Underscoring safe and healthy. Neither Jeremy nor I has any preconceived idea that our experience “has” to go in a “certain” way. Even if we end up drafting ideas for a birth plan, it would be more of an exercise in focusing in on our own priorities and values than it would be a “plan” in any conventional sense. The process of labor, delivery, and childbirth is one that defies planning. It benefits from preparation, communication, and support. But I can be certain that we will be surprised. That we won’t really know what to expect until those hours and days arrive. That we will be challenged. That we won’t always know what is best, and that we will have to trust our instinct, communication skills, and the support of caregivers and loved ones to ensure that safe, healthy, and happy happen.

Moving up in the hierarchy of needs, we enter the world of values, experience, and preference. Some women truly fear labor. I have friends and acquaintances for whom the ideas of the potential pain, trauma, and physical hardship that come with vaginal childbirth are overwhelming and terrifying. There are women and families for whom those fears are so all-consuming that a maximal level of medical intervention, i.e. a planned cesarean section, is a welcome option. I admit in advance that I do not know what I will “want,” if there are options on the day we’re trying to bring this baby in to the world. I know that I want all medical options available, should they be necessary. I want my provider to be able to care for me and this little baby no matter what happens during labor and delivery. But, if everything goes smoothly, I also would prefer to minimize the level of medical intervention.

But what does minimizing medical intervention mean? To me, it means staying at home during labor as long as possible. Being able to walk, sit, move, shower, bathe, dance, and shift positions during labor for as long as possible. To use alternative methods outside of medical analgesia to manage painful contractions. To be as active a participant as is possible in bringing this baby into the world. To (myself) be able to focus on natural, normal, productive bodily processes, while allowing my care providers to be concentrating on data points. At each crossroads, whether it be administration of medication, use of monitoring, or addition or more staff to the room, to be able to say “yes” or “no,” and make that decision an informed, thoughtful one, not made in the heat of the moment. And not made under undue influence of a well-intentioned caregiver who might not have the same priorities as my family. It means being supported if we choose not to have an epidural. To minimize the chance of an unnecessary cesarean section or assisted birth. And after, g-d willing, that baby is born, to allow family contact, bonding, and establishment of breastfeeding to take precedence over “box-checking” medical procedures that can wait. To provide encouragement, support, and certainty, when saying “no” matches my and Jeremy’s value system, even if it feels difficult or like an inconvenience. Essentially, to maximize the chances of allowing the normal, if extremely challenging, process of childbirth to unfold in a way that is safe, healthy, and happy, while minimizing the chances of undue physical, mental, or emotional trauma.

So, how will a doula help us achieve these goals?

Here comes the science.

I actually started prepping this post some time ago, while searching for scientific evidence to use for a prepared-in-advance rebuttal to what will certainly be an initial denial for insurance coverage of doula fees. But I came up with much more than I expected, and much more data that spoke to me than I had anticipated. First, data to support the use of doulas dates back to at least 1991, when an article appeared in the Journal of the American Medical Association (JAMA), which is one of the top three international medical journals read widely by physicians of all different specialties. Although this article was not accessible in full text, it was a “randomized, controlled trial” (theoretically the highest level possible of evidence in medical literature) that compared three groups of “identical” (prospectively randomized) women giving birth: one control group, one group that was observed without doula support, and one group that had continuous support from a doula. The outcomes were simple: reduced rates of cesarean section (18% vs. 13% vs. 8%) and reduced rates of forceps-assisted deliveries. Similar trends were seen for other types of intervention: reduced rates of epidural anesthesia (55.3% vs. 22.6% vs. 7.8%); less use of oxytocin (used to “speed” contractions or promote the onset of productive contractions), shorter duration of labor (who wouldn’t be excited about shorter labor?), shorter infant hospitalization (again, a no-brainer to me), and less maternal fever.

An even earlier study in the New England Journal of Medicine (also among that triad of highly-touted medical journals) in 1980 showed a similar pattern when studying the impact of doula services on outcomes: shorter time from admission to delivery (8.8 vs. 19.3 hours), more awake hours after delivery, more maternal engagement (verbal and non-verbal) with infants, lower rates of cesarean section, and fewer perinatal “problems,” generally defined.

These studies from 1980 and 1991 set the stage for studies from that time until now that essentially confirm and further support all of these findings. Across cultures and socioeconomic groups (including countries outside of the U.S., including the wealthy and the poor, those with public insurance and those with private insurance), doulas have consistently been show to have statistically significant effects including: lower rates of cesarean section (particularly relevant when hospitals in the D.C. area have C-section rates ranging from 30-80%, even for low-risk women!), fewer epidurals, decreased use of any medical pain killers, decreased use of oxytocin and forceps, shorter labors (particularly shorter second phase of labor), higher APGARscores for babies, higher rates of successful breast feeding (and earlier/more “timely” milk let-down), and longer duration of successful breastfeeding.

Scientifically, hiring a doula is entirely in line with our family’s goals. If we can pay $1200 (or convince my insurance company to pay some, or all, of that cost) to reduce my chance of having a cesarean section by at least 40%, decrease the chances of needing an epidural or other medical analgesia, decrease the need for device-assisted delivery (and the possible adverse side effects of such instrumentation), and improve my ability to nurse effectively, sign me up. May well be the best $1200 we spend in this preparing-for-baby process. And that would be if the benefits of having a doula stopped with what I have listed above, but they don’t.

The scientific literature has gone a step further, looking at psychological outcomes of doula care. Although these measures are not as refined, and have not been replicated in as many systematic or randomized studies, doula support has been shown to result in, for mom: improved sense of security, less helplessness, less distress, higher self esteem, higher rates of “good” experiences with labor and sense of ability to “cope,” and higher perception of mom’s own “performance” and positive image of their bodies’ strength and ability. Again, sign me up. I would be ecstatic if, after delivering safely a healthy baby and staying healthy myself, I can also feel powerful, proud of my body, strong, and have a higher degree of self-esteem. I love thinking of labor and delivery through this lens: as a way to be empowered, inspired, and awe struck by the abilities of my body and this little baby. What a tremendous psycho-emotional outcome to which women should be able to look forward, instead of fear.

Although non-scientific, there are still many, many aspects of the importance of a doula’s support not delineated in the above research and detailed arguments. Time and time again we hear from friends and acquaintances how pivotal the support, reassurance, and creativity of their doulas meant to them. How it helped them be stronger as a family. Feel safe. Feel empowered. These stories are balanced by those of friends and acquaintances who didn’t work with doulas and have birth stories that make clear where the absence of a doula made the time more difficult, frightening, or disempowering than it should have been.

And at the end of the day, we hope and dream that the doula feels superfluous. That we are blessed with a safe, healthy, and happy delivery that requires minimal support, minimal intervention, and few difficult decisions. If that is the case, we will be so grateful that the money spent will seem a distant memory. And I bet I will still be grateful for the postpartum home-visit to support breast feeding and make sure that I am physically and emotionally healing and recovering from such a tremendous, challenging experience.

So, in one of my most epically-long posts thus far, I hope that I have been able to more articulately, thoroughly address the much-welcomed question of “Why a doula?”

Jeremy and I aim for a safe, healthy, happy, and intervention-minimizing (and I’ll take empowered if that comes, too!) childbirth experience. And through the preponderance of clinical evidence as well as anecdotal experience, hiring a doula is one of the best ways to increase our chances of achieving those goals.

________________

Addendum: It  surprises me quite a bit that, given all of the findings above, insurance companies still refuse to cover doula expenses. For a health care system obsessed with minimizing costs and “intervention,” why not invest the up-front money to support women in labor when there are so many positive medical advantages, and significant potential cost-savings?

On the same note, I think there is one important study notably absent from the canon described above: evaluating the impact of doula support on malpractice claims. It may simply be a hypothesis, but it would seem that a supportive third party who helps a patient and her family take an active role in decision-making for their care and improves physical and psycho-social outcomes would be extremely likely to reduce the probability of her client filing a law suit against other medical providers. I could be wrong, but it seems like an intuitive next step. Given the significant malpractice insurance costs associated with obstetrics, maybe someone will finally realize that it might be worth funding a trial that measures malpractice claim filings and settlements as one of its outcomes.

And maybe, just maybe, the option to work with a doula would then be accessible to more women and families who could benefit from their support, while the health system at large also benefits. Few health care conundrums are win-win-win for patients, providers, and insurers. But this one certainly could be.

Easter 2013

Easter 2013 was a rare and beautiful thing for March in New England. Sunny and warm with clear blue skies. We could not have asked for a better, more cooperative day. Thanks, Mother Nature!

The girls L-O-V-E-D hunting for eggs. Courtland in particular was too much fun to watch – we hadn’t expected her to be so aware and truly engaged in the activity. I just love this age – so crazy cute – so crazy. Of course, the Jelly Bellies embedded in the eggs often caused distraction from the task at hand – but hey, why not sugar ’em up for a four hour car ride (from hell) home? After hunting, there was much playing outside – on the hammock, on the boogie board (land bound), and on the lounge chairs. Delicious food was consumed. All was right in the Universe. Hooray for egg laying bunnies.

Sunny and I made these tie dye eggs using this tutorial.

Month 20

h my darling Kicky Kaks,

I’m beginning this letter with this photograph because it captures the essence of everything Courtland in one quick frame. You are a total ham, my darling. A ridiculous, hilarious, frenetic ball of energy that sweeps through our home leaving laughter and laundry and trash and tears and books and mud in its trace. You have a smile that kills me dead with every over-the-top “CHEETH!” and accompanying giggle. You set out to make us smile, and for that, we are eternally grateful. You bring us so much joy.

I’ve been saying it for 20 months, but the highs with you are so very high, and the lows, well, like a black hole. There’s this new Tumblr called “Reasons My Son Is Crying” and I could so very easily create a comparably absurd tribute to your wails of discontent on a hourly basis.

I didn’t let you take your nap in the refrigerator.

Grass tastes funny.

You’re wearing shoes.

I didn’t put toothpaste on the toothbrush in under 0 seconds.

Dog food is not your dinner.

Ursa licked your hand.

Your sister is now playing with the book that you flung across the room in disgust.

I won’t let you sit in that puddle of water.

You’re wet.

Daddy didn’t let you hold the butcher knife.

I didn’t buckle you into your highchair.

I did buckle you into your highchair.

And so on…

Your world is more tumultuous and drama-filled than a day time soap. And your execution of a full on tantrum of body and soul is Oscar-worthy. The arching and flailing and kicking culminates in the defeated limp body with great shrieks and screams fading into a staged and lugubrious wail. You will literally plod around the house, shoulders slumped, moaning on queue whenever you notice that our attention is aimed your way. It reminds me of this priceless display. You toddlers sure are a piece of work. I now understand the whole “terrible twos,” a phenomenon foreign to this household until your arrival. Much like your height, you’re tackling this milestone ahead of the curve.

But despite all the tears, and boy does it feel like our days are tuned to a soundtrack of your cries, there truly is so much happiness. And cheeky smiles. And laughter. And delight. And babbling new language and attempts at communication. I will never forget what it feels like for you to stop the world in its tracks by holding my face in your hands and planting a kiss on my mouth, just because the moment struck you as one to pause and demonstrate your affection. I treasure that about you.

Happy 20 months, kiddo. You sure are on your way to 2.

143 Mama

The Language of Flowers

When I think of my mother, one of the first images that comes to mind is her coated with soil and earth, vibrantly patterned gardening gloves in hand, wild blonde hair perched atop her head in a loose and messy ponytail (a look you’d never witness on Allison, unless she was working in the garden) up to her elbows in lush flowers and plants. To this day, she spends hours upon hours out in her gardens during the warmer seasons, weeding and planting and prepping and clipping her floral babes. For a woman who hates to sweat, she has no qualms about truly getting her hands dirty in the name of gorgeous flower beds.

While I do not share her green thumb, I have a deep and lifelong appreciation for flowers thanks to this upbringing. While some people bemoan flowers as a frivolous, fleeting expense, I see the deep and meaningful beauty and joy that they can bring to a home. I understand the profound impact that they can have on the recepient of such a fragile, temporary gift. Fresh flowers make a home more welcoming, more beautiful, more cheerful. It’s an amazing transformation, really. Perhaps that’s why my mother was a member of no less than three garden clubs during my childhood.

In addition to her love of flowers, my mother is a total bibliophile. I remember listening to the hum and chatter of her book club late into the evenings each month growing up. Wine glasses clinking. Laughter hanging in the air. Food and books and friendship filling our hallways.

In my early 20s, I was home one summer visiting my parents, and was invited to participate in one of my mom’s book club’s monthly discussions. I remember sitting on our front porch in that circle of women who had gathered together for more than a decade over their love of the written word and friendly gossip, and I hoped that I could one day claim such a space, too.

I’ve been lucky that for the past five months, a group of women and I have started a monthly book club in our own little community. Much like my mother’s group, there’s the perfect mix of wine, and literature, and cheese, and laughter, and gossip, and friendship. It’s not only carved space into my daily life for reading, but it’s an excuse to come together with a group of women I admire and enjoy, and claim a few hours for myself during the otherwise compressed days of work and parenting.

This month we read The Language of Flowers, a quick and enjoyable read, though certainly not great literature or anything terribly profound. What I found most compelling about the book, in fact, was this concept of the language of flowers – an actual dictionary of flowers and their meaning from the Victorian era. As someone raised with the sense that flowers were their own source of communication, I loved taking that one step further and thinking about composing arrangements and bouquets infused with meaning for the recipient.

I decided to put this language to work and create a bouquet for our hostess of this month’s gathering. I was limited to flowers that were available and in season, but ultimately touched on this notion of friendship and warmth of feeling that is at the heart of our meetings. While also acknowledging the hostess’s own generosity and loveliness.

I am completely enamored with this concept, and plan to think about all future bouquets with this added level of meaning. And what interesting arrangements could arise from this language. Mint and oranges and freesia and carnations, a flower I would otherwise never use if not for its delightful sentiment, combine to make the perfect gift and message for a hostess.

Stay tuned for future bouquets and floral expressions. Victoria’s Dictionary of Flowers here. 

Sunny Day

Sunny’s basking in her 15 minutes over on the Bobbledy Books blog. Check her out here. And if you are looking for a unique and fun present for a child in your life, definitely give Bobbledy a gander. Sunny loves receiving personalized mail filled with books and drawings, and the stories are quite quirky and delightful for adults, too. I’ve waxed poetic about my love of Robbi and Matt before, but seriously, this duo is brilliant.

Spring on the Cape

After a wonderful, inspiring, exhausting weekend with a glorious cohort of Ephs, I’ve spent this Monday morning in pajamas, cup of coffee in hand, sorting and editing the myriad of photos that have backlogged. I’m taking a pause from the day job to focus on all the amazing bits of life that have been captured in the past week.

First up, a glimpse at our spring weekend on the cape. I’ll have pictures of Easter Sunday in a separate post, but here’s a look at our time spent in sunny Sandwich, MA. We lucked out and had gorgeous spring weather – a rare but beautiful thing for New England.

We arrived in time for dinner on Friday evening. And Sunny and Kaki delighted in time spent perched on Doda’s lap re-watching (again and again and AGAIN!) they’re mutual favorite “lightening” video.

Saturday morning walks to the beach to observe big construction trucks moving sand and repairing the dunes destroyed in all the winter storms.

Check out Kevin’s amazing swoufit. 60 has done wonders to the man’s sense of style.

Our happy Bologna Tongue Super Mutt.

The “CHEESE!” face.

Doda returned from Japan with gorgeous presents for Auntie Kimmy – i.e. this insanely gorgeous kimono. One day we’ll learn how to properly tie the obi. The Youtube lessons only took us so far.

The sisters danced in the afternoon light prior to our birthday dinner for me and Momar. Sunny is our budding Jackie O in her new dress and jacket from Momar.

Lazy mornings in bed. A much enjoyed weekend indulgence.

14/52

“A portrait of my children, once a week, every week, in 2013.”

Sunny: She’s James’ sous chef every Sunday morning. Blueberry pancakes are her speciality.
Kaki: She approves of the choice of berry and consumes the ingredients while Sunny flips over the stove. Stained fingers and toes and smiles.

More details about The 52 Project here. To view all the portraits in the series with explanations as to why I’ll be capturing the portraits in the early morning, visit here.

It’s Friday!

This week has been, well, A Week. Photos will have to wait, as I’ve got a fun but crazy work schedule all weekend. (It began last night with a bagpiper led parade, a righteous bonfire and S’more consumption. Tough job, I know).

It’ll be worth the wait – if nothing else than for the matchy matchy sister ensembles on Easter Sunday. Sneak peek below.

My Princeton Husband

Alright, fine. We won’t ever see James sporting a tiger tuxedo, but I wouldn’t put it past the man to rock a killer cow-spotted blazer.

So, what really differentiates an Eph from a Princetonian, save the dominance of orange or purple in one’s closet?

Princeton? Williams? Yale? Amherst? Those of us who attended any of these elite, private institutions could certainly debate the “cultural” differences between a Yalie versus a Lord Jeff, but when it comes down to it, we’re representative of a small percentage of people who had access to that kind of education.

A fellow Eph (and ironically the woman who introduced me and James (and is also married to an Eph-man)) forwarded me this article from the Daily Princetonian. It’s made the rounds this week through the media, but if you have not given it a read, I’ll wait…

So yeah, Courtney and I were in a glass-cage of emotion. The feminists in us issued a collective groan and sigh of disgust. I’m pretty sure Betty Friedan rolled over in her grave. I heard the thud.

I’m not saying anything new when I comment on the sexist, generalist tone of her argument. And the nauseating unease I experience when I read her thoughts.

And yet, I couldn’t shake the lingering thought… what if she’s right?

I mean, here I am, married to a fellow classmate from my own elite, ivory-tower. And I have many many friends in a similar situation. In fact, the majority of my adult friends are from Williams. There’s something to be said for shared experience, values and intellect.

But then Patton claims:

Men regularly marry women who are younger, less intelligent, less educated. It’s amazing how forgiving men can be about a woman’s lack of erudition, if she is exceptionally pretty. Smart women can’t (shouldn’t) marry men who aren’t at least their intellectual equal.

And yuck, gross. But, um, also true. Which is probably why it feels extra gross. Because what Patton does in her letter is call out some of the disturbing, skewed realities of marriage in our patriachal society.

And herein lies my issue with her advice. She lays out these sexist realities, but then, instead of encouraging a change in the system, she preaches a way for women to adapt within it. A Here’s the way it works – so make it work for you mentality. 

And to that I say, HELL NO!

It’s reminiscent of when we tell women to not wear short skirts or “suggestive” clothing to avoid getting raped. That’s accepting rape culture and teaching women to function within in it, instead of confronting the ugly realities of it and addressing the very root of the problem. Yes, it’s a complex problem, but it doesn’t mean we should just accept it as is and learn how to “cope” within its problematic realities.

I was angry that Patton, a smart, savvy, educated woman, would so willingly accept the reality of these imbalanced relationships and marriages in our society and ask fellow smart, savvy, educated women to do the same.

So yes, there’s something to her argument. But instead of encouraging women to accept this notion that she must catch a man of the same intellect, who’s older than she is, before it’s “too late” – she could have spoken to women AND men about the merits of finding an equal partner. Someone with a shared value system and outlook on life. She could have spoken to the value of marriage being rooted in meaningful, balanced partnerships, for both men and women.

James and I have a strong, healthy marriage because of our mutual respect and admiration for one another, not because of our shared obsession with bovine decor and purple apparel and the name of the institution attached to our diplomas. What we want to teach our daughters is that they should look for partners that challenge them, respect them, and share common values. And we’d do the same for our sons. Stressing that they need not marry someone from Alma mater like mom and dad, or someone of the opposite sex, or at all. In 2013, I’d hope we all could be more nuanced and balanced about how men and women approach their personal and professional lives. And recognize that where one goes to college (if at all) does not determine intelligence, class, or grace. Something Patton has clearly demonstrated to us all this week.