Sunday, October 31, 2010

Caterpillar cake

This summer, we found a big, fat caterpillar in our garden that looked like this.
Zari still talks about it. When I asked her what kind of cake she'd like, she first said "a soccer ball cake!" That was the cake of chioce for her second and third birthdays. But then she decided that she'd really like a caterpillar cake. I can do caterpillars.

We baked the cake and cupcakes on Friday and put them in the freezer; there are fewer crumbs when you apply frosting to a frozen cake. I did the initial frosting on Saturday night and the final decorations this afternoon before her birthday party. Here's the caterpillar cake:
The cake is a dense dark chocolate wedding cake with a raspberry filling (raspberries, cornstarch, & a small amount of sugar), baked in a Bundt pan. I cut the cake into two pieces and arranged them in an S-shape. The caterpillar is decorated with green cream cheese frosting and red raspberry filling. The "dirt" is cake crumbs and crushed graham crackers, held in place by a thin chocolate icing. I had lots of raspberry filling left over, so it went on the cupcakes.
It was a lovely crisp fall day, so we stayed outside the whole afternoon.
 
 Dio enjoyed the cupcakes.
Happy 4th birthday Zari!
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4 years old!

Our town did trick-or-treating yesterday--we gave out 1,050 pieces of candy in an hour and a half! So today was exclusively for Zari (not that she minds having her birthday on Halloween). We got out her memory book and looked through pictures of her first days and weeks. We told her the story of when she was born. She hasn't looked at the book for a while, so most of the pictures were new to her. "Oh look, that's me when I was teeny tiny! Look, that's me nursing when I was a baby!"

If you're newer to this blog, you might enjoy looking at these posts and pictures of her birth:
As much as it is bittersweet to see my children grow up so quickly, it's also so fun to see them develop into their own unique selves. Zari is quirky and still sometimes solitary, but she is also learning how to play with friends. She loves dragons and dinosaurs and scary stories. She's developing a vivid imagination and will often act out various pretend scenarios in great detail. I love that she hasn't been inculcated with Disney or cartoon culture yet. She doesn't know who Dora is and I am quite happy with that! She loves to talk about her dreams and her daydreams. Most mornings we talk about our dreams. Often she'll hear mine and then pipe up with her own version of my dream. But sometimes she tells ones that must have actually happened in her own head, they're so strange! Her latest daydream involved riding on an elephant in the forest.

Zari is starting to sing. She still doesn't stay on pitch very well by herself, but she can match our pitches if we sing along. She surprises me with the songs that she knows. Every night when Eric puts her to bed, he sings The Beatles' "I Will." I've caught her singing it to herself several times now. When Dio gets hurt, she sings him the song I used to sing to her when she was sad or hurt.

I started a smiley face/frowny face chart a month or two because Zari was incessantly tormenting Dio. She gets smiley faces for being helpful, doing nice things for Dio, doing her "jobs" (putting the clean silverware away), sleeping all night long, etc. She gets frowny faces for temper tantrums, pushing, hitting, taking toys away from Dio, etc. I think it's working. She's very motivated by getting smiley faces; she'll often share things with Dio, then ask me right after, "Does that mean I get a smiley face?" Fine with me!

I'm so honored to be her mother. I love that she tells me almost every day, "I love you so much, mama." The past few days she's said during our morning family snuggle: "I love you as high as the moon, and I love papa as high as the sun" (or vice-versa).

Happy birthday!
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Halloween costumes: butterfly and cape

One of my favorite childhood rituals was poring over Jane Asher's Fancy Dress every Halloween (also published under the title Jane Asher's Costume Book). My mom made us numerous costumes from that book. I was a Christmas tree, a jellyfish, a horse & rider, a Christmas present, and more. I bought a used copy of the book last year, and now Zari likes looking through it. Besides the dragon costume, which is still her al-time favorite, she really loved the butterfly. So here's my rendition:

Butterfly costume, inspired by Jane Asher
 
The Jane Asher version had more appliques, but I stopped after the wings and torso. I made the costume out of fabrics I had sitting around the house. The body was made of cream stretch cotton twill. The wing appliques were two different iridescent polyesters, and the butterfly torso was faux persian lamb. I used a gold metallic thread for the appliques (satin stitch in the front, zig-zag stitch in the back to save time). The zipper was recycled from an old bag I took apart.

Dio's costume was much simpler. I used the rest of the faux persian lamb to make him a cloak.
It was the same design as Zari's Little Red Riding Hood cloak (see this tutorial) , but without lining or a hood. I edged the whole thing in shiny black fold-over-elastic. A Celtic pewter cloak clasp in my sewing box for the perfect finishing touch.
Time to go trick-or-treating!
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Friday, October 29, 2010

Birth around the World: MamaBaby Haiti

MamaBaby Haiti is a new non-profit organization run by naturopathic doctors and midwives to serve Haitian women and babies. 
MamaBaby Haiti is a non-profit organization dedicated to improving the health and well being of mothers and babies. Our mission is to lower the maternal, fetal, and neonatal mortality rate in Haiti. MamaBaby Haiti is formed by a group of midwives and naturopathic doctors who serve women and families out of their birthing center and clinic in Haiti. They provide free prenatal, birth, postpartum, and pediatric care, in addition to education and other life saving services.
MamaBaby Haiti is opening a birth center in Cap Haitian in early November 2010. You can see pictures of the center, mid-construction, from earlier this year. I love the organization's vision for how the birth center will function within the community.

As you might have heard, there is a cholera outbreak in Haiti. MamaBaby Haiti is accepting supplies (IV fluids and electrolyte replacement powders) and cash donations. They are sending 14 volunteers to Haiti in the next few weeks. To donate, contact:
Patricia Couch, CPM, LDM
Telephone: 503-487-7683
Email: pcmidwife@gmail.com
You can follow MamaBaby Haiti on Facebook.
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Wednesday, October 27, 2010

Pregnant pumpkin carving pattern

Want to make this?
You can download the free pattern (PDF)!

I also love this breastfeeding-friendly pumpkin that TopHat made.
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Tuesday, October 26, 2010

18 months old!

Dio has just gone to bed, so the house is quiet. I enjoy being with my children, but I also relish--without any guilt--the quiet time in the evenings. Dio is so easy to put to sleep. For both naps and bedtime, we sit on the bed and hold him in our arms (if it's me, I'll nurse him for a minute or two, then cuddle). He snuggles his sock monkey. Once he's either sleeping or really relaxed, we lay him down in his crib on his side or stomach. At night, he'll stand up and fuss for a few seconds when I leave the room. Then he lays himself back down and he's out. It's the blessing of a second child, I think. Dio has had to learn how to go to sleep on his own because I couldn't always be there to nurse them all the way to sleep, every single time, like I did for Zari.

Over the past several months, I've noticed less screaming and shrieking from Dio. In part, Zari is learning (slowly) not to torment him as much. And he's more verbal; he can now say what he wants instead of just making lots of noise. This is the real payback time for me; my children enjoy playing together and my role as referee is winding down.

On the other hand, he's getting more and more attitude. Some of the things he does--pouting, throwing things down on the floor in a huff--are perfect mimics of Zari. I can see him purposely forcing or exaggerating his emotions, rather than just purely reacting to a situation. If he were someone else's kid, his attitude would drive me crazy. Luckily I'm his parent so I find it endearing as well as annoying.

Dio loves putting on shoes and socks, carrying random objects around like beads or pom pom balls, talking on the phone (in which I prompt him to say a list of words--dog, cat, shoes, cracker, cheese, ball, etc.--until he announces, "done!"), watching airplanes and squirrels and cats, looking at babies, chasing Zari around the house, and eating. Seriously, he sometimes eats more than I do! He isn't so fond of going potty lately.

I'm not sure what to call Dio at this stage. At 18 months, he's definitely not a baby, but toddler still seems too old...
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Monday, October 25, 2010

Pregnant pumpkin

We carved pumpkins this evening. Eric & Zari made the standard spooky face. I bucked tradition and made this:

Want the pattern? Click here to download.

Extra-scary pregnant pumpkin here.

News update: Pregnant pumpkin gives birth, nurses baby
.
W
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Sunday, October 24, 2010

Birth Around the World: Home Birth in Hungary

In 1998, a decision by the Hungarian Parliamentary Ombudsman confirmed a woman's constitutional right to give birth in the location of her choice, including at home. However, the Hungarian government has still not implemented any regulations or implemented licensing procedures, making it nearly impossible to have a home birth in Hungary. Home birth providers are actively prosecuted for attending births.

In early October, physician and home birth attendant Ágnes Geréb was arrested minutes after she attended an unscheduled birth at her birth center. She was charged with "reckless endangerment committed in the line of duty." She is currently being held in a maximum-security prison and is facing a 5-year jail term.

Here is more detailed information about the events leading up to Dr. Geréb's arrest:
Events of 5 October 2010
On Tuesday, 5 October, the police took Dr. Ágnes Geréb into custody. The intervention by the police was in response to a birth which took place at the Birthing Centre (located on Alma utca and founded by Ágnes Geréb) when complications arose which required the help of paramedics. Originally, Ágnes had declined to assist at this particular birth, as she felt a home birth would not be a safe option, based on certain conditions present during the pregnancy. Accordingly, she agreed to perform the necessary examinations on the mother prior to her hospital birth. When the expectant mother arrived at the Birthing Centre for her consultation on that Tuesday, she presented herself in an advanced stage of labour and the child was born extremely rapidly. As the midwives began to assist the mother, they also immediately called for an ambulance. The ambulance arrived approximately 20 minutes after the call, and the police arrived a few minutes later.

Steps taken by the police
While the infant was still being treated, the police began to demand the identification papers of the child's father as well as those of the health professionals present. Meanwhile, in another room in the Birthing Centre, a prenatal class was underway. The police did not permit the families present (primarily pregnant women) to leave the building until everyone had produced their identification papers. Dr. Geréb was taken into police custody at 3 PM that day, and her hearing began that evening at 10 PM. Meanwhile, the two other midwives who had assisted during the birth were also taken away by the police and interrogated them some 4 or 5 hours later. On the evening of that day, Ágnes Geréb was placed into 72-hour custody as a suspect for having endangered life during the exercise of her profession (a crime under the Hungarian Criminal Code).

That same Tuesday the police investigators closed the Birthing Centre and confiscated the documents that they found there. After going over the documents (among the papers seized were several hundred client information sheets), the charges against Dr. Geréb were expanded to include the crime of quackery. The only reason given for this was that, according to the documents, approximately 200 births had taken place over the last year that involved her.

The police then chose to interrogate the infant’s mother in the hospital shortly after she awoke from the effects of a full anaesthetic received for an operation. Because of this, both she and the child’s father will be launching a complaint procedure against the police. The parents will be represented by the Birthing Centre's legal counsel.
Dr. Geréb has attended close to 9,000 births, over 3,500 of those at home. She worked as a hospital-based OB-GYN for 17 years before becoming an independent midwife in 1991. The Guardian recently reported on Geréb's arrest in Midwife Agnes Gereb taken to court for championing home births. Thousands of Hungarians showed up for protests in the days following her arrest. An excerpt from The Guardian report:
Geréb, founder of the Napvilág birthing centre, is a highly experienced gynaecologist, midwife and internationally recognised home birth expert. She has successfully helped deliver 3,500 babies at home. But her reputation means nothing to the authorities in Hungary, a country that has, campaigners say, relentlessly pushed to criminalise home births and make hospital deliveries compulsory.

In the hours after her arrest on 5 October, Geréb was subjected to intense interrogation before being called to a closed court at 10pm. Held for a further week without charge, she finally appeared in an open court on 12 October, shackled in leg chains and handcuffs, accused of negligent malpractice. She also faces several other charges, including one for manslaughter relating to an earlier home birth when a baby died after a difficult labour.

Geréb's is the story of home birthing in modern Hungary and has sparked international outrage. A hero to women across Hungary, she has dedicated the past 30 years to defending the right of mothers to choose their birthing experience.

Her arrest is, say her supporters, the "logical climax of [the state's] campaign of vilification and criminalisation" of those who support a mother's right to have a non-hospital birth.

Support for her plight is growing, with backers including Sheila Kitzinger, the British natural childbirth activist and author, Professor Wendy Savage, Britain's first female obstetric consultant, and the Labour MP Caroline Flint.

The constitution in Hungary gives a mother the right to give birth at home but prevents her doing so by arguing that the practical conditions to ensure a safe home birth do not exist: a situation created by the refusal of the ANTSZ, Hungary's public health authority, to issue licences to independent midwives, and the failure of successive governments to implement regulations compelling them to do so.

Women wanting to give birth at home, therefore, find themselves in an unlicensed and unregulated hinterland. Any midwife who gives medical assistance is breaking the law. In the last five years, police investigations have become increasingly aggressive. There are just 15 midwives in Hungary who will help women give birth at home. Five of these currently face lengthy prison sentences.

"The state's campaign against home births has lasted nearly 20 years and is rooted in the determination of a clique of obstetricians to maintain their own power and earning potential from hospital births," said Donal Kerry, spokesman for the Hungarian Homebirth Community.
A press release issued October 11, 2010 by the Hungarian Homebirth Community (1) gives more information about Dr. Geréb and the home birth climate in Hungary: 
The story of Ágnes Geréb is the story of homebirthing in modern Hungary. A story that shows how Hungary, since its return to full independence in 1990, continues to restrict free choice to its citizens in the hugely important area of childbirth. From the all- powerful Board of Obstetricians down to the local police, the Hungarian state has continually tried to force expectant mothers and their partners to give birth in hospital. But there have always been couples determined to choose their own way to birth and who needed to find someone who could help them fulfill their wishes. Ágnes Geréb took on that role when after seventeen years of hospital service she decided in 1991 to become an independent midwife. She was prepared to face the risk of heavy fines and imprisonment to help parents to satisfy their desire to have their babies at home.

Now, nearly 20 years later and with over 3,500 healthy homebirths behind her, she still encounters incredible resistance within the Hungarian establishment to home birthing. She has been struck off the doctor’s register by a licensing body which dogmatically opposes homebirth and, even before Tuesday’s detention, she and 4 colleague midwives are currently before the courts facing further serious criminal charges. Like all other independent midwives and the parents of homebirth babies, she is continually exposed to levels of harassment and intimidation from police, ambulance and hospital staff whenever a homebirth delivery has to transfer to the hospital system. Her arrest was the logical climax of a campaign of vilification and criminalisation which has last nearly twenty years and which is rooted in the determination of a clique of obstetricians to maintain their own power and earning potential from hospital birth. Obstetrics is one of the most lucrative branches of Hungary's supposedly free healthcare system, in which parents expect to pay up to a month's salary to the doctor who, according to law, must be present at each birth.

Also, Ágnes Geréb's work is not restricted to homebirth as she has long represented the opposite end to the over-medicalised, over-interventionist practice of hospital birth. Her work proves that it is possible for midwives to take over the doctor's role, in Hungary, as the main health-care professional at birth.

The persecution of Hungary's most experienced midwife in gentle, natural birth continues, despite a 1998 decision by the Parliamentary Ombudsman, confirming that the Constitution affords mothers the right to give birth where they wish. But foot-dragging by successive governments has prevented any regulations from actually being implemented. As a consequence we expect both the Hungarian Constitutional Court and the European Court of Human Rights to rule against the Hungarian Government in the near future for failing to draw-up and introduce the necessary regulations, and to order Parliament to do so without further delay.

In the meantime citizens are exposed to the double-speak of a state which admits a mother’s right to choose her home as a birth location, but prevents her from doing this on the pretext that the practical conditions for conducting homebirth safely do not exist. By continually failing to introducing legislation to support the practicalities of home birthing they have tried to remove homebirth as a birthing choice for its citizens. But many parents still insist on doing what their Constitution allows through the services provided by Ágnes Geréb and a small band of independent midwives. These midwives have been refused the ”necessary” licenses to operate legally, but are prepared to give their professional support to parents despite being under the constant threat of arrest and imprisonment. The state has, until now, not taken the logical next step of prosecuting the parents of homebirth children, as well as the unprotected professional service providers. We parents remain baffled and desperately saddened that the Hungarian State has yet again chosen to attack not only a true servant of the people but a highly ethical and professionally gifted doctor and midwife.
On October 14, 2010, the Hungarian Homebirth Community emphasized that the struggle to free Ágnes Geréb was not just about home birth:
All we are asking is for women to be empowered, in hospital and at home, to give birth in the position, in the way, and with those present, whom they choose. Our campaign to free Ágnes is not just about homebirth. It is about establishing a mother-centred, midwife-centred, baby-centred practice in hospitals as well.

For further reading and information:
Support for Agnes Gereb Facebook page
www.birth.hu (which also has an English version)
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Thursday, October 21, 2010

"BabyBabyOhBaby" infant massage DVD

At last year's Lamaze conference in Orlando, one of the general sessions was about research on massage therapy: for premature babies, for healthy term newborns, and for pregnant women. The research evidence is very strong and very consistent for the benefits of massage for mothers-to-be and babies. We learned from Dr. Tiffany M. Field, director of the Touch Research Institute at the University of Miami School of Medicine, how massage plays a role in "preventing prematurity, reducing length of labor and labor pain, enhancing growth of infants, increasing attentiveness, decreasing depression, reducing pain and enhancing immune function."

At this year's Lamaze/ICEA conference in Milwaukee, I had the pleasure of meeting filmmaker David Stark. He was exhibiting his DVD on infant massage: "BabyBabyOhBaby: Bonding With Your Brilliant & Beautiful Baby Through Infant Massage".
Here is some of the back story on how his DVD came into being:
How did a man with no children end up producing an infant massage DVD? I'm as surprised as you are. The answer is that I had an amazing mother. It was inspired by and produced in memory of my mother, Beatrice.

As a filmmaker, I've worked on Miss Universe Pageants, shot in the canopy of the Giant Sequoias and done interviews at the White House. But this DVD was a personal project and has been the most satisfying. I think it is also the most important.

I grew up in a family where love was conveyed by touch. Mom put my brother, sister and me to sleep by stroking our backs ... what we called "being tickled." From her touch we learned love and so much more. The thread that binds our family started with that touch.

At the beginning of 2004, Mom had a stroke. During the months before her death, we had a masseuse come to the house a couple of times a week. We all "tickled" Mom as well. It was a way to tell her how much we loved her. It was such a visceral reminder of the power of touch.

During those months, I happen to rekindle a friendship with someone I hadn't seen since my freshman year in college, some thirty years ago. Turns out that Mindy, among other things, taught infant massage. We talked about touch and Mom. I started doing some research and sat in on a infant massage class for fathers and their babies. There was one father in particular who just did 'still touch' ... putting his fingers on the chest of his daughter only weeks old. The sparks flew between those two. A bit of magic was happening. I was hooked.

After Mom's death, I decided to produce "BabyBabyOhBaby" as a way of passing on some of that magic.

Of course, the DVD teaches the mechanics ... the strokes of infant massage, but most importantly it is about the bonding between parent and child. I'm proudest of that connection which we captured as we filmed six real families learning to massage their babies. I love the emotion and trust on the screen.

I've found working with the families so satisfying. I want to extend the title by producing companion DVDs to go with infant massage. I think Mom is looking down from above and laughing at me. I'm the one who never wanted children and here I am surrounded by babies. Life can be interesting.
"BabyBabyOhBaby" guides parents through the techniques and pleasures of infant massage. A female narrator keeps the tone light and humorous, reminding parents to relax and to enjoy the quiet, connecting time with their baby. The DVD demonstrates the massage techniques on a doll, then shows how they work in "real life" with six different parent-infant duos. We see how parents massage "real" babies--the ones who wiggle, squirm, crawl, and try to eat their toes!

The DVD was filmed entirely with a brilliant white background. The parents wear simple gray athletic clothing. This visual simplicity places the focus on the baby-parent interactions. David Stark explained to me that he wanted the overall message of his DVD to be less about technique and more about relationship. "Infant massage isn't something you do to your baby; it's something you do with your baby." He sees infant massage as an improvisational dance between parent and child, as a way to connect and relate with each other. I love watching the babies and parents interact in this DVD. You see a dad with tattoos and piercings tenderly stroking his baby--probably one of my favorite images.

To see what I have described, watch this 3-minute preview of "BabyBabyOhBaby."

The 45-minute DVD has an introduction and 9 instructional chapters, each focusing on different parts of the body: still touch, connecting strokes, legs & feet, stomach, chest, arms & hands, face, back, and stretches. There is also a 25-minute "Just Music & Babies" track, set to music with no narration, showing parents doing all of the massage strokes. Once you have learned the basic techniques of infant massage, you can simply play the music & babies track as you massage your baby.
"BabyBabyOhBaby" comes in a slim eco-wallet, is available in English or Spanish, and costs only $26; click here to order. Wholesale purchases are available upon request for hospitals, birth centers, specialty baby stores, infant massage instructors, doulas, and more.

And if this isn't exciting enough, David Stark has a breastfeeding DVD currently in production. Here is the sneak preview. It's a must-see!
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Wednesday, October 20, 2010

Little Pim giveaway winner...

... is "Serenyd"! Please let me know your preferred DVD number & language and your mailing address.
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Tuesday, October 19, 2010

Thoughts on "Le Premier Cri"

Oerall, Le Premier Cri was a hauntingly beautiful film. It followed women from around the world as they gave birth. The film was part-documentary, part-fiction. The women and their birth were all real, but they did not actually all give birth during a solar eclipse, as the film shows. The cinematography was beautiful and seamless--no hand-held home video feel anywhere. It was a documentary in the style of March of the Penguins or Babies or Microcosmos, in which the characters themselves tell the bulk of the story. There was no meta-narration, no talking heads, no interviews with any of the women. Just beautifully filmed scenes of the women living and laboring and birthing, with French voiceovers of each woman telling her own story. (The film has English subtitles for non-Francophones).

I loved the parallel editing in Le Premier Cri. For example, in the beginning of the movie, we see a Mexican woman swimming with dophins and floating in an azure ocean, an Amazonian woman bathing and swimming in a jungle river, and a French Canadian woman swimming in a lake. Then we see the three of them being painted. One has the baby in utero painted onto her belly; another has her entire face and body painted to beautify her for her baby's arrival, and another models nude for a group of artists.

The film follows women all over the world:

Majtonré, a Kayapo Indian in the Brazilian Amazon, is expecting her third baby. She gives birth in her hut at night, holding onto a horizontal wooden bar. Suspended in a half-squat, half-sit, she cries quietly in pain as the baby emerges. Her body is adorned with intricate patterns and stripes of paint.

Gaby & Pilar in Cancun and Puerto Vallerta, Mexico, plan ocean/dolphin births. Gaby lives near the water's edge. When labor begins, she floats in her large swimming pool. She plans to move to a nearby secluded beach for the actual birth, but the baby arrives too quickly. Soon after the birth, she is carried in a makeshift stretcher to that beach, where she coos over her new baby.

Pilar has her first baby in a dolphinarium. Two trained dolphins swim alongside her as she pushes her baby out.

Vanessa, a Quebecoise sharing a house in Maine with her partner and 8 others, have an unassisted birth for their first baby. Although their birth is without a midwife, it certainly isn't private. The commune members crowd around, watching her labor and birth.
Sandy, a dancer in Paris, France, is expecting her first baby. She continues to practice and perform into her eighth month. She attends childbirth classes, where they are taught how to push. Most women around the world, the teacher explains, don't need to be told how to push. They are usually kneeling or standing or squatting. But since most women in France have epidurals, they need to be taught how to push--and they way they are taught is artificial. Sandy wonders why she needs to be taught how to have a baby.
Mané, Touareg woman expecting her first baby in the Kogo Desert of Niger. After a long, hard labor, her breech baby is stillborn.
Kokoya, a Masai woman, the fifth of ten wives and awaiting her seventh baby. She gives birth in a desert hut in Tanzania. It is expected that she be stoic and express no pain.
Sunita, who lives near the Ganges River in India. She moved from the countryside to the city in hopes of a better life, but she is still poor. Pregnant with her fourth (and she hopes last) baby, she sells dried cow dung and her husband drives a bicycle rickshaw. She is disappointed when her fourth baby is born and it is a girl. Having a girl means needing more money for her dowry.
Elisabeth, a Dolgan nomad in extreme northern Siberia, is helicoptered into a hospital for the birth. She is totally alone. Her husband has remained home to tend their reindeer (who pull their small caravan like sled dogs). It is -50 Celsius. The attending physician thinks the baby is too big to be born vaginally, so she orders a cesarean.
Yukiko was herself born at Dr. Yoshimura's clinic. She had her first baby there and is waiting the arrival of her second. Dr. Yoshimura believes that modern living has harmed the birth process. Part of his clinic is a recreated 18th century Japanese house where his pregnant patients live and work. A firm believer in the natural process of birth and women's inherent ability to give birth, Dr. Yoshimura says that giving birth is like the sunrise--you can neither slow it down nor hurry it along. Yukiko gives birth to her baby girl on her hands and knees, in a dim room, with her husband and daughter at her side.
The last "character", so to speak, isn't one woman but multitudes--some of the 45,000 women in 2006 (now close to 66,000) who gave birth at the world's largest maternity hospital, Tu Du Hospital, in Ho Chi Minh, Vietnam. 17,000 of those 45,000 births were spontaneous vaginal births, with the other 28,000 babies born through forceps, vacuum extraction, or cesarean. This hospital is literally a baby factory, with almost 200 babies born per day. Women line the halls, lay side by side on beds filling room after room, give birth one after another in parallel delivery tables. Babies are whisked away by busy maternity staff, lined up in a central hub one after another in pink or blue blankets awaiting their processing. I have never seen anything like this hospital, not even close.
Zari was very disturbed by the scenes in which newborn babies were removed from their mothers. Of all the hospital births, only Sandy, the Frenchwoman, is allowed to hold her baby after it is born. Zari kept asking what would happen if my baby were taken away, or if someone had taken Dio away. I thought the stillbirth would be the hardest part to watch--the footage was mercifully brief--but I found these hospital scenes far more unsettling--both the separation of mothers and babies and also the lack of humanity and human touch in the Vietnamese and Siberian hospitals.

This is truly a must-see film. Buy it from amazon.fr, borrow a friend's copy, interlibrary loan it, request it for your birthday present...whatever it takes!
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Monday, October 18, 2010

How to watch "Le Premier Cri"

Almost 3 years ago, the film Le Premier Cri was released. I've been eager to watch it, but it never came to any local theaters, nor has it been released on DVD in North America. When I was in France this summer, I finally decided to buy a copy. The region coding won't play over here, but I decided that I'd find a way to make it work. Somehow.

Tonight, I came across a brilliant solution: recode my DVD player to become region-free! It took about 30 seconds. I googled the name and model number of my DVD player, along with the words "region free code."

I watched the first 15 minutes of the film and had to tear myself away to get ready for bed.

If you read the comments to this post, you'll hear from several people involved with the making of the film, as well as some of my own translations. I've also translated information provided on the film's website about Vanessa, the Canadian woman who had an unassisted birth, here.

To purchase a copy, visit Amazon France. It costs 10 Euros plus shipping.


I can't wait to watch the rest tomorrow!
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Sunday, October 17, 2010

Readings on breech birth

I recently came across these two articles about vaginal breech birth and wanted to pass them along. The first is an editorial by Dr. André B. Lalonde in the Journal of Obstetrics and Gynaecology Canada, titled Vaginal Breech Delivery Guideline: The Time Has Come (full text PDF). Dr. Lalonde is the executive vice-president of the SOGC. In the editorial, he reviews the changes that occurred after the Hannah trial and describes the most recent evidence that planned vaginal breech birth can occur safely. He then outlines Canada's need for re-training in vaginal breech birth. An excerpt from his conclusion:

Women in Canada and abroad are requesting the option of breech vaginal delivery. Will it be obstetricians and gynaecologists offering this, or, since many hospitals are not offering breech vaginal delivery, will women rely on midwives to do so? Some women with a breech presentation elect to deliver at home because they believe they will be refused a breech vaginal delivery at the hospital. It is urgent that we take on this responsibility and that every hospital in Canada offer safe breech vaginal delivery. We need to meet with our colleagues in midwifery to support their request for breech vaginal delivery in hospital and access to consultation with their obstetrician colleagues.

The other article of interest is Evolving Evidence Since the Term Breech Trial: Canadian Response, European Dissent, and Potential Solutions (full text PDF). Written by Betty-Anne Daviss, Kenneth C. Johnson, and André B. Lalonde, this article also appeared in the JOGC. The authors surveyed the 30 largest maternity hospitals in Canada to see how their breech policies changed after the initial Hannah findings and then again after the two-year followup. They found that "Hospitals were almost five times more likely to adopt a policy of requiring Caesarean section for breech delivery when current evidence suggested that it decreased risk for the neonate than they were to reintroduce the option of vaginal breech delivery when it did not." They concluded: "The weight of epidemiologic evidence does not support the practice developed in Canadian hospitals since the Term Breech Trial that recommends delivery by Caesarean section for all breech presentations. Obstetric and midwifery bodies will require creative strategies to make clinical practice consistent with current national and international evidence."

And if you're new to this blog, please visit these earlier posts addressing breech birth, mostly in chronological order:

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Saturday, October 16, 2010

Birth Educator Cloth Diaper Kit

One of my favorite exhibitors at the Lamaze Conference was the Real Diaper Industry Association. It is a non-profit organization dedicated to making "reusable cloth diapers the primary choice for babies’ parents and caregivers while emphasizing responsibility and sustainability through a focus on people, planet, and profit."

If you are a childbirth educator, the RDIA has a fantastic offer to help you educate your clients about cloth diapering options. For only $25 (shipping included to the US or Canada), you can receive a Consider Cloth Diaper Demo Kit. Worth well over $100, this kit allows your class attendees to see and touch all of the basic types of cloth diapering systems (AIO, Pocket, Fitted, Flat, Contour, Wool or PUL Diaper Cover, and Wet Bag, all donated by manufacturers). 
To give you an idea of what your kit may contain, here is what came in my kit:
This is an amazing offer. If you're a childbirth educator, be sure to order a kit before supplies run out. The RDIA has also offered these kits to qualified, registered doulas, childbirth educators, midwives, birthing center directors, and lactation educators; inquire to see if you are eligible to purchase one.
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Handyman's stroller

One of my favorite memories is getting wheelbarrow rides from my dad...passing the tradition on to the next generation
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Friday, October 15, 2010

Homemade leg wax recipe

I haven't shaved my legs for...oh, probably 8 years. I never particularly liked shaving. It only lasted a day or two, and the stubble was prickly and uncomfortable. I almost always gave myself nicks and scrapes. Then I discovered hot waxing and quickly switched over.* I've had good results with the hot wax kits found in pharmacies and grocery stores, but the price has crept up from $5 to $11 as of last week. I just can't handle spending that much money!

A few years ago I tried making my own sugar wax, but I overcooked it and it didn't work right. After having sticker shock at the pharmacy last week, I decided to give it another go. I borrowed a candy thermometer from a friend and cooked up a batch. It's ridiculously simple; I used a variation of this recipe:

Homemade leg wax:
2 cups sugar
1/4 cup lemon juice
1/4 cup water

Boil the ingredients together until the syrup reaches 250 F (121 C). Let syrup cool. Extra wax will store indefinitely at room temperature, so double or triple the batch and save yourself some time down the road.

Use like any hot wax. Heat syrup in a microwave until it is hot, but can still be applied comfortably to your skin. Reheat as necessary in a microwave for 5-10 seconds at a time. Apply in the direction of hair growth with a wooden paddle or, preferably, a rolling applicator. Place cloth strip over wax and rub a few times. Pull off quickly in the opposite direction of hair growth. Place the used cloth strips in a bowl of hot water. Soak and then swish to remove wax and hair (or put them in the wash). Hang to dry.

The verdict: I used a rolling applicator and cloth strips saved from store-bought waxing kits. I got excellent results when I applied the wax with the roller. When I applied the wax with a wooden paddle, the results weren't as good; the hair didn't all come off, and I had some bruising (I've found this to be true with purchased kits, too).
 Homemade leg wax in roll-on applicator. 

Definitely use a candy thermometer. It's easy to overcook the syrup without one. 

You can make your own cloth strips by cutting rectangles from muslin, old sheets or pillowcases, etc.

Overall cost to wax both legs: $0.25

Worth the effort? Definitely

*The majority of the time I still let my leg hair grow, because I'm lazy and leg hair doesn't bother me. I probably wax twice a year. Since I've started wearing compression hose again--yay for varicose veins--my leg hair itches like crazy when I take the hose off at night. So I need bare legs at least until the baby is born.
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Wednesday, October 13, 2010

Little Pim language DVD giveaway!

My husband and I both speak French and hope to pass that skill onto our children. We began speaking French at mealtimes last year. In addition, Eric has started speaking to Zari only in French. She's made incredible progress just in the past month or two. When I am alone with the kids, I speak mostly in English, with some French at lunch time. I've found that it's too exhausting to do everything in French all day--and take care of two little kids!

When Dio naps, I let Zari watch French movies or language DVDs. I've tried several different language DVDs and my favorite by far is the Little Pim series. We've had discs 1-3 for about a year and recently received disc 5, "Happy, Sad, and Silly," courtesy of Little Pim! Zari loves the new Little Pim DVD and asks to watch it all the time. The other day, she was tickling Dio and saying "chatouille, chatouille!" (tickle) in between giggles. It's amazing to see how quickly young children pick up new words.

So I'm thrilled to offer a giveaway of a Little Pim language learning DVD! The winner will receive a Little Pim DVD of their choice. In addition, if the winner is a Little Pim Facebook fan, they will also receive a Little Pim plush panda.

Little Pim offers language immersion DVDs in Spanish, French, Chinese, Italian, Japanese, Hebrew, English (ESL), German, Arabic, and Russian, with additional languages coming soon.

How to enter:
1. Leave a comment mentioning your favorite Little Pim DVD (language and disc number). Please note if you are a Little Pim Facebook fan. Also, if you grew up in or are raising a bilingual family, please share your advice or suggestions! Be sure to leave an email address or other way to contact you (blog, website, etc).
2. For an additional chance to win, link to this giveaway on your blog, website, Facebook, etc. Then post your link as an additional comment, please.
3. Giveaway ends Wednesday, October 20. The winner has 48 hours to respond.
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Tuesday, October 12, 2010

No guarantees

When I become a parent, I realized how tenuous life is. I find myself imagining all sorts of terrible situations that might befall my children—quite outlandish things that come unbidden to my mind when I’m drifting off to sleep or daydreaming. Accidents, kidnappings, incurable diseases, that sort of thing. In these scenes, I’m always one step or one shout too late. These waking nightmares became particularly intense after Dio was born, to the point that I had a hard time sleeping for a while because I kept worrying that someone was going to kidnap my children. My logical mind knew it was a bit silly, but my primitive brain--the part that controls instinctual responses and emits adrenalin--was on high alert. 

In real life, my children have never met with disaster. We’ve had our share of scrapes and falls, of course. And some really scary near misses—like the time a few weeks ago when Zari was riding her trike and I was walking behind her, pushing Dio in the jogging stroller. We came to an intersection. Instead of stopping and waiting for me, as she always had done in the past, she pedaled even faster. Right into the path of an oncoming semi truck.

Of course this story turned out happily. The truck driver saw her and stopped. A friend who was walking with me ran into the street and snatched Zari back onto the sidewalk. Another woman across the street had been watching and was running towards Zari as well, yelling at the oncoming traffic to stop. Afterwards, my mind replayed the incident, and I couldn’t stop thinking what if the truck hadn’t seen her? What if my friend hadn’t been there with me? What if what if what if?

This afternoon Zari and Dio were playing inside a tent on the living room floor. I was on the couch, reading a book. Dinner was made and we were waiting for Eric to come home from playing ultimate Frisbee. The sounds of play—talking, giggling, babbling, minor squabbling—suddenly stopped. Dio began screaming. Not the usual “you took my toy away!” scream, but a piercing shriek of pain. I opened the tent flap and saw blood all over Dio's face, shirt, and hands. Zari had been cutting paper inside the tent, so I knew that the scissors were somehow involved. Zari shrunk away from me and wouldn’t make eye contact. I had to quickly figure out a) where the blood was coming from and b) what had happened.

I looked at his face first. No active bleeding, no scissors in the eye or mouth or anything awful like that. Okay. Hands next: I saw blood flowing from his index finger. The tip of his finger had been cut off. Now, that sounds worse than it really was. More specifically—a piece of skin the diameter of a lentil was missing at the tip. I told Zari to run get a towel, but she wouldn’t move.

So I ran Dio into the bathroom and rinsed the cut off. He was shrieking and writhing, so we soon had blood all over both of us. I held a washcloth around his finger and opened the first-aid kit. I tried a band-aid first, but it soaked through and was dripping blood in just a few seconds. So I opened up a gauze eye patch, put it around his finger, and wrapped it snugly with medical tape. This was more complicated than it sounds, because he would not hold still. I ended up pinning him on the ground between my legs while I bandaged him up.

He needed lots of snuggles and nursing the rest of the evening. I put a new bandage on right before bedtime, since his old one had slipped loose. I hope the new one stays on all night. The bleeding is still fairly brisk when there’s no bandage applying pressure to the cut.

I never could get a straight story from Zari about how exactly his finger had made it into her scissors. She wouldn’t make eye contact with me for a long time. My guess is that it was an accident.

Even though I was only about three feet away, it still wasn’t enough to prevent the accident. Sure, I could never keep a pair of scissors in the house…but Zari has been using scissors quite competently for a long time. She enjoys doing “activities”—cutting paper and fabric, gluing on pompoms and glitter and googly eyes, tracing patterns, and using her stamp sets. (After today’s incident, though, I did explain that she can only use her children’s scissors, rather than my “adult scissors.” More for Dio’s sake than her own, since he’s started to imitate whatever she does.)

Part of being a parent is realizing that you cannot be there every moment. You cannot anticipate every eventuality. You cannot guarantee that your children will be safe and unharmed, or even that they will be alive the next day. That sounds a bit morose, but it’s a reality that hits me especially hard during pregnancy. I have to live with the knowledge that my baby might not survive. Although there's a very good likelihood that my pregnancy will continue to term and that the baby will be born alive and healthy, it's never 100% certain. I'm still working to find the right balance between hoping and planning for life and accepting the possibility of mortality. Or even just plain-Jane things like getting the tip of your finger cut off by your older sister.
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Sunday, October 10, 2010

Seminar at the Yoshimura Clinic, Nagoya, Japan

An announcement from Ina May Gaskin:

I would like to announce an exciting opportunity for obstetricians, family physicians, and midwives to attend a seminar to be held in Nagoya, Japan, at the Yoshimura Clinic. This 3-day event will take place on November 12-14, and will be presented by Dr. Takashi Yoshimura, founder of the clinic, which is world-famous for having maintained a very low rate of obstetrical intervention without sacrificing safety of either mother or baby. (The cesarean rate for the clinic is < 5%).

I will be co-presenting with Dr. Yoshimura (whom I met for the first time in March of this year). We found that we have much in common in the ways we consider ideal for helping women prepare for childbirth and how to best use resources to maximize the incidence of physiological birth.

Expert translation (English-Japanese, and vice-versa) will be available throughout the event.

Place: the Yoshimura Clinic, Nagoya, Japan Date: November 12-14, 2010
Charge: US $2,000, which includes hotel and meals
Optional tour date in Tokyo or Kyoto on November 15: US $500
Contact agent Masae Kakizaki at masaek0108@i2planning.org

Ina May Gaskin, CPM
The Farm Midwifery Center
149 Apple Orchard Lane
Summertown, Tennessee 38483 USA
www.rememberthemothers.org
www.inamay.com
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Saturday, October 09, 2010

Currently reading

Gang Leader for a Day: A Rogue Sociologist Takes to the Streets by Sudhir Venkatesh. Gripping read about his 10 years spent following a gang leader in inner-city Chicago.

The War on Moms: On Life in a Family-Unfriendly Nation by Sharon Lerner. I highly recommend reading this book. It shows how the supposed "mommy wars" distract from the real problem with American culture--the total lack of support for mothers and children. By keeping women occupied with blaming themselves or finding fault with other moms, the real offenders responsible for making motherhood so difficult go unchallenged. Anyway, I will refrain from turning this into a lengthy review. Get your own copy and tell me what you think!

Radical Homemakers: Reclaiming Domesticity from a Consumer Culture by Shannon Hayes. I finished this one a few days ago and have a lot of criticisms. Overall, wonder why she created an arbitrary division of homemaking into the "good" kind (the radical, feminist, eco-conscious, gender-equal, stick it to The Man, homemaking-as-deliberate-choice) and the "problematic" kind (your everyday garden-variety homemakers or, gasp, fundamentalist Christians). Her historical overview was extremely spotty and way, way overgeneralized. Too much of we used to live in a happy peaceful matrilineal society that valued men's and women's work equally until evil Industrialization and Capitalism ruined the world. I am happy, though, that people are beginning to reclaim the lost domestic arts--cooking, canning, gardening, home renovations, car repairs, sewing, thrifting, etc.--and find value in domestic/manual labors. I wonder what kind of homemaker she would label me. Would I fit into the exclusive club of radical homemakers? Or would I be one of those who isn't doing it for the "right" reasons? I've had this on my mind today in particular, as another family came over with a huge load of apples to can together. We put up 23 quarts in 4 hours with all four of us adults working and the kids amusing themselves for the most part.

Many of these domestic skills are ones I simply find normal, logical and entirely sensible. I grew up learning how to cook and garden and sew as ordinary yet important life skills. (And this wasn't just for us girls--my little brother learned the same things). When I do shop for clothes or household items, I almost always go to thrift stores. Why spend all that money when you can find it secondhand?

My Name is Mary Sutter by Robin Oliveira. Another fast read. A novel about a skilled American midwife in the mid-19th century who wants to become a surgeon. When war breaks out, she volunteers as a nurse in a Washington, D.C. hospital and eventually gains the skills to work as a battlefield nurse & surgeon. Of course the childbirth parts are wonderfully/terribly dramatic. For example, Mary comes home to attend her sister's first birth. Her sister's pelvis is too small for the baby to be born. After a bumbling doctor tries forceps and mutilates her sister's insides, Mary cuts a symphysiotomy and helps the baby be born alive. Her sister then dies immediately after the birth of an eclamptic fit.

Women of Courage: Intimate Stories from Afghanistan by Katherine Kiviat and Scott Heidler

Three Tracy Chevalier novels: Falling Angels, Burning Bright, and The Lady and the Unicorn. I originally wanted a different one of her novels, but it was checked out. I pulled a few others off the shelf to read.

Towards a Philosophy of Education by Charlotte Mason.

I also have a stack of books and DVDs to review. In roughly this order:
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Wednesday, October 06, 2010

Pregnancy update: 20 weeks

I had to double-check my pregnancy Excel sheet to see how many weeks along I was. I hardly can believe that I am pregnant, except I definitely am showing now and I've been feeling movement for the past several weeks. Here's what my belly looks like right now. I don't know how people manage to take nice self-portraits because I was contorting myself and took about 30 shots in a mirror and still only came up with this:
Here I am at 27 and 32 weeks along with Zari. I even weigh less this third pregnancy than I did with the first two...and still, it's crazy how little I showed the first time.
With each of my pregnancies, it has taken longer to sink in--in large part, I am sure, because I have less quiet time to myself! When I was expecting Zari, I could just sit and be pregnant...meditate about the life inside me, envision the labor and birth, and reflect on the changes I was going through. I also had many, many birth dreams during her pregnancy. When I was pregnant with Dio, I had maybe one or two total. None so far with this new baby.

I've been a bit anxious--probably unwarranted--because I still haven't been able to find heart tones with my fetoscope. With my first two, I found heart tones easily and consistently at 15-16 weeks. But with this pregnancy, I'm hearing tons of placental sounds and maternal heart beats...and nothing else. A few times I swear I heard something for a second or two, and then it disappeared. Almost as if the baby were playing hide-and-seek.

All (measurable) vitals look good, according to my nerdy Excel sheet. I do my own "prenatal checkups" about once a week. I chart weight, blood pressure, fundal height, heart tones, & exercise. I also keep tabs on things like swelling, quality of sleep, varicose veins, nutrition, how I'm feeling in general, etc...I love being able to see how things are changing and developing. So for me, the clinical part of midwife visits is a formality--I already know most or all of what's going on!

Just for kicks, a random picture of Zari.
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Tuesday, October 05, 2010

Lamaze/ICEA Conference part 3

I woke up Sunday morning feeling so much better. I took Dio to breakfast with me and brought him back before the first breakout session. 

Mary Lou Moore, PhD, nurse, and faculty member at Wake Forest School of Medicine, spoke about The Perinatal Care System in the 21st Century: Induction, Cesarean Birth and Late Preterm Birth, sponsored by the March of Dimes. Her presentation covered recent research showing that elective deliveries (induction and cesarean) should not be performed before 39 weeks. In addition, it's advisable not to induce at that point unless the Bishop score is 8+ for primips and 6+ for multips.

These "early term" births at 37 & 38 weeks have increased rates of complications for baby and mother. (We're not talking about mothers who go into labor spontaneously at these weeks.) It's not just an issue of fetal lung maturity, but a wide range of other physiological changes the term baby undergoes before labor beings. We only understand a small number of these complex mechanisms. We know, for example, that a baby's brain grows rapidly between 34-40 weeks; the frontal lobes are especially vulnerable to elective deliveries as they are the last to fully develop.

She then outlined several hospitals around the country that have implemented these new guidelines for elective deliveries:
  • Starting in 2004, Magee Women's Hospital in Pittsburgh implemented a policy of no elective deliveries before 39 weeks. Between 2004-2007, their rate of elective induction (EI) went down 30% and the overall induction rate fell 33%. The cesarean rate for primips dropped 60% over those years from 34.5% to 13.8%.
  • The Perinatal Quality Collaborative of North Carolina (PQCNC, pronounced "picnic") decided to stop elective deliveries before 39 weeks in 38 hospitals across the state. This led to a 12% reduction in elective deliveries, a fall in newborn complications and NICU admissions. 
  • The Ohio Perinatal Quality Collaborative (OPQC) has had similar outcomes.
For more information and resources on reducing early term elective deliveries, visit The March of Dimes' toolkit on reducing elective deliveries before 39 weeks. What I found most remarkable about Dr. Moore's presentation was how rapidly changes have occurred in some places. The Joint Commission backs these new guidelines for elective deliveries as part of their Perinatal Care Core Measures, giving hospitals increased motivation to implement them.

Zari joined me for the final keynote speaker: Linda Smith, author of Impact of Birthing Practices on Breastfeeding. I missed about the first third of the presentation because Suzanne Arms pulled me aside and said, "I hear I need to meet you!" (How cool is that??!) We talked about what we're both working on and her future plans in trying to gather people from all walks of life and all parts of the world to envision a new global strategy for improving all things related to birth and breastfeeding.

Back to Linda Smith's presentation...I entered right before she showed an excerpt from a fantastic new breastfeeding DVD Skin to Skin in the First Hour After Birth: Practical Advice for Staff after Vaginal and Cesarean Birth. Here's an excerpt for you to watch:

I really hope I can obtain a copy of this DVD to review. It was produced for health care providers and teaches immediate, uninterrupted skin-to-skin for both vaginal and cesarean births. It also shows nine stages that newborns go through in the first hour after birth when they are placed skin-to-skin immediately after the birth. Really amazing stuff!

Linda emphasized that 30+ years of birth advocacy have done little to change childbearing practices. However, using the breastfeeding angle to change birth practices has been remarkably successful. In fact, the new Baby-Friendly curriculum includes a Mother-Friendly module as part of step 3: "Inform all pregnant women about the benefits and management of breastfeeding." I wasn't able to write down the details, since I was keeping Zari occupied, but you can email Linda if you'd like more information about this. She urged us to keep an eye out for the Surgeon General's breastfeeding statement that will be coming out in the next few months. There's a lot of support behind breastfeeding--witness Michelle Obama's many supportive statements about breastfeeding--especially because it is associated with lower obesity rates. In sum, if you want to change birthing practices, use the breastfeeding angle. There's a lot of money, government support,  momentum behind breastfeeding, so run with that to improve health care for both mothers and babies!
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Monday, October 04, 2010

Lamaze/ICEA Conference part 2

Saturday did not start well for me. I slept maybe 2 hours the night before, due to a combination of congestion and two little children who decided to wake up and either cry (Zari) or party (Dio) most of the night. I wondered how I would make it through the day...

But I didn't have much choice. My presentation--based on my article Attitudes Towards Home Birth in the US (PDF)--was in the morning. I arrived early and ran through my presentation to make sure I wouldn't go over time. I used prezi rather than PowerPoint, as I think it's a much more dynamic and visually interesting platform.




I had a fun time giving the presentation. We had lots of discussion and comments both during and after my talk. Even though I was dead tired, I didn't feel it while I was speaking. We had to cut the discussion short to make it to the big celebratory luncheon. I sat with April, a lovely CPM from Dayton, Ohio, who works closely with Dr. Guy of Miami Valley Hospital in Dayton and Dr. Can't-Remember-His-Name in Cincinnati. These OBs are known for supporting women who want VBACs, vaginal breech births, vaginal twins & triplets, etc. She and I talked about her training (master's level degree from the Midwives College of Utah) and her reservations about the loopholes in the CPM certification process.

Later in the day, I found out that Geradine Simkins, president of MANA, and Dr. Raymond De Vries were both in my audience! I had never met them face-to-face before and so didn't know who they were at the time. I talked with Geradine afterwards for a while. She urged me to consider doing research with the home birth statistics MANA has been compiling over the past decade or so. She was especially curious about my suggestion that NARM upgrade the CPM certification into a 4-year university degree. We weren't able to talk much because of our busy schedules, so I'll have to continue our conversation via email or phone.

I did double duty in the afternoon breakout sessions. First, I listened to Christine Morton's presentation about the historical evolution of doulas and how the profession is intimately connected with the development of childbirth education. Really fascinating! I've "known" Christine online for a while--she's a sociologist at Stanford University and doula--but never saw her in person before the conference. I never had time to talk with her face-to-face, unfortunately. But here's a virtual wave hi, if you're reading!

I then ran to another session about MoreOB, an evidence-based program being adopted throughout Canada. The presenters were an obstetrician, Dr. Karen Bailey, and two nurses/childbirth educators, Liz DeMaere and Sharon Dalrymple. With MoreOB, what childbirth educators teach in the classroom is exactly what happens once the laboring woman arrives in the hospital. This is definitely not the case in most parts of the US, as attendees emphasized over and over again throughout the conference.

The speakers gave a case study about how MoreOB works in their hospital regarding fetal monitoring. The hospital staff has a clear set of guidelines for when to use intermittent auscultation (IA) and when to use continuous electronic fetal monitoring (cEFM). Basically, unless a woman has certain clearly-delineated risk factors, she will only be monitored with IA. If a nurse, midwife, or physician wants to use cEFM, they have to document which specific medical condition warrants using cEFM. If it does not meet the established criteria, they won't be allowed to use cEFM. And they'll receive a talking-to from the charge nurse!

I entered when Dr. Bailey was talking about the before and after experiences in her hospital. She works in a small rural hospital in High River, Alberta that cares for only low-risk laboring women. Before adopting MoreOB, every woman would automatically be hooked up to the fetal monitors and confined to bed. After MoreOB was put into place, no one goes on the monitors--no 20-minute admission strips, even--unless there's a very specific reason for it. At her hospital, that means almost everyone receives IA and is encouraged to stay out of bed. Dr. Bailey explained it like this: "I'm an old cowgirl. And every cowboy or cowgirl worth their salt knows that you can't just slip your feet into a good-fitting pair of cowboy boots. You have to wiggle and jump and shimmy your way into your boots!" (This said as she's hopping around the room on one foot demonstrating the gymnastics required to put on cowboy boots). She was adamant about keeping women walking and moving and out of bed. She joked about how they used to always know where to find the laboring women--in bed. But now, they never know where to find them. "Where's patient X? Not in her room? Not in the shower? Where could she be? Oh....probably the staircase!"

We then moved into three small groups, each tackling a common scenario in US hospitals: augmentation, induction, and restriction of food/drink. We were instructed to discuss how to implement evidence-based, consistent policies, similar to what their hospital has done, for these various scenarios. I joined the induction group, which Dr. Bailey was part of. Our group, I sensed, felt extremely hampered and frustrated with how little they felt they could do to change the rampant rates of both elective and quasi-medical inductions (i.e., for a "big baby" or being "overdue" at 40 weeks and 1 day). Where Dr. Bailey works, they only do elective inductions for really extreme circumstances--such as a grand multip with a history of 30-minute labors who lives two hours away from the hospital and a really big snowstorm is moving in (close to a direct quote from Dr. Bailey). They don't start offering inductions for post-dates until 41 weeks 3 days. So if a physician wants to book a patient for an induction, and the induction doesn't meet certain evidence-based criteria, the charge nurse will tell the doctor--and I quote Dr. Bailey--"Bullshit."

The last session on Saturday was a general session by Dr. Warren P. Newton. He teaches at the UNC School of Medicine and works with UNC's department of Family Medicine. He spoke about developing a systems approach to health care. While the quality of individual physician-patient (or midwife-client) interactions is key, we also need to ensure that everyone has equal access to such care. He explained the implementation of the Family Centered Medical Home into the UNC Family Medicine Center and demonstrated very impressive results: much less waiting time for appointments, better health outcomes, etc. I'm still fuzzy on what exactly a FCMH is and how it different from standard medical care systems, but it was very intriguing.

The last part of his presentation explained how he applies these approaches to maternal-child care. His staff includes family physicians, nurse-midwives, nurse practitioners, and acupuncturists. They have really impressive numbers with their maternity patients. They do about 350 births/year and have a primary cesarean rate twice as low as the overall primary c/s rate at UNC. Their practice's epidural rate is 25%, compared to 82% for the rest of the hospital's maternity patients. (He noted that not allowing the anesthesiologists into the woman's room soon after admission to "talk about her pain relief options" and "assess her airway in case she needs an emergency cesarean under general anesthesia" had a significant impact on lowering the epidural rate.) He's also been involved in backing up the only freestanding birth center currently in North Carolina, the Women's Birth and Wellness Center, which does about 400 births per year. He demonstrated a strong belief in the normality of the childbearing process and of women's inherent ability to give birth, especially when given the time and space to do so.

By time 5:15 pm rolled around, I was beat. I could hardly stand upright and was feeling quite unwell. I wanted to stay longer and talk, but I needed to get back to the kids, eat dinner, and go to bed. My sister and I split a Tylenol PM; the sleep aid is benadryl, so it was perfect for our congested noses. (Thanks to April for finding someone with medications on hand!) It did the trick, and I was able to have a good night's sleep (which meant I only woke up 3 times to pee, and Dio only woke up once at 2am.) My apologies to anyone who thought I seemed disinterested or distracted on Saturday...it was just the fatigue!
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