Monday, August 19, 2013

Changing Infant Paradigms (part 2)

Now that you have examined and thought and pondered over the basics of how praxis is developed, how about examining a new thought on practice.

So, if you're working as a professional in the birth field, sit back and examine what you would do if presented with a mother. Be it, expecting or nurturing her newborn. Think of all of the experiences that have shaped your own perception. What is the first picture that comes to mind - of a contemporary mother.

It's dependent upon your own praxis and the practice which has evolved. It's interesting to think of how many pictured a mother holding her newborn with a bottle. A certain percentage of people would. Some would see a mother standing over a crib, and others will see a woman cradling a new baby in her arms. Maybe they would see this mother sobbing on the couch, staring at this new bundle and asking the professional to fix something. Perhaps, they would even see this mother in a skin to skin position with a baby (swaddled or unswaddled? That is an appropriate question). Depending on praxis, and maybe even personal bias, she may see the newborn in an isolette with tubes and lines. We are all shaped by praxis, to evolve our practice.

The picture a health care professional sees first, flashing in the pan, is important. This will indicate what comes further to this. When the mother says - "now what", her next words would seem to be important. Does she fix the latch and position and encourage the feeding, does she recommend a strict schedule with weights and ins and outs and start thinking of pathophysiology and intervention, or does she look at the bigger picture? Many HCP's I know and many stories I have heard, all look to the dyad but in peculiar ways. I still remember the common practice being "mashing" babies into mothers, breaking seals, making daft comments about the clipboard and schedule, and sticking a gloved finger into the mouth of the newborn. I remember undressing babies (but, not mothers?), and being the face of ignorance with flippant remarks like "let's see how the next feed goes", or "have you thought about suck training?". I had no effing clue what the implications would be. Lucky for me, nursing pairs may have figured it out or just kept tripping and stumbling along with a medium result.

What would seem to be productive would be to look further into the practice and what the average HCP should practice - with considerations of scope. Why was a new nurse even making a diagnosis of poor suck based on a single interaction with a glove? Why were conclusions being made about meconium and diapering without truly knowing what was going to change that? When did the position of the sun/moon (aka clocks) ever dictate hunger for anyone, beyond "sleep happened at some point for mother, and baby probably ate and slept a lot". We know from early history that women carried their children close to keep them safe and nourished. Yet, practice and praxis are both dictating a dangerous place can only be known as "in the arms of the mother". Why ELSE would mothers and babies be separated by devices?

When an HCP is developing their practice, need they look at the historical perspective? Likely not. Infant mortality has decreased, one would think. Are rates rising... newest literature says, yes, rates are increasing again... but the stories are told as "it's still better than the cave".

If you want to change the praxis... you need to change the practice. Yeah?

Nursing my last child... the final chapter?

Jonas came to us in June of 2011. I had been nursing his big sister through most of that pregnancy, and she was freshly three years old. Previous to this, big sister was nearly four when we did the big wean. I chose the "end", the finale, mostly.

It's bittersweet. I nursed my first child through an abusive session, which may have saved both of our lives. I am not entirely sure if we were entirely at risk of death, but, I clearly remember being choked with a child at the breast and wondering what kind of situation I had gotten myself into. I made the choice far later down the road... with nursing my child being a place of happiness and comfort for both of us through that tumultuous journey. When it was done, I felt that I had found other ways to correct our situation and I was seeking closure, or permission to move along with life. Not that I have ever wanted to break the connection with my child.

I think now to breaking the connection with oxytocin and the "lact" in my life. The hormonal shift that needed to come was likely partially psychological as well as pharmaceutical in nature. We wouldn't benefit from cessation of nursing on a lazy level. I really had a desire to make sleep something that was continuous and uninterrupted for me... but ultimately, I wanted other ways to derive the good feelings. It wasn't even out of boredom. Possibly a way to allow myself to pro-create again? It wasn't birth control, but at that point I hadn't really given myself permission to allow myself to renew the source of oxytocin. We basically put a lock on it and had a fairly mature discussion about the end, establishing the new ground rules. It seemed like a rite of passage at the time, and like I had won the game, accomplished my mission, and secretly held her nursing as something we owned beyond the naysayers and establishment.

Jonas' pregnancy brought a short-wean for my middle girl. I was having pain through the days and felt as though my supply had tanked. I didn't want to be the bedtime messiah anymore, so I let her moan and cry with daddy for weeks. The connection was never broken, and, to this day, it's still there. We nurse on/off (and this is a five year old), and I still feel like that both weaning choices were made for me in an offhand way.

This time, I don't know what to do about it. Jonas is only two, yet, I feel like the five year old needs it more than him. He's a git-er-done kind of nurser, whereas the girls were all into the connection. I still feel him nuzzle in, despite the sweaty head and reluctance on my part to let him tweak and twist and caress his other nipple. I know the day will come, but I really don't know how to break the relationship into something more constructive.

Is it a final chapter... and can I write this one differently? We had a violent night with our middle... she just hasn't given up the goose yet, and I know that it's not done with her. I need a right of passage to break the spell of mommy comfort, or, rather, rewrite her last chapter. I feel that closure for one child will come when I can effectively deal with the entirely non-weaned five year old.

Monday, April 15, 2013

Changing Infant Feeding Paradigms

A long time ago, in a world far, far away, lived a (fictional) family in the 1400's. Traditions at the time dictated that the rich and famous had access to breast milk, and the poor working class/lower class did not. If they survived pregnancy and birth, and were able to nourish their own infants - they would. If they had access to a wet nurse, they would attempt that. More often then not - women who could not lactate would make a feeding replacement from grain mash and water (not necessarily as safe as what comes from your tap). Needless to say - mortality rates were far higher than they are today. The rich and famous, of course, also had access to wet nurses. To feed your baby, with breast milk, made sense.  (Jan Riordan is my source on this)

Surges throughout history waxed and waned - the church, of course, had opinions on breasts and dictated how newborns were fed. The world's rich and famous have always had opinions of their own on how to rear children. As have medical professionals. Even today - if you ask around - the opinions are loud and proud. One would expect that these surges and trends will continue through the eons.

In contemporary times, we look to celebrity, we look to peers, and we look to health care professionals to make our parenting decisions. As a health care professional, as a graduate of a school of nursing, I have pondered why I have developed my current paradigm and why the shift in my own profession is so narrow in both scope and practice.

When you look at the praxis involved in developing nursing practice paradigms related to feeding of infants, you have to look at the primary attitudes that circulate in contemporary times.

1. Birth culture in contemporary times dictates that when you are pregnant, you should see your physician, who will "diagnose" your pregnancy via blood or urine, and will then set you on a course through your pregnancy. Your physician will tell you to eat healthy and will be there along the way to categorize your symptoms into normal, abnormal, and questionable. You will see an Obs/Gyn, you will take birth classes, and you will attend the hospital to have your baby. Nursing care will take you from the birth suite to home, and from there your family physician will handle well-baby, sick baby, and your post partum follow up.

2. Primary knowledge of infant feeding practices comes from the "breast is best" world. Your medical professionals know that breast milk provides immunity. Your medical professional knows that formula will need to be given when breast feeding does not work. Your medical professional knows that pumps and creams and mastitis and thrush all co-exist in a wonderful world of solutions. Your medical professional will send you to a Lactation Consultant, who will know the tips and tricks and will get you on your way.

3. The personal paradigm - be, it, previous clients, your own babies, your friend's baby, the lady across the street, the lady in the mall, etc. Not only do you build upon your knowledge, but you also absorb on a constant basis. If you work in the birthing industry, you hear the wishes of the women in practice, as well as the stories about why infant feeding needs to work or does not work. Media is also a constant and continuous flow of stimulus.

The praxis and general consensus of how infants will be fed is typically going to look at the nursing dyad together, with the emphasis put onto the mother. Mothers fail to make breast milk and are given a solution including pumps and supplements. Rarely does the investigation lead to the "bigger picture". The birthing process is finished once the perfect little baby has arrived. The birthing process is still taking place largely in hospital, where many hands have examined both mother and baby.

Eventually mothers will look to peers or family, ask her partner, struggle, and then seek further advice. If, they have survived and endured running the feeding gauntlet, and have eventually found their solution - they will have a combination, or a success/failure.

What if? I like to write a lot about the utopia - and, I like to hear about the ideal course happening. On occasion, all of the stars align, and a woman has a normal course of birth and nursing. Changing the paradigm has a lot to do with changing attitudes around women and pregnancy, which is a given. Separating mothers from their babies is consistent in industrialized countries - separation and milk supply go hand in hand - otherwise, we'd all be lactating all of the time (it's a true story if you think about the evolution of mammals). The other side of this, is changing the attitudes about the bigger picture.

Having a close connection with women and their stories has done more for developing knowledge and praxis then any course in nursing ever did. From there, looking at bigger pictures and looking to those who hold knowledge has made a big dent in my own practice. Finally, looking for solutions that may exist within the confinements of the medical-model of birth has cemented it in.

Evolving and changing my own paradigms - and, more on this to come.

Friday, June 15, 2012

I want versus I wish

I recently had some moments to myself, and went through the list of wants/wishes.  I think I wish sounds a little more attainable, maybe like asking the world to provide a little?  Maybe helping me formulate a goal?

- I wish to breastfeed Jonas until he is at least two.
- I wish to find a career solution!
- I wish to continue birth work... I wish I could be doing what I want right now, without the constraints of three children (I want to be a midwife or work directly in home birth/birth)
- I wish to have more work flexibility, I WANT to have more work flexibility.
- I WANT there to be better birth in my community, I wish I knew the easiest way to get there.
- I wish that our mothering community was not so divided, I wish that it wasn't a crime against humanity to give the kids Kraft Dinner once a month, I WANT women to have that flexibility in mothering.
- I wish my child care situation wasn't hanging by a thread, again, I WANT a solution that takes my family from this point to age ten.
- I wish the money tree would plant itself and I could stay home, and keep busy so that I didn't go nuts here ;)

What are you wishing? What do you want?

Monday, June 4, 2012

A year spent entrenched in birth

My year of maternity leave is almost up.  I am in the lazy days now (have been mentally for a while), and I'm in a state of reflection.  I remember the end of the pregnancy vaguely, mainly because I was keeping myself busy learning and reading about the upcoming birth and figuring out where I was going to end up in it all.  There were definite moments where I was afraid of ending the pregnancy in a c-section (we had a breech scare and the midwife laid it out that she could not do a breech delivery).  I wondered what way my pregnancy would go.  My advisory committee told me that number three could go any way, longer, shorter, or a combination.  In the end - it was an identical process to the other two births.  The pregnancy was a slightly better experience - I had more knowledge and an easier job that allowed me to stay still and ride the nausea train.

So I reflect on what I learned this year being off.  I took the babywearing educator course earlier in the spring, and my mind was blown at all of the linkages between attachment parenting and a normal outcome.  I had always held breastfeeding in ultra high esteem, on this special pedestal.  I always wanted to be an advocate and champion of the movement, while supporting anyone who did not breastfeed.  That was important to me, the mother to mother support despite all odds.  I knew what women were up against - shit, I experienced enough hardship in my own life to make it a definite rat race.  Like everyone else, I suppose.  We all have our own challenges to overcome.

I just keep seeing this whole woman of domination pose being struck, and I keep backing off and not wanting to be a part of that.  I think I have an addiction to the drama (I KNOW I do).  But I think one of the most valuable lessons I learned is that there is just this damned fight for women to raise their children, period.  It's not about the regular south-end parent (pointed out to me last week) who wants a home water birth, and it's not about the core mom who just wants a square meal through her pregnancy at least once a week.  It's about the babies - however they are brought into the world and however they are offered love and food.  It strikes me as a big cop out by the mom-industry to just rake in the profits when they could all be jumping on the other train and getting just as much love.  I bet if every car seat company (not just Britax) did their market research and looked at what a company like Didymos has done with their carriers, maybe we would see the AP movement being mainstream?  Let the hippies have their lotus birth, but produce some great products to allow that to happen?  I see a whole line of high quality dolls coming along and watch these women fight over a $400 stuffed toy, would they do the same if they could jump the line and hire their own midwife?  They do, every day, just like Beyonce booked the entire floor of the hospital for her birth (which was a c-section).  I don't know, I just keep wondering what else will happen this week.

The Time article fired me down - coming off of that high, I learned that my valued husband needed a kick start and a pat on the back for at least sticking it out with me through the crazy year it was.  I think I learned too, that the birth stuff wasn't as hurtful (being in the hospital) to him because in the end we did get our baby.  Our customer satisfaction was low, but we didn't jump the cue and we saved our money for other things over the year.  Like camping, and taking another trip to Edmonton, and some really fun baby carriers (which I admit, I do like to stare lovingly and then think about someone trying to rip them out of my cold dead hands).

I learned this year where my heart needs to be.  I need to pick one cause and do it well, instead of holding myself up and dragging it out into slow deaths.  But others need to come around and take ownership too, it's not a singular cause and certainly not a singular outcome.  I didn't sign up for my own interests, I signed up for others.  I am bitter but I learned about how others are experiencing the system, and I think that is highly valuable.

I am tired, though.  Not because of the amount of work done, but because there is so much more to do and so little time.  I know my family needs me present for a while, and I think they deserve that of me.

So, I may disappear for the summer... haven't yet decided how that will pan out, but it may just happen on it's own.  I won't force it, and definitely won't invite it, but I won't burn down any establishments in the mean time until there is a force to be reckoned with that I can spend some time with.  And once my family life is settled and organized again.  I love my messy house, it means we are busy doing other interesting and fun things, and not spending it fretting and cleaning.  The laundry can wait - momma has another train to jump on.  I loved that part of my leave.  It was grand.

To my family, for making it possible to spend the time learning, and digesting the year.


Friday, May 11, 2012

Time Magazine celebrates Mothering

Yesterday the mothering post went viral. I have read a few tidbits on why this is so "hot", and definitely sure that Time is going to make a bundle off of that issue. Personally, I am going to be running into Chapters to snap that issue up just for the cover photo. I haven't really been into magazines the past few years, mainly because I can get most of that content online and I'm not a fan of gloss and advertising (some of you may find that funny, seeing that I'm working on a project at the moment). I see the issues every single day, because I'm immersed in mothering culture. I choose to do that, be it being a social media cow or whatever you want to call it - grazing and chomping and chewing the cud for as long as my gut needs it to be chewed, and either spit out or dumped in a large patty onto my poor husbands ears (the poor guy, has to listen to everything and then some). I think that there are reasons to celebrate this image - and, another image of a gangsta-like midwife that came across my desk yesterday. I think it is time to celebrate that there are women who are beautiful and strong who are connecting with their children between whatever it is they do. I think we got lost in our feminist movement when we threw all of our trust into Nestle and our mothers (some who did not breastfeed for their own reasons) or aunts or grandmothers even. I have more family who breastfed their babies and a real mix of working and staying at home. It seemed to fit in different times and places that the women in my family were hard workers at home and out of the home. My baba had a large garden and small livestock, raised nine children, and is probably rolling in her grave knowing that her great granddaughter relies on her husband for the gourmet gardener/cooking and even the laundry. In her age, men smoked and drank and worked their hands into blisters, and made damn sure they were good at cards and shooting pool (and probably throwing fists around as needed). How times have changed - but I feel pretty empowered that I can still manage to hold breastfeeding up to the same standard as my great grandmother. It may be a romantic notion that my grandmother still remembers breastfeeding (she would have been five or six). Was it driven by poverty? Or was it a social norm? I think it was probably both - formula was always expensive, and WalMart didn't exist. Would they have wet-nursed another baby for a neighbor or relative? I would think so, but I don't think it was something that was shared or discussed or shouted from the rooftops. I heard on CBC's The Current this morning two pundits - one who was likely a fan of the homeschooling gen-x'ers, and another woman who was disabled and agreed that attachment parenting is anti-feminist. All I keep thinking is that heck - I am what some people may call disabled (I have a chronic back injury), and I'm still able to enjoy what both worlds have to offer. I'm slightly selfish in that I spend 90% of my time with my kids and 10% of the time partying (and I estimate about 70% of the time complaining about feeling anchored and not able to do the amount of partying I'd like to do). I do think that attachment parenting has saved my children's lives at one point or another. Had I not breastfed my first child, we may have been in grave danger of her being abused as well as me. I don't know that I would have survived that element of life and gone to school had I not worked hard on that bond and wanted to do better. With my second, we dealt with severe colic and a high needs child - breastfeeding and co-sleeping likely saved my husband and I from being awake 90% of the time. It sucks sharing a bed - it wasn't always pleasant and warm and cuddly and lovely, I had to lay with my chest exposed for her demands to be met (sometimes contorted), my husband got kicked in the head regularly (or face or back or groin even), and in pregnancy (let me tell you), it was probably the most irritating thing I could ever experience. I don't hate my children, I don't hate attachment parenting philosophy - the only time I may get to be with my kids is during night time or during breastfeeding. I couldn't imagine parking them in containers 20 hours a day. Why have kids? As much as I say I like to party, I spend the entire time out talking about my children or my work, and usually talking about work difficulties usually links directly back to my kids! In my opinion, it's really time to celebrate mothers and the fact that mothers can do both things if they want. You don't have to home school to be an attachment parent. you don't have to breastfeed for that matter, but you should feed with love and companionship. Like I have been saying consistently - being attached to a breast doesn't work for some people (I get that), but it shouldn't be work to get help if that's what you want to do. Be it said, it's easier to go out and buy a pack of smokes than it is to pay for a lactation consultant. We are on the cusp of a public health crisis of lifestyle disease in North America, and we'd rather yell at the screen at a photo of a woman feeding a child with breastmilk than we would point the finger back at the big formula companies and their minions. I guess what I am saying is that Nestle wins when mothers are critical of each other. Why should I try if I can't even go out into public without being told to cover that shit up? I'd rather celebrate the art and appreciate the difference and fight for a right to do WHAT is right.

Thursday, May 3, 2012

Shutting the door on Post Partum Mood Disorder

Not many people know my unique situation with mood disorders.  Or maybe you do.  I still remember the first time I was told by a man that I was psycho, and the situation that came from.  Instability in life seems to create instability in mood, and perhaps choices in who we surround with our love.  Maybe I wasn't thinking clearly when I matched myself with an overweight and depressed man?  Much of our issues were related to his own poor mental health.  I do not think either of us knew or understood that life wasn't easy, and we had to make choices that weren't always easy.  When I left him behind the first time, he showed up at my door threatening to kill himself if I didn't take him back.  It went both ways.  I know where I went wrong those early years - I made the choice to go with birth control medication without being informed about what that would do to my body and mood.

I can link back directly to hormonal supplements and when my ability to deal with life was hampered.  I stuck with birth control for most of my 20's, and my mood would cycle along with whatever I was taking.  My best moments in life were the moments where I was able to leave the medication behind.  In the post partum periods of my life, especially in the first year, my body reminds me that mood issues are alive and well.  I don't tend to stick with depression as much as just a labile mood - a mood which changes rapidly.  Finding support for labile mood is not easy, understandably (who wants to accept that kind of ill behavior in their day to day life as being normal).

With this last pregnancy, it's been a challenge dealing with a toddler and a busy house hold.  Saving grace has been good friends and events to look forward to - whatever it may be.  Social isolation wasn't the answer - I know that in my own experience, being alone has been extremely difficult as well.  Speaking with others and looking at situations from different angles has been helpful in beating the worst of it.

This week is a new beginning for us - I decided to put my pre-schooler into full time childcare in hopes that I can explore and beat the general malaise.  It's not going as well as I had hoped, but like everything in my life - the transitions aren't easy and the benefits just need to be accepted in a slow and gradual change rather than immediate pay off. 

I don't have much advise, but I have some goals for transitioning out of the post partum period.  I'd like to re-establish a routine, set some small and realistic goals for organizing, and return to work with some gusto and love for my profession.  Even if my goal isn't to be the world's best mother and full time employee, we do have to work the transition with some grace.  I think by spending the last part of my days with a balance of creativity, joy, nutrition, exercise, and some time spent on organizing I will beat the last of this and enjoy the moments with my baby while he is still a baby.

The biggest part is enjoying, looking at the brighter side, and battling against embitterment.  Looking forward to doing that!