1820s Motherhood

Last week, while a friend was in from out-of-town, we were able to tour the Isaiah Davenport House here in Savannah, GA. I was immediately intrigued by this photo:

This is a silhouette of Sarah Davenport, given to her as a gift after delivering her 10th child (7 survived infancy). It was done in 1828 by a silhouette artist by the name of Master Hanks. The thing that blew me away is that this piece was made when she was one week postpartum!

This and some of the other artifacts (pictured below) made me wonder, what was it like to be a mother in the 1820s.

With further research, I have compiled some interesting tidbits about birth in the 1820s.

1. It was deadly.

If a woman were to survive the birth itself, she was susceptible to childbed fever, now known as puerperal fever. The quick-progressing symptoms of this bacterial infection of the reproductive tract consisted of extreme abdominal pain, fever, and weakness. It took many years for doctors to learn the cause of the disease, which was eventually found to be caused by the lack of sanitation at the time. Doctors would often go directly from autopsies to births, with no hand hygiene between. The idea of doctors spreading the disease was first proposed in the early 1790s by Alexander Gordon, but was not accepted until 1885. It remained a problem due to carelessness in antiseptic routine, until sulfa and penicillin were introduced as treatments in the 1930s and 40s. We also cannot neglect the fact that deliveries were much more traumatic in this time, causing more wounds and a greater opportunity for infection to set in.

If women did not succumb to the fever, there were of course other deadly complications such as postpartum hemorrhage or obstructed labor. In fact, women wrote their wills upon finding out they were pregnant. Non-deadly, but life-altering, complications also occurred. These included damage from untreated infections and venereal diseases (antibiotics were not widely used for nearly another century),  uterine prolapse, and fistulas.

Cornelia Augusta, Isaiah and Sarah's ninth child, died of childbed fever in 1853 at age 29.

2. Pain relief

Ether was first used in 1847, and chloroform shortly thereafter, but obviously were not available for Sarah's births in the 1820s. These medications also made the use of forceps more common, as they made it difficult for women to push effectively.

3. Doctor or midwife?

Before the 19th century, all births were attended by midwives. In the 1820s, most births were still at home (only 5% of deliveries occured in hospitals by 1900), but began to be attended by doctors as well. Sarah most likely had a home birth with a midwife, but we can't be certain.

 

Sources:

http://www.davenporthousemuseum.org/

https://www.bellybelly.com.au/birth/why-women-used-to-die-during-childbirth/

https://www.fitpregnancy.com/pregnancy/labor-delivery/checkered-history-delivery-room

http://www.loyno.edu/~kchopin/new/women/bcabortion.html

Birth: The Surprising History of How We Are Born by Tina Cassidy

Lying-In: A History of Childbirth in America by Richard Wertz & Dorothy Wertz

 

Placenta Pills Infect Baby!!! Probably Not...

Recently, a CDC report was released blaming placenta encapsulation for late-onset GBS infection in an approximately 16 day old baby. Yes, this is a scary thought, but there are some gaps in the research and processing of this placenta I want to break down.

So, we'll start with the issues in the report. First, GBS is a transient bacteria, which means it can come and go throughout a woman's life. So even though the mother was negative at 37 weeks, she could have been positive at birth. On the other hand, how many women are told they test positive, receive treatment, but are not actually colonized at birth?

Second, the capsules did test positive for the same bacteria baby was infected with. The mother's breastmilk, the most likely way the bacteria would have been transmitted, tested negative for the bacteria. The report also notes, "transmission from other colonized household members could not be ruled out".

Three of my colleagues raised excellent points and worded them much better than I can.

"You are also dealing with a severely immunocompromised infant who has just come off of a very rough course of antibiotics and was ill which makes that baby much more susceptible to any infection from any source." -Shannon Mitchell

"A logical conclusion is the initial infection wasn't eradicated and the secondary infection was basically a relapse. There was no gbs in the breast milk. I think that's an important part of the puzzle when assuming the placenta was the cause for reinfection. That said, the placenta doesn't seem to have been processed properly and probably shouldn't have been encapsulated to begin with given the immediate onset of the initial infection." -Deanna Norris, APPAC

"Late-onset GBS has generally been attributed to the presence of GBS in the infant's environment. Did they culture the doorknobs in the family's home? The client's nipples? How about burp rags or swaddling blankets? If the client had it on their hands, then they could have quite easily transferred it to the capsules when they were taking some out of the jar. To suggest that the capsules were the *source* of the organism seems like *quite* a stretch." -Wendy Gordon, Midwife

Now onto the problems with the processing of the placenta by 'Company A'. First, "the company does not ask about intra- or postpartum infections". This is HUGE! I absolutely ask this of my clients. Encapsulators never want you to consume infected tissue! In my practice, I will not encapsulate your placenta if you have chorioamnionitis, a confirmed GBS infection (not colonization- in that case your placenta would be prepared by steaming before encapsulation), or GBS infection of the newborn.

Also concerning is the fact that "according to Company A’s website, the placenta is cleaned, sliced, and dehydrated at 115°F–160°F". Any temperature below 160° is NOT safe for dehydration. Below 160° would keep the tissue in the 'danger zone' where bacteria grow rapidly, easily doubling in 20 minutes. When a placenta is dehydrating for 12+ hours, this is simply unsafe, unsanitary, and unacceptable. This is taught in any food handling course, so it makes me wonder if this encapsulator does not follow safe food handling standards.

In summary, in my practice and experience, GBS is only a concern when the mother or baby has a confirmed infection, or the placenta is prepared improperly.

 

References:

https://www.cdc.gov/mmwr/volumes/66/wr/mm6625a4.htm?s_cid=mm6625a4_e

http://placentaassociation.com/group-b-strep-placenta-encapsulation-safety/

https://www.fsis.usda.gov/wps/portal/fsis/topics/food-safety-education/get-answers/food-safety-fact-sheets/safe-food-handling/danger-zone-40-f-140-f/CT_Index

Standards & Scope

There is no one, single definition of the scope of a doula. Each doula training organization defines these for themselves. These are the standards, scope, and other information from the organizations I have trained and certified with. I am proud to be a part of these organizations, and honored to hold myself (and be held) to these standards.

 

New Beginnings

Statement of Professionalism

Scope and Standards

Code of Ethics

Stillbirthday

Principles of Service

 

Rebozo Workshop with Gena Kirby

I am so happy I finally got to do this training! While I was at Stillbirthday Homecoming, Gena posted on Facebook asking if anyone would want to come to a workshop in Tampa. That's only 4 hours away (the closest she's been to Savannah), and I knew she was taking next year off! So I contacted a colleague and we decided to split the gas and drive time and go!

We learned more than just rebozo techniques, we learned about truly connecting with and loving a woman in labor. I recommend this workshop to anyone working with pregnant and laboring women.

Gena is an amazing, passionate teacher. When explaining what true undisturbed birth is, and what birth can look like, her voice cracked and tears welled up in her eyes. That moment, I knew this was the woman to learn from. This is a woman making a difference in the birth world. This is a woman I can look up to, and want to learn every possible tidbit from.

I had a blast and made some truly amazing friends! I can not wait to use what I have learned with my clients.

Also, Gena's books, Rebozo Me Mommy and How to Sell Your Client a Bridge are incredible and so worth reading! Learn more about Gena, her books, and workshops at: http://genakirby.com/

Male Doulas, Pt. 4

Wow! I really had no idea we'd make it this far. I hope you all are enjoying reading these as much as I am putting them together.

Next is Louis Maltais, student midwife in Montreal, Canada. This post was edited, with permission, as English was not his first language.

-Tell us a little about yourself and your work.

I am a student midwife at the half of my third semester of the program. I study in UQTR (Université du Québec à Trois-Rivières) which is the only university in Quebec thats offers this program. I started to study when I was 27 years old. Before, I was a gymnast-acrobat-dancer and I worked in some companies for different shows. I also did a one year course in massage therapy. After a few experiences with pregnant women, I knew that I wanted to learn more about pregnancy and midwifery.

-What led you to become a birth-worker?

It’s hard in few words to explain all the feelings and the thoughts that led me to want to become a midwife. I really like to work with the limits of the body, with the intensity, with the natural medicine and with the essential things in life like love, health, emotions, birth and death. Since I began working with midwives I love this job more and more.

-What do you like to be called?

In french, which is my first language, we call a man midwife a 'sage-femme' (midwife) or a 'homme sage-femme' (man midwife) and I really appreciate to be called like that. For me I don’t think that it’s necessary to say man in front of midwife, but it doesn't really bother me. But a lot of people think that we call me 'sage-homme' (kind of midman). Sometimes, I say nothing but I often prefer that they call me midwife even though I am a man. I explain them that 'wife' is attribuated to the pregnant woman [not the provider] and people are positively surprised, and usually understand why we don’t have to change the name of this occupation.

-People don't hesitate at the thought of a male OB/GYN, but often scoff at the idea of a male birth-worker. Why do you think that is?

The job of an OB/GYN is very different of a midwife. First, they are specialists with complicated pregnancies, while midwives work with low risk pregnancies. A sepcial part of the job of midwives is to support the physiology of the labour and the delivery. Now, we all know sides that less interventions during a labour increase the chances of the woman to have a physiological delivery, which is the most secure way to give birth. I think that it’s necessary to be comfortable to do nothing but support [the woman] in all the normals steps of a labour including pain and all the difficult emotions. For this reason, socially, we are more comfortable imagining a woman to feel confident with a woman in labour because she has to be very empathic with her. Even if one needs more 'feminine' qualities to be a midwife, I think that men can also be empathic and good supporters with a woman in normal labour. In fact, general practitioners also work with low-risk pregnant women, and some of them practice the midwifery model of care. So I prefer to be compared to a general practitioner who chose to only work with pregnant women. An OB/GYN has to do interventions in front of abnormal factors during a pregnancy, and it’s "less important" in these situations to support women. [An OB's] goal is to keep them alive, and we can thank them because we can save women that a midwife probably couldn’t. In this kind of job, we can easily imagine a man because we know that they can be comfortable when they have something to do.

-Are dads uncomfortable with hiring a male birth-worker? / Do men ever feel insecure about having another man support their wife or girlfriend?

Most of dads are comfortable with a male midwife, but they have different reactions. Some are very surprised, most are open and curious, some are suspicious. Some men of different religions don’t want another man seeing their wife intimately.

-Do you have a hard time finding clients comfortable with a male birth-worker?
In Quebec, midwives only work for public services, so people don’t really choose their midwife, but they can refuse a man, exactly like with doctors. Most of the time, women and men are very enthusiastic to meet me.
-Do you feel that you can offer something different from a female birth-worker?I feel that I can offer something different from a female midwife which means that sometimes it will be easier and sometims harder, and most of the time it will be similar. I also think that being a man show to the women that it’s them, the women, who give births, and not the midwives. In all the ways, everyone will learn from each other. The most important thing that really helps me to learn how to be a good midwife is the openmindness of the women. They are generous, confident and very powerful!
-Do you provide hands on help with breastfeeding?It’s a very important part of the job to help with breastfeeding, so yes I give a hand in that. For the moment, I don't give much advice to the women because I’m still studying, but I feel very comfortable with this part.

Find out more or contact Louis here: maltais_louis@hotmail.com

If you could ask a male doula any question, what would it be?

Male Doulas, Pt. 3

I have to say, my readers are awesome. Thank you all so much for the great feedback.

Next up is Jacob Engelsman, aspiring doula in Athens, Georgia. He is currently the owner of Engelsman's Finest Ferments and Local Cook at Earth Fare - Athens.

-What led you to become a doula?

I believe that everybody has a super power. Some people play music by ear, some are natural cooks, some are really lucky, etc. I call mine baby-magic. I've always been one of those people, even when I had spikes on my jacket and a big pink mohawk, that babies just love.  

About 2006, before I even knew that male doulas were actually a thing, I was living in Asheville, NC. Doulas and midwives are pretty common there, and I've always felt a connection to babies but it seemed to me like being a midwife or doula was somehow "off limits" to men. A lot of research and conversations I had did not dissuade me from this feeling. So the idea was put on the back burner. Then life happened; I met my future wife, ended up moving back and forth across the country 4 times (long story), married her, and helped put her through grad school. Finally, we decided to settle down in Athens, GA, and I got to thinking about what I actually want to do with my life.  

All that bouncing around the country led to a lot of different jobs, but pretty much all of them were food service, with which I have lately been growing weary. I started thinking about what, when I'm older, would I regret never having done with my life. That's how I decided that 2015 will be the year I decide, once and for all, if I really want to be a doula. If I do, fantastic; if I don't, no regrets. I've been reading books and articles, watching documentaries and talking to many people about it. The world definitely seems to have opened up to male doulas in the last 9 years, and now it really seems like a feasible goal.

-What do you like to be called?

I'll just go with, "doula." I'm fairly certain that I hate the word, "dudela" but I have a complex relationship with puns :)

-How does your spouse feel about your work?

My wife, Liz, is very supportive of me in this endeavor. She knows that I've always felt a connection to babies and, since we've decided not to have children ourselves, does everything she can to encourage me.

-People don't hesitate at the thought of a male OB/GYN, but often scoff at the idea of a male doula. Why do you think that is?

I'm sure you could write a whole essay on this question alone, but I think a good short answer is: sexism. Historically, when people think of doctors they think of men and when they think of caregivers, they think of women. While women are breaking down barriers to become doctors and OB/GYNs, fewer men have become professional caregivers.  

-Do you have a hard time finding clients comfortable with a male doula? / How much of the time are you sought after *because* you are male?

Since both of these will be purely conjectural for me, I elected to combine the questions.

I don't foresee a time when there will be so many male doulas that we will be the only option for a woman (or couple.) I imagine that anyone who hires me will do so specifically because of who I am (which may or may not include my gender,) and not despite it. 

-Do you feel that you can offer something different from a female doula?

I have met some women who feel more comfortable with men as opposed to women. I could be helpful with those new mothers. Other than that, any doula offers something different from other doulas. I don't necessarily believe male doulas offer something different from female doulas, on the whole.

You can contact Jacob here: finestferments@gmail.com

If you could ask a male doula any question, what would it be?