Breastfeeding - A Good Way to Get Fired?

It has been a win some/lose some week for breastfeeding moms who work.

The California Fair Employment and Housing Commission ruled (CFEHC) that a woman cannot be fired for breastfeeding during break time. Marina Chavez, a cashier at Acosta Tacos in Los Angeles, was fired from her job when her manager discovered she had been using her breaks to breastfeed her premature baby. When manager Jaime Acosta discovered that Chavez's boyfriend had been bringing the 4-week-old baby to the restaurant so Chavez could nurse the child in the car, Acosta told her she could not come back to work until she stopped nursing her baby. When she stated that she could not wait that long to return to work because the family needed the money, Acosta fired her. The CFEHC ruled that breastfeeding on one's own time (as the break is considered to be) is protected under California law. Acosta Tacos was ordered to pay Chavez $41k and pay a fine to the state of $5k.

At least one state got it right. Unfortunately, it would seem that another state got it wrong.

The Ohio Supreme Court ruled that the Totes/Isotoner Corporation was lawful in firing LaNisa Allen from her job for taking unauthorized breaks in order to pump milk. According to Ms. Allen, she was told she could pump during her lunch break, more than 5 hours after last nursing her then 4-month old son. When she waited the 5 hours, she found that her breasts would hurt and she would leak milk. After noticing that other workers took unauthorized breaks to use the restroom and have a cigarette, she began taking a break at 10am in order to pump. When her supervisors discovered this, they fired her for taking unauthorized breaks. Ms. Allen filed suit, claiming she had been discriminated against. The Ohio Supreme Court disagreed.

Really, how is this anything but discrimination? Many lactating woman cannot just "hold it" for 5+ hours without suffering from pain and engorgement, at the very least. Not allowing an engorged woman to empty her breasts can lead to blocked ducts and mastitis, a serious breast infection. Would the Ohio court have ruled it was ok for the Totes/Isotoner corporation to fire someone with diabetes if they took "unauthorized breaks" to check their blood sugar and take insulin? Or how about if they fired someone with bladder issues who had to use the restroom more often than once every 5 hours? As it is, according to Ms. Allen, co-workers took unauthorized breaks to smoke and use the bathroom - why was she singled out and what was lawful about that?

To make things even worse, Totes/Isotoner touts their Comfort for a Cure Campaign to raise money for the breast cancer research. Yep, the very same body part that produces breastmilk. By the way, did you know that breastfeeding has been found to reduce the risk of developing breast cancer? So it would seem that Totes/Isotoner only cares about finding a cure, but not supporting the prevention of breast cancer.

Yeah. You can send those emails to customeraffairs@totes.com.

Protecting the United States

Having been subjected to the abject cheesiness and mind-blowing silliness of Indian mainstream cinema while growing up, there is a part of me that understands why Homeland Security might see Bollywood as a threat. But, come on, did they really have to detain Bollywood icon and superstar Shah Rukh Khan at Newark airport for "secondary questioning" for two hours? I mean, was he threatening to start a non-sequitur, perfectly choreographed and lip-synced dance sequence or something?

According to Khan, his only possible crime was having the last name "Khan." I guess having the name Khan might be construed as sign of a possible threat, you know, if you were Captain Kirk or something. But guys, this is Shah Rukh Khan! All Homeland Security had to do was google the man's name to know who he is and what he looks like. Hell, they could have just gone out and asked some of the cab drivers waiting outside the airport to ID the man!

I'm not saying that an actor - any actor - is above the law or rules and regulations. However, it is a little scary when the Department of Homeland Security's information gathering is so poor that they can't correctly identify the biggest actor in India - especially in less than two hours.

Epic fail guys.

Back on the Grid

Like a lot of women who opt for a homebirth, I did not choose to let my mainstream ob/gyn provider know that I was leaving that practice for the rest of the pregnancy and the birth, instead opting to "go off the grid" quietly by not scheduling another appointment. My last prenatal appointment with the practice was at 18 weeks. As such, I expected to get some questions when I showed back up at the practice last week with a two-week old baby and case of mastitis. However, I must say, I was a little surprised at some of the questions I got.

The nurse in the office was a little surprised to learn that we had delivered our son at home without assistance. But what seemed to really surprise her was the fact that the homebirth midwife sewed up the 2nd degree tear that I had; her facial expression and tone of voice suggested that she wasn't aware that direct-entry midwives knew how to do such things. The doctor who examined me also had some questions, such as whether I had received any prenatal care from the midwives (um, yes - I received excellent prenatal care from the midwife, as a matter of fact) and whether I was receiving any postpartum care from the midwife (again, yes).

What was interesting, to me at least, was that prior to leaving the practice and opting for a homebirth, the subject of having a homebirth came up during one of my visits, and the care provider railed against the idea, calling it "dangerous." And yet, from the questions I was being asked following my successful homebirth, it was obvious that at least two providers in the practice had little understanding of what homebirth actually entailed or what the training of the homebirth midwife might have involved. It makes you wonder - how can you argue against something if you honestly know nothing about it?

A Homebirth Story

I've talked about planning a homebirth in previous posts, so I thought it was only fair to share the story of how the homebirth went. The following is my homebirth story:

D was born at 7:20am on Saturday, July 18, 2009. He weighed 8lbs, 9oz and measured a healthy 21.25in in length. D managed to make his entrance into the world in approximately 39 minutes from the first contraction. The story probably begins the day before, on Friday. Scott, my husband, IM’ed me from work to ask, hypothetically, what we would do if the midwife and her assistants were unable to make to our house in time for our planned homebirth. Given that our first son was born in under 2.5 hours, it wasn’t an outlandish thought, but I still thought it was silly. In spite of that, I responded that we would let my body do what it needed to do, but I would need him to “support my perineum.” Scott asked what that involved, and in trying to describe it to him, I decided to find an article or two that explained emergency childbirth and send the links to him. In spite of his busy day at work, Scott did, in fact, take the time to read the first article I sent him. This was a good thing, as it turned out. He also said that should he have to deliver the baby, his fee would be a Mesa Boogie amplifier and Paul Reed Smith guitar.

I woke up around 6:41am to use the toilet and as I was getting out of bed, I felt a contraction. As with my first labor, I found that an assisted squat was the most comfortable position to ride out contractions, so I spent the first contraction sitting on the toilet. After it was over, I went back to bed and woke Scott up, telling him that I thought I was in labor. I laid on my side as Scott rubbed my back and timed the next two contractions: 4 minutes apart, 30 seconds to 1 minute in duration, and painful. Definitely time to get up. Scott got dressed and went downstairs to call the midwife. I decided to take advantage of the “early” labor and get into the shirt I planned to birth in. After riding out another contraction, I put in my contacts and brushed my teeth. In retrospect, I should have realized how much faster the labor was proceeding, as I had to stop several times while brushing my teeth in order to stretch and breathe through contractions. There seemed to be very little break between the contractions. I went back to the toilet in the master bath to ride out another set of contractions and Scott came back upstairs. I suggested that he lay down the shower curtains and vinyl tablecloths on the floor in the guest room, where we had planned on having the birth, as well as put the waterproof sheet on the bed in there. At that time, I noticed I was starting to bleed, a sure sign of transition. Scott suggested I go into the guest room, but I said I would rather go into the other upstairs bathroom (across the hall from the guest room) because I would be more comfortable using the toilet to squat on. At this point, there was no break between the contractions. I walked to the other bathroom, groaning and breathing deeply the whole way. When I was in labor with older son, I had screamed during contractions until the midwife, at the hospital, suggested groaning deeply; the change in vocalization actually helped a great degree, and I remembered this when I was in labor with D. I labored in the hall bathroom for probably around 5 minutes as Scott and my mother got the guest room ready. At that point, I felt the urge to use the toilet; only thing was, when I pushed, I distinctly felt the sensation of a head descending. At first, I thought I was mistaken. Then I felt the urge again and started pushing and realized, no, in fact, that was a head descending. I told Scott the baby was coming. He came into the bathroom and asked me what I meant. I stood up, half bent over on the toilet, using the seat to support myself, and reached down and felt between my legs – and felt the top of D's head, still in the placenta. “I can feel his head,” I said. Scott began to panic a little and told me to move to the bedroom, and I told him no, I was not moving. I felt the urge to push again and felt my water break. Scott insisted, again, that we move to the bedroom, and I told him, no. “Catch the body,” I told him as I pushed a fourth time and caught the head. Scott, somewhat awkwardly, managed to pick my leg up above the toilet seat and get his hands beneath me to catch the body. I vaguely recall him saying “Oh my god” several times. I backed up a little and we maneuvered D out of the toilet so that I could hold him to my body to warm him up; little D looked quite stunned, but began to cry almost immediately. My mom looked down at her watch and noted it was 7:20. Scott directed my mother to get some towels from the guest room, and D proceeded to pee on me. As the towels were brought to us, I started to feel the urge to push out the placenta. Not wanting to have to dig it out of the toilet, I told Scott to take D so I could catch the placenta. He took D and I delivered the placenta. It was bit surreal: I was sitting/squatting over the toilet, holding my placenta with both hands, as I watched my husband warm our newborn son up in a blue bath towel. After a few minutes, I realized I should try breastfeeding and order to keep myself from hemorrhaging, and asked my mom to get the plastic bin to put the placenta in. She did, and I sat down on the toilet and attempted to nurse D, but found it difficult given the position. Scott asked my mom to help me to the bed, while he used a bulb syringe to clean out D’s mouth and nose. I felt woozy as my mom helped me to the bed and felt grateful to lie down; the midwife estimated, afterwards, that I had lost double the normal amount of blood giving birth, so it was no surprise that I was feeling light-headed. As Scott was bringing D to me, I heard his big brother singing to himself in his bedroom – he had slept through the entire thing. I attempted to nurse D while lying on my side on the bed, but found it quite difficult considering he was still attached to the placenta, which was lying in the plastic bin on the bed. Scott called the midwife, who was on her way, to let her know that he just delivered a baby and we were anxiously waiting for them. About 20 minutes after D was born, Bethany, the midwife assistant/apprentice who lived closest to us, arrived. She clamped D's cord and had Scott cut it. Then Meliea, another assistant/apprentice arrived. They got D cleaned up, weighed him, and helped me to nurse him as we waited for Amy, the midwife to arrive. Once Amy arrived, they examined D. My mom went and got my older son ready, and he got to meet his new baby brother; he was less than impressed and wanted to go downstairs and watch cartoons. My mom and older son went downstairs, Scott following shortly after with D, as Amy, Bethany, and Meliea tended to me, cleaned up the bathroom, and documented all the details. Once I was all taken care of, Scott brought little D back and I spent some time falling in love with my new baby boy.

It was not the ideal delivery, but it did go rather smoothly. It was an amazing, surreal experience, and I so glad we knew what to do and planned for a homebirth – better than the likely alternative of giving birth in the car on the side of the road! Only problem is, now, in addition to the midwife’s fee, I also have Scott’s fee for catching D!

The Man in the Mirror

I've never been a huge Michael Jackson fan. Sure, I've enjoyed his music, but I never bought one of his albums, never went to a concert of his. And yet, like so many, I was stunned and shocked by his untimely passing at the age of 50.

As a child of the 80s, his music was a part of the soundtrack of my childhood. I remember watching MTV at my friends' houses and marveling at his music videos. I'm sure I recorded a song or two of his off the radio for my mix tape collection. I danced around in my room to his songs. And, like every one else, I was increasingly disturbed by his transformation from a handsome young black man to an ethnically ambiguous caricature of a human figure. The lightened skin, the continued plastic surgery - it was all so bizarre. And as a child and then as a teenager, it made no sense. As an adult, however, it became clear that what we, the public, were seeing on the outside was a representation of the pain and disfigurement on the inside. Stories emerged from interviews with Michael himself, as well as family members and those who knew him, about physical and emotional abuse at the hands of his father, Joe. His immense talent - the very key to his fame and fortune - seemed to be the trigger for his father's driving him like slave to rehearse and perform. Rather than statements of love and approval, young Michael heard insults about his nose and the darkness of his skin. His talent, which brought him the love and admiration of a worldwide audience, only caused his father to push him more, to isolate him more, to abuse him more. And no one stood up to protect Michael. Is it any surprise that he became a man who could not survive as an adult? Is it any surprise that he became a man who could not see the beauty in himself and instead subjected himself to countless cosmetic procedures in order to achieve "perfection?" That little boy who had seemed to have everything, in truth, didn't even have the basic thing most children have: the love, acceptance, and protection of a parent.

That is the tragedy of Michael Jackson's life. His greatest gift was the reason for his downfall. And what is so tragic is that every day, we see that others are not heeding the moral of Michael Jackson's story, that there are still parents who treat their children not as a special gift to protect and nurture, but as a meal ticket to exploit and sell. There are still parents who see their children as a means to an end, and not a joy to cherish for its own rewards.

My favorite Michael Jackson song is "Man in the Mirror." In it, he talks about the need for change to start with each person looking at himself or herself and making a commitment "to make that change" starting with that "man in the mirror." It is so sad that when Michael Jackson looked at the man in the mirror, he saw the distorted image painted for him by his father, and not the one the rest of the world saw. Rest in peace, Michael. I sincerely wish you had found that peace while here on Earth.

Bad Medicine

Oh this ticks me off! The American Medical Association has come out against healthcare reform, primarily because of opposition to a public health care plan. One of the major reasons for that opposition is the contention that "the corresponding surge in public plan participation would likely lead to an explosion in costs that would need to be absorbed by taxpayers."

Right. Because our current system, in which there are 40 million Americans without health insurance, leading to a focus on emergency medicine rather than preventative medicine, is really cost effective.

Or is it that the AMA is worried about the effect of having someone who calls for evidence-based medicine holding the purse strings for medicine? What would happen to billing for the "machines that go ping" if the guys writing the check said they wouldn't pay for them because they do not improve outcome?

Whose health is the AMA more concerned with: the health of the average American, or the health of their members' bank accounts?

RIP Dr. Tiller

It has been several days since the Wichita doctor, George Tiller, was murdered while in his church. And I am still sad over his death. I have debated whether I wanted to blog about him and about abortion, about whether I wanted to enter the fray. And I have come to the decision that one of the best ways to honor Dr. Tiller's memory is to be open about the reasons women went to see him.

Back in February, my husband and I, accompanied by our toddler, went to the ob/gyn's office for what I expected would be our last visit before I transferred care to my homebirth midwife. I was approximately 18.5 weeks pregnant and was going to have the now-routine anatomy scan done. Technically, the scan is done to make sure the fetus is growing correctly, that the pregnancy is proceeding normally. But I would say most women see it as the chance to find out whether they are having a boy or a girl. My husband and I were hoping to learn that we would be having a little girl, though we would also be happy to find out we were having a healthy little boy as well.

The ultrasound technician was cheerful and made jokes with us as she began the scan. She remembered my son from our previous two ultrasounds and was joking with him as she went through the scanning process. My husband and I waited anxiously to find out whether we were having a boy or girl, and the technician quickly told us we were, in fact, having another boy. Lying on the table, I gave my husband a wry grin - another boy. We were in for another exhausting couple of years.

As the scan continued, I noticed that the technician became quiet. She stopped talking to my husband and I. She stopped joking with my son. I remember looking at my husband quizzically several times and noting from his expression that he, too, had noticed the change in her demeanor. After over half an hour, the ultrasound technician told us that a nurse would be in to take us to another room to speak with the doctor, and the technician left without looking at us. Both my husband and I knew something was not right. As we sat in the next room, waiting for the doctor to talk to us, I could hear the technician in the hallway, speaking with the doctor. I heard her say to the doctor, "I've never seen a cyst that big before." I was becoming extremely worried.

The doctor came in soon after and told us what the scan had found: the fetus had what appeared to be two large cysts, known as choroid plexus cysts, on his brain. He also had what appeared to be an enlarged stomach. Individually, these would not be cause for alarm, but since our baby had both, there was concern that the fetus might have a chromosomal abnormality. We would need to see a high-risk obstetrician with a more powerful ultrasound machine in order to determine whether there were more soft signs of abnormality and, based on that, we would need to decide whether to have further testing, such as an amniocentesis. I asked what chromosomal abnormality the fetus might have; the doctor said that choroid plexus cysts tend to be seen in fetuses with Trisomy 18, a condition that is generally not compatible with life. The doctor said that she would call the women's center downtown and make an appointment for us; since we were the last appointment on a Friday afternoon, we would have to wait until Monday to find out when our appointment would be.

I know I held it together until we left the doctor's office. I was sent to the lab to have some blood drawn, and the phlebotomist asked about the pregnancy and whether I knew what I was having. I remember thinking, "I don't know that I'm really having a baby" but actually telling her, in a daze, that it was a boy. Once we left the building and got in the car, I broke down crying. My husband and I sat there, with our son in his carseat, holding each other as I cried. I remember thinking this couldn't be happening. This couldn't be possible.

As soon as we got home, I looked up Trisomy 18. What I read was not heartening. If our baby had Trisomy 18, the chances of him making it to term were slim; 95% die in utero. Those babies with Trisomy 18 who do survive to delivery die within days, if not hours. The median lifespan for Trisomy 18 babies who make it to term is 5 to 15 days. I was heartbroken. Instead of sending out a happy email to friends telling them we were expecting another boy, my husband and I were facing the prospect of losing our child. It was at this point that we began to seriously talk about what we would do if the tests showed the worst case scenario was reality. We talked about abortion.

I spent the weekend reading more about Trisomy 18 and about abortion, between bouts of crying. My husband and I found that neither of us wanted to talk about the baby, it was just too painful to consider what might be, but we both wanted to comfort each other. But both my husband and I were honest with each other: if our baby turned out to have Trisomy 18, we would not carry to term. It was that weekend that I learned about Dr. Tiller and his practice in Kansas. I read the stories his patients had posted on different websites. I read about his compassion for women, for couples, having been dealt a cruel hand by Mother Nature and having to make a difficult decision. Above all, I spent the weekend hoping that I and my husband would not have to make that decision, that everything would be ok, that it was just a false alarm.

For nearly 4 days, I and my husband wrestled with the what-ifs, wrestled with the possibility that we would have to make the difficult decision to end the pregnancy. It was with great relief that I laid in a different ultrasound room on the following Tuesday and learned that the baby showed no other signs of Trisomy 18 or, for that matter, any other chromosomal abnormality. A follow-up ultrasound four weeks later showed the two cysts on the brain had disappeared and the stomach, while still somewhat large, was normal in size. It was going to be ok. The high-risk obstetrician discussed with us the very low likelihood of there being a chromosomal abnormality, given the level-II ultrasound results and the results of my bloodwork; based on that information, we opted not to have an amniocentesis. It was going to be ok.

I am grateful that we did not have to make the decision to terminate the pregnancy - to abort the fetus. But I know that there are other women, other couples, who do not receive happy news at their follow-up appointments, who do not get the sense of relief when their testing results come back. And it is for them that I also mourn. For while the service Dr. Tiller provided, late-term abortion, is not one that all people would like to have exist, it is one that needs to exist. And the health of women in the United States, the options of couples and families facing the realities of a pregnancy gone horribly, horribly wrong, is threatened by the loss of Dr. Tiller.

Rest in Peace Dr. Tiller.