Saturday, December 31, 2011

A simple Christmas?

I follow a few design blogs (Little Green Notebook and more recently Centsational Girl, after I found her board and batten tutorial). I saw CG's home tour a few weeks ago and laughed at how she described her holiday decorating:
I’m keeping it simple, my decor this year is mostly garland for scent, poinsettias scattered here and there, ornaments in various vessels, and always branches ~ simple touches since I want to spend most of the next week enjoying the twinkle lights, the baked goodies, the traditions, and our family.
Beautiful and magazine-worthy? Yes. Simple? No. 

My definition of simple Christmas decorating goes like this:
1. Buy a tree (but only on years when we'll be at home for Christmas)
2. Decorate the tree with hand-me-down ornaments from my own childhood. Nothing matches and I love it that way. 
3. Put up a nativity set and felted wool stockings for the kids
4. Done!
Now I don't think there's anything wrong with elaborate holiday decorating. But there's also no need for false modesty. If you do something that you're proud of, own it. It won't spoil the effect if you are upfront about how much effort it really took.

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

I'll end 2011 with a picture taken on Christmas day after church and before we opened presents.
 
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Friday, December 23, 2011

Birthingown giveaway winner...

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

I need you to contact me ASAP with your mailing address. If I don't hear from you, I'll select a new winner on Monday.
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Saturday, December 17, 2011

Birthingown Giveaway!

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


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


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

coco & pink Birthingown

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

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

Now for the fun part...

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

 
 Giveaway rules:
  • To enter, visit the Birthingown website and leave a comment about what you like best about the gown
  • Open to US or Canada residents
  • Expecting moms get an extra entry--leave another comment, please
  • Contest ends at sundown on Winter Solstice (aka 5 pm EST on December 22nd)
  • Extra entry to anyone who submits a caption for this photo and makes me laugh out loud:
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Monday, December 12, 2011

Robin Lim named CNN Hero of the Year

Robin Lim, a midwife in Indonesia, was just named the CNN Hero of the Year! She was well-known among many midwives in Iowa (where I did my PhD work), where she practiced before moving to Bali. Here are some excerpts:
Robin Lim, an American woman who has helped thousands of poor Indonesian women have a healthy pregnancy and birth, was named the 2011 CNN Hero of the Year on Sunday night.

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

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

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

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

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





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Saturday, December 10, 2011

It was just a dream

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

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

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

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

He found a bat flying around in her room.

This called for my superior bat-catching abilities; I've caught at least 6 bats in the past few years. Here's how you catch a bat:
1. Get a medium-sized bath towel.
2. Close the doors to the room if possible.
3. Swat at the bat every time it flies by you. Bats tend to fly in circles when they're trapped indoors, so it's pretty easy to swat them down. You have to really snap the towel quickly. Once it falls to the floor, throw the towel over the bat and gently pick it up.
4. Release outdoors.
Eric settled Zari down, then came back to bed. About a half hour later, he woke up convinced that there was a bat in our bed. (He does this fairly regularly. Over the years I've had to fend off attacks when he thought some creature was on top of me and assure him that no, there really wasn't a giant lobster-sized centipede trying to attack me.)

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

"Are you sure?"

"Yes. It was just a dream. Go to bed."
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Friday, December 09, 2011

White Paper on Cesarean Deliveries & Opportunities for Improvement‏

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

For immediate release
December 8, 2011


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

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

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

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

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

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

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

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

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

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

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

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

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

The report, Cesarean Deliveries, Outcomes, and Opportunities for Change in California: Toward a Public Agenda for Maternity Care Safety and Quality, is available for free download from the CMQCC website
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Tuesday, December 06, 2011

Sleep miracle

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

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

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

I probably could have moved her out of our room a month or two earlier, when she started to have longer and longer sleep stretches and before all of her developmental milestones caused her to wake up so often. But I'm just happy that we're both sleeping so soundly. Here's hoping the trend continues!
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Monday, December 05, 2011

You're Doing It Wrong: Nursing Cover Edition

Thanks for your witty submissions for my nursing cover caption!

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


Close runner-up:

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Saturday, December 03, 2011

9 month pictures

Curious girl
Showing off her teeth
3 siblings
Zari took this picture...
...and this one
We like to make animals out of bread
And then we eat them!
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Friday, December 02, 2011

9 months old!

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

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

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

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

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

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

Pictures coming soon!
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Tuesday, November 29, 2011

Birthplace in England: A Tale of Medical Reporting

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

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

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

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

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

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

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

This is how I'm feeling right about now:

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

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

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

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

News reports emphasizing risk
News reports emphasizing safety
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Friday, November 25, 2011

I need a guinea pig!

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


If you'd like to try it out, send me an email describing why you'd be a good candidate. If I select you, you agree to test the Kegel exerciser and write up a detailed, honest review. The device will be yours to keep in exchange for doing the review.
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Tuesday, November 22, 2011

The problem with nursing covers

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

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

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

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


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

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

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

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


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


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


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



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

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

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

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

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Monday, November 21, 2011

God Was My Midwife: My Interview with Shifra Mincer

Last week, I spoke with Shifra Mincer, who runs the Jewish birth site Layda Birth. She had intended to interview me about my dissertation findings on unassisted birth, but our conversation soon took a more personal turn. We spoke about why I chose to give birth unassisted the first time--and why I did not for my subsequent two babies. We also discussed the LDS understanding of the Feminine Divine (a.k.a. Heavenly Mother) and how I found strength and wisdom from turning towards her in my first pregnancy. We ended with my thoughts on feminism's near silence on birth issues. If you're interested to read more, please read God Was My Midwife.

An excerpt:
A Mormon, Freeze has the practice of speaking to God directly through prayer and meditation. Mormons have the concept of God the Father and God the Mother, a kind of Godly husband and wife, she said.

When she was pregnant with her first child, Zari, Freeze said she found herself reaching out more than ever before the Divine Mother, asking her for guidance. “I did find myself, during my birth and pregnancy, connecting to my Heavenly Mother. I was like, okay Father, I need to talk to Mother." Then I would tell her, "I need your help and guidance, I need you to be there with me for this process. I need a female presence to guide me through this process.”

As she meditated and listened to hypnobirthing CD’s before the birth, a visualization kept coming to her: “My pregnant self was walking down this long hallway next to Heavenly Mother, this serene Mother who led me down to the room where I would give birth. There I had to do it myself. And then after I gave birth, I came out another door where I saw these crowds of women who had gone through this before.” Throughout the meditation she said felt a sense of real closeness with the Divine Mother and of “needing her with me. I really relied on that heavily during my first pregnancy.”
Read the rest here.
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Sunday, November 20, 2011

I no longer have a placenta in my freezer, version 3

A shipment of six dwarf fruit trees arrived on Friday: Asian and Bartlett pears, Bing and Black Tartarian sweet cherries, Elberta peach, and Methley plum. I turned a lovely sunny spot of the yard, next to the vegetable garden and driveway, into a fruit orchard.

Inga's placenta has been lurking in the depths of our freezer, and it was time to plant her tree of life.I'd like to say there was some deep symbolism behind which fruit tree the placenta went underneath. But honestly, I decided that I really liked dark sweet cherries and so under the Black Tartarian it went!

Zari helped me dig the holes. She wanted to touch the (still frozen) placenta and umbilical cord before the burial.

Zari's placenta went underneath a climbing rose. Dio's went under a rose tree. Now that I've branched out to fruit trees, I wonder what type of plant the next placenta will nourish.

Do you still have a placenta in your freezer? What are your plans for it?
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Thursday, November 17, 2011

Rep. Roybal-Allard Applauds Consensus Agreement of Home Birth Summit

For immediate release:
November 16, 2011
Contact: Douglas Farrar
(202) 225-1766

REP. ROYBAL-ALLARD APPLAUDS CONSENSUS AGREEMENT OF HOME BIRTH SUMMIT

WASHINGTON, D.C. - Congresswoman Lucille Roybal-Allard (CA-34) spoke in the House of Representatives today [click here for video] to recognize the significance of the consensus document produced by the Home Birth Consensus Summit that took place in Warrenton, VA between October 20 and 22.

"The publication of the Home Birth Consensus document is of critical importance to all current and future childbearing families in this country," said Rep. Roybal-Allard. "I am pleased that the report supports the need for maternity service reform which I champion in my MOMS for the 21st Century Act (H.R. 2141). With the support of the diverse stakeholders of maternity services, I call on Congress to act to pass this important legislation to make evidence based maternity care a national priority. The mothers and babies in this country deserve nothing less."  
The Home Birth Consensus Summit marked the first time a multi-disciplinary group of maternity care providers came together with consumers and industry leaders to determine what the maternity care system could do to make homebirth the safest and most positive experience possible for all moms and babies. The Delegates were charged with finding common ground to move the issue of safe home birth beyond professional differences and toward consensus-building. The result of their effort was a consensus document released on November 1st of this year. This important document sets out 9 essential statements of agreement about the ideal system to promote the safest and most positive birth outcomes across all birth settings including:
  • All childbearing women, in all maternity care settings, should receive respectful, woman-centered care, including opportunities for shared decision-making to help each woman make the choices that are right for her.  
  • Physiologic birth is valuable for women, babies, families and society and appropriate interventions should be based on the best available evidence to achieve optimal outcomes for mothers and babies. 
  • Collaboration within an integrated maternity care system is essential for optimal outcomes. And when necessary, all women and families planning a birth center or home birth have a right to: a respectful, safe, and seamless consultation, referral, transport and transfer of care.
  • All health professionals who provide maternity care in all settings should have a license that is based on national certification that includes defined competencies and standards for education and practice.
  • In order to foster effective communication and collaboration across all maternity disciplines, all students and practitioners involved in maternity and newborn care must learn about each other’s disciplines, and maternity care in all settings.
Additionally, the Consensus Document calls for:  medical liability system reform, a compulsory process for the collection of patient data in all birth settings, the elimination of disparities of care and increased consumer participation.
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Sunday, November 13, 2011

SRSLY illustrated

My little brother created this for me:
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Friday, November 11, 2011

SRSLY?

Some things make me go "You can't be serious. They actually SAID that?"

#1: Old uterus = deflated balloon

Commenting on Michelle Duggar's annoucnement that she is expecting her 20th child, NBC chief medical editor Dr. Nancy Snyderman said: "She [Michelle Duggar] is a high-risk pregnancy because she’s 45, and because that uterus can’t have any spring in it anymore. I mean, really, it’s gotta be like a water balloon that has no tensile strength."

This is your uterus
This is your uterus on kids



#2: Breast is best, so feed your baby formula

From an report about a recent study showing--surprise!--that formula advertising decreases breastfeeding rates, I found this gem:
Alex V. Castro III, executive director of the Infant Pediatric Nutrition Association of the Philippines that groups infant formula makers, said the association fully supports breast-feeding.
Ha. Hahaha. Seriously!?! If you fully supported breastfeeding, you wouldn't be in business. Your business is dedicated to fully undermining breastfeeding. 
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Wednesday, November 09, 2011

Neither/nor, or how getting a job improved my life

Since I began teaching freshman composition this fall, I no longer fit into any tidy label. I'm a stay-at-home mother (mostly). I'm a working mother (partly). I'm neither fully one nor the other. And you know what--I love it!

I feel so lucky to be able to spend the bulk of my days raising my little children. I also love teaching and keeping current with my academic endeavors. Teaching one class per semester has created the perfect balance for me. Three mornings a week, I slip away to teach my 8 am class. Immediately after class, I exercise at the college gym. Eric meets me on campus at 10 am with all three children. He goes to his office; I go to the locker room with the kids and shower. (Our university athletic facility has a free laundry service, so I never have to tote exercise clothes back and forth from home. Amazing.) Then we're off for our morning activities.

You know what the best part about teaching is for me? 3 days a week I don't have to get the kids up, dressed, fed, brushed, or out the door. It's positively brilliant. Getting my children ready in the mornings is one of my least favorite things, and working lets me skip out of that responsibility. It's a win-win situation for both Eric and me. I get a break from the kids, while he gets more time with them 3 days a week. We're both really happy with our situation.

I''d also argue that this job has improve my marriage. Since Eric and I finished graduate school, our interests and activities have drifted farther apart. My world was increasingly dominated by babies, breastfeeding, toddlers, and preschoolers. My being involved in academia again--albeit as a teacher rather than a student--has given us more common ground. I like being able to ask Eric about what teaching strategy he'd suggest or which books he likes best for a given course. We can discuss grading strategies, groan over grammar errors, and celebrate when we see excellent writing or have a lively class discussion.

I like being in the nebulous area between a stay-at-home mother and a working mother. I recognize how fortunate I am: I get to do something I love and get paid well for it, without sacrificing time with my children. It's a dream situation for me right now.

I have had to give up some things: most evenings, internet time and blogging have been replaced by grading papers and prepping for class. It's a trade-off I'm happy to make, though.
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Sunday, November 06, 2011

Join IFFC

You're invited to join the IFFC (Inga Freeze Fan Club). The delightful Judy Norsigian, executive director of Our Bodies Ourselves, has enthusiastically volunteered to serve as President.
Judy and Inga at the Home Birth Summit. Photo courtesy of Jill at The Unnecesarean.

Membership is free and open to all. IFFC Benefits include updates of Inga and cute photos.

Warning: joining IFFC may cause your ovaries to go into overdrive.
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Wednesday, November 02, 2011

Zari is 5!

Zari turned 5 on Halloween and we were too busy doing Halloween-y things to write about it. Like carving birthing pumpkins and dressing up as Zorro (Eric), a "fancy lady from a long time ago" (me), a jellyfish (Zari), a dragon (Dio), and a "mini me" (Inga in a black cape that matched Eric's).

We also didn't take any pictures of her. Oops!

But I did take several pictures of her cake. Zari requested an "earth cake." Can do. Using the same recipe from Inga's Blessingway cake, I dyed the batter blue and green to match the frosting. 

North America turned out pretty well.

Europe, Africa, and Asia were a bit iffy.

After I did those continents, I realized that I left no room for Antarctica and the Arctic. Blame it on global warming.

We had lots of batter left over, so we made a few dozen cupcakes decorated with Swedish Fish. Why Swedish Fish? I don't know...it seemed appropriate.

We also had a volcano-shaped piece of cake trimming. I dyed applesauce red to make lava. Only the final effect was meatloaf with ketchup, not a volcano spewing molten lava. It's still sitting in the fridge.

We had family visiting over the weekend: my mom, my two younger sisters and their kids. 6 adults + 8 children in one house = 1,352,759 decibels. I needed to decompress from the noise and commotion.

I've been telling Zari, "I am happy that you are 5 years old but sad that you're growing up so fast." This usually leads to a conversation about how she will some day be grown up and become a mama with her own children, and then I will be the grandma. I mentioned once that I would be sad because she wouldn't be living with me any more when she is grown up.

She replied, "But I don't want to live in a different house. I want to live in your house when I am a mama!"

I can't argue with that.

Five years is a huge milestone. Zari is learning to read, just mastered riding a "real" bike, speaks fluently in French as well as English (thanks to Eric speaking only French to her starting a bit over a year ago), and has a vivid imagination and a very good memory. She's old enough to have lifelong memories now. Wonderful and kind of scary, from a parent's perspective.

In lieu of birthday pictures, here's a snapshot from a few nights ago:
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Tuesday, November 01, 2011

Common Ground Statements from the Home Birth Summit


The following statements reflect the areas of consensus that were achieved by the individuals who participated in the Home Birth Consensus Summit at Airlie Center in Warrenton, Virginia from October 20-22, 2011. These statements do not represent the position of any organization or institution affiliated with those individuals.

In creating these statements relating to maternity care and birth place in the United States, we acknowledge the complexity inherent in each topic of concern, as well as some disagreement about how to best achieve or demonstrate these principles. While all agreed that there is great value and need for further work in these areas, action plans that flow from these principles may be carried out by individuals or in newly formed, multi-stakeholder work groups according to their own, or shared, values and priorities.

Summary statements such as these can be interpreted differently by different readers. Therefore, although there was both unanimity and consensus about the topics addressed, there was not necessarily unanimity as to all of the specific words chosen to create the statements. For example, words such as “autonomy”, “independence”, and “collaboration” may have different implications for practitioners, policy makers, and consumers.


These common ground principles are intended to provide a foundation for continued dialogue and collaboration across sectors, as we work together towards a common goal of improving maternal and newborn care for families choosing home birth.

STATEMENT 1

We uphold the autonomy of all childbearing women.

All childbearing women, in all maternity care settings, should receive respectful, woman-centered care. This care should include opportunities for a shared decision-making process to help each woman make the choices that are right for her. Shared decision making includes mutual sharing of information about benefits and harms of the range of care options, respect for the woman’s autonomy to make decisions in accordance with her values and preferences, and freedom from coercion or punishment for her choices.

STATEMENT 2

We believe that collaboration within an integrated maternity care system is essential for optimal mother-baby outcomes. All women and families planning a home or birth center birth have a right to respectful, safe, and seamless consultation, referral, transport and transfer of care when necessary. When ongoing inter-professional dialogue and cooperation occur, everyone benefits.

STATEMENT 3

We are committed to an equitable maternity care system without disparities in access, delivery of care, or outcomes. This system provides culturally appropriate and affordable care in all settings, in a manner that is acceptable to all communities.

We are committed to an equitable educational system without disparities in access to affordable, culturally appropriate, and acceptable maternity care provider education for all communities.

STATEMENT 4

It is our goal that all health professionals who provide maternity care in home and birth center settings have a license that is based on national certification that includes defined competencies and standards for education and practice.

We believe that guidelines should:
  • allow for independent practice
  • facilitate communication between providers and across care settings
  • encourage professional responsibility and accountability, and
  • include mechanisms for risk assessment.

STATEMENT 5

We believe that increased participation by consumers in multi-stakeholder initiatives is essential to improving maternity care, including the development of high quality home birth services within an integrated maternity care system.

STATEMENT 6

Effective communication and collaboration across all disciplines caring for mothers and babies are essential for optimal outcomes across all settings.

To achieve this, we believe that all health professional students and practitioners who are involved in maternity and newborn care must learn about each other’s disciplines, and about maternity and health care in all settings.

STATEMENT 7

We are committed to improving the current medical liability system, which fails to justly serve society, families, and health care providers and contributes to:

  • inadequate resources to support birth injured children and mothers;
  • unsustainable healthcare and litigation costs paid by all;
  • a hostile healthcare work environment;
  • inadequate access to home birth and birth center birth within an integrated health care system, and;
  • restricted choices in pregnancy and birth.

STATEMENT 8

We envision a compulsory process for the collection of patient (individual) level data on key process and outcome measures in all birth settings. These data would be linked to other data systems, used to inform quality improvement, and would thus enhance the evidence basis for care.

STATEMENT 9

We recognize and affirm the value of physiologic birth for women, babies, families and society and the value of appropriate interventions based on the best available evidence to achieve optimal outcomes for mothers and babies.


In addition to practitioners, consumers, insurers, lawyers, ethicists, administrators, and policy makers, the participants included researchers with expertise in epidemiology, public health, midwifery, obstetrics, pediatrics, nursing, sociology, medical anthropology, legal, and health policy research. However, the goal of this summit was not to examine, debate, or form a consensus statement regarding the evidence published regarding safety or maternal-newborm outcomes of planned home birth. Rather, the goal was to discover areas of common ground among these diverse stakeholders, when considering the future of home birth in the United States. By addressing our shared responsibility, we were able to identify several important and relevant topics that may benefit from ongoing multidisciplinary engagement.

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To read more about the Home Birth Consensus Summit, visit the website. If you would like to contribute towards supporting the Summit's expenses (which exceeded the anticipated budget), click here.
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Monday, October 31, 2011

Pregnant pumpkin gives birth, nurses baby

Last year a pregnant pumpkin made a guest appearance on this blog.

I recently ran into her and asked how her labor went.

"Labor was intense but manageable," she told me. "I ignored contractions for as long as possible--I love being in denial! When I felt like I just couldn't take it any more, I got in the birth pool. It felt amazing.

"Soon I felt my body starting to push. It was like throwing up in reverse. There was nothing I could do to stop it. Pushing hurt more than I had expected, and at first I fought it. Of course that just made everything worse! But once I realized that I just had to go along for the ride, the baby moved lower and soon was crowning.

"Boy was that intense! I totally understand why it's called the ring of fire. You feel like you're going to split in half. But of course you don't!

"Right after the baby was born, I picked her up out of the water and pulled her to my chest. We snuggled skin-to-skin, which was indescribably sensual: warm silky baby on my bare chest, that newborn smell....mmmm...

"My baby nursed within the first hour and has been a happly little vampire baby, as we call her, ever since.

"She's now almost eight months old. I can't believe it's gone so quickly. She's already crawling and pulling herself up on furniture. I love nursing her, but I have to say those sharp teeth can hurt!"
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Sunday, October 30, 2011

iBirth review & giveaway

At the Lamaze conference last month, I learned about a new app called, appropriately, iBirth. I'm really excited to share more about it and to offer a giveaway for 5 lucky winners.
So what is iBirth? It's an Apple app with four main features (Android version in progress):

1) 26 short videos showing positions for early labor, active labor, back labor, and pushing. Each video is about 1 minute long and has a brief narration with the benefits of that position. I love this part of the app; with a touch of a button, you can see a woman leaning over the back of the bed in early labor, doing a "labor hula" with her hips, and pushing on hands & knees. Three of the videos show mild, moderate, and intense vocalizations, familiarizing women with the normal sounds of labor. These short clips were filmed professionally in a birth center setting that is neutral enough to appeal to women planning both hospital and home births.

You can watch a sample video here:


The creators of iBirth have also made a DVD of these 26 short clips. It's a great resource for childbirth educators, doulas, and midwives. And at only $30, it's a great price!

2. Contraction timer. With a large start/stop button, this timer automatically calculates length and spacing of contractions.

3. Prenatal nutrition guide. This is quite useful when you're meal planning or grocery shopping. It includes important nutrients for pregnancy and lists which foods contain those nutrients. For example, if you were looking to eat more calcium-rich foods, you'd touch "calcium" and find a long list of whole foods and how much of each to eat.

4. Tips & Lists: There are over 140 suggestions and tips to help women through labor. These range from affirmations to tips for long labors or back labor.

The iBirth app is currently on sale for $2.99 (normally $4.99). It's totally worth the money, in my opinion. My favorite part is the video library. For those people who just can't be without their gadgets, even in labor, this one would definitely be helpful!

To purchase the app, visit the iTunes store. The DVD is available at the iBirth website or on Amazon.

Now, for the fun part--a giveaway! I am offering one iBirth DVD ($30 value) and 4 free iBirth downloads ($4.99 value). If you do not have an Apple device, you will receive a free 9-month online registration to iBirth, which includes all of the features except the contraction timer.

How to enter:
  • Look at the iBirth website, then leave a comment about a) your favorite iBirth feature and b) which product you'd like to win (DVD or app). 
  • Be sure to leave your email or website so I can contact you.
  • One extra entry for sharing on your blog, website, Facebook, Twitter, etc. (new comment please)
  • Giveaway ends Friday, November 4th at 5 pm EST.
  • DVD for US residents only; iBirth app for anyone, anywhere! 
 
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Thursday, October 27, 2011

Caught in the act!

Raiding my tupperware drawer...
not to mention standing up by herself...
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Wednesday, October 26, 2011

Birth as Art

Last week, I briefly mentioned Brooklyn performance artist Marni Kotak, who was planning to give birth inside an art gallery-turned-birth space. I found a more detailed article about her art installation here at the Mail Online. The article includes several photos of Marni in her gallery, which was fitted out with a shower, birth tub, double bed, and kitchen. I had envisioned this large gallery that could hold hundreds of people, but the space is actually more intimate, with room for about 15 observers plus Marni and her birth team.
image source: http://www.dailymail.co.uk

Although giving birth in an art gallery in front of an audience might seem rather disconnected and exposed, Marni has been connecting with her future audience as they visit the gallery and chat with her:
About 20 people a day stop by to talk to Marni or see the free exhibit, which opened on October 8. Visitors can leave contact information if they want to return for the birth.

Marni said her audience 'won't be total strangers.' She said those who spend time talking to her about motherhood, birth and art and learning about the project will be notified when she goes into labor. If she's home at the time, she will go to the gallery.

'I'm developing an authentic relationship with these people,' she said. 'For me, it's like building a community of people who are really interested in this.'...

Jill McDermid, a curator and co-director of the performance art Grace Exhibition Space in Brooklyn, called Marni's work 'daring, challenging and honest.' She said people shouldn't be shocked.

'The audience is very limited. Marni views them as people she can trust, who are interested in her work and in her,' Ms McDermid said.
And just a few minutes ago, a notice came into my Google Reader: Kotak gave birth yesterday morning in her gallery to a baby boy. She will be adding a video of the birth to her installation.

Although my first reaction to the news of Kotak's performance art made me pause, I've been thinking about how it's not so much different from webcasting births (such as Dr. Nancy Salgueiro's recent livecast) or sharing birth videos on YouTube. I personally prefer to place a temporal break between giving birth and sharing the videos. I'm a really private laborer, but having a camera hasn't intruded on that privacy because I had control over when/if to share the footage.

Your thoughts?
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Saturday, October 22, 2011

Home Birth Summit

I just came home from the Home Birth Summit. It was 2 1/2 exhausting but rewarding days of dialogue, discussion, and consensus-building. I was thrilled to be in a room with all of the key stakeholders in home birth and to have honest, open conversations about such a normally divisive issue.

At the end of the Summit, we (meaning all 80 of us delegates) came to consensus on nine key points. We're waiting back for the written report, but in the meantime here are 8 of the 9 main topics. I am totally blanking on the ninth!:
  • Role that liability and (fear of) litigation play in increasing costs, decreasing access, restricting collaboration and narrowing women's childbearing choices
  • Importance of childbearing women's autonomy and shared decision-making
  • Linked data collection and sharing
  • Need for collaboration between providers and a system to enable safe, seamless & respectful transfers of care
  • Involving consumers in physician & midwife organizations 
  • Need to address midwifery licensure in all 50 states, including dialogue on CPM core competencies, working towards licensing DEMs (most likely CPMs, perhaps expanding CM credential) in all 50 states, & eliminating CNM practice barriers
  • Addressing inequalities in maternity care (access, affordability, outcomes, etc.), especially for poor, rural, & minority women
  • Valuing both physiological birth and the timely & appropriate use of evidence-based interventions
The English professor in me was wincing at times; when you're writing these kind of statements by committee, the language tends to get stilted and overly wordy...but I just had to take a few breaths and let that pass.

I was thrilled that we accomplished so much in so little time. What we did at the Summit was huge. For example, we had the president-elect of FIGO and the immediate past president of ACOG hammering things out with the president of MANA and an epidemiology professor and a malpractice insurer and a direct-entry midwife. (Remember, of course, that all stakeholders attended on their own, not as representatives of their organizations.)

And of course, we had some fun along with all of our work. We had a running joke going about the disappearance of pubic hair in obstetrics (one of those "you had to be there" moments). We also met last night to share birth stories. I showed the video of Inga's birth and I was so honored that such a mixed group got to see and talk about it.

One of my favorite activities was when each stakeholder group created a Proud/Sorry list: 3 things they were proud of and 3 things they were sorry for. Jill of The Unnecesarean and I immediately turned to each other and said, "We are sorry for fanning the flames of divisiveness through anti-OB and anti-hospital rhetoric." That became #1 on our Sorry list.

Over the years I've been blogging, I've matured a lot in my rhetoric and understanding of birth and breastfeeding. I find myself more willing to embrace other viewpoints, less strident in my advocacy for home birth or natural birth (although I still feel passionately about it), and more eager to engage in true dialogue with those groups typically cast as the enemy. Repeat after me: Doctors are not the enemy. Hospitals are not the enemy. (If anyone or anything is--and I think almost everyone at the Summit would agree--it is our malpractice/litigation system.)

The OB group's Proud/Sorry list--which stretched far beyond three items in both categories--was particularly touching. It's too bad we don't have more opportunities for this kind of sharing and conversation. I think we'd find we have so many common goals and that the stereotypes just don't hold up.

I better stop now before I start singing Kumbaya and getting all touchy-feely on you.
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Wednesday, October 19, 2011

Home Birth Summit!

I'm heading off to the Home Birth Summit early tomorrow morning. I am so excited to participate! There are about 80 delegates attending (click on their names for bios), some of whom I know in person and others I know through reading their books or articles. I can't wait to meet Lauren Plante or Mark Sloan, author of Birth Day.

If you aren't attending but would like to contribute, you can do the following:

1. Share your thoughts here

2. Help cover my registration costs by purchasing a sling or advertising on my blog. I have a current 3-for-1 advertising promotion where you can purchase 3 months for the price of 1, or 1 month at 67% off! The Summit received grant money to cover some travel expenses, but I still have to pay for registration and housing (~$600) on my own. Finances are tight right now and I almost didn't go. But I just couldn't pass up on such an important event.

I might not be able to offer matching ceramic yoni charm bracelets, but I'll definitely give you a virtual home birth hug-fest.
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How low can you go?


I've been playing chicken with my thermostat. Right now our house is a frigid 51 degrees Fahrenheit (10 degrees Celsius). I am wearing two layers on my feet and three on my body, plus a hot rice sock around my neck. It's way too cold for me.

Normally I'm not so hard-core with my house temperatures, but we are currently replacing our boiler. Our old one was a behemoth that was operating at 40-50% efficiency at best. Our new boiler--to be finished tomorrow--will run at 95% efficiency. We have a big house, and I wanted the highest possible heat savings.

Only one more cold night. I bet we'll be in the 40s inside before our heat comes on tomorrow. Brrrr....

How low can you go in the winter?
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Monday, October 17, 2011

Birth at 90 mph

A new birth story just showed up in my Google reader, even though it was posted back in February when I was waiting...and waiting...for Inga to be born. It's an amazing story of a baby born on the freeway on the way to the birth center. But unlike most car birth stories, the parents weren't freaking out. Instead, here's what happened:
Davey got me in the car and thank God he had the brains to grab a blanket as we ran out the door. He threw it in the back and we raced towards the freeway. As we flew down the street I started to feel a serious adrenaline rush. And as we merged onto the freeway, I started to feel something even more serious.....the urge to push. We made it about 4 exits until I knew that we weren't going to make it. [The birth center was an hour drive away.] The urge to push turned into the necessity to push and I told Davey, "I have to push!! I'm taking my boots and pants off! Seriously! I need to push now!! Pull over! Pull over!" He started to pull off the freeway and called Lori [the midwife] and told her what was going on. She said not to pull over until we had a head out. So he turned right back around and we were back on the freeway.

Four minutes down the road, on a dark, quiet stretch of freeway, on a rainy night, in the middle of the hills of Lake Elsinore, our baby was born. I reached down and with one, big push felt the babies head moving down towards my hands. And with the next push his head was in my hands and I cupped my hands softly around his neck to make sure there was no cord and also to steady his body as I pushed the rest of him out. He slid out like silk and I turned him toward me and lay him on my belly. He was perfection. Davey was hollering, "YAH!!! WHOOHOO!! You did it baby! You did it!" And the loud, strong cry of our newborn filled the car. He was instantly pink, instantly breathing, and instantly loved and adored. I raised his little leg and exclaimed, "It's a BOY!!!" And Davey and I just smiled and laughed and it was an awesome moment.

Davey pulled over and ran to the back of the car to grab the blanket. He wrapped our son in it and got back in and we quickly proceeded to the birth center. The whole car ride there was like we both were on an emotional high. There was SO much happiness and excitement in that car. I held him tightly in my arms and just gazed at him in amazement and Davey and I couldn't stop rejoicing.
Doesn't that make you want to have a baby all over again?

Read the rest of the story here
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