“Doulas are getting paid by people who can afford it. But people who can’t afford it don’t get doulas. We want to make sure that group can get a doula, because their babies are dying, being born too small – and we know that doulas can help. To not support them in getting a doula is unconscionable. Women who are on Medicaid who want a doula should have one. And we should find a way to pay for it.”
–Shafia Monroe, founder of the International Center for Traditional Childbearing (ICTC) in Portland, OR
“The mission of ICTC is to increase the number of Black midwives, doulas, and healers to empower families, in order to reduce infant and maternal mortality.
–From the ICTC Mission Statement
Shafia Monroe is a midwife, community leader and the force behind Oregon’s House Bill 3311. HB3311 was the first legislative step toward reimbursing doulas through Medicaid and highlighted questions of class, access, and health disparities in Oregon. Over 99% of American births take place in hospitals where, despite the aura of safety, US maternal mortality doubled since 1987. “African-American women are nearly four times more likely to die of pregnancy-related complications than white women,” according to Amnesty International and infant mortality in African American communities is twice that of non-Hispanic whites. Shafia Monroe and her allies responded to the crisis with research and community organizing at the state level, and Oregon is taking steps to increase health equity.
The Oregon Health Authority (OHA) issued a report showing disparities in Apgar score, birth weight, cesarean birth, infant mortality and postpartum depression for Pacific Islanders, African Americans and Native Americans. OHA examined existing community-based doula programs – the Farmworker Doula Program, the Connect One Project and The Haven’s Doula Program – which demonstrate the benefit of what ICTC terms “full-circle care”; prenatal, birth and postpartum support. In these programs, doula-supported women were more likely to use prenatal care, had babies with healthier birth weights and breastfed more easily. In its conclusion, OHA wrote, “the Committee recommends doulas as an overall strategy to improve health equity in Oregon’s birth outcomes.”
(ICTC Sistah Care students display signs they made for actions supporting HB3311 at the state capitol in Salem.)
For doulas outside wealthy areas, paying the bills can be more daydream than reality, a fact that spurred Shafia into political action. For years, she trained doulas in African American communities, where babies have the “highest death rate in the nation,” but discovered they couldn’t support themselves. “Every time we turn around,” she said, “they have [day] jobs! They’re not doing the work! We found out that the clients they see are so low income they can’t afford to pay them. And they can’t afford to do it for free.”
Despite the promise of HB3311, questions of access remain. For now, there’s talk of limiting reimbursement to time spent at births, negating the benefits of prenatal and postpartum support outlined by OHA’s report. Also, the initial figure is paltry. A thoughtful article on Science & Sensibility outlines the importance of carefully considering socio-economic implications of compensation: “One…consequence may be that the resulting system will continue to perpetuate a model of economic marginality and potential exploitation for the doulas who serve a low income population of childbearing people.”
“I can count the doulas of color in Oregon,” Shafia told me. “It’s extremely low. So this is another way for women who tend to be underpaid anyway, just sort of based on who they are, this is a way for us to get more doulas, whether they’re Puerto Rican, Hispanic, or Asian. It’s just a way to help other people to consider this as a profession, because otherwise it’s not attractive.”
***
Labor Day, 2013
According to Mahmoud Fathalla, past president of the International Federation of Obstetricians and Gynecologists,“Women are not dying because of untreatable diseases. They are dying because societies have yet to make the decision that their lives are worth saving.”
–Reducing US Maternal Mortality as a Human Right, American Public Health Association
(Washington DC, Rally to Improve Birth, 2013)
(Washington DC, Rally to Improve Birth, 2013)
(Detroit, MI, Rally to Improve Birth, 2013)
(Los Angeles, CA, Rally to Improve Birth, 2013)
(Northwest Indiana, Rally to Improve Birth, 2013)
(Orlando, FL, Rally to Improve Birth, 2013)
(Philadelphia, PA, Rally to Improve Birth, 2013)
***
Fun facts: In 2011, the American College of Obstetricians and Gynecologists found two thirds of its practice bulletins lacked basis in “high-quality, consistent scientific evidence.” US patients lack inexpensive options to support physiological birth, such as a nitrous oxide and nation-wide hospital midwifery care, while costly technology, sometimes with questionable benefits, is the norm. For years, American consumers were uncharacteristically passive, paying more than any other country for maternity care that ranks about 40th in the world for maternal mortality.
But change is in the air thanks to a powerful tool that’s jumpstarting innovation – an educated public with purchasing power and a voice. I’ll offer two examples of progress: for-profit insurers actually beat Medicaid to the doula-reimbursement game in 2009 and this fall my So-Cal doula listserv was buzzing with reports of real live walking epidurals at Cedars-Sinai, a prominent LA hospital.
Since CPT codes were established for birth and postpartum doulas, families can file for reimbursement from their insurer after paying their doula. Tammy Ryan, third-party reimbursement coordinator for DONA International, cautiously estimates that about one-third of submitted claims receive some type of reimbursement.
Successful reimbursement depends on consumers’ persistence. According to an experienced LA doula: “The person who answers the phone [in the claims department] has one job … to say, ‘NO, we don’t reimburse for that!” But, “I’ve had several clients reimbursed for 50-70% after being told that the insurance company did NOT reimburse…the ones who are persistent are the ones who get reimbursed!”
If you’re curious about the process, here’s what you need (templates of required documents here):
– Insurer’s claim form or the 1500 Universal Claim Form.
– A superbill from your doula. Ask for itemization and cost breakdown of visits, birth and phone/email support.
– A letter from your doula detailing her services, credentials and training.
– A letter from your doctor or midwife describing medical necessity, health benefits and/or lower costs associated with having a doula.
– Your letter, explaining why you want/need a doula (optional, but really helpful.)
Tips for successful claims:
❤ Straight-up calling your insurance company before birth to ask for preauthorization for a doula. This streamlines reimbursement, which is nice because doing paperwork while caring for a newborn could easily be an advanced interrogation technique.
❤ Asking your doctor or midwife to write a “Letter of Medical Necessity.”
❤ Making sure your doula has a National Provider Identifier (NPI) number. It takes 20 minutes to apply for one.
❤It’s probably best, though not absolutely necessary, to hire a certified doula.
❤ NLP the claims person: “How much will I be reimbursed for my doula?” vs. “Do you reimburse for doula services?”
❤ Keep copies of all your claim materials in a folder IRL or on your desktop, and be ready to resubmit them at least four times.
Sounds fun right? Well, anyway, that is how it’s done.
Ok, onto the exciting news. During my doula career (est. 2009), there have been occasional birth-improvement-type rallies at Cedars-Sinai in LA – people standing on a corner, holding a sign and being part of a collective voice. The hospital is responding with encouraging attentiveness. Among other things, they’ve premiered a fellowship program in obstetric anesthesiology – hence the giddy reports of walking epidurals.
Imagine: Being able to walk and maneuver your body. Being able to use the toilet, no catheter necessary. With an epidural.
Let’s do birth activism together and organize for Cedars anesthesiologist Dr. Mark Zakowski to travel the country providing trainings!
(Seriously, contact me if you’re interested in trying to do something like that.)
***
“It keeps startling me that at the beginning of this 21st century, at a time when we can . . . explore the depths of the seas and build an international space station, we have not been able to make childbirth safe for all women around the world. … This is one of the greatest social causes of our time.”
–Thoraya Obaid, executive director of the UN Population Fund, quoted in Amnesty International’s “Deadly Delivery” report
During pregnancy and birth in America, combined oppressions affect who has a safe birth and who doesn’t – racism, poverty, unequal access to resources, profit before people, poor nutrition, rape culture, female subjugation, high incarceration, exposure to environmental damage, violence against women, a decade-plus of war, disenfranchisement – does this list have an end? Addressing these issues in the context of pregnancy and birth requires us to address them outside the hospital as well. We birth community witches have a favorite kum-ba-ya: “Peaceful birth for a peaceful earth.”
In patriarchy, the war has been on the mommies, not among them. Disagreements about foreskins and breastfeeding and “natural” vs. “unnatural” diffuse when we get real about health inequity and the glacial pace of mortality- and injury-reducing innovation in American maternity care. But to be honest, I’m hopeful about the future of American birth. Consumers of maternity care are finding a voice to demand the advances they deserve because healthier births cost less. A quote attributed to Marsden Wagner says, “Birth will not change until the women take to the streets.” In the current global climate of financial distress and turbulent social movements, our care providers, governments and hospitals are actually listening to us very closely. What will we ask of them?
***
Further reading:
Mother-Friendly Hospital Initiative
Baby-Friendly Hospital Initiative
Why Trayvon Martin Has Everything To Do With Black Women’s Birth Outcomes
Pushed by Jennifer Block
Born in the USA by Marsden Wagner
Tags: birth, class, doulas, feminism, janna blair slack, race
This was great, and relevant to my interests now that I’m 9 weeks pregnant with my first child (still sounds weird to say!). Question for the author, if you’re reading these, Janna: will most insurance companies reimburse (a portion, at least) for doula services, even if they’re not listed in the benefit plan? Doulas aren’t listed as not covered, but they’re also not mentioned anywhere. Thanks!
Hi llamaj! Success varies incoherently with the general CPT code in use, but overall about a third of claims are reimbursed according to DONA. The fact that doulas are not specifically named in your insurance literature could actually work in your favor. Medicaid doula codes, currently being created, will standardize support and expand access through other insurers (the plan.) For now, one thing that seems to have a good effort-to-success ratio is trying for preapproval during pregnancy. Most success stories I’ve heard hinge on customer persistence 🙂
ok perhaps it’s because I’ve never given birth and don’t ever intend to, but I have no idea what any of the terminology in this article means. Apgar score? Practice bulletins? NLP? CPT codes? There is an asterisk that leads nowhere? I am really confused. Adorable kid in sunglasses in that second to last picture, though, so on the basis of that I am now all for doulas.
Oh, I actually know one of these! Apgar scores are used to rate infant health immediately after birth. It has to do with how healthy the color is (blue is bad), breathing, etc.
blue is kinda bad for all humans, no?
NLP is neuro-linguistic programming – which I only know from fuckin’ pick-up artist sites.
Hi Chickpeas!
A CPT code allows a provider to bill an insurer for a certain service. No CPT code, no reimburesement. Practice bulletins are medical guidelines for providers, in this case from the American College of Ob/Gyn (ACOG).
Me too. What’s a walking epidural?
On the one hand, I’m all for this!, because I have doula/doula-in-training friends and am vaguely rah-rah supportive (without being knowledgeable at all, truly) of birth reform here in the US. It’s nice to hear that the tide is getting turned. On the other hand, this article is a little overwhelming without some sort of intro for the newbies. Any help?
Also, I want to hear more about the women-of-color-as-doula thing! Why did that only get discussed at the beginning? That is super interesting.
A walking epidural means that your epidural doesn’t keep you stuck in your bed, you can get up and move around and squat (with help! and caution!): http://www.babycenter.ca/a542575/ambulatory-or-wa…
I can’t believe I didn’t know this. I now understand a little better why some women don’t want an epidural. The “natural” argument always confused me. I still can’t believe I didn’t know this.
Hello mollpants, re your last question, a couple places off the top of my head to start: http://www.ictcmidwives.org; http://www.radicaldoula.com, @radicaldoula, @miriamzperez (+ get the guide!); http://www.chuladoula.com, @chuladoula; Shodhini Institute, shodhini.blogspot.com, @shodhini; http://www.indigenousmother.blogspot.com...
I agree. I probably know a little more about this stuff than your average non-mom (I have relatives involved in natural birth movements, and I will forever be proud of my perfect Apgars), but there were quite a few terms I didn’t know. A lot of this didn’t feel like it was tailored towards a general audience, which is a shame because it’s such an important/interesting topic, and it sounds like the author is involved in great work!
yes, exactly. I’m still a little unclear on what a doula can/can’t do, medically speaking? Do they work with midwives in some sort of birthing dogsled team? What is the training like? etc. More please! (all of which will serve to convince me to never pass another human being through my vagina, ever. Eeeek.)
You are pretty much correct with birthing dogsled team. My doula likes to phrase it as \”the midwife is there to keep tabs on and catch your baby, the doula is there to support the mom and to be someone she can shriek at and be a real bitch to instead of whoever put the baby inside you.\”
” US maternal mortality doubled since 1987.” Good Lord. Another reason why the people who protest maternity care being an essential health benefit under the ACA are a bag of dicks.
One of the reasons I liked this piece is that it’s not the variant of birth activism that tries to convince all women to leave the hospital system in favour of homebirth. I think that women should make their own choices, but I also think that there is no reason that hospitals cannot provide better care to laboring moms under their own roofs, and walking epidurals and moving towards gas-and-air availability and training are great steps in that direction. I had SUCH a great, safe hospital birth, and I was allowed to be as crunchy and earthy as I wanted to be, and I knew that if anything went south with that plan I could be sectioned in minutes.
My hospital let me push for 3.5 hours, and I never felt like I was messing up anyone’s day. I heartily endorse the University of Utah maternity ward, and suspect that I would absolutely have had a c-section at many, many hospitals. Which would not have been a disaster, but I was allowed to give birth vaginally while intermittently monitored, and I’m stoked about it and my easier recovery.
Yes! make choices and have choices and have them be honored! I was able to do CNM (certified nurse-midwives) and deliver in a hospital where my midwife (LISA YOU ROCK STAR) stuck with me throughout 18 hours of labor, didn’t give me shit about asking for an epidural, and hugged me and cried when my kid was born hollering and perfect. She did my 6wk pp checkup and again, let me cry on her shoulder when I told her about the PPD. When I got knocked up wtih #2, I couldn’t run to the midwives fast enough, because I feel like it’s a mutual relationship of trust.
Wholeheartedly agreed. There simply aren’t a lot of good options unless you kind of get lucky, because our hospital system (like so much with maternity care) isn’t consistent at all, and lacks a lot of evidence-based medicine. I gave birth in a hospital, and honestly? I would have had a better standard of care at home or at a birthing center. The hospital was overcrowded, there weren’t enough nurses, and I had to yell “help!” to get the administrator at the admitting desk to bring me a vomit bag because there was no one else around. Since there were no rooms, I labored in triage, and delivered in recovery (sorry, ladies who were recovering!). I was just lucky in that I was only in labor for about 4.5 hours (about 3.5 of those at the hospital), so while my experience was miserable, at least it was short and uncomplicated.
This. Is. Awesome. Love this: “Disagreements about foreskins and breastfeeding and “natural” vs. “unnatural” diffuse when we get real about health inequity and the glacial pace of mortality- and injury-reducing innovation in American maternity care.”
Doulas are wonderful. Everyone should have access to one. Mine coached me through labor while the L&D nurse was off flitting around somewhere or haranguing me to sign consent forms in the middle of contractions. She made sure I knew my options. She even taught me how to nurse side-lying, which is the most wonderful thing in the middle of the night or if your back feels like it’s going to go into permanent spasms from holding a newborn in nursing position near-constantly. Definitely going to check out some of these links – maybe I’ll make my Christmas donation for birth activism this year.
This is great, and so relevant to my interests (part of the reason I switched from OB/GYN to family medicine was due to my interest in community medicine and team-based care, rather than more traditional models). Like Nicole discusses in her comment above, I think it’s really important to agitate for change within the current health system (like advocating for insurance reimbursement) because the vast majority of women still receive their care in hospitals, and they can (and should) be a safe place for women to give birth on their own terms.
Home birth movements TERRIFY me (basically all of the children in my immediate families had completely normal, uncomplicated pregnancies and then the actual delivery was a shitstorm), but as I am now moving into thinking about getting pregnant, it’s also horrifying to imagine my physician telling me how and when I should deliver my child. And I will be a physician myself in 6 months, so I can’t imagine the fear and frustration felt by women with even more of a power imbalance in that relationship.
Something about birth I think about a lot is related to “I Didn’t Know I Was Pregnant”: every single woman on the show says “and then I thought I was dying,” because giving birth is the closest a lot of people come to dying before they actually, um, die, because it’s so PUNK ROCK, the whole thing, and one of the reasons that home birth was never for me is just that.
YES! I was always super annoyed by those people who were so cheesy about the “miracle of birth” and then my very first day on L&D a lady had a placental abruption and everyone sprinted to the OR and it was NUTS and all of a sudden my arm was literally inside her abdominal cavity. And then I saw them the next morning and they were both fine.
So yeah, totally awesome and scary.
Homebirth usually works out just fine, although I am made uncomfortable by it as a concept, but as a feminist, I’d like to see the damn system accommodate women better, instead of us literally having to take our ball and go home.
YES. I’m hopeful that with the shift of medical education from “doctors in charge, everyone else step aside” to a more team-based model, with revolving leadership roles, patients will feel more comfortable advocating for themselves, and the providers will be better equipped to listen to patients and adapt to their needs. Medicine is such a patriarchal system, and even when the women are the providers, a lot of that old care model informs their decisions.
Yes, yes, yes, 1,000x yes.
Having done the whole birth thing this year, the one thing that I still can’t believe is that we all got here basically the same way. Somebody birthed us. That is so fucked up. They totally aren’t kidding when they say that birth means pushing another human out your vagina or cutting her our of your abdomen.
It was by far the most metal thing I have ever done, and I am so glad that I did not have to do it in my house, where I could have died (or gotten placenta on my sheets, the idea of which horrified me as much as death when I was considering my birth options).
Oh, man, my water broke prior to labour, like in the movies, and it was everywhere. No one tells you you have basically a kiddy pool of pinkish water in there, and that you will leak more of it every time you change positions for the next 48 hours.
There are entirely too much bodily fluids involved in birth. I feel like if there is a god, the human birth process is evidence that god is a man, because what the FUCK, man.
The mess! THE MESS. Most of my close friends have had home births, and they are all much tidier than I am. I feel if I were to go that route, we’d be finding placenta everywhere for years, much as we find dog hair now. No thanks, but rage on, my most metal of sisters. Plus let’s be real: I am a goddamn fainting goat when it comes to all things concerned with the physical form, as is my partner, so hospital + doula would be the plan if/when the time comes.
For me, a free-standing, certified birth center was the perfect middle ground. Qualified nurse-midwives, life-saving equipment, a block from the hospital … Unfortunately, birth centers face occasional regulatory skullduggery.
Of course, babybellewitch decided to poop in her amniotic fluid early in labor, so I ended up having a non-emergency transfer to a hospital (see grumping about my L&D nurse, above), which was 100% the right call. But I’d absolutely do the birth center again in a heartbeat. Their emphasis was on education and patient-centered care, as opposed to my original OB-GYN, who when I told her I wanted to do nonmedicated birth, said “Oh, we’re very supportive of that. And when you change your mind mid-labor, we won’t make fun of you.” (Which of course made me determined to refuse an epidural out of shear spite.)
I had the best fucking doula. ANGIE. Angie was my goddess. “You’re a strong, confident woman. You can do this. You are a warrior princess. Picture Lucy Lawless.”
I’m so lucky to have the room in my budget for a doula with our first baby this summer – good luck Oregon!!! Continue leading the way in Being Awesome!
I am so far from being a hippy, but if you look at the research, it’s crazy how terrible our current healthcare system is on pre/postnatal care, and how much outcomes are improved in countries that focus on natural birth, doula coaching, etc. I’m also one of those who’s just a bit squicked out by home birth, but maybe if my first one goes smoothly in hospital I’ll consider doing the next one at home…
I’ve been researching this topic pretty thoroughly recently for a lot of reasons, none of all which involve me actually being pregnant on this day. I’m really, really lucky in that there is an awesome midwife practice in my city that is affiliated with a progressive hospital that lets the midwives run the show with whatever options the mother desires (water birth, squatting birth, bed birth, epidural, sit-ups until the baby pops out, whatever), but with doctors hanging around for complications. Birth is scary as hell and there is no way I’d feel comfortable doing it at home, so I am endlessly glad this option exists. And also that I have insurance and that my insurance covers this practice and that I have the luxury of affording a doula when I want one (which I will). But really it comes down to the issue that it shouldn’t be up to the luck of where you live and the luxury of a good salary to get these things. These should be options all women have available. The default really shouldn’t be “medicate you to the gills and then when you’re too drugged to properly contract decide to cut the baby out.” Blah blah blah I’ve been watching way too much Call the Midwife this week.
Ha, glad I’m not the only one with Call the Midwife on the brain when I read this post. One of the things that I think about every time I watch that show is how completely unimaginable the idea of such comprehensive pre/postnatal care is in America. Trained nurses who make weekly house visits both before and after birth? The full cost subsidized by the government? A portable gas-and-air setup for home birth? WHAT SOCIALIST NONSENSE.
Janna! Toast! I am so excited there is an article about doulas on The Toast! I’m nearly certified as to provide Music Therapy Assisted Childbirth, though I’m not a doula yet, and this is a really great and informative article. Thank you!
Also, plug for the Radical Doula! If you’re interested in learning more about birth support outside the “typical” (white, middle/upper class, heterosexual, etc.) doula scene, Miriam Zoila Pérez has a short book on the topic and it is great.
“The Radical Doula Guide” by Miriam Perez:
https://www.wepay.com/stores/the-radical-doula-gu…
Amazing gift! It’s a life-changing work, read it and pass it on! ♥
So….wow.
Usually I love nearly everything y’all publish on Toast but this essay has me concerned. Why do I love what’s published? Usually because it’s smart, fresh, and not preachy. This piece is NONE of the three.
I say this as a feminist-mid-thirties-mother-of-two who also happens think and read a LOT about birth and American birth ‘wars’ through both anthropological and global lenses.
It saddens me as a librarian and researcher that this author, who has clearly not looked into WHY African-American and/or non-middle-upper-class women die or have complications at higher rates than white middle and upper class women during childbirth (hint – it’s not because they don’t have doulas) or WHY maternal mortality has risen since 1987 (hint – it’s not because hospitals are getting worse), would choose to frame her activism with those elements. (oh and the sources?! is any other librarian/academic pissed off about them??).
It saddens me as a feminist and a Marxist (okay, definitely a feminist and *sort-of* a Marxist :)) that the author would conflate genuine empowerment with consumer access to choice. If homebirth-doula-unmedicated birth is Whole Foods, and hospital-epidural is Walmart, is it really a FEMINIST thing to say “Black women should be able to shop at Whole Foods too!!” or “I feel so empowered shopping at Whole Foods!”? Or “You guys, I went to Walmart for organic strawberries/a doula and they DIDN’T HAVE ANY. Let’s fix the system!!!!” No. In fact, it’s condescending.
This is an advertisement, plain and simple. It is an advertisement for doulas. Doulas may or may not be awesome (I didn’t bother for my two kids because yeah, it seemed like too much money for something I didn’t need – a type of product that formerly poor ladies like myself, and currently poor ladies like many others, are well used to identifying). But dressing up an advertisement for doulas with a “see if you can get someone else to pay for it” is not any sort of advocacy for class or racial justice.
For shame.
Sounds like somebody’s angling for a doula of her own!
I’m a little confused. Originally, I commissioned this piece because I just wanted a how-to on strong-arming your insurance provider into paying for your doula, because readers had had a lot of questions about that arising from a narrative we had about being pro-reproductive choice AND a doula, and the author I had in mind said she’s been spending a lot of time talking to POC within the birthing community and would rather take the opportunity to bring Shafia Monroe and her compatriots into the discussion so that our readers could see what the grassroots birthing movement is like outside the white-mommy-blogging sphere.
There’s nothing about homebirth in this article. The POC involved in this conversation are in a better position to say what they want than any outside observers are, ourselves included, and this article is about informing women about choices and giving them some specific advice about how to wangle those choices out of the existing system. There is nothing here that suggests this has to happen by ignoring all other contributors to bad birthing outcomes, which include institutional racism and the oppression of the poor, and I’m pretty sure the ICTC (http://www.ictcmidwives.org/) is more informed about those issues than I, you, or the majority of our readers, and I’m happy to draw attention to what they have to say.
I agree with Sarah, this post disappoints me in some of the leaps of logic it makes….. I don’t think that not having Doulas has very much to do with why the american system is broken.
I’m a physician working within the system, and much of the problem is not having access to any education/pre-natal care of any type, along with poor nutrition, increased rates of drug abuse, incarceration, sexually transmitted diseases…. all which are disproportionately high in minorities.
Plus in order to take advantage of this “ways to talk an insurance company into paying” you have to A. Have insurance and B. Have enough education and time to spend wrangling with the insurance company in order to make them cover it.
(and yes! I do agree that midwives and doulas should be covered by insurance!!)
Anyways, I don’t like this article, but I do like doulas and I do want to see a better approach to childbirth and I am very proud that my hospital has multiple midwives on staff and allows many “alternative” therapies like water-birth to be utilized.
That’s great that your hospital offers alternatives to traditional childbirth. I’m learning more about water-birthing myself and it sounds like some women could benefit from this technique. I’m glad that the hospital also offers doulas and I do agree that they should be covered by insurance. Do they have resources for doula training as well?
Ha, glad I'm not the only one with Call the Midwife on the brain when I read this post. One of the things that I think about every time I watch that show is how completely unimaginable the idea of such comprehensive pre/postnatal care is in America. Trained nurses who make weekly house visits both before and after birth? The full cost subsidized by the government? A portable gas-and-air setup for home birth? WHAT SOCIALIST NONSENSE.
Oh, thank you! I did get referred to the local hospital LC and now we're in the hell of double pumping with the hospital grade pump after every feeding which, let me tell you, SUCKS when you are home alone, and I'm honestly not sure we're going to be able to get my supply back up because I also never get sleep like this. Babies…so cute…such life ruiners…