Review: Birth Work As Care Work

These days, more and more pregnant people are starting to spend time researching birth before actually giving birth. They’re researching where they’ll give birth, who their care providers will be, who their support team will consist of.

And yet, as a society we still have a long way to go. A long, long way.

It’s easy for those of us who benefit from societal privileges to be completely blind to the advantages we have. It’s easy to forget that some birth givers don’t have access to the “good” hospitals because of location, insurance, or financial means. For some pregnant people, a higher risk of unwanted interventions or unnecessary surgery is unavoidable. For some, home birth is not an option. For some, hiring a doula is either impractical or impossible. For some, prejudice is faced at every turn due to skin color or gender identity.

For some, it’s a blessing simply to be able to give birth without being chained to the bed.

There are many issues that those who perform birth work need to be concerned with. Midwives, doulas, and childbirth educators are always learning, always reading. A new book to add to the “to read” pile is Alana Apfel‘s Birth Work as Care Work: Stories from Activist Birth Communities.
This anthology delves into a lot of sensitive ideas that are not often discussed in more mainstream birth communities, although there are certainly individuals and groups out there that are working in these areas.

“Ultimately the anthology is conceived as a platform through which to honor birth–in all its forms–as itself a profoundly radical act that holds the potential for deep transformative change.”

For example, many sections discuss the idea of white privilege with regards to birth, although those aren’t the exact words used. But there are discussions about how birth is experienced by racial minorities, and how marginalized groups have less options and less choice, and often face a certain amount of judgment simply for who they are. In addition, these people must sometimes deal with more affluent birth workers–because birth work often tends to draw in white, wealthier women–and the stigma of being “saved.”

“One such problematic narrative relates to the language of ‘choice’ within modern maternity care. The danger of celebrating the rise of choice within transactional birthing environments lies in masking ongoing forms of coercion that result in a denial of choice for marginalized communities and those with less access to the kinds of choice-making power enjoyed by more privileged counterparts.”

Also discussed is how birth is shaped by a person’s gender identity. Sure, plenty of white, hetero, cisgendered women give birth every day, but that doesn’t mean that birth is restricted only to straight women or even to those who identify as women. This book is sure to get readers thinking about ideas that some may have never encountered before.

And of course, Birth Work as Care Work talks about some of the issues that are widely known about among birth workers of all stripes, such as how the institutionalized medical model of care affects birth outcomes, the value of midwives, our society’s implicit (but not always well-deserved) trust in medical professionals.

“People see their doctors as authorities with complete control over their bodies and their babies–to the extent that they expect to be raped. The word rape might sound extreme, but I am quick to point out that when someone does something to your genitals without your consent, that is rape.”

Readers will get an overview of some basic herbal medicine–just a discussion of herbs, but no recipes–because of the importance of reclaiming medicine for ourselves. There is also a wonderful, straightforward glossary: the “Political Dictionary.” This gives readers an easy understanding of some terms they may be less familiar with, which makes this book even more accessible to everyone.

There are discussions of how doulas can serve different kinds of pregnant people, and readers will learn about groups they may not have heard about before: volunteer doulas, prison doulas, doula training programs, doulas that work in areas of reproductive health not normally associated with doulas at all (like abortion or adoption).

There are also a number of birth stories, which readers will love. Birth is beautiful, and these stories celebrate it in all of its messy, myriad forms. This is the kind of birth the author and others are fighting for, and readers will enjoy getting to experience it up close.

Overall, Birth Work as Care Work is a book that will leave readers thinking and questioning, and perhaps wanting to get involved (if they’re not already). This is a fascinating and thoughtful collection of stories, questions, and essays, and a book that any birth worker would benefit from picking up.

“Transformation happens when we come together and meet each other where we actually are, not where others perceive us to be.”

*****

I received this book from the publisher, PM Press, in exchange for an honest review. The opinions expressed within are completely my own.

Review: Harvest

Do you ever find yourself wondering what to do with some of those more obscure fruits or veggies that come in your weekly CSA box? What does one do with quince? How about huckleberries?

Or what if you decide to be a little adventurous in your own gardening endeavors? How do you harvest rhubarb? When is the best time to plant herbs like oregano, feverfew, or lemongrass? Where do poppy seeds even come from?

Or perhaps you're just looking for some unique ways to utilize nature's bounty. Did you know that you can make a lovely floral arrangement using artichokes? Or that you can make delightful seasonal salads composed entirely of herbs?

If any or all of the above describe you to some degree, be sure to check out Harvest, a gorgeous hardcover book by Stefani Bittner and Alethea Harampolis. This is not your standard cookbook, and it's definitely not a normal gardening book. Instead, it contains some basic growing info on a wide variety of plants that are harvestable in the early growing season, mid-season, and late season. Some are common garden plants, while others might be ones you've never even thought about adding to your own yard. Some, like lilac, are plants you may not have realized were edible at all.

The recipes, meanwhile, go beyond kitchen creations. There are also ideas for floral arrangements, teas, personal care products, and more.

Each plant is featured in a four-page spread. One page features a full-page, beautiful color photograph of the plant, while the second discusses growing instructions and how to harvest the usable parts. The final two pages include a recipe of sorts and a photograph of the recipe results.

What makes this book stand out is the uniqueness of the recipes. Everybody has heard of making rhubarb pie or rhubarb jam, but pickled rhubarb will be a new concept for many. We all know berries are delicious to munch on or turn into traditional preserves, but have you ever heard of a shrub? A shrub is a type of beverage made by preserving fruit with sugar and vinegar, and readers will learn how to make a delicious huckleberry shrub. Persimmons make a delicious snack, and the branches pruned every fall can be turned into a gorgeous wreath.

This book is just packed with ideas! Harvest is definitely a great addition to the library of any gardener, or anyone who is just looking for unique ways to work with plants.

***

I received this book from Blogging for Books in exchange for an honest review. The opinions expressed within are completely my own.

An Rh Sensitized Pregnancy (Part 3)

Somewhere between 30 & 31 weeks

 About 28 weeks into my pregnancy, my baby started to show potential signs of anemia.

At that point, we'd been doing weekly ultrasounds for quite some time (I've honestly lost track of how long exactly). Half of those ultrasounds were at my normal doctor's office, while the other half were in the hospital where I've been seeing a different specialist, one who has a lot more experience with my particular medical condition (Rh sensitization).

As I explained in my last post on this topic, they've been monitoring four things in particular:

• the MCA, or how fast the blood is flowing through a particular artery in the brain (faster blood flow = thinner blood, which could indicate anemia)
• the presence of hydrops, or excess fluid around certain organs or under the skin
• swelling of liver or spleen, both organs that deal with old red blood cells (larger organs = baby's body is working harder to deal with the red blood cells that my immune system is attacking)
• level of amniotic fluid

Any of these is considered a soft marker for anemia in a baby or fetus; the presence of two or more of these signs is much more indicative of a problem.

At about 28 weeks, the MCA shot up. Before that, it had been staying on a nice curve (it naturally increases speed as baby grows) well within the "acceptable" limits. They've been tracking it on this nice-looking chart (I wish I had a picture of it to share, but I do not) that shows my numbers and what's considered both too slow and too fast. As my doctor once explained, a high MCA doesn't necessarily mean anemia, but he's never before seen a baby with anemia whose MCA wasn't above that acceptable limit. So once my baby's MCA became borderline too high, my doctor immediately ordered cordocentesis. Yes, it was only one of those markers mentioned above, but when dealing with fetal anemia, it's much better to be conservative and to do more tests than it is to watch and wait.

Because one of the potential risks of cordocentesis is early delivery, I was required to have two shots of a corticosteroid ahead of time, which helps speed up the development of baby's lungs. I had the first after that fateful 28 week ultrasound, and the second on the following day at my regular hospital. Both are shots to the butt, so I probably don't need to say anymore about the unpleasantness of it.

Cordocentesis is known by several other names: fetal blood sampling, or percutaneous umbilical cord blood sampling (PUBS). It's a test used to detect certain abnormalities in a baby or fetus; in my case, the goal is to obtain the baby's complete blood count (CBC), a number that can be obtained within minutes, which then indicates, among other things, how many red blood cells baby has (red blood cell count, or RBC). A low number for RBC is a definite marker for anemia. Additional blood tests are also done with the sample collected, but I'm not sure what all else they did.

So here's the basic procedure for cordocentesis. It's an outpatient procedure, so I wasn't checked into the hospital. I got to stay in my regular clothes. They created a sterile area around my stomach with drapes and cleaning solutions, then gave me a shot of local anesthetic to numb the area. Using ultrasound as a guide, a larger needle was inserted through my abdomen and into baby's umbilical cord. Then they took a few small vials of blood, did the red blood cell count with some of it, and kept the rest to be sent to the lab later. The initial CBC did not show that baby was particularly anemic, so that was that.

After the procedure, I had to spend 20 minutes being monitored electronically; they were watching baby's heart rate, to make sure baby had no issues from the procedure, and they were monitoring me to make sure the procedure hadn't set off contractions.

There are definitely risks to cordocentesis, but they're generally pretty small. There's a risk of internal bleeding, hemorrhaging even, since they are sticking a needle inside me and inside baby's umbilical cord. There's a risk of preterm labor. There's a risk of baby reacting badly to the procedure, which might necessitate immediate (cesarean) delivery. There's a small risk of baby dying. But those risks are all small, and (in my mind) they were definitely outweighed by the benefits of knowing for sure if baby was anemic or not.

We spent the better part of the morning in the hospital, then left, ate lunch, and headed home.

The following week, I went back for my normal ultrasound (I'll be getting all of my scans at the higher risk hospital from here on out). Apparently, the MCA had jumped up further above that acceptable limit, so my doctor came in and told me that after cordocentesis the following week (which was already the plan, since we needed to see how baby was holding up over time), it was almost certain that we'd be doing a blood transfusion as well.

Intrauterine blood transfusion. It's exactly what it sounds like: a blood transfusion to a baby (or fetus, depending on how far along the pregnancy is) while it's still in the uterus.

Suddenly, my upcoming appointment was a whole lot more nerve-wracking. My appointment time was moved up and I knew it would be a longer day.

Of course, I now realize I really had no idea what to expect from this new procedure. Sure, I had talked to specialists and read everything credible I could get my hands on, but the theoretical just didn't quite match up to the reality. I assumed they'd do it all at once, cordocentesis followed immediately by intrauterine blood transfusion, and that since they wanted me to arrive sooner it'd all be done fairly early. Instead, we spent pretty much the entire day in the hospital.

The morning started with a blood draw for me (yay?), followed by the usual ultrasound. MCA was still high; still no sign of hydrops, stressed organs, or abnormally high amniotic fluid levels. Then, I was checked into the hospital. Formally. Intrauterine blood transfusion carries much the same risks as the cordocentesis does, but the numbers are higher. This time, the procedure would be inpatient, performed in one of the operating rooms just in case there was an immediate need for a cesarean.

I was brought up to labor and delivery and checked in. We managed to sneak my husband and son up (well, bend the rules a bit might be a better description; the hospital recently instigated a "no visitors under 18" rule, and technically my son wasn't supposed to be there at all. If I had known that, both of them would have just stayed home all day!), and I was put into a labor room. I had to change into a hospital gown (ick) and they gave me an IV (double ick; also: ouch). I was not allowed to eat or drink anything (yay for nil per os? Except not, since it's an outdated and non-evidence based policy) because of the slight risk of immediate delivery under general anesthesia. They wiped my belly down and shaved it (also in case of cesarean). They had me sign lots of consent forms. They even wanted to give me a catheter, but I managed to put that off unless actually necessary, since it literally only takes a few minutes to do. And they put the monitoring belts on me. I was all but prepped for a cesarean.

So there I was, stuck in bed for HOURS, waiting until the blood was ready for the baby (and for me too, just in case). My husband and son got to stay for part of it, but once they left to get lunch, they couldn't come back. Finally, at some point after lunchtime, they were ready. I at least got to walk myself over to the OR, where the setup was much the same as with the cordocentesis. Sterile area on my belly, drapes, me lying there crying (because that's what I do when I'm anxious). Lots of doctors and nurses crowded around. Ultrasound machine on, and a quick scan to make sure everyone knew exactly where they were aiming. The local anesthetic, which my doctor described as a "bee sting," hurt a lot. The needle through my abdomen hurt even more (because I was only numbed on the surface).

Not a lot of pain from the procedure itself; instead, I felt a lot of pressure and tugging. I kept crying off and on, but I tried to focus any tension I had on gripping my kleenix box (since I couldn't hold my husband's hand this time; next time, I'm bringing a stuffed animal!) so that I could keep the muscles in my belly loose. Lots of yoga breathing, and I like to think that the essential oils I applied just before leaving my room helped me stay calm, too.

Turns out baby was more anemic than last time, but not as anemic as the doctor was expecting her/him to be. Consequently, the blood transfusion was rather small; they just gave baby a little boost with some fresh, thick, healthy blood. Everything was all over relatively quickly, thankfully.

I was walked back to my room (yes, at least I got to use my own legs again!) for recovery. After an hour on the monitoring machines, I was allowed to eat lunch (which my wonderful husband brought, although my nurse had to go downstairs and get it from him), and the simple fact of consuming real food made me feel so, so much better. I hadn't been lightheaded or anything before, since I'd been receiving IV fluids, but there's something to be said for a good, hearty salad and a nice chunk of bread.

Apparently, the norm for intrauterine blood transfusions is to continue monitoring mom and baby for at least three or four hours post-procedure. I managed to talk them down to two hours; I wanted to go home and be with my family, and there were absolutely no signs of distress in the baby or pre-term labor in me. And it's a long drive home. So after a few dull hours of sitting in bed--monitoring belts attached, peaceful music on the TV, book in hand... you'd be surprised at how weird and boring this was for me--I was finally able to sign my discharge forms. The dreaded IV was removed, I got to put on my real clothes again, and my little family and I began the long drive home.

And guess what? Before too much longer, I get to do it again. And probably again a few weeks after that. And again every two or three weeks until baby is term enough for induction to be safer than another transfusion. This is the reality of an Rh sensitized pregnancy. It's not pretty. It's far from fun. But it's necessary to keep baby healthy and strong. Ideally, I won't be induced until 38 or 39 weeks, but we'll see how the reality plays out.

***

See more:

• An Rh Sensitized Pregnancy (Part 1)
• Mid-Pregnancy-Ish Update
• An Rh Sensitized Pregnancy (Part 2)
• An Rh Sensitized Pregnancy (Part 4) 
• The Birth of Coconut Baby
• An Rh Sensitized Pregnancy: Aftermath (Part 5) 

Review: Healing Your Body Naturally After Childbirth

If you go to your nearest bookstore, you will no doubt find an extensive selection of pregnancy books: general guides, week-by-week or even day-by-day books, books geared towards "natural" mamas, books that appeal to "cool" mamas, books for dads, books that tell you what to expect if you're a beginner or going for a VBAC,books that tell you what to eat.

What you won't find are books that deal with the postpartum period.

Well, there will be plenty of books related to your baby during that period: breastfeeding, baby sleep, doctor's visits and vaccines, milestones, natural remedies, raising boys or raising girls, how to soothe your babies and what to do with them.

What's missing are books related to you during those first few postpartum months.

And just think about everything your body has been through in the past ten months. You've grown not only an entire human being, but also a brand new organ (your placenta) and an expanded blood supply. You've gained weight. You might have been through hours of intense labor. You might have a tear in your bottom area after pushing that baby out, or you might be recovering from major abdominal surgery.

Surely, you deserve to focus on yourself for a bit, too.

So pick up a copy of Healing Your Body Naturally After Childbirth, and start learning about the steps you can take to take care of yourself!

Jolene Brighten is a naturopathic doctor who truly knows what she's talking about. In particular, she has an extensive knowledge of how pregnancy can affect a woman's thyroid and adrenals, which is a subject that many care providers sadly know little about. She uses her knowledge about the topic to educate readers, providing information about both hyper- and hypothyroidism, as well as adrenal dysfunction. She talks about treatment options and provides effective--and safe--natural remedies to help women take control of their own health.

Dr. Brighten provides similar information on a whole host of postpartum topics. Breastfeeding mamas will appreciate ideas for natural ways for soothing hurting breasts, remedies for thrush, and recipes for making your own lactation tea. Mamas who gave birth vaginally will surely find comfort in an herbal sitz bath and appreciate knowing what supplements they can take to help ease postpartum discomfort. C-section mamas will be thankful for her recipe for an herbal wash to help keep infection away.

There are ideas for dealing with common postpartum complaints: constipation, "baby blues" (and information about how to distinguish between simple blues and actual depression), low energy, vaginal dryness, stress, and more. There are recipes for all kinds of teas, soups, and smoothies, and even body scrubs for self-care and delicious cookies. There supplements that will help with all manner of healing. There is information on postpartum nutrition, including how to support yourself through breastfeeding.

The information in Healing Your Body Naturally After Childbirth will make a tremendous difference in the postpartum experience of any new mama, and as such is highly recommended for both expecting mamas as well as those who have recently given birth. Midwives, doulas, lactation consultants, and anyone else who works with pregnant women will find great value in this book as well.

New mamas deserve to know how to take care of themselves while they heal from birth and adapt to new parenthood. This book helps fulfill that need. So do yourself--or your partner, or your clients--a favor and dive right in.

*****

I received a copy of this book as a gift from the author, although not with any expectation of a review, positive or otherwise. The opinions expressed within are completely my own.