Share The Love: Valentine's Giveaway

I'm hosting a Share The Love Giveaway on Valentine's Day. I already have three fantastic items: a bottle of Avishi Organics Intensive Repair Oil ($38.50 value) plus a batik ring sling ($60 value) and an infant scale sling ($25 value) from Second Womb Slings. I'd love to add more items to this giveaway--here's how you can play a part!

If you own a small business, make handcrafted items, or sell products that would interest Stand and Deliver readers, I'd like to invite you to submit an item for the giveaway. Please include photos and a brief description of yourself & your company. I will open the giveaway on Valentine's Day, so please submit your item by Monday, February 13th.

As the owner of a small business, I love finding ways to connect with parents looking for slings. I hope this giveaway can others spread the word about the amazing things they make and sell!

11 months old!

Remember when I wrote about how I felt that Inga and I were more than one but not quite two? Well, that is no longer the case--she's definitely her own separate person now. She has developed so much personality. And attitude (mostly cute, even when she's upset). She's thrown her first few tantrums when someone takes away a toy or food. She will shake her head no if she doesn't want the food you offer. She's learning how to interact with her siblings; I'll catch her trying to join in the same silly games they're playing. If I were to choose adjectives to describe Inga, I'd use vivacious and silly and content (usually) and happy.

She's so close to walking. We've seen her take a few steps, once in the bath of all places. This is from last week--it was more falling than walking. But today both Eric and I saw her take a few steps all on her own.

She can stand up on her own without pulling up on something. Like this.

hat from Danish Woolen Delight

She loves standing in the middle of a room and taking it all in. She's started signing "potty" back at me when I signal her to pee. Her version is opening and closing her hand into a fist. She loves clapping her hands. She's learned how to climb up and down stairs. I'll often have to go up one or two flights of stairs to find her! She has figured out how to climb up our step stool and reach on top of the kitchen counter. Nothing is safe anymore.

She tried the same trick at the playground but only made it up one rung.

She's not eating much food--mostly little tastes of table food plus lots of Cheerios.

This is what Zari wants to say about Inga:

She likes to play with toys, crawl, stand up, learn how to walk. I give her toys sometimes. I love her. She likes playing with her bear. She likes to eat everything. That's all. Actually something else: she likes her mama. She likes to eat dirt. She likes to do what I'm doing. We play Follow The Baby with Inga. I love my family and Inga. Inga likes to suck on orange peels. She likes to play with toys in the attic. She likes Dio. I love my family so much and we lived happily ever after. The End. That's all.

New blogs

My blogroll is in serious need of updating. Part of the problem comes from me constantly discovering new blogs that I have to follow. Like the wickedly funny Labor and Deliverance, written by an OB practicing in the South. His recent post Is a Cesarean right for you? Of course it is! was spot on. Then there's The Many Colors of Changing Woman written by a Native American CNM. It's as serious and reflective as Labor and Deliverance is irreverent. (Recently many of her posts have been disappearing; they show up on my Google Reader but are gone from her blog. What's up?)

I read a lot of things besides birth blogs. I just added Design Seeds and the affiliated fresh news for color inspiration. I like Little eco footprints for ideas and inspiration about living more lightly on this earth. And Mother Wheel for the fun to seeing what happens when you mix Paganism & Mormonism.

So tell me, what blogs have you recently fallen in love with?
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Baby #4 is on its way!

It's coming some time in March!

I've been involved with this book project since the 2009 Lamaze conference in Orlando, where I met two LDS childbirth educators: Beth Day and Katy Rawlins. We talked about the intersection of LDS spirituality and birth and agreed that someone needed to write a book about it. When we returned home, we connected with Felice Austin and other women, and eventually this book project was conceived.

The Gift of Giving Life: Rediscovering the Divine Nature of Pregnancy and Birth is a book written for LDS women and families. It contains collections of essays and stories connected to childbearing, including infertility, adoption, breastfeeding, prenatal/postpartum depression, pregnancy, and birth. (I contributed an essay about Heavenly Mother and a birth story about Inga's resuscitation.) The twelve chapters address these topics:

• Our Legacy
• The Importance of Giving Life
• Personal Revelation
• Patience
• Preparation 
• Meditation
• The Spirit-Mind-Body Connection
• Fear
• Pain
• The Atonement
• Unity
• The Fourth Trimester

My favorite part of the book are the incredible stories we received from hundreds of LDS women. We received so many stories that we could only accept a portion of them; imagine how difficult that task was!

To get a feel for the book's content, you can read The Gift of Giving Life blog. You can also read excerpts of the book here.

This book would be perfect for LDS women and families in their childbearing years. The book's release date is scheduled for March. In the meantime, the publisher is accepting discounted pre-sales here. If you order now, you can save 10% off the list price.

New CDC report on home birth

The CDC's National Center for Health Statistics just released a report on home birth (PDF) . Filled with graphics and easily understood language, this report is visually appealing and accessible to the lay public. This report, titled "Home Births in the United States, 1990-2009," has spurred a NPR report and CNN news article.

Home school or public school: What if you don't like either option?

Zari is 5 years old and will be kindergarten age next fall. Ever since she was born, I've been telling myself that I'll do whatever schooling option is best for her needs and best for our family. The problem is, the  right option hasn't become any clearer in the past five years. I'm just as undecided now as I was then. To be honest, I don't really want to home school and I don't really want to send her to public school. But I live in a small community with only one school system--no charter schools, no alternative schools, nothing but One-Size-Fits-Most schooling.

I find myself resisting arguments for either type of schooling. Home schooling advocates can seem so...evangelistic in their enthusiasm for home school and their implicit (or explicit) critiques of public school. I just can't buy into the "public school as prison" mentality that gets passed around. I also have serious reservations about how I'd be able to find the time and energy to home school when I have a baby and a toddler to look after (and hopefully one or two more babies down the road). I believe in having a balanced life, and adding home school would seriously skew the lovely equilibrium I have right now. If I added home school, I don't know what I could subtract to keep my commitments at a doable level.

I also get the feeling that Zari needs something more. Honestly, she's bored and antsy a lot of the time and then starts acting up in subtle ways because there isn't enough for her to do at her level. Much of my day is taking care of necessary tasks: getting children dressed and fed, walking around town running errands, cooking meals, and tidying up. As mundanes as these tasks are, they still need to be done.

There's a Christian homeschooling association in town, which could offer Zari opportunities for interacting with other children. But I'm not super enthusiastic about the Christian part (even though I am Christian, I'd prefer to keep education and religion in separate spheres).

With my hesitations about home schooling, you're probably thinking "then just send her to public school!" But I am not thrilled about that option either. Our school district moved to full-day kindergarten before we moved here, and half-day isn't even offered anymore. In addition, the district closed all of the neighborhood elementary schools. Even though we live kitty-corner from an elementary school, Zari would have to ride the bus to the consolidated mega-school that serves our entire city. 

I have other misgivings about public school, some specific to our town and others in general. Like I mentioned, we have just one district so there aren't any other options or alternatives. There is one "high ability" classroom from kindergarten through high school, which Zari would likely be placed in. But that also means that she'd be with the same group of peers her entire time at school!

My general hesitations about public school stem from the inefficiency of classroom learning, from peer culture, and from the lack of time for free, unstructured play. I am reluctant to put my children in a classroom for 7 hours a day, when they could easily learn the same amount of information in just a few hours with one-on-one instruction. When I was in elementary and middle school, I was bored much of the time. I'd finish my homework in a few minutes and spend the remainder of class time reading or drawing. In middle school I'd read one or two books every day during school hours.

A common concern voiced about home schooled children is their lack of "socialization." (And I'll admit it, I've met some very, very strange, awkward home schooled children. Of course who knows if they'd be just as odd if they went to public school...) But I don't like a lot of the socialization that goes on in an institutional school setting. Besides the Big Bad Things that children learn from their peers (sex, drugs, alcohol), there's a lot of Little Things that bother me just as much: learning from peers how to be catty, to be a picky eater, how to form cliques, how you're supposed to only interact with those your own age.

I also firmly believe that children need plenty of time to just be children. This means free time to play, to wander around the neighborhood, to ride bikes, to climb trees. The 7-hour school day encroaches on this enough as it is, but then kids are sent home with homework. It's enough to ask little bodies to sit at desks for hours a day. But to send them home with even more work? Criminal.

I'm also really hesitant about having to adhere to an institution's rules. We travel a lot and I want the freedom to take our kids out of school when I want to. The public school does not coordinate its schedule with the university, so fall, Christmas, and spring breaks do not coincide. If Zari goes to school, then suddenly I am not in charge of my day anymore; I am tied to an institution's routines and hours. I resent that loss of freedom.

My ideal situation would be a school that met only in the mornings, that spent much of the time outdoors doing hands-on learning, and that never had homework. Alas, that does not exist here.

I seriously need advice.

Brand Baby

From Adbusters, a spoof ad titled "Brand Baby":

Upcoming conferences of interest

February 3-4, 2012

University of Utah, College of Nursing Auditorium, Rm. 2300

Sponsored by:

• The Utah Affiliate of the American College of Nurse-Midwives (ACNM)
  
• The University of Utah College of Nursing
  

This conference will be of interest to all women's healthcare professionals. Local and regional midwifery and women's healthcare providers and researchers will present on a variety of topics, including:

• Clinical approaches
• Evidence based practice
• Research
• Theory
• Philosophy
• Community, public and educational projects

Click here to register.

~~~~~~~~

Transforming Pregnancy Since 1900

29–30 March 2012
Department of History and Philosophy of Science, University of Cambridge

Poster promoting prenatal care, c.1936. Library of Congress, Prints & Photographs Division, WPA Federal Arts Project Poster Collection (LC-USZC2-5511).

Around 1900, few pregnant women in Europe or North America had any contact with a medical practitioner before going into labour. By the second half of the twentieth century, the hospitalization of childbirth, the legalization of abortion and a host of biomedical technologies from the home pregnancy test and IVF to obstetric ultrasound and prenatal genetic diagnosis promised unprecedented control. New regulatory frameworks, changing relations between expectant mothers and medical practitioners and technologies for diagnosing, monitoring and intervening in pregnancy offer rich histories to explore. With scholarly writing predominantly dispersed among local studies of maternity care or focused on specific innovations, we lack a synthetic account of transformations in the management, experience and understanding of pregnancy across the whole twentieth century. This conference aims to break new ground by investigating the making, organization and communication of knowledge around pregnancy among experts and laypeople in Britain, France and the United States since 1900.

This interdisciplinary conference will bring together scholars with expertise in the history, sociology and anthropology of reproduction. Talks will be 10-minute summaries and commentaries of pre-circulated papers, followed by discussion in 50-minute slots in such a way as to promote dialogue and critical engagement between fields and approaches.

• Salim Al-Gailani (University of Cambridge): Folic Acid: Making a Technology of Pre-Pregnancy
• Caroline Arni (University of Basel): The Psychic Life of Pregnant Women: Early Twentieth-Century Prenatal Psychology
• Tatjana Buklijas (Liggins Institute, New Zealand): Fetal Physiology, Nutrition Research and the Origins of the Barker Hypothesis
• Angela Davis (University of Warwick): 'Heroes and Stoics': Women's Narratives of Maternity Care, c.1945–1990
• Rose Elliot (University of Glasgow): Abortion, Miscarriage or Criminal Feticide? Medical Understandings of Early Pregnancy Loss in Britain, c.1900–1967
• Ofra Koffman (King's College London): Temporary Crisis or Life-Long Disorder? Adolescence, Unwed Motherhood and Mental Pathology
• Ilana Löwy (CNRS, Paris): Looking for Malformations, Looking for Risks: Fifty Years of Prenatal Diagnosis
• Aryn Martin (York University, Canada): 'Something there is that doesn't love a wall': The Elusive Placental Barrier in Medical and Popular Health Discourse
• Deborah Nicholson (University of the West of Scotland): 'Unseen Citizens': Ultrasonic Fetal Images and Narratives of Life Before Birth
• Jesse Olszynko-Gryn (University of Cambridge): Diagnosing Pregnancy in the 1930s
• Amanda Raphael (Independent Scholar): Deep Breaths and a Nice Cup of Tea: Antenatal Education Since the 1950s
• Leslie Reagan (University of Illinois): Avoiding 'Monstrous' Babies Through Prenatal Care: Rubella, Girls, and Vaccination

The registration fee of £30 (£15 for students/unwaged) includes lunch and tea/coffee on both days. To register, please fill in the registration form and send it with a cheque for the registration fee (made payable to 'University of Cambridge') to:

Salim Al-Gailani
Transforming Pregnancy Conference
Department of History and Philosophy of Science
University of Cambridge
Free School Lane
Cambridge
CB2 3RH

Registration form

Organisers: Salim Al-Gailani (Department of History and Philosophy of Science, University of Cambridge), Angela Davis (Centre for the History of Medicine, University of Warwick) and Jesse Olszynko-Gryn (Department of History and Philosophy of Science, University of Cambridge).

Supported by a Wellcome Trust strategic award in the history of medicine to the Department of History and Philosophy of Science, and the Cambridge Interdisciplinary Reproduction Forum.
For further details, contact Salim Al-Gailani .

Life imitating art imitating life

A reader sent me this photo of a woman nursing her baby at the Fountain of the Four Seasons. Located at Iowa State University's Memorial Union, the fountain was created in 1941 by artist Christian Petersen.

More information about the fountain (source):

Placed around a circular fountain the four seated American Indian women represent an Osage chant of thanksgiving. The four women face north, south, east and west, each demonstrating a line of the prayer: The first women is planting the seed, “Lo, I come to the tender planting.” The second bends close to the earth, “Lo, a tender shoot breaks forth.” The third holds a harvest basket of maize, “Lo, I collect the golden harvest." The forth nurses her newborn baby, “Lo, there is joy in my house.” These four sculptures are carved from bedford limestone and are placed around a circular base of terra cotta which is sculpted with a corn relief. Artist Christian Petersen took these notes during the sculpture's early stages:

Full water display symbolizes the fullness of the elements . . . arch of the sky . . . the lifegiving rains . . . the calmness of the Indians in the face of the turbulence. . . tranquil water . . . tranquility of the Indians. . . much water symbolizes elemental turbulence.

Currently reading

Sometimes I come across a topic I want to know more about and start reading everything I can get my hands on. One recent interest was abortion providers. I wanted to learn why someone would choose this line of work given the violence and persecution they face. I first read Suzanne P. Poppema's book Why I Am an Abortion Doctor, followed by Susan Wicklund's book This Common Secret: My Journey As an Abortion Doctor. The writing in both books was so-so, but the stories were gripping. During my searching I also read a lecture by Dr. Garson Romalis, also titled Why I am an Abortion Doctor. I just finished the book Dispatches from the Abortion Wars: The Costs of Fanaticism to Doctors, Patients, and the Rest of Us by Carol Joffe and am still wanting to read more.

I have to say that the more I read about abortion debates in North America, the more incensed I become at the whole mess. In the past, I'd never strongly identified with either of the two ideological camps. I had understood abortion as a morally complex issue laden with shades of gray. It wasn't something I would have chosen for an unintended pregnancy after consensual sex (I've never been in that situation, so it's easier said than done), but definitely something I would have considered for other situations--rape, incest, threats to my health, etc. I've  never felt that abortion should be illegal or inaccessible. There are so many reasons, so many situations, that bring women to that decision and I find it incredibly arrogant that some people want to take away that option across the board. Abortion won't go away simply by being illegal or inaccessible.

As I've been reading more, I find my feelings intensifying. I dislike how both pro-life and pro-choice rhetoric victimizes women: Pro-life groups portray women as victims of their abortions ("abortions hurt women"); pro-choice groups portray women as victims of their pregnancies and of the lack of access to abortion. Is there a way to talk about abortion without casting women as victims?

The hypocrisy of many pro-life arguments, which glorify motherhood (by wishing all women to become mothers, however unwilling) yet do nothing to actually support mothers or babies, incenses me. I'd much rather see that energy focused towards helping women avoid unwanted pregnancies; securing universal health care, paid maternity/paternity leave, affordable quality childcare, and flexible work arrangements; and ensuring that all babies are wanted and that women can become mothers willingly and joyfully. That is pro-life. Not the hateful rhetoric that values an embryo more than the woman whose body carries it.

Overall, I find the North American obsession with abortion puzzling and troubling. It distracts people from more pressing issues. It's focused on symptoms, not on underlying problems. It's like nit-picking over whether or not a bandaid is the right shape while the patient is hemorrhaging to death.

Iknow that discussing abortion will bring out the crazies, but I had to get this out. I cherish my children and my babies. I love being pregnant and giving birth. I also want abortion to be safe, legal, accessible, and, ideally, rare*--not because I don't value life, but because I value it so highly.

[Deep breath]

I remember reading a book during my graduate student years by a sociologist (or maybe anthropologist?) who spent time with both pro-choice and pro-life groups and explained the worldviews and values of both camps. I can't remember the title but it was really interesting. Any more recommend readings on this topic? 

Note to commenters: Keep it civil and on-topic otherwise I will employ the Almighty Delete Button. 

* Dr. Wicklund mentioned that, ironically, one goal of abortion providers is to work themselves out of their job by helping women avoid unwanted/unplanned pregnancies in the first place. But the challenges are immense: lack of access to health care and contraception, partner sabotage of birth control (including threats of violence for using birth control), our hyper-sexualized yet hyper-prudish culture, etc.

Christmas Craft #1: Felted wool sweater blanket

My family likes to make things. When we get together for Christmas, we usually have a large family project. In past years, we've done silk painting, soap making, jewelry making, book binding, and fishing pole making. This years' family project was handmade wooden marble runs, one for each sibling with children. More about this in an upcoming post.

We also have lots of individual projects going on during the holidays. This year I went 100% natural and 100% recycled using felted wool sweaters. After I saw this tutorial for a felted wool sweater blanket, I started collecting wool sweaters. I've fallen in love with Goodwill Outlets, where everything is sold by the pound! Once I had enough cream and gray sweaters, I made this:

It was my Christmas present to my family. We use it every day. And it probably cost me $5!

Fine print:

• I straight-stitched all of the seams, then went over them with a wide zig-zag stitch. Some sweaters felted better than others, and I didn't want anything to unravel. 
• I made sure that all the outside edges and corners had finished edges. Because of that, I didn't put a backing fabric on or do anything else to finish the edges. 
• My blanket was made of 9" squares (except for two double-sized pieces): 6 blocks wide and 8 blocks high.

10 months old!

I was looking through similar posts from Dio's babyhood and getting really nostalgic. I love the baby stage so much and feel sad when it's over. I don't know how I'll ever be able to decide that I'm "done." But I don't think I'll keep on having children indefinitely, either. I'm 33 so one or two more children seems about right. Plus finding a vehicle becomes really tricky once you have more than 7 passengers!

Self-portrait

So, let's talk about what Inga is up to: she's cruising the furniture all the time, and a few nights ago I caught her standing up all by herself for about 5 seconds. I wouldn't be surprised if she walks fairly soon. Zari did at 10 months, while Dio took a bit more time and walked right before his first birthday.

Other new skills: pointing, clapping her hands, saying "mama mama" (it may or may not mean anything, though), pulling books off the shelf, "jumping" on the designated jumping bed, fast crawling, can climb up & down one stair.

Those little pointers. Picture by Zari.

Sleep: Most nights she goes to bed at 7:30 pm and wakes up to nurse twice around 3 and 6 am. Then she's up for the morning around 8 am. Because she's sleeping in, she's starting nap only once per day about half the time. It's been nice being on break from teaching an 8 am class. All of us sleep in until 8 am--lovely!

EC/diapering: Like with my other two kids, I potty Inga at regular intervals, either after naps or during diaper changes. She'll often pee for me, but lately she's been so busy that she doesn't want to sit down long enough to go. No big deal. Poops are more tricky since she usually goes in the early morning before she wakes up. Dio's been out of diapers for a while now (except for a backup one at night, but he's mostly dry at night, too).

Food: I've started letting Inga have tastes of food this month. She usually gets a handful of Cheerios and frozen peas when we're eating breakfast, then bits of fruits or vegetables during other meals. She's not a big eater, so most of her nutrition still comes from me. She likes to grind her top and bottom teeth together, just like my other two children. Sounds like she has a mouthful of rocks.

Now & Then: birth to 10 months

1 week old

10 months old

Lying down is for babies!

2 weeks old

10 months old

Those pesky legs kept coming up. Zari tried to help.

A simple Christmas?

I follow a few design blogs (Little Green Notebook and more recently Centsational Girl, after I found her board and batten tutorial). I saw CG's home tour a few weeks ago and laughed at how she described her holiday decorating:

I’m keeping it simple, my decor this year is mostly garland for scent, poinsettias scattered here and there, ornaments in various vessels, and always branches ~ simple touches since I want to spend most of the next week enjoying the twinkle lights, the baked goodies, the traditions, and our family.

Beautiful and magazine-worthy? Yes. Simple? No. 

My definition of simple Christmas decorating goes like this:

1. Buy a tree (but only on years when we'll be at home for Christmas)
2. Decorate the tree with hand-me-down ornaments from my own childhood. Nothing matches and I love it that way. 
3. Put up a nativity set and felted wool stockings for the kids
4. Done!

Now I don't think there's anything wrong with elaborate holiday decorating. But there's also no need for false modesty. If you do something that you're proud of, own it. It won't spoil the effect if you are upfront about how much effort it really took.

While my decorating is definitely simple, my family's style of get-togethers is definitely not. We hosted my entire immediate family. With 17 people staying in our house and 19 people total, it was chaotic (in a good way) and busy and productive. We ate amazing food, spent lots of time reading and talking and playing games, and worked on several projects. My dad made wooden marble runs for the grandkids and helped me with several electrical/wiring projects. Pictures coming once I get around to it!

I'll end 2011 with a picture taken on Christmas day after church and before we opened presents.

 

Birthingown giveaway winner...

is the commenter known as "University of Utah Student Midwives"!

I need you to contact me ASAP with your mailing address. If I don't hear from you, I'll select a new winner on Monday.

Birthingown Giveaway!

When I was at the Lamaze conference this fall, I met the creators of the Birthingown. Finally, a maternity gown that's as beautiful as it is functional! Designed by a L&D nurse, this dress makes the laboring woman feel beautiful and works with any kind of birth--from active & unmedicated to high-intervention.

The Birthingown is an Empire-waist wraparound dress in a soft, curve-hugging rayon/lycra jersey. It crosses over in the back, rather than the front, allowing for anesthesia access without requiring the woman to disrobe. Unlike typical hospital gowns, which don't even come close to covering a woman's backside--especially when she's walking and swaying--the Birthingown's generous knee-length wraparound design keeps everything fully covered. Each shoulder flap opens to allow easy access for skin-to-skin contact and breastfeeding, as well as IV/BP lines. The top of the gown is fully lined.

Just imagine if you arrived at L&D and the nurse greeted you with your choice of Birthingown, rather than those frumpy hospital gowns!

coco & pink Birthingown

Where to buy:
Birthingowns are sold at several brick-and-mortar stores around the US and Canada. Online vendors include BellaBlu Maternity and Stella Maternity. 

Cost: retails around $65. Deep discounts available for bulk orders. Custom fabric colors available. Please inquire for details.

Now for the fun part...

I am thrilled to offer this coco & blue Birthingown to a lucky winner! If you're an expecting mom, you get an extra chance to enter the giveaway. You can also earn an extra entry by creating a funny caption for the hospital gown photo below.

 
 Giveaway rules:

• To enter, visit the Birthingown website and leave a comment about what you like best about the gown
• Open to US or Canada residents
• Expecting moms get an extra entry--leave another comment, please
• Contest ends at sundown on Winter Solstice (aka 5 pm EST on December 22nd)
• Extra entry to anyone who submits a caption for this photo and makes me laugh out loud:

Robin Lim named CNN Hero of the Year

Robin Lim, a midwife in Indonesia, was just named the CNN Hero of the Year! She was well-known among many midwives in Iowa (where I did my PhD work), where she practiced before moving to Bali. Here are some excerpts:

Robin Lim, an American woman who has helped thousands of poor Indonesian women have a healthy pregnancy and birth, was named the 2011 CNN Hero of the Year on Sunday night.

Through her Yayasan Bumi Sehat health clinics, "Mother Robin," or "Ibu Robin" as she is called by the locals, offers free prenatal care, birthing services and medical aid in Indonesia, where many families cannot afford care.

"Every baby's first breath on Earth could be one of peace and love. Every mother should be healthy and strong. Every birth could be safe and loving. But our world is not there yet," Lim said during "CNN Heroes: An All-Star Tribute," which took place at the Shrine Auditorium in Los Angeles and recognized Lim and the other top 10 CNN Heroes of 2011....

[Christy] Turlington Burns introduced Lim's video tribute during Sunday's show, before the Hero of the Year announcement. As founder of Every Mother Counts, she is also a passionate advocate for maternal health around the world.

"Eight years ago, after giving birth to my first child Grace, I felt what could have been a life-threatening complication," she told the audience of nearly 5,000. "It suddenly got very scary, very fast. If I hadn't received the expert care in the hospital birthing center I was in, then I may have not been so fortunate.

"My wish is that every mother all over the world has the same chance surviving childbirth I had. My friend Robin Lim shares that wish and she spends her days and nights making it so."

Read the rest here.

It was just a dream

Last night at 1am Zari burst out of her room yelling at the top of her lungs. Think 5-year-old girl imitating Braveheart. She yelled all the way down the hall and ran into our room. Once Eric got her calmed down enough to talk, this is what came out:

"Papa, papa, il y a un oiseau dans ma chambre!" Dad, dad, there's a bird in my room!

Of course we knew that was totally silly and that she'd had a nightmare. Eric assured her,

"Je crois pas qu'il y a un oiseau dans ta chambre. C'etait un cauchemar. Viens, je vais voir." I doubt there is a bird in your room. You just had a nightmare. Come, I'll take a look.

He found a bat flying around in her room.

This called for my superior bat-catching abilities; I've caught at least 6 bats in the past few years. Here's how you catch a bat:

1. Get a medium-sized bath towel.
2. Close the doors to the room if possible.
3. Swat at the bat every time it flies by you. Bats tend to fly in circles when they're trapped indoors, so it's pretty easy to swat them down. You have to really snap the towel quickly. Once it falls to the floor, throw the towel over the bat and gently pick it up.
4. Release outdoors.

Eric settled Zari down, then came back to bed. About a half hour later, he woke up convinced that there was a bat in our bed. (He does this fairly regularly. Over the years I've had to fend off attacks when he thought some creature was on top of me and assure him that no, there really wasn't a giant lobster-sized centipede trying to attack me.)

I told him, "There's not a bat in the bed. You're just having a dream." I used my best mother-telling-her-child-she-had-a-nightmare voice.

"Are you sure?"

"Yes. It was just a dream. Go to bed."

White Paper on Cesarean Deliveries & Opportunities for Improvement‏

The California Maternal Quality Care Collaorative (CMQCC) has just released a White Paper: Cesarean Deliveries, Outcomes, and Opportunities for Change in California: Toward a Public Agenda for Maternity Care Safety and Quality. More information below:

For immediate release
December 8, 2011

In California, surgical delivery of babies, also known as cesarean delivery, has jumped 50% over the last decade with no demonstrated improvement in outcomes over normal vaginal childbirth, according to a new study released today.

Cesarean deliveries now account for 32% of births in California, raising the potential for increased rates of surgical complications, infections, risks in future pregnancies, and much higher costs to patients and society, the report said.

While cesarean deliveries are often performed for medically necessary reasons, the report from the California Maternal Quality Care Collaborative (CMQCC) identified dramatic geographic variation with rates ranging from 9% to 51% among low-risk women having their first baby. This large variation among California regions and hospitals cannot be explained by medical factors alone and therefore suggests that labor management practices and local attitudes help drive the use of cesareans during labor.

Reasons for the increase also include: physicians' concerns about medical liability and avoidance of risk, as well as specific labor practices such as the increased reliance on labor induction, early labor admission, lack of patience in labor, and the virtual disappearance of vaginal birth after a prior cesarean, the report found.

"Over the last 15 years, cesarean deliveries have become so common that in some hospitals and communities they are considered 'normal births' despite the increased risks," said Dr. Elliott Main, medical director of the CMQCC and a practicing obstetrician.

"The most serious and often overlooked risk for a woman having a first cesarean is the increased likelihood of having a cesarean delivery in subsequent pregnancies. Currently, in California, if a woman has her first birth by cesarean, over 90% of all her subsequent births will also be by cesarean, each with escalating risks," said Dr. Main.

Undergoing multiple cesarean deliveries markedly increases the chances for complications, such as life-threatening hemorrhage due to placental implantation problems.

There is also strong evidence that babies born by cesarean delivery without the contractions of labor (i.e., scheduled), have significantly higher rates of neonatal respiratory problems than those born vaginally.

The cost of a cesarean is nearly double that of a vaginal birth — $24,700 compared to $14,500. The Pacific Business Group on Health (PBGH), a co-author of the study, estimates that these additional cesareans cost public and private payers in California at least $240 million in 2011 alone. An effort to reduce cesareans could save California between $80 million and $441.5 million a year depending on the number of cesareans prevented.

However, the study says that reducing cesarean deliveries will not be easy and a multi-pronged set of strategies will be required. The study recommends that hospitals, doctors, and insurance companies (including Medi-Cal, which pays for over half of the births in California) band together to develop quality improvement efforts to reduce first-birth cesareans among low-risk women.

The program would need to include sharing best practices with real-time benchmarking; public reporting on a balanced set of quality measures; payment reforms to eliminate incentives for cesarean delivery; and broad-based, statewide educational outreach to foster a balanced view of cesarean delivery and its short- and long-term consequences.

With planning grant funds from the California HealthCare Foundation (CHCF), which also funded this report, CMQCC is leading an effort to develop a California Maternal Data Center to achieve these goals. The project has recently received major funding for statewide implementation from the US Centers for Disease Control and Prevention's Division of Reproductive Health.

"To help hospitals and doctors in their efforts to improve pregnancy outcomes, we need a robust source of timely maternity care data," said Dr. Main. "And once the data is vetted we will want to share the results with women so they can make informed decisions."

The report, Cesarean Deliveries, Outcomes, and Opportunities for Change in California: Toward a Public Agenda for Maternity Care Safety and Quality, is available for free download from the CMQCC website

Sleep miracle

Four nights ago, we put Inga's crib in a separate bedroom in the hope that she would sleep better. The bedroom is very dark, we moved the white noise machine over, and no one else is sleeping there. Turns out that was the perfect combination: Inga has slept like a champion the past 4 nights! She wakes up once around 3 am to nurse but otherwise sleeps a full 12 hours. Wow.

She hasn't once stood up in her crib; I think the pitch-dark room keeps her more interested in sleeping than in trying to see what's happening. I haven't slept this well for a long time, probably since halfway through my pregnancy. I stayed in her room after she nursed on the first night, since I didn't know what to expect. But now I'm coming back to my bed after I nurse her, since I can expect she'll be asleep until at least 8 am.

I sleep so much better when my newborns are right next to me in bed. Even when they're in a nearby crib, I can't relax as well. Then the months pass and all of a sudden neither of us sleep as well when we're together. Zari has always been a sound sleeper, but she became more and more wiggly as she got older; she went into her own room around 20 months. Dio and Inga were both more sensitive to our noises and movements and left our bed around 5-6 months of age. So yes, I love co-sleeping until it stops working for one or both of us!

I probably could have moved her out of our room a month or two earlier, when she started to have longer and longer sleep stretches and before all of her developmental milestones caused her to wake up so often. But I'm just happy that we're both sleeping so soundly. Here's hoping the trend continues!

You're Doing It Wrong: Nursing Cover Edition

Thanks for your witty submissions for my nursing cover caption!

This one scored highest on my laugh-o-meter:

Close runner-up:

9 month pictures

Curious girl

Showing off her teeth

3 siblings

Zari took this picture...

...and this one

We like to make animals out of bread

And then we eat them!

9 months old!

Inga developed so many new skills between 7 and 9 months. She started crawling right around 7 months and learned how to pull herself up to standing at 8 months. Now she's cruising the furniture, sometimes using only one hand. She's also mastered a speed crawl. This past month, Inga got two more teeth, so now she has a matched set of top & bottom teeth. The fourth popped through this morning.

Maybe those teeth explain why her nighttime sleep has completely deteriorated. It's a good thing that Inga is so cute and content during the day, because her sleep has gone down the toilet over the past month. Ever since she started standing up, she wants to do it all the time, even at 3 am. Instead of squirming and fussing when she wakes up at night, she immediately pulls herself up to standing in her crib. This, of course, wakes her up completely and then I have a wired baby on my hands who won't fall back asleep for 1-2 hours. (She'll stand in her crib, jump up and down, point and babble at the windows or light fixtures. If I bring her into bed with me, she crawls around and plays with our faces. Anything but sleep.) She's also been waking very frequently all night long--often every sleep cycle. The best stretches I've been getting this past month is 2 hours at a time. So between the frequent waking and the night "parties," I am totally wiped out.

When people joke about how parents of newborns are sleep-deprived, I just laugh. For me, the first 6 months are so much more restful than the next 6 months. Newborns just nurse and sleep, nurse and sleep. It's when they start rolling around and crawling and standing up that their sleep--and consequently mine--goes to pot. Give me a newborn any day!

I've mulled over possible strategies with my friends, my sister, and my husband. But honestly, now that I have 3 kids I have learned that I know nothing about raising babies. It's SO easy to think you know it all with your first. Then you have more kids and everything gets blown out of the water. So my strategy is to wait it out. Her sleep will eventually get better, right? RIGHT?!?

We did take one fairly drastic measure today: we moved Inga's crib out of our room and into an empty bedroom down the hall. (She's been sleeping predominantly in her crib for the past 2 months; she has become more sensitive to our noises and movements and sleeps better in a crib than with us.) Maybe this will help? I have a feeling I'll be sleeping in that bedroom a lot for the next few months, but at least I can have my own bedroom back. It will so fun to actually turn the lights on and not have to creep around in the dark. I can even flush the toilet and brush my teeth and not worry about waking Inga up! The things you think are awesome when you are a parent...

So onto another parenting topic: solids. I'm still withholding solids but Inga is quite adept at picking up every crumb that falls off the dinner table. She's as good as a dog! Her diet lately consists of peas, Cheerios, pomegranate seeds, and popcorn kernels. I've also let her gnaw on apples and sugar snap peas. Between Inga's frequent night nursing and delayed solids, my cycles still haven't come back and I am quite happy with that.

Pictures coming soon!

Birthplace in England: A Tale of Medical Reporting

A large prospective study comparing planned place of birth (home, hospital, freestanding midwife units, and in-hospital midwife units) for low-risk mothers in England, the BirthPlace study, was just published in the British Medical Journal. What has followed is a barrage of news headlines about the study--with drastically different conclusions.

If you click on the Daily Mail report, you'll be warned that "First-time mothers who opt for home birth face triple the risk of death or brain damage in child." TopNews Arab Emirates reports that "Motherhood is bliss but a minute mistake in planning the birth may lead to severe complications," while its US affiliate asserts that "According to a recent study, first time mothers should always opt for hospital birth." Even more dramatic is NewTonight's comment that home birth is "an extremely dangerous practice." (Definitely some one-upmanship going on here!)

If you're thinking that home birth is akin to traipsing over a minefield, you only have to turn to another set of news headlines that herald the opposite conclusion. "Study finds home birth is safe" proclaims the Peterborough Herald. "Women who have low-risk pregnancies should be able to choose where they give birth -- hospital, home or midwifery units -- researchers in Britain say," according to UPI. The Huffington Post declares that "over half of all pregnant women could give birth at home."

I've seen one report claiming that Professor Peter Brocklehurst, one of the study's authors, has "expressed disappointment that there is a significant increase in the number of first -time mothers who are planning to deliver their baby at home." (Granted, this was not a very reputable-looking site.) In contrast, the Huffington Post quoted Brocklehurst thus: "Birth isn't an abnormal process, it's a physiological process. And if your pregnancy and labor is not complicated, then you don't need a high level of specific expertise."

If news reports are this conflicting, imagine what's going on in the blogosphere. "SEE I TOLD YOU HOME BIRTH KILLS BABIES!" is coming from one corner of the net, while "SEE I TOLD YOU HOME BIRTH IS SAFE!" is coming from another. This controversy will keep certain bloggers entertained for months.

At this point, a reasonable response would be "what the $#@! is going on? Can't anyone agree on anything?"

Another reasonable response would be "So what about midwifery units? All the hullabaloo has focused on home and hospital birth and left out the other two studied locations!" 

This is how I'm feeling right about now:

I'm not going to tell you what to think. But here's where I'd suggest starting:

1. Read the original study.
2. Read the official National Health Service discussion of the study's significance and ramifications.
3. If your statistical skills are a bit rusty, you can polish them up over at Science and Sensibility's statistical discussion of the study.
4. Another statistical examination of the study: Are homebirths really risky? at Statistical Epidemiology

Original Study
Birthplace in England Collaborative Group. Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study. BMJ 2011;343:d7400

Project details, including qualitative case studies and economic analysis
http://www.sdo.nihr.ac.uk/projdetails.php?ref=08-1604-140

News reports emphasizing risk

• Home birth 'carries higher risk' for first-time mothers BBC News
• First-time mothers warned over home birth risks The Daily Telegraph, November 25 2011
• Home births three times more risky than hospital, says study Metro, November 25 2011
• Women with low-risk pregnancies 'should have birth choices' The Guardian, November 25 2011
• First-time mothers who opt for home birth face triple the risk of death or brain damage in child Daily Mail, November 25 2011
• Home as safe as hospital for second births The Independent, November 25 2011
• Home birth risks up for new mums The Sun, November 25 2011
• Home Birth Imposes Higher Risks for First-Time Mothers MD news press release
• Home birth riskier for first time moms Press TV
• Home Birth Can Be Dangerous for a Baby TopNews Arab Emirates
• Hospital Birth Safer As Compared To Home birth TopNews United States
• Home birth 'carries higher risk' for first-time mothers International News Network
• Home births riskier for first-time moms: Study IBNLive

News reports emphasizing safety

• Study finds home birth is safe Peterborough Today (UK)
• British researchers OK birthing options UPI.com
• Home Birth a Good Option for Second-Time Moms Associated Content
• British Study: Half Of All Pregnant Women Could Give Birth At Home Huffington Post
• England study: Low-risk births don't need hospital Aurora Sentinel

I need a guinea pig!

A new company Intimina recently contacted me about reviewing their Laselle Kegel exerciser. I don't have any underlying pelvic floor issues, so I offered to find someone more appropriate to test and review the device. (If I didn't know what these were, I would have guessed some kind of baby toy!)

If you'd like to try it out, send me an email describing why you'd be a good candidate. If I select you, you agree to test the Kegel exerciser and write up a detailed, honest review. The device will be yours to keep in exchange for doing the review.

The problem with nursing covers

On the surface, nursing covers seem to be the perfect solution for moms who want to breastfeed but are uncomfortable doing so in public. Moms can nurse "discreetly," passers-by aren't made uncomfortable by seeing a woman's breasts in action, and babies can eat when they're hungry. Nursing covers are often marketed as breastfeeding helps. According to some of the most popular nursing cover sites, they "allow you to breastfeed anytime, anywhere." You can "nurse discreetly and in style."

Are there any potential downsides to nursing covers? In this post I explore how nursing covers may do a disservice. Here are some of the reasons why:

1. You need to see it to learn it
In order to breastfeed successfully, women need to watch other women nurse their babies. A lot. They need to see how to hold a newborn, how to help them latch on, how to deal with those pesky arms, how to adjust an uncomfortable latch. They need to see it again and again, until those actions become so ingrained that they become second nature.

As I argued in my presentation at the 2011 Lamaze Conference, breastfeeding in a modern, Western context is like learning a foreign language. We no longer speak breastfeeding fluently. In earlier times, it used to be our mother tongue, but now most of us are second-language speakers. Hiding breastfeeding underneath a blanket keeps us from gaining fluency in this language. It's the equivalent of trying to become in French by reading textbooks, but never hearing spoken French or going to a French-speaking country. It is nearly impossible to become fully conversant in a foreign language without interacting with native speakers.

2. Caution: Keep Out
Nursing covers ghettoize breastfeeding by creating an artificial divide between public & private breastfeeding, then labeling public breastfeeding as inappropriate unless carefully hidden. They perpetuate shame and guilt for an essential, life-giving act. The cultural mandate to hide breastfeeding extends into private spaces; some women use nursing covers even in designated mother's lounges! Covers draw attention to an act that would otherwise be easy to mistake for holding a sleeping baby.

3. One (unnecessary) degree of separation
Nursing covers make breastfeeding unnecessarily complicated by placing a layer of fabric between the mother and her baby. This layer keeps mothers and babies from making eye contact and visually interacting. Many covers have attempted to compensate for this by incorporating a rigid band of plastic or metal band that arches the fabric away from the mother's chest and allows her to peek at her baby. It's a solution to a "problem" that doesn't need to exist in the first place.

4. Hiding hooters & covering udders
Nursing covers reinforce women's status--and their breasts in particular--as objects of sexual desire. (Hooter Hiders, anyone?) By hiding breastfeeding, they send a message that nursing a baby is the equivalent of a sexual act.

The photos below, taken from the Udder Covers website, show women in sexually alluring makeup and poses. This first photo shows a heavily made-up woman with false eyelashes, bleached hair, and an inviting, seductive expression. You could easily transplant her head onto the body of a Victoria's Secret model selling lingerie or swimwear.

This next picture shows models with whitened teeth, false eyelashes, and carefully groomed hair. It sends the message that showing skin is acceptable, as long as it is not in the context of breastfeeding. Bare shoulders? Fine. Cleavage? No problem. Breasts in action? No way. 

Sometimes nursing covers do not sexualize women; instead, they make them look entirely asexual.

I mean, who wants to wear an bib? That's so toddler. Even with a cute floral print.

5. The problem is cultural, not individual
Nursing covers hide the fact that disapproval of nursing in public is a cultural problem. Instead, the rhetoric of "covering up" frames breastfeeding as an individual person's issue that can be solved with the right product. (I'm not confident enough to nurse uncovered. I don't want to see women whip it out. Nursing is okay but I feel it should be discreet.) By keeping the focus on the individual, nursing covers keep us from seeing the issue as a cultural one.

6. Breastfeeding: The anti-porn
"But what if my 12-year-old boy sees it?" My response would be "Awesome! He'll have a healthier view of the female body by seeing breasts in their proper function." The pornographic view of breasts sees them as objects of male desire. A functional view of breasts--not hidden under a cover, not exposed with the intent to arouse sexual desire--sees them as objects that nourish and comfort.

Nursing covers ultimately aren't an aid to breastfeeding--they are a well-intentioned tool that inadvertently undermines breastfeeding. The solution to breastfeeding in public isn't to hide it under a bib; it's to make nursing so ubiquitous, so everyday, that the divide between nursing in private and nursing in public disappears. I long to live in a culture where there is no such thing as "nursing in public"--a place where breastfeeding is, simply, breastfeeding.

Reader Challenge:
This photo is begging for some awesome captions. The best caption gets the official Stand & Deliver seal of approval.