Along with "a housekeeper" "a laundress" and "a mansion on the beach with private surfing lessons given by Laird Hamilton,"...

Recently I've been fantasizing about all the midwifery items I'd purchase if I won the lottery. Most of what I want is books, as midwifery texts cost a freaking fortune. Most of them are in the $50-ish range, which isn't too awful, but some, like "Midwifery: Community Based Healthcare During the Childbearing Year," is $135. Myles Textbook for Midwives is over $70. I'm just thinking about the NARM primary reference list, although I know I'll come across many more books and texts that I want as I progress through AAMI. In my dreams I own most -- if not all -- of them, and have extra copies of books that I think are helpful for clients, like The Nursing Mother's Companion, The Baby Book, The No-Cry Sleep Solution, Attachment Parenting, etc.

Other than books I'd love the following:


1. A one-handed bp cuff. Oh, to me, that is the height of luxury. Whenever I take blood pressure, I feel like I have two left arms, I'm craning my neck around to read the sphyg, and all the cords are in the way. This one would be so nice.

2. A Littmann stethoscope. My friend Amy works in a hospital and I'm always asking her to steal me one; it seems like they're everywhere. You can hear so clearly with them. I don't even know why I bought my $20 sphyg/stethoscope set, since it's so quiet that I usually use Leigh's (slightly more expensive) set anyway.

3. A Leff fetoscope. It looks like just a regular fetoscope, but it's actually $300. They have really incredible sound quality, and actually block out other noises. They are supposed to actually rival a doppler, which would be fantastic for clients who want to limit u/s exposure. I'd like to try one before purchasing it, but if I really won the lottery, what's $300?

4. A birth stool. This one just looks so comfy and perfect for giving birth. Much better than a toilet.

5. An iPhone. You're thinking, this has nothing to do with midwifery, right? But you're totally wrong! Just check out these applications for it: iPregnancy, OB Patient Tracker, Due Date Calc, Bishops Score Calculator, and Weight Converter. Not to mention the GPS, huge amount of storage space for all my clients' info, and internet. I WILL HAVE ONE!

6. That tree in our backyard. Except $100s on it, instead of $1s (lame!) Although I'd take a few branches of $1s. Beggars can't be choosers, right?

7. While I'm in fantasy mode, a day with more than 24 hours in it (in which I still need only 8 hours of sleep -- or less!) Sometimes it seems like there's more to do than there is time to do it and still see my family. I am definitely starting to see the push-pull of the working mom. On one hand, sometimes I miss my family. On the other hand, I feel that what I'm doing is so important -- for me, and for the women I help, and even for society -- that I need to do it and I need to do it NOW. I cannot wait or put it off til my children are adults.

La Carpa Roja

I went to a BOLD Red Tent on Saturday, which included a raffle with all the benefits going toward the Birth Center. It was a good time, full of positive energy and healing and woman-empowerment. I think I can say that without sounding all New Age-y. The purpose of a BOLD Red Tent is to have a place where women can come together and celebrate ourselves, through birth or just anything woman-related in general. It was a little different for me this year -- although still just as hot as it was last year, and I don't care what happens next year, I absolutely insist that our next BOLD Red Tent either take place in February, or at another location where we're not on the second floor facing directly west, on a 100-degree afternoon. It was different because last year I hardly knew anyone there, as I was still fairly new to Charlotte and hadn't gotten involved with the local doula group. I had Sydney with me at the time, and I shared an unhappy birth story, and most of the women after me shared sad/angry/traumatic birth stories. It was a very intense night. This year, I know all the doulas, I knew many of the women who were attending, and I didn't feel like going as deep as I did last year. Yes, I've had three births (for four children) and they were not all perfect; in some ways the hospital birth was the best one, which is pretty screwed up. I shared about my twins' birth, and basically talked about the support I had at that birth. My point was that being supported during birth is important, and I appreciated being in a place where I could say that and other women got it and didn't say, "But at least you had a healthy baby!" Ugh, I hate that. I've had four healthy babies, who are now healthy children, but their births did and do matter.

There was a group of girls from a local home for pregnant young women who are at-risk in some way or another. Most of them didn't seem too interested in being there, but one of them shared. I hope the ones who stayed at least got something out of it. I'm really grateful to spend most of my time among women who believe, like I do, that birth matters. At first I thought I was a total weirdo -- and when I lived in Yuma, AZ, I was one of the only two, along with my BFF, Angela -- but here in Charlotte there are enough women who care about birth that I can actually pick and choose to be around them most of the time. It is really liberating to live in a place where I can do that. I can embrace my passion for pregnancy, birth, and postpartum -- as well as babies, of course -- and I actually have people to hang out with!

Today Leigh and I went to our most recent client's house and did the PKU on newborn. The PKU is not a fun test, because it's a heel-prick that will make the baby cry, and then we have to get 5 drops of blood on the card, which involves squeezing blood out. Not fun at all. I thought the client might get upset because the baby was crying during the test, but it's an important test. It detects metabolic disorders. I was glad not to do it, but I'll probably be doing one sooner or later.

I finally figured out what I mean when I refer to myself as a moron when it comes to midwifery; I'm not a moron, but I expected my doula training and experience to help me with midwifery in some way, and... no. Not really. Not very much. The fact that I've seen births prior to entering midwifery training is probably the only advantage I bring to the table. So that's what I mean. I'm not a moron; but neither are my years of experience as a doula all that helpful. I would imagine that I'm pretty much where most women start off.

In which my puppy attends her first homebirth

... not counting her own, of course!



Yes, Maizey attended a homebirth yesterday. I was so focused on finding a sitter for the kids that I didn't even think about Maizey. My older dogs can handle being crated all day -- once in a while -- but Maizey is just barely 12 weeks. Also, I thought the birth would go quickly, so I just dropped the kids at Emily's neighbor's house and drove to the birth. The kids were at Emily's neighbor's house because their usual sitter was at the hospital with her daughter, who was also in labor! Oh life, you are so ironic. Anyway, a few hours after I got there, while the mom was laboring with her husband and I was trying to teach Leigh how to play some card games, I realized that Maizey might be on her own for approximately 8 hours, which is way too long for a puppy. So Maizey came to the birth. She was very good. However, I learned that I need to put a spare key somewhere near my house so a neighbor can let her out. I'm sure not every client will be as cool and dog-loving as this one.

Also, I learned that (1) I'm not much help to Leigh yet, however (2) that's in my job description, so (3) we need to practice. Suffice it to say the birth didn't go as easily as the last one we attended, and the mom needed some assistance. Leigh and I had touched briefly on some procedures, but we hadn't practiced anything. So when push came to shove, I didn't know how to help.

I was whining to my friend/midwife for Sydney's birth, Charlotte, who told me that it's okay that I'm not much help yet; that I'm not going to be much help for a while, til I have more experience. I am somewhat of a help because I have two hands and I can take bp, pulse, temp, and find fetal heart tones. And I can write! (And I think my writing is beautiful! Leigh totally disagrees!) I can chart. Leigh and I are going to do some drills on procedures so that if she ever comes across a situation like this, I can actually help.

I really look forward to the birth center opening. I think I'm going to get more experience on a regular basis -- before this, Leigh and I hadn't attended a birth together since late March, I think? -- so things will be more cohesive in my mind. Right now it's new AND it's infrequent. Fabulous!

Feeling slightly less totally incompetent

The title is my roundabout way of saying I actually feel slightly MORE competent lately. Which is a relief. I can't point out anything concrete, but I just feel like some clinical things are starting to click in my mind. Maybe it's that checking fundal height is finally getting a little easier -- for some reason, I have a really hard time finding the exact spot on the pubic bone to start measuring. I used to be off by up to five centimeters. Now I'm getting a little more accurate.

I have also long proclaimed that I know nothing about midwifery, but as I'm delving deeper into AAMI, I can say that though I may be an idiot currently, I'm going to be a freaking genius by the time I graduate from AAMI. The coursework is all copyrighted so I can't say much, but suffice it to mention that the sheer volume of readingis enormous. And that's not to mention notes, papers, reviews, commentaries, and critiques.

For those (my three readers!) who are considering midwifery school, I recommend AAMI. Just looking at the small bit of curriculum I have now, I'm going to get a very thorough education. It takes a while to get used to AAMI-isms, but once you start drinking the Kool-Aid, it makes more sense. Plus the other students are very supportive and will share how they are balancing everything -- life, apprenticeship, education. The most difficult part is probably the money, which unfortunately is not something we have a lot of. Just this last week my oldest dog, Deuce, had an emergency vet appointment and treatment (she's fine now), and Dustin accidentally broke one side of the double-paned window next to our front door. Babysitting costs is what really kills me, although I appreciate the situation I have: a woman and her 5 daughters babysit the kids. The daughters were all homeschooled and are all (except one) married with kids and live close by. So I almost always have coverage, and I don't have to drive far, and next year when we're homeschooling, they will understand that and not think it's weird that 6yos are home during the day. It has really worked out nicely. The daughters are all into natural birth, so hopefully one of them will use the birth center in the future!

Last night I went to a Mother's Blessing ceremony for my friend and fellow doula and midwifery student, Brooke. This is her third pregnancy in four years; she is ridiculously fertile and has very fast labors. I didn't know her before her last Mother's Blessing, but apparently everyone gave her candles which she never even had time to light during the labor. It was less than two hours. We all joked that if she doesn't get a chance to use the candles with this labor, she can save it for the next one. HA. Soon she will be tandem nursing three children. Go Brooke!

The Ethics of Formula Companies

Copyright Erika Gebhardt, 2009. May not be reprinted without permission.

In 1981, the United States became the only country to vote against the World Health Organization’s International Code of Marketing Breastmilk Substitutes. Although the United States eventually supported the Code, little has been done in nearly thirty years to enforce it and the United States lags behind many countries who call for more strict regulations on the sale and promotion of formula.

Formula companies market relentlessly without concern for health ramifications, as each pregnant and postpartum woman is a possible consumer who will bring in revenue. Once a mother’s breastmilk dries up, she is dependant upon that substance to nourish her baby for up to a year or longer. Although the Innocenti Declaration of 1990 encouraged all countries to maintain the Code by 1995, in practice, the Code is rarely enforced.

The Code’s main provisions include no free samples to mothers, no advertising, and no gifts or personal samples to health care workers. With regards to the last rule, formula companies circumvent it by donating samples to health care organizations – such as hospitals or medical offices – rather than specifically targeting health care workers. These gifts are not just the formula itself but also helpful parenting tips (including the “breast is best” adage), diaper coupons, and, more often than not, a free diaper bag. These tactics are particularly manipulative with regards to lower income families – especially non-Hispanic black women, who have the lowest breastfeeding rates in the United States – as the free gifts are an important aspect of their birth experience. However, the increased financial cost of uninsured mothers receiving formula from WIC burdens all taxpayers. The gifts may be free, but the long-term ramifications are costly.

Forced not to advertise directly, formula companies came up with a brilliant trick: “follow-up” formula for babies who have been weaned. As follow-up formula targets mothers of babies who have been weaned, its promoters claim freedom from following the Code’s guidelines. Unsurprisingly, manufacturers advertise this formula for babies as young as three months. This type of formula – which has the same name as the infant formula, making it nearly indistinguishable from the infant version – is marketed with pictures of cherubic, smiling babies drinking formula from bottles.

The next marketing ploy used by formula companies is promoting breastfeeding. Since formula companies cannot state that formula is superior to breastmilk, they must concede that breastmilk is best and advertise as such. However, these pamphlets, books, and videos often contain advertisements for the formula company. In addition, many depict breastfeeding mothers as exhausted, nursing in a dark room by themselves. This is a marked contrast to the smiling woman bottle-feeding her chubby baby, surrounded by family and friends.

When trying to market formula that is nearly as good as breastmilk, formula companies have again damaged babies and mothers. Specifically, formula companies have added laboratory-produced oils that contain DHA and ARA in order to compete with breastmilk, which naturally contains both fatty acids. However, the DHA and ARA found in formula are extracted from fermented algae and fungus, via hexane, a solvent known for being neurotoxic. Formulas marketed to contain DHA and ARA only contain 40-50% of each fatty acid, with the rest made of components not found in human breastmilk – resulting in diarrhea in babies who consume this formula.

The most conclusive evidence that formula companies place profit above health comes from the Philippines, where three large United States-based companies – Wyeth, Abbott, and Mead Johnson – attempted to block the introduction of formula marketing regulations similar to the WHO code. In fact, the three companies sued the Philippine Government in order to prevent ethical marketing guidelines for formula. The WHO estimates that 16,000 babies die in the Philippines each year because they are not adequately breastfed, and that 90% of babies under six months who die are bottle-fed and fed foods other than breastmilk.

Time flies when you're waiting on a baby

I haven't posted since May 8, which was a client's due date. Today is June 1. I had a ton of stuff going on between then and now, much of which I tried to put off until after the client had her baby. For example, I planned to attend a homeschooling conference but didn't want to make formal plans to go until after my client had her baby. Same with contacting another client who is due in August. Same with planning a party for my birthday, which was May 23.

My client went to 42 weeks 4 days.

What I have learned from this experience is that I need to calm down and not avoid living my life because I'm on-call. They all have babies. I have babysitters set up. Everything works out just fine. (I have never missed a birth except for the sand-road situation with Leigh, which was not my fault.) But not sleeping and stressing out because I'm waiting is not good for me. Or my family. Or my friends, or Leigh, to whom I whined about my dilemma.

However, I did not skip my birthday trip to NY state, where I got a new puppy! Yes, my first puppy. Her name is Maizey and she is a Cardigan Welsh Corgi, with many many champions in her immediate family (in fact, nearly everyone for three generations back). I have always had older dogs from the Humane Society, so I was a little nervous about getting a puppy, but she's doing very well. Along with my AAMI books and literature, I'm reading Dr. Ian Dunbar's book "Before and After You Get a Puppy," and "The Art of Raising a Puppy," by the Monks of New Skete. I'm following all the rules, and in return, she's having very few accidents (none today!) and chewing only appropriate chewtoys, and sleeping in her crate when I can't keep my eye on her and at night. I plan to show her and try to finish her. The breeder, Kate Roberson of Hagaren Cardigans, was very kind and generous, and if I am able to title Maizey, and if she is breedable, I'd like Kate to breed her. If she wants to, of course.

(Aside: my birthday trip was when I was technically off-call, as I'm on-call til 42 weeks, and my birthday was at 42 weeks 1 day. I did set up a back-up doula, just in case.)

Leigh gave me my first bit of constructive criticism, which was a terrifying moment for me. She had said, "I need to talk to you about something," and my first thought was, "Aw fuck, what did I do?" LOL. We have been in the honeymoon phase, as Carla refers to it in "Helping Hands," where it's all sunshine and compliments and she's the best preceptor ever and I'm the best apprentice ever. (I am probably the funniest apprentice ever.) Leigh had some genuine concerns about maintaining my (slow, but steady) progress and not moving too fast in clinical practice before I get there in academic study. Totally valid stuff. The initials "CD" and "CBE" behind my name really mean very little when it comes to midwifery (perhaps I've mentioned this before?) and I am really starting from square one, just like everyone else. She was very kind and I felt like an idiot for being so worried. That's always how I feel when someone says, "I need to talk to you;" I always assume I've done something completely wrong and I rack my brain trying to come up with whatever it is, and then when it turns out that I haven't ruined the world, I think, Oh. Right. Just like stressing about being on-call, I need not to stress when it's time to receive constructive criticism. It's just information really, that can help me to improve. Leigh and I have the same goal, which is to prepare me for being a licensed midwife.

Here is another picture of Maizey. Her AKC registered name is Hagaren's Maizey Rockstar. My kids picked the middle name Rockstar.