Politics

It's time for a short political aside.

So, I was talking with my mom last night about the upcoming elections. She's traditionally voted Republican--she identifies most with Minnesota's Progressive Republican tradition. For this election, though, she is voting differently. She said that she, and many of her women friends who have voted Republican in the past, are supporting Obama. She's very disenchanted with the direction that the Republican party has gone, and with the choice of McCain & Palin in particular.

I've been enjoying Hathor's new comic, Mama Is, and in particular her views on Palin, white privilege, and family values. Lots of heated discussion going on in the comments section there.

But enough of all this serious stuff. I think humor says it better for the most part. You've got to read My Gal from The New Yorker. It is hilarious, especially if you have ever taught freshman composition (misplaced modifiers, run-on sentences, and terrible grammar galore!).

I don't know about you, but I was squirming in my seat when I watched Sarah Palin's interview with Katie Couric. If you haven't watched it, you really should. Then watch this SNL take on the Palin-Couric interview:



And this SNL classic with Palin and Clinton is also a scream!

Norwegian princess gives birth at home

Maertha Louise, the oldest child of King Harald V and Queen Sonja of Norway, gave birth to her third baby at home yesterday.

I was intrigued and wanted to learn more about what it's like to have a baby in Norway. I wasn't able to find much on birth practices specifically, but I found several articles about Norway's generous maternity and paternity leave.

For those of you interested in history, here is an excerpt from a January 1952 issue of The American Journal of Nursing, called "Having a Baby In Norway" (vol. 52 n. 1, p. 50-51.) It's a fun snapshot into Norway's birth practices a few generations ago:

If a woman goes into labor, she calls this [emergency hospital and medical services] number, and she is then sent to one of the municipal hospitals which has an empty bed in its maternity division. If she has planned to have a private obstetrician, she has previously registered at a small private maternity hospital. Midwives attend all normal deliveries--in both private and public hospitals--and almost all deliveries are done in hospitals. The midwife usually has only one patient in labor, and the patients generally do not receive much medication. If medical aid is needed, an obstetrician is always at hand or on call. Of course, in the isolated areas of North Norway, the midwife must carry the whole responsibility herself.

There are two midwifery schools in Norway. The course lasts one year, and many midwives are not nurses; the student must deliver fifty babies before she can graduate. Although at the present time not all midwives are nurses, a new regulation which went into effect last year requires them to take nurse training first and then take midwifery training as special or post-graduate work. In the larger hospitals, only nurse midwives are in charge of maternity units...

There are a few mothers' classes, but not enough, and fathers' classes are unheard of. Nurses and midwives complain .that women know very little about childbirth and pregnancy, although good books on the subject are available. One popular woman's magazine has published a series of articles on relaxation exercises, following Dr. Read's theory. A class based on "natural childbirth" is offered in Oslo, but it is so overcrowded that some women who wish to take it are turned away. As a whole, Norwegian women are very much interested in natural childbirth. The Norwegians are sport-loving people--everyone skis in winter, hikes and swims in summer--so physical exercises appeal to them, and the young women have had well developed muscles from childhood on.

Birth Quilt

Thanks to Susana for pointing out this beautiful birth quilt. You can read more about the quilt's story here. Maybe I've found a new post-dissertation and pre-baby project--making my own birth quilt!

Midwife shortages, rise in home births in UK

Over the past two days, I've seen several articles about projected midwife shortages and a rise in home births in the UK. The government has promised all women their choice of birth place by the end of 2009, with a target goal of 10% home births by 2010, but in some areas midwife staffing is inadequate to ensure that. (If a woman is booked for a home birth, but all midwives are busy when she goes into labor, she will be asked to go to hospital.) The UK has also seen a recent rise in the national birth rate, making the midwife shortages even more pronounced.

• Number of births at home on rise
• Midwives recruited
• Home births boom as more women fear hospital infections and midwife shortages

For an in-depth exploration of women's experiences of home birth in the UK, including UK-specific midwifery issues, I suggest reading Birthing Autonomy by Nadine Pilley Edwards.

New and used cloth diaper sale

A woman whose blog I follow is selling some of her new & used cloth diapers. There are minky pockets, fitted Goodmamas and Thirsties, matching diaper/dress sets, wool longies, and more. I think the prices are in Canadian dollars.

Have patient's rights undermined obstetrics?

Several recent posts have touched on the issues of informed consent, patients' rights, and the importance of respecting maternal autonomy in decision making. I came across an article yesterday that left me dumbfounded: How I (and my OB colleagues) swindle patients into thinking that their decisions make any sense. It's a short blog post written by an anesthesiologist, plus a repost of another anesthesiologist's piece of writing, "How Obstetricians Ruined Their Lives (And Mine)."

Let me repost the two excerpts here, and then add some commentary:

Dr. Diastolic wrote: Call me old fashioned, but I am not alone. I often believe that patients don't have the capabilities to make proper decisions about their clinical options. When the issue is childbirth, excuse me, patients are often nuts. Just witness the epidemic of home childbirths!

Dr. S.W. McFee of Parkville, MO wrote to the American Society of Anesthesiologists Newsletter: "How Obstetricians Ruined Their Lives (And Mine)."

If the tone of this epistle is less cordial than you’re used to, well then so be it. I’m feeling a bit surly.

It is 0230 again. We could have done this case nine hours ago. The sun was still up, and she’d been stuck at 6 cm longer than the life cycle of some butterflies. We should have done this case nine hours ago, but the patient “really wanted” to delivery vaginally. Apparently becoming a mother just wasn’t enough, and the actual avenue of the child’s arrival had some bearing that I, as a sleep-deprived and callous male, just couldn’t grasp.

She had been told that the baby was too big and that a primary C-section was indicated, not what she wanted to hear. She doctor-shopped until she found one who agreed with her diagnosis. It doesn’t always happen this way, but this time we got a meconium-stained, cone-headed, floppy baby that required resuscitation. I guess that balances with the patient’s need to labor and attempt an ill-advised vaginal delivery. Or not.

No other specialty has allowed itself to deteriorate to the state of patient control that obstetrics has. We are all concerned about patient rights. We have to be. But come on. Let’s say you have a kidney stone and you present at the urologist’s office wincing with pain but holding in your hand a seven-page stone-retrieval plan and a list of dates that are satisfactory to your social calendar (and as a bonus would make the stone a Libra) – the urologist would and should inform you that his afternoon was booked but that his esteemed colleague from across town would (he’s sure) be happy to see you.

Patients don’t always know best. I’m not suggesting that doctors always know best. I am suggesting, however, that we can make an expensively educated guess and be right enough of the time to eclipse the records of Jean Dixon, Nostradamus or the average meteorologist.

Good medicine should not infringe on the patient’s rights. I’m afraid our brethren in OB have let patient’s rights infringe upon their medicine.

First off--the title of the blog post is confusing. I get that the doctors don't think their patients' reasoning makes sense, but I am not sure how they are swindling women into thinking their decisions do make sense.

Epidemic of home births? Not sure that something that affects 1-2% of the population, and that has been relatively stable since the 1970s, could be considered an epidemic.

The second post accuses the woman of doctor shopping, while in fact her decision to find a physician who was on board with a vaginal birth was an entirely reasonable one. Even the ACOG's practice guidelines note that induction or elective cesarean for a suspected large baby (fetal macrosomia) are controversial and do not seem to yield clear benefits. Some excerpts from the practice guidelines:

Randomized clinical trial results have not shown the clinical effectiveness of prophylactic cesarean delivery when any specific estimated fetal weight is unknown. Results from large cohort and case-control studies reveal that it is safe to allow a trial of labor for estimated fetal weight of more than 4,000 g. Nonetheless, the results of these reports, along with published cost-effectiveness data, do not support prophylactic cesarean delivery for suspected fetal macrosomia with estimated weights of less than 5,000 g (11 lb), although some authors agree that cesarean delivery in these situations should be considered....

In cases of term patients with suspected fetal macrosomia, current evidence does not support early induction of labor. Results from recent reports indicate that induction of labor at least doubles the risk of cesarean delivery without reducing the risk of shoulder dystocia or newborn morbidity, although the results are affected by small sample size and bias caused by the retrospective nature of the reports.

It's not as if the woman had a complete placenta previa at term and went doctor shopping for someone who would agree to a vaginal birth (which would be a bad idea, hands down).

It's also not clear what the eventual outcome of the birth was, although it sounds like it was a vaginal birth. And the existence of molding in the baby's head is certainly not a pathological sign--it's what babies heads are meant to do during a vaginal birth!

And the really bad analogy of childbirth to kidney stones...totally different situations. Add that to the other bad analogies I've seen used in comparison with childbirth: dental surgery, brain surgery (I've seen one article compare home birth to do-it-yourself brain surgery), and broken bones, to name a few.

I was disturbed by the antagonism and hostility directed toward the laboring woman, especially because it kept the anesthesiologist from getting a good nights' sleep. As if it was her personal fault that he was tired, that she had a slow labor. Now birth attendants should be allowed to be human, which means getting tired and grumpy at times. But to take it out on the woman, blaming his suffering on her silly desire for a vaginal birth, is not fair at all.

I fail to see how this story illustrates that patient control has hijacked the practice of obstetrics. I have yet to come across a woman who felt that her physician or hospital staff gave her too much control! I would argue that it's the other way around: coercion, lack of true informed consent, denying women the ability to refuse certain medical procedures (such as mandatory cesareans instead of allowing women to choose a VBAC or vaginal breech birth), failure to follow evidence-based guidelines such as intermittent monitoring rather than EFM, and manipulation to get women to adhere to hospital policies seem to still be common in our current birth culture. What obstetrics needs is more respect for patient autonomy, not less.

Note the doctor's view of long labor (in this case, over 24 hours) as inherently problematic.

A final thought, based on the comment that "We could have done this case nine hours ago." I had an aha moment when reading this, although it's probably not that profound and certainly nothing that original. For many physicians working in the field of childbirth, birth is the end to a pregnancy. From that perspective, it's better to finish things sooner rather than later, because after all it will have to end one way or another. And it is just one day in a woman's life; what's the big deal about waiting it out and causing yourself needless suffering, when we can just end it now, quickly and easily? A woman has her baby and leaves a few hours or a few days later, and for the hospital staff it is the end of the experience.

But for many women, birth is the beginning of a lifelong relationship. It's not about something ending, but something beginning, and from that perspective it is very important to guard the woman's experience, to ensure that she is able to make her own decisions about what is happening to her.

I do have one positive comment, though: I loved the waterbirth picture!

A lawyer speaks about VBAC and informed consent

Sara L. Ainsworth, senior legal and legislative counsel at Northwest Women's Law Center, wrote this opinion piece for the Seattle Post-Intelligencer: High rate of C-section births is health concern for women. From her article:

Both the law and respect for women's humanity require that every pregnant woman be fully informed of the risks of all forms of labor and delivery in a language she can understand; that she be supported in her decisions about how to bring her children into the world, whether it be in a hospital, a birthing center or at home; and that she not be penalized for those decisions either medically or legally....

Policies and practices that force pregnant women to submit to unnecessary surgery cannot be justified. We would never countenance that practice for any other patient. Pointing to potential risk to the baby does not justify ignoring the mother's decisions about her medical care.

Reference needed

I am trying to find a reliable reference for the average length of a prenatal visit with an OB (not the time waiting in the office, but actual time spent with the physician). I know I've come across at least one source before, but can't seem to find it. I'd also like to find the average length of prenatal visits with both hospital based- and home birth midwives, if that has been studied. Can anyone help me with this?

Maternity care in France

I've been corresponding with an American woman who teaches at a midwifery college in France. I asked her about what maternity care is like in France. I think many of us Americans will be surprised at what really goes on there. We sometimes have this rosy vision of midwives in European countries, but the reality can be quite different than the picture we've had painted for us. She traveled to England for a HBAC after no midwives in France would accept her, as she discusses later on in her post. She has several American degrees, then went back and got an MA and PhD in France. She is currently a professor of psychology and does outside teaching in Paris, Nancy, and in Toulouse at the midwifery school, as well as occasional private practice and teaching jobs at international schools. Below are excerpts from our email conversations, reposted with her permission.

Although France has a great national health system, there is a lot that isn't said about it, in my opinion, that isn't great. Ironicaly, NPR did a piece on it this summer. I responded to them as follows:

As an expat living in France for the last 16 years, I always cringe when I hear NPR wax lyrical on the French health system. I will grant NPR (and the rest of the inhabitants of the US) that it is a decent system, its most perfect quality being that the extremely poor and disadvantaged can have access to care. But this doesn't tell the whole story, as your report failed to do as well. While providing comprehensive healthcare is an excellent goal, it isnt the only goal. Although the WHO does recognize that the French system is one of the best, its approach to maternity care is not well-regarded by the WHO. For example, France is a leader in performing excessive numbers of questionable interventions in birth (episiotomies, epidurals, cesareans, etc). I do research in the domain of maternity and breastfeeding, and not only does France have one of the lowest rates of breastfeeding in Europe (how can a good health system allow this?), it doesn't provide any constant or long-term support for mothers after the birth, like the German system does. Your report mentioned the baby nurses--their visits are limited to one visit post-partum! A woman must then motivate herself to go to well-baby clinics, but again, the focus is entirely on the baby, not the mother. So while France does provide excellent care for babies and pregnant mothers, I would submit that aside from the fact that your report glossed over a large number of unpleasant realities about the French system (too many to ennumerate in this comment), it isn't truly focused providing care for new mothers.

France is a VERY medicalized system. Teaching at the midwifery school I see it, and these women are on the fence about it. Some like the medicalizaton; some are horrified. But you have to take a step back and realize that people who are training to be midwives in France STARTED as medical students. After year 1, they do a big test and the best get to go onto medical school, the next best get to be dentists, the next best get to be physical therapists, and the next best can be midwives. In my opinion, a weird way to get people into midwifery to start with.

Toulouse is particularly medically oriented, and so the midwives trained here are little medical robots for the most part. I did direct the thesis of one woman last year who had done her internships in Lyon with an independent midwife (IM) and "discovered" what birth could be. She realized what a rarity she was.

The problem with IMs in France is that they no loner have insurance coverage for home births, not since 2001. There are a few who treat the quasi-legal area and go ahead and do home births ("Too late to transfer"...) but they are rare. And even those who do really, really pick and choose their clients. For example, with one previous c/s I was not an acceptable candidate for any IM here. Which is why I went to England for my hbac attempt. I found VERY supportive IMs there who, ironically, do not have insurance either but instead of letting the system wear them down, they have clients sign off when they engage an IM. Very different reaction from the French IMs.
Really, there are a few supportive midwives here, but they seem to have their hands tied. They won't do home births. They might do really good birth prep classes (which is part of the prenatal care; the classes can range from awesome to absurd depending who gives them). But that is it. And in the hospital or clinic, it isn't obvious who is a midwife and who is a nurse or baby nurse (puericultrice) or whatever.

And don't get me started on breastfeeding. Extraordinarily low rates. Really poor support. Rampant erroneous beliefs about breastfeeding (the biggest one is "breastfeeding will make my baby too dependent on me"... sigh... What is a baby if it isn't dependent??? And why would we want them to be anything but dependent at the beginning???) And extended breastfeeding, snort, we just won't go there, lol!!! (My younger daughter is nearly 3 and still has "nursies." My older daughter had them until about 3 as well. This current one may go longer, but reaction can be quite shocked. I ignore it for the most part.)

Maternity care here is like anywhere else. On one hand, it is a "normal" event but this has transformed it into a factory-style approach (go to hospital, get heplock, get induced/augmented/whatever, get epidural, if you don't progress, get a c/s). If a woman has a traumatic experience it is written off and she can't talk about it ("The most important thing is a healthy baby...") I also do PTSD research in birth here. And to think Odent came from France! But of course, it is obvious why he lives in England now, which is having its own woes with regards to birth and independent midwifery. But I think they will muddle through still providing women with what they want and need for birth. (Did you know that the UK is the *only* country to my knowledge that guarantees a woman the right to birth where she feels most comfortable, despite what medical opinion might recommend: be it home, hospital, a tree, wherever???)

There is such a dopey perception about France and midwifery, and then the fact that Odent came from here makes it an obligatorily "great" place to birth. But then he left, and the "real"countries to birth in are the Netherlands and England, in my opinion.

Treat us like women, not children

Nicole from Bellies and Babies wrote a great post about how pregnant women should be treated as competent, thinking adults. And if they aren't, they should do something about it. It's the kind of post that makes me stand up a little taller and go "Mm-hm, yeah!"

This goes beyond questions of home or hospital, midwife or doctor, natural or medicated. Nicole's own story illustrates the wide range in treatment she received from two family doctors and an obstetrician. It's about asserting our fundamental need for respect, for being treated as autonomous adults capable of making our own decisions.

Current reading list

I have a stack of slightly overdue books that I need to return to the library, so I thought I'd make a list of what I've been reading recently. I checked out several dissertation-related books, some to re-read for citation checks, others that were new to me.

• Mainstreaming Midwives: The Politics of Change
• Vaginal Politics: A Midwife Story
  
• Birthing Autonomy: Women's Experiences of Home Births
  
• At work in the Field of Birth
• Husband-Coached Childbirth
• Birth Crisis
  
• Born in Zion by Carol Balizet (really, really wacky stuff. It took me years to find a copy; the library finally had to order it from the Library of Congress).
• Performing (your own) childbirth: Issues of sexuality and identity in online narratives of unassisted home birth (2002 MA thesis by Amy Donelle Schriefer, George Washington University).
• Lying-In: A History of Childbirth in America
  

A few for enjoyment that caught my eye:

• Shadow Child: An Apprenticeship in Love and Loss
• Our Babies, Ourselves
  

And some pleasure reading: Twilight by Stephenie Meyer. I read the whole 500-page book in one day. I haven't read a lot of vampire lit, other than Sunshine (which has some mouthwatering food scenes and some butt-kicking vampire slaying). The writing in Twilight was okay, but the story was riveting. Now to get my hands on the other 3 books in the series...

Those darned Swiss...

While Americans are busy freaking out over a bit of skin that might or might not be showing due to breastfeeding, one Swiss chef has decided to serve meals cooked with breastmilk. He first started experimenting with breastmilk after the birth of his daughter and shared the following technical hint:

"One can cook really delicious things with it. However, it always needs to be mixed with a bit of whipped cream, in order to keep the consistency."

I think this is the perfect solution to America's anxiety over breastfeeding. Just add it to a few restaurants' menus, and all the controversy will shift away from those indecent nursing mothers who have the gall to nurse in public!

ps--I love the picture featured with the article.

Media coverage of Newman Clinic

A blog reader sent me this link to a recent story about the Newman Clinic's search for funding:
Lack Of Funding Threatens To Close Respected Toronto Breastfeeding Clinic.

An excerpt from the article:

Kernerman said along with a lack of consistent breastfeeding education across the province, many women still feel uneasy nursing in public, and that needs to change in order to improve breastfeeding success rates.

"Breastfeeding, like walking, is natural, but it's a learned behaviour. And so when your child goes and falls the first few times you're not going to say, okay, that's it, it's off to crutches for the rest of your life. No, you're going to pick that child up and you're going to learn how to walk with that child and that child will learn to walk with you," she said.

"And it's the same with breastfeeding. We need to learn, we need to learn by watching women around us breastfeed and we don't see women breastfeed because women are afraid to do it out in public."

My first publication!

I've been working on an article with three other co-authors about why women choose home birth. My role was more behind-the-scenes; I supplied the data for the article and some grammatical/stylistic suggestions to the written manuscript. Anyway, we received this notice today:

"Staying Home to Give Birth: Why Women in the United States Choose Home Birth" has been accepted for publication in the Journal of Midwifery & Women's Health. Your article will appear in the Mar/Apr 2009 issue of JMWH.

No complaining

When I got pregnant with Zari, I vowed not to complain about being pregnant. We had tried for years to have children, even going through IVF once, unsuccessfully. I had a very easy pregnancy, so it wasn't hard to keep my resolve to stay positive.

This time around has been a bit more difficult. I feel dizzy and woozy all the time, as if I've been fasting for a long time. I have a constant feeling of hunger & low blood sugar, but at the same time the thought of food makes me feel icky. Food doesn't taste good when I eat it. And no matter when or how much I eat, I always feel faint and weak. And I get tired fairly easily. Yay for being pregnant! I don't remember having these sensations last time around. Thing is, it's still fairly mild. I haven't ever thrown up. I'm not debilitated. Just a little bit under the weather.

I have found that I feel better on days that I exercise, especially if it's right away in the morning. I go to the gym at least 3x/week and do 30 minutes of elliptical and 10 minutes of rowing. I've tried going every day during the week, but I am just too tired at this point to go every day.

Besides the "morning sickness" (I guess that's what you'd call it?), it hasn't really sunk in that I'm pregnant. When people ask me how I'm doing, I have to stop for a few seconds and figure out what they mean. Oh yeah, I'm pregnant. Kind of forgot.

Visual representations of childbirth

How we visually represent the birth process is not just a minor detail, but a reflection of fundamental beliefs about the nature of birth and women's bodies. In other words, visual depictions of women giving birth are politically charged texts, not just neutral representations of reality.

Take, for example, the almost universal lithotomy (or in layman's terms, stranded beetle or beached whale) position in illustrations of the birth process. This position is certainly not culturally consistent or physiologically appropriate in most cases. It emerged out of a particular set of historical circumstances and has become solidified in Western obstetric practice, despite it being one of the worst positions, mechanically, for the birthing mother. Not to mention more painful for most women! It is, however, more convenient for the birth attendant.

For example, these two 3-D videos of birth, showing the baby in relation to the mother's skeletal structure. They are beautiful illustrations, but of course they show the mother supine.

3D Medical Animation of Normal Vaginal Birth

Normal Birth Animation

My suggestion: tilt your head or your computer screen 90 degrees to view an upright birth (supported squat, birth stool, or sitting on a toilet) and 180 degrees to see birth on hands & knees. A simple but effective technology! If you are a doula, midwife, childbirth educator, or one of those wonderful progressive physicians, you can subvert the message of your existing supine illustrations by simply rotating them around, emphasizing to your clients the importance of giving birth in upright, physiological positions that work with gravity and the maternal pelvis. And, of course, stress that the woman should always have freedom of movement and position changes during labor and birth.

You might also have noticed that both of these animations show just the torso or the pelvis, rather than the entire woman giving birth. This is another artifact of a certain cultural view of birth and of women's role in the birth process. For a more lengthy discussion on this topic, please read Bearing Meaning: The Language of Birth. In particular, chapters 6-8 and 10-11 analyze the changing meanings and representations of birth in both Williams Obstetrics and Our Bodies, Ourselves.

One of the most remarkable departures from the disembodied-supine-torso representation of birth is this series of illustrations from Birth International, an Australian childbirth education and midwifery products company. They designed a series of six charts showing the birth process, designed to enable "women to develop confidence in being able to give birth." The illustrations show "a woman truly giving birth to her child, rather than being delivered of a baby." The charts' purpose is to teach women that they have the ability to birth their babies without assistance. The text comments: "If you want to show women how they can 'do it themselves,' then you need these pictures to reinforce your message."

Note that the charts show the whole woman in relation to the physiological process. The woman is upright and mobile, and because she is close to the ground, needs no one to "catch" the baby for her.





Now, I do take issue with some of the wording in the advertisement--that they are
"the only charts in the world that show birth in its truly natural state"--because the term natural is highly charged with multiple layers of meaning, some that are oppressive to women, some that essentialize female nature, and some that emphasize biological determinism. However, I find Birth International's political project admirable. These charts call into question the "natural" position of lying on one's back, integrate the woman giving birth back into the baby's descent and emergence, and encourage confidence and power in the birthing woman.

Marketing advice for ACOG

I first met Jill through her comments on my blog. She's outspoken, and irreverent. And she just had a home birth after a previous cesarean! (Although technically it wasn't at her own apartment, but at a rental house that belongs to one of her midwife's parents. Minor detail, though.) I thought you would like her post about how the ACOG could take some lessons from the food industry. She likens the ACOG's attack on home birth midwifery--which is now the second most important issue on its state legislative agenda--to:

McDonald's, a multibillion-dollar worldwide corporation, attacking a little mom-and-pop restaurant for making a chicken sandwich similar to theirs. I don't get it. If you're truly that upset about that measly 1% not coming to you for that service, MAKE YOURS BETTER. If you want to win them back, then improve what you have to offer. Don't continue in the same unpleasant vein that drove that 1% away from you in the first place, or it will grow to 5%, 10%, 30%. That's not what you want, so why are you doing things to encourage it along?

I could suggest many changes that would benefit all women and that would be less likely to drive women away from hospitals. Navelgazing Midwife already has. Of course, home birth would not entirely disappear even with the most progressive hospitals. That's a topic for another post, though...

Help Dr. Newman's breastfeeding clinic

Dr. Jack Newman and Edith Kernerman

I just got word that the Newman Breastfeeding Clinic & Institute of Toronto is losing its private funding at the end of this month. This means that both the clinic and the website will close, unless they can secure funding through outside donations. I found Dr. Newman's website an extremely valuable resource and would hate to lose it. Please join me in donating towards keeping the clinic and website operational!

Congratulations, it's a . . . line!

Coming earthside some time between Earth Day and Mother's Day!

Cloth diaper reviews

I have a good friend pregnant with her first who wants to use cloth diapers. She'd like advice about what brands and styles to try. I suggested that she buy one of many different kinds in a newborn size from somewhere like DiaperSwappers, plus disposables to fill any gaps if she doesn't have a complete stash. She can wear & wash them for a while until she finds one that she likes the best. Then when the baby is ready to move on to a bigger size, she can sell most of them back and buy a full stash.

So please help me out by suggesting your favorite cloth diapering brand or system, including:
1) average price for the new and/or used diaper
2) style (AIO, pocket, contour, fitted, etc)
3) what you like best and least about the diaper
4) technical info such as absorbency, drying time, ease of use, etc.

Many thanks!

Time, respect, and dignity

It's easy to sit around and bemoan all that is wrong with childbirth in the United States. But one woman is doing something about it: 81-year old midwife Ruth Lubic. She opened a midwifery clinic in Washington, D.C., where the infant mortality rate is twice the national average. She sees primarily low-income women on Medicaid in one of the poorest areas of the city. So far, all 800 babies have survived, and she has halved the prematurity rate. Her secret?

She believes low-income women, many on Medicaid, need the prenatal education that midwives provide. Everything from posture, to nutrition, to how the baby grows....

"Do you think it boils down to just the time you spend with them," Andrews asked Lubic.

"I think so," she replied. "I'm convinced that's what it is. It's time, respect, it's treating people with dignity."

Read the rest here: Midwife On a Mission. And thanks to Fearless Birth for pointing it out!

An Australian freebirth

Congrats to this new mama, who recently gave birth unassisted to baby #3! Her birth story is a good read, especially for showing how women may act and think during transition. Yes, you may seriously want someone to kill you, right there, and you may know that you are going to die, no way about it. But somehow you get through those feelings and then, like magic, your body starts pushing and a baby arrives. It's at this point in labor that having a calm, reassuring person around can make a world of difference--even if you are mad at them for not killing you! I've seen both helpful and unhelpful comments to laboring women in transition. Helpful ones generally are brief, calm, and reassuring. Unhelpful ones are where the helper tries to argue with the woman.

(Of course not every woman experiences this classic "transition." I largely didn't, other than thinking very rationally "hmmm, I sure would like this to stop but I know it won't. But I see why people would say things like that.")

And I love the picture of her baby, half born, emerging under the water with his eyes wide open!

A few of her comments from when she was struggling with transition:

Not long after things really intensify and I start to feel like I am struggling to cope with the contractions, nothing helps anymore and I begin to really yell and SCREAM my way through contractions. I yell stuff like, *$%#, get me out, make it stop, help me and in between contractions I start begging Jamie and Lith to get me out and make it stop, that I'm not coping anymore and I don't want to do it anymore.

Transition sucks, LOL. This was the toughest part for all of us and it felt like it went on forever even though it was only about an hour, by the end Jamie was nearly in tears because there was nothing he could do or say, and Lith pissed me off by being uber calm and telling me how awesome I was etc and I whined and yelled that they weren't listening to me.

Strange things went through my head during this time, I wondered if this was transition, but didn't care because it was so hard, LOL, and I also pondered ways to escape...at one pointed I toyed with the idea of saying that I thought there was something wrong with my c/s scar but couldn't bring myself to because a- it meant lying LOL, b- I had a feeling they would see right through me and c- the thought of getting up and getting out of the pool, then having to try and deal with the pain in a moving vehicle was too much to bear. So I didn't...instead I went on to say that I wanted to die and would they please kill me.

Birth options in Serbia

A woman emailed me for information on midwives or birth support in Serbia. Can anyone help with this? She wrote to me:

I have a friend due in about 3 months who is in Serbia (her birthplace) and the hospitals there are about as corrupt and brutal as they get. She's terrified. This is her first baby though, and she has also had a fibroid that's been of concern, so she's also unsure of what else she can do.

Do you know any resources that would help her find some midwives or at least some good birth support of any kind? They probably won't allow a doula or even her husband inside the hospital unless she bribes them--it's pretty nightmarish there. But I was hoping there might be some international group that could help her in any way.

I already found what I could through the International Confederation of Midwives, but there is no one listed in Serbia itself. My friend is actually in Belgrade proper; she's a Serbian citizen, her husband is American.

Thandie Newton on pregnancy and birth

The Sunday Times recently interviewed Thandie Newton about her new role as Condoleezza Rice. She said this about her pregnancies and births:

Within a month [after turning down a role in Charlie's Angels] she’d fallen pregnant with her first daughter, Ripley. “People talk about pregnant women as if they’ve gone a bit mad,” she says. “You know, ‘She’s a bit hormonal.’ But I felt as though I’d been introduced to myself for the first time. You become totally uncompromising, wild and fierce.”

She gave birth to both her girls at home in a birth pool. “Birth is very challenging in the best way possible. Every fibre of your being is alive. It’s like you are conducting electricity; literally creating something. I’d like to give birth every year if I could, just for that experience.”

Is brown the new green?

Let's face it, everybody is going green. If it's not a $92 silk-and-organic-cotton sweater set for your baby, it's a $42,000 Lexus hybrid SUV or a multimillion dollar green mansion. Now that green is hip, all you need to do is spend more money and buy more stuff, and you too can join the green revolution. After you drive your hybrid SUV to the mall to buy organic cashmere sweaters and natural seagrass rugs and organic latex and wool mattresses, you can come home with a clear conscience. You have done your part to make the world a greener place. Of course, don't forget to recycle your plastic water bottle on your way home; it's important to make sacrifices for Mother Earth.

Thankfully, not everyone has fallen into the trap of buying their way into a greener lifestyle. Rebekah's take on going green is an old-fashioned, but refreshing, approach to green living.

And Hen and Harvest had a great point--perhaps we need to abandon green altogether. Let's make brown the new green!

So, what are your suggestions for living green (or rather, brown)?

Sick and tired

Zari and I are coming down with something. Symptoms include headache, runny nose, sore & scratchy throat, sneezing, achey body, and restless sleep. Bleh. Plus when I'm sick I get really thirsty, which means I wake up every hour at night to pee.

And we have crickets. Sometimes they come into our bedroom and then we have to hunt them down at 1 am because they are so loud we can't sleep.

I just want to curl up in bed and sleep all day.

House pictures

As requested, a house tour. Sorry for the poor quality pictures, but I didn't have a lot of time to take nice ones. Most of the wall colors are fairly bland, and we hope to repaint soon.

I don't have any pictures yet of the living room, which has an old arched fireplace, or the upstairs bedroom & bathroom. The living room connects to the piano room via a large archway, which is on the left side of the following picture (but hidden from view by the door that is open).

Front entrance, viewed from piano room

Piano room

In the piano room, with staircase on the right.
To the right of the little hallway is the dining room; to the left is Zari's room.
I love the transom windows above the doors, the extra tall windows, and the 10' ceilings.

Dining room (we just stripped the wallpaper on the top half of the room).
It was a horrid green & purple floral. We're still deciding on paint colors.
The curtains are temporary; it gets sunny and hot in the late afternoon.

Silver & crystal light fixture in the dining room.

Master bedroom

Entrance to master bedroom is off the kitchen.

Zari's room, from the front hallway door.

The door in this picture leads to a bathroom, hallway, & closet
that are shared between the two downstairs bedrooms.

Zari's sleeping space (twin mattress on the floor)

The only room I really detest in this house is the kitchen. It's tiny, cramped, and poorly laid out. The ceilings are 7' high, whereas the rest of the house has 10' ceilings.
We have plans to renovate & expand it some time this school year.