Sunday, May 30, 2010

Confidence, competence, and preserving breech birth at home

Just a few days after my review of Karin Ecker's documentary "A Breech in the System," Australian midwife Lisa Barrett posted the story of a breech home birth she attended (watch the birth video here). Both women's stories are remarkably similar. Originally planning to use in-hospital birthing centers, they are told their only option is a planned, pre-labor cesarean when their babies turn breech. Both women go through great lengths to encourage the baby to turn, including an attempt at ECV. Both find encouragement and support from home birth midwives, even though neither one plans a home birth. Both plan a natural breech birth "in the system."

The woman whom Lisa attended had settled on a hospital birth with Lisa attending and supporting her. However, once she went into labor, her plans changed. (Read the story, linked above, for the surprising conclusion.)

I admire Lisa for her generosity in helping this woman at the last minute. In fact, when Dio was breech and I was wondering what I would do, Lisa invited me to come stay and birth with her. I was floored by her offer. At that point, we had not yet met in person, so she only knew me from my online presence. Lisa's the invitation meant so much to me during that time of upheaval and uncertainty. Fortunately, Dio turned vertex and I did not need to consider traveling halfway around the world.

One problem with preserving the art of breech is that of numbers. Very few obstetricians, let alone midwives, have attended a significant number of vaginal breech births. However, a birth attendant needs to be both confident and competent in attending breeches. Confident enough to stay calm, to keep their hands off the breech,  and to know their limits. Competent enough to have seen and dealt with the rare but serious complications of breech birth, in addition to a sufficient volume of "uneventful" physiological breech births.

I feel strongly that we need to preserve not only vaginal breech birth, but also vaginal breech birth at home. In today's obstetric climate, it is often the only place where a woman can avoid a cesarean for breech. And even if she can find an OB willing to attend a breech birth in a hospital, a woman often faces an uphill battle for an undisturbed, peaceful birth. Lisa's client commented on the advantage of giving birth to a breech at home: "Being at home meant we didn’t have to negotiate for a normal physiological birth without intervention – it was assumed because there were no problems." Not all women wanting a vaginal breech birth will chose to do so at home, but losing or outlawing that option would mean a great loss for women's autonomy and their ability to choose what is best for their babies and their bodies.

Lisa's client ended her story with these remarks:
I’m so grateful that I was able to have a natural breech birth without panic or fear. The birth of our daughter was such a fantastic, positive experience and it saddens me to think that women are led to believe that breech birth is always dangerous or even impossible. As a woman in the public hospital system, I became a black sheep because I questioned their policies and their underlying evidence and refused to accept their way as the only way. I was too much trouble and was effectively turned away. The only reason I was able to birth naturally was because I was lucky enough to find a midwife who believed in birth and believed in me and because I have a like-minded husband who supports me. These things don’t necessarily guarantee anyone a birth free from intervention, but they certainly give the birthing woman a say as to what happens to her baby and her body, placing her at the centre of the decision making process – which is exactly where she should be.
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Saturday, May 29, 2010

Weaning party

A few weeks ago, Zari looked up from eating breakfast and said, "I'm think I'm done nursing."

"Whenever you're ready," I told her.

"Well, I think I'm all done, though," she said.

She didn't ask to nurse for a week. I think she would have gone longer, but then we traveled to France. With all of the upheavals--new location, new time, new language--she has nursed a few times in the past two weeks.

Zari's latch had been getting very lazy even before her sudden announcement that she was done. But after her week-long hiatus, I realized that she had literally forgotten how to nurse. She would roll my nipple around in her mouth, give a few half-hearted sucks, and then stop.

It was time to wean.

I told Zari that we would have a "nursing party," since she was forgetting how to nurse. When she was ready, she could pick any cake she wanted from a patisserie. We would have a party, eat the cake, and then she would be all done nursing.

Nursing parties--more commonly called weaning parties--date back thousands of years. For example, Abraham threw a big party when his son Isaac weaned: "And the child grew, and was weaned: and Abraham made a great feast the same day that Isaac was weaned." (Genesis 21:8). They're still done today, too; see examples of modern-day weaning parties in Australia and the States.

Several times this week, Zari asked about going to the patisserie. This evening, while I was cooking a potato & leek soup, Eric and Zari went on a walk to buy her "nursing cake."

After dinner, we brought the cake out. I told her the story of when she was born and when she first nursed. We took pictures. I hugged her and told her how much I loved her. I told her how glad I was that I was able to nurse her for a long time.

And then we ate cake. It was good.
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Friday, May 28, 2010

Spirituality in Childbearing Women

New qualitative research by Lynn Clark Callister and Inaam Khalaf, published in the Journal of Perinatal Education, examines spirituality in childbearing women. For their article "Spirituality in Childbearing Women," Callister and Khalaf examined narratives from 250 culturally diverse women and found that spirituality played a significant role in women's approach to and understanding of childbirth. The women came from a variety of religious traditions and countries. From the article:
For the present study, we performed a secondary analysis of published and unpublished descriptive narrative data from cross-cultural phenomenological studies that we conducted over the past 20 years with childbearing women espousing Christian, Jewish, and Islamic religious traditions and with childbearing women from countries in a variety of global regions (Australia; Europe; Middle East; North, Central, and South America; Southwest Pacific; Western, Northern, and Eastern Asia; and Western and Southern Africa).
You can download the full text of the article from the abstract page. Lamaze International has also issued a press release about the article, in which Callister explains more about her research. An excerpt:
The study, published in the spring issue of the Journal of Perinatal Education, found that understanding the spiritual dimensions of childbirth is essential in clinical settings. As such, authors of the study recommend clinicians include the question, “Do you have any spiritual beliefs that will help us better care for you?” during their clinical assessment.

“Childbirth and motherhood provide many women with an ideal context in which to recognize the spiritual aspect of their lives,” said Lynn Clark Callister, R.N., Ph.D., FAAN, a professor of nursing at the Brigham Young University College of Nursing and study co-author. “Our research illustrates that for most women, childbirth is a deeply spiritual experience. As healthcare providers, we need to recognize and support this evidence, and listen to women’s voices to guide their care.”
I'd love to hear about your experiences of spirituality in pregnancy and childbirth. Please share!
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Thursday, May 27, 2010

13 months old!

What does Dio like at 13 months old?

Dio loves dogs, birds, nursing, drinking water, eating dirt and sand, playing dinosaur with Zari, bathtime, giving hugs, snuggling his sock monkey when he sleeps, trying to eat with utensils, and crawling around being silly with Zari.

This week, Dio decided that walking was more interesting than crawling. So now he toddles around everywhere, arm stretched out like a zombie in a bad sci fi movie. When they aren't pushing each other over, pulling hair, or taking each others' toys away, Zari and Dio are best buddies. She's taught him how to be a dinosaur, so now they walk around the house with their arms outstretched, saying "roar! roar!" If you say the word "dinosaur," Dio will say "roar!" back.

Dio is sleeping fairly well (waking once around 3 am to nurse), but he's started waking up earlier and earlier every morning. Back home, he used to wake up at 7 am on the dot. I could almost set a clock by it. Then, his waking time started creeping back. Within a few weeks, he was up at 5:30 am. Sometimes I could get him back to sleep, sometimes not. I hoped that jet lag and re-setting his internal clock would stop this. The first few days in France, both kids were on a 9-to-9 schedule. Then it happened again...wakeup time is now 6 or 6:30 am, which mean bedtime has to be earlier. I've been able to nurse him back to sleep the past few days, thankfully, because no one is happy if he's up at 6:30!

Teeth #5 & 6 are almost all the way down now. I just found a first molar peeking out last week. His top eye teeth also look ready to break through.

Today's adventure with Zari and Dio: attending a huge manifestation. By accident--we had plans to go to a botanical park/zoo/aquarium, but all tram and bus services were closed.
I understand it was nation-wide. It felt more like a street party or parade than a protest. I'm not exactly sure what the protest was for. Something involving retirees and the reduced income of public servants and the weak economy. The French communist party (PCF) had a huge banner saying: "Make the banks pay, not the people!"
 
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Wednesday, May 26, 2010

Review of documentary "A Breech in the System" by Karin Ecker

Last month, I briefly mentioned the documentary "A Breech in the System". Karin Ecker, the filmmaker and mother featured in the film, contacted me to see if I'd be willing to review her film.

A Breech in the System:
Who's in charge of birthing my baby?

A new film by Karin Ecker
Edited by Sharon Shostak

This 40-minute documentary follows Karin's journey through the last three months of pregnancy and the birth of her first child. At six months pregnant, Karin moves from Austria to Australia and learns how to navigate through a new medical system. When she discovers her baby is breech at 36 weeks pregnant, her plans for a natural birth in an in-hospital birthing center have to be abandoned, as breech births are not allowed there. Pressured to have a scheduled cesarean at 38 weeks, Karin begins examining her options and realizes that she has to try for a vaginal breech birth. Never knowing until the last moment whether she will be allowed to make this choice, she continues to move forward, hoping that her choices are right. She feels torn between the support from her friends (several of whom have given birth vaginally to breech babies) and the rigid opposition to vaginal breech birth from the hospital system.

Karin's story unfolds in counterpoint with interviews of various people involved in Karin's pregnancy: friends, doulas, midwives, childbirth educators, family physicians, and OBs. They speak about the physiology and pathology of breech birth, about issues of informed consent and refusal, about the meaning and significance of pain, about a pregnant woman's need for support and information.

A third narrative line in the documentary is one without words--hauntingly beautiful images of pregnant Karin. We see her immersed upsidedown in a pool, gently cradled by her partner. We see her belly dancing on the beach, waving a veil that billows behind her. We see her underwater, motionless, wrapped in layers of transparent red chiffon, her eyes closed and her hands near her face--mirroring her baby's secret, watery environment.

A Breech in the System makes a strong statement about the "breach" in the Australian maternity care system by showing, rather than telling, the incredible obstacles one woman faced to have a vaginal breech birth in a hospital setting. In the end--and you can read more about this in the synopsis below--she was able to give birth vaginally by a stroke of sheer luck and coincidence. Not because the system in any way supported or facilitated her choice, her desires, or her autonomy.

This film is not a how-to instructional video of vaginal breech birth in a hospital setting. Nor is it an agenda-driven film striving to push vaginal breech birth as the best or right choice. Rather, A Breech in the System shows the complexity of the decision-making process for pregnant women, especially when their choices are outside those "the System" allows.

With the increased interest in vaginal breech birth from the SOGC, perhaps Karin Ecker would be interested in producing a companion video for physicians, midwives, and nurses. I envision this as an educational film consisiting of minimally edited labor and birth footage, along with voice-over narration from Karin explaining what was happening. Karin's birth footage is especially valuable because it shows upright, physiological breech birth in a hospital setting.

To purchase the film or arrange a screening, visit the documentary's website. The film can be downloaded for AUS $28.50, purchased in Australia for AUS $49.95 or internationally for AUS $49.95 (plus postage).

Trailer of A Breech in the System:


For an in-depth summary of the documentary, please read the synposis below.

Synopsis
The film is divided--organically, not overtly--into 3 main parts. In Part I, we meet the pregnant Karin and follow her journeys through the Australian maternity care system. She moved to Byron Bay, a seaside town in New South Wales on the eastern coast of Australia. Karin finds this beautiful, natural place at odds with the rigidity of the obstetrical system she will soon encounter once she discovers her baby is breech. Before this turning point in her pregnancy, however, she had selected to birth a hospital birthing center that felt perfect for her. The staff facilitated women to birth without medications (gas & air and morphine were available in the birthing unit, but rarely used). The center encouraged water births and provided large, spacious tubs for that purpose.

Even before her discovery of breech, Karin started questioning her maternity care. In Austria, women received ultrasounds every month, and they were seen as a very natural and normal part of pregnancy care. In Australia, though, people tended to view ultrasounds with hesitation and worried about the potential negative effects on the baby. She started wondering why one culture would see them so benignly, and another so suspiciously.

A newcomer to Australia, Karin was fortunate to have strong support system in Bryon Bay. The film features several of the women and men supporting Karin: her friend, support person, and camera person Sharon, home birth midwife Sue, friend and childbirth educator Suzanne, birth consultant Jayne, and Karin's partner. In addition, we meet Karin's GP (family physician) Dr. Marc Heyning and the OB who was on call when Karin went into labor, Indian-trained Dr. Geeta Sales.

Part II begins with the discovery that her baby was breech. At 36 weeks pregnant, her doula was feeling Karin's belly and remarked that she was fairly sure the baby was head-up. When the breech presentation was confirmed, Karin and her partner initially felt confident that the baby would turn. They tried almost everything to encourage their baby to move head-down: talking to the baby, inversions in water, yoga, homeopathics, and massage. Finally, as pressure was mounting for Karin to schedule a cesarean at 38 weeks--something she was not at all keen to do--they tried an external cephalic version. The baby turned, and after a 30-minute monitoring session, Karin got up to use the bathroom. She touched her belly and felt the baby's head back up near her ribs, and she knew it had turned breech again.

This moment marked the crucial turning point in Karin's journey. She almost succumbed to the cesarean, which was scheduled in just 4 days. She had a brief moment of relief that she wouldn't have to go through all the pain, all the laboring. But even during the version, when the baby was head-down and she was on the monitors, she remarked to the camera, "I wouldn’t want to have somebody I don’t know cut me open and lift my baby out of my body.” She realized that she had to try to have her baby vaginally. She simply could not agree to a scheduled cesarean.

Part III: With the medical system providing no options but a scheduled cesarean, Karin began digging deeper. She did not feel right about leaving the system entirely and birthing her breech at home--something her friend Sharon and midwife friend Sue had done with their breech babies. So she started looking for a back door, so to speak. She knew that vaginal breech birth was possible and had her friends' support for that choice. She felt the clash of two opposing mentalities: the natural environment she was living in, versus the medical system saying no, you have to do it our way.

When she met with the physicians at the hospital where she would now have to give birth, she found a small opening in the door. Initially, she was hoping to just convince them to let her go to full-term before scheduling the cesarean. During her meeting, they told her: "We’re not allowing you to have a natural birth. But we cannot force you.” She pressed further. "The midwives will definitely love you if you try for a natural birth," they said. "But no, we cannot support you." These mixed messages--no you can't, but yes you can--gave her the hope to at least try for a vaginal breech birth. She spoke with Sue extensively about what informed consent meant and her legal rights to not be bullied into making decisions.

The day of her scheduled cesarean, Karin called to cancel the surgery. She was expecting to be scolded over the phone, but the midwife on the phone was quite friendly and supportive. Karin went into labor on her due date, not knowing exactly what her plan would be or if she'd even be allowed to try for a vaginal breech birth. She arrives at the hospital with her friend and camera person Sharon. Sue, the homebirth midwife, had agreed to support her at the hospital and arived soon thereafter. Together, the three women held the space as they waited for the on-call OB to arrive. Deep in labor, Karin also had to deal with the anxiety of not knowing whether her wishes for a vaginal breech birth would be honored.

Finally, the OB, Dr. Geeta Sales, arrives. Dressed in casual street clothes and several gold necklaces, she learns of Karin's desire for a breech birth. How will the obstetrician react?

It is a moment of serendipity when Dr. Sales smiles and says...Oh, I've done lots of breech births! The tension in the room melts away. Sue and Sharon no longer have to protect Karin from the hospital. Instead, the staff--and physician in particular--are totally on her side. Dr. Sales, who trained and then practiced obstetrics in India before coming to Australia, is very comfortable with vaginal breech birth, which was the norm in India. She goes through Karin's birth plan line by line and is on-board with everything. Karin's wish to birth in an upright position gives Dr. Sales some hesitation, but when Sue assures her that the mechanism of breech birth is the same, Dr. Sales agrees.

Now it is time for Karin to surrender and give birth. We see Karin laboring and pushing in several positions: kneeling, standing, in the tub, side-lying, squatting. Loving hands and smiling faces surround Karin. The OB quietly explains to Karin's partner what to expect--the task is to simply wait patiently until the buttocks emerge.

Karin births her son's body in a kneeling, forward-leaning position. After the body has emerged, she is lifted into a supported squat/sit for the birth of the head. The birth of the baby occurs very quickly. Her son is quickly whisked to the resucitation table and given a bag-and-mask. In what is the most transcendent moment in the entire film, a naked Karin walks to the table, sobbing with joy, and caresses her son. The mother and baby are soon snuggled into bed together, naked and skin-to-skin. We see Karin taking in the enormity of what she has just done. As she and her baby nuzzle and caress, Sinead O'Connor's A Hundred Thousand Angels plays in the background. The first verse of the song goes:
Do you
Hear me calling you
The voice of a mother, a father and a child
Would you recognize the truth
Do you feel a love that's falling from my eyes
Every time I watch this part of the film, I cry. (This is coming from someone who did not cry when her own children were born.) It is that beautiful.

Karin explains that when she held her baby for the first time, the fear and trauma of the birth were all gone, wiped away. She experienced incredible happiness and relief that her ordeal was over. The documentary ends with Karin saying: "I felt there is nothing I can't do."
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Monday, May 24, 2010

Antisuburbia

This post is inspired by Michelle's post at Birth After Cesarean: Suburbacide and the New York Times article As Suburbs Grow, So Do Waistlines.

I'm living in ultra-urban territory this summer, and I'm loving it. We're in vieux Nice--the very, very old part of a very old city on the southeast coast of France. Most buildings are 5-7 stories tall, with shops on the ground floor and apartments above. A few of the roads are wide enough for cars, but most are so narrow that only pedestrians and the occasional delivery vehicle can pass through. We're on one of the few "big" streets in old Nice.

When I look out my window, this is what I see:
To the right:
To the left:
Within a few blocks there is a large daily produce/cheese/bread market that runs every morning until about 1 pm, pharmacies, confiseries (candy), chocolateries (chocolate), bakeries, patisseries (pastries and cakes), cookie stores, ice cream stores, olive oil stores, wine stores, clothing shops, a few small grocery stores, handmade soap and spice stores, and more. And so many restaurants you could never hope to visit them all. There's the bread store around the corner where I buy our daily baguette--sometimes the "plain Jane" baguette de tradition, other times the baguette à l'ancien or the baguette rustique. This particular bakery is just one of many artisinal bakeries in the area. Nothing remarkable to locals, but extraordinary to those of us from North America, where in most places you can only buy varations on a theme of Wonderbread. We're just a few minutes' walk away from the tram and the main bus station in town, from which you can take a bus anywhere in the entire region, from Cannes to Monaco, for only 1 Euro.

Living in a very small 2-bedroom apartment has taken some getting used to. Our bedroom is just big enough to fit a double bed and not much else. The kids' bedroom is even smaller. Zari sleeps on the twin bed, and Dio sleeps on the floor in the space between the bed and the wall. It's in the middle of the apartment, so there's no window in their room. Then there's a living/dining room, a small kitchen, a very small bathroom, and a teeny tiny WC. So small that they had to install the toilet at an angle because there wasn't enough room front-to-back to put it in straight.

The apartment is small (to us) but fairly typical for French standards. Between the lack of toys and limited space, we spend most of our waking time outdoors. We don't have a balcony or terrasse in this apartment; the laundry hangs on a rack installed below our bedroom window.

I do admit that my ability to enjoy super-urban, super-crowded conditions comes in part from knowing that I have a larger house, and a yard, back home. Our house in an old residential neighborhood that dates back to the late 1800s. Our house was built in 1883, one of the first in the area. It has 3 bedrooms (1800 sf) and a double city lot (so about 75x200'). Still, even there, we live a mainly urban lifestyle even though we're in a small town. At home, we're within 3-5 blocks of everything we need on a day-to-day basis: Eric's work (campus), post office, playground, bank, public library, gym and indoor track (both free and on campus), 2 pharmacies, 2 thrift stores, pizza store, taqueria, Mexican food store, and all the other downtown shops (which aren't doing super well as a whole; they're suffering from the big box stores south of town). We drive for bigger grocery trips, church, home improvement stores, all of which are about 2 miles away and on busy roads. Actually we used to ride our bikes to church in the warm seasons, but it's on a busy 50-mph road with no shoulder, so we eventually gave that up for safety reasons.

I like urban living--even if it's urban small-town living like we have at home. I still prefer having a house and some yard, because I love having space for the kids to run around in and, most importantly, a place to grow food. But I think I could adapt to apartment living if I were close enough to a park and had sufficient patio/balcony/rooftop space to grow things. I feel incredibly liberated not having to use a car to get where I need to go. I love my neighbors. Seriously, we have the best neighbors ever. And if I lived in a typical suburban enclave, where you rarely walk to school or work or shopping, I wouldn't know my neighbors very well. But I'm always walking around, and I say hi and chat when I pass by. We bring each other food, mislaced mail, keep an eye on others' houses when they are out of town, comment on renovation or gardening projects, and just enjoy the human interaction.

Now I'd like to hear from you: What is your ideal living situation--urban? rural? suburban? small town? How have you adapted to less-than-ideal living/housing circumstances?
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Saturday, May 22, 2010

What we did today

We took a bus to Cap Ferrat
We played in the sand (actually small pebbles). I love Dio's swim outfit.
 Zari looked pretty cute, too. I found her springsuit at a thrift store for $1.50.
We waded in the water.
We found lots and lots of jellyfish.
We went hiking along the coast
We found a great place to snorkel
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Tuesday, May 18, 2010

Barb Herrera: The Deal with Dr. Wonderful

Barb Herrera, CPM, LM, explains the deal with Dr. Wonderful. Check it out if you want to learn more about her encounters with Dr. Biter, his pracice style, and how one might view him through malpractice lawyers' or hospital executives' or physician colleagues' eyes.
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Monday, May 17, 2010

Nursing in public and formula advertising in France (updated)

I had two encounters with breastfeeding yesterday, my first day here in France.

Encounter #1:
We were riding a bus on the way to church. Dio was really, really fussy and started lunging toward my chest. I was wearing my favorite wraparound dress. When you're jetlagged and feeling like you're wading around in a fog, it helps to have a pretty dress on. I pulled my dress open and nursed Dio, who went at it with gusto (and then passed out a few minutes later). Obviously, this wasn't "discreet" nursing since I had to pull my dress down, rather than lift the fabric up like you do with a shirt.

I was facing two older women in their 60s or 70s. When I began nursing Dio, they smiled and began talking to me. They said "Ah, he knows what he wants!" as Dio was nursing voraciously. They remarked how good it is for a baby to have his mother's milk. They reminsced about nursing their own children back when it wasn't "à la mode" to breastfeed. Eric and I chatted with them for until we reached our stop.

Encounter #2:
I saw this pharmacy display window when we were going for a walk and had to take pictures. It is an advertisement for Novalac formula.
Closeup of the poster on the right, which reads "Bien le nourrir, c'est bien choisir." Note the cow holding a baby in one hand and a bottle in the other.
Loose translation: "A good choice for feeding your baby well." (Or "a good choice for good nutrition" or "Feeding well is choosing well" but those sound awkward in English.)

Look more closely at the breastfeeding baby's latch.
It's okay in some ways--the lips are nicely flanged out--but problematic in others. The baby is latched on symmetrically, rather than asymmetrically. You really want to see the baby's chin deep in the breast, while the baby's nose should be farther away from the breast. In addition, the baby's body seems quite far away from the mother's body and breast. Ideally, the baby should be very close to the mother's body, which helps the baby tip its head back and thus achieve a better latch.

What we're seeing is the bottlefeeding norm being applied to breastfeeding. Look at how the breastfeeding latch closely parallels the bottlefeeding latch:

Overall, this advertisement really puzzles me. I'm trying to figure out the subtext and having a really hard time.

First, I think the text is meant to be read in this order.
Allaitement ou lait infantile?
La réponse qu'attend maman...
Pourquoi?
Breastfeeding or formula?
The answer that mom is waiting for...
Why?
Or should it be read in this order, in which case it makes less sense?
La réponse qu'attend maman...
Allaitement ou lait infantile?
Pourquoi?
The answer that mom is waiting for...
Breastfeeding or formula?
Why?
And what is the message behind this advertisement? Here is what I think it's trying to communicate:
Expectant moms are asking themselves the question: breastfeeding or fomula? But why even ask the question? Formula is the obvious choice.
If the ad is really saying what I think it is, I am a bit stunned at how blatantly it makes out formula to be clearly superior to breastfeeding. In North America, formula ads give lip service--in the form of small print somewhere at the bottom of the ad--to the idea that "breast is best." They portray formula as the "next best thing" to breastfeeding and note that X or Y formula is  made with the same components as breastmilk (DHA, etc). But this French Novalac ad seems to say that formula is clearly the superior choice and that really, there should be no "breastmilk or formula?" question at all.

You native French speakers out there, please chime in. How would you translate both the literal text, and the implied message behind the text and images?
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Sunday, May 16, 2010

Flying overseas with 2 kids and no husband

I've done several cross-Atlantic flights with a baby or toddler. But this summer, I had to bring both Zari and Dio to Nice, France by myself. (Eric flew over a week earlier to lead an immersion trip for one of his university courses.) We found tickets with only one layover in JFK. Still, flying solo with two young children gave me some trepidation.

Yesterday was the big day. We arrived on time at the airport and had to wait an hour for the agent to issue the infant ticket--because a "free" infant still costs quite a bit of money when you fly internationally. Two years ago, Zari's "free" ticket cost $550. Dio's cost $125. I have no explanation for the wide variation in price, except that we flew on different airlines each time.

When we arrived at the gate, our flight was delayed an hour, giving me only 20 minutes to make my connection in JFK. There were no other flights to Nice on any airline that day. I experienced a rising sense of panic.

While we waited, the kids played on the moving sidewalks and crawled around the waiting area, giggling. I fed them snack after snack to keep them content. An hour later, we finally boarded--only to get sent off the plane a minute later due to further unexplained delays. Another half-hour and we were on our way.

My flight to Nice was scheduled to leave at 5:40 pm. We arrived at 5:45 pm. I strapped Dio into the Ergo, put Zari in the stroller, and ran. Dio wasn't too happy about that. We made the connection seconds before the final gate closure. Relief.

Now the long flight began. Zari started saying "I don't want to go to France. I want to go back home" ad nauseum about 15 minutes into the flight. Dio just wanted to crawl around, but the flight attendant wouldn't let him sit or crawl in the aisle, even if I was holding onto him, "because it is so dangerous and he could slide all the way to the back of the aircraft." (In the event of the plane suddenly tumbling out of the sky, I guess, in which case I don't think we'd survive the fall anyway.) And every time I removed Dio from the aisle--so basically every few minutes--he screamed at the top of his lungs in protest.

The time passed slowly. We built a fort out of airplane blankets and hid underneath it. We looked out the window at the clouds and ocean. We ate more snacks. We put on glow-in-the-dark bracelets and played with silly putty. We watched movies. We went to the bathroom multiple times. And of course both kids had to come with me. Have you ever tried to go to the bathroom in an airplane with 2 kids? Oh, and put on thigh-high compressioin hose at the same time? I can attest that it is possible, but you have to contort yourself into some very strange positions.

Several hours after their bedtime, both kids finally fell asleep. I was pinned to my seat the rest of the flight, holding Dio.

I was very happy to arrive on schedule and to see Eric waiting for us. I had already been by myself all last week while he was in France, and the overseas flight just about did me in.

Still, I'm not complaining too much, because spending the next 7 weeks in France as a family makes it all worthwhile. I'm not sure if I have any sage advice for parents anticipating international travel. I am sure some people on the airplane did not appreciate hearing Dio's shrieks or Zari's whining or being kicked in the back of their seats. But we survived.
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Writing Contest: Honorable Mention #2

Another essay that I, and several other judges, liked was "Patience" by Natasha. One of the judges wrote: "Well-written. I liked this one for the same reason that I didn’t need to be told how she transformed, I got to witness it."

More about Natasha:

I'm a 32 year old working mum from Gibraltar living in England with my husband Keith, our son Alfie, and our two dogs. We lead quite an unremarkable existence; I work in IT and my husband is a stay-at-home-dad whose primary focus right now is to bake the perfect bread and finish planting our vegetables for the year.


My son was born by C-Section after a failed induction last November, which at the time shattered every hope and dream I had for the way in which I wanted to become a mother. In its way though, it was something of a blessing because it has given me the desire to keep active in promoting birth as a natural life event rather than a medical emergency. As a result I have become very involved in the work of the National Childbirth Trust and also a member of my local maternity services liaison committee. I have found a lot of comfort in writing my blog The Maybe Diaries as well as following the blogs of the many other like-minded women out there who are trying to reclaim birth. I hope I can continue to add my voice to those others in the right places and at the right times to make a difference.

~~~~~

Patience

Of all the virtues I have always struggled hardest with patience. My enthusiasm for life and hunger to experience everything in it has always made it hard for me to embrace the art of doing nothing. I suppose then it was only right that my son should teach me what beauty there is in the quiet of waiting.

We waited over a year for him to join us, and it was a long year, full of bitter disappointment and hope dashed, and rebuilt and dashed again. We sought help in all the usual places, and then in unusual places, and still he made us wait. It wasn’t until we did what many couples eventually do and stopped trying that we gave him the space to come into our lives, our tiny little alien baby so determined not to be seen by some nosy sonographer.

Each milestone came with the same frustrations for me, taking their own sweet time, as these things will. The first kick, the first hiccough, each moment another leap towards meeting my child for the first time rather than an experience in of itself.

The biggest challenge of all though was the countdown to the birth, which was planned to absolute precision. I grew heavier and wearier as my due date drew near and the sense of expectation became almost tangible.

When I sailed through my due date, nobody was surprised, least of all me, and as with his conception, it was in the last moments of his gestation that my son taught me most about what it is to savour each experience for what it brings.

Each day we ventured deeper into the strange land of Overdue, full of monsters called Placental Failure and demons called Induction and each day he spoke to me through two small pads attached to my tummy and said “I’m OK mum, hang on in there, we’ll be OK.”

It was so very strange that right when the doctors and midwives around me were becoming increasingly scared for our safety, my son finally showed me the beauty of doing nothing. I spoke to other women, both women who had been through overdue pregnancies and midwives not bound by the chains of our health service and they gave me courage, and helped me celebrate the wisdom of the human body.

It wasn’t until we hit 43 weeks that we eventually caved to the pressure of an induction and it will always stand as the biggest mistake I could have made. I laboured their false labour for three long days, not allowed to eat or drink for fear I might need to have my son cut out of me. My body wasn’t ready yet, my son wasn’t ready yet, and so we struggled on, through the storm of augmented contractions, until we were both exhausted. The time for patience was gone and all that was left was for my boy to be cut from me under the glare of the operating room lights.

He was cross at his birth, so very cross, and I was deeply and desperately sad. We had known, he and I, that we weren’t ready to be parted and yet here we were, separated for the first time and it had been someone else’s doing.

We looked at each other for those first few days and it was like looking into a soul you know as well as your own. A beautiful old, wise soul both entirely his own and yet still a part of you and we knew, we could have done things our way if we had been given the chance to exercise patience.

I still have those moments with him even now, some 16 weeks later. We look at each other and know, in the quiet moments of the day when there is nobody else around that each of those moments is precious, and not to be used as a stepping stone to the next, but to be enjoyed entirely in of itself.

I don’t look at the updates I get from baby websites telling me what my son is doing “this week” and what I can expect. I can’t remember the last time we had him weighed, or when I judged him against his peers because I know, in a million tiny ways each day that whatever he does and however he does it is worth waiting for.
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Saturday, May 15, 2010

Writing Contest: Honorable Mention #1

I only had four prizes to give to the Writing Contest winners, but there were so many other fantastic essays. Here is one by Shannon, called "The Book of Jochebed." Hers was the only fiction--well, technically creative non-fiction--entry. One of the judges wrote about her essay: "Clever. I love this story of Moses and how clever she was or God was… and she told it in a clever way. Even though it was not about her, per se, it is an example of how pregnant woman just have pregnancy on the brain."

More about Shannon:

Shannon writes at Seagull Fountain and is eagerly awaiting the birth of her fourth daughter. And the first tomatoes of the year.

~~~~~

The Book of Jochebed*

When I was a little girl, I pestered my mother to read me the story of Sarah and Isaac one more time. I liked the idea of a mother wanting a baby so badly, of a father wanting a baby so badly, of a baby born to parents like that. Children like to think that they are the center of their parents' existence, and in the story of Sarah and Isaac, the baby really is the center of the world.

The part where Sarah had to watch as her husband led her now-grown boy away from home, up the mountain, to answer God's command wasn't my favorite part. The older I got, the more I worried about that little mother, left at home, left to mourn, strong in faith and hopeful of the future, but deep down inside, despairing. Then the long climb, the obedient Isaac gathering stones for an altar, laying the sticks for fire on top. And then the relief, the blessed denouement of the Angel telling that the test was passed. And still, even with the happy ending, days of waiting for Sarah, before they got back, and she fell on Isaac to hold him. Isaac, who impatient as an active boy with a mothers' caresses, held her back this time and absorbed her trembling.

I hoped the rest of God's promises to Abraham would be fulfilled without my having anything to do with it. But I am the daughter of Levi, the granddaughter of Jacob and Leah. When I was old enough, I gave myself in marriage to Amram, my brother's son. We were happy. Amram was a good man who honored his father's heritage. Though we were slaves to the Egyptians, we were important to our people, and I was blessed with a daughter, Miriam, who has been my planner and my fixer, and a son, Aaron, who is quick of speech and a natural leader.

But the Egyptians were not happy with our growing numbers. They laid burdens on our backs but couldn't ignore how strong those backs were. Pharaoh commissioned our midwives to destroy our male babies. Our midwives rebelled. Pharaoh decreed that all male children should be cast in the river. By this time I was older even than Sarah at the time of Isaac's birth, and yet I found myself with child again, and feared.

It was made known to me that the son I carried would be a deliverer of our people, a savior, a type of the Messiah to come who would be our spiritual Savior, a way for us to escape our bondage. I fretted. How could this come to pass if Pharaoh's law was enforced? How would I survive, with aching emptiness after carrying my baby, with milk for a child not slated to suckle?

I had my sweet baby for three months, hidden from Pharaoh's watchers. Miriam suggested we build an ark of bulrushes, to carry the baby as we cast him in the Nile. We would time it to the Pharaoh's daughter's time in the river. We would have faith, hope in the future, praying no leak would spring or gust of wind blow up, praying God would soften her heart, keep and save my poor son, this boy who should, somehow, be our deliverer out of Egypt.

Still, deep inside, beyond the faith and hope and God, I despaired. The ark looked so small, so insecure, so easily buffeted by the waves. I couldn't watch. Miriam hid in the rushes and saw the daughter of Pharaoh take my baby from the water, and call him Moses. Miriam waited until she was noticed and then offered to find a wet nurse for the baby that Pharaoh's daughter wanted to adopt.

And so I was able to mother my baby while not being his mother. I lost the name of mother, the role I had seen for myself in his life from the moment I quickened, to save his life, to be what he needed, to have the chance to teach him who he really was.

I still didn't see how he would be the deliverer. How God would keep his heart while in the court of the Pharaoh. But if God can make a mother not a mother to the world but still a mother to her child, God can do anything.
 
*There are several varying Jewish traditions about Yocheved, mother of Moses. This is based on the account in the KJV Old Testament and the wild imaginings of a fellow pregnant woman and mother.
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Friday, May 14, 2010

Writing Contest: Fourth Place

I'm happy to announce another Writing Contest finalist--Andrea, author of "A Well-Researched Bond"!

This essay stuck with me long after I had finished reading through all of the essays. I loved her honesty, her ability to acknowledge that reality often trumps the most careful planning, her realization that she was strongly bonded with her children, just differently than she had imagined. I loved the short, repetitive syntax alternating with longer narrative segments.

Andrea wins $25 worth of handmade cotton play food from Hooked in Harmony.

More about Andrea:

Andrea lives in Texas with her husband and two children.

~~~~~

A Well-Researched Bond

I sometimes like to call my children, a three-year-old girl and a four-month-old boy, "well-researched." I spent the ten years prior to my daughter's existence reading various articles and books and sites on such interesting subjects as breastfeeding and natural childbirth. I had always wanted to be a mom, and I wanted to do it in what I thought was the "right" way, so I studied. I graduated from public libraries with their paper-based card catalogs to online forums, and continued my dreams and planning by talking to others who had been where I wanted to be.

And oh, how I wanted to be a mom. I would read about all the physical and emotional changes that would take place once my newborn was here, and I could hardly wait. I really just couldn't wait for the bonding to happen. When I found out that I was expecting my firstborn, I was so excited. Finally, it would be my turn to try for a natural birth, to breastfeed, to bond to a sweet little newborn, to join the club called "motherhood."

The pregnancy was uneventful. I had the expected morning sickness and weight gain and movements. I chose not to find out the gender. My husband and I signed up for childbirth classes. We were going to do this birth drug-free. We toured the hospital. Everything was in order.

My water broke in the morning and my daughter was placed in my arms 12 hours later, after a textbook labor and delivery. I had achieved my goal of doing it without drugs. I had a girl, which was a first for my side of the family. I stared at her. I kissed her. I marveled at how much hair she had. I nursed her for the first time. I counted her fingers and toes.

And I waited for bonding to happen.

They moved us to the postpartum room. My child stayed with me the whole time. I nursed her on demand. I changed her diapers. I did kangaroo care with her to keep her warm.

And I continued waiting for a bond.

We went home a couple of days later. We gave her a bath. We showed her around our home. We took her to church. But it still didn't feel real. I didn't feel like a Mom. I felt like I was just babysitting her and her real family would come to take her away soon. But of course, they never came.

A few years later, I found out I was pregnant again. This time, we planned a homebirth. I thought that maybe the hospital procedures somehow interfered with the bonding process. I'd read dozens of homebirth birth stories and seen the homebirth pictures, where the new mama is just overjoyed and elated once the baby came out. I wanted that feeling.

My second pregnancy, also, was uneventful. Five days after my due date, my son was born, at home, after a labor that wasn't quite as textbook as my daughter's was, but it was no harder. After all, I'd done the drug-free thing before, and I easily did it again.

But then the same thing happened afterward. I didn't feel that instant, euphoric bonding that I'd heard about and read about and wanted. What happened? What was wrong with me? I began to worry that maybe I didn't love my children or that something subconscious from my past was preventing me from having a real bond. I developed a moderately severe case of the baby blues.

I didn't treat my newborn son any differently than I had treated my newborn daughter. I changed his diapers. I hugged him. I took care of him. I kissed him. I smiled at him.

And then one day, his eyes focused right onto mine, and he smiled back.

And I cried.

A euphoric post-birth high is great, if it happens. But it's not the be-all end-all of love and bonding. Love and bonding, I've come to find out, happens in the little things. It doesn't make me any less of a mother because I didn't experience the post-birth high.

Bonding happens when my 8-month-old is being carried and she starts patting me on the back.

It happens when my 3-month-old wakes up in a good mood because he knows Mommy will be there first thing in the morning.

It happens when my 2-year-old can hold real conversations with me (and can make me smile as she tries hard to learn the intricacies of the English language).

It happens when my 5-week-old is nursing and his hand clenches my finger so I won't go anywhere.

It happens when my 3-year-old notices me crying and asks me if I'm okay and gives me a hug.

It happens when my 2-month-old laughs, a REAL laugh, for the first time.

It happens when my 18-month-old is so proud of all the things she can do by herself and shows me her skills and talents.

It happens when both of my children are smiling and laughing together, and I can see what pure, unconditional love is all about.

Bonding happens, not just with one climactic big event, but in all the little events that make your heart smile.
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Writing Contest: Third Place

I love announcing Writing Contest winners. I wish I had even more prizes to give away, so I could make more of these announcements! The third place winner of the Writing Contest is Kate.

One of the judges wrote this about Kate's essay: " I don’t even know what to say about this one. The writing is sublime, raw and accessible. The way she defines her transformation from that young woman on the couch to the 5 a.m. feeding mother blew me away. I’m not sure if the description of the transformation or the nature of the transformation itself won me over—I suppose it was a combination of the two—but I enjoyed feeling like I was taken by the hand and shown a movie of her life in just a handful of paragraphs."

Kate wins her choice of one of these prizes:

~ handknit wool soaker (up to $35 value) from Monkey Muffin Creations
~ $25 worth of handmade play food from Hooked in Harmony 

More about Kate:

Kate is an academic at a large Midwestern university and is a proud attachment parent, with her husband, to a beautiful 9 month old daughter.

~~~~~

I still remember a warm autumn night spent with a new boyfriend in my college apartment. He showed up at my door stressed about a history paper, and in a calm voice, I encouraged him to meditate with me. We finished a glass of red wine and sat cross-legged on my worn leather sofa, faced one another, pressed our palms together and chanted om. He would tell me years later that, in that moment, he found me so amazingly cool, so calm, so sophisticated, and so deeply interesting. He fell in love with me there, hair drizzling out of my messy bun, seated cross-legged on the couch next to my battered copy of Villette and my half-completed application for the Ph.D. in English Literature. I was already smitten, and we married shortly afterward, moving halfway across the country together to pursue advanced degrees in the musty and mighty Midwest.

The truth is that I was so very far from being the woman he thought I was that night. Or, as I told him later, maybe he saw in me, as I tucked myself into the couch, the woman I would become just six years later. Barely twenty-two, I had already lived too many lives: I had a substantial drinking problem, had narrowly survived a brutal sexual assault, was a heavy chain smoker, attached myself fiercely to horrible, self-centered men (the present boyfriend excluded), and was deeply, irreversibly depressed. In hindsight, there were barely-perceptible symptoms of strength – after all, I was a competitive candidate in a brutal graduate school market, and I had apparently picked up something valuable from the inherited MTV Power Yoga DVD – but I was in most ways an exhaustively broken human being. I have always known how lucky I am that he just didn’t see that, that night on the couch.

It is six years later, and my steady and beautiful partner has seen me through therapy, through the unexpected and heart-exploding loss of close friends, through most of graduate school, through medicated stupors and sleepless nights of empty tears, through quitting smoking and drinking and through a heart-wrenching miscarriage and a traumatizing c-section. And we are now sitting cross-legged on the couch again cradling our newborn daughter. There are just no words for how ravished we are by her, how stunningly in love. He expresses fear: am I up to the task of motherhood? Will she inherit my anxiety, my sleepless nights, all my broken pieces that have taken six years and arduous emotional labor to “fix”? For the first time in my life, I am not worried. I tell him: when you realize that you are the woman – you are the woman she is going to hold up against all other women, you are what she will know when she becomes her own woman – you want to be some woman. I mean, you want to be the most amazing woman in the universe. He smiles a weary, wary smile. I have made these promises before: a better wife, a better student, a better person. He believes but does not trust that I will be a better mother.

I begin my time at home with her: four months before returning to school. We struggle and cry a lot at first. I hold her close every time. I find myself outside in the autumn air, walking her briskly, breathing slowly. She hates to sleep alone. I understand intuitively her fears and move her into the bed with me. We sleep, sweaty and jubilant, pressed up nose-to-nose. We breastfeed timidly at first, then boldly, defiantly, in the park and at the café over morning breakfast. She begins to smile – this crazy grin, this insanely radiant grin – and I lose whole mornings in the ready pink of her gums. I buy slings, carriers, anything to keep her heart close. I devour blogs and books on attachment parenting. She blows raspberries at me as I begin a daily yoga routine, sometimes bringing myself nose-to-nose with her in downward facing dog. She gives me that gummy, toothless grin as I chop veggies and pore over vegan cookbooks. My body becomes healthier and stronger than when I was a teenager. We nap together every day at 2:00, falling asleep just as Wayne Brady makes his first deal. It occurs to me that I am becoming a woman.

And then I have to go back to work. She starts full-time at a wonderful daycare. We cry together every single morning. She refuses the bottle and I insist on going over every three hours to feed her rather than start her on formula or solids. My pediatrician congratulates me on four months and says she can try other things. I quietly but vehemently disagree. My husband and I have long discussions about how important my dissertation is (very) and how much I can get done with her in the house (not much). We pull her out of full-time daycare anyway. She goes part-time now, and her gummy grin has returned.

I get up at five a.m. on Saturday and work, fiercely and determinedly. I want her to know me as fulfilled professionally as well as personally. In down moments, I passionately research natural childbirth and vaginal birth after cesarean. I want another of these reasons to live, these wonderful, life-changing beings. I want the next child to come into this world at peace and awestruck, into my partner’s waiting arms.

Last night, we were lying in bed, the three of us, my daughter taking deep, contented, heaving breaths. I say to him: I don’t think I’ve ever been this happy. He says to me: I think you have become the woman I fell in love with all those years ago on the couch. I smile: Welcome home, Kate, I think. This is the life you have always dreamed of. This time the om is real.
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Thursday, May 13, 2010

Seminar on Skin-to-Skin care with Nils Bergman

Optimizing Infant Neural Regulation: 
The Practice and Science of Skin-to-Skin Care

July 13, 2010 
Chicago, IL

Nils Bergman, MD, MPH University of Cape Town, South Africa
Heidelise Als, PhD Children’s Hospital Boston, Harvard University
Stephen Porges, PhD University of Illinois at Chicago, Brain-Body Center

Rosemont Hotel 7:00 am - 5:00 pm
Registration Fee: $160 ; Early registration: (by May 15, 2010) $140

The NIDCAP Training Center at UIMC along with the Departments of Women and Children’s Services, Pediatrics and Obstetrics is pleased to present a clinically practical, evidence-based, one-day seminar for physicians, nurses, psychologists, lactation consultants and therapists in the use of skin-to-skin care (kangaroo care) with term and preterm infants.

Click here for more information and registration information. 
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Writing Contest: Second Place

I am thrilled to announce the next Writing Contest winner--Amy, author of "Lessons From a Belly Button"!

One of the judges commented about her essay: "I love the irreverence in this, and I can also relate to the fear of being judged as a parent. It was really hard to choose a #1 story, because several of these were my faves. But this one was the most unique to me." I love this story for its honesty, humor and fresh approach.

Amy wins her choice of one of these prizes:
~ handmade hat (up to $40 value) from Paper Raisins
~ handknit wool soaker (up to $35 value) from Monkey Muffin Creations
~ $25 worth of handmade play food from Hooked in Harmony

More about Amy:

Amy is expecting her first child in eight weeks! Due to the nature of her current job (she and her husband teach at an international school in Kigali, Rwanda), she is planning on giving birth in her parents' home in the States. It will be an entirely different take on the home birth experience! Amy looks forward to returning to Rwanda with the baby and, while her husband continues teaching, enjoying the benefits of a breastfeeding-oriented society and further exploring the challenges of cooking in an African country.

~~~~~

Lessons from a Belly Button

I thought that I had prepared for this. My husband and I bought baby books, spent hours talking about getting pregnant, being pregnant, and preparing for a baby. We evaluated our relationship and finances. We prepared ourselves for months of dietary and lifestyle changes to allow our 20-something bodies to be in prime baby-producing form.

Then we got pregnant right away.

So we started doing yoga every morning, he started cooking to accommodate my morning sickness and we tried to focus on keeping positive energy surrounding our interactions. We knew pregnancy was about being flexible and open to anything. We were so ready.

Now, at 22 weeks, I’ve met my Waterloo. I’ve found my point of inflexibility.

I cannot bear to lose my indented belly button.

Every day I check that small anatomical feature in the mirror. I take photographs to document its gradual flattening. I, somewhat obsessively, e-mail a select group of girlfriends about the “belly button saga.” And I mourn the progressive creep outward.

But I have to ask myself, what is it that I mourn? I have waited eagerly for this baby and I feel very little resentment over sharing my body for a few months. I enjoy the hourly kicks and pulses of life.

But I cannot bear the thought of an “outie” belly button.

When my navel protrudes, it will be impossible to hide. I can’t stand large flowing shirts and in my current wardrobe any lumps along my midsection are clearly visible. Is that what I mourn - the uncontrollable, “unsightly” elevator button that will precede me for the next four months?

In Delphi, Greece, there stands the “belly button of the world.” I’m pretty sure that somewhere I have a photograph of myself standing next to the mid-sized monument. The navel points up to the sky in a triumphant way.

I am afraid that my soon-to-be protruding navel will have the same triumphant manner. And it tells me that I have to allow myself to be triumphantly presented to the world through the life of a child that has half my genes and reasoning skills all its own. I will be represented, judged, evaluated and eventually remembered through the life of this child. Can I let go of my identity enough to be presented in such a way? Am I ready to surrender pieces of myself to the impulses of the next generation? What if I don’t like the picture they create with those pieces?

In my current job as an educator, I know too well the tendency to judge a parent based on the behavior of their child. If the child is obsessed with grades, the parent must have unrealistic expectations. If the child is constantly misbehaving, the parent must be lenient. Toddlers throwing a tantrum must indicate a lack of attention at home. Serial dating high school students must be trying to fill a parental void. Reason says that these cause-and-effect patterns are true only some of the time. The personality of a child cannot be dictated by a parent, even if their behavior influences each other. But people find it all too easy to chalk every action up to parental failings.

I am afraid of being judged because of my child. I’m afraid of my parenting being viewed as too permissive or too harsh, my education choices being critiqued for leaning too far toward my own interests. I worry about people telling me to control my child or getting dirty looks when we fly around the world to visit family. I’m afraid that people will think I am too introverted, headstrong, hands-off or opinionated because of things that my child says or does.

So I find myself contemplating my belly button. It is still a small dimple and assures me that my individuality is safe with me. But the shallowness of its curve and the way it stretches toward one side reminds me that I will not be able to hide for much longer. Soon I will be forced to allow myself to follow behind. It is preparing me to follow behind my child, to celebrate their individuality and the aspects of me that they truly represent. It is preparing me to ignore the stares of strangers and graciously accept the comments of anyone who feels compelled to speak. It is preparing me to celebrate my own individuality.

So much for the baby books, the yoga and the high-protein diet…I’m going to take my lessons from my belly button.
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Dr. Robert Biter of San Diego, aka Dr. Wonderful

Over the past few days, a maelstrom has arisen over Dr. Robert Biter's sudden loss of privileges from Scrippes Encinitas in San Diego. You may recall that he is the "Dr. Wonderful" of Navelgazing Midwife's blog. I won't attempt to rehash what has happened, but will instead provide links to the back story, information on the rally tomorrow (Rick Lake will be there!), and more information about his work as a physician.

First, some links that explain what's happening:
More about Dr. Biter's new freestanding maternity center, Babies by the Sea
  • Babies by the Sea already houses an eco-friendly mama-baby boutique of the same name
  • Dr. Biter writes about the birth center, which will be a freestanding maternity center (my term; meaning it has surgical capabilities in-house): "In Spring 2010, Dr. Biter will celebrate the next evolution in his vision as the new Babies by the Sea Birth Center opens, affording his patients the ability to birth their babies in a natural, healthy setting, with the convenience of having all the necessary surgical and medical back-up in the event of crisis situations."
  • Another article about the birth center in progress comments that will will feature "ob-gyns and midwives working side by side....It will also be natural-birth friendly and feature surgical rooms in case a patient opts for-or needs-medical intervention."
How to get involved and keep updated:
More about the man behind the mask:
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Mother's Day tribute, scientist-style

I saw this over at Descent into Motherhood. The science geek in me loves it!
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Tuesday, May 11, 2010

Announcing my newest baby...

...an article just published in the May issue of The Expert Review of Obstetrics & Gynecology! It's titled Attitudes Towards Home Birth in the USA.
Citation:
Freeze, Rixa Ann Spencer. Attitudes towards home birth in the USA. Expert Review of Obstretrics and Gynecology, Volume 5, Number 3, May 2010 , pp. 283-299(17).

Abstract:
Home birth is highly controversial and divisive. Medical organizations oppose the practice, while other maternity-related organizations (nursing, midwifery, public health, consumer advocacy, doula and childbirth education) uphold home birth as a safe, reasonable choice for healthy pregnant women. Individual physicians and midwives have more complex perspectives on home birth than their professional organizations. Women choose home birth primarily for safety. In addition, they also have had negative hospital experiences, desire low intervention rates, trust birth and want a familiar, safe environment. Public opinion centers on four main issues: safety, choice, women's experiences and critiques of maternity care. Ironically, medical opposition to home birth compromises safety. After reviewing current attitudes towards and research about home birth, this article discusses how discarding the status quo of hostility and mutual distrust in favor of a pragmatic, autonomy-based approach that fosters communication and respect would make home birth a safer choice.
This article has been almost a year in the works. It entailed substantial primary research, extensive secondary research and compilation, and hours of wading through bibliographies and Medline. I would love your feedback, comments, and critiques. Please email me if you'd like to read it!
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Writing Contest: First Place Essay

I am pleased to present the first place winner of the Writing Contest! One of the judges commented about her essay: "I thought this one was the most well written. It was transportive. I felt the transformation happening. I didn’t need to be told it how it happened. She showed it."

Melissa wins her choice of one of these prizes:
~ $50 gift certificate from Second Womb Slings
~ handmade hat (up to $40 value) from Paper Raisins
~ handknit wool soaker (up to $35 value) from Monkey Muffin Creations
~ $25 worth of handmade play food from Hooked in Harmony

More about Melissa:

I'm a biological anthropologist, studying maternal investment and the weaning process in wild Nicaraguan mantled howler monkeys. While I was writing my dissertation, I got pregnant. I suffered from severe nausea and vomiting the entire pregnancy and as a result, didn't enjoy being pregnant very much. Two days before my 30th birthday, my husband and I welcomed our son, William Miles, into the world. I struggled mightily to breastfeed during the first few months. Managing to successfully get through that difficult period is a far bigger accomplishment than anything else I've ever done.

For the moment I am staying at home with my little boy (now 9 months old), while also working on research publications and trying to figure out how to have a meaningful career that still lets me spend time with my son. I love oceans, lakes, volcanoes, trees, and guys on road bikes (in particular, my husband). I'm a vegan.  I've run 9 marathons and am looking forward to my 10th. I love to write, and whenever I have a chance, I blog at Cloth Mother.


~~~~~

I never wanted to have children. My husband and I had such full lives already. I enjoyed being free and untethered, and I couldn’t imagine ever feeling any other way.

We moved to Nicaragua for a year, where I spent my days in the jungle observing wild howler monkeys for my dissertation research. At the end of the dry season, I met a little boy named Eduardo who lived in the village. He was 12 years old but looked more like he was 8 or 9. He worked at the field station in exchange for English lessons. He had the sweetest smile and an uncommon generosity.

Eduardo became my shadow. He helped me with small tasks, ate breakfast with me, and brought me fruit he had picked from the trees. He was endlessly fascinated with my many possessions—such as my flashlight, compass, pencils, and hiking boots. “Tienes muchas cosas bonitas, Meli,” he told me. You have many beautiful things.

As my year in Nicaragua drew to a close, I became immeasurably sad at the thought of leaving him behind. I wanted to take him home with me. I wanted to fix him breakfast every morning and see him off to school. I could imagine myself tucking him in at night and wishing him sweet dreams. I wanted to get him a bike that fit his small frame, unlike the one he rode now that too large even for me.

One night Eduardo stayed late at the field station and asked to borrow my flashlight so that he could see on his way home—riding his oversized bike on the bumpy dirt road that was littered with jagged volcanic rocks. He promised to bring the flashlight back to me first thing in the morning. And sure enough, there he was, tapping at the door before 6am the next day. He was wearing yesterday’s clothes, his hair was rumpled, and his eyes were still small with sleep. He was golden.

Eduardo stayed to talk with me. He swung back and forth in the large hammock across from the room my husband and I shared. The hammock was colorful and ornate, with the name William woven into the side. That hammock had been right outside our room the entire year, and I had often wondered who William was and why he had left it behind. I suppose someone at the field station might have known, but I had never asked.

Some tourists came to join us, and they asked Eduardo what he wanted to be when he grew up. He said he wanted to be a volcano guide. It was the hardest job around, but it had the best pay. Guides got $15 every time they led a group on the arduous 8-hour hike up and down the volcano. The tourists asked Eduardo if he wanted to travel, and he said yes. He said that he wanted to come to the United States. He said he wanted to come and live with Rob and me, in our house. I smiled and then turned my head so that he wouldn’t see the tears in my eyes.

Rob and I left Nicaragua during the wet season. Eduardo came to say goodbye on the morning of our departure. I boarded the dusty bus and waved at Eduardo until I couldn’t see him any longer. I cried all 2,000 miles home.

For a year I pined over him. I couldn’t sleep at night, and when I did, I would dream that I was stretching my arms out wide over the water but I could never quite reach him.

Finally I could stay away no longer. Rob and I went back to Nicaragua when it was the wet season once again. We visited the monkeys I had studied, and we saw all our friends. We looked for Eduardo. He wasn’t living in the village anymore. I found out that his mother had sent him away to live with some relatives, but I never did understand why. We found him eventually. He was 13—suddenly shy and a little bit aloof. His smile was less childlike and didn’t light up his face anymore, but he seemed happy nonetheless. I realized that as difficult as his life must be here, how selfish it would have been for me to really take him home with me—to take him away from his family and friends and language and culture. When he said goodbye and walked away that night, I knew that I would never see him again. But I wasn’t sad. In a strange way, I was finally at peace for the first time in a year. I realized that knowing Eduardo had forever changed the way I saw the world.

Four months later, I became pregnant with my first child. The baby was born in August, during the wet season. It was a boy. The moment I saw him, I loved him with all my heart. We named him William.
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Monday, May 10, 2010

Writing Contest Winners!

I am excited to announce the Writing Contest winners! First, let me introduce the three judges and give them a big thank-you:


Details on the selection process: I did an initial read-through and selected 15 semi-finalists to send to the judges, with names and contact information removed from the essays to keep things totally fair and anonymous. I asked each judge to give me her top 5 choices with a short comment on their favorite. I also read through the essays multiple times and formed my own list of favorites. Not surprisingly, all of the judges' winning essays were on the top of my list. My final task--not easy at all--was to put the top essays in order.

Over the next several days, I will be posting the first, second, third and fourth place winners, in addition to a few honorable mentions. I also will announce the randomly-chosen winner of the Writing Contest handmade leather bag giveaway. Stay tuned!
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Sunday, May 09, 2010

Mother's Day Blues

Am I the only mother who doesn't like Mother's Day?

Honestly.

I have two children of my own whom I love beyond anything I could have imagined. I spend almost all of my waking (and many of my sleeping) hours with them.

But Mother's Day leaves me grumpy and cranky and all in a funk.

I don't like being told that my most important roles are chauffeur and cook and maid. Even if it's said in earnest by men and children trying to show their appreciation, it falls flat. I don't like the sentimental tributes that lump all mothers together and assign us certain universal qualities. Like The Amazing Ability To Clean And Cook And Look After The Kids Since I (The Masculine, Slightly Helpless Husband) Am Just Not Born With Those Skills.

I'm just not feeling the love.

If we really valued mothers--speaking both individually and culturally--we wouldn't have one day of lip service, followed by a year of neglect. Give us a year's paid maternity and paternity leave. Give us Mother-Friendly care in all hospitals and birth centers. Give us a culture that really, truly values mothers and children and finds ways to keep them together even when the mother needs to earn a living, like flextime, on-site childcare, or babies-at-work programs. Give us a month of daily home visits from postpartum helpers who can cook, clean, do laundry, and help with the other kids so we can snuggle and nurse our newborns. Give us generous social and emotional support for the tremendous work of mothering.

But please don't give us flowers and a sappy tribute to 1950's gender roles and think that will suffice until the next Mother's Day.
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Saturday, May 08, 2010

The ritual "nick": AAP statement on female genital mutilation

An article in The New York Times recently reported that the AAP supports legalizing the option of performing a "ritual nick" in order to prevent parents from taking their daughters overseas for more extensive genital cutting. I was curious to read the reasoning behind this position, so I looked up the AAP Policy Statement on Ritual Genital Cutting of Female Minors, recently revised in May 2010. Here is an excerpt concerned with legalizing a small "nick" or pinprick:

Some physicians, including pediatricians who work closely with immigrant populations in which FGC is the norm, have voiced concern about the adverse effects of criminalization of the practice on educational efforts. These physicians emphasize the significance of a ceremonial ritual in the initiation of the girl or adolescent as a community member and advocate only pricking or incising the clitoral skin as sufficient to satisfy cultural requirements. This is no more of an alteration than ear piercing. A legitimate concern is that parents who are denied the cooperation of a physician will send their girls back to their home country for a much more severe and dangerous procedure or use the services of a non–medically trained person in North America. In some countries in which FGC [female genital cutting] is common, some progress toward eradication or amelioration has been made by substituting ritual "nicks" for more severe forms. In contrast, there is also evidence that medicalizing FGC can prolong the custom among middle-class families (eg, in Egypt). Many anti-FGC activists in the West, including women from African countries, strongly oppose any compromise that would legitimize even the most minimal procedure. There is also some evidence (eg, in Scandinavia) that a criminalization of the practice, with the attendant risk of losing custody of one's children, is one of the factors that led to abandonment of this tradition among Somali immigrants. The World Health Organization and other international health organizations are silent on the pros and cons of pricking or minor incisions. The option of offering a "ritual nick" is currently precluded by US federal law, which makes criminal any nonmedical procedure performed on the genitals of a female minor.

The American Academy of Pediatrics policy statement on newborn male circumcision expresses respect for parental decision-making and acknowledges the legitimacy of including cultural, religious, and ethnic traditions when making the choice of whether to surgically alter a male infant's genitals. Of course, parental decision-making is not without limits, and pediatricians must always resist decisions that are likely to cause harm to children. Most forms of FGC are decidedly harmful, and pediatricians should decline to perform them, even in the absence of any legal constraints. However, the ritual nick suggested by some pediatricians is not physically harmful and is much less extensive than routine newborn male genital cutting. There is reason to believe that offering such a compromise may build trust between hospitals and immigrant communities, save some girls from undergoing disfiguring and life-threatening procedures in their native countries, and play a role in the eventual eradication of FGC. It might be more effective if federal and state laws enabled pediatricians to reach out to families by offering a ritual nick as a possible compromise to avoid greater harm.

Efforts should be made to use all available educational and counseling resources to dissuade parents from seeking a ritual genital procedure for their daughter. For circumstances in which an infant, child, or adolescent seems to be at risk of FGC, the American Academy of Pediatrics recommends that its members educate and counsel the family about the detrimental health effects of FGC. Parents should be reminded that performing FGC is illegal and constitutes child abuse in the United States.
Thoughts? Is it better to allow a "ritual nick" in order to theoretically prevent more extensive, and more dangerous, genital mutilation? Or is it ethically/morally wrong to support any form of FGM? How might these arguments apply to male genital mutilation (i.e., circumcision)?
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Wednesday, May 05, 2010

Test leads to needless c-sections


In an article about electronic fetal monitoring for the Philadelphia Inquirer, Test leads to needless C-sections, maternal-fetal medicine specialist Alex Friedman tells the story of an eclamptic patient:
My patient needed to be delivered. She had just developed eclampsia, a potentially fatal disease that afflicts women in the second half of pregnancy. She had suffered a seizure and dangerously high blood pressure, and was at risk for far worse, including a stroke. No one knows why this condition arises, but delivery sure clears it up in a hurry.

So we gave medication to start labor, and the nurses placed a fetal heart monitor....

For three or four hours that night, I struggled with my patient's bad fetal heart strip. I wanted her to avoid a cesarean section. She had type 1 diabetes, and I expected her sugars to swing wildly after surgery, and her recovery to be slow.

To improve the strip, the nurses and I tried giving her oxygen, changing her position in the bed, even rubbing the baby's head through the cervix to wake it up.

Finally, at 3 a.m., I felt compelled to recommend cesarean. The strip continued to look bad, and my patient's labor progressed slowly.

We went to the operating room, and delivered the baby by cesarean. My patient's child greeted the world pink and well-oxygenated.

The test was wrong again.
Between those opening and closing paragraphs, Dr. Friedman discusses the strange history of electronic fetal monitoring. As a resident, he had strong faith in fetal monitoring's ability to detect a compromised baby.
I have performed hundreds of cesarean sections during residency, and many were the result of bad heart-rate strips....For the worst readings, we believed every second counted and rushed the surgery: If the baby wasn't delivered one minute from the first incision into the skin, we had moved too slowly.... But almost every time we whisked a mother back to the operating room, and I cut through skin, fat, fascia, and finally the muscle of the uterus, expecting a blue, floppy baby, the child I delivered emerged pink, healthy, and a little bit angry.

Were we saving lives and averting disaster? Or were we performing unnecessary surgery?
The rest of his article discusses the ins (few indeed) and outs (many, and increasingly well-documented) of electronic fetal monitoring, which Dr. Friedman calls "an appallingly poor test." Towards the end, he discusses why obstetricians still use EFM when the evidence is strongly weighted against it [emphasis mine]:
Why do doctors cling to continuous fetal heart monitoring? An obstetrician will most likely point to the fear of being sued, but the complete answer is more complex. Our medical culture prizes technology and tests, even if they don't work and can cause harm. "It's our bias that anything that can be quantified is an improvement," said H. Gilbert Welch, a professor at Dartmouth Medical School whose research focuses on harm caused by screening and over-diagnosis. "I think we get in trouble when we start promising things to . . . well [patients]," Welch said in an interview. "It is not that hard to make them worse."
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