Mom bodies and haters: an open letter to Matt Walsh

Matt, I’m a big fan of your blog and your viewpoint, but I think Maria Kang is a particularly bad example to lead off your post about those who hate success.

First, let me clarify that I agree that the ad hominem attacks, closed-mindedness, and general hatefulness you are talking about are ridiculous and destructive.  I just happen to think that using negative “inspiration” to push a particular body image is also ridiculous and destructive.

I understand that there is a “fitspiration” culture that uses the “what’s your excuse” meme, but negativity in the name of inspiration is still negativity. Kang could have said “if I can do it, you can too” or “Mom bodies rock” or just “you can do it.” I love seeing people overcome all kinds of challenges to do what’s important to them, but putting down those who have not reached those goals–or whose goals are not the same–is not inspiration; rather, it is its own form of hating. (As the mommy wars have made abundantly clear.)

Unfortunately, in our negatively skewed, divisive culture, saying anything truly positive tends to get us labeled as saccharine, or else accused of hating on the people we’re not even talking about (like saying positive things about mothers and getting accused of hating on fathers). It’s really quite the vicious cycle, and I’ll admit that in a different culture, Ms. Kang’s meme might not be taken so negatively. That doesn’t mean she has no responsibility for considering the context of her message.  Am I going to go hate on her blog now?  Nope, I’m not even going to send her a link to this post.  But I don’t think her message to mothers is okay, either.

Beauty Redefined has a truly inspiring and positive blog post trying to ease the pressure on moms to “get their body back.” They’ve included a photo of a mother of two and runner who is clearly fit, yet whose stomach still does not conform to the rock-hard, taut, smooth, pre-baby ideal so prevalent in our media and culture. That body ideal 1) is unrealistic for many women and 2) may not be as important to many women as it is to Maria Kang.

It is not an “excuse” if a woman has stretch marks or loose skin, or chooses to focus on overall health and fitness rather than on conforming to a particular body ideal, or has other goals and responsibilities on which she chooses to spend her time. The culture that tells women they are failures if they don’t look a certain way is the same one that is telling mothers that they are worthless if they don’t have a career. (Recalling your blog post on that topic…)

In fact, I would encourage you to explore the Beauty Redefined blog to understand how body image is used to manipulate women, which is why so many of us are sensitized to these kinds of images. It’s kind of like realizing there is a political bias in the media. You start to react to a whole lot of statements and images that you never even noticed before.

For further positive inspiration for mothers to find beauty, health, and strength in their post-baby bodies, see also the 4th trimester bodies project, with images like this.

Is this image promoting obesity or neglect of health by showing a non-“ideal” body in a positive light? Good grief, no.   (Anyone who associates the idea of obesity with a woman this shape needs serious help, by the way.)

Is this image promoting healthy postpartum body image, which is part of the overall package of good health?  Absolutely.

 

To Be Needed, or Not To Be Needed

An acquaintance had her first baby on Friday.  She has been asking me a few breastfeeding questions today (for once the obligatory nosy text on my part was well-received! 😉 ), and I asked about baby’s latch.  Waiting for the answer via text, I was dreading a negative answer, and wondered why.  Do I not really want to put out the effort to help?  Don’t I want to put my expertise and information network to use?

 

Then I realized that I don’t want them to need me.  I want them to have a normal, straightforward breastfeeding relationship.  I want to be able to support them by simply saying, “You’re doing great.  Keep up the good work.”  And of course, that’s the deep desire of the best doulas, midwives, and other caregivers, too:

• To be helpful and supportive, but not to be needed.
• Not to be the hero, but to empower mothers to be their own heroes.
• To be able to say, “You’re doing great.  Keep up the good work.  You can do this.”

I get the strong impression that the deep unspoken psychology of Western medicine is just the opposite.  Anyone who has studied the differences between the physiological (“midwifery”) model of care and the medicalized (“obstetrical”) model of care knows that the medical mindset expects problems while the physiological mindset expects normalcy, but I’m talking about something deeper than skills training or habit.

I think the medical mindset’s expectation of problems stems from a need to be needed: a sense that if there are no problems to be “fixed,” then the caregiver has no professional value, and by extension, less personal value.  And I think the stereotype of doctors as egotistical and arrogant, and the all-too-common lack of respect for pregnant and laboring women, have the same root.  The more a caregiver thinks of women (or any patients) as foolish and incompetent and broken, the more the caregiver feels needed.

 

To this, I can only repeat the words of R. Buckminster Fuller: 

“In order to change an existing paradigm, you do not struggle to try and change the problematic model. You create a new model and make the old one obsolete.”

 

Let’s spread the empowerment paradigm until the paternalistic one fades into the oblivion it deserves.

 

Who do you listen to?

Who do you listen to?

Do you listen to fashion magazines and makeup manufacturers and surgical clinics whose very livelihood would disappear if you valued yourself for who you are instead of what you look like–or to the people who love you?

To Nestle and Gerber and the retailers who make money when babies are fed artificially–or to the moms next to you who breastfeed because it’s normal and healthy and actually quite convenient?

To pharmaceutical companies and medical lobbies whose livelihood is based on suspension of illness, not actual health–or to someone who teaches you how to support your body’s innate ability to heal and function normally?

To financial gurus whose main source of income is selling financial advice–or to someone who actually lives off their own investments?

Who do you listen to? The people who want you to internalize their messages unconsciously, or the people who want you to think for yourself?

 

Hey Girl…

I got the idea for these from the Birth Without Fear “Hey Girl” contest.  I didn’t get them done in time to enter the contest, of course ;), but I had to share!

 

 

Why I Support an OB for President

Did you know that Ron Paul, a top-tier candidate for the Republican presidential nomination, is an OB/GYN who has caught over 4,000 babies, and left Congress voluntarily from 1984 to 1997 to return to his private practice?  (If you weren’t aware that he’s a top-tier candidate, you can thank the mainstream media blackout, but that’s another blog post.)

I’ve been a fan of Dr. Paul for years.  He’s been my lodestone when it comes to sorting out the baloney that gets proposed in Congress every year, and I was a local meetup coordinator and helped set up a campaign office for his 2008 campaign.  (Since then I’ve had two children, which makes that kind of outside time commitment a nostalgic impossibility.)

A friend told me recently that it seems ironic, considering my fairly intense disagreement with the obstetrical model of birth, that I avidly support an OB for president.  Until then I really hadn’t even thought about that potential conflict, and the reason why is the essence of why I support Dr. Paul in the first place.

Dr. Paul could completely disagree with my choice to have a home birth, but he would still completely support my right to choose my own place of birth and care provider.  Plain and simple, that distinction is the core of his politics, and my own.

It’s time to think long-term and get away from the politics of trying to elect the guy who will force our favorite ideas on society.  I would not vote for someone who said “I’m going to propose legislation to require every hospital to have midwives on staff.”  Why?  Because the federal government simply does not, and should not, have that authority.  If we clamor that today’s President and Congress can and should force the medical industry to integrate midwifery, then we are granting that tomorrow’s officials, with different opinions and financial backers, have the authority to force midwives to work in hospitals and not in the home, or to be trained in ACOG-approved schools.  (And considering the established medico-pharma lobby, which scenario is really the more likely?)

In other words, we need to stop thinking about what we want “our guy” to do, and start thinking about what we don’t want “their guy” to have the power to do.  And if we really want tolerance and acceptance and freedom of choice for birthing mothers, we have to include all birthing mothers, and non-mothers, and families, and individuals.  Special interests serve only to divide us from each other so that we squabble while the establishment continues to ratchet our freedoms away.  Every individual has a right to bodily autonomy (life and liberty), whether we agree with their choices or not.  The vast majority of politicians neither understand nor respect this natural right.

Dr. Paul is the only candidate I trust to take into account individual liberty and Constitutional law when he makes his decisions, so that even if he doesn’t agree with me on everything, he is still going to do his best to leave me alone–and make Congress uncomfortably aware of the limitations on their own Constitutional authority.  He also has a reputation for being lobby-proof, and that is exactly what we need: a return to principle over influence, right over might, the individual over the state or corporation, and law over lobby.

 

What Is Beauty?

Thank you to Caitlyn Blake for sharing her poem and beautiful stretch-mark photo on Birth Without Fear.

Commercialized “beauty” is fake, brittle, cold, and dead.  Real beauty is found in a father’s strong arms, a mother’s fertile belly, and all the other ways our bodies look when we live in them.  The great delusion we have allowed to be foisted on us through unrealistic ideals of appearance is that body changes from motherhood and maturity are a sacrifice.

Having the body of a mother is not a sacrifice, or a punishment, or an embarrassment. Having the body of a mother is a blessing.

If I did not have the body of a mother, my babies could not have grown to full term inside my big, stretchy belly.  My babies were born beautifully round and healthy because I grew beautifully and healthily round.

If I did not have the body of a mother, I could not have nursed my own babies for as long as they needed, and provided extra milk for others besides.

Those of us who long for children and have been unable to conceive, or who dearly wanted to nurse their babies and could not breastfeed or did not get the support they needed, would give anything for those stretch marks or those unpredictably-sized breasts.

We put on wedding rings because we feel the need to signify physically that we have committed our lives to loving and nurturing another.  When we become mothers, we make that same commitment to our children, and we are blessed with the beautiful changes that signify our motherhood.

For pictures of the many badges of motherhood, check out The Shape of a Mother.

 

Your Baby: A Project That Deserves a Little Extra Time

Please note: This post is about healthy, uncomplicated pregnancies.  While there is some evidence that post-dates pregnancy – and that means past 42 weeks – can involve complications, those complications have clear signs that are in and of themselves indication for induction, regardless of gestational age.

One of the most frequent comments I hear from women about their pregnancies is some version of “My baby was X days overdue so my doctor induced” or even “I just don’t go into labor.”  A first-time mom was talking to me yesterday about her low(ish) birthweight baby, and I asked if the baby had been early.  She said, “No, she was actually two days past the date they gave me,” as if that were some anomaly.  And while lot of women do know intellectually that 38-42 weeks is a normal gestation, somehow anything past 40 weeks is still “overdue,” with all its attendant emotional distress, because it’s past their “due date.”

I have many issues with the concept of the “due date.”  Since anywhere from 38-42 weeks is average, and anywhere from 37-44 (or more!) weeks can be normal and healthy, at the very least we should call it a “due month.”  When you’re due in “late September or early October,” there’s no magic “due” date to make you feel like you’ve missed a deadline (more about that in a minute).  And all of this assumes that your provider is counting from your exact date of conception, which simply is not the case unless you chart your cycle using basal body temperature.  The typical margin of error for ultrasound dating is 8% (measured in days), so even a “highly accurate” 8-week ultrasound has a margin of error of five days, and the inaccuracy just increases from there.

Furthermore, the average length of an uncomplicated first pregnancy is over 41 weeks.  But typical care providers don’t add a week to a first-time mother’s due date; they just let her, or even encourage her, to think that she is broken if she goes past that magic date.

While I would love to see the “due month” become the standard way of talking about when a baby will be born, I know change like that takes time.  So what can mothers and those who love them do in the meantime?

Well, the current paradigm of the due date is that it is a deadline, and if you go overdue, you’ve failed.  All we really need, culturally speaking, is a tiny shift in how we think about that date, and we don’t even have to take it out of the lexicon of the workplace:  Some women can get all their work done in a 38-hour week, a large number do so in a 40- or 41-hour week, and others take 42, 44, or even 46 hours.  Some women work the same number of hours each week; others have a variable workload and are all over the map.  Women who are experienced at their job can usually get it done in a little less time than at first.

Going past your guess date is like working some extra hours to get the job done right.  There is no more “failure” involved in gestating a 42-week pregnancy than there is in working a 42-hour week.  You’re not broken, you’re working hard and finishing your project completely.  Your baby IS going to be born, you WILL go into labor, and everything before that is like staying late on Friday to complete a project before the weekend: you may not particularly enjoy it, but it’s rewarding and it’s important.  The baby’s healthy arrival is your goal, not a particular date on the calendar.

So if you go into labor at 39 weeks, you get to leave work a little earlier than expected.  (Of course, moms know the work is just beginning!)  If this is your first baby and you go into labor at 41 weeks, you’ve worked a normal first-time pregnancy.  And if you go into labor at 42 or 43 weeks, you’re working overtime and you deserve some extra support (which includes reasonable monitoring of your health and the baby’s), not harassment or fear-mongering.

Here’s to the day baby registries only ask for a due month, and women feel confident and proud of growing their babies to natural term.

 

The Circular Reasoning of Interventive Obstetrics

How often have you heard these kinds of statements from women or care providers?

1. “A lot of women can’t dilate all the way.”
2. “Placentas don’t come out on their own.”
3. “You can’t have a baby without pain medication.”
4. “We have to break your water.”
5. “The cord was around the neck, so we had to cut it right away.”
6. “She needed a cesarean because she wasn’t making enough progress.”
7. “Lots of women can’t breastfeed.”
8. “We have to induce or your baby is going to be too big to birth vaginally.”
9. “Once a cesarean, always a cesarean.”
10. “My body just doesn’t go into labor.”

The ultimate source of this anti-birth, anti-evidence bull hockey is a topic for another post (or book, such as Ronnie Davis-Floyd’s insightful anthropology-based Birth as an American Rite of Passage).  But I do want to point out the self-reinforcing nature of these obstetrical ideas that have no basis in scientific evidence, nor even common sense.

Take, for example, the OB quoted on My OB Said What?!?: “It’s SO weird that you’re in labor! I haven’t had a mom go into spontaneous labor in over a year!”  In other words, this physician schedules inductions so routinely–and so early–that he or she almost never lets a baby grow to full term.  (Iatrogenic prematurity is also a topic for another post, but let’s at least remember here that gestational age estimates can be off by two weeks or more, and that late preterm infants are at risk for severe complications at birth and in the long term.)  Since this OB almost never sees women going into spontaneous labor, his practice of routine induction is self-reinforcing.  After a while it becomes easy to forget that women and babies are designed to go into labor on their own; and with almost no normal experiences for comparison, it also becomes easy to ignore the risks to which routine induction exposes these clients.  This may be an extreme case, but with more than one in five labors in the U.S. being induced as of 2006, induction is clearly a norm for many care providers.

If you re-phrase the list of quotes above, it turns out that we hear this kind of circular self-reinforcing thought process all the time:

1. “I expect cervixes to dilate on a specific schedule, and if they don’t, they must not be able to dilate.”
2. “I don’t wait for the placenta to come out on its own; I’ve never seen a placenta come out on its own.”
3. “I don’t supported unmedicated births; I’ve never seen an unmedicated birth.”
4. “I almost never see a mother’s water break on its own; I always perform artificial rupture of membranes at 4 centimeters.”
5. “I always cut the cord on the perineum; I’ve never seen a baby with a nuchal cord deliver normally.”
6. “The average labor (under a care model that labels a long labor as dysfunctional and intervenes accordingly) is 12 hours; since she wasn’t pushing by 12 hours, she needed a cesarean.”
7. “I don’t see much point in taking the time to support breastfeeding; I don’t see many women breastfeed successfully.”
8. “I’ve never seen a baby over nine pounds born vaginally; I always induce if I think a baby is getting big; I require my patients to birth on their backs.”
9. “Once a cesarean, always a cesarean.”
10. “Your baby is not going to come on her own; I don’t wait past 40 weeks.”

These self-reinforcing habits of thought and practice not only help many physicans avoid learning about evidence-based medicine (and I’m not trying to be snarky here; learning is hard work, and doctors are just as prone to intellectual stagnation as the rest of us), but they also affect the beliefs of birthing women.  It doesn’t help that when a quarter of our countrywomen have inductions and a third have cesareans, major medical interventions in birth seem normal.

Which leads us to the biggie, the overarching self-reinforcing assumption of the disease model/interventive medical model of birth: “You need to be in the hospital/have continuous electronic monitoring/[insert intervention here] because labors fail and babies go into distress all the time.”  The prevailing culture and media constantly barrage us with the message that birth is is a disaster waiting to happen, and that birth emergencies are sudden and common.  And that message is reinforced every time the normal process of labor is hijacked by medical intervention, because it’s not the intervention that gets questioned when the assumption is already in place that birth and the female body are the faulty parts of the situation.

So what’s a thinking pregnant mama to do?  First, find a care provider who practices evidence-based care, respects your decision-making autonomy, and will offer you the support that is so important for success in goals like natural birth and exclusive breastfeeding. (CIMS’ Ten Questions is a good way to start your interviews.)  Consider hiring a doula for continuous labor support and initial breastfeeding support.  And find a network of people who will support you as you create your own messages:

1. “I’m a normal, healthy woman and my cervix will dilate in its own time.”
2. “The birth process works best and is healthiest when every stage proceeds on its own time frame.”
3. “I cannot give myself stronger contractions than I can handle.”
4. “Intact membranes make a good cushion for baby and help protect us both from infection.  It even used to be good luck for a baby to be born ‘in the caul.'”
5. “About a quarter of babies carry their cord safely with them around the neck.”
6. “My labor will progress in the timeframe that’s needed by my body and my baby.”
7. “Breastfeeding is natural and normal.  Most women’s bodies are able to make enough milk to support one or more babies.”
8. “My body will not grow a baby too big to birth.  By growing my baby to natural term, I’m protecting him until his body is ready to breathe, nurse, and keep itself warm.”
9. “VBAC is a safe, healthy option and not only gives this baby the benefits of labor, but also prevents compounded complications from multiple cesareans.”
10. “My body knew how to perform the miracle of making this baby from almost nothing; of course it knows how to go into labor when my baby is ready to be born.”

 

Your Baby Is Not a Cake

When doc treats your baby like cake,
Remember, there’s too much at stake–
Lungs and brain need to grow
And they let you know
So insist you need more time to bake!

 

Inspired (as much as limericks are ever “inspired”) by the information about brain development in the last few weeks of pregnancy found in this excellent Mother’s Advocate post about labor induction, as well as research indicating that the surfactant produced in baby’s lungs to prepare for breathing may be a primary trigger for labor.

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Please feel free to share, post, or print.  Credit appreciated, but not required (just don’t pretend you wrote it, or the plagiarism goblins will come and steal your firstborn).

 

A Personal Update

While I don’t usually post personal news on this blog, I’d like to think that I have a reader or two who might wonder where I’ve been the past two months!  I have, in fact, been in first-trimester land, where all-day nausea is just not conducive to coherent writing.  We expect baby in February, so that elusive transition to second trimester is gradually bringing me back to the world.

This will be baby number two and, barring any evidence-based reasons otherwise, home birth number two.

I’ve been adding many drafts that I look forward to polishing and posting soon.  Thanks for hanging in there with me!