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The Big Letdown: A Book Review

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It’s been a long time since a book has hit the scene that really resonated with me to the point of wanting to discuss or promote it. The Big Letdown: How Medicine, Big Business, and Feminism Undermine Breastfeeding, by Kimberly Seals Allers, is the first book in a while that not only chronicles the path taken to where we are, but also lays out a plan for next steps.

The first part of the book covers history, politics, and science and is well researched. The middle of the book really gets to the heart of structural barriers, racial disparities and lack of meaningful support for breastfeeding.

I find it interesting that some of the negative reaction to the book I have seen is rooted in the notion that being a feminist means that you are not allowed to look at how women are approaching issues of equity and decide that there are new ways to approach it. Women need to continue to demand the same opportunities, pay and influence as men have. Of course we need and want more and better and longer paid family leave in the US so that (all) parents can take time off to care for a new baby or a sick relative or themselves if they have an unexpected health issue. This would most definitely ease the burden on those who have just experienced childbirth, or adopted, breastfeeding or not.  Addressing policy is the first point that Ms. Sears Allers invites us to focus on next. Yet at the same time, we need to push the needle forward on valuing things such as breastfeeding and mothering.

Valuing mothering does not mean devaluing fathering or parenting or grandparenting or dictating a strict set of rules for how to parent. This passage from Chapter 5, Nipple-omics and the Value of Motherhood, sums it up: “In a world where we are fixated on time and overwhelmed with overscheduling, breastfeeding is framed as confining and restrictive because it works best unscheduled. Instead, we should challenge why we have no freedom to be temporarily unstructured or unscheduled or made to feel like less of a woman for exercising this freedom.” I agree. Not everyone wants to choose an unstructured and unscheduled path, but as a person who supports new parents, I sure can’t keep up with the inquiries from new mothers who wish they did not have to return to work so soon or would like to relax and slow down as they adjust to parenthood but just don’t know if it is ok to do that.

The book challenges whether or not aspects of the feminist movement have helped mothers. It’s a fair question. Is choice really choice as far as breastfeeding goes when there are so many obstacles? Just like with health care, is it really impossible to have health care for everyone or does America just not value that? Is it really impossible to make breastfeeding easier for people or are we just not willing to ask the questions or have the conversations that seek to support the idea that breastfeeding is really valuable. Not just nutritionally, but societally.

Ms. Sears Allers outlines a set of seven starting points for taking action. The time is right for moving the needle forward and these areas to focus on are clear and well articulated. No doubt the task at hand is a challenging one, and complicated! There is a lot to consider in discussing how society, politics, and women themselves, intersect to create the current lactation landscape. Yet I am inspired and motivated by reading her perspective and I urge you to get a hold of a copy and consider how you might be able to incorporate some of her ideas on the way forward into your work.

Spotlight on Rebecca Dekker and Evidence Based Birth™

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Working through the multitude of childbirth care options and decisions during pregnancy and labor can be a daunting task.   Pregnant women and their families can often be overwhelmed when faced with some of the various tests, suggested procedures or interventions that are offered or recommended to them prenatally or while laboring.

Rebecca Dekker, PhD, RN, APRN is one of those women whose first time through the gate left her feeling uneasy, so she started asking questions and seeking answers.  Rebecca felt that some of the restrictions that were in place during the birth of her daughter had not worked in her favor. She began to wonder if they had truly been needed.  Was it really imperative that she not be allowed to eat or drink during labor? Was the risk of cord prolapse great enough to justify the bed rest that kept her from being more upright and active during labor? Being a researcher and a nurse herself, Rebecca set to work investigating the basis for some of the recommendations that she took for granted were based on clear evidence. It turns out that the evidence was scant for some of the policies and procedures she had assumed were necessary and that realization prompted her to do things differently with her second child.

Armed with new information based on the all of the good quality research she could get her hands on, in her second pregnancy, Rebecca placed herself firmly in the driver’s seat and sought out care that was supported by medical evidence. After her son’s birth, she felt the opposite of uneasy, and instead, she felt she could do anything!  She followed her gut and turned her newfound bursts of inspiration into something that would help others gain information to more easily navigate the birth care maze. Rebecca’s story is not uncommon. Many women have their minds and hearts jostled a bit during their first birth experience when things either don’t go as planned, or the overall experience is not what they had envisioned. As a long time postpartum support group facilitator, I have personally seen countless new mothers do a lot of rethinking of the choices they made, especially in regard to interventions or care they felt they had no choice about or did not quite understand the real risks or advantages of.

All of this questioning and examination usually yields good results.  And, fortunately, for all of us out there who care about improving maternity care and providing pregnant women with quality information to help make decisions about their care, Rebecca used her experience, skills and research and took big action. Her website, Evidence Based Birth™ , is a virtual treasure trove of birth related research, distilled down into forms that the non-researcher can easily understand and utilize.

The EBB website offers, a long list of articles in Q & A blog format, printable documents, video-based online classes that include continuing education credits and a newsletter. Subjects are well organized and can be accessed using an alphabetized topic list.

I had the opportunity to speak with Rebecca on the phone and was able to ask her a few questions about her new venture, which has garnered a fair amount of attention in a short amount of time since she launched the site in 2012. Some of the recent or upcoming topics she is working on which include Vitamin K for newborns, moxibustion for turning a breech baby and the oft cited ‘failure to progress’ as a reason for birth interventions.

When asked what she felt was one of the best things a pregnant woman could do with the content available on her website as far as taking action, Rebecca said that using the data and information to choose a care provider that they feel will provide evidence-based care was at the top of the list. I agree wholeheartedly with this because a woman who exercises her power to purposefully choose a care provider that supports the vision she has for her birth is a key element to a positive experience.  In addition to birthing women, Rebecca’s EBB website resources are highly desirable and useful to childbirth educators, doulas and other birth and medical professionals in the work they do with clients prenatally, during birth and postpartum.

With less than stellar maternal and infant mortality rates here in the US, there is much discussion in the birth world about finding ways to improve these results. It is challenging finding a balance between expecting the maternity care system to take responsibility for ensuring, quality, evidence-based care for all while simultaneously urging pregnant women to take responsibility for learning as much as they can in order to make informed decisions about who and how they are cared for when they give birth. Both of these things are important.  I love that Rebecca has made it easier for all of us to access and understand the research that is out there in order to get a clearer picture of the path that seems best for a woman in her own unique situation.  So if you are trying to find your way (or help others) to the birth you desire and feel lost and uncertain about which way to go, bring your questions to Evidence Based Birth™

and you may just find the answers you are looking for.

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Note: My interview with Rebecca was the inspiration for an article I recently wrote for Peggy O’Mara’s website about evidence based medicine as it relates to birth.  Click here to read it.  As the long time editor of Mothering magazine and founder of, Peggy has been a tireless advocate for women and families as well as the author of several wonderful books. At her new self-titled website, she continues to curate and create great content about natural family living, social justice and making healthy choices. I highly recommend this site as a place to spend time reading about and digging into issues that are near and dear to all of us who want to live well and support positive change in the world.



Keeping Current With Online Continuing Education

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More and more quality online continuing education offerings are popping up out there and I wanted to highlight a few coming up that look really worthwhile.

  • Evidence-Based Care for Suspected Big Babies: 

Rebecca Dekker, PhD, RN, APRN of Evidence Based Birth has launched her first video-based class entitled Evidence-Based Care for Suspected Big Babies.  This is an in-depth course with several video lectures and handouts that is worth 2 nursing contact hours. More offerings are slated for later in the year so keep an eye on her site or sign up for her newsletter if you want to be in the know on what the upcoming topics will be.

  • Social Media for Lactation Professionals:  Skills to Maximize: 

Praeclarus Press has two webinars coming up in October, 2013.  The first is Social Media for Lactation Professionals:  Skills to Maximize featuring Lara Audelo, CLEC author of The Virtual Breastfeeding Culture:  Mother-to-Mother Support in the Digital Age 

  • Welcoming African American women into your practice: Seven steps to creating a culture of respect and inclusivity: 

The second offering from Praeclarus Press is entitled Welcoming African American women into your practice: Seven steps to creating a culture of respect and inclusivity with featured speaker is Sherry L. Payne, MSN, RN, CNE, IBCLC of Perinatal ReSource 

  • An Integrative Approach to Tongue-tie, Lip-tie & Breastfeeding: the Interdependent Roles of the Lactation Consultant, Surgeon & Bodyworker: 

Another interesting offering is with Jennifer Tow, BFA, IBCLC, in collaboration with Larry Kotlow, DDS scheduled for October 21 and 22, 2013. This two part webinar is called AnIntegrative Approach to Tongue-tie, Lip-tie & Breastfeeding: the Interdependent Roles of the Lactation Consultant, Surgeon & Bodyworker


These are just a few of the online lectures, courses or webinars that I have seen available Fall 2013.  I love in person conferences and seminars but the internet makes hearing the latest info from leading professionals out there easy and convenient. Check them out!



Summer Meetup #1 recap

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Sunday was the first of three in-person summer Meetup gatherings at Life Alive in Salem, MA.  There were several of us who gathered to discuss a number of current events and issues in the world of birth. Jenne, who is a nursing student at North Shore Community College, shared how seeing ‘The Business of Being Born’ before she had children really “blew my mind wide open”.  Jenne also commented on how the social narrative about childbirth from movies and most of the stories people tell really set women up to be afraid while painting a picture that is not necessarily accurate. I know this is a big reason why I feel that it is important to include younger men and women in our conversations about birth practices and available birthing options out there. The more people are aware of and informed about before they are pregnant, the better.  Speaking of being aware, this is an eye opening article about the cost of birth in America that just came out in the New York Times. It is a lengthy article so be ready!

We discussed a book that I just read called “Cut, Stapled and Mended: When One Woman Reclaimed Her Body and Gave Birth on Her Own Terms After Cesarean” by Roanna Rosewood. I really got engrossed in the story and was struck by how open and raw it was.  I didn’t think that with all of my years of working with childbearing women and the issues they are faced with, that I would be stunned by an account like this but I was. It underscored for me how strongly some women feel about giving birth and how complicated it can be to navigate the emotions involved. I already knew this, but the very personal details of the author’s journey made an impact. The best part about the book, for me, was the in depth way that Roanna explored her own feelings and attitudes.  She worked very hard to connect the dots about what was driving her actions and did not heap blame on those around her.  She owned her experiences and processed each of her births in such a way as to clearly see and understand them without really worrying about justifying or defending. A lot of honesty there.
A few of the participants that attended are lactation professionals and we talked some about the Affordable Care Act and how insurance companies are all over the map in the way that they may or may not covering lactation services. Maire is one of several International Board Certified Lactation Consultants (IBCLC) at Home Visiting Lactation Consultants who provide some useful links at their website with more information to assist families in getting reimbursed.

Jen, who is a Certified Lactation Counselor (CLC) shared a bit with us about her work with WIC as well as her experience with the Hypnobabies method of childbirth preparation. She also mentioned that La Leche League of Danvers/Hamilton is going to be at the Beverly Farmer’s Market on July 8th answering questions and giving out information on local breastfeeding support resources.
All in all it was a great meeting chock full of good info and discussion. Join us on July 14th when we will do it again! Happy 4th of July everyone…
Summer meeting