Permission to Mother

Years ago, I first became acquainted with Dr. Denise Punger by an article that she had written that was posted somewhere on the internet. That she was a pro-natural/home-birth MD was refreshing as well as memorable. I remembered her story about Jayne, who was the first woman she had attended in labor who had a doula, although I didn’t know anything else about Dr. Punger. Fast-forward a few years, and I rediscovered her, along with her blog which was given the same name as her book, Permission to Mother. Now, I have read the book and must say it was thoroughly enjoyable.

It is written from the perspective of a woman and a mother who happens to be a doctor, rather than from the perspective of a doctor who happens to be a woman and a mother. And that makes a big difference. It is her personal story, part autobiography (birth experiences and breastfeeding years up to homeschooling, or unschooling), part “why I chose what I did” (including extended breastfeeding, bringing her child(ren) to work with her, and homeschooling or unschooling), and another part her perspectives on certain medical issues (like the triple screen done during pregnancy, or resolving breastfeeding problems).

The subtitle to the book is “Going Beyond the Standard of Care to Nurture Our Children.” What is the “standard of care”? In a nutshell, “what everybody else is doing.” You remember those times when you were a child or teenager and you did something that was dumb, or you knew you shouldn’t, or you knew your mom wouldn’t approve, and you got caught, and your mom or dad asked you The Dreaded Question — “Why on earth did you do that???” and you shuffled your feet and said defensively, “But everybody else was doing it, too!!” Well, that’s basically the same thing, only nobody’s going to ask the doctor sarcastically, “And if everybody else jumped off a bridge, would you do it too?!?” Instead, it’s a legal safeguard to protect the doctor or hospital — as long as they’re doing what “everybody else” is doing, then they’ve got a defense. And, as long as “everybody else” is doing what is right or best, then we can all be happy. But sometimes that’s not what happens. For example, take my sister who was advised by her doctor to wean her son when she was put on an antibiotic. Sure, that’s what doctors are trained to do (“we don’t know if it’s excreted into breastmilk, so to be on the safe side…”), so that’s what “everybody else” was doing: when in doubt, advise to wean. However, the antibiotic that she was on is also given to infants much younger than her baby was at the time! The amount of drug that might have ended up in her breastmilk was almost certainly less than what the baby would have received had he been prescribed the antibiotic himself. By this example, you can see that “what everybody else is doing” is not always what is right — sometimes, it’s just what is easiest or most defensible.

Starting from her days as a “candy-striper” volunteering at her local hospital, through med school, residency, and beginning her own practice, Denise tells stories of pivotal and memorable experiences that helped to shape her as both a mother and a doctor. From the preface to the book:

People who didn’t know me before I had my three children often assumed that all my births were homebirths, and that it always was easy for me to trust my body to birth and nourish my children the way I do now…

The first birth was not satisfying. It was undermining and left me unfulfilled… I was grateful that my obstetrician had patience with me that night, but for two years afterward I dwelled on what a demoralizing expeirence that birth was.

My second birth, two years later, was also a planned hospital birth. Still, that birth restored to me the trust that my body knows how to labor. It allowed me to regain confidence in myself. It helped that this time I had a doula that had had nine homebirths herself.

Most of my patients find it hard to believe that the field of obstetrics doesn’t teach much about real-life pregnancy and birth, and that pediatrics teaches next to nothing about breastfeeding beyond the first few days of life. Now, I share my own experience.

Some of the chapters and stories in this book were originally written as articles for a doula publication, and are brief (just a page or two), which is very good for the busy mother who wants to squeeze in just a little solo reading while the kids are all happy, or who only has a few minutes to read before falling asleep at night. However, other chapters are lengthier, particularly the stories of her children’s births, or other pivotal stories which need more depth to explore.

Many of the choices that Denise Punger has made are not “the norm” of society — extended breastfeeding, “family bed,” home birth, cloth diapering, baby-wearing, unschooling, etc. Hearing her positive experiences can be helpful to people who are considering these for themselves, moral support for those who are already doing them (and perhaps may be facing family or societal pressure to stop), or a learning experience for those who have never heard of such.

As I said at the beginning of this blog post — thoroughly enjoyable.


Would’ve, Could’ve, Should’ve

It’s so easy to play “Monday morning quarterback.” Take any situation, and say, “Well, if that had been me…” or, “If I had been in that situation…” And you may be right. Some people are just wired differently — are able to come up with a witty comeback, or are able to think more clearly or more quickly, or able to react faster or better than others. But you may be wrong — most likely, you would have reacted in exactly the same way as the person you are (unknowingly) criticizing.

There have been several instances on the My OB said WHAT?! blog in which comments have taken that turn — doctors making rude or nasty comments, or even downright sexual harassment, and several women have said things along the lines of, “If my husband had heard that, they’d probably have arrested him for assault, for punching the doctor’s lights out!” or “I’d’ve kicked that doctor in the face!” (for saying x, y, or z when he’s between the woman’s legs while she’s pushing.” Although I don’t think I said anything along those lines, I know I thought it, or agreed with those who did say it out loud. And yet… would I have? Sure, it’s easy enough to say when I’m reading it on a computer screen, in the comfort of my home, and the full force of the hurtful, rude, or harassing words comes through loud and clear, with no other “background noise” to drown it out. But what if I were really in that situation? How would one go about kicking someone in the face, when she’s numb from an epidural? or with her legs up in stirrups? — not exactly an easy position to get out of quickly.

Some of the women who had submitted the comments originally replied to some of the comments, saying that the “could’ve, should’ve, would’ve” comments were actually hurtful. I know that none of the commenters (or those who did not comment, but thought the same things — like me) intended for the words to hurt. For myself, I would say that when someone said, “I’d’ve kicked that guy in the face!” that she was really meaning, “that guy deserved to be kicked in the face for what he said!” Most of us probably tend towards non-violence against our fellow man, so we probably would not really have physically acted out what our immediate, visceral reaction was. Or if we were in the room when a husband did punch a doctor in the face, we might be shocked and/or horrified (even if we would have been shocked and/or horrified at the comment or action that provoked the violence).

It’s so easy to say things. It’s much harder to carry through with them. It’s easy to say, “I would never have given in to the pressure to have an unnecessary [C-section, induction, augmentation, epidural],” but much harder to actually do — especially when you’re in that particular situation, facing that particular pressure. There is an element in which it is good to hear these kinds of stories, and play through them in your mind, so that if you’re ever faced with it, you may be better prepared for a certain reaction. “Practice makes perfect.” But far better to keep these things in mind while you’re screening your midwife or doctor, or during your prenatal visits, so you can completely avoid situations like these. That’s not fool-proof by any means, unfortunately. Sometimes you can do all the “right” things and still end up on the wrong end of the stick.

If you’ve been in situations like these, please, please, please go to The Birth Survey and report the health-care provider, so that others can be forewarned and forearmed. If you’re looking for a provider, go there to see what others have said about doctors or midwives who are options for you. And if someone you know is pregnant or of childbearing age, be sure to tell her about The Birth Survey so she can get a good match for a care provider. Otherwise you or someone you care about may end up saying, “I should’ve picked a different care provider, and I would have if I only could have known.”

Doctor or Midwife?

Take this quiz to find out which would be a better match for you, based on your preferences.

h/t to Midwife Connections for the link

Educated Birth

This is a video which was made for the Birth Matters Virginia Contest. It’s not my video, but I liked it. (I’m sure there are many other videos made for this contest, so you can probably do a YouTube tag search and find them. If I have time, I’ll try to remember to do this myself.) Because it’s in the contest, please make sure to rate it!

Thanks to Diana for the link!

Birth Survey is here!

Although I haven’t gotten anything official, the national results for The Birth Survey have finally been released! Woo-hoo!!! I checked it a couple of weeks ago, and I didn’t see any local hospitals — or any care providers outside of New York City — but today I checked, and it’s up! Yippee! Of course in my area (backwards as it is), there are only a few responses, but I hope to change that. I’ve got a stack of postcards and take some with me to the store, and when I see a pregnant woman or someone with a small child, I try to give him or her a postcard and explain what it is about. Yes, I gave a “Birth Survey” postcard to a man — how’s that for being unsexist? — he had an infant, so he was fair game, as far as I was concerned! 🙂

If you have had a baby in the past 3 years, please fill out the survey about your experiences — whether you loved or hated your doctor, midwife, nurse, anesthesiologist, etc., or just found him or her to be “okay”, other women in your area want to know about it! Think about it this way — if you had a real jerk for a doctor, don’t you wish somebody had told you he was a jerk before you ended up with him? Do someone else a favor, then, and tell them through the survey. Contrarily, if you had a great doctor (or other care provider), you can also do other women in your area a favor and tell them about your wonderful experience.

One of the good things about this survey is that it asks about so many things, and you can rate your care providers and place of care individually — in other words, if you had an awesome nurse but an awful hospital, you can reflect that in your ratings. Or if your nurse left something to be desired but your doctor was wonderful, you can say that. Also, if your doctor was great on prenatals but not so great during birth, you can say that. Or if he was ho-hum during prenatals but the best birth attendant you can think of, you can say it. Were you pushed into having unwanted drugs or other interventions? — say it! Did you ask for an epidural and had to wait a long time? — say it. Did your doctor tell you one thing during pregnancy and then totally change the rules during labor? — say it!

Ok, I’m so excited! But I’m going to stop now before I ramble on even more. Yee-ha! Go check it out, and if you haven’t yet filled it out, do it!! Your pregnant sisters now and in the future will thank you for it. Let your voice be heard!

Under the Influence?

One of my readers sent me a link to a study that concluded that about 10% of Certified Registered Nurse-Anesthetists (CRNAs) “misused” controlled drugs. It noted that the results were comparable to other studies of anesthesiologists and registered nurses, except for the drugs of choice.

Pharmacists may also be prone to this (although having worked as a pharmacy tech for many years, I only ever heard of one pharmacist in our area who became addicted to drugs). But think about it (and I’ll speak of this from the perspective of being in a pharmacy) — there are shelves and shelves full of drugs that are controlled because they are addictive or highly addictive, and/or produce some sort of “high” or other desirable effect to some people.

I was never tempted to take drugs — I rarely even take over-the-counter drugs — but it could be a very tempting environment to many people. It would have been easy to take a few pills without being noticed; or perhaps even a few bottles and think it would not be found out. Just as pharmacy employees can be tempted, so can other people who are around drugs a lot. And anesthesiologists and anesthetists are certainly around controlled substances a lot.

In one way, you might think they’d be less likely to be tempted, because they see first-hand the negative aspects of drugs. Although I was not tempted to take drugs, if I had been, seeing the druggies coming in on a daily basis trying to get just a few pills to keep going would have been enough to turn me off. It was really quite sad having people come in practically begging to get their pain pills filled “just a little bit early,” and I never wanted to end up in that place, so never set foot down that path to start with. But in another way, having easy and constant access to drugs can become a great temptation.

The likelihood is that every health care professional you meet will be completely sober, not under the influence of any drugs or alcohol. (The study did not say whether these CRNAs actually operated while under the influence, or if they kept their illicit drug activity restricted to “off duty” hours. Still, considering that they likely abused drugs they used on other patients, it is a possibility that they were abusing drugs on hospital property. Which is scary.) However, there is the possibility that someone you meet — whether doctor, nurse, anesthesiologist, anesthetist, pharmacist, pharmacy tech, etc. — will be operating under the influence of some sort of controlled substance. So always be alert when interacting with people (especially those who are giving you drugs and are in charge of keeping you safe), to make sure that they are completely sober. Most likely, you’ll never need to use this advice. But it’s good to remember anyway.

Some great articles

I hope you have The Unnecessarean blog on your blog roll or Google Reader or however you keep up with blogs you like to read. She’s had some really great stuff in recent days, and rather than just link to every article I like, you might as well just add her so you can read it when I do. 🙂

But the most recent one, on shoulder dystocia, in addition to being well-written and well-thought-out, has several great links. Including this one, which is so good, I just have to link to it myself!

It’s a birth story written by a doctor of a woman whose last two children both had shoulder dystocia, and what she (the doctor) learned between those births that made a difference. (Both babies were fine, but the births got understandably tense after the distinctive “turtling” of the heads indicating shoulder dystocia was remarked.) Apparently, the doctor discovered that natural birth advocates had picked apart the first baby’s birth story for the doctor not using the Gaskin maneuver (turning the mom to hands-and-knees) to resolve the shoulder dystocia, and she had replayed the baby’s birth in her head thousands of times and learned more about the Gaskin maneuver after that birth, and decided to use it the next time SD was apparent. Very cool story.

Update: I decided to read more of this doctor’s blog (having read a post from it some months ago — I’m pretty sure I recognized the name and design, anyway — I think it’s the kind of thing I’ll like, so added to my Google Reader), and the post immediately after the post I linked to indicated that apparently this doctor had been “Tuteured”! Not only did she link to the comment thread (I didn’t click, but I recognized the URL), but one of the comments she quoted was easily identifiable as coming from the keyboard of none other than Dr. Amy. If she didn’t write “Rural Doc…gives the impression of not knowing what she is doing sometimes,” then I’d be very much surprised. (I would say “I’d eat my hat”, but there is just a small chance that one of her comrades wrote it, and I don’t like the taste of velvet or straw — I have two hats, one black velvet and one cream-colored straw, and neither one looks particularly delectable, just on the off-chance that Suzanne or somebody else wrote such an arrogant, condescending sentence.) Knowing that she’s drawn the ire of Dr. Amy makes me like “Rural Doc” better than just about anything else could do. 🙂 So when you go to the blog, make sure you read the “next entry” as well.