One woman's path through doula training, childrearing, and a computer science Ph. D. program

Wednesday, August 26, 2009

Book report: Motherwit

Onnie Lee Logan (as told to Katherine Clark). Motherwit: An Alabama Midwife's Story, 1991
My score

My review

This is not an inspirational book. This is a book that seeds a few ugly, shocking birth stories, while attempting at some history. It is hard to read, anticlimactic, and lacking useful information.

Imagine a hot summer day, humidity in the high-nineties. You are on the front porch of a hand-built house in the middle of rural Alabama. There are 14 or so children running around -- all borne from the same mother. On the porch swing sits Onnie, a large black woman in her sixties, sipping sweet iced tea with fresh mint, the ice cubes ringing gaily in her glass. Onnie's slow, southern drawl is telling you her life story. Slowly. Meanwhile, mosquitoes as big as your fist are buzzing around your head, and you have a nagging feeling you have to be somewhere else.

The tone of Motherwit is just that: Onnie Lee Logan dictating her memoirs. The southern drawl, the slang, and the verbal self-corrections are all immaculately captured. I literally had to read the book aloud to myself on several occasions to see what on earth some words were supposed to be. Pick'n some co'n -- oh!

Onnie portrays a black-hating, rural, poverty-ridden world in Alabama. She introduces her large family (her mother spent almost all her adult life pregnant), and talks about her early days as first a home-care, and, later, midwife assistant.

In the second half of the book, however, the tone takes a turn for the worse. Since when did "memoirs" become synonymous with "here, let me describe to you the things that were so awful, so terrible, so heart-wrenching, that I cannot get them out of my mind -- and you should suffer with me?" That which has been read, cannot be unread.

Unlike Ina May's guides, which are full of information for anyone interested in how midwives function, or in labor, or in labor customs, Onnie's memoirs have virtually no useful information. I was hoping to discover the labor techniques for poor women living in squalor, or read some inspiring or heartening birth stories told from a black midwife's perspective, but alas. The setting was a background on which to paint an ugly canvas and dig up painful memories that just will not die.

I hate posting bad reviews of books, and I was hesitant to post this one. But there you go.

Monday, August 24, 2009

Book report: Spiritual Midwifery

Gaskin, Ina May, Spiritual Midwifery, Fourth Edition
My score

My review

Oh, Ina May... If you only pick up this book to flip through and look at all the photos of laboring hippies, do it. Even after four editions of the book, she still talks about feeling telepathic with all laboring mothers ever, how childbirth is so heavy, and uses her own terminology, such as "butt-hole" for anus, "taint" for perineum -- because "'taint what's above and 'taint what's below", or "cootchie" (what is that?). Spiritual Midwifery will teach you how to be a midwife in the astral sense of the word, using your inner peace to deliver the baby not only in the physical plane but energetically as well.

As with Ina May's Guide to Childbirth (see my review), the first half of Spiritual Midwifery is birth stories, including the story of Ina May's own tragic first birth. This section of the book is a history lesson on how The Farm came into being and how the hundreds of people traveled across the country in school busses, birthing babies along the way and picking up the knowledge they would need to become the birthing community they are today. Some birth stories are long, some are short; some end beautifully while others end tragically. All are inspirational.

The second half of Spiritual Midwifery focuses on the medical side of giving birth: how to conduct prenatal exams, how to turn a breech baby, how to sew up a tear, how to revive an asphyxiated baby, and so on. The figures are numerous and informative. After reading Ina May's descriptions, I feel intimately familiar with the procedures that go on in a delivery room.

Ina May has shared with me natural birth as it is meant to happen, introduced me to many unlikely complications for moms and their fetuses (and what is normally done about it), and has given an in-depth, heartfelt tour of the midwife's maternity and birthing room.

Friday, August 21, 2009

Any day now

Any day now: This was my standard post-37-weeks answer when anyone would ask, gazing at my large, round form, when my baby was due. Even knowing that most first-time mothers do not deliver before 40 weeks (I think 41 is the mean), somehow I knew that, at 38 weeks, it was "any day now." I delivered at 38 1/2 weeks.

My first doula client is due any day now. That is, she is about 35 1/2 weeks along but it is becoming clear that it will be soon. Her baby has dropped ("lightening") and is in position. She has been having fairly consistent Braxton-Hicks contractions for six days, getting progressively stronger. And at home, she has been boiling diapers and hanging clothes lines. Sure, it could take another month, but probably not. If she holds out until Sunday, she can deliver at the birth center rather than the hospital. Hang in there, girl!

As the time draws near, I am both excited for her and apprehensive about my own role as her doula. She is my first client, and I have quite a bit of performance anxiety. What if I do not fulfill her expectations? What if I say or do something wrong? And my biggest fear -- what if she feels unsupported, afraid, and alone?

There is only one way, short of those hypnosis re-trainers of dubious credentials, to get over something, and that is to do it. My mind tells me I will be a fine doula for her. I know her well, and we have discussed all aspects of her pregnancy at length. She is as overprepared as I am. Yet as my mind is certain I am ready (and prepared) to be a strong and gentle support person in her labor, my emotions are raging. I have even been having anxiety dreams!

Do doulas get labor support -- while on the job? Maybe I should hire one for myself!

The $800 immunizations: Part 2

The bill arrived today: $644.42 for my son's four-month checkup.

I called the insurance company (BlueCross/Aetna Prudent Buyer PPO). As expected, they said there is nothing they can do; I went over my $750 annual limit for well-child care. In the future I should make sure I stay under the limit.

Next, I called the business office of the doctor's group. I expected them to discount some of the charges. Why? I don't know -- out of the kindness of their hearts, perhaps.

The lady in customer service said no, there are no discounts for which I am eligible. In some instances, there is a 25% discount for prompt payment, but not in this case. This is a balance due to going over a benefit maximum -- that is, it already has been touched by insurance -- and therefore is ineligible for the 25% discount. There are no discounts that apply...

Except one!

If I let my balance due go over 90 days, I am eligible for a 10% "settlement offer." After 90 days of my balance being due, I can call the business office and ask for the settlement offer. I will be given a 10% discount, which, for me, will be $60-$70 per round of vaccines.

The catch is that after 90 days, past-due balances are sent to a collections agency. In order to avoid collections, I must call and pay between 90 days past-due and 99 days past-due. One day more and collections will receive my balance, and the 10% discount is gone.

I asked the lady one more question.

"How," I asked, "am I supposed to know how much a doctor's visit will cost, so that I can plan ahead in the future?"

"You can call the doctor," she replied, "and ask for the exact procedure codes for each procedure that will be done at the visit. Then you can call us at the business office and read off the procedure codes. We can calculate what the visit will cost." We shall call this item A.

Next, I would take this information to the insurance company. I would call and ask which procedures are covered, and how much. I would ask how close I am to meeting my maximum benefit. This is item B.

Finally, I would subtract item B from item A and get item C -- the amount the well-child visit would cost me out of pocket.

Oh, a simple four-step process. Excuse me as I drip with sarcasm.

I told the lady that unfortunately, for financial reasons, we will not be returning to the medical group for any of our medical needs, and will seek another doctor.

She was unfazed.

Another case of the baby brains

The "baby brains" is a condition recognized by new parents and, unfortunately, everyone they interact with.

From sleep deprivation and the necessity to pay constant attention to the baby, the brains undergo a transformation that makes one seem dumber. But it is not idiocy: it is the inability to multi-task.

Take, for example, my husband. Just this week, his baby brains were to blame for the following blunders.
  • On Monday, he left his coffee at the sandwich shop. It took him 20 minutes of walking to track it down.
  • On Tuesday, he put shaving cream in his hair. In his defense, it comes out of a can, just like his mousse.
  • On Wednesday, he filled the water-filter pitcher and then immediately poured its contents over his head, trying to drink from the spout.
  • On Thursday, he lost his belt somewhere. This is the second belt to go missing this month. Where is he removing his pants? No one knows.
It is now Friday. I have yet to see what happened today, but I am sure it will not disappoint!

Thursday, August 20, 2009

Relaxation in labor

Check out this fantastic video of a contraction from YouTube.

Pay attention to this woman's shoulders. See how wonderfully loose she is in her shoulders, her neck, and her throat. Even at the peak of the contraction, she is doing fantastically.

Tuesday, August 11, 2009

Five more things to have on hand: Preparing for childbirth

You can find lists of things to pack in your hospital bag for when you have your child. Or lists of things have ready in the nursery (or wherever the baby will sleep) for when your child comes home.

Here are five lesser-known things to prepare for the first days.
  1. Coconut oil, vegetable oil, olive oil (thanks, anonymous commenter!), or vaseline, for putting on the diaper area so you can get the meconium off easier. Otherwise you spend about 5 minutes rubbing their poor sensitive bums. Bring this to the hospital (put it in your for-baby bag). Apply liberally after every diaper change until the meconium is gone.
  2. Disposable diapers, even if you plan on using cloth diapers. Use disposables during the first few days, while meconium is coming out. You do not want to scrub tar-poo in the sink... plus, the vaseline may stain cloth. Some birth centers provide organic disposable diapers, and the local hospitals provides diapers for the stay (and you can ask to take some home), so you should not have to purchase any. Otherwise, a pack of diapers is fairly cheap. Anonymous commenter (below) suggested asking for a cloth diaper service as a baby shower gift, if you are set on using cloth diapers.
  3. Disposable breast pads, even if you plan on using cloth ones, because you do not want to have to wash your bras or breast pads in the first days. The first days are for laying in bed with the new baby and having people bring you food.
  4. Lots of changes of t-shirts for you to sleep in. You will sweat like a pig at night (because all of the pregnancy fluids are finally getting out), and will likely want to change shirts when you get up to feed your lil'un.
  5. Rags, rags, rags for spraying breastmilk. One side feeds the baby, the other side hoses down your bedroom. Your body thinks it is feeding octuplets. I like receiving blankets and kitchen towels. What comes out is mostly foremilk, which is low on fats, and comes out in the wash.

Sunday, August 9, 2009


I had the opportunity to go with a client and her partner to her prenatal appointment with her obstetrician.

The obstetrician, incidentally, delivered my baby six months prior. She delivered him, but she was not our care provider; she was the on-call OB when it was time to deliver.

At the question and answer portion of the appointment, my client was asking about the routine procedures that she and her other partners use during delivery.

"We like to have things go normally and naturally," the OB replied. "We don't want you to have a c-section. We try not to cut episiotomies unless they're really, really necessary."

I know, maybe she says that to everyone. It is entirely possible that she was just toeing the line.

When I heard that, I got instant closure. For me, she had cut a "surprise" episiotomy that tore to a third-degree laceration, and I had secretly or subconsciously wondered if it was really necessary (even though all of the reading I had done said it likely was). Hearing her say that, I instantly felt better about my own birth experience. It was unexpected -- but very nice. And now I trust her so much more with my client.

Thursday, August 6, 2009

The rating system

Here it is: the breakdown of my rating system for books.
  • 10/10: A must-own book for a lay-professional in the field.
  • 9/10: A desirable book for the bookshelf of a lay-professional.
  • 8/10: Will certainly reread this book.
  • 7/10: This book has some great information, and I will likely reread it.
  • 6/10: This book was worth a once-through, but I would not reread it.
  • 5/10: I would recommend skimming this book and/or looking at the pictures.
  • 4/10: There were a couple of good points, but not more than a couple.
  • 3/10: I can see the value of a book like this, but it is unreadable and/or terrible -- not even worth skimming.
  • 2/10: Reading this book was a waste of time; it contributed nothing to the discussion and was poorly written and/or unreadable.
  • 1/10: Even the cover was a waste of time.

The $800 immunizations, part 1

Why does a set of immunizations cost $800 (and cost me, the consumer and new parent, $650 out of pocket)?

I got a letter from my insurance company a few days ago saying that it is my responsibility to pay around $800 -- no wait, we negotiated it down for you, to $650 -- for my son's four-month checkup and set of routine immunizations.

Before the four-month well-child (or "well-baby") visit, I had read The Vaccine Book, and I knew the risks and benefits of each vaccine my son was going to receive. Still, I decided that the benefits outweighed the risks for us, and we got all of the immunizations that were recommended by the American Association of Pediatrics (AAP).

So, at the well-child visit, we got the following vaccines (combined into three shots and an oral), as recommended by the AAP. These are the same vaccines as we got at our two-month well-child visit.
  • Second DTaP (diptheria, tetanus, pertussis) vaccine
  • Second polio vaccine
  • Second Hib (Haemophilus influenzae type b) vaccine
  • Second hepatitis B vaccine (since the first was done at one month, not birth)
  • Second rotavirus vaccine
The letter that I received from the insurance company lists the following. I have broken it down by vaccine and administration fee as listed on our doctor's bill from our two-month well-child visit.

Preventitive Service
  • Total billed: $161.00.
  • Amount exceeding the benefit maximum: $64.00
  • In excess of the allowed expense: $48.90
  • Claims payment: $31.28
Immunization: DTaP/Hib/Ipv (polio) Vaccine (Pentacel)
  • Total billed: $84.00
  • Amount exceeding the benefit maximum: $84.00
Immunization: administration of the first vaccine (injection)
  • Total billed: $65.00
  • Amount exceeding the benefit maximum: $65.00
Immunization: Pneumococcal Conjugate Vaccine
  • Total billed: $211.00
  • Amount exceeding the benefit maximum: $211.00
Immunization: administration of 2+ vaccines (injection)
  • Total billed: $42.00
  • Amount exceeding the benefit maximum: $42.00
Immunization: Rotavirus vaccine (Pentavalent)
  • Total billed: $104.00
  • Amount exceeding the benefit maximum: $104.00
Immunization: administration of 2+ vaccines (oral)
  • Total billed: $38.00
  • Amount exceeding the benefit maximum: $38.00
Immunization: Hep B vaccine
  • Total billed: $85.00
  • Amount exceeding the benefit maximum: $85.00
Immunization: administration of 2+ vaccines (injection)
  • Total billed: $42.00
  • Amount exceeding the benefit maximum: $42.00
It is your responsibility to pay: $654.42
It is not your responsibility to pay: $147.30 (How kind of them to allow us "patient savings!")

I thought this was kind of ridiculous. Especially since these are not frivolous expenses -- these are immunizations that all infants should get. I called the insurance company to see if there was some mistake. The result? No, it's no mistake: the benefit maximum per year for immunizations is $750. Dollars. Per year. It is worth noting that my quarterly premium is around $700 for my son.

In the first year, infant immunizations are part of the well-child checkups at one month, two months, four months, six months, nine months, and 12 months. Check out the government article on well-child visits.

This means that the first and second round of shots -- at one month and two months, respectively -- cost around $750, were covered by insurance, but consumed my entire allowable for vaccinations for the year. The next round -- at four months, about which I am writing -- cost around $800, but were negotiated down to around $650, and will in all likelihood have to be paid out of pocket. The six-month round of vaccinations, which we just got two days ago, will be another $650 out of pocket. And... there is still one more visit to go before the end of the benefit year, on September 20.

The really depressing thing is that this is the insurance provided to graduate students here at the university. And I have to pay -- through the nose, as where is a grad student going to come up with $700 each quarter? -- for my son's premium.

Be warned, moms of new babies. I do not want to sound like Michael Moore, but it feels like I should be choosing the immunizations that are the least expensive, not the ones that are most important.

Congratulations, Anthem Blue Cross. You have transformed thinking about vaccinations from a risk-benefits analysis to a cost-benefit analysis.

Saturday, August 1, 2009

Book report: Nighttime Parenting

Sears, W., Nighttime Parenting, 1985

My score

My review

It is a little old, but the lessons discussed in Nighttime Parenting are still valid today. In fact, I think this little book became an entire chapter in The Baby Book, part of the Sears library. Nighttime Parenting urges parents to try co-sleeping (that is, sleeping in the same bed with their children). Sears argues that babies and toddlers do not and should not be expected to sleep through the night; that nighttime nursing is essential for their emotional development; that parenting does not end with the setting of the sun, but continues into nighttime. Children should be "parented to sleep."

As a wholehearted supporter of co-sleeping, and of night nursing, I was amused to find among the pages of this book photographs depicting our exact sleeping arrangment throughout the last several months: first, a co-sleeper; usually, bed sharing; and finally, a crib attached to the queen-sized bed. I picked up this book (at a used book sale) for advice on how to handle constant nighttime nursing on night wakings, how to move the baby into the crib (which is attached to our highly-preferred bed), and tips on how to cut out some of the hourly (or less!) night nursings that had creeped into our nighttime routine. What I got was not answers, but instead support for whatever the baby decides is right for him, as long as it works for the parents.

So, does it work for the parents? It works, and it doesn't. There are nights that he wakes every two hours (which are the good nights) and nights in which he nurses nearly constantly. Although on average, we have found ways to deal with it, it could be better, and hence I am not over-eager to try other methods.

On the bad nights, nursing is punctuated with occasional yells. This book and others on the same topic suggest teething pain to be the culprit. Time heals all wounds, the books say. I guess we will wait it out and see what crumbles first: my steadfast support of co-sleeping, or the desire for daytime energy.
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