Collaboration, transfers, and attitudes towards home birth

One of the blogs I follow, Midwife with a Knife, has a new post about her views on home births. She's a high-risk OB training to be a perinatologist. I enjoy hearing from physicians who can talk rationally and sensibly about home birth. I don't agree with her on every point. For example, I do think that HBAC is a reasonable choice. And in many places, it's one of the only ways to have a vaginal birth. It's refreshing to hear from someone within the obstetrical system who understands why some women make this choice and who doesn't resort to the typical scare tactics or accusations of maternal selfishness. Perhaps there is hope in bringing together obstetricians and home birth midwives in collaborative, respectful relationships. After all, better communication, respectful treatment during hospital transfers, and open, collaborative relationships would only enhance safety for home birth families.

This is something that two Oregon State University researchers have been examining, in fact: conflict between obstetricians and home birth midwives and possible ways to create collaborative relationships. Assistant professor Melissa Cheyney (who had a baby at home a few weeks ago) and doctoral student Courtney Everson found that in Jackson County, Oregon:

assisted homebirths did not appear to be contributing to the lower-than-average health outcomes and, in fact, that the homebirths documented all had successful outcomes. But even more importantly to Cheyney, discussions with doctors and midwives uncovered a deep mistrust between the two groups of birthing providers, with doctors expressing the firm belief that only hospital births are safe, while midwives felt marginalized, mocked and put on the defensive when in contact with physicians....

One of the biggest problems Cheyney sees is that physicians only come into contact with midwives when something has gone wrong with the homebirth, and the patient has been transported to the hospital for care. There are a number of reasons why this interaction often is tension-filled and unpleasant for both sides, she says.

First is the assumption that homebirth must be dangerous, because the patient they’re seeing has had to be transported to the hospital. Secondly, the physician is now taking on the risk of caring for a patient who is unknown to them, and who has a medical chart provided by a midwife which may not include the kind of information the physician is used to receiving.

And because the midwife is often feeling defensive and upset, Cheyney said, the contact between her and the physician can often be tense and unproductive. Meanwhile, the patient, whose intention was not to have a hospital birth, is already feeling upset at the change in birth plan, and is now watching her care provider come into conflict with the stranger who is about to deliver her baby.

“It’s an extremely tension-fraught encounter,” Cheyney said, “and something needs to be done to address it.” As homebirths increase in popularity, she added, these encounters are bound to increase and a plan needs to be in place so that doctors and midwives know what protocol to follow.

“We’re having a meeting in early May to propose a draft for a model of collaborative care that might be the first of its kind,” in the United States, Cheyney said.

Physician blogger KevinMD agrees that physicians and midwives need to cooperate more. He writes:

From the doctor’s side, the only times they interact with midwives is when trouble arises....Doctors should also see things from the midwife’s perspective, and collaborative programs where they can experience successful midwife cases can help resolve the conflict between the two camps.

Make sure you read the comments as well as KevinMD's original post.

Unfortunately, not all physicians or nurses are respectful or rational when working with homebirth transports, as the L& D nurse blogger at Stork Stories illustrates. In OB Docs and Nurses Scoff at Homebirth, she writes about the attitudes her OB and nurse colleagues have displayed when they encountered transports.

Often the OB’s didn’t handle themselves well...certainly not professionally. We had this one OB who would call for the OR to be opened before he even examined the patient or evaluated the situation...regardless of why they came in. And he often actually yelled at the mother, in the middle of her scary situation. “Your baby will die if we don’t do an emergency C/S right now, why did you let this happen!”

Most often the backlash was directed at the midwife who cowered in the hallway- uninvited by the staff, left alone detached from her patient. She never left the unit though until she was afforded the opportunity to visit and speak to her patient...

I feel that instead of the midwife or mother receiving hostility (or even the mother being whisked away to the OR without a trial of something if the baby was deemed stable...) the staff should have behaved in a compassionate professional manner, acting on any urgent situation with consideration that this mother is now experiencing not only labor but fear and grief over the loss of her beautiful planned birth.

I have written earlier about my issues with the ACOG's and AMA's official positions against home birth. Probably the most significant repercussion of these official position statements is that they strongly discourage physician-midwife collaboration. For example, the CNM who attended Dio's birth needs to have a signed collaboration agreement with a physician in order to administer certain emergency medications in our state (IV abx for GBS+, anti-hemorrhagic meds, lidocaine for suturing, etc). The agreement does not require the physician to take on a supervisory role, nor does physician assume any liability for the midwife's clients. She has contacted over 150 physicians in our state, and not one was willing or able to sign the agreement--including some of her own physician clients! This was often due to the physicians' malpractice insurance policies or hospital regulations, which of course are strongly influenced by ACOG and AMA recommendations.

Wouldn't it be fabulous if all medical students, especially those going into family practice or OB/GYN, did rotations with out-of-hospital providers? And if all home birth midwives were able to do hospital internships as part of their training? And if we had some kind of forum for OBs and nurses and midwives to meet and talk about how to improve maternity care, a dialogue where they really learned from each other. Imagine midwives sharing how they are able to achieve such low cesarean rates. Imagine physicians giving suggestions for how to make transports smoother (what kind of charting would be helpful for the hospital staff or having the midwife call the local L&D when a client is in labor so the staff is prepared in case a transport is needed).

What suggestions would you have--as a physician, a nurse, a midwife, a doula, or a birthing woman--to improve collaboration and communication and to make home birth transfers smoother and safer?

Sleeping

I was chatting with a friend the other day about Zari's sleep habits and our nighttime routines. After she was able to roll over and crawl, we'd put her to bed in her crib, which was next to our bed. When she woke up to nurse, we'd bring her into bed with us for the rest of the night.

Zari co-slept until she was around 18-20 months old. Once she reached about 18 months, we were ready for her to be out of our bed because she was a very wiggly sleeper. As in: one or both of us would be kicked in the head on a regular basis! We also were in France for the summer, and our accommodations necessitated that she sleep in her own room. Between having her own room, darkening the room with shutters (which are a staple in any French bedroom), and having a fan running, she started sleeping through the night for the first time ever (or waking up just once to nurse, which was a huge change from waking up every 2-3 hours to nurse).

When we came back home, we had to work on establishing this same pattern. I found the book The No-Cry Sleep Solution for Toddlers and Preschoolers by Elizabeth Pantley extremely helpful. The No-Cry series has wonderful advice for parents who want to help their children sleep better, but who are not supporters of the "cry it out" technique.

Our current bedtime routine for Zari consists of the following:

• Eric helps Zari go potty, brush her teeth, and put her pajamas on.
• They read books together in her bed for 15-20 minutes.
• Eric calls me in, and we say prayers together.
• Eric leaves and turns the lights off, and I nurse Zari for a few minutes.
• Zari and I snuggle and talk about what we did that day. I'll often sing to her or tell her stories as well.
• I tuck her in, tell her I love her, and leave the room.

I'd love to say that she always goes to sleep right away at this point, but more often she'll start fussing and ask for us to come snuggle again. So usually each of us has to go in once or twice more and snuggle her for a few minutes.

Once Zari is asleep, she often sleeps the entire night without waking up. Perhaps 1/3 or 1/2 of the time, she wakes up once in the middle of the night and needs one of us to lay her back down and put her blankets on. I usually nudge Eric and have him do this, since I'm busy with Dio. We did have a rough period after Dio was born when she was waking up frequently and asking to go in our bed (and asking for me specifically) and would scream and thrash around irrationally if Eric was the one helping her out. Thankfully we're over that now.

I've included some excerpts from the No-Cry Toddler edition below:

*****

Eight Sleep Tips For Every Child

The following sleep ideas are of value to almost any sleeper, regardless of age. These tips can bring improvement not only in your child’s sleep, but also in her daytime mood and, last, but certainly not least – improvements in your own sleep and outlook as well.

1. Maintain a consistent bedtime and awaking time seven days a week.

Your child’s biological clock has a strong influence on her wakefulness and sleepiness. When you establish a set time for bedtime and wake up time you “wind” your child’s clock so that it functions smoothly.

Aim for an early bedtime. Toddlers and preschoolers respond best with a bedtime between 6:30 and 7:30 P.M, and most children will actually sleep better and longer when they go to bed early.

2. Encourage regular daily naps.

Daily naps are important since an energetic child can find it difficult to go through a long day without a rest break. A nap-less child will often wake up cheerful and become progressively moodier, fussier or hyper-alert as the day goes on, and as he runs out of steam. Moreover, the length and quality of naps affects nighttime sleep – good naps equal better night sleep.

3. Set your child’s biological clock.

Take advantage of your child’s natural biology so that he’s actually tired when bedtime arrives. Darkness causes an increase in the release of melatonin, the body’s sleep hormone, and it is the biological “stop” button. You can help align your child’s sleepiness with his bedtime by dimming the lights in your home during the hour before bedtime. Exposing your child to morning light is like pushing a “go” button in her brain — one that says, “Time to wake up and be active.” So keep your mornings bright!

4. Develop a consistent bedtime routine.

Routines create feelings of security. A consistent, peaceful bedtime routine allows your active child to transition from the motion of the day to the tranquil state required to fall asleep. A specific before-bed routine naturally and easily ends with sleep.

An organized routine helps you coordinate the specifics that must occur before bed: bath, pajamas, tooth-brushing. It helps you to function on auto-pilot at the time of day when you are most tired and least creative.

5. Create a cozy sleep environment.

You may have never given much thought to where your child sleeps, but it can be one of the keys to better sleep. Make certain the mattress is comfortable, the blankets are warm enough, the room temperature is right, pajamas are comfy and the bedroom is welcoming.

6. Provide the right nutrition to improve sleep.

Foods can affect energy level and sleepiness. Carbohydrate-rich foods can have a calming effect on the body, while foods high in protein or sugar generate alertness, particularly when eaten alone. A few ideas for pre-bedtime snacks are: whole wheat toast and cheese, bagel and peanut butter, oatmeal with bananas, or yogurt and low-sugar granola.

Vitamin deficiencies that are due to consistently unhealthy food choices can affect a child’s overall health, including her sleep. Make your best effort to provide your child with a daily assortment of healthy foods.

7. Help your child to be healthy and fit.

Many children don’t get enough daily physical activity. Too much TV watching, coupled with a lack of activity amounts to a sedentary lifestyle – which prevents good sleep. Children who get ample daily physical exercise fall asleep more quickly, sleep better, stay asleep longer and wake up feeling more refreshed.

Avoid physical activity in the hour before bedtime, though, since exercise is stimulating and has an alerting effect – so they’ll be jumping on the bed instead of sleeping in it!

8. Teach your child how to relax and fall asleep.

Many children get in bed but aren’t sure what to do when they get there! It can be helpful to follow a soothing pre-bed routine that helps create feelings of sleepiness. A common component of the bedtime ritual is story time, and for good reason. A child who is listening to a parent read, or tell a tale, will tend to lie still and focus on the story. This quiet stillness will allow him to become sleepy.

Commit to working with these eight ideas and you’ll likely see improvements in your child’s sleep, and yours too.

"My whole heart is in that incubator"

The Motherwear Breastfeeding blog recently featured a fantastic guest post by a woman whose son was born 3 months early and weighed less than 3 pounds. She writes about how breastfeeding was her and her son's lifeline. Here is an excerpt from her post, My whole heart is in that incubator:

I was 37 years old. I thought I knew what love was. I thought I knew. But I have never loved anyone, anything, so fiercely, so terribly, so wonderfully, so achingly, as I did my little son, my only child, struggling in that incubator....

I loved and still love that boy with all I have. Because I couldn't hold him much, and felt terrible guilt for not being able to 'hold him in' for the entire 9 months he deserved, I was determined to breastfeed. I pumped every 3 hours for weeks on end. That pump and the milk that came out of me was my lifeline. It was somehow the way I was going to make it up to him for giving him such a lousy start in this world. So when I read stuff like "The Case against Breastfeeding" I get so angry. I believe that my breastmilk, and the good care we got at BC Children's, saved my child's life. It saved my life. If there is anything in this crazy, crazy world that is really is a gift from God it is the babies we can create and the milk that comes from our bodies.

If anything is pure and natural, and real and true, it's breastmilk. It made me feel like a mother when my baby was all alone inside a machine when he should have been inside me.

Anyone who dismisses breastfeeding so casually, or by their attitude or indifference creates an environment that doesn't hold up and encourage and cheerlead a new mom into a successful breastfeeding relationship, has lost touch with something. They've lost touch with a sense of what it means to be a mother, what feeding a baby is all about, what it means to nurture, how significant that breastfeeding can be to both mother and child.

Lamaze Media Award for Birth Bloggers

Lamaze International is offering a Media Award for a birth-related blog. Details are included below.

I'm curious to hear from you: which blog post of mine "best exemplifies blog content that supports the Lamaze mission"? (The mission of Lamaze International is to promote, support and protect normal birth through education and advocacy. We envision for the future a world of confident women choosing normal birth. Lamaze International believes that women who are fully informed, confident and supported will want normal birth. Lamaze International believes that caregivers should respect the birth process and not intervene without compelling medical indication.)

I might choose Biodynamism: Body and Soil. I haven't had time to go through my earlier posts, though, and perhaps there's another post that best represents this blog. So which one(s) would you choose?

And of course, you are welcome to nominate me if you feel so inclined!

*****

Media Award for Birth Bloggers

Each year, Lamaze International presents awards to the best and brightest in childbirth education and advocacy at its annual conference. We are thrilled to announce that for the first time, bloggers will be considered for the annual Lamaze Media Award. Increasingly, bloggers are shaping the conversation about birth, highlighting the need for maternity care reform, and reaching childbearing women with critical messages about safe and healthy birth practices. Be recognized for your unique voice and important impact in childbirth education and advocacy.

The winner will receive:

• Publicity in communications to Lamaze members, the public, and the media
• One free registration to the 2009 Annual Conference in Walt Disney World, FL, where the award will be presented
• Up to $500 reimbursement for travel to the 2009 annual conference

Nominations are due by June 15 and should be sent to amyromano@lamaze.org. You may nominate yourself or another blogger.

Please include:

• The name and URL of the blog
• The direct link to a post that best exemplifies blog content that supports the Lamaze mission
• The credentials of the main blogger(s)
• A summary of the traffic and influence of the blog (e.g., monthly site traffic; links from other influential blogs or the mass media)

Then & now, 1 month

Birth / 1 month
7 days / 1 month

What does giving birth feel like?

I remember reading a book by Sheila Kitzinger back in my early graduate school years called Giving Birth: How It Really Feels. I can't remember too many specifics from the book at this point, but it reminded me to write a post about what labor & birth feels like. This event is hard to describe, because there's really no other physical experience quite like it. Most of us resort to metaphor or analogy, usually in reference to some bodily function: menstruation, elimination, & sex are the most common.

The closest I can come to describing what a contraction feels like is: a sharp, knifelike menstrual cramp that I feel right above my pubic bone, from hipbone to hipbone. It's funny that I use menstrual cramps as my analogy, because for me cramps are a dull, constant ache, whereas contractions are strong, sharp, and intermittent. But that's the closest sensation I can compare it to. Many women describe their contractions as coming in waves or peaks. I would do the same. The prevalence of electronic fetal monitoring has probably cemented that imagery, since the contractions are traced on paper as oscillating peaks. If I think of peaks (as in mountain peaks or steep hills), I think of something that requires effort, that becomes harder and harder, and then goes downward and becomes easier.

When my body began pushing, I experienced three distinct sensations. During Zari's labor, I had about an hour of "throwing down": abdominal pushiness/heaving that felt just like throwing up, only it was in a downward direction. No rectal pressure, very mild. I skipped this stage with Dio's labor. Next, I felt intense rectal pressure as the baby moved down, like my butt was going to split in two. I really didn't like this sensation. And finally, the rectal pressure subsided as the baby began crowning. In its place I felt intense stretching and stinging as the baby's head emerged more and more.

I was thinking about something one of my sisters-in-law told me about her experiences of labor. Her first three births (with obstetricians) were either augmented or induced with Pitocin and, not too surprisingly, followed by epidurals. She had told me that labor felt like your skin was being turned inside out--basically that it was pretty awful. Then with her fourth and fifth babies, she had unmedicated hospital births (with CNMs) and no Pitocin during labor. She realized that the awfulness that she had assumed was inherent in labor itself was due to the Pitocin.

We know that a majority of women in the U.S. receive Pitocin during labor. It's not entirely clear how big of a majority it is, but the Listening to Mothers II survey found that 50% of the mothers surveyed received Pitocin to either induce or augment labor. Others have estimated that the number is much higher. Of the women Robbie Davis-Floyd interviewed for her 1992 book Birth as an American Rite of Passage, 81% received Pitocin during labor. In any case, at least half and quite likely three-quarters or more of women experience a Pitocin-enhanced labor.

I wonder if this is responsible for a large part of our culture's fear of labor pain. It's no wonder that so many women talk about labor as being excruciating if more than half of them have had Pitocin! Almost all women who have labored both with and without Pitocin report that Pitocin makes labor much more painful. Pitocin contractions are usually longer, stronger, and closer together than those of a spontaneous labor. I haven't ever had Pitocin during labor, so I can't comment personally on this.

So I would love to hear from you:

• What did labor and birth feel like for you?
  
• What made labor more or less painful for you?
  
• If you have experienced labors with and without Pitocin, how would you describe the difference between the two?

Four weeks old

Dio is settling into more of a schedule. He wakes up for the day around 9 am and is awake, except for catnaps, until around lunchtime. Then he takes a long 2-3 hour nap. Zari takes a nap after lunch, which means on most days I can have a bit of time to myself while they're both sleeping. The rest of the afternoon and evening he alternates napping and being awake until about 9-10 pm.

Nights are tiring for me. His first sleep is nice and long and deep, usually 3 or 3 1/2 hours. But then he's up every 1-2 hours the rest of the night and his sleep is quite restless. He grunts and squeaks and wiggles during the last half of the night so even when he's not nursing, he keeps me awake a lot. I've started running a fan--for me as much as for Dio--and it helps a little bit to mask those noises. I hope he'll start sleeping more deeply and for longer periods at night. Zari always conked out right away after night nursing and within the first few weeks had settled into a 3-hour waking pattern at night.

He's already looking so huge to me. Some friends of ours had their baby a week ago (at home, with the same midwife) and Dio looks like a monster baby compared to her, even though he was a bit smaller at birth than she was.

Dio is still cranky at times. Nothing terrible, just very different from Zari, who rarely cried and was calm and content when she was awake. We have to do lots of rocking and bouncing and patting and holding him just so. He also has a very short fuse. He can go from completely content to screaming bloody murder in about 2 seconds flat.

I have--gasp--started using a pacifier. Or soother, as Canadians call them. Anyway I never thought I would, but then again I never had a baby with such a strong suck need until Dio came along. Much of the time he isn't interested in it, but it does come in handy at times when I need to get certain things done and need both hands free: showering or getting lunch/dinner ready (because often at this point he's been in the sling for a while and wants out). It also comes in most handy in the evenings when he has a really fussy period, which I call the witching hour. After I've nursed him to bursting and pottied him and tried bouncing/rocking/patting/whatever and he's still upset, I'll hold him in my arms with the pacifier in. His body relaxes, and he looks around calmly. Sometimes he'll even fall asleep for a nap. I thought he might take it at night, but he's never interested in it then. Which is fine with me--I am wary of his becoming too dependent on the pacifier.

Ever since my mom left 2 weeks ago, Zari has been a bit fussier and needier. Which is to be expected. We've been working on having her tell us what she wants, rather than throw a tantrum. But on the other hand, she's really sweet and helpful with Dio. Most of the time. Sometimes I have to tell her, "no, please don't kick him." Or "no jumping on Dio!" She likes to "help" me nurse by laying her hand on my breast. She also gives me--well, my breasts, specifically--"nursing kisses."

When I do have free time, I've been busy working on a few projects. I am getting my book proposal ready to send to publishers (it will be a revised version of my dissertation). One of my dissertation committee members looked through the proposal and gave it a thumbs-up, so now it just needs a final read-through before I send it off. I also need to start researching presses to send it to. I have a few that were recommended to me for starters. Next, I have been invited to write an article about perceptions of home birth in America for Expert Review of Obstetrics & Gynecology. I've started working on an outline for the article. Once I've decided what topics to cover, I need to delegate various research & writing tasks to the other co-authors and work on my own contribution. And it's supposed to be done by July 1st! Yikes! And last, I am hoping to present at the International Breech Conference that's taking place in Ottawa, Ontario this fall. A friend and I are working on an abstract and research questions. We'll likely be interviewing/surveying women about their experiences of breech pregnancy and birth. So much to do and not enough time! Between these projects and my lack of sleep, my blogging has slowed down.

Now for the fun part--pictures from this week!

Both Zari and Dio like to adopt the "cello player" pose.

Dio is on the right.

My last post was about the risks that repeat cesareans pose to the baby, specifically higher rates of NICU admissions and respiratory distress. I wanted to share one woman's personal experience facing those risks, in which she almost lost her baby due to a (not-entirely-elective) repeat cesarean.

Sarah H is a nurse who blogs at The Wonder of Birth. Her first cesarean was for twin boys, who were both lying transverse. She wanted a VBAC for her second but reluctantly "chose" a repeat cesarean for her daughter Audrey in part because she had so little support for her VBAC plans.

You can read about her first cesarean and the factors leading up to her "elective" repeat cesarean. Then read the birth story of Audrey.

Thanks to Birth Faith for the link.

US News: Risk to Baby Rises With Repeat C-Sections

THURSDAY, May 21 (HealthDay News) -- Babies delivered by elective, repeat cesarean section delivery are nearly twice as likely to be admitted to the neonatal intensive care unit (NICU) than those born vaginally after the mother has previously had a c-section, a new study finds.

These c-section babies are also more likely to have breathing problems requiring supplemental oxygen, the researchers say.

"In addition, the cost of the birth for both mother and infant was more expensive in the elective repeat c-section group compared to the vaginal birth after c-section (VBAC) group," noted Dr. Beena Kamath, the study's lead author and a clinical instructor of pediatrics at the University of Colorado School of Medicine, Denver.

The study appears in the June issue of Obstetrics & Gynecology.

Read the rest of the article here.

Currently reading

The Food of Love: The Easier Way to Breastfeed Your Baby by Kate Evans. It is laugh-out-loud hiliarous. And it has lots of really helpful information. And it is full of cartoons! (I'm actually reading the UK version The Food of Love: Your Formula for Successful Breastfeeding. There are more British-isms, such as "nappies" for diapers, and a few different cartoons). I hope to write up a longer review of this book soon.

A cartoon from The Food of Love

Heloise & Abelard: A New Biography by James Burge. A gripping read so far. Here's the description from Publishers Weekly:

The romance of Héloïse and Abelard remains one of the greatest love stories of all time—one of forbidden love; the eventual lifelong separation of the lovers, cloistered in a monastery and convent; and the vengeful castration of Abelard by Héloïse's uncle. More tantalizingly, we know of the affair only from eight surviving letters between the couple. But British Sunday Independent columnist Burge draws on 113 recently translated letters that have been attributed to the lovers. Based on all of these letters, Burge analyzes the feelings and states of mind of the correspondents, and he can be a bit pedantic at times. But who can fail to be moved by the passion expressed in the letters? "Even during the celebration of the Mass," Héloïse famously wrote, "when our prayers should be purest, lewd visions of the pleasures we shared take... a hold on my unhappy soul...." Burge relates Abelard's theological struggles with the medieval Church, especially with the powerful Cistercian leader Bernard of Clairvaux. Unlike in previous biographies, Héloïse emerges as a leader, too, in her role as abbess of the Paraclete, which she developed into a substantial institution. A complex woman, she sought a unified sense of self that would incorporate both her sexuality and her religious faith. Readers new to this medieval drama will be drawn to this vivid account.

Your Best Birth: Know All Your Options, Discover the Natural Choices, and Take Back the Birth Experience by Ricki Lake and Abby Epstein

Stiff: The Curious Lives of Human Cadavers by Mary Roach. I never knew dead bodies could be so interesting!

Musicophilia: Tales of Music and the Brain by Oliver Sacks. Really fascinating, and each chapter can be read independently of the others. I have perfect pitch (also called absolute pitch) and I enjoyed reading up more about this variation (abnormality?) of the human brain.

Dio's waking up and wants to nurse--so that's all I have time to list for now!

"Coop" interview

I recently came across this interview with Michael Perry, author of Coop: A Year of Poultry, Pigs, and Parenting. I've included some excerpts from the interview below. Definitely a book to read this summer!

TP: How did you mentally and otherwise prepare for the home birth of your daughter? How was it different from what you imagined it would be?

MP: Despite the fact that I am a registered nurse and have worked as an EMT and first responder for twenty years, until my daughter was born, I had never witnessed a live birth. I had only delivered plastic babies with snap-on umbilical cords. So I re-read the obstetrics section of my original EMT textbook, watched some home-birth videos, met with the midwife. But above all I realized I was destined for a supporting role in every sense of the word, and as such, I pretty much let my wife and the other women involved take the lead. I can't say the experience was different than I might have imagined, but I can say I was unprepared for how powerfully my wife's strength during the delivery reinforced my love for her, and I was also struck by the peaceful transition from the dramatic act of birth to simply being together -- four of us, now -- in our home....

TP: How are farming and parenting similar?

MP: Wow. First time I've been asked that one. Seems a bit of a minefield! The first thing that strikes me is that both have a way of blasting away any pretension or false sensibilities you may have carefully constructed for yourself. Maybe you thought you were a bigshot, but the pig just pooped on your boot anyway. And then the baby does the same thing. Then there is this constant sense that you have assigned yourself responsibility for a being that is dependent on you acting like a grownup at some point. You also discover the limits of your influence and the importance of sometimes standing aside. You can regulate every second of that pig's existence, but you'll wind up with pale meat. Good then, to turn the animal loose and watch it root around joyfully, finding the food it was designed to find, long before you showed up with your Farm & Fleet boots and a bag of feed. Same with children. You must tend the fences, be the grownup, remain in charge ... but you must also at some point let them go free-range, a little bit at a time, beginning earlier than you might think.

Giveaway winners!

I've contacted most of the winners, but one of them didn't have a blog or email address linked to their comment. "Mama" (comment #42) please send me your mailing address and I will have the publisher send the book your way!

Three weeks old

At our two week visit (which actually took place this Friday when Dio was almost 3 weeks old), we found that Dio had gained almost two pounds. He weighed in at 8 lbs 14.8 oz. This sparked some bittersweet feelings, similar to ones I had when Zari was a newborn. While I am thrilled that Dio is thriving and nursing well, I also have this deep sense of sadness and loss. Just as I am beginning to get to know my newborn, he is already changing and, in a sense, gone forever. So I find myself dealing with feelings of loss alongside the sense of love and discovery. He's already looking different to me, which his body filling in. He no longer has those skinny chicken legs. His cheeks and face have filled out. His arms and legs look plump now.

Dio is definitely more temperamental than Zari was. When he is awake, he has short periods of calm, quiet alertness, but more often than not he's fussing. Sometimes it's half-hearted crankiness. Other times it's full-out screaming and arching his back and acting like he's dying. I never experienced this with Zari. It's heartwrenching to see my baby so unhappy and to be unable to fix it some of the time.

He also has a very strong suck need. From the day he was born, he's always been chomping his fingers and fists. When nothing else will calm him down and his stomach is full to bursting, I'll offer my index finger. I actually have thought about trying a pacifier for those times when sucking on something is the only thing that will calm him down. I never thought I'd even consider one until Dio came! On the other hand, I am wary of introducing an object to which he might become overly attached (although you could make the same argument about my index finger).

Dio loves being in the sling, taking showers with me, and sleeping on our chests. We love to lie on the couch reading with Dio snoozing on our chest. He does not like change--waking up, falling asleep, getting dressed or undressed, or changing his diaper. I've been catching a lot of his pees and poops because he is so vocal about needing to go; any sudden fussiness I take as a cue to potty him, and usually he'll go right away.

16 days old

17 days old

20 days old

21 days old today!

Nursing self-portrait

What if you never saw a birth like this?

One of my readers, doctorjen, submitted this birth story for the book giveaway. I am reposting it here with her permission. She is a family practice physician who works in a small rural hospital. I always enjoy reading stories of the births she attends.

Sometimes I attend a birth that reminds me how different my experience is than many hospital providers. This birth was very powerful and beautiful, and reminds me again how awesomely powerful women's bodies are. It was not an easy birth, but the hard parts were still handled by the mama and her baby with amazing power and just a little help. I know that most hospital practitioners have never seen a birth like this - and I wonder how my view of birth would be different if I never had either.

B. is another one of my teenage clients. Unlike many of my teen moms that come of difficult backgrounds, B. was an excellent student, with loving, supportive parents. B.'s pregnancy was a huge shock to her family, and to her large circle of loving family friends. The circle of friends includes the family that are executive directors of the maternity home I often do prenatal care for. This family had known B. since birth, and despite their career being focused on caring for women with unintended pregnancies, B.'s was still a big shock. Family and friends both recovered well from the initial shock, and B.'s mom especially was very supportive and wonderful throughout the pregnancy, attending all her visits and being happy about the baby, even though she was disappointed about the timing.

B. was sort of a high maintenance pregnant client. She'd obviously been the petted baby of her family, and reacted strongly to all the discomforts of pregnancy. She had quite a number of unscheduled visits for belly pain, back pain, nasal congestion, pelvic pressure - you name it. She had multiple visits to labor and delivery for pre-term contractions (never true pre-term labor.) Her family, and even her boyfriend, always responded to her with loving concern, and attempts to make her feel better. I have to admit to getting a little frustrated with her - but did my best to keep it to myself.

During the third trimester, B. "studied" childbirth with a couple of family friends. Both of them had taken a Bradley class, and they went over their work book and notes with her. She also borrowed several books from me, and wrote a term paper in her junior English class on the risks of epidurals. She wrote a birth plan that looked very Bradleyish, and included not wanting to be induced and not wanting any pain medicines. Having at this point seen her in tears so often due to back pain, or Braxton Hicks contractions, I privately wondered about this birth plan - was it hers, or the friends? The one friend had a lovely unmedicated VBAC with me 3 years ago and she and her mother (who is the executive director of the maternity home) planned to be at the birth as support people.

As B. approached her due date, she stopped complaining about contractions. She joked about how ironic it was that she'd had them for months and now they were gone when she wanted them. Her due date passed, with no interest on her part in induction - she never even mentioned it, despite mentioning often how much she wanted to see her baby. At 41 weeks, she was scheduled for a biophysical profile. B. called on the way to the ultrasound to say she was having a little bit of pink tinged mucus when she wiped. By the time the ultrasound was done and she went up to labor and delivery for the NST portion, she was still having a little bloody show, and now having some irregular contractions as well. She asked a labor nurse to check her. The nurse called (my favorite nurse again) and said she thought B. was trying to start laboring. She was 1 cm dilated and 60% effaced, with irregular contractions (about 10 o'clock in the morning.) The ultrasound, however, showed a decent sized straight posterior baby. The nurse told me she'd suggested that B. go home and spend as much time on hands and knees as she could stand, and try to get this baby to turn around. She had appointment with me later in the afternoon, and planned to keep it.

Around 3 pm, B. came for her appointment. She told me the contractions had slowly been getting stronger and a little closer together all day long. She also told me she'd been crawling around as much as she could, and had her mom rubbing her back and was feeling contractions mostly in her back. She asked me if I'd check her again. During the visit, she had 3 strong contractions, and during the 3rd one, she started to cry, and when her mom asked her what was wrong she said "This just hurts so much!" I checked her a few minutes later, and she was now 3 cms and 80% effaced. B. was cheered up that she was actually making change. To my surprise, she said she wasn't ready to go to the hospital yet. I suggested she go home, eat supper, take a soak in the tub, a nap if she could manage it, and that I guessed she'd be back to the hospital later this evening. Her boyfriend was due to give a speech in a college class that evening, and decided to try to still get there to give it, while her mom planned to stay with her.

Around 8 pm, B. arrived back to the hospital. At this point, her contractions were every 3 minutes, and she was breathing hard with them and having a lot of pain and pressure in her back. Her whole support team arrived with her - boyfriend (who'd gotten an A on the speech), mom, dad, family friends (the mom and daughter who were to be her designated labor support) The nurse called me and said B. was now 4 cms dilated and 90% effaced, and contracting regularly. I came in to see her at this point. B. was bouncing on the birth ball when I got there, and one of the friends was kneeling on the floor pushing on her back. B. was obviously working hard now, but excited that she might soon see her baby. Although she mentioned that she was hurting, she also seemed calm and determined, and although she asked for the support she needed ("Rub my back!" "Where's my drink?" "I'm hot!") she didn't talk about pain medicine.

For the next few hours, B. got in and out of the tub (we were having issues getting it hot enough, so she'd stay in until she was cool, then get out while we drained and refilled it) walked in the halls, bounced on the ball, drank juice, and leaned on her support team. For a long while, the contractions seemed to stay about the same, and then, they started to become less frequent instead of more frequent. B. started to be tired, and crabby, and struggled to stay on top of contractions. She'd not wanted a lot of cervical exams, so we kept trying to help her be comfortable. Finally, around 2 am, when B.'s contractions were only about every 7-8 minutes now, and she was falling asleep between them and waking up struggling to cope with them, I asked her if she wanted a cervical exam, and she said she did. I checked, and she was still 4 cms dilated, and 90% effaced. B. was really discouraged at this point. She'd now been laboring since about 7 in the morning, and had had absolutely no change since arriving to the hospital 6 hours ago.

We discussed options at this point. First of all, I told B. that her baby was fine, she was fine, she was coping beautifully and keeping up her hydration, peeing well, and overall doing great - so there was no medical need to do anything at this point. We could just wait and see what happened. I suggested if she wanted to wait, that we try dimming the lights, and tucking her up on her side in bed with all kinds of pillows for support, and she see if she could rest. She was exhausted at this point, and sometimes dozing off between contractions. Second, if she didn't feel like resting was an option, and she didn't want to just continue waiting, we could try something to augment her labor - either AROM or Pitocin. She asked a lot about what either intervention would mean. (Pitocin would mean continuous monitoring, and being stuck to the IV pole - AROM would commit her to delivery, might make contractions more painful, and might encourage the baby to stay in a poor position - but would leave her with the freedom to still move and be off the monitor,) She cried a little at this point, and said she was just so tired, and scared, and not wanting to hurt anymore. Her mom, who is very emotional, cried too, and said she felt so helpless to help her daughter feel better. Her dad, the boyfriend, and the family friends were all for AROM, wanting to get this show on the road. Seeing her distress, I suggested that she try just resting for a while, that there was no need to make a decision right now, and she calmed down and said she'd try that.

A few minutes later, at about 2:15 am, we had her tucked as comfortably as we could on her side, with pillows under her leg and arm, and mom rubbing her lower back still. We turned off the lights, and the nurse and I told her we'd be right outside the door if she wanted us. For 30 minutes or so, she was quiet, and we hoped she was able to sleep a little. Then, we started to hear her moaning through contractions and breathing hard again, although the contractions were still 7-8 minutes apart. Finally, around 3:15 am, her dad came out of the room and said B. would like to talk to me.

B. said again that she was so tired, and just so worried that doing anything would make her hurt more. I told her honestly that it may well make her hurt more - but I was also a little worried that she was so tired now, that if we waited a few more hours and she was still unable to rest that she would just be that much more tired and still in the same position. I assured her again that she didn't have to make any decision urgently, because she and the baby were fine. She thought for a moment and said she thought she'd like to try having her water broken. I checked her again - still 4 cms, 90% effaced, 0 station - and hooked her membranes with an amnihook, and clear fluid spilled out. B. had been lying in bed at this point, but the very next contraction, she sat straight upright, called for her friend to rub her back, and rocked back and forth. "That was much stronger!" she said, "I can't do this lying down!" We encouraged her to get up, and the next few contractions, which came faster and faster, she walked in the room, and leaned over her mother during a contraction. Soon, she was breathing harder, moaning through contractions, and saying this laboring stuff was not much fun. She wondered if getting in the tub would still help, and we decided to find out.

Once B. was soaking in the tub again, she was smiling some more. Contractions continued to come every 3 minutes or so, but she felt less pressure and less and less discomfort in her back. Since she was more comfortable, and anyway had such good support, I decided to lie down for a bit. By 4:15, I was snuggled in a recliner with some blankets from the blanket warmer and was able to doze. I slept fitfully off and on until the nurse woke me at 5:45. "B. is pushing a little with contractions, and she wants you" she said.

Back in B.'s room, the scene had taken on a much more intense feel. Somewhere along the line B. had shed all her clothes. She had the external fetal monitor strap on, and not one other thing. She was standing up, and during a contraction leaned forward holding up hanging from her mom's shoulders, and the friend was rubbing hard on her back (the friend later told me she was sure she'd left bruises since B. wanted such hard rubbing!) B. was sweating, and breathing hard. "Please, can't I just push?" she wanted to know, and I asked her if she felt like pushing. She said not really, but she just wanted it to be over. I suggested she just wait until her body started pushing. She reached out and grabbed my arm and said "Then please, won't you give me some pain medicine?" This was the first I'd heard her mention it since she walked in the door. I tried to talk to her about it - saying I thought she was close to having her baby, but she just kept saying "oh please, please do something!" Her support people (who've attended many births) both suggested that she was in transition, and tried to remind her what that is like. Her mom started to cry again, and said it was just so hard for her to see B. in pain. I had to agree it was hard to see her hurting and wished there was something to do for her. I told her we'd have to do an exam if she truly wanted pain medicine, and she willingly flopped down on the bed and said "Just check me then!" I did - but she was 8 cms or so dilated, with the cervix just stretching away during the exam, and the baby's head descending through it. Too late for IV pain meds, and even an epidural might not make it in time. Hearing this news, B. said again she did not want an epidural, so just forget it!

B. hopped back out of bed immediately, and went back to leaning on her mom. She was still working hard, but looked determined again. She'd snap at whoever was rubbing her back "Harder! Don't stop!" and snap at the boyfriend to bring her drink right now. After 10 minutes or so, she suddenly plopped down on the floor - completely naked, leaking amniotic fluid all over, sweating, breathing hard - flat on her rear end on the floor. Her mom sat down behind her, and soon she flopped backwards into her mom's lap. Mom sat cross legged, and B. laid with her upper body in mom's lap, curled her arms around mom's arms, and rolled back and forth with contractions. We could easily see each contraction build across her belly, and almost the outline of the baby since she was thin to begin with. After just a few contractions, she said she was having more pressure in her butt, but still no real urge to push, but couldn't I just check her again and couldn't she try to push the baby out anyway. And furthermore, she was not getting off this floor, couldn't I just get down here on the floor and check her anyway?

I can get on the floor of course, and after convincing her to at least slide a clean bed pad between her rear end and the (possibly yucky) hospital floor, I did a quick exam. Tiny anterior lip, with the baby pretty much through the cervix. B. said she just wanted to try to push, and I encourage her to wait for a true urge, but didn't think she'd hurt anything by pushing. Lying in her mom's lap with her arms curled under and gripping mom's arms, B. pushed with the next contraction. For the first couple contractions, she pushed in short bursts, or just grunted a little. Even so, we could soon see the outline of the baby's head bulging the perineum. B.'s mom's leg fell asleep, and she asked B. if she could move, and B. snapped "Don't you dare move!" The mom took a deep breath and held as still as she could. After a couple more contractions, B. said her tailbone hurt, and I asked her if she wanted to move. "I am NOT getting in that bed!" she said with a serious glare. I meekly replied that I just meant maybe she could try squatting or kneeling and get off her tailbone. She thought for a moment and said she'd try that.

B. slowly turned over - it taking quite a bit of effort to get off the ground at this point. She made it over to her knees, and I suggested she hold on to the bed. Her boyfriend lay down across the bed with his head at the side of the bed, and she knelt at the bedside, holding his forearms for support, and resting her head on his shoulder. He whispered encouragement to her - and told her he was sorry for doing this to her - and she held on to him for dear life. The poor mom finally made it to her feet with her asleep leg, and the support people moved to supporting the mom, who was just overwhelmed at the intensity of it all at this point. B.'s dad had been in and out of the room, and now was back in, but in the corner of the room. He could see B.'s head over the bed, but not the rest of her. The mom and the 2 friends stayed behind B., wanting to see the baby. Shift change happened just then, and the 3 new nurses joined the 2 I already had in the room. I knelt on the floor next to B. Although it sounds like a huge crowd, it was very quiet and intense in the room. The only sounds were B. working hard, and her boyfriend encouraging her, and the nurse or I telling her how wonderful she was doing. Within just a couple pushes, baby's head was staying visible even between pushes.

With the next contraction, B. slowly pushed her baby's head out, and mom started to cry, dad across the room started to cry, the friends cheered, the boyfriend started to cry. Even though B. was kneeling on the floor, I could see the baby's head emerge, and then almost look sucked back against the perineum - a turtle sign that immediately made me think of a shoulder dystocia. Baby was LOA, having turned I think somewhere late in labor. I waited for B. to take a few breaths, and asked her if she could push again, and she started to push. The baby didn't move at all and her face suffused with purple while B. pushed. I reached for the head and pushed up gently to see if the anterior shoulder would be freed - but it didn't budge. While B. pushed, I switched directions and tried to free the posterior shoulder - but it didn't budge. B. took a few more breaths, and when she started to push again, I lifted the head up again, and with a slight popping sensation, the baby's anterior shoulder came free, and almost immediately the whole baby slid out into my hands. There were 2 tight wraps of cord around the neck, but baby splashed right out. B. heaved a huge sob of relief and dropped her head and shoulders down on the bed. One of the nurses squatted on the floor with me and unwound the cord, and dried the baby's face as she coughed a couple times, and then started to cry. With the first cry the whole room erupted into laughter and tears and whoops of joy.

Within a minute or so, B. was looking around for her baby. A nurse threw a clean pad down on the bed, and B. stood up, lifted her leg up while I passed the baby under to her hands, crawled onto the bed holding the baby, and sat cross legged on the bed holding her baby to her chest. (Only teenagers are that athletic in the minute after birth!) Her boyfriend wrapped his arms around them both, and we put a couple warm blankets around them all, and everyone sort of stepped back and breathed some sighs of relief ourselves. Baby was born at 7:17 am, about 24 hours after labor started, 11 hours or so after she'd come to the hospital, but just 4 hours after she'd been 4 cms and had her water broken.

After a while of sitting and holding her baby, B. started to feel more cramping and more uncomfortable and wanted to get the placenta out. She lay back on a few pillows, still holding her baby to her bare chest. We clamped the cord, and the boyfriend cut it with shaking hands, while everyone else took pictures. B. pushed once, and the placenta was out. While B. was pushing the baby's head out, since she was kneeling and leaning forward, I could easily see her perineum. The head had slid out slowly and atraumatically and I didn't think she'd had any tears at that point. However, as the shoulders came, there'd been a sudden little gush of blood, and I worried that the popping sensation as the shoulder came was a perineal tear. Sure enough, I could see a midline tear. At first, I though it was just the skin, but as I tried to follow it downward, I couldn't quite see the base of it. Worried about the extent of this tear, I decided to take apart the bed and put B.'s legs in the foot pedals and get decent light to see what was what.

Unfortunately, the tear turned out to be a partial 3rd degree laceration. The sphincter capsule and muscle fibers hung loose in the middle. I explained to B. that she would need some local anesthesia and stitches. This sounded like a just terrible idea to her at this point, but I was able to inject the local pretty much without her feeling much (sometimes the vagina and perineum are numbish from the stretching of the baby and overload of the nerves.) While B. snuggled her baby, and drank a Sprite lying down, I repaired the sphincter, then the perineal muscle layer, then the skin. The tear didn't go quite all the way through the sphincter, and the rectal mucosa was all intact.

Soon, we were done, and B. wanted to have the baby weighed. This skinny 17 rd old had managed to push out an 8 lb 13 oz baby girl - in less than 30 minutes! I asked B. if she was upset about not getting pain medicine and she said "Heck, no!" and that she'd have been very disappointed if she'd gotten pain medicine that close to the baby's birth after getting through all that labor on her own. We helped B. put the baby to breast, and cleaned up the room. B.'s baby mostly did not leave her arms for the next 24 hours, but snuggled with her mama, and nursed, and was loved. The next morning, the nurse who came on in the morning did her assessment exam - and was shocked to find crepitus over the right clavicle, and the baby wincing whenever she touched it. An xray showed that her right clavicle was broken. Looking back, I'm sure that was actually the pop I felt as the shoulder came free. Fortunately, babies' clavicles heal easily, and she has no nerve damage or other problems and just needs to have no one pull on her arm while she's healing. B. felt great, despite the long labor, the extensive perineal repair, and the lack of sleep. She positively glowed while describing her birth - and was so in love with the baby.

See, the thing about this kind of birth is that this mama had it in her to do it. All she needed was the space to do it in. She just needed folks around her to believe she could. It was not an easy birth, or a short birth, or an uncomplicated birth. It was ordinary and yet sacred, moving and extraordinary. Mostly, we just encouraged this young mama to do what felt right to her, and she took the powerful, primal energy of birth and used every bit of it to make it hers. Watching her, who'd seemed so young and vulnerable and needy, turn instead into someone powerful, and strong, and even commanding was an amazing thing. When she was hurting, she didn't need me to rescue her or feel sympathetic, she just needed me to trust her and give her the space to keep going.

So: What if you attended births, but you never saw a birth like this? What if instead your system encouraged, or even coerced, needy, opinionated teenagers like this into lying in bed, strapped to a monitor, until they were overwhelmed? And then you talked them into an epidural to make them comfortable? What if their birth plan was treated as the hubris of an inexperienced child and laughed at? What if her request for limited exams was seen as childish and responded to with "You were able to open your legs to get this baby in there!" type comments? What if she'd pushed and pushed, but her baby had been wedged posterior by the epidural, and her sacrum couldn't move squashed against the bed and the baby never came out? Or she did come out, but the sticky shoulders in hands and knees was a full blown shoulder dystocia in semi-sitting and she'd had a huge episiotomy and a brachial nerve palsy, or worse brain damage from lack of oxygen? Then you'd say "Those damn teenagers think they know what they're doing. Can you believe she thought she could do this? Thank God we saved her baby!" And knowing you were right about it all, you'd treat the next client just the same. Occasionally, you'd see some quick birth happen before you could intervene much, but those would be chalked up to luck, and the rest would have the full gamut of technology you can provide.

I've seen that alternate birth story during my training. I've heard it told to me by friends and clients who birthed elsewhere. I'm always so grateful when I get to witness a birth like this, a birth that took a woman to the limits of her abilities, but she stretched herself and did it. These are the births that keep me going, that I remember in middle of night awakenings, that remind how strong women are, that I wish every birth attendant would be required to witness.

Giveaway of "Your Best Birth"

I have 5 copies to give away of Your Best Birth: Know All Your Options, Discover the Natural Choices, and Take Back the Birth Experience, the new book about childbirth choices by Ricki Lake and Abby Epstein!

To enter this giveaway, please share one of the following:

• A satisfying, empowering birth story, or
  
• Something you wish you'd known before you gave birth, or
• Tips for creating a better birth experience
  

Giveaway ends Saturday, May 16th at 5 pm EST. US or Canadian residents only; no PO boxes.

More about Your Best Birth:

The national C-section rate is at an all-time high of 31 percent. Are all these C-sections necessary, or are some of them done simply for the sake of convenience? Inductions seem to be the norm, but are they always needed? Today, expectant mothers are often left feeling powerless, as their instincts are replaced by drugs and routine medical procedures.

What you are about to discover is that you have a choice, and you have the power to plan the kind of birth that's right for you--whether it is at a birth center, a hospital, or at home.

With chapters such as "Obstetricians: Finding Dr. Right," "Epidurals: You Haven't Got Time for the Pain," and "Electronic Monitors: Reading between the Lines," Lake and Epstein will encourage you to consider whatever your doctor, mother, and best friend may suggest in a new light. The book also includes inspiring birth stories, including those from well-known personalities, such as Laila Ali and Cindy Crawford. Packed with crucial advice from childbirth professionals, and delivered in a down-to-earth, engaging voice, YOUR BEST BIRTH is sure to renew your confidence and put the control back where it belongs: with parents-to-be!

To find out more, visit the book page or read an excerpt.

Two weeks

Having a two-week old baby and family visiting was a great way to celebrate Mother's Day. Eric named and blessed Dio at church today, since we finally decided on a middle name (Spencer). I wore yet another of my slings; you've got to coordinate with your outfit, after all! Dio was awake during most of church, so he's been napping soundly this afternoon.

My mom and I played a violin-piano duet during church today. My mom, a Suzuki violin teacher, often "volunteers" us to play when she visits. I'm glad to have someone urging me to play my violin, because it's not something I'd remember to do on my own right now.

We took some pictures of the cousins after church. They have so much fun together. My sister is expecting #4 in October, so we'll have even more cousins soon!

Picture time!

Children's Museum

We met up yesterday with my mom, my sister and her family at a children's museum about an hour away. It's supposed to be one of the best and biggest in the country, and we weren't disappointed. If anything, it was a bit too overwhelming--all of the noise and the people and the sheer magnitude of things to do. We bought a year's membership, which will pay for itself after one more visit.

By the end of our visit, I was exhausted. We had been up quite late the night before because Zari wasn't feeling well. My midwife had a blessingway in the evening, and I had to cancel going. I was disappointed that I missed the festivities--including bellydancing lessons!--but I was wiped out.

Indoor sandbox

Dio with his cousin E.

On my own

My mom left yesterday afternoon to visit one of my sisters for a few days before she heads home on Sunday. I had my first taste of what it's like to take care of two children by myself. Eric was up on campus meeting with students, so I was on my own for the afternoon. We took a walk to a nearby thrift store (Zari in a stroller, Dio in a sling), where I bought a Graco SnugRide infant carseat for Dio ($30) and a pair of sandals for Zari ($2.75). The carseat was nearly new, probably used for just one baby since the expiration date was 2013. If price were no object I'd buy a Britax, but I decided to use an infant carseat for the first year. Then I'll move Dio into Zari's Britax Roundabout (which I bought from my friend Jen) and buy a larger Britax carseat or booster for Zari. Then Zari played in the sprinkler for a bit while I nursed Dio.

This morning I was on my own as well. I picked up my cell phone from a restaurant about 10 minutes out of town; I left it there a few weeks ago. Then I wandered all over the countryside looking for a garage sale I saw advertised on Craiglist. I never did find it.

I think Dio's face is already starting to fill out--something I find satisfying yet bittersweet. He nurses really well, enough that he usually nurses just on one side at each feeding. He's having more alert periods during the day. He and Zari both wake up around 8 am, and Dio often stays awake for 2-3 hours before conking out.

Nights are typical for a newborn. He takes up every 2-3 hours to nurse. He has a bit of trouble falling back asleep all the way. I often have to rock him, snuggle him on my chest, or let him suck on my finger a bit before he drifts all the way off. Zari, on the other hand, always passed out immediately after she was done nursing.

I've started doing elimination communication, by default and necessity. Dio really does not like having a wet or messy diaper. He also fusses quite a bit right before he needs to go. So it's become easier potty him if he wakes up and still has a dry diaper, or if he starts fussing out of the blue. And at night, if I potty him right before he nurses, he sleeps much better. I'm still getting used to male anatomy. I learned pretty quickly to always keep him covered during diaper changes, since he can spray objects several feet away. I also learned to point his penis downward before I put a diaper on (a friend of ours calls it "the 6 o'clock position"), otherwise he'll pee right out the top of his diaper. Always something new to learn.

8 days old