Tag Archive | education

Scooters and Birthwork

Me, on my scooter in February.

Me, on my scooter in February.

I love riding my scooter.  My dad rides a motorcycle and I always loved riding with him.  A few years ago, I gave up my car (by “give up”, I mean totaled, and refused to replace). I’m not a terribly good driver, and it is much harder to get distracted on my scooter.  I chose a scooter partially because I have a tendency to wear skirts every day; I’m not much of a lady most of the time, but straddling a motorcycle in a skirt is a bit beyond my comfort level.  This leads to an interesting world in which some motorcycle riders acknowledge me as two-wheeled kin, and some don’t.  I love seeing motorcyclists and scooterists on the road.   To me, its a party where we all try not to get killed by drivers. And I always give a head nod or wave, either way.  It isn’t always returned.  I’m sure there is an argument to be made that a scooter can’t always go as fast, is a cop-out, and other reasons that motor cyclists might not openly recognize me.  And that’s fine.  While it is nice to see a head nod, wave, or two fingers flashed over a handlebar, the absence of recognition doesn’t make me go home and cry at night.

As I rode along a few miles from home, I was thinking about how this correlates to the birth community.  Some see it as an adversarial system, where OB-GYNs just want money for c-sections and their evenings free, and labor and delivery nurses are either overworked and surly or saints, midwives are angels, but home-birth midwives  might be irresponsible, and doulas take over the roles that friends and families should fill and just annoy the nurses.  And of course, they all have trouble working together.

I remember when I first chose to start down the path to become a midwife, I chatted with a labor and delivery nurse one night at a friend’s house.  I told her I was really glad to hear what she did, and asked her some questions about her experiences.  Eventually, she asked me what my plans were. When I told her I wanted to be a midwife, she laid into me saying that any time a woman had a midwife they always ended up in her care with interventions.  My decision was foolish, and harmful.  I was shocked at the vehemence.  I never ran into her after that night, so I never had the chance to understand the experiences that lead to her frustration with midwives and home births.

Her line of reasoning didn’t make sense, from multiple angles.  There are many midwives who work in hospitals, and there is plenty of evidence showing that home births and birth center births are effective for many women.

I don’t think either view has much merit.  In birth, no one has a direct ride to the front of the class. Each position has strengths and weaknesses.  Every care provider picked their occupation to help pregnant and laboring mothers.  OB-GYNs have a level of skill that is required for more complicated cases.  Midwives have skills to lead uncomplicated cases safely through pregnancy and birth.  Nurses provide care and  valuable monitoring and liaising with a hospital.  Home birth midwives fulfill a community need for supervision and guidance, even in the simplest of cases.  Doulas provide one-on-one support, hands-on assistance, and useful education.  They can all work together, within their own scope of practice, to create a community that supports parents at every level.

And maybe we can all go for a ride afterwards.

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Adventures in Personal Training

Young Tough Girls
From flickr user: sixmilesoflocalhistory

I am pursuing personal training for a bunch of reasons.  In order of importance, these reasons are:

  • I really, really like moving things around and being freaky strong
  • I like being able to walk, scurry, sprint, ride my bike, swim, and play on swing sets without getting winded
  • I like being flexible and bendy
  • The apocolypse
  • It will likely improve my cardiovascular fitness and overall health

Keep in mind I, personally, find all these things important.  You may enjoy (or tolerate) physical activity because of all, some, or none of these reasons.  Or you may not.   I love a Health at Every Size mentality and will continue to talk about it (a lot), but health is not a moral imperative.  Health is not a ticket to basic dignity and respect.  I’m at a place where I’m doing things that I enjoy, that improve my health.  This does not make me better or worse than anyone else.

It does, however, make me do ridiculous things like meet with a personal trainer.  Rob and I introduced ourselves yesterday, and we sat down at my local hamster wheel to fill out the appropriate paperwork.  We talked about goals, what I’ve been doing for fitness lately, why I’m coming to this gym (online coupon for a month’s membership and 4 personal training sessions).  And then we get to the fun part.  I’m far enough removed from my dieting days that my weight and such are more of a passing curiosity than a cause for panic, so we measured my weight and body fat percentage. He wrote down the numbers and said, “Of course, we’d like to see your body fat percentage around [number redacted] percent.”

“Well, that’s a relative “we”.  See, I’m here to work on these goals, regardless of any changes in weight or body composition.”

“But diabetes, cardiovascular disease, mortality….”

I told him I understood his concerns, but that long term weight loss is not statistically likely.  And that my health can improve significantly from improved diet and activity that I enjoy.

We went a couple rounds, with me citing these studies, and him citing his book of clients.  I’m thrilled for his clients.  They have achieved something that they wanted.  But only one client he showed me had maintained the weight loss past five years, which seems to correlate with the statistics I cited in our conversation.  Her goals are not my goals, and those odds are not odds I’m interested in.

We stopped debating when I said, “Here’s the deal.  If I lose weight, you get a giant gold star and a letter from me for your book.  If I don’t lose weight, but I do gain strength and reach my other goals, then we still both win.”  We came to a truce and he sent me out for a warm-up of my choice.   I like the elliptical machine.

We then did barbell squats, leg presses, leg extensions, and wall sits.  And by we, I mean I.  He pushed me to do reps, and we laughed as my legs shook.  We gossiped and talked a little smack.  It was glorious.  I’m sore today, but I can’t wait to go back next week, after doula training.  While Rob and I don’t see eye to eye about weight, I have an ally in my corner because I was able to advocate for myself and put down boundaries about what I wanted out of my personal training.

I Want to Move It, Move It?

Maybe someday I'll be this awesome.

Maybe someday I’ll be this awesome.

retrieved from flicker use banafsh

Last week, I was invited to go to an archery range with a new friend while I was in Seattle.  I didn’t know what to expect. I was nervous; arrows are rumored to be pointy, and I’m not always known for my physical grace.  I shoot handguns a few times a year, but this is completely different. 

I ended up having a great time!  We shot for about two hours.  It was calming to focus on exactly how to hold my body for the next shot.  When I got a good shot it was exciting, and every few minutes someone yells “Clear!” and I’d walk down to the end of the lane and pull my arrows out of my target (or from near my target).  I loved focusing on where my arms were, my posture, my footing, and exactly what level of strength balance were required.  I had a pretty righteous crick in my neck from sleeping in hostel beds, and it felt great every time I pulled the bowstring back and brought my shoulder blades together. It may not have been awfully strenuous, but I was moving for the whole two hours.  I’ve looked up an archery range close to me, and I look forward to visiting it soon.

Movement and activity are important for health.  Traditionally, we look at movement and activity as exercise- often a punishment for the outrageous sin of eating.  When we remove the goal of weight loss, movement and activity are important for other reasons.  Regular physical activity improves mood, blood lipid levels, sleep, blood pressure, blood sugar levels, and energy levels.  We breathe better and our cardiovascular system responds quicker and recovers faster.  When you find something you enjoy, it is a great stress reliever, too.

I haven’t always loved going out and doing physical things, because exercise felt like a chore for so long.  A few years ago, I removed the ‘should’ from activity.  It took a while, but I started wanting to fit some activity into my life.  I feel better when I move.  I have less pain, breathe better, and recover faster when I have to hustle somewhere.  Also, I’m having a lot of fun!

Joyful movement is all about finding something you love.  I love swimming, elliptical machines, biking short distances, weight lifting, chasing my friends’ kids, and I just may love archery now, too.  I have a game on my phone, Ingress, that means I walk around for hours stopping near public art and landmarks looking suspicious (It is a sort of highly technical multi-player, never-ending version of capture the flag that uses Google’s maps and your GPS). 

Jimbo Pelligrene found something he loves!

Jimbo Pelligrene found something he loves!

I’m still discovering things I like to do, and how to fit them into my schedule, especially as my schedule is so variable.  I like working out at a gym; not everyone does.   I got a deal online for a month’s membership and some personal training sessions at a local gym.  I’m looking forward to getting to know their machines and find out how I can improve my ability to “throw things around.”  I love my strength.  While you can almost always find me in a dress, and often find me in heels and makeup, I still love the opportunity to help carry a couch, or climb a tree, or move some boxes. 

I have friends who love to dance, love to run, love yoga, love to garden…  When you remove the temptation to judge activity solely by its calorie-burning attributes, it really is all about what you like.

Movement has also been an opportunity to pay attention to how I feel.  For a looong time, I assumed that I got winded before my muscles ever even noticed what was going on, and my feet hurt, because I was ‘out of shape.’  Turns out, I have asthma (I thought I got rid of it as a kid), a pretty impressive heel spur, and a decent case of plantar fasciitis (Those translate roughly to “perpetually walking on spikes”).  I got an inhaler, and it works like magic!  I have orthotics coming in next week, and I can’t wait to be able to step up my game, physically.  I’ll have to figure out how to fit them in my dressier shoes, but I expect to feel quite a bit better on my feet.  That means I can do more walking with less pain, which is so great when I like to play Ingress and wander around on foot for hours.  Paying attention to yourself as you become more active means you can understand your own needs better. 

What do you like to do?

Back from the HAES® Training

Lucy Aphramor, Amy, and Linda Bacon

The training was amazing.  Linda Bacon and Lucy Aphramor were brilliant.   There were over 50 people at the training, and about half of them were dietitians.  There were people from as far away as Australia.  Everyone in the room believe that fat people have the same health goals as thin people. We covered a few things I have thought about before in conjunction with Health at Every Size®, but never quite connected in the same way.

We talked about how health is multi-dimensional- there is physical health, emotional health, spiritual health, social health- you can’t hold one above the others and expect to feel well.

I mentioned First, Do No Harm in my previous post.  I’ve talked in classes before about the futility of prescribing weight loss to patients, as it almost inevitably results in weight rebounding and worse health than just being fat.  I’ve talked about how our current medical model creates a barrier to treatment.  However, Linda and Lucy clarified and condensed these issues.  These are all issues of medical ethics.  Providers, by and by large, get into the business to help people.  But when providers are taught to prescribe weight loss, and that weight is a result of laziness and a lack of willpower, they are harming the vast majority of their patients.  That is simply unethical. If providers knew and shared the facts about long term weight loss attempt results, we wouldn’t recommend it anymore, and more and more, people wouldn’t consent to trying it.

In the next few months, I’m setting up a forum to create a conversation between fat patients in Denver and Denver care providers.  Hopefully we can address some of these barriers to quality care.

We talked about the fact that being fat can exacerbate some conditions.  Being fat can impact joint pain, diabetes, and heart disease.  However, is weight loss necessary? Experiencing one of these conditions doesn’t make weight loss any more reasonable of a goal.  Also, there are things that you can do for any condition that doesn’t include such drastic measures with such poor results.  While it is clear that eating a varied, enjoyable, quality diet and physical activity can improve diabetes and heart disease regardless of weight loss, joint pain is harder to assess.  Eating low-inflammatory foods and getting enough sleep can improve joint pain, and sometimes physical therapy can improve symptoms, without weight loss.   Thin people with diabetes, heart disease, and joint pain are given suggestions to improve their health that don’t include weight loss.

The last thing that I took away from this training a reminder of the community available to me.  I was reminded of the HAES Community, where you can find researches, authors, activists, care providers, and more in your community.  I heard more about ASDAH, who actually owns the HAES trademark.  They have another listing of health professionals that work within a HAES mentality.   They hold annual conferences, do lots of work in the community, and have excellent educational resources on their site. I heard of local HAES activists, and left having met many many awesome people.

Headed to Health at Every Size® Training!

Today I start the Health at Every Size® fascilitator training, and I am super excited about it.  I’ll spend a week learning how to best teach people in my community (that means you!) about the concepts of HAES.   Until then, here is an overview.

The HAES concept doesn’t erase that people of different size may face different health concerns.  It does acknowledge that long term weight loss is nearly impossible, and we need to address health concerns with people where they are, not when they reach an ideal body.  There are people who lose significant amounts of weight and keep it off, but that is a very, very small minority of people; different studies show no more than 2-5% of dieters are able to keep off significant amounts of weight for five years.  There is no weight loss method that has a decent success rate (which explains why nobody publicizes their results).  Weight loss attempts usually lead to regain, and often lead to weight gain above and beyond the loss.  This weight cycling is more damaging than just being fat.  In a culture where people often start trying to lose weight in childhood, it means that they are weight cycling again and again and again.

The obesity epidemic panic also does a disservice to thin folks.  Culturally, we assume that thin people are healthy, and don’t talk about how being inactive can impact their health, or that thin people need to be screened for the diseases and conditions that we associate with obesity, like high blood pressure, heart disease, and diabetes.   When we teach assumptions about what kind of people get these diseases, we harm those outside of that demographic by reducing their awareness of their own personal risks.  These assumptions are also found in health care providers, reducing the quality of care that both fat and thin people recieve.

Better than focusing on weight, what we can do is focus on health. While changing eating habits and exercising may not impact weight, they clearly impact health.  If we focus on changing eating habits, and creating opportunities for enjoyable movement, we see that regardless of weight, health markers improve.  This means lipid levels, blood pressure, resting and exercising pulse rate, blood sugar levels, blood insulin levels- all markers of physical health.  This is an approach that works for thin and fat people.

A big part of this approach is self-acceptance.  There is a lot of stress associated with thinking that you’re failing at losing weight.  That stress, combined with other life stresses, snowball into a lot of the diseases we currently consider ‘weight-related’*.

Many people have dieted and exercised in ways that have moved them out of touch with their bodies.  I have dieted and exercised in ways that got me way out of touch with my body.  But understanding what your body needs doesn’t go away entirely, it just gets shouted over so much it is hard to hear.

HAES promotes intuitive eating, the idea that when you remove foods from being off-limits, and pay attention to how foods make you feel, you will make far more healthy choices than when we are stuck in a good food/bad food dieting denial loop.   I know what foods make me feel good, what foods don’t, and when I want a little ice cream, I don’t finish off the carton because I’m afraid of my diet tomorrow, and that I’ll never again remember what it tastes like.

HAES also promotes enjoyable activity.  Find something you like doing, because movement, however you define it, benefits health.  Physical activity, whether difficult or easy, improves mood, sleep, and all the other health markers talked about earlier.

*See Robert Sapolsky’s book, Why Zebras Don’t Get Ulcers.