Autonomy, beneficence, and non-maleficance

Big words, big issues, and a fantastic post at Birth Sense putting them all together. The blogger at Birth Sense summarized Dr. Andrew Kotaska's recent presentation at the annual ACNM meeting. Dr. Kotaska helped author the new SOGC breech guidelines and is a passionate advocate of maternal autonomy and true informed consent (i.e., informed consent + the ability to make real choices).

Some excerpts from his presentation, via Birth Sense:

Dr. Kotaska posed the question, how does a physician or midwife stay with a patient when she declines your recommendations? ...

Dr. Kotaska argues that we need to promote the policies that systems like those Britain and Ontario, Canada have adopted. The Royal College of Midwives' policy is "If a woman rejects your advice, you must continue to give the best care you possibly can, seeking support from other members of the health care team as necessary." Midwives in these areas do not have to remove themselves from their patients’ care (effectively abandoning them), but are expected to continue to support and care for the woman even if she refuses to follow the midwife’s advice.

Dr. Kotaska urges providers to "explicitly state your commitment to her [the woman's] autonomy over your idea of beneficence." He emphasizes that each provider should embrace these three points:

• Your job, as a provider, is to inform your patient
• She is free to decline your recommendations
• She will not lose your support if she declines your recommendation

What is the result of a provider maintaining this type of attitude with their patient? Dr. Kotaska asserts that women trust these providers because they have not threatened the therapeutic alliance. He also stated that "informed consent" is not truly an informed consent if the woman will not be supported in her choices. For example, giving a woman informed consent about the risks and benefits of a trial of labor after cesarean, while telling her that your hospital does not allow VBACs, is not truly giving her an informed consent because she has only one option.

When asked how a woman should respond when she is refused a trial of labor, Dr. Kotaska replied that a woman should create her own "informed consent" form that she asks the provider to sign. It should state that:

• she does not want a repeat cesarean section
• she is aware of the potential risks of a repeat c-section, including placenta accreta, hemorrhage, increased risk of stillbirth, infection, increased risk of maternal death, and four-fold increases in neonatal respiratory distress
• she is not being offered a choice of how she will give birth
• if she experiences any complications as a result of being forced to have a c-section, she will be pursuing legal action against the provider who would not support her in a trial of labor.

With this proposal, Dr. Kotaska received a standing ovation from the midwives attending his presentation. What was clear to me is that midwives and mothers are fed up with the status quo in modern obstetric care today, and if change will only happen through women creating an informed consent form they ask their provider to sign, so be it. It’s time for a birth revolution, and it has to start with midwives, mothers, and a few progressive physicians who are not afraid to challenge the status quo.

Read the rest here.

Breech workshop in the UK

For my blog readers across the pond, there is a Breech Workshop with Mary Cronk and Joy Horner in Totnes, Devon on September 24th.Wish I could join in the fun!

Special discount for upright breech workshop

We are offering a special discount for non-medical professionals* as part of the Vaginal Breech Skills Workshop. For just $100, you can attend Betty-Anne Daviss' day-long session on upright breech birth. Her workshop takes place on Sunday, July 17th from 8 am - 5 pm at Butler University in Indianapolis.

The workshop will use a combination of lecture, discussion, videos, handouts, demonstrations on doll and pelvis and mannequin, and hands-on acting out of vaginal breech maneuvers. At the end of the session, participants should be able to:

• Describe why in the past breech birth practitioners delivering vaginally reverted to having the mother on her back.
• Discuss and critique the Hannah Term Breech Trial, its impact on breech birth, and subsequent research on vaginal breech birth
• Release one’s fear of vaginal breech birth through an understanding of why the RCT was not the absolute answer to calculating the risks of cesarean vs. vaginal birth, observational research is a respectable form of research and such European research demonstrates both safety and new answers to old questions about how to conduct vaginal breech birth.
• Develop trust and respect for the ability of the mother and baby to negotiate the baby’s descent after the practitioner has watched videos of babies literally fall out of the mother in the hands and knees position.
• Describe why the vaginal breech birth in the upright and hands and knees position is more physiologically sound than requiring the mother to be on her back. Demonstrate the cardinal movements of the vaginal breech birth.
• Demonstrate the skills of receiving the breech and trouble-shooting impediments to the descent of the breech, including what not to do.
• Identify when breech birth becomes dangerous—whether by cesarean or vaginally.
• Understand the future of vaginal breech birth and how it can be preserved

If you can't attend the day-long workshop, please mark your calenders for Betty-Anne's free public lecture on upright breech birth on Saturday, July 16th at 7 pm.


* I.e., anyone who is NOT a nurse, midwife, or physician. Doulas, childbirth educators, & lactation consultants are eligible for the discount.

U-Suck

Our big move is on Saturday (hence the blog silence) and I am beyond frustrated with U-Haul. They were the only company with a rental office in town, so I reserved a truck with them. I just got a call today that they have no trucks available--despite my having reserved one. I now have to drive to another location to pick up and return the truck. It's going to cost a bundle to pay for the gas, not to mention the three hours of additional driving time on an already busy day.

I was not very friendly with the customer service person. I did not say oh thank you for not fulfilling your part of the contract. Oh thank you for making me drive way out of town to pick up my "in-town" truck.

U-Haul, U-Suck.

Home renovations with small children

We move into our new house next Saturday. We had planned on just moving in, but then we thought...while the house is empty, why don't we refinish the wood floors? The first floor is 1800 square feet. About 1/3 of that space (kitchen & dining room) needed a full sand down to bare wood. The rest (living room, entry hall, library, and half bathroom) needed just a buff & recoat.

With three small children, doing home renovations isn't easy. With the help of friends to watch the older two and a very cooperative baby (floor sanders are the BEST white noise machines ever!), we were able to keep up a decent pace. We even had a few sleepovers in our empty house so that we could both work at night while the children slept.

We pulled out the old carpet in the dining room. The floors underneath had the original shellac and were in decent condition. There was one section with old termite damage that had been patched up with plywood. We tore that out, repaired and reinforced the subfloor, and laid new flooring. In the picture below, you can see the patch on the left and the first pass with the floor sander to the right.

After going over the floors once with the drum sander & edger, they looked like this.

Who would ever paint a room the exact color of baby poop? Ugh. I'm definitely changing the color ASAP.

We did a total of four passes with the drum sander (50-60-60-100 grits). Usually it would take less, but there were a lot of uneven areas. We then did two passes with a buffer using 80 & 180 grit sanding screens. Finally, we hand-sanded and scraped in the corners and edges as needed.

Yesterday we buffed the entire main floor, vacuumed, and laid the first coat of polyurethane. For this, we had to tag-team since we couldn't have any children underfoot. Eric did the first two tasks and I applied the poly. It was messy, stinky work and I had to wear a respirator. But the floors look wonderful. We'll lay two more coats of polyurethane tomorrow and Tuesday, buffing between coats.

Random man talks homebirth & homeschool

Remember Random Man? Well, we ended up hiring him to make storm windows for our new house (the old-fashioned wood kind with a modern twist--they have interchangeable glass & screen panels that you can change from the inside, so you don't have to carry the storms up & down a ladder twice a year). We signed the contract today and...guess what...

All five of his children were born at home.

And he homeschooled all his children.

He held Inga while we talked windows and home birth and home school. And things like how much did our children weigh when they were born (his smallest was a hair under 10 lbs, and the largest was something like 11!). His wife runs the local homeschooling association, so he said he'd put me in touch with her. (For the record, I have no idea if I will homeschool or public school; I'm keeping both options open at this point.)

He also showed me a very awesome tool, a Rockwell Sonicrafter. How did we ever survive without it?

The wedding

My older sister, the oldest of us five children, got married last weekend in Washington, DC. We had a great time seeing relatives and of course seeing my sister so happy to finally be joined with her husband.

The Spencer sisters & their spouses, plus my little brother (the bearded "mountain man" on the right)

My family

Lots of sling wearing. The wedding slings were made of a pink & green iridescent silk dupioni

 

I love this one of Zari

Dio & my mom

Candid camera

 

 

3 surveys--please participate!

I've received word from several researchers wanting people to complete surveys. If you are eligible, please participate!

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Survey #1: Baby Food Survey

This is a research study about infant feeding practices. This study is conducted by Amy Bentley, Ph.D.,Department of Nutrition, Food Studies and Public Health, Steinhardt School of Culture, Education and Human Development, New York University.

Who can participate: anyone who has had one or more children. This asks questions about how and when you introduced your baby to solid foods.

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Survey #2: Coping and the Unplanned Cesarean Section: Examining how women cope with the need for an unplanned cesarean section

More about the survey from the researcher Nedra Goldman:

My name is Nedra Goldman and I am a graduate student at DePaul University. I am currently conducting a research project titled “Coping and the Unplanned Cesarean Section: Examining how women cope with the need for an unplanned cesarean section” as a requirement to obtain my Master’s Degree. The purposes of this study are to examine the coping mechanisms/strategies utilized by women age 21-39 during the labor and delivery process when an unplanned cesarean section is indicated and to describe the self-efficacy of the women. I am seeking out women who are willing to participate in my study. Inclusion criteria for this study include a) women, b) who were between the ages of 21-39 when they delivered, c) had emergency cesarean section, d)normal pregnancy, e) speak and understand English sufficiently enough to complete survey. If you or someone you know meet these requirements and are willing to participate in my study please click on the link below which will lead you to an information sheet and the study. There is no need to respond directly to this email if you are interested.

For privacy and confidentiality purposes no identifying information such as name, address, or insurance information will be collected, I will be the only person who has access to the survey responses for analysis purposes, and all responses will be coded.

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Survey #3: Parenting Perceptions & Attitudes About Mothering

More about the survey from researcher Miriam Liss, PhD, Associate Professor of Psychology at the University of Mary Washington:

I am researching attitudes about mothering with some of my colleagues at the University of Mary Washington and our students. We are collecting data from people over the age of 18. We are looking for parents and non-parents but are especially interested in the views of attachment parents.

2 months old and off to her first wedding

Inga is nestled in the corner of my chair, drifting off to sleep. We're leaving tomorrow morning for my older sister's wedding in Washington D.C. Zari is super excited to wear her new "wedding dress," as she calls it. She and Inga and all of her girl cousins have matching dresses--cute ones that you can actually wear in places besides a wedding.

Inga is such a fun, smiley, zen baby. She does fuss occasionally, but as long as she's tended to (either nursed, diaper changed, played with, or put down for a nap) she's really content. Her latest fascination is staring at the ceiling fan as it turns around. She also loves being talked to. If you take your eyes off her, she gets upset and starts squawking. But as soon as you face her again and start talking (or cooing, or making random noises) she smiles and babbles right back. She stores most of her fat on her chin and cheeks. So cute! Her new hair is growing in, and I'm curious to see what color it will be. Her original hair is a reddish auburn. Like my other children, she has a widow's peak, but hers is off-center. I love these little quirks of genetics.

I hope my poison ivy rash calms down. It's all over my arms, ankles, backs of my knees, on my neck, behind my ear, and even on both breasts. Believe me, I definitely did not garden in the nude--I had long pants on, in fact--so don't ask me how poison ivy got there. Itchy itchy itchy...

Oh, and what would a wedding be without wedding slings? All of the bridesmaids with babies (which is 4 of us) have matching silk dupioni slings. I made three and my youngest sister made the fourth. Pictures coming when I get back home!

Off to get both of us to bed. I'm so excited for this weekend!