Birthcycle |

(What are these reviews all about? See my “Introductory Concepts” post.)

Let’s start at the very beginning, a very good place to start. Although if we were honestly going to start at the beginning, we’d need to start with the menstrual cups patented in the 1930s. Here’s a patent for a menstrual cup from 1932!

But for our purposes, and for me personally, the beginning of the modern, commercially viable menstrual cup is The Keeper, which was first manufactured in the US in 1987.

A Keeper menstrual cup stylishly presented on a piece of wood, maybe? Note the length of the uncut stem.

This is the only cup that was available for me to buy (in 2002, in Vancouver, British Columbia, Canada) when I wanted to find a safe, cheaper, less wasteful option for dealing with menstrual fluid. The Keeper is still available from their website (from whence I have also borrowed the above photo, since I no longer have my own to take a picture of). It came in 2 sizes, and I bought the smaller of the two, as this was what was recommended for menstruators who had never given birth vaginally, which was true of me then.

I used my Keeper for every period I had between the summer of 2002 and fall of 2004, and then used it part-time from 2004 to 2008,  when I conceived my kid and stopped menstruating for a while. When my periods returned in 2010, I decided that the “gum rubber” of the cup had degraded too much to use it any longer and discarded it.

1. Material Quality – 4/10

The Keeper has always been described as being made of “natural gum rubber”, though I note the current addition of the parenthetical “(latex)” at the end of that description. The Keeper has also always been touted as having a usable life of up to 10 years.

As regards material strength and rigidity, the gum rubber used in the Keeper is not a bad choice. When using any menstrual cup that shares some slight variation of the bell-shaped cup with the Keeper, you generally insert it folded in one of several ways, and it’s important for the material that a cup is made of to have enough strength to consistently and without drama unfold again inside of the vagina.

Two more views of the Keeper. In the foreground, a side view showing the somewhat steeply conical bell shape of the cup, and the long untrimmed stem. You can just see one of the tiny air holes under the ridge below the rim, on the right-hand side. In the background is an image of a hand holding a Keeper that has been folded for insertion. It is shown end-on, perhaps to reassure the viewer that when folded, it isn’t too different in size to a standard tampon applicator.

Basically, the material of the cup needs to be able to resist the pressure of the vaginal walls enough to pop back into a cup shape, because it can’t catch menstrual fluid if it doesn’t. The gum rubber in the Keeper is sufficiently flexible to allow it to be easily folded without damaging the material, and sufficiently firm to be pretty reliable at popping back to its intended in-use shape. Almost as important, it also has enough rigidity to prevent the worst possible disaster of menstrual cup use: the dreaded “accidentally pushing it out of your vagina into the toilet while bearing down to poop” event. This can happen more easily if the material combined with the design of a menstrual cup allows too much  horizontal (side-to-side) flex. This tragic event never once happened to me when using the Keeper.

But let’s get right to the critical point, here: gum rubber, natural or not, is simply not the best material for something you’re using this intimately and for this long. A menstrual cup is a device that you wear inside your body 24 hours per day for up to a week at a time. Ideally, you would want that device to be non-reactive, non-porous, and sterilizable in case of disasters as described above. Gum rubber is porous, so it is reactive and changeable in a way that medical grade silicone (the material used for almost all modern cups) simply isn’t. The gum rubber reacts to your vagina and its chemistry over time and can get darker or discolour. The Keeper website suggests that, “this natural discoloration is a sign that you are giving your cup a long and happy life. A discolored cup is still clean and very usable.” Perhaps so, but it can still be a little offputting to use a darkly mottled cup, and discolouration inevitably makes it harder to determine cleanliness through visual inspection. Is it darker under the rim because it’s discoloured or because there’s still residue that should be cleaned off? That’s not a pleasant judgment call to have to make.

Relatedly, In my experience and from conversations with friends, it seems that it’s not unusual to find that the Keeper develops a mild odour with use that seems impossible to completely remove by cleaning in the ways recommended by the manufacturer. Because boiling to sterilize the cup is not recommended – it harms the material and shortens its life – if a smell does develop, and you can’t shift it with soap or a mild vinegar solution, so long as it doesn’t become strong or quite unpleasant, you might just have to make the choice to live with it.

As a final point on material, “natural gum rubber (latex)” is also, quite obviously, inappropriate for anyone who has a latex allergy, which research suggests is 1-6% of the general population and 8-12% of workers in health care and other industries where exposure to latex gloves and other products is a constant (like hairdressers). This difference is because increased exposure to latex increases the likelihood of sensitization. This suggests that it’s possible for a menstruating person who uses a Keeper to increase their chances of developing a latex allergy over time, especially if they are also exposed through work. Not good.

2. Design – 4/10

a. General Shape – 9/10

The Keeper has a very standard general design for a menstrual cup, a bell-shaped cup with a thicker band of material around the rim, “air holes” to release suction beneath that rim, and a long stem at the bottom. Most menstrual cups on the market shares these basic qualities, so the design differences come in the subtler details.

The general shape of the cup is fine. It has a somewhat steeper conical bell shape than some cups, but it’s hard to tell what practical difference this kind of variation makes. Certainly, the cup ably contains menstrual fluid in useful quantities.

The rim is a reasonably comfortable shape to insert when folded. The rounded rim and the thicker section of the cup below it, combined with the qualities of the material itself is likely what contributes to the Keeper’s reliability in unfolding once inserted. Basically, enough material has been included in the design to ensure the right degree of material strength.

The Keeper’s stem is comically long prior to first use, and the intention is that the Keeper’s user will trim the stem with scissors to the correct length for their anatomy. Users are supposed to leave the stem long enough so that it can be grasped in order to remove the cup, but short enough for the stem not to cause discomfort regardless of its wearer’s movements when the cup is positioned correctly. Ideally, the users shouldn’t be able to feel the stem at all when the cup is properly inserted. With the Keeper, I prefered a very short stem. Anything longer than around a quarter of an inch meant that I could feel the stem in my vaginal opening, and the sensation of this was unpleasant and sometimes sharply painful. Early experimentation helped me find the right length and I have  found that slightly “beveling” the cut stem end with the scissors so that there were no sharp corners also helped. If I have one criticism of the stem, it is that because it was smooth and untextured, it was difficult to grasp, especially when wet or slippery from menstrual or vaginal fluid, which it usually is.

b. Surface Details – 0/10

Full disclosure: I HATE surface details on a menstrual cup. A menstrual cup is a practical object, spends its in-use time primarily invisible inside the body of its user, and very specifically is inside that body to collect menstrual fluid from the beginning to the end of its user’s period. Decorations are inappropriate, unnecessary, and usually counter-productive. Menstrual fluid is a substance that is perfectly natural and normal, but also sometimes, a bit… messy? Sometimes there are clots, or long gelatinous goo strings, and for some menstruators, menstrual fluid at the start and/or end of a period can be scant, thick, sticky, and brown/grey. Details imposed on the surface of the interior of the cup therefore primarily serve as anchor points for the messier parts of your menstrual fluid.

Note the interior surface details: raised measurement lines and “KEEPER” in all capitals stamped just inside the rim. These details make the Keeper harder to clean.

The Keeper has a plethora of surface details, including measurement markings within the cup and the word “KEEPER” in stamped on the interior of the rim. Measuring the volume of your menstrual fluid is an interesting novelty*, but I’m unconvinced that it’s a benefit that justifies that added time spent cleaning the gunge off these measurement lines with your fingernail. Also, the best way to make me hate and resent the name of your product is to design your product so that I have to spend time scraping sticky brown late-period menstrual fluid off your product name every. fucking. month. No love. This didn’t need to happen.

c. Air Holes – 0/10

Air holes are such a problem. It’s hard to know how important it is to have them in the first place. A few modern menstrual cups are designed without any air holes at all, and still seem perfectly usable. Nonetheless, air holes are pretty ubiquitous. Those in the Keeper are tiny. It seems as though the designer must have been concerned about the air holes permitting menstrual fluid leakage, as the air holes are just pin holes really.

Because the holes are so small and narrow they rapidly become clogged, and they’re too small to properly clean with any kind of tool you’re likely to have in your house. It’s also difficult to tell if they’re actually blocked, because they’re small and weirdly angled so it’s very difficult to get water to visibly flow through them even when they’re not clogged. Since the “natural gum rubber” is opaque, you can’t even tell by looking closely. It seems inevitable that a Keeper’s air holes probably function mainly as repositories for bacteria, which is a pretty unpleasant thought.

3. Ease of Use and Comfort (8/10)

The Keeper was my first cup, so it’s the one that taught me about cups. In using a cup there are a number of important considerations for ease of use. A few obvious considerations are if it is difficult to insert or remove, if it causes pain or discomfort, and whether or not the cup commonly leaks during standard usage. But perhaps most importantly to me is whether it is possible to unambiguously assess whether the cup has been inserted properly before you leave the bathroom. A cup that leaves this ambiguous is a cup that is introducing unnecessary stress into your life.

The Keeper, for the most part, was solid on this point. To insert it, I would generally sit on the toilet with legs spread, fold the Keeper into a tight “U” shape as shown in the image, wet it with water from the tap for minor lubrication, and pushed it into my vagina with my thumb and two fingers. Once inside, it usually only took a little bit of gentle nudging and repositioning to get it to sort of “pop” open inside, and this was accompanied by a very noticeable physical sensation. When I felt that sensation, I could then turn the cup with my fingers and it would rotate easily and smoothly inside my vagina, which confirmed that it was inserted properly and ready to go.

This insertion technique was relatively easy to learn and not painful. The tricky part was figuring out how to hold the Keeper once it was folded so that it didn’t pop open prematurely, and figuring out the right angle and pressure for comfortable insertion.

I did experience occasional leaks on heavy days, which is why I always work cloth pads on those days as a back-up. Leaks were more likely if I was sneezing or coughing frequently, while I was lying down for a long sleep overnight on a heavy day, or if I had to wait too long between emptying the cup on a heavy day. Occasionally it seemed as if the presence of a stool in my anus may have disrupted the Keeper’s position in my vagina and caused a leak. Completely leak-free periods were, for me, in the minority with the Keeper, perhaps only one in four, but the leaks were rarely catastrophic with the cloth pads as backups.

The Keeper was incredibly comfortable. Once I’d sorted out the stem length and figured out how to tell when the cup was properly inserted, I would usually not feel it at all when wearing it, except occasionally when laughing, coughing, or sneezing.

Conclusion

The Keeper was a great product in its time, and for over a decade, pretty much the only product of its kind available. But I truly believe its time has passed, mainly because of the problems inherent in the “natural gum rubber” still being used to make it. If it was somehow once again the only menstrual cup available in the world and I needed to get a cup, I would buy it again in a heartbeat, because it did work for me for a long time despite its problems, and it has worked for many other menstruating folks as well. But given almost any other option, and especially given the many excellent options available today, I cannot recommend it except as a museum piece. Sorry, Keeper.

*It’s important to note that the volume of your menstrual fluid is not the volume of your blood loss as a result of menstruating. Around half of this fluid is made up of other fluids, expelled uterine lining, etc.

Yes, this is definitely how blogging begins again. I’m sure of it.

So, from time to time and on no predictable schedule at all, I will be posting reviews of various menstrual cups here. It’s actually a pretty exciting time in the reusable menstrual cup world, with many types and variations of cups available, unlike 15 years ago. I suspect, but have no data to back this up, that this is due to a generational shift, with many younger menstruating folks have a greater awareness of their own anatomy and being perhaps much more comfortable with touching their own genitals than past generations, along with an increased desire to have a lower environmental impact. Regardless of why though, it’s awesome.

First Principles

In these reviews I’m going to be super real with you, readers. There will be descriptions of menstrual fluids, of anatomy, and of sensations. There will, inevitably, be occasional mention of urine and feces (proximity sometimes demands it, after all). There may be swearing, for emphasis, when I’m feeling particularly passionate about something.

When describing anatomy, I’ll be using the fairly universally understood words “vagina”, “labia”, “vulva”, etc., for clarity, but please note that I don’t intend this usage to imply any gender essentialism. For myself, I identify as genderqueer/non-binary, and have some small knowledge of how menstruation can be a complicated thing to fit into a non-cis-female gender identity (though I do not wish to presume that I necessarily know anyone else’s experience). If those anatomical words don’t resonate for you or don’t fit your understanding of your body I invite you to use any terms you’d prefer in comments.

Menstruating is a fine and ordinary thing for a person to do. It’s not a curse or a punishment or something that makes you unclean, incompetent, or monstrous in some way. It’s also, thanks to science, not an obligation. Menstruating is sometimes uncomfortable, physically or psychologically or socially or in relation to a menstruator’s practiced religion. There are menstruators who enjoy it, just as there are menstruators who despise it. I will always affirm anyone’s right to take advantage of the choices offered by science to avoid menstruating regularly, or to alter a menstrual cycle in whatever way makes sense for them, to use reusable products such as a cup, cloth pads, or natural sea sponge, or to use disposable pads or tampons or cups, or anything else. Being the possessor of a uterus that, left to its own devices, would likely menstruate in a culture that associates that uterus with femaleness and associates femaleness with inferiority is complicated enough without judgment.

Why Me?

First, let me establish myself as a bit of an expert on the subject: I’ve been using menstrual cups as my primary tool (backed up by cloth menstrual pads when necessary) for dealing with menstruation since 2002, when I started menstruating again after a four-year gap thanks to hormonal contraception. Except for during my pregnancy and for the 18 months following, when I experienced Lactational amenorrhea, I’ve been menstruating somewhat regularly ever since, and I’ve used a menstrual cup every single time. I estimate that I have menstruated 130 times since 2002 (my cycles run a little long, and I occasionally skip). I would also estimate that during the five to six days I menstruate each time, I insert and remove a menstrual cup approximately 10-14 times. That makes for a total of around 1300-1820 insertion/removal episodes in total.

I’ve also used a cup in a lot of varied circumstances. I have inserted and/or removed a menstrual cup in my own home, at work, in hotels, at the mall, at the homes of friends and relatives, in hostels, in dormitories, on moving greyhound buses, on moving trains, dozens of times on airplanes and in airports. I have done so in Canada, the United States, New Zealand, Australia, India, England, France, Japan, Ireland, and the Czech Republic. I have used a cup while glamping/car camping/middle-of-nowhere camping, at conferences and retreats, while motorcycle touring, in shared bathrooms and private ones, with no running water, with no running potable water, with no access to laundry, with either hand, and several times (out of desperation) with a nursing toddler on my lap. I have done it well and I have done it badly. I have dropped the cup in the toilet and on the ground. I have managed everything tidily many hundreds of times and I have also spilled menstrual blood on the floor or on my clothing, more than once.

I have an awful lot of experiencing using cups, and I’ve also used a bunch of different cups over varying periods of time. This means that my reviews won’t be based on a a single fumbling first try, nor on longer use of only one product. I can offer observations and comparisons based on long-term regular use in many situations.

Why Menstrual Cups?

What it comes down to is this: for me, even with occasional mishaps, a menstrual cup is far and away the best solution to the problem of dealing with menstrual fluid. No other options even comes close. Cups can be life-changing. For example, while I have reason to believe that my periods have always been in the longer and heavier end of the normal range, they’re not outrageous. But as a teenager, in addition to further complicating my already stressful relationship with gender, they were a significant practical inconvenience, and the products available to me to deal with them were inadequate in a number of important ways that made every period an unnecessary trial.

Disposable pads, even the most absorbent ones, could never keep up with the two heavy days in my period (in which I’d need to change my pad at least every hour, sometimes hard to manage at school) and they often shifted in my underwear unpredictably, allowing sometimes catastrophic leaks to happen. On light days, the extreme absorbency of some pads left my vulva uncomfortably dry, sore, and irritated. The adhesive on pads pulled the fibers out of my underwear, making them threadbare much more quickly than might otherwise be the case, and many times it also stuck to my public hair or my delicate inner thigh skin, causing completely unnecessary pain.

Tampons are superior to pads, not least because they make swimming an option. But for me, tampons either also couldn’t keep up with my heaviest menstrual flow days, requiring too frequent changes, or were far too absorbent for my lighter days (even the supposed “Light Day” versions), when they irritated my vagina and caused sometimes intense pain during removal.

Cloth pads, which I started using at the same time as my cup, and which I love as a backup for my cup, are better than disposable pads in many ways – more reliably absorbent of menstrual fluid, paradoxically somewhat better at staying in place, not damaging to underwear or self, not irritating or painful. Care is unbelievably simple, since I just wash and dry mine in my ordinary laundry with no special treatment, so they don’t add any extra work to my life. And of course, they’re much much cheaper than disposal products over the long term – I’m still using some of the original pads I bought in 2002 15 years later, which really puts the $12 I paid for them in perspective. But, just like disposable products, cloth pads can’t keep up with my heaviest flow days with any reasonable replacement schedule (running out to replace your menstrual product once per hour or once every two hours is not reasonable, in my opinion), they do shift sometimes and allow leaks, and swimming is, of course, not an option.

But using a menstrual cup completely changed my relationship with my menstruating body. Menstrual cups made menstruating “okay” for me in a way that disposable pads and tampons never could. Because absorbency isn’t even a part of the equation, cups don’t cause irritation and pain as a result of dryness. They’re equally comfortably on heavy and light days, and don’t irritate my anatomy. Even on my heaviest days, I can go four hours between emptying the cup without worrying about leaks, which means I can get through a full morning or afternoon at work. On lighter days, I can get through an entire work day without needing to worry about it. I never run out and need to run to the store, hoping they’ll have the brand I like at a decent price. By not relying on disposable products I’ve both saved hundreds if not thousands of dollars over the years, and I haven’t sent thousands of disposable products to landfills. All of that is well worth the occasional mishaps.

Cups work! But some work better than others. Which is why I’m posting these reviews.

How This is All Going to Work

I’m going to rate the menstrual cups I review in three main categories, with a few sub-categories:

1. Material Quality – The material of which the cup is made, its qualities, and how well-suited those qualities make it for the purpose. Will include observations on things like durability, sterilizability, rigidity, discolouration probability, and so on.
2. Design – All of the properties of the cup as a designed physical object with an incredibly practical intended use, such as shape, features, size, and how it interacts with its wearer’s body and function during insertion, internal use, removal, emptying, and cleaning. This categories will be split into three sub-categories:
   1. General Shape – The shape and size of the cup itself, its rim, and its stem.
   2. Surface Details – Any textural details, measurement markings, etc.
   3. Air Holes – Size, angle, other qualities.
3. Ease of Use and Comfort – How likely I think it is that the cup will be easy and comfortable to use for all the various categories of menstruators.

Those ratings will be on a scale of 1-10, and are likely to be imperfectly objective at best. I’ll probably also maunder on for far too long about specific details, because I am a person for whom the details always matter. I’ll try to be thoughtful about when any specific criticism or approval is likely going to be a universal one, versus when it might be unique to me, or limited to people who share certain qualities with me.

I have no monetary or commercial relationship with anyone involved in the manufacture or sale of menstrual cups, nor am I seeking such a relationship. If I criticize or enthusiastically endorse a product in a review, it’s because I genuinely feel critical or enthusiastic about it.

I invite you to comment if you wish. Ask questions, offer feedback, contribute your own experiences with a product. Agree with me, disagree with me. Let’s try to remember that not all women menstruate and not all menstruators are women, and keep the language used gender-neutral as much as possible. Feel free to use whatever terminology makes sense for you for anatomy. Good-natured engagement with language and concepts is never off limits, and making mistakes is understandable, but pointless trolling will result in comment deletion regardless of the specific verbiage used.

Let’s do this.

Ran out of energy on this one while struggling with post-partum depression and the difficulties of raising a young family as a single parent. May return to it one day, but for now if you’re interested in finding out what’s occupying my brain late at night, I’m transcribing old correspondence from my family’s history here:

Write Me A Letter (From The Past): An archive of familiar correspondence

I intended it to be a relatively simple and approachable project, but already I’m finding some of the letters challenging from a gender/culture/religion/normativity point of view.

As I have pontificated testily in the past, if there are inherent differences between boys and girls, we don’t really know what they are, and where differences between genders do exist they are small, and significantly dwarfed by the difference within a gender. In fact, as regards social behaviour, I would contend that it is impossible for us to measure this because children do not grow up in a vacuum. There are gendered messages for children to take in every single day of their lives, from the moment they are born, and unconsciously or consciously, parents, caregivers, older children, other family members all subtly reward behaviour that fits the gendered stereotype, and subtly discourage, ignore or redirect behaviour that doesn’t fit. I spend my time pontificating testily about these topics, and I’m certain that I still do this, because I grew up swimming in the patriarchy just like everybody else. It’s inescapable.

So here’s my theory for boys and girls and gender: boys and girls (and frequently even the kids who fall outside that binary) are very similar in their ability to be socially sensitive to these cues. They are very similar in their desire to please the people around them and to do what is expected of them socially, to fit into their community/pack, to please their elders/protectors, to get along with their friends. There is variability within the genders, and individuals who, for whatever reason, find this fitting in more painful than others. There are communities and families that more harshly reward gendered conformity and others that strives for more individuality in expression, but the children themselves universally try to respond to all of these subtle messages so that they can fit in with their communities and be what it is they are expected to be.

There’s a reason that social ostracism feels so life threatening after all, why our emotions come on so strongly in response to rejection, why we can feel desperate to fit in, and that’s because social rejection was life threatening when communities/family groups were literally the defense against death. It makes sense that kids would come in acutely sensitive to fitting in. They are told they have a role based on a physical characteristic, and they are told each and every day how to perform it. So they do.

Wouldn’t it be nice if I had the time or energy to write a big long post about this and my thoughts thereon? I mean, it would if you like reading the posts I write when I write like that, I suppose. Supposing you don’t, I’d keep it to yourself – I hardly need more encouragement not to write.

Apparently J Crew sells clothing or something? In the states apparently? Whatever. Apparently they decided to put up an ad with a mother and her young son who likes pink nail polish on his toenails. People are all “Yeah, woohoo, buy stuff at J. Crew!” and “OMG, they’re pushing trans-ness on kids, for shame” and so on, because the internet is full of people, giving a shit.

I live with a toddler who loves nail polish and likes nothing more than demanding that the roommate apply it, in specific colours on specific fingers. I have no interest in this, but hey, what they do is what they do. Toddlers like to do stuff with colours. Playdough. Paint. Crayons. Socks. As adults we might code this as feminine but there’s nothing inherently vagina-uterus-clitoris-possessing* about it.

I have a friend or two and family members who seems to delight in pointing out to me when he conforms to gender stereotypes. I’m not sure why. They’re just so pleased by it, and it sometimes feels like they wants to rub my nose in it a little. See Kenzie? There really is something to gender stereotypes!

I never said that there were no differences between boys and girls. All I’ve ever said is that if there are, we don’t know what they are. Not really.**

And one kid conforming to one stereotype is not even data. It’s not even interesting in the bigger picture. Maybe he’s well-coordinated as regards large muscle stuff not because he’s a boy, but because he was carried so much when he was an infant – babywearing and carrying seem to contribute to better balance and physical development of kids at 6 months and a year in some studies. Or maybe because he was born so very very full-term and well-developed and 9 1/2 pounds and he got a head start. Or maybe because that’s the body he came with, part of the normal variation inherent in bodies. Who knows.

So pointing it out and thinking that we know the explanation for it because, you know, penis and testes and a Y chromosome is just so much buying into the concept of the patriarchy. And it’s not neutral. “Boys develop large muscle coordination earlier than girls” feeds right into “boys are more rough and tumble than girls” which feeds right into “boys are more aggressive than girls naturally” which feeds right into all of the horrible narratives about adolescent and adult sexual aggression by boys and men, about men’s natural dominating assertiveness in the workplace, and so on (including all of the complementary narratives regarding girls and women). It’s all of a piece.

And of course, these same people don’t sit around commenting that he’s empathetic like we tend of think of girls being. That he’s a peaceable kid who most of the time likes to get along, like we think of girls being. That his language development is not at all delayed the way we think of boys’ language development being. That he likes pink frilly dresses and his stuffed animals and every baby doll he encounters the way girls are supposed to and boys aren’t.

I frequently feel that people are being unscientific, picking and choosing their data to fit their preconceptions, but that in their opinion I’m the difficult and unreasonable one for not going along with it and just declaring this feminism thing a crock because the kid climbs well.

* I mention these body parts that not all women possess not because I believe that these parts are what make a person a woman (I do not), but because the sort of person who tends to consider maleness and femaleness to be these massive irrefutable inborn and opposite things also tends to believe that being born with these parts is what makes someone a woman and therefore inherently feminine.

** I’ve also said, and will continue to say, that as regards almost everything we think of as dude, so male, and woah, so female can almost always be plotted as two significantly overlapping bell curves. And that there is almost always more variability between two members of the same gender than there is between the genders in general. Height. Strength. Hip to waist ratio. Body hair quantity (before shaving and depilating and lasering). Levels of so-called sex hormones like Estrogen and Testosterone. Even boob size.***

*** Seriously, look around at the men you know. There are a lot of A and B cups around on men. And larger. They’re just not as noticeable as the equivalent ones on women because they’re not propped up on a shelf under a form-fitting shirt. And we’re not looking for them. Sure, most of the very flat-chested people you meet will be men. But not all of them! And sure, most of the D+-cupped people you meet will be women. But not all of them!****

**** Bodies are awesome in all their shapes and sizes and conformations and abilities. Don’t let anyone tell you different.

I’m not American, I’m Canadian, so that means that I live in a country with an integrated military, at least as regards sexualities. Heck, I play in a queer* concert band, and we played a joint concert called “Sounds Like Freedom” with the local army band ten years ago, in part because our conductor was an openly lesbian trombone player and a seargeant in said army band. And for those of us in this situation (you know, in a country where having out gay and lesbian service people did not destroy the armed forces), all this wacky fuss in the U.S. regarding whether or not it’s okay for queer service people to be queer just seems bizarre and nonsensical. And of course, full of very real consequences for people’s lives, like any enforced closet has, including for straight people.

Melissa over at Shakesville just posted about a republican threat to filibuster the new sorta kinda repeal of Don’t Ask Don’t Tell. As usual, she’s right on the money, but I did have an interesting thought when I read this bit:

When he says he’s going to “support the men and women of the military,” naturally he means only the straight ones.

You know, when people are homophobic shitheads, they probably hate homosexuals so much that they think they’re doing them a favour when they enforce the closet. Like, queer folk are probably deep down inside grateful that they don’t have to come out and tell their shameful secret to world. So in a sense, they probably do think they’re supporting queer people. They’re dead wrong, of course.

* I’m using “queer” here, as I often do, to indicate the broad LGTBA community.

There will, of course, be spoilers for Season 1, which is all I’ve watched so far. This is a warning re: such, and I’d really really appreciate it if you didn’t comment with spoilers for seasons *past* Season 1. Any such spoilers will a) make me all angry and annoyed, and b) not be approved. Thanks.

Read the rest of this entry »

When changing birth culture meets fighting rape culture – Spilt Milk gets this so right and says it so clearly. This is a must read. In particular, this is the part that really got my attention:

When a woman has a hand or an instrument inserted into her vagina whilst she screams and thrashes out her non-consent, and when this action is sanctioned by society because it occurs in a medical setting (and because it is believed it must be for the ‘safety of her baby’ if carried out in this setting, regardless of whether or not it was medically indicated or evidence-based care), we have a problem.

But read the whole thing.

I committed to writing a post a week for the month of May on the above topic, because I attended a session called Social Media, Social Justice at the Northern Voice 2010 conference, and we were asked to make a concrete commitment in some area of social justice that was near and dear to us. This is post #1.

Although of course these posts are going to be about the medical and religious procedure most commonly know as circumcision, but let me first speak about values.

When I use the word values, I mean the moral weight and reasoning that we use to evaluate the world. We all have values, most of which are unspoken and unacknowledged, and they aren’t universal, even though it feels very much like they are. Values also aren’t entirely logical, though we can usually rationalize them, and our values can over time change through education and experience. I think it’s important to be able to speak our values so that people know where we’re coming from, so here’s a few of mine.

Value 1: People who choose to parent children have a responsibility to protect them from harm. This seems perhaps obvious, but there’s a lot of uncertainty on what that protection means. And what harm means, for that matter*. Nonetheless, once you know or suspect that a harm is occurring or likely will occur, it seems to me that by choosing to be a parent (an undoubtedly complicated choice) you also make a choice to take on the responsibility of protecting your child from that harm.

Value 2: People are more important than concepts. Concepts, including values and religious ideas, are intangible. And of course, they can be important. But for instance, it’s very difficult to say whether a concept has been harmed by someone’s actions or how great that harm is. Concepts need people to define them, to explain them and to speak for them. Concepts do not and can not exist without people.

Value 3: Actions should be judged by their effects, not by their intent. Good intentions do not erase the actual bad effects of the things we do. Knowing that a friend meant only good when they served a meal full of allergens doesn’t make the allergic reaction any less, for example. Unintended bad effects are no less bad.

Value 4: Adults, in my world, get to do whatever they want to do with their own bodies. Any marking, piercing, modification or amputation that an adult wishes to do or have done to their own body is or should be their right. There is nothing we possess more totally than our bodies, they are entirely our own.**

Given that these are my values, I know very clearly where I stand with regards to medical or ritual male or female infant or youth genital cutting, sometimes known as circumcision or mutilation. It is, quite simply, wrong.

My values tell me that it is wrong to permanently alter the bodies of children and infants without their consent (and as children and infants they cannot consent to this). It is wrong to cause them pain for no medical benefit, perhaps the most excruciating pain of their lives, and this is true regardless of what the reasoning behind the pain causing is. It is wrong even when “pain relief” is used, as this is rarely sufficient to remove all pain and can cause further problems and damage. It is wrong to risk their lives, their health and their sexual future for aesthetic reasons.

Next post: Some musings on religion and the clash with values.

*I suspect the concept of harm in parenting is based on another set of values. For instance, if you believe that children are inherently “sinful” and/or inherently inclined to be uncooperative, then you’re going to view things like punishment and rigid parenting practices and a child’s behaviour very differently than if you believe that children are inherently community-minded and inclined to want to get along with others. For the record, my beliefs re: children and therefore my practice as a parent tend more along the latter values set.

**I want to state this because I don’t want to be misinterpreted as saying that cutting/amputation/body modifications are a wrong in and of themselves. In my view, these are neutral acts, and their morality is decided by the context in which they take place.

Over at Mothers for Women’s Lib. Check it out!

Cult of Mommon over at Letters from Gehenna. In general, read the whole post, but in particular, this bit:

The “gift” of motherhood is a trap, simultaneously erasing investment and effort and commitment and choice and dedication and making it unconscionable to express displeasure, talk about issues, have postpartum depression, express a realistic picture of what it is to have a baby. It erases the experience in order to replace it with something clean and pristine that can be adored without contemplation of consequences or actual respect for the real efforts of mothers.

An Interesting Parallel and
Parallels Part 2 over at Keyboard Revolutionary. My teaser for you:

So what does it mean when another wielder of authority says, “Do what I say or your baby will die”? Are they looking out for your best interest….or are they a bully, a rapist, an abuser, deliberately playing on your unignorable instinct to protect the ones you love in order to get what they want from you?

My opinion: doctors and obstetricians who manipulate and coerce women into unneeded surgery are committing assault. They need to know that this is what they’re doing, and the ones who don’t care and won’t change need to be prosecuted.

Single Serving Pie in a Jar. I need canning jars and pastry. Stat.

When to Bear DownThe woman may be told to “push” when the presenting part appears at the vulva; to do so before then incurs the risk of the os not being fully dilated.

The natural urge to “bear down” is experienced by the woman when the presenting part reaches the pelvic floor, so then would seem to be the proper time for her to be encouraged to do so. If she is told to “push” as soon as the os is fully dilated and the head has not descended to the pelvic floor, she fritters away her energy and will have no strength left to push properly when the need arises to overcome the resistance of the perineum.

(Some authorities do not approve of encouraging the woman to make any expulsive effort and do not find prolongation of the second stage because of this.)

I’m amused at how accurate this is 40 years later and how little it resembles second stage protocols I’ve seen in hospitals lately. An OB telling a primip to push at 9cms “to dilate your cervix” would be the most egregious example, but in general there’s a lot of checking and checking and checking and then “Hurrah! You’re fully! Start pushing!” Definitely no waiting for descent.

In general, allowing women to push in whatever way seems best for them when the time comes is the best policy. There’s no need to direct women in how to push and when to push, since as is noted in the final paragraph above, it’s not necessary and may not even speed things up appreciably. It’s really the uterus doing the pushing after all, not a muscle we have a lot of conscious control over, unlike the abdominal muscles. Purple pushing, where a woman is told to hold her breath for a count of whatever while pushing is not good – can cause a drop in oxygenation, is very exhausting, and may not allow the time necessary for proper rotation to occur at specific points, perhaps causing shoulder dystocia, among other problems.

Most women pushing spontaneously and in response to their body’s cues do so while letting air escape, perhaps by grunting, groaning or letting air hiss out between their lips, instead of holding their breath completely, and instead of tucking their chin in to their chest (as is often recommended by birth professionals), may rotate their neck or drop their heads back at various points. This kind of pushing is still very effective at helping babies emerge, and there’s no need to make a birthing woman wrong if she’s not doing it the way a birth professional prefers.

Previous: Part 1: I maunder on about my experiences as a doula
Part 2: Statistics
Part 3: Illustrative Non-Fiction
Part 4: The more things don’t change

But then, I’m kind of an optimist. Or perhaps the better word would be idealist, although I think we are wrong as a society to say “idealist” with the kind of sneer. If we do not ask for and strive for the ideal then we’ll never come close. Asking for a compromised position right off the bat means that the eventual product will inevitably be even more compromised (just look at the current American health care debate for a prime example of that).

As I said before, I don’t believe that all or even most doctors and registered midwives are evil people looking for the quickest and most painful way to hurt people. That’s ridiculous. Of course most of them are caring and well-meaning people. I say that even though I’ve witnessed quite a few fairly ignorant or arrogant people in the field, one or two exceptionally abusive and manipulative individuals, and rather a lot of folks who exhibit that passive “just following orders/my protocols/our customs” well-intentioned uselessnes.

But the problem is this. The system is broken. It did not and does not have women’s best interests or the best interests of their babies at heart. It is a fraud.

A 30% c-section rate (and a 19% primary c-section rate) is not a bug, it is a feature of the broken system.

That some women would choose to give birth unassisted because they fear what they will experience otherwise at the hands of the medical system, this is also a feature. Unassisted birthers can be used by the mainstream model to make homebirth seem extreme and outlandish, something that only those crazy hippies or religious fundamentalists would do.

I say that as someone who chose to give birth unassisted, and who feels that this can be an awesome valid choice for some folks, but that it should never feel like the only choice available.

When I say that I believe people are well-intentioned, I should also say that it’s time for folks to face the fact that intentions really don’t matter. Or at best they matter only a little bit. What matters is not what you intend, it is what you do. It is the real results of your actions in real people’s lives. If you as a provider through your action or inaction facilitate 20% of of your clients right into unnecessary surgery with very real and significant impacts on their life, health, future fertility and reproduction and on their future children’s life, health and births, but you meant well, it doesn’t reverse the effects. It doesn’t change the real effects that a cesearean scar on her uterus and belly produce.

It seems to me that with a system as broken as this there are only two ethical choices. The first is the actively try to fix the system from the inside. The second is to work outside the system to provide another option for women. I suppose, now I think of it, that there’s a third ethical choice, which is get out of this business entirely. Passively continuing within the system, acting in such a way that you perpetuate the harm that it does, this is not an ethical choice.

I’ll be honest, I’m not sure if it is possible to fix the broken system from the inside, but if you are a care provider within the medical model, there’s a lot you can do to try. Here’s a few suggestions:

• Practice research-based care.
• Accept that women are individuals, their bodies are individual, and there is a wide range of normal.
• If a rule is a bad rule, don’t follow it.
• Don’t induce women at 38 weeks, at 39 weeks, at 40 weeks, at 41 weeks, at 42 weeks because you’re pretty sure she should deliver by now.
• Actually, don’t induce them at all if you can help it. Women will, for the most part, go into labour spontaneously when they and their baby/ies are ready.
• Don’t hold the threat of induction over their head, ever. “If you don’t go into labour by 42 weeks, we’re not allowed to do a homebirth.”
• Don’t encourage women to induce “naturally”. We do not know exactly causes labour to start spontaneously, but we know that it seems to be a combination of factors regarding readiness for both mother and child. Knowing that, it seems foolish to think that a “natural” induction would be any less dangerous than an “unnatural” one. I would suggest that there is no such thing as a “natural” induction.
• Actively encourage home birth for all women, low and high risk, since this is actually supported by research. Don’t force it, of course, but assume as a matter of course that this is where birth occurs. Research has shown repeatedly that hospital birth is not as safe as home birth.
• If a woman prefers a hospital birth, do not admit her to the hospital before she is in active labour (4 cms).
• Do very few cervical checks. Do none if you can manage it. Learn to gauge the progress of her labour using other less interventive signs.
• Intermittently monitor the fetal heartrate with a stethoscope instead of using continuous electronic fetal monitoring.
• Accept that it is not uncommon and not pathological for labour to proceed in a less than straight ahead fashion. Pauses and breaks in labour are actually quite common and don’t mean the process is broken and needs fixing.
• Learn about non-narcotic comfort measures for women in labour.
• Accept that there is a difference between pain and suffering, so that just because a woman is experiencing pain, that doesn’t mean she is suffering.
• Accept that you don’t need to rescue women from their birthing process.
• Learn to sit on your hands. A lot. Birth needs very little “doing”. If sitting on your hands isn’t a good option for you, learn to knit. Embroidery is probably another good option. Machine quilting might be a bit much.
• Buy a good quality labour and birthing pool and make it available for your client’s births.
• Don’t transfer women to the hospital or start otherwise intervening because of arbitrary timelines that have nothing to do with what is actually happening for her in her body. This includes long early labour, long active labour, long pushing stages, long periods with membranes released before the birth of the baby.
• Use antibiotics responsively, not automatically.
• Practice informed consent. Be able to articulate the benefits and problems inherent in the interventions you do offer or that clients request, so that nobody ever says, “if only someone had told me what this could do”.
• If a woman has PROM (premature rupture of membranes), do no cervical checks at all. Be watchful for signs of infection and encourage good hydration and nutrition, but otherwise just be patient.
• Talk a lot more about nutrition with your clients, since this is one of the only things actually shown by research to make a difference in the health of women and their babies.
• Study methods to safely facilitate vaginal breech birth.
• Keep mother and baby together in the period immediately following birth (out to a half an hour or more). They need each other.
• Practice expectant management of the third stage of labour (delivery of the placenta).
• Leave the cord intact until the placenta is delivered.
• Foster friendships with likeminded individuals in your field. Have someone you can call when you think things aren’t going as they should.
• If a cesarean is necessary, be as humane as possible. Don’t let a hospital’s rules get in the way.
• Don’t be a martyr. Take good vacations. Get sleep at night. Spend time with your family. Birth work is unpredictable, but try to just live your life.
• Take good naps at homebirths and eat good food. Nobody needs your attention 100% of the time, and it can be reassuring for women if her care providers remain relaxed and low key.
• Get help to deal with stress. Foster positive relationships in your personal life.

Perhaps you already do some of these things. Perhaps these do not seem like workable suggestions to you. But if not, ask yourself why and own your answers. And feel free to add your own in the comments section.

Previously: Part 1: I maunder on about my experiences as a doula
Part 2: Statistics
Part 3: Illustrative Non-Fiction

I didn’t stop being interested. I hung around with a lot of unassisted birthers online. I didn’t stop reading or following research. The evidence for less interventions or for only appropriate usage of interventions keeps piling up, they reversed the prohibition on “allowing” women to go past 41 weeks without inducing them, a vancouver doctor did a massive study on episiotomy and proved once and for all how useless and dangerous it was and the rate actually dropped, there are positive changes.

At the same time, the rate of positive change is very very slow, and it often seems like for every one step forward there’s half a step back and one step off in a complete other non-helpful direction. I’ve been witness to two births in the last couple of months, one a homebirth and one a very interventive hospital birth. It was night and day between the two.

The homebirth was a VBAC and resulted in a home waterbirth to a beautiful baby. This was after the mother was told she couldn’t possibly have a homebirth after a previous cesarean. She then asked her care providers whether she could at least labour in a tub of water in the hospital and was told that of course she couldn’t. Irrirtated at being undermined at every turn in her very reasonable and safe wishes for her birth, she sought out a traditional birth attendant who had no problem facilitating her (safe) homebirth.

The hospital birth was of a young woman having her first baby with registered midwives as her caregivers. It was truly shocking to me. It was as though someone had brought to life my old story of the cascade of interventions. The fact that the birth ended in a c-section was all so unnecessary, every step along the way so unsupported by the available research.

It’s sometimes mind-boggling that as a birthing community, in which I include doctors, midwives, doulas, OBs, pregnant women and partners and all the rest, we can know the right things to do or not do. We can have the research in front of us, from well-executed and documented studies and trials and we can have it for years with every new study backing it up, and yet the reality of the abuses that occur in mainstream birthing all in opposition to what we know continue. Does spontaneous uninterfered with birth just not have a great marketing department? I don’ t know, and I sometimes feel very discouraged.

Next: Part 5: The system is broken. What next?

Previously: Part 1: I maunder on about my experiences as a doula
Part 2: Statistics

The last birth I went to as a doula was for an aboriginal woman and her husband who had been referred by a friend of a friend. I met them, literally, outside the hospital’s door when they were going in for an induction. She was only 38 weeks pregnant, but was diabetic and her doctor was quite concerned that her baby would be enormous. “Huge, 10 pounds at least!” was the way it was quoted to me.

She was pretty chilled out about being induced early, because with her previous child, now an active three-year-old, she had been induced at 38 weeks as well. 10 hours later she was holding her vaginally birthed baby in her arms. Hard to argue with that record of success, and although I suggested that perhaps waiting at least another week would be a good idea, big baby or no, I could see that this idea was falling on deaf ears. I didn’t say much.

She went in for her induction in the evening and they gave her prostaglandin gel applied to her cervix. Her cervix was “unfavourable”, which is to say, nowhere near ready for giving birth, but the induction happened anyway. By 1 a.m. she was having frequent sensations and was throwing up – often a good sign of progress in birthing. This continued through the night. Her husband wouldn’t lie down and sleep for an hour to remain rested, so when morning came they was pretty exhausted, but they were both convinced that things must be going swimmingly and the birth would be soon.

The OB-of-the-day arrived and checked her and her cervix was as it was before, not dilated at all, not effaced, still posterior. Still, in other words, unfavourable. But still, her sensations were still frequent, and so the doctor started her on pitocin. The sensations became more uncomfortable and during one when she was moaning through the sensation a nurse poked her head in the door and said, “You look like you’re in pain. I’ll get you some demerol.” She came back and put it in the IV, I think. This, by the way, is an excellent example of the kind of “informed consent” that is often demonstrated in hospital births. She wasn’t asked whether she wanted it. She wasn’t even asked if she was in pain or suffering. She wasn’t presented it as an option with these pros and these cons. It was just given to her.

Once the pitocin was started, of course, external fetal monitoring was put on next. The contraction monitor worked consistently, but the baby, as babies pretty consistently do, kept moving around and the monitor would no longer be correctly placed so that the nurse would come in and fuss with the monitor, get the baby heart swooshing away on the speaker again and then bustle off, only to repeat the scene five or ten minutes later. She dozed with the demerol for quite a while, not even feeling her contractions any more and her husband and I dozed too in uncomfortable upright chairs against the wall.

The OB-of-the-day kept coming in and telling the nurse, who had already been upping the pitocin on schedule, to up it some more. At one point the nurse said, “We’re already at the limit that we’re supposed to use for an induction.”

The OB replied, “This is an augmentation, not an induction. Up it some more.” The nurse bit her tongue and did as she was told.

Every time she was checked her cervix was unchanged. Or no, a little changed. Effaced (thinned) to two fingers instead of three, still not dilated at all, but perhaps less posterior. This was considered to be progress.

Finally, after 24 hours from the first prostaglandin gel and about 2 hours before the OB-of-the-day was supposed to end her shift, the OB came and inspected the situation.

The baby was healthy as a horse, moving around, repeatedly bashing and kicking at the monitor, strong heart rate throughout, so they couldn’t use fetal distress as their reason for a c-section.

For some reason (because her cervix never dilated much most likely) they had never gotten around to rupturing her membranes, so they didn’t have that artificial timeline on their side, something to point to with assurance for why they needed to do a c-section.

Since she’d had a previous large baby vaginally it would be very difficult to argue cephalopelvic disproportion (where the pelvis is too small or narrow to allow the passage of the baby’s head).

And of course, they couldn’t just let her go home, say, “Oops, our mistake, your body wasn’t ready.” Not with that enormous ten pound baby inside.

Nope, they needed an ironclad irrefutable reason to cut this woman’s belly open. So they told her her baby was breech.

How big was that baby, do you think? 7 pounds, 3 ounces. And showing signs of prematurity. And sleepy, oh so sleepy, wouldn’t get on the boob and nurse, not for days and days and days. I lost track of them when she went home to her active three-year-old with her belly cut open.

It’s not like I did them any good. And while, as I say, I kind of suspect I just really wasn’t very good at this doula thing, I’m not sure that another doula could have improved things, prevented the outcome. I realized that as a doula I didn’t have any power to change the system. I might be able to occasionally help a woman emotionally or practically, but I would be witness to so much abuse. I stopped going to births as a doula.

Next: Part 4: The more things don’t change
Part 5: The system is broken. What next?