Tag: birth

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Creative solutions for facilitating traditional Navajo birth

It was a whopping 102 degrees during the day with plummeting temperatures at night in Shiprock, New Mexico on the sacred land of Navajo Nation. The soon-to-be new parents’ camp was set up completely off grid with no running water or electricity.

Indigenous Doula, student homebirth midwife, and New Mexico Doula Association birth equity co-chair Natasha Bowman and her colleague Indigenous Doula and the Executive Director for The Navajo Breastfeeding Coalition Amanda Singer, CLC got to chatting about how they could best serve their client who desired a traditional Navajo birth under these conditions.

Considering their own well-being and the safety of their clients, Bowman and Singer initially joked about hauling Bowman and her fiancé LaDarrell Skeet’s fifth wheel out onto the land. But Skeet helped make it a reality.

The team was able to set up a mobile birthing suite for the new family and their care team complete with air conditioning, clean water and a bathroom. What’s more, the certified professional midwife attending the birth brought along her small trailer too.

“When we do births on the Navajo reservation, we have to think outside of the box,” Bowman explains.

Bowman, who has always been interested in labor and delivery, realized while working with the University of New Mexico’s Birth Companion Program, the lack of Indigenous birth workers. During one training, in a roomful of 40 participants, three were Indigenous.

“I was shocked,” Bowman says. “There has to be a change. There has to be more Indigenous birth workers.”

Later, Bowman attended another training with the Changing Woman Initiative, where she first met Singer. Since then, they’ve been realizing their vision of more Indigenous doulas and birth workers.

Bowman and her partners are continually learning the traditional Navajo ways of birthing and bringing those rituals to their clients.

“Some [clients] are for it, and some are against it because they have always been told they should be birthing in a hospital,” Bowman begins.

She goes on to explain that some of her clients have been scolded and ridiculed by pediatricians, other health care providers and even family and friends for planning a home birth despite the evidence confirming that among low-risk women, planned home births result in low rates of interventions without an increase in adverse outcomes for mothers and babies.

Bowman describes some of the elements of traditional birth which include integrating song, herbal remedies, teas and tinctures, and traditional dress in sash belts and moccasins.

“We believe in the exchange of energy and thoughts,” Bowman continues. “Good intentions, pure thoughts, and lots of prayers.”

It is customary for birth workers to tie a bandana over their heads as well as a Sani scarf, sash belt, or rebozo with an arrowhead tucked inside around the waist to protect the reproductive system.

“It is to protect us from the powerful energy the laboring parent is releasing,” Bowman explains. “It is like armor for us.”

Bowman and Singer and their partners are confronting the health realities in their community through other collaborations too. Their funding partners are The Kellogg Foundation, The Brindle Foundation and United HealthCare. Partnering organizations include Indigenous Women Rising, New Mexico Doula Association, Bidii Baby Foods and Saad K’idilyé, a grassroots organization dedicated to providing traditional teachings to the urban Diné communities around Albuquerque, New Mexico.

Last summer, the Saad K’idilyé Diné Language Nest (SKDLN) opened as a  central urban hub where Saad K’idilyé meets with families, babies, caretakers, and its community.

“A language nest is a community site-based language program for children from birth to three years old where they are immersed in their Native (heritage) language,” as described on their website. “SKDLN is a safe, home-like environment for young children to interact with Diné Bizaad speakers, often elders, through meaningful activities.”

Bowman was able to witness the interactions.
“It was amazing!” she exclaims.

Eventually, Bowman says that she and her colleagues would like to create their own Indigenous Doula training with teachings specific to Navajo birth culture.
In the meantime, they’re celebrating National Breastfeeding Month with Indigenous Milk Medicine Week: From the Stars to a Sustainable Future during the week of August 8 to 14. The breastfeeding coalition will reveal a Navajo translation breastfeeding art piece during this celebration.

And while the fifth wheel doula mobile has stirred up great interest within the community on social media, for the time being, there won’t be an expansion of this service. Bowman and Skeet’s fifth wheel remains on the move though, helping keep the birth team comfortable. Follow its tracks by following the Navajo Breastfeeding Coalition on Facebook.

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Respectful maternity care: the problem and suggested solutions

Guest  post by Donna Walls, RN, BSN, CLC, ANLC with intro by jess fedenia, clc

 

Donna Walls’s, RN, BSN, ICCE, IBCLC, ANLC unmedicated births were sort of a fluke.

“I remember being horribly afraid of someone sticking a needle in my back,” she recalls.

The “glorious” feelings of confidence and joy were unexpected consequences, but thinking back, Donna says, “Boy, I am sure glad I [gave birth that way.]”

In all other aspects of parenting, Walls credits growing up in the 1960s for becoming a self-described Granola Mom.

“When everything went ‘back to nature’, that was a big influencer for me,” she says.

As a nurse, Walls was always drawn to maternity care and supporting breastfeeding as the natural progression after giving birth.

It felt thorny to her when babies were taken to the transition nursery immediately after birth and later given back to their mothers.

This ritual sent the message that “We (as in the staff) can take better care of your baby than you (as in the mother) can.” That never sat right with Walls.

Then, one pivotal moment in particular, Walls on duty in the transition nursery, walked by a baby only a couple of hours old.

“He was frightened,” Walls begins. “His lip was quivering and he was splayed out underneath the warmer. He was so frightened. It just affected me.”

After that, Walls galvanized to change the culture in this hospital. She worked very hard alongside a physician colleague to open a birth center within the hospital. In 1995, Family Beginnings at Miami Valley Hospital in Dayton, Ohio was unveiled, offering families an option where birth wasn’t pathologized and where mothers and babies were honored as dyads. (Birthing at Family Beginnings remains an option for those in the Dayton area today.)

The center was designed to look like a home. There was no nursery for babies to be separated from their parents. When mothers came in to labor, the staff would pop in bread to bake, a special touch of aromatherapy.

Freshly baked bread, though enticing, wasn’t the number one reason families signed up to birth here. Instead, they chose Family Beginnings because they didn’t want their babies taken away from them, Walls reports.

Walls has since retired from her work in the hospital, but respectful maternity care remains forward in her mind and in her advocacy.

She graces us with reflections on respectful maternity care in her guest post this week on Our Milky Way. Read on!

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As a nurse in maternity for over 40 years, I have too often witnessed what I refer to as the “empty vessel theory”. Women are regarded as merely a container for the fetus and care providers merely the technician to remove it, usually as quickly as possible. I have often been saddened when the emotions and spirituality of birthing are disregarded or even mocked. This miraculous process is a rite of passage with all the inherent pain, joy, lessons and connections needed to begin the journey into parenting. My hope is that through discussions and activism, we can reach a point where the birthing family is honored and all newborns are brought into the world with love and respect.

Photo by João Paulo de Souza Oliveira: https://www.pexels.com/photo/gray-scale-photo-of-a-pregnant-woman-3737150/

Respect is “showing regard for the feelings, wishes, rights or traditions of others”. Concerningly, there is an abundance of anecdotes from patients and caregivers that demonstrate how maternity care practices are often disrespectful, sometimes even abusive.

Disrespectful care encompasses racial inequity, lack of confidentiality, physical and/or emotional abuse, denial of care or provision of substandard care, lack of informed consent or coercion or condescending communications. This type of care occurs in all countries around the world, to all demographics of women and their families. Fortunately, disrespectful care has drawn the attention of many health organizations, including the World Health Organization, and steps are being taken to stop disrespectful, abusive care practices.

Examining the intersection of maternity care and human rights has been a recent topic in many maternal and infant care advocacy groups as well. We cannot assume that hospital admission for an appendectomy is equal to admission for the birth of a baby. This is because  the scope of the process of birthing impacts a person, a family, a community and a nation which is not so of a surgical procedure.

Most women and families expect they will receive safe, inclusive, compassionate care and trust their caregivers to provide prenatal, intrapartum and postnatal care with honest communication and respect for their needs and choices. Provision of safe care should look beyond the basics of preventing maternal, fetal or neonatal morbidity or mortality and consider how to support the family’s human rights– rights inherent to all people, without discrimination, regardless of age, nationality, place of residence, sex, national or ethnic origin, color, religion, language or any other status. (White Ribbon Alliance, 2020)

Photo by Dipu Shahin DS: https://www.pexels.com/photo/baby-in-pink-and-white-blanket-4050647/

The first stated right is to be free from harm and mistreatment, yet we find continuing cases of physically and emotionally abusive treatment of pregnant and birthing women. Secondly is the right to competent, culturally sensitive care for both mother and newborn.  Next is  the right to companionship and support, and lastly the right to meet the basic life-sustaining needs of the dyad, including breastfeeding support for the newborn.

The first step toward respectful care is choosing  healthcare providers who value open, honest communication and who will discuss options and listen to the family’s needs and concerns. WHO defines respectful communication as communication which  “aims to put women at the centre of care, enhancing their experience of pregnancy and ensuring that babies have the best possible start in life.” (WHO, 2018)

Other components of respectful communication include the use of positive body language, active listening, the use of non-judgmental language, assuring patient privacy and honoring physical and emotional needs.  Respectful communication can begin with simply referring to the person by the name they prefer. If it is not documented, ask.

Another important step is selecting the birthing place. (Niles, 2023) Most care providers practice at one to two hospitals or birth centers. Choosing the birthing environment is an important decision in creating a birth experience which is in line with the family’s expectations and goals. Research and discussions with childbirth educators, lactation care providers and other families can give insights into common or routine practices at that institution. Will the family’s requests be honored? Will questions be answered with open and honest informed consent? Will the birthing and breastfeeding practices support their goals? These are all questions that need to be answered before a birthing place decision is made.

Creating an environment of respectful care in the birthing place is foundational. It is care that assures women and their families will be regarded as capable of making decisions. Making decisions which respect the values and unique needs of the birthing woman can only be made when patient autonomy– the right of patients to make decisions about their medical care without their health care provider trying to influence the decision–  is recognized.

Photo by Rebekah Vos on Unsplash

Individuals often comment on birthing in the hospital as a time when you lose all modesty; however, it is possible to follow protocols that set a standard for assuring privacy and modesty which can positively impact the birth experience. Simple steps like not discussing patient history or current conditions in front of others (without the patient’s permission), being mindful of covering intimate body parts (or culturally sensitive covering) whenever possible, asking permission before touching or knocking (and waiting for a response) before entering the room are a huge part of maintaining patient dignity. It cannot be overstated that any cultural requirements for modesty must be respected at all times.

More on respect in health care on Our Milky Way here, here and here.

Other recommended resources 

The International MotherBaby Childbirth Initiative (IMBCI) A Human Rights Approach to Optimal Maternity Care

Inclusive, supportive and dignified maternity care (SDMC)-Development and feasibility assessment of an intervention package for public health systems: A study protocol.

The Giving Voice to Mothers study: inequity and mistreatment during pregnancy and childbirth in the United States.

Exploring Evidence for Disrespect and Abuse in Facility‐based Childbirth: Report of a Landscape Analysis

 

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Monumental ‘Skin-to-skin contact after birth: Developing a research and practice guideline’ calls for immediate, continuous, uninterrupted skin-to-skin contact for all mothers and all babies from 1000 grams, after all modes of birth

In Western culture, we tend to trust the process of pregnancy and the capability of a human body to grow and nourish a fetus, but there’s a moment between then and the approaching birth of the baby and beyond when that confidence is lost. Among other reasons, loss of trust in the female body forces mostly unnecessary and often harmful interventions on the process of labor and birth. Thereafter, though the safest place for most newborns immediately after birth is skin-to-skin with their birthing parent, common maternity practices often strip the dyad of this sacred, critical transition diminishing the capability of the mother and the infant.

As the authors of The nine stages of skin‐to‐skin: practical guidelines and insights from four countries put it, alarmingly, “despite the research and compelling directives from world authorities, the implementation of immediate, continuous and uninterrupted SSC for all healthy mothers and newborns, regardless of feeding choice, has not become standard practice.”

Last month, Kajsa Brimdyr, et al published the monumental Skin-to-skin contact after birth: Developing a research and practice guideline.

Authors not in order of appearance: Kajsa Brimdyr, Jeni Stevens, Kristin Svensson, Anna Blair, Cindy Turner-Maffei, Julie Grady, Louise Bastarache, Abla al Alfy, Jeannette T. Crenshaw, Elsa Regina Justo Giugliani, Uwe Ewald, Rukhsana Haider, Wibke Jonas, Mike Kagawa, Siri Lilliesköld, Ragnhild Maastrup, Ravae Sinclair, Emma Swift, Yuki Takahashi, Karin Cadwell

It’s an “excellent overview of the huge quantity of evidence supporting skin-to-skin contact after birth and give evidence-based guidelines, endorsing the recommendations of the World Health Organisation, that ‘immediate, continuous, uninterrupted skin-to-skin contact should be the standard of care for all mothers and all babies (from 1000 grams with experienced staff if assistance is needed), after all modes of birth,’” Andrew Whitelaw writes in this editorial.

Source: United States Breastfeeding Committee (USBC)

In the review, the expert panel– representing all continents but Antarctica– sifted through roughly 8,000 articles and ultimately pared down to only include those with a clear definition of immediate, continuous, uninterrupted skin-to-skin contact.

The panel concluded that “delaying non-essential routine care in favour of uninterrupted skin-to-skin contact after birth has been shown to be safe and allows for the progression of newborns through their instinctive behaviours.”

The guideline includes the Pragmatic Implementation Guide for Skin-to-Skin Contact after Birth which serves as a how-to for staff, preparing them to facilitate skin-to-skin contact before and during the birth. The document is downloadable here: Appendix S1.

Brimdyr points out that none of the information presented is new; instead it’s consolidated in a way that hasn’t been done before.

“It takes the expertise of so many people and puts it in one place,” she explains.

Brimdyr says she believes it will give practitioners the confidence to make this practice work for moms and their infants.

“All of these babies, all of our mothers really deserve this opportunity,” Brimdyr advocates. “They deserve to have the best start.  This research is so well established… the fact that we’re not doing it everywhere is absolutely upsetting.”

Also last month, Brimdyr released a new film, The 9 Stages of Premature Infants, which documents  the nine stages as demonstrated by premature infants. The film brings to life the implementation of facilitating skin-to-skin for this population of infants and their parents.

“There is something absolutely magical seeing how capable babies are that really transforms any words on a page into reality,” Brimdyr says. “The research has been there to say premature babies can do this, but it’s so much more powerful to see premature infants do this.”

You can find a collection of skin-to-skin research here.

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‘Full pandemic mama’ becomes full spectrum doula

Allysa Singer was, as she describes, a “full pandemic mama.” Singer became pregnant with her first child in the winter of 2019. As she became aware of the threats and the consequences of COVID-19, she started researching her options and her rights in the delivery room she’d find herself in August 2020.

What started as personal preparation– How many support people would she be allowed? Would she be allowed a support person at all? What restrictions would she encounter? How could she advocate for herself? What were her options?–  propelled her into a world of birth support and autonomy advocacy.

“I was just dumbfounded by the disparities that exist in maternal health,” Singer begins.

In 2020, Alabama, where Singer and her family live, had the third-highest Maternal Mortality Rate in the nation, at 36.4 per 100,000 live births.

BIPOC families suffer from massive disparities in maternal and infant deaths. In a recent piece, Childbirth Is Deadlier for Black Families Even When They’re Rich, Expansive Study Finds, Tiffany L. Green, an economist focused on public health and obstetrics at the University of Wisconsin-Madison is quoted: “It’s not race, it’s racism…The data are quite clear that this isn’t about biology. This is about the environments where we live, where we work, where we play, where we sleep.”

Still, unlike so many of her peers, Singer reports having had an amazing birth experience.

Inundated by birth horror stories, she decided to change care at 27 weeks in hopes that she would be better supported in her choices at a different institution.

Here, she was allowed a doula and support person to accompany her during her birth.

“Not a lot of women had that luxury,” Singer comments.

Knowing well that birth support is a right and not a luxury, she started her own doula practice in December 2021. 

Singer shares that she experienced severe postpartum depression, but she was able to divert and ultimately reshape this energy into her doula work.

“My doula training was the lifeboat that saved me from drowning in my PPD,” she says.

And now her practice, Faith to Fruition, has become the lifeboat for many of the birthing people Singer supports.

She shares: “I don’t believe that a birther’s desire to have more children should be dictated by their birthing experience. I have heard so many stories from people who had one kid but say, ‘I would never do this again because my experience was so traumatic.’ One of my biggest missions and goals is to support birthers to feel empowered in their process; not as bystanders of their process.”

Singer also holds a full time position as an industrial psychologist where she channels her advocacy work, pushing for organizational change and understanding of proper maternal support.

In fact, as part of a public speaking course for a training curriculum, Singer presented on why it’s important to support breastfeeding. She reports that her audience of roughly 25 was engaged, especially as she pointed out the absurdities of infant feeding culture in our country: How would you feel if I asked you to eat your meal in the bathroom? How would you like to eat with a blanket tossed over your head? for instance.

Singer also points out the “insanely amazing public health outcomes” breastfeeding affords.

If 90 percent of U.S. babies were exclusively breastfed for six months, the United States would save $13 billion per year and prevent an excess 911 deaths, nearly all of which would be in infants ($10.5 billion and 741 deaths at 80% compliance). [Bartick, Reinhold, 2010]

“Not only is there a personal investment, there is a public investment and value to understanding the larger implications,” Singer comments. “As a taxpayer, [breastfeeding] impacts you; as someone who utilizes our healthcare system, [breastfeeding] impacts you.”

With the recent passing of the PUMP Act and the Pregnant Workers Fairness Act coming soon, Singer says “We still have a long way to go.”

Organizational policy doesn’t support motherhood; instead it fuels detached parenting which goes against nature, Singer goes on.

“Mothers feel the brunt of that more than ever,” she says.  “[We aren’t] supported to be able to care for our children the way that we want to.”

Singer says she sees it as her mission as an organizational psychologist to encourage change that supports parenthood, so that women don’t feel threatened to care for their children the way that they want to. This means ensuring that women are provided with ample space to pump their milk while away from their babies and empowering them to approach HR when there aren’t appropriate accommodations.

“Outside forces shouldn’t be able to dictate how you care for and feed your child. The end of one’s breastfeeding journey should be a personal decision.”

She continues, “It’s amazing that legislation is catching up. The thing that I fear with any law, there are still people behind those laws that have to enforce them and carry them out. Education and garnishing an understanding of what this looks like is a key component to implementation. The people behind those policies have to make them successful, but this is  moving things into a very good direction, and I hope that more changes to legislation follow suit, especially with paid parental leave. It’s a catalyst for change; I am hopeful but cautiously optimistic.”

Singer says she owes her personal success continuing to breastfeed her two-and-a-half year old to Chocolate Milk Mommies, where she now serves as a board member.

Through Chocolate Milk Mommies, Singer started a subcommittee to focus on education for individuals within the breastfeeder’s support system.

“The people in the village need to be supportive. When you don’t know better, you can’t do better,” she explains.

Singer recently completed the Lactation Counselor Training Course (LCTC) as part of Chocolate Milk Mommies’ mission to best support their constituents and as a way to benefit her doula clients with more well-rounded support.

“I really loved the training because I already thought that our bodies are amazing, but learning more science was great. I would text my friends the ‘Boobie Fact of the Day’,” Singer shares. “[The science] allows me to really appreciate my journey that much more and how impactful I’m being with my daughter.”

You can follow Singer’s work here and here.

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Breastfeeding is part of a continuum. 

–This post is part of our 10-year anniversary series “Breastfeeding is…”—

Breastfeeding is part of a continuum.

It has been hypothesized that starting around nine weeks of fetal development, the pattern and sequence of intrauterine movements of the fetus seem to be a survival mechanism, which is implemented by the newborn’s patterns of movement during the first hour after birth  (described as the 9 stages)  when skin-to-skin with the mother to facilitate breastfeeding.

Photo credit United States Breastfeeding Committee

This very behavior refutes the idea that breastfeeding is “an adjunct to birth” as it is generally viewed in maternity care settings in America.

Not only are human babies hardwired to progress through 9 stages and self attach to the breast, mammalian bodies are hardwired to produce milk too.

Around 16 weeks of pregnancy, the body starts to prepare for breastfeeding. This phase, called Lactogenesis I is when colostrum begins to be created. During Lactogenesis II, the secretion of copious milk follows the hormonal shift triggered by birth and the placenta delivery. After this phase, milk production must be maintained through a supply-and-demand-like system. [Neville 2001]

Even before a pregnancy is achieved, individuals are being influenced by the infant feeding culture that surrounds them, consciously or subconsciously laying a foundation for how they feel about feeding their own babies.

Pat Hoddinott’s, et al study found that women who had seen successful breastfeeding regularly and perceived this as a positive experience were more likely to initiate breastfeeding.

Exposure to prenatal breastfeeding education also affects breastfeeding outcomes. Irene M. Rosen and colleagues found that women who attended prenatal breastfeeding classes had significantly increased breastfeeding at 6 months when compared to controls.

Photo by Luiza Brain

Mode of birth and birth experiences influence infant feeding too, for both members of the dyad.

A growing body of evidence shows that birth by cesarean section is associated with early breastfeeding cessation.

Intrapartum exposure to the drugs fentanyl and synOT is associated with altered newborn infant behavior, including suckling, while in skin-to-skin contact with mother during the first hour after birth. [Brimdyr, et al 2019]

What’s more, the authors of Intrapartum Administration of Synthetic Oxytocin and Downstream Effects on Breastfeeding: Elucidating Physiologic Pathways found “No positive relationships between the administration of synthetic oxytocin and breastfeeding.” They comment, “Practices that could diminish the nearly ubiquitous practice of inducing and accelerating labor with the use of synthetic oxytocin should be considered when evaluating interventions that affect breastfeeding outcomes.”

Photo by Olivia Anne Snyder on Unsplash

In Transdisciplinary breastfeeding support: Creating program and policy synergy across the reproductive continuum, author Miriam Labbok takes a detailed look at “the power and potential of synergy between and among organizations and individuals supporting breastfeeding, the mother-child dyad, and reproductive health to increase sustainable breastfeeding support.”

Labbok points out that a paradigm shift on the issues in the reproductive continuum – family planning, pregnancy and birthing and breastfeeding– is needed.

“These are issues that are intimately, biologically, gender linked in women’s lives, and yet ones that are generally divided up to be addressed by a variety of different professional disciplines,” Labbok begins.  “Despite the impact of child spacing on birthing success, of birthing practices on breastfeeding success, and of breastfeeding on child spacing, we are offered family planning services by a gynecologist, birth attendance by an obstetrician or midwife, and baby care by a pediatrician. Having these ‘silos’ of care, each with its own paradigm and priorities, may lead to conflicting messages, and hence, may undermine the search for mutuality in goals, and collaboration.”

One such initiative looking to deconstruct siloed care is the Baby-Friendly Hospital Initiative which includes standards and goals for birthing practices, for breastfeeding-friendly communities, and guidance for birth spacing, in addition to reconfirming the original Ten Steps to Successful Breastfeeding, in recognition that breastfeeding occurs along a continuum.

Source: United States Breastfeeding Committee

1,000 Days emphasizes how breastfeeding fits within the global picture as a crucial part of a whole.

In the U.S. context, the 1,000 Days initiative recognizes comprehensive health coverage, comprehensive guidelines on nutrition during pregnancy, lactation, and early childhood for women in the first 1,000 days, paid family  and medical leave policy for all workers, and investments to ensure parents and caregivers can access good nutrition as solutions to a well nation and a well world.

 

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As part of our celebration, we are giving away an online learning module with contact hours each week. Here’s how to enter into the drawings:

Email info@ourmilkyway.org with your name and “OMW is 10” in the subject line.

This week, in the body of the email, please share with us some or all of your birth stor(ies).

Subsequent weeks will have a different prompt in the blog post.

We will conduct a new drawing each week over the 10-week period.  Please email separately each week to be entered in the drawing. You may only win once. If your name is drawn, we will email a link with access to the learning module. The winner of the final week will score a grand finale swag bag.

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