The sudden slide into depression

semi colonI’ve been pretty open about my daily life as someone who lives with anxiety. I do have enough readers and I do know that what I say has helped others reach out and feel less alone. What I haven’t been as eager to be open about is that, as long as I can remember, I’ve also had at least one depressive episode per year. It’s nothing so extreme that suicide is contemplated, but it’s definitely more than just feeling sad.

The anxiety has been a struggle this year. A big struggle. At some point last year I switched from Zoloft to Celexa. The Celexa never really did much. In retrospect, this was a terrible decision, but as I felt the creep of anxiety increasing, I was desperate to stave it off. This spring, I ended up switching to Prozac and Buspar (seriously one of the stupidest names ever). That’s when the sideways slide into depression really began.

The thing about depression is that I don’t notice it’s hit until the dark thoughts begin. Maybe this is normal, but since we don’t talk about the reality of mental health openly very often, I don’t have anything else to go off of. Someone pointed out today that we should talk about mental health the way we talk about physical health– like asthma (which I have) or allergies (which I also have); it’s a chronic condition. Most of the time these things are under control. Sometimes, the medications that I take to manage the asthma, allergies, or anxiety aren’t enough, though.

Starting in April, and through May, I was trying to help my grandmother recover from a very serious illness that needed weeks of hospital and rehabilitation center care. I mostly got through it ok, but I was without one of my teachers due to maternity leave, and some of the things about owning a business really got very seriously neglected to the point where I wasn’t capable of doing more that just showing up to teach.

It’s manageable to own a business with anxiety; the act of doing things to promote and grow and run the business become fantastic ways to soothe the nerves. If I’m doing something, I’m less anxious. It is, however, impossible to run a business once a full-blown depressive episode hits. Returning phone calls? It seemed like too much work. Reach out to providers and partners in the community? Nope, I’ll stay balled up in bed instead. Check out what others are doing to get a feel for the market? Thanks, but the mean voices in my head telling me I’m not good enough have enough fuel for their fire. And as I did less I felt more shame, inadequacy, and doubt about my ability to run a business.

Depression lies. The narrative in my head got darker as summer began. I grew desperate. I did meet with my therapist, but that didn’t help. Finally, in late June, everything came crashing down. I never got to the point of suicide being an issue, but the screening forms for anxiety and depression were startling; since I work so much with mental health through the nonprofit, seeing the scores on paper was scary.

I was so desperate to feel better. The anguish of the sadness and hopelessness grew. I’m lucky that I have wonderful friends and family did everything they could to keep me afloat. But still…

I don’t remember much from the last week of June and the first week of August. I remember feeling an overwhelming desire to check myself into a mental health unit and be hospitalized, but I also rationally knew that beds are very hard to find, and going through the hell of finding a place to be didn’t sound appealing. Again, if it was an asthma flare up, the steps would be obvious; if I got to the point of not being able to breathe, I’d go to the ED. There would be plenty of beds I could stay in while I got the meds I needed to be able to breathe. This simply is not an option during depression or anxiety flare ups.

This is what’s so bleeping frustrating about our system: while the barriers to care have slightly improved, as has been studied over and over, it’s still hard for anyone to get access to mental health for people with more minor challenges; for someone is crisis, a helpline isn’t enough. The mental health infrastructure just does not exist. We essentially have a two-lane road made of a mishmash of bricks, asphalt, concrete, and gravel that really needs to be upgraded to an eight-lane highway. Politicians like to talk a lot about “improving mental health”, but money isn’t going into building the clinics and hospitals and coverage and creating easy access to the mental health care providers that families need when they reach a point of desperation.

I am getting better. I am better. I went back on my old-old meds, and they finally kicked in July 10th. Yes I remember that day because I needed to make sure I placed my marker back into the passage of time rather than just float through the days and months as I had before.  The fog is still lifting, but I am finally getting back into the groove of life, or parenting, of running BabyLove and the non-profit. I’m getting there. I had so many friends and family, especially my husband, who held out their hands so that I had something to hold onto until I had the strength to hold on myself. I have anxiety and depression, but that’s not all who I am, and if you’re in the same place I am, it is not all who you are, either. My value, your value, is still there. We’re still here. Let’s stay here and help each other get through this thing called life.

Finally, if you are reading this an need help, you can find local and national resources over on NAMI Minnesota’s website. More work is needed to fund these community mental health response teams, though. We need more funding, more training in our state and in the US to make sure it’s as easy to get the right care for severe depression, anxiety, or other mental health concerns as it would be to get help for an asthma attack.

Warmly,

Veronica

Veronica Jacobsen, BA, CLC, CPST, LCCE, FACCE
Birth Doula, Certified Lactation Counselor, Child Passenger Safety Technician, Lamaze Certified Childbirth Educator, Fellow of the Academy of Certified Childbirth Educators

Opening BabyLove in September of 2011 has allowed me to build a space where all families can come to get good information in a caring, welcoming environment. I have found that not only do I love teaching more than ever, but I also really love running a business. Hopefully my passion for every aspect of BabyLove shines through.
I live in Richfield with my husband, and I am a mother of a two great children. When I can steal a few free moments, I love to go on adventures with my family, cook, garden, thrift, can, and craft.

What the Allina Nurse Strike Means for Birthing Families

Given the news that nurses at 5 Allina hospitals are set to strike starting Saturday Sunday, there are a few things to keep in mind if you’re due soon and are facing the chances of going in to give birth and were planning to have your baby at United, Abbott, or Mercy, there are some things you should be aware of.

The replacement nurses will be trained in Labor and Delivery. That’s the good news. The bad news is that they will bring in their own ideas, which will very likely be very different than the hospitals regular protocols and policies. We have far better outcomes in Minnesota than, say, the South. Many of these nurses will be coming from areas with very high c-section rates, where waterbirth is banned, where there are de facto VBAC bans, etc. Be aware that you may face huge opposition from your nurse if she’s not normally around these things that families in Minnesota have come to expect as the norm.

Also, when replacements are brought in to any strike situation and cross the picket line, patient safety becomes a concern. Nurses unfamiliar with even where various items are kept or who will be struggling with an unfamiliar Electronic Health Record system won’t be able to provide the same level of care that the staff nurses can provide. Also, if staffing agencies had a hard time recruiting enough L&D nurses, patient ratios may be even worse than normal– a long time sticking point between the nurses union and Allina.

So, what can you do if you’re facing an impending strike and you’re days away from birth?

If you have the option to give birth at a non-Allina hospital with your current maternity care practice, do so. If you don’t have a non-Allina option, speak with your doctor (and since Allina is the only hospital group without a midwife group, it’s probably just a doctor that you have) about how he or she is planning to help keep patients safe during the strike. Will they be spending more time in the hospital while patients are laboring?

And even at this late stage, consider hiring a doula. She can’t provide medical care, but she will be able to be another set of eyes and hands and can help protect your birth, even with replacement nurses. It may be possible to hire a private doula, but I can get families birth doulas my non-profit. Our fees are on a sliding scale, too. You can find more info here.

It was stressful for patients during the last widespread strike, even though that strike only lasted 24 hours. Hospital administrators will always spin things to try to reassure patients, but parents have a right to understand that things won’t be the same.

If you have any specific questions, post them in the comment section!

 

Veronica Jacobsen, BA, CLC, CPST, LCCE, FACCE
Birth Doula, Certified Lactation Counselor, Child Passenger Safety Technician, Lamaze Certified Childbirth Educator, Fellow of the Academy of Certified Childbirth Educators

Opening BabyLove in September of 2011 has allowed me to build a space where all families can come to get good information in a caring, welcoming environment. I have found that not only do I love teaching more than ever, but I also really love running a business. Hopefully my passion for every aspect of BabyLove shines through.
I live in Richfield with my husband, and I am a mother of a two great children. When I can steal a few free moments, I love to go on adventures with my family, cook, garden, thrift, can, and craft.

Do we expect too much from dads at births?

dads birth doulas

This month is International Doula Month, and as such, I’ve been thinking about what I really wanted to say about doulas that I maybe haven’t said before. There have been a few interactions I’ve had lately that really got me thinking, although this is nothing I haven’t thought about before or even mentioned in classes.

We expect FAR too much from dads during birth.

So, here’s the deal:

Back in the day, like 130 years ago or more, when a woman went into labor, the local midwife would come into her home. The mom’s female friends and family would come to help– they would prepare her a birth space,  soothe her, help keep her fed, hydrated, and reassure her. Birth was a normal part of life, something that most woman would be familiar with long before it came time for them to give birth as well.

I’ll say this again: Birth was a normal part of life.

The role of a birth doula is to try to bring into the picture those women who were very experienced when it came to birth. Unless you’ve been around a couple of women as they give birth before, birth is a pretty weird process that no amount of videos can ever prepare you for. So while I’m not saying we should go back to the time when it was considered “improper” for men to witness births, I’m saying that the idea of a partner having to bear the responsibility of caring for emotionally and physically supporting a mom through birth is unfair to everyone– it’s unfair to the partner, it’s unfair to the mother, and it’s unfair to the baby.

We have mounting evidence of dads (there is no info out on same-sex partners) experiencing PTSD as a result of being at the birth of their babies. Even if there aren’t ANY complications, while we should try very hard to prepare partners to be active participants at birth, there’s nothing to really prepare anyone for the twists and turns of birth. Doulas can’t predict how a birth will go, but they are prepared to walk the journey with families, no matter what that ends up looking like. Doulas provide that reassurance to EVERYONE during the process, no matter what, helping reduce trauma.

Doulas aren’t emotionally attached, not do they have to bear the responsibility for the medical care being provided.

Hiring a doula isn’t a value judgment on the state of your relationship; in fact, having a doula can help provide the space and time for those critical moments during labor and birth that can bring couples closer together.

Hiring a doula will not take away from a partner’s role at birth; having a doula present will give him more confidence to be involved in a way that he’s comfortable with.

Hiring a doula means that the laboring mother will have what’s very biologically normal– the care and support of an experienced woman who will stay with her through the whole process.

Hiring a doula isn’t a luxury. Hiring a doula should not be a status symbol. Hiring a doula should not be political. Hiring a birth doula is a logical, critical, SMART choice that can help ensure that no matter what happens at a birth, everyone in the room was able to benefit from the professionalism and reassurance and care that a birth doula provides.

I believe in birth doula care SO MUCH that I have created a non-profit that, in addition to providing mental health services, provides doula care on a free and sliding-fee basis. Families who are interested in doula care through The BabyLove Alliance can come to our Information Nights. Upcoming dates are May 20th, June 24th, and July 29th at 7 PM at BabyLove. Find out more information about our unique program here.

Hire a doula. It’s important.

Veronica Jacobsen, BA, CLC, CPST, LCCE, FACCE
Birth Doula, Certified Lactation Counselor, Child Passenger Safety Technician, Lamaze Certified Childbirth Educator, Fellow of the Academy of Certified Childbirth Educators

Opening BabyLove in September of 2011 has allowed me to build a space where all families can come to get good information in a caring, welcoming environment. I have found that not only do I love teaching more than ever, but I also really love running a business. Hopefully my passion for every aspect of BabyLove shines through.
I live in Richfield with my husband, and I am a mother of a two great children. When I can steal a few free moments, I love to go on adventures with my family, cook, garden, thrift, can, and craft.

Medical Bill Basics: Explained

medical bill explained

Ever since Vox.com put out a video on how hard it is to determine the cost of birth, I’ve found myself wanting to put my head on my desk numerous times per day. If you haven’t seen it yet, check it out:

Some people have pointed out that there are tools to help figure out how much a birth will cost, though it’s usually on a per state basis. Late last year, you may remember that I did a couple of extensive blog posts where I took a few hours to pull together the information for Twin Cities costs for births depending on the mode of delivery and the health of the baby.

The problem with that, though? It doesn’t even to start to take into account one tricky little layer: Each health insurer has different contractual allowances that ultimately determines how much you pay.

So, let me explain it this way:

  • Louise has a procedure done. The provider bills her insurance $175 for it.
  • Louise’s insurance has pre-set a rate of $90.47 for the maximum allowable fee arrangement for that specific procedure.

A few ways this could play out:

  1. Louise has yet to meet her deductible, so she has to pay $90.47 out of pocket to the provider for it.
  2. Louise HAS met her deductible, but she has to pay a co-pay amount. In this example, let’s say she has a $40 co-pay. She would pay the $40 to the provider, and the insurer would reimburse the provider $50.47.
  3. Louise’s insurance has a 30/70 split on all billed costs. Louise then pays $27.14 to the provider for the procedure, and the insurer would reimburse the provider for $63.33.

And this can go on and on and on in various permutations depending on all of the possible plan set ups. A different insurer could set that maximum allowable fee at a paltry $30.17. (Good for their shareholders, totally awful for the providers.) Can you see how it would start to be totally impossible to actually get an idea of what birth would cost?

Keep in mind, too, that everything done during birth can be turned into a billed procedure. There’s no way to anticipate what that might look like, because some hospitals will even bill you a couple buck PER TYLENOL.

This situation is  really, really, complex and has a lot of nuance I don’t think anyone has tried to explain too hard. I’ve even tried my best to explain what the process of “taking insurance” looks like from the provider side, and that doesn’t even begin to scratch the surface of how awful and infuriating it is.

All this is to say that, yes, it is really complex. I have my own opinions of how US Health Care could be made less expensive and safer, but I also know it’s not as easy to unravel as anyone who talks about it thinks it should be.

 

Have I missed anything? Are you a health care smarty with something to add?

Warmly,

Veronica

 

Veronica Jacobsen, BA, CLC, CPST, LCCE, FACCE
Birth Doula, Certified Lactation Counselor, Child Passenger Safety Technician, Lamaze Certified Childbirth Educator, Fellow of the Academy of Certified Childbirth Educators

Opening BabyLove in September of 2011 has allowed me to build a space where all families can come to get good information in a caring, welcoming environment. I have found that not only do I love teaching more than ever, but I also really love running a business. Hopefully my passion for every aspect of BabyLove shines through.
I live in Richfield with my husband, and I am a mother of a two great children. When I can steal a few free moments, I love to go on adventures with my family, cook, garden, thrift, can, and craft.

The Problem* with Breastfeeding

Problem with breastfeeding

When I meet people for the first time and tell them that I’m a doula, Lamaze educator, lactation counselor, and car seat technician, it’s interesting how they react. Some people respond by telling me all sorts of things. I end up being told birth stories, completely unprompted, or they tell me about a friend who is also a doula, or they tell me what their breastfeeding journey was like. Sometimes, there’s an air of defensiveness to their confessions. And I get it– I really do. Breastfeeding isn’t the most cut and dry thing to wrap our arms around.

1) We have no good way to tell how much milk a mom is making- If a mom pumps milk, we assume that the pump, which is this expensive machine that’s supposed to be really good at getting milk out of human mammals, is going to do so efficiently and is a good way to determine if a mom has supply issues or not. Yeah, that’s not the case. Not everyone responds well to pumping, especially in the first week or so, and if you use pumping to see if a mom is making enough milk, there’s a good chance that her pumping output is going to be disappointingly low. Ignorant providers use this as proof that a mom’s body is broken and can’t produce enough milk. Oh, and by the way….those pumps are having major quality issues and breaking all the time.

2) Since there’s no gauge on the side of the breast, we have to guess how much milk a baby is taking in- There’s an elaborate method of weighing a baby before and after a feeding to estimate how many ounces of milk a baby took in, but that’s still not bullet proof. It’s not an uncommon impulse to have so little confidence in the breastfeeding process that providers will make mothers bottle feed babies just to verify input. Even when bottle feeding pumped human milk, the message is strong–you can’t be trusted, your body can’t be trusted, and only the bottle can be trusted.

3) The nutritional content isn’t static, so it’s really hard to know what the caloric content is- The more we understand breastfeeding and the production of breast milk, it’s become startlingly clear that the milk a mom makes for her baby changes hour by hour, day by day, month by month. It changes depending on which child you’re feeding. If you have a preemie, we’ve just realized your milk is really a lot more calorically dense than we ever thought. We do know that on average, breast milk is a lot more calorically dense than formula, so it does take a higher volume of formula to approach the nutritional needs of a baby. At least, though, health care providers know exactly what is in it, unlike breastmilk, which changes if baby is getting sick, or needs more calories, or based on the time of the day.

4) It’s really hard to trust that you’re breastfeeding the baby as much as you say you are- When we talk about breastfeeding, we tell moms to watch for cues. We call them hunger cues, but babies also cue out of thirst. News flash– babies are human and get thirsty, even when they aren’t hungry. Expecting a baby to get hungry and thirsty on a set, quantifiable schedule is about as crazy as expecting you to only be thirsty every 3 hours. So with breastfeeding, every time you sit down to nurse baby can be different in length and frequency, which is maddeningly hard to plan out and account for.

5) Only a few people are qualified to help you- Breastfeeding has a learning curve. It’s not easy for most moms and babies at first, but if they can make it past the 2-3 week mark, it usually gets much easier. However, getting past that hump can be really, really %@$*!#* hard. If you had a baby 100 or 200 years ago, by the time you had your own kids you would have watched lots and lots of babies be breastfed, and most women knew enough about breastfeeding that they could help each other. Now, we not only have so few people (including medical professionals) that are appropriately and accurately trained to help with breastfeeding, but we wall them off and only make them available during banking hours. It can take a lot of dedication, perseverance, and tenacity to get through the early breastfeeding struggles, but there’s a huge role that luck plays. If you find the right lactation specialist, you’re good. If you have a bunch of lactation specialists who don’t really care…you’re probably screwed.

6) Your mom didn’t breastfeed, and her mom didn’t either- Breastfeeding rates have risen since the 1950s, when only about 5% of moms ever breastfed their babies, but the 6 week breastfeeding rates in the US are still pretty low. Initiation rates are high, but almost 70% of moms give up breastfeeding before they initially planned to. There are a lot of moms out there who had bad breastfeeding experiences. This makes breastfeeding seem impossible; more tragically, it can unintentionally undermine a mom’s desires for feeding if she’s hearing from others that it’s just not important. And this one is the trickiest thing about breastfeeding. We know there’s a sociological component to breastfeeding. The barriers aren’t just biological. The biological barriers can be real, but we still struggle to have good, healthy conversations about breastfeeding within the larger construct of motherhood.

As is the case with most medicine, we’re realizing more an more that there’s a whole hell of a lot of nuance with breastfeeding that we have to get used to. Pumping and bottle feeding human milk can seem like a good solution, but most people who suggest it completely ignore how draining the process of pumping for every feeding or after every feeding becomes. They suggest pumping and make it seem that it’s as easy as brushing your teeth. Constant pumping sucks. I don’t have anything super simple to offer as a solution to any of these things, other than education. Humans are mammals. We are mammals with young that need fed. Rather than think that the process is broken, I’d posit that breastfeeding usually works– but we are the ones who are making it not work with our bad information, lack of trust, and unrealistic expectations.

*I decided to couch it in these terms. It’s kind of tongue in cheek.

Veronica Jacobsen, BA, CLC, CPST, LCCE, FACCE
Birth Doula, Certified Lactation Counselor, Child Passenger Safety Technician, Lamaze Certified Childbirth Educator, Fellow of the Academy of Certified Childbirth Educators

Opening BabyLove in September of 2011 has allowed me to build a space where all families can come to get good information in a caring, welcoming environment. I have found that not only do I love teaching more than ever, but I also really love running a business. Hopefully my passion for every aspect of BabyLove shines through.
I live in Richfield with my husband, and I am a mother of a two great children. When I can steal a few free moments, I love to go on adventures with my family, cook, garden, thrift, can, and craft.

Can you have a natural birth and use Nitrous Oxide?

Nitrous Oxide Twin Cities

I’ve had this blog post tumbling through my head most of the week, and so it needs to be written so my brain can start processing other things…like different blog posts.

So, I don’t know if you know this, but we’re really lucky to have some of the things we do in the Twin Cities. Within the next week or so, almost all of the the hospitals in the area will have nitrous oxide as an option (Although it looks like the wait will be a number of months for St. John’s and Woodwinds), and I’m pretty certain that all of the birth centers have it available. Do you know how rare that is in the US? I know it’s popped up a couple of other places, but not in the widespread availability we have here. Ever since it first showed up as an option, I’ve been including it in our discussions of pain medication and interventions in classes, discussing the pros and cons. It is a medication, after all. But…..

Philosophically to ME anyway, using nitrous just doesn’t seem to be on the same plane as narcotics or epidurals. It doesn’t have any meaningful long term effects on mom or baby within a minute or two of not using the nitrous. It doesn’t involve restrictions on labor beyond the mom having to be the only one touching the mask and she must administer it herself. And the analgesic effects are only felt with active use, meaning a mom must actively breathe it in. The risks are low, the benefits are high, a mom can use it off and on throughout her labor as needed. It doesn’t work for everyone, though, and not everyone likes it.

You know what it reminds me of? Hydrotherapy, i.e. soaking in a tub or using a shower. The ease of use is about the same, the risks are low for both, you’ll still find providers actively against the practice. (ha!)

What worries me is that, as more people use nitrous for their labors and births, that this option– which was first embraced locally by birth center midwives– becomes another thing for “natural birth” proponents to place into the “bad” category. First of all, I’m not sure on any given day what people are labeling as “natural” (vaginal?), but the process of making decisions for birth isn’t a binary one. Things aren’t either good or bad. Pitocin isn’t inherently bad. Epidurals aren’t inherently bad. You can’t make decisions about birth that way. Birth and the process of making decisions IS a continuum. It’s always best to start from the place of the normal biological process of birth and then build in an understanding of where interventions, including pain management options, fall on that line. However, I’m concerned that parents aren’t choosing to take birth classes that help them understand the full scope and use, opting instead to take classes with little to no actual content, but endorsed by the hospital, or to take a class that does lean heavily on labeling certain interventions “bad”.

Using nitrous oxide is on one end of the pain management spectrum. Epidurals are on the other end. Both totally have their place in this world. As nitrous becomes an option everywhere and more families are informed about their pain management options, I’ll be interested to see how it ends up being labeled in the good/bad universe of birth options. For now, I’m going to very loudly and very firmly hold it as an option that may work for some people, that is fast acting, and has very few side effects when used properly…just like hydrotherapy.

That’s what I have for today. Thanks for listening.

Warmly,

Veronica

Veronica Jacobsen, BA, CLC, CPST, LCCE, FACCE
Birth Doula, Certified Lactation Counselor, Child Passenger Safety Technician, Lamaze Certified Childbirth Educator, Fellow of the Academy of Certified Childbirth Educators

Opening BabyLove in September of 2011 has allowed me to build a space where all families can come to get good information in a caring, welcoming environment. I have found that not only do I love teaching more than ever, but I also really love running a business. Hopefully my passion for every aspect of BabyLove shines through.
I live in Richfield with my husband, and I am a mother of a two great children. When I can steal a few free moments, I love to go on adventures with my family, cook, garden, thrift, can, and craft.

2015 Twin Cities Medical Group Primary Cesarean Rates

I’m a big nerd when it comes to birth data. Maybe you’ve noticed. So when new information becomes available, it’s like Christmas to me. Yesterday, I figured out that MN Community Measurement had finally released their 2015 Health Care Quality Report. For the second year in a row, they reported Primary Cesarean rates by Medical Group.

So, some good news. The State’s rate of primary cesarean dropped from 22.2% to 21.9%. After a decade of rapid increases in cesarean rates, this is just another measure that shows we’re going in the right direction. Whee!

OK, time for the real stuff. From highest rates to lowest, here’s what the report has for Medical Groups. For comparison, I put the rate from 2014’s report in parentheses.

  1. Allina Health Specialties- 34.7% (27.9%)
  2. Comprehensive Healthcare for Women- 33.0% (30.5%)
  3. Western OBGYN- 29.2% (26.1%)
  4. OBGYN West-27.9% (24.1%)
  5. Women’s Health Consultants- 27.0% (24.9%)
  6. Metropolitan OBGYN- 26.0% (29.5%)
  7. Partners OBGYN- 25.2% (27%)
  8. Clinic Sofia- 25.1% (25.1%)
  9.  Obestetrics and Gynecology Associates- 24.8% (21.9%)
  10. Hennepin County Medical Center Clinics -24.7% (19.1%)
  11. Fairview Health Services- 23.5% (24.8%)
  12. Adefris and Toppin Women’s Specialists- 21.9% (27%)
  13. Healthpartners Clinics- 21.7% (n/a)
  14. Allina Health Clinics- 21.6% (25.8%)
  15. Southdale OBGyn Consultants- 21.5% (21.6%)
  16. Park Nicollet Health Services- 20.1% (19.2%)
  17. North Clinic- 19.6% (24.4%)
  18. Multicare Associates- 19.3% (29.5%)
  19. U of M Physicians-18.4% (17.3%)
  20. Oakdale OBGYN- 16.3% (18.7%)
  21. John A Haugen Associates- 16.2% (21.2%)
  22. Hudson Physicians- Minnesota Healthcare Network- 14.9% (11.8%)
  23. AALFA Family Clinic- 4.7% (13.0%)

You can read the full report for 2015 here.

Coming up in the next post, I’ll share my thoughts on some of these numbers. In the meantime, enjoy!

Warmly,

Veronica

Veronica Jacobsen, BA, CLC, CPST, LCCE, FACCE
Birth Doula, Certified Lactation Counselor, Child Passenger Safety Technician, Lamaze Certified Childbirth Educator, Fellow of the Academy of Certified Childbirth Educators

Opening BabyLove in September of 2011 has allowed me to build a space where all families can come to get good information in a caring, welcoming environment. I have found that not only do I love teaching more than ever, but I also really love running a business. Hopefully my passion for every aspect of BabyLove shines through.
I live in Richfield with my husband, and I am a mother of a two great children. When I can steal a few free moments, I love to go on adventures with my family, cook, garden, thrift, can, and craft.

Is there a problem with doula care?

Last week Choices in Childbirth released a report on doula care and insurance coverage. As someone who is deeply interested in the subject (and very opinionated on the specific barriers and possible solutions), I found it very interesting and even useful. Unsurprisingly, the report also became fodder for an anti-doula option piece. On Slate, Elissa Strauss wrote the very click-baity titled piece “More Doulas Can Lower the Cost of Childbirth. There’s Just One Problem.” My mom actually ended up sending my the link, asking me if I could believe what she wrote. I read it. I yawned a little. It was nothing I hadn’t heard before, but I think it’s still a good idea to address her article point by point.

Point #1:  Doulas aren’t regulated or licensed

Yep, this is totally true, and realistically, it is creating a major issue in many ways. In fact, Strauss writes,

Anyone can call themselves a doula without any training, certification, or practice. I could declare myself a doula right now. So could you.

Some doula trainers that I totally respect and admire have pointed out the number of certifying organizations has increased exponentially in the last couple of years. Every program is a little different, some requiring more documentation than others, some having in-person trainings while others are mostly done online. Not every organization promotes certification, either. Certification can protect families by knowing that, absent any other regulations, the doula can be sanctioned by her certifying organization. I am a birth doula who was trained to be a doula in November of 2006 and have been certified through DONA International since August 2007. Currently, no doula organization is accredited, either; however, Lamaze International IS an accredited childbirth education program.

I have more opinions about this specific subject than can fit in this post, but parents can still find doulas who are held responsible in some way, shape or form. Which brings me to her next point:

Point #2: Some doulas resent certain protocols

OK, so this is a really sweeping generalization, and I’m not sure if it makes for a good argument about why doulas are in of themselves bad. However, yes, my experience in the last 9 years is that there are doulas who can push the limits of what a non-licensed professional can and should do. However, in the absence of a standardized Scope of Practice (I follow the scope and standard of practice as set forth by each certifying organization depending on which hat I’m wearing), it’s up to the hiring party to figure out what that needs to look like.

Point #3: They are biased!

This is a tricky as heck little paragraph. Strauss states,

With standardization, women, as well as insurers, could feel confident that the doula they hired would be providing them with sound advice. This means providing information that is accurate as well as unbiased. Doulas currently have a reputation as being advocates for intervention-free childbirth; for many of them, having an epidural is a sign of personal weakness and/or capitulation to the medical industry and maybe just a big, fat failure. (Note how the report mentioned above doesn’t distinguish between C-sections and epidurals in terms of their potential value to mothers.) There are some good—if often overstated—reasons to avoid epidurals, but there are also manygoodreasons to get one. It would be unfair to women to populate our labor and delivery units with doulas who insist that childbirth will not hurt too much if the mother just remains calm and breathes.

First of all, as I’ve stated before here, too often the discussion of pros and cons is labeled as being biased. As far as I know, at no point was the CiC report meant to be a comprehensive report on the use or overuse of maternity care interventions. If Strauss needs to be enlightened on evidenced based maternity practice, I’d suggest she start by looking at the groundbreaking Obstetric Care Consensus “Safe Prevention of the Primary Cesarean Delivery” released by AGOC and SMFM. Maternity care in the US needs to be be improved in all metrics, including cost.

Second, all humans are biased. All professionals are biased. However, some are better at recognizing their biases and at removing those biases from their day to day professional interactions. As a doula, I would never, ever talk a mom out of an epidural. Now, that’s different than telling a mom who has a baby’s head halfway out that the epidural might take longer than the one push needed to finish giving birth. No care providers, be they doulas, nurses, midwives, or doctors, should ever, ever, EVER disrespect or manipulate patients. Period.

Point #4: I didn’t have one

Whenever I read or hear discussions about public health policy, it’s really silly to bring any one person’s experience into the larger discussion. Really, it’s not how anything scientific ever gets done. Since Strauss didn’t have one, it’s a great reason to ignore a really well-done report, I guess. Or it’s not. Let’s go with this being a bad reason to ignore the report, ok?

Overall, the piece points out nothing that those of us who are working on doula care access don’t already know, namely that we have a lot of work to do on standardization and definitions before we can even talk about reimbursement. And on it’s face value, it’s possible that Strauss could have written a more thoughtful piece on the other issues that exist in doula care being covered health services. Instead, it comes across as a piece to justify her own rejection of doula care under the guise of commenting on the Choices in Childbirth/ Childbirth Connection report.

Interestingly enough, the use of doulas to improve a medicalized life experience have popped up in conversation about health care on the other side of the life continuum: Death. PBS’s Next Avenue brought up the topic this week. My ideal solution to gain access to doula care as a covered service recognizes that there is a need for emotional and physical support for patients in many different health care scenarios. A proper doula serves as a conduit, a guide, a translator, and a constant companion who is wholly invested in the emotional support of the patient and his or her family. Doulas fill the gaps.

My post is by no means meant to be a comprehensive discussion on the state or future of doula care. I do have very practical, actionable ideas on insurance coverage of doula services that I’d be happy to talk about with people in person. But just because a writer on the XX Blog thinks doulas are terrible, it’s no reason you should too.

Speaking of doulas, the non-profit I run, The BabyLove Alliance, Ltd, offers doula services on a sliding scale. Our very first Doula Information night is coming up on January 29th at 7pm at BabyLove at 4590 Scott Trail, Suite 102, Eagan, MN. Come meet our doulas (who aren’t pushy, btw), find out what makes our doula services more complete than anywhere else, and ask any questions you have about having a doula at the birth of your baby. Email info@thebabylovealliance.org or call Veronica at 651-200-3343 for more information. Spread the word!

Veronica Jacobsen, BA, CLC, CPST, LCCE, FACCE
Birth Doula, Certified Lactation Counselor, Child Passenger Safety Technician, Lamaze Certified Childbirth Educator, Fellow of the Academy of Certified Childbirth Educators

Opening BabyLove in September of 2011 has allowed me to build a space where all families can come to get good information in a caring, welcoming environment. I have found that not only do I love teaching more than ever, but I also really love running a business. Hopefully my passion for every aspect of BabyLove shines through.
I live in Richfield with my husband, and I am a mother of a two great children. When I can steal a few free moments, I love to go on adventures with my family, cook, garden, thrift, can, and craft.

One thing about using nitrous oxide during labor

I’ve long thought that dental work has parallels to obstetrics in that finding a good doctor (or midwife? What would a tooth midwife be?) in either category can mean the difference between being OK with your regular appointments or being intensely fearful of going in to have anything checked out. My mouth is what I jokingly call a “million dollar mouth” insofar as it’ll eventually cost me a million dollars to fix all of the issues with my teeth. The last 2 months I’ve had ongoing tooth pain with my top molar– first, a chipped filling that resulted in a crown prep, a CAT scan that revealed the root canal that was done 2 years ago wasn’t done correctly, TWO root canals to try to clear up a massive infection that was raging in the neglected canal, and all of that culminated in having the damn tooth pulled last Friday. Seriously. All that work and the stupid thing was fractured and couldn’t be saved.

While spending hours and hours in the dentists’ chairs, I’ve written a version of this blog post over and over in my head–the problem being that I was under the influence of nitrous oxide, so when I came to me senses, the brilliant blog posts left my head. HOWEVER….I did have a MAJOR ah-ha moment on Friday that I needed to share.

See, as more and more hospitals and birth centers add nitrous oxide as a pain management option, there’s one thing that may be obvious about using it, but it may not be very obvious to everyone. Nitrous oxide requires active participation by the user in order for it to work; epidurals and analgesics work systemically without the user actively doing anything to feel an effect.

Bottom line? If you’re using nitrous for labor pain and anxiety management, you gotta breathe it in. The best results happen when you focus all of your attention on breathing in the “gas and air” mixture. If you don’t breathe it in, you’re not going to feel anything significant.

You see, when they were getting ready for the extraction, I really wasn’t feeling the effects of the NO2; it turns out, I wasn’t really breathing much because I was so nervous. After the nurse pointed out I needed to focus on my breath, it look less than 30 seconds of deep breathing to feel the wave of relaxation rush over me.

I needed to breathe.

So I do know that the mixture of nitrous to oxygen used during labor is different, and unlike the cannula (see the first picture) used by dentist offices, moms self-administer the nitrous oxide via a mask (see the second picture) or a mouthpiece (an example is shown in the third picture), but my point still holds: If you’re going to give nitrous oxide a whirl, you’ve gotta actually breathe it in, or it won’t work.

Breathe on, people!

Warmly,

Veronica

What do you think about this? Have you tried “gas and air” during your labor and birth?  Is it something you want to use? 

Veronica Jacobsen, BA, CLC, CPST, LCCE, FACCE
Birth Doula, Certified Lactation Counselor, Child Passenger Safety Technician, Lamaze Certified Childbirth Educator, Fellow of the Academy of Certified Childbirth Educators

Opening BabyLove in September of 2011 has allowed me to build a space where all families can come to get good information in a caring, welcoming environment. I have found that not only do I love teaching more than ever, but I also really love running a business. Hopefully my passion for every aspect of BabyLove shines through.
I live in Richfield with my husband, and I am a mother of a two great children. When I can steal a few free moments, I love to go on adventures with my family, cook, garden, thrift, can, and craft.

Twin Cities Hospital Baby Costs

Twin Cities Baby Costs

In case you missed it, last week I published a blog post that compiled the costs listed on the Minnesota Hospital Price Check website. Like I said then, there are some limitations on the information; those numbers don’t reflect variations in deductibles, co-pays, and co-insurance. Also, I used the “Average Cost”, which takes into account that various hospitals and various conditions have longer or shorter average lengths of stays. However, it’s a number that makes for some useful comparisons.

One thing I wanted to mention: If you’ve been following this blog over the last 4 years, you’ll know that I think this data is exceptionally important to help parents pull together the information that they need to make decisions about safe births. Giving birth is the one “medical” life event that usually allows people enough time to plan and ask questions in preparation for finding good care. Where you go and who your care provider is is THE biggest factor in determining outcome. Not mom’s health. Not baby’s health. And certainly, hospitals are businesses (although non-profits), so following the money is really important.

I love to have in-depth discussions about these things in my childbirth classes, and I love to help families who are unsure about their options or the choices they made ask the questions they need to ask to find the best care for their family. It’s a huge part of Lamaze education, and it’s something I think every parent can benefit from.

Back to today’s chart. Most births involve healthy newborns, but there are times when complications arise for baby. For this reason, I included 6 total diagnosis codes in the chart. Some hospitals, due to lack of appropriate facilities to care for sicker babies, won’t have data listed; they transfer those babies to hospitals with NICUs. Also, in the “Prematurity with Major Problems” and the “Extreme immaturity or respiratory distress syndrome, neonate” categories, you’ll notice some hospitals have very low costs listed compared to other hospitals. Those “cheaper” hospitals had very few babies in 2014 with those diagnosis codes, usually less than 10. Those are outliers that can mostly be ignored. And certainly, this doesn’t capture all the intricacies, so I urge anyone who really wants to know more to look at the data on his or her own, or leave comments below.

Baby Hospital Costs

If you think this is valuable, please check out everything I offer at BabyLove and come see me!

Warmly,

Veronica

Veronica Jacobsen, BA, CLC, CPST, LCCE, FACCE
Birth Doula, Certified Lactation Counselor, Child Passenger Safety Technician, Lamaze Certified Childbirth Educator, Fellow of the Academy of Certified Childbirth Educators

Opening BabyLove in September of 2011 has allowed me to build a space where all families can come to get good information in a caring, welcoming environment. I have found that not only do I love teaching more than ever, but I also really love running a business. Hopefully my passion for every aspect of BabyLove shines through.
I live in Richfield with my husband, and I am a mother of a two great children. When I can steal a few free moments, I love to go on adventures with my family, cook, garden, thrift, can, and craft.