Tag Archives: death

Spotlight On: Birth, Breath and Death

Birth Breath and Death Front Cover copy

An interview with author Amy Wright Glenn about her book Birth, Breath, and Death: Meditations on Motherhood, Chaplaincy, and Life as a Doula.

Tell us about your book.

Birth, Breath, and Death: Meditations on Motherhood, Chaplaincy, and Life as a Doula is a heartfelt account of my work with the birthing and dying. I am a doula. I hold space for women as they give birth. I am a chaplain. I hold space for the dying. I am drawn to life’s thresholds. I am drawn to these doorways.

Birth, Breath, and Death is also a deeply personal exploration of what it meant for me to become a mother, given the painful legacy of my mother’s mental illness. I write about the healing attachment found in cosleeping, breastfeeding and babywearing. I weave together research on attachment and brain development, with reflections on empathy and compassion.

Finally, I share personal stories about birth and death, combined with philosophical reflections as my academic background is in the study of comparative religions and philosophy.

What inspired you to write this book?

My husband, Clark, came up with the title of this book during my training as a hospital chaplain. However, I wasn’t ready to write this book at that point in my life. It was the birth of my son–and the subsequently profound opening of my heart–that compelled me to write this book.

I didn’t want to go back to full-time academic work after holding my newborn in my arms. I knew I could use my skill as a writer to contribute financially to the family and fulfill my heart’s longing, and the longing of my young son, to stay at home and nurture him with the best of my energy and talents.

Much of Birth, Breath, and Death came to me in meditation, and I often woke up from sleep with sentences running through my mind. Writing has opened up many doors for me, and I’m grateful to find a way to work from home and share my insights, struggles, hopes and experiences.

How will this book benefit families?

All of us are born. All of us die. I write about the deepest questions we can examine in life. Within our family circles, we encounter both the miraculous and the mundane. Within our families, we most deeply encounter the transformative energies of birth and death.

I believe we all benefit from reflecting upon what it means to be born and what it means to die. These are life’s big questions. Even if one disagrees with my responses to these big questions, it is still invaluable to take the time to reflect upon them with an open heart and mind.

Parents, in particular, will benefit from reading this book as I reflect on what it means to be a parent and find one’s own way, trust one’s intuition, and draw upon best practices and scholarship to bring out the best in oneself and one’s children.

You share birth stories and reflect upon your work as a chaplain supporting the dying, but tell us more about the “Breath” part of your book.

The first thing we do upon leaving our mother’s body is breathe in, and the last thing we do before we die is breathe out. The breath is the link, the thread. It is a powerfully loyal friend throughout life’s journey between birth and death.

I practice meditation and teach yoga. Conscious breath awareness is central to these mindfulness practices. It’s central to living a mindful life. The “breath” part of the book relates to teachings drawn from many wisdom traditions that help us keep our hearts open as we live with love and seek truth.

You studied comparative religion and taught this on the college and high school level, so how does this impact your writing?

My studies of comparative religion and philosophy profoundly impact everything I do. I love making links between the particular and the universal, between the day-to-day patterns of living and the deep reflections that thinkers across time and culture bring to human life. My book is academically rigorous in the sense that I draw freely from my training as a scholar in the telling of birth, breath and death tales.

What are your views of Attachment Parenting International and what API is doing? How does your book work within our mission statement?

Attachment Parenting International is an organization I admire, support and celebrate. I’m very grateful for API’s commitment to link best parenting practices with research, and support families to develop secure attachments that foster the development of empathy, courage and resilience.

I found myself naturally practicing many AP styles of mothering and applied my previous research in the field of ethical development to the work of nurturing my son. I certainly want to support all parents to “raise secure, joyful, and empathetic children.” We do this best when we as parents embody these qualities ourselves.

My book chronicles my own journey of working through the pain of a difficult childhood and emerging with joy and empathy to embrace openhearted mothering.

Where can readers find more information?

Readers can visit my website www.birthbreathanddeath.com to read reviews of the book and find purchase information.

 

Grief in Children

By Margie Wagner & Callie Little, Child Development Media, www.childdevelopmentmedia.com, reprinted with permission

It goes without saying that the grieving process is a complicated and intensely personal one. It is difficult enough for adults to deal with the loss of a loved one, but it can be even more difficult for children, particularly if their adult caregivers are working through their own grief. Understanding how grief affects children at various developmental stages and knowing the best ways to assist children as they grieve can help children to process their grief in the most healthy way possible. Keep in mind that, while grief is usually associated with a death, there are many circumstances under which children grieve. Separation due to the dissolution of a relationship or due to a military deployment or job-related separation can also cause grief in children.

Reactions to Loss and How to Help

How old a child is at the time of loss certainly affects the child’s perception of the event.  Although babies are unable to express themselves verbally, they will certainly exhibit reactions to loss. They may seem more fussy, inconsolable, or have changes in their eating and sleeping patterns. Very young children, ages 2 to 4, are egocentric: they think the world revolves around them, and their concept of death is limited. They may think that death is reversible, and their main reactions to death may be that their daily routine and care are altered. The adult whom they have lost, or who is also grieving, will be either absent or unable to care for the child in the accustomed manner. At this age, reactions are often regressive, exhibiting themselves in eating, sleeping, or toileting disruptions. Children this age need reassurance and consistency. Try to maintain regular routines and to be comforting, giving hugs and kisses and lots of gentle touches. Keep the discussions of death short, but keep interactions with the child frequent. Even if you feel like the baby or young child cannot understand your words, they will understand your interest in their feelings and your wish to console them. Keep talking – it will help you to get used to the discussions that will become longer and more detailed as the child gets older, and it will help you to figure out what to say.

Continue reading Grief in Children

Why You Should Talk to Your Kids About Death

By Sarina Behar Natkin, LICSW, www.growparenting.com, reprinted with permission

As a parent educator, I rarely use the word “should.” As a matter of fact, I cringe at the idea of giving parents one more SHOULD, almost as much as many parents cringe at the idea of talking to their kids about death.sarina natkin

But after a spate of violence and random death in Seattle, I realized how few parents discuss the topic of death with their children before they are forced to. This is where the SHOULD comes in. We should talk to them because it will help our children and us move through the pain of loss just a little bit easier. For those of us who have lost loved ones, even the tiniest bit easier is worth it.

Many parents say they don’t talk to their kids about the concept of death because they don’t know what to say. While that may be true, I suspect that belief is coming from the idea that we don’t want to scare our children or worry them. But we do our children a disservice if we let those hard emotions stop us from sharing something that is as much a part of life as life itself.

Imagine your child’s first day of school. What if, because you didn’t want them to feel scared or worried, you avoided the word “school” for years? What happens when the first day of school arrives? How might that first drop-off feel for them? For you? My guess is with no framework or understanding of where they are and what they are doing there, our kids might feel pretty scared, alone, and quite anxious.

Of course we don’t do this! Many parents spend a great deal of time carefully preparing their child for school. It’s not usually a sit-down formal conversation about the history and theory of elementary education. It’s many small moments throughout early childhood that help them build a mental model for this concept of school. Those mental models are what help decrease fear and anxiety, and more importantly, normalize a part of life for most Americans. Continue reading Why You Should Talk to Your Kids About Death

The Danger of Pharmaceuticals

By Adrienne Carmack, MD

Danger of PharmaceuticalsIn April 2005, Rani Jamieson gave birth to a healthy baby boy, Tariq. She was given Tylenol #3, a medication containing acetaminophen and codeine, for postpartum pain. She took two pills twice a day, less than the prescribed amount, and cut this dose in half two days later after experiencing fatigue and constipation. She was told it was safe to take this medication while breastfeeding, and did so.

When he was seven days old, Tariq became excessively sleepy and had trouble breastfeeding. His mom began pumping and froze her extra breastmilk while continuing to nurse. She brought Tariq in to see his pediatrician when he was 11 days old for poor feeding; the pediatrician noted he had regained his birth weight and nothing further was done. On his 13th day of life, Tariq became unresponsive. When the ambulance crew arrived, he was already dead. Six months later, an autopsy showed a deadly overdose of the codeine his mother had been taking.

Codeine is generally regarded as a safe medication for use by breastfeeding moms immediately postpartum. In 2001, the American Academy of Pediatrics issued a report stating that codeine had not been reported as causing signs or symptoms of problems in breastfed infants and that it had no effect on lactation. It was included in a list of medications “usually compatible with breastfeeding.” Actually, several reports of apnea in infants whose mothers were taking codeine had been previously reported, in 1993 and 1984, according to a study published in the January 2007 issue of Canadian Family Physician.

Even today, the Academy of Breastfeeding Medicine, a breastfeeding advocacy organization, reports that codeine is generally a suitable choice for postpartum pain. In their report on pain control in breastfeeding mothers, they advise limiting doses of pain medications to the minimum amount necessary and suggest that nonpharmacologic means of pain control such as hypnotherapy may be better. However, they ultimately conclude that codeine is generally safe because it has been widely used by millions of women worldwide.

How can a medication that has been safely used in millions also be dangerous enough to kill a newborn baby, even when used at lower doses than the standards recommended? Scientists have recently begun studying the role of genetic variations in drug reactions. They have found that individuals with certain forms of genes are more likely to metabolize drugs in ways that lead to higher side effects. For example, the chemotherapy drug cisplatin causes hearing loss in some of the people who receive it, particularly children. However, until recently, no one knew why this was. It’s now been shown that certain forms of genes are responsible for this side effect, as published in the September 2007 issue of American Journal of Human Genetics.

For codeine, the answer lies in a gene called CYP2D6. Those with a certain form of this gene metabolize codeine very rapidly. Codeine works as a pain medication after it is metabolized to morphine, which then acts on pain receptors in the body. Those who metabolize codeine very rapidly end up with very high levels of morphine in their bodies very quickly. In the case of Tariq, his mother had symptoms early on, suggesting that she was a “fast-metabolizer” of codeine. Tariq was found to have morphine levels of 90 ng/mL, much higher than the level usually seen in infants receiving intravenous morphine, about 12 ng/mL. Rani’s frozen breastmilk contained 87 ng/mL of morphine.

Why, before codeine was deemed safe for the infants of nursing mothers, weren’t morphine levels in breastmilk studied? They were. A study published in The Journal of Human Lactation in 1993 measured the levels of morphine in the blood and milk of seven mothers taking codeine and in the blood of their infants. The levels of morphine in the infant’s blood never exceeded 2.2 ng/mL, which is generally considered a safe level, and is much lower than the levels found in Tariq’s blood.

Claims of medication safety are usually made after drugs have been tested in uniform populations at standard dosages, not in diverse populations that represent our society. In the case of CYP2D6 gene variations, the fast-metabolizer form occurs in up to 29 of every 100 people, depending on ethnicity, as published in the Canadian Family Physician study. It’s easy to see how measuring the levels of morphine in the milk of seven mothers of an ethnicity with a 1% rate of genes causing fast metabolism of morphine would be unlikely to include a mother with this variation. Had the study been done in mothers of Ethiopian descent, who have the highest chance of having this form of the gene, the researchers likely would have seen very high levels of morphine in the milk of at least one of the mothers.

Given these facts, it is likely that millions of infants worldwide go through their first days of life sedated and drowsy, while their mothers are reassured that the medication they are taking is harmless. Many new moms, unfamiliar with an infant’s behavior, may not recognize that their babies’ behavior is unusual. If they do worry and seek medical care, many doctors would fail to recognize the symptoms as a drug effect. One can only surmise the effects of this early drug exposure on brain development.

Genetic mutations such as this also account for other side effects of medications. For example, the CYP2D6 gene is also important in how the body handles another pain medication, tramadol. Those with the gene variation causing rapid metabolism are much more likely to experience nausea than those who do not. Half of rapid metabolizers develop nausea, compared to only 9% of those who are able to metabolize tramadol completely, according to a study published in the February 2008 issue of Journal of Clinical Psychopharmacology. Similarly, individuals with this form of the gene who take codeine have a 91% chance of becoming excessively sleepy with the medication, compared to 50% of those without it. Those who metabolize codeine very rapidly have 50% higher levels of morphine in their systems.

This new understanding of the role genes play in the way our bodies process drugs illustrates the reasons why pharmaceuticals that seem safe can still be very dangerous. Since this report was published, some strategies that have been recommended are using medications such as ibuprofen instead of codeine in breastfeeding mothers, using codeine for a shorter time after the baby is born, or even performing genetic studies in all mothers to determine if it is safe for them to use codeine while breastfeeding. These strategies are flawed. Simply reducing or changing the pain medication used is not likely to be effective in controlling a mother’s pain. Carrying out mass genetic screening would be extremely costly and time-consuming.

Not only are these strategies impractical, they fail to address the real issue. Pharmaceuticals are dangerous. Reports indicate that adverse drug events occur in 67 of every 1,000 hospitalized patients and are fatal in 3.2 of every 1,000 patients, according to a study published in the April 1998 issue of Journal of the American Medical Association. Worse, 95 of every 1,000 hospitalized children experiences an adverse drug event. Of every 1,000 children admitted to the hospital, 20.9 are admitted because of drug reactions. Almost half of these are life-threatening reactions. It’s estimated that 14.6 of every 1,000 children who are not hospitalized will experience an adverse drug reaction, as published in the July 2001 issue of British Journal of Clinical Pharmacology. According to the United States Food and Drug Administration, if these rates are accurate, adverse drug reactions are the fourth-leading cause of death in the United States. Even when drugs are thought to be safe for many years, using them can still have devastating consequences.

The best strategy, one that isn’t commonly proposed, is simply avoiding medications in the first place. Medications are widely overused. In the case of postpartum pain, choosing a natural childbirth, with alternate methods of pain control if needed, provides the safest environment for the baby. This option avoids the risks of codeine in particular and also lets women avoid all of the drug effects that are not yet understood and can’t be predicted. If a mother does feel that taking a medication is important for her health or that of her child, she should diligently watch for any side effects. Mothers are wise to listen to their bodies and to not hesitate to seek alternate treatments if concerning symptoms occur while taking a drug.

Some mothers who chose to avoid drugs while pregnant and breastfeeding do so because they are aware of studies showing the harms this can cause to their infants. Most, however, likely are led to this choice by their innate wisdom. The choice to have a natural childbirth is often criticized as unnecessary because of claims that drugs such as codeine are safe. The new understanding of genetic variations provides evidence that the instincts of mothers who choose to avoid these situations should be trusted.

Mothers who are in a situation where they are offered pharmaceutical treatments should carefully weigh the potential, unknown risks of taking these medications. Because the effects a drug will have on one individual cannot be predicted by what has happened in others, one cannot be too cautious in making this decision. As with many parenting decisions, the choice to use pharmaceuticals cannot be taken lightly. It is prudent for all individuals, but especially nursing mothers and growing children, to avoid these potentially toxic chemicals whenever possible.

Two Years and Five Months: An Adoption Story

By Juliette Oase, leader of API of Portland, Oregon

**Orginally published in the Winter 2007-08 Adoption issue of The Journal of API

Juliette, her children, and her parents
Juliette, her children, and her parents

I remember the day my daughter turned two years and five months old.

The reason I remember it so well, imprinted like a stamp on my heart, is because when I was exactly that age, two years and five months old, my life came tumbling down in a way that life never should for someone that age.

At two years and five months old, I was the girl people read about on the front page of the newspaper. The tragic story of my mother’s death, shot while walking down the street in Los Angeles, not only made the nightly news but carried into the morning shows as well. People wondered, no doubt, whatever would happen to that cute little girl in the stroller…the one who watched her mother die on the street. Continue reading Two Years and Five Months: An Adoption Story