Happy 3rd birthday Dio!

Dio turned 3 a few days ago. We just had his party today.

working on it...

3 years old!

He requested a dinosaur cake. I wasn't about to attempt anything like this, so we compromised on a dinosaur egg. We decided that blue with purple dots was a great color scheme.

Even better, the inside was a blue ombre cake. Why not make it fun? (Desiree, I blame you for the inspiration!)

Ever since he was a newborn, Dio has had an intense personality. This goes for his happy moods as well as his cranky ones. He has an instant on/off switch, and we never know when he's going to flip from silly giggles into shrieks. As much as the intensity is challenging at times, he can be quite delightful to be around.

His language skills are quite developed now; I love hearing him verbalize his thoughts and observations. And he has the most endearing franglais. When he's trying to speak French, he usually starts out in English and then ends the sentence in French. It takes him a few words to get warmed up.

He's been full potty trained since he was 2 1/2, but he can now go pee all by himself. It's so nice not to have to help him every time! I still haven't switched him over from a crib into a regular bed. We've tried taking him out of his crib, but he's much harder to get down for naps (or to stay put in the middle of the night) when he can "escape." So for now, we're sticking with the crib. Zari hardly ever slept in a crib, except for naps or to start out at night before we came in. Then she went directly onto a twin mattress on the floor.

I think Dio's nursing days are coming to a close. I nurse him just once every 2-3 days. His latch is getting worse and worse, and he's hardly getting any milk out. We're going to be in France this summer, so I might have a nursing party for him like I did for Zari. He still really likes the comfort of nursing, though, and I worry about arbitrarily ending it too soon. I love how he says, "I want to nurse you, mama."

Happy 3rd birthday, Dio. We're so glad to have you in our family!

photo by Zari

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Menstrual cups

My period just came back last week, 13.5 months after Inga was born. (Thank you breastfeeding!) It's funny to say, but I was actually excited for it to return. I've been wanting to try reusable menstrual products ever since I was pregnant with Zari. Now I finally had the chance!

Diva Cup

I thought about trying cloth pads, but I wanted something even easier to (re)use. I wanted something that would work night and day, with a heavy or light flow, whether I was running or swimming or lying still. I wanted something I wouldn't have to think about. I wanted something that wouldn't leak. The obvious choice soon became a menstrual cup. These are soft silicone or rubber cups that sit inside the opening of the vagina, forming a seal and collecting menstrual fluids.

A few months ago, I obtained a Diva Cup from my nurse-midwife's office boutique. I was a bit apprehensive of using it, after a very unpleasant experience with a disposable Instead Softcup in college (who knows if I inserted it right, and it cause such horrific cramps that I never tried one again). But after I saw this video last week (thanks to Sazz for the link), I decided to give it a go.



Learning curve
I've heard people say that it can take a few cycles to get used to menstrual cups, but honestly, I got used to mine in about 30 seconds. I watched the video and did exactly as it recommended: fold, insert, and twist. Super easy. The cup doesn't go way up high like a tampon, just high enough to get the entire thing inside with the bottom of the cup near the vaginal opening.

Insertion
Inserting the cup took slightly more effort than inserting a tampon, but it was still pretty easy to do. I remember back to my teenage years when I first tried to figure out tampons...it was not fun and took so many tries before I figured it out! In comparison, using a menstrual cup was a cinch. Of course it helps to have many years of tampon wearing and fertility awareness under my belt :)

One tip: cut the stem off all the way. You definitely don't need it. 

How often to empty
Menstrual cup manufacturers advertise that you can go up to 12 hours before emptying the cup. I found that to be absolutely true. Even during my heaviest flow, the cup was only one-third full after 12  hours.

Emptying the cup is easy: pinch the bottom and pull the cup out. Empty the contents into the toilet and wash the cup with soap and water and reinsert. If you're in a public restroom (not likely, since you only need to change it once in the morning and once at night), you could clean it with packaged alcohol wipes.

Leak protection
The most amazing thing about using a menstrual cup was that I did not have a single leak, ever. Can I say how amazing that is? Even with using tampons AND pads for backup, I always had leaks during my period. Plus tampons tended to fall out during exercise--no fun when you're in the middle of a run. But my Diva Cup stayed in place all day long, every day. Honestly, I forgot I was even having my period. It worked that well.

Disadvantages
The only possible downside of a menstrual cup is that you have to remove it to have vaginal sex...but of course, the same goes for wearing tampons.

Worth the Investment?
YES! Menstrual cups cost between $20-40, depending on the brand and can last for 10+ years. They'll pay for themselves after just a few cycles.

I wish I had known about menstrual cups years ago. I think of all the money I spent on disposable products that still didn't work that well anyway. I don't have to spend another penny for at least 10 years. I never have to worry about leaks again, and best of all, I only have to change it once in the morning and once at night.

Some brands of menstrual cups:

• Diva Cup (made in Canada, sold in North America)
• Mooncup (UK)
• Instead (US) This comes in disposable or short-use (1 cycle) versions only  
• Lunette (made in Finland)
• Juju (made in Australia)
• Miacup (made in South Africa)
• MeLuna (made in Germany of TPE, thermoplastic elastomer)
• The Keeper (rubber) and the Moon Cup (silicone)

Disclaimer: You'll notice that Diva Cup is one of my sponsors--and I'm proud to have them be part of Stand and Deliver! However, I obtained my Diva Cup on my own; this review was not sponsored by Diva Cup.
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Double Trouble

I usually only nurse one at a time...but sometimes I can't resist doubling up.

Photo by Zari
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Home birth regulations around the world

Midwives across the United States face arrest or imprisonment if they practice in a state that does not recognize their certification, such as this Indiana CPM Ireena Keeslar who was arrested and released on $10,000 bail. Keeslar serves a large Amish population in her county and, ironically, can practice legally just over the border in Michigan.

In Ontario, Canada, midwives and consumers have been calling for birth centers; currently the province's midwives can only attend home or hospitals births. The neighboring province of Quebec has a long, successful history of birth centers with 11 currently in operation. But since Ontario began regulating midwifery in 1994, it has only offered women the choice of home or hospital birth. Just a few weeks ago, Premier Dalton McGuinty announced a $6 million pilot program of 2 birth centers in Ontario. The locations are yet to be determined; one will likely be in Toronto.

If you thought having a home birth was difficult in Canada (where in some provinces you have to book a midwife the minute you take a pregnancy test) or in the US (where midwives practice "under the table" in several states), Israel is taking home birth regulations to a new level. Last December, the Israel health ministry drafted new rules regulating home birth. Some of the proposed restrictions include:

• The mother must obtain a "letter from her family doctor testifying that she is both physically and mentally sound"
• The home can be no more than 30 minutes from the hospital
• The room where the birth will take place must be at least 10 square meters (108 sq ft)
• Birth attendants must recertify in neonatal resuscitation every year, rather than every 2 years
• Maternal temperature cannot go above 37.8 degrees Celsius
• Active labor must begin within 6 hours of the water breaking
• The placenta must be born within an hour
• The attendant must return to reexamine with woman 24 hours after the birth

The proposed regulations are a round-about way of further restricting, if not stopping, home birth. A few of these (more frequent NNR certification, 24-hour postpartum visit) may be reasonable, but most place onerous burdens upon woman seeking home births. After public criticism of these guidelines, the Israel health ministry delayed their implementation and organized meetings with stakeholder groups, including home birth midwives.

In the UK, the BBC series Call the Midwife, about midwifery in 1950s London, has sparked renewed interest in caseload community midwifery. Annie Francis, programme director of Neighborhood Midwives, describes what caseload midwifery looks like:

Once they've booked with us, we'll guarantee that they'll be seen by a midwife they know, whether it's in their home or in a clinic, every single time they need to see a professional during their pregnancy, birth and afterwards. If their needs change and they need to see an obstetrician, we'll go with them. If they end up needing a caesarean section, we'll still be there by their side.

We're expecting that between 80 and 90% of our clients will give birth at home – and that's compared with a national home birth rate of around 2% [in England], although studies show that many more women would like home births than are currently given the chance to have one.

In the Czech Republic, the Prague Municipal Court ruled that hospitals must provide home birth services to women who desire them. "[R]eferring to a recent ruling of the European Court of Human Rights in a similar case in Hungary, the judge said women indeed have the right to choose the place where they give birth to their children. The court also said that the woman was entitled to all necessary assistance from the hospital because the state had so far denied the registration of private midwives who would otherwise do the job." More articles on the topic here and here and here.

In Australia, Professor Euan Wallace, director of obstetrics at Southern Health, has called for more publicly funded home birth programs.

A South Asian study found that using delivery kits and associated clean delivery practices improved infant survival for babies born at home in "rural areas with limited access to healthcare." The kits include soap, a sterilized blade for cutting the cord, clean string for tying the cord, and a plastic sheet.

Finally, in Liberia, President Ellen Johnson Sirleaf "has given a strict mandate that no woman should give birth at home, as has traditionally been the case." Health officers commented that in order to make the mandate effective, the country must build more maternity centers, especially in remote areas.

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Talking to your kids about sex

Have you had The Talk with your children yet? It's supposed to happen some time in early grade school, before their peers have time to (mis)inform them about what sex is all about. Having The Talk is a ritual many of us go through, first as children and then as parents. I still remember my parents sitting us down. I don't remember much of the details, although some kind of illustrated book was involved.

But what if you never had to give The Big Talk? Here at the Freeze household, reproduction is a matter-of-fact part of everyday discussions. I don't think I'll ever need to officially sit my children down and explain the facts of life, because they will already know them from numerous conversations.

Here's an example of a conversation between me and the kids while I was driving to visit my younger sister, who's pregnant with her second and due this summer:

Dio: Is aunt B going to have another baby? (in a super excited voice)

Me: Yes, she has another baby inside her belly.

Dio: And is the baby going to crack open?! (probably thinking of how he pretends to be a dinosaur egg after baths and cracks open out of his towel)

Me: No, the baby won't crack open out of her belly! Remember, the baby is born out of a special hole called a vagina.

Zari: I know that! (in a know-it-all voice)

Dio: And can I be pregnant and have a baby?

Me: No, only mamas can get pregnant and have babies. But papas can help the mamas get pregnant. (Zari and I have talked about this on other occasions, and I've briefly explained the basics of sex and fertilization.)

Dio: Oh.

Me: And did you know that when the baby is inside the mama's belly, it lives inside a special muscle called a uterus. It's like a balloon and stretches bigger and bigger when the baby grows.

Dio: Oh.

Me: And when the baby is ready to be born, the uterus squeezes really tight and helps push the baby out.

Dio: Oh.

Me: And did you know that when the baby is inside the uterus, it lives inside a bag of salty water? It's like being inside of a swimming pool! The baby swims around, kicks, and splashes. When you and Zari and Inga were babies, you swam inside this salty water the whole time you were in my belly. This salty water is called amniotic fluid.

Dio: Why is the baby in the water?

Me: Because it doesn't need to breathe inside its mama's belly. The baby has an umbilical cord attached to the placenta, so it doesn't breathe air until it is born. 

Dio: Oh.

Me: And guess what? When the baby is ready to be born and the uterus is squeezing really tight, sometimes the bag of water breaks and splashes all over!

Dio and Zari: Hahahaha!

How do you talk to your kids about sex?
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An OB talks about what it's like to be an OB

I've had this in my "draft" folder for several months now and thought I'd finally hit "publish"!

Don't you love it when you find a new blog to follow? Some new favorites are Mothers in Medicine and Ob/Gyn Kenobi? In this post called Ob/gyns are terrible people who deserve to die, and other misconceptions, Ob/Gyn Kenobi talks about what it's like to be an OB, a female, and a mother. And most importantly, a human being who needs to sleep and eat occasionally.

An excerpt:

It's the malpractice, multi-million dollar coverage premiums to pay yearly, the threat of lawsuits for up to 18 years after the fact, shrinking reimbursement (universal for all physicians), trying to pay our staff and our overhead, having to fit more patients into the same hours in the day, trying to be a good doctor for them, trying to at least support our family since we can seldom be there to see them. It's medicine, surgery, primary care, and caring for two patients all rolled into one, and sometimes it eats at your humanity. Sometimes, you come home at the end of the day so emotionally exhausted that you have little to give to the rest of your family. Sometimes the sadness of discussing a cancer diagnosis, or miscarriage, or fetal death lasts for weeks or days. Sometimes it is impossible to *not* take your work home with you. Sometimes we care *too* much, causing us to start separating ourselves from our patients, building a wall, becoming callous, so the better to protect ourselves.

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Turn a women's sundress into a child's dress

I bought this knee-length halter-top sundress at a thrift store for 10 cents. It would have made a lovely swimsuit coverup, but it was one size too small...so out came the scissors and pins.

This was a really simple retrofit for my 5-year-old. I took in the sides first. Then I marked new armholes (using the highly sophisticated "eyeballing it" method), keeping the original back and zipper. I removed the grosgrain ribbon binding from one of the neck ties and used it to bind the new armholes and neckline. Finally, I used the other tie to make the two shoulder straps.

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Happy Easter!

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DIY laundry sorting surface

We have a lovely, light-filled 2nd floor laundry room in what used to be the maid's bedroom. (Okay, I might have made that last part up; I don't know for sure if the original owners had a maid in 1900, but if they did she would have slept in that room.) I was tired of carrying piles of laundry into my bedroom and using my bed, or my floor, as a folding surface. Piles of laundry + little kids = let's pretend we're climbing a mountain!

I browsed on Craigslist for a used countertop, table, or marble slab, but I didn't find anything even remotely close. It needed to be 6 or 7 feet long, and I didn't want to pay a lot of money. I finally gave up and decided there had to be something we already had on hand that I could use.

I headed down into the basement and found an old interior door. I had marked several ingenious uses for old doors on Pinterest, from garden arbor supports to china hutch doors. I knew I could make this door work.

The bottom few inches were rotted, but it was the perfect size for the room. When I trimmed the rotted areas away, it was exactly long enough to fit from wall to wall. I cut out a corner to fit around a chimney. I also made the door high enough to accommodate my rolling triple laundry sorter. Once the heating season begins, I'll staple reflective foil behind and above the radiator to make sure the heat reflects into the room.

I got the entire thing done, from thinking "I really need a laundry folding surface!" to varnishing the installed door, in one day. And didn't cost anything! Perfect. I love re-purposing an original item from the house and giving it an unexpected second life.

This is what it looks like most days....

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Don't punish mothers

I just finished reading The Scalpel and the Silver Bear, the story of the first Navajo woman surgeon. In her book, Lori Alvord describes how she integrated her Navajo spiritual beliefs into her surgical practice. One incident really challenged her determination to treat all her patients with respect, dignity, and cultural sensitivity: A young girl came into her hospital in extreme pain. Every symptom pointed to acute appendicitis. But the girl's grandmother, the key decision-maker in the family and in Navajo culture, refused. Dr. Alvord describes her feelings at that moment:

I could see both sides of the story. One side--the trained medical practitioner, who fathoms the body's mysteries as a detective directs a beam of light into a dark room to look for clues about the source of physical disharmony--said, Roll her into the OR now! But the Navajo part of me, who had once been a little girl, could see the inappropriateness of interfering. Navajo eyes warned: The beauty of the body would be disturbed. A surgical knife would defile an intact, miniature universe, with rules and systems that evolved naturally over millennia. I could see the sacredness of that body, how all its many parts are one harmonic system.

She knew that this grandmother's fear of white, western medicine went back to the grandmother's firsthand experience witnessing Navajo children being forced into white boarding schools, back (only a few decades) to when the Bill of Rights and religious freedom did not apply to Native Americans, back even farther into the strong cultural memory of the Long Walk of 1863 that displaced and killed thousands of Navajos.

While Dr. Alvord was trying to find a way to meet this grandmother on her own ground and persuade--but not force--her to consent to the girl's surgery, the pressure was rising. Hospital social workers were seeking a legal court order to override the family's opposition. Even though this would save the girl's life, Dr. Alvord wanted to find a way to preserve the family's dignity and autonomy. She decided to give the grandmother control. "I told Bernice that the decision was hers to make. It was something I had begun to tell patients more and more, a show of respect that I believed would be empowering; that they alone, not the doctors or anyone else, control the fate of their bodies," she writes. More relatives arrives, more time passed, and the court order was closer to completion. "Although the court order might save the girl's life, it could also be a cultural disaster, and it would make a liar and an enemy of me."

At the end of the day--the girl still sick, the hospital staff in suspense, the grandmother still unrelenting--Dr. Alvord had a quiet conversation with the girl's father, letting him know that the decision was still his, but that it needed to be made soon before it was too late. Soon after, word came via her pager that the consent forms were signed. She rushed in and removed the infected appendix.

This small drama illuminates a larger truth about meeting patients on their terms, not the provider's or the hospital's. Women who wish to give birth outside the norm--whether an unmedicated hospital birth with intermittent monitoring and no IV access, a planned home birth, or a vaginal breech birth--often face ridicule, hostility, and threats of punishment. These tensions are particularly strong during hospital transfers or when a woman actively disagrees with her care provider about her plan of care.

Earlier this year, Australian Medical Association WA president proposed criminal penalties for mothers who have high-risk home births. "We're talking about when people choose to proceed with a homebirth when it's clear that there is an extreme danger to the baby and particularly when that's encouraged by people who should know better," Dr. Dave Mountain said. Michelle Mears, spokeswoman for Homebirth Australia, remarked, "To suggest that traumatised women who are refugees from obstetric medical care and their care providers should be charged with a crime is a proposal to move back to the dark ages." In February, the Attorney General struck down that proposal, so homebirth related deaths will not be part of the proposed fetal homicide laws in WA. But this will not erase tensions over women's childbirth choices.

I understand why some hospital staff might struggle to understand women's desire for a home birth (or a vaginal breech birth, or even an unmedicated birth). But this doesn't negate the very real fears, desires, and values that women bring to their births. Punishing women for insisting that their own values and wishes are important is the wrong approach. It will only further the divide between home and hospital advocates and push home birth women and midwives deeper underground, deeper into riskier territories. Meeting women where they stand, respecting their values and beliefs, and always upholding their autonomy--these actions are what are when obstetric conflict arises. Not punishment or threats.

A surgeon will see a necessary appendectomy as a no-brainer: Do the surgery and live. Don't do it and die. Likewise, for some people, a cesarean section is a minor event and causes little heartache. It might even be seen as preferable to a "bloody, messy" vaginal birth. But to others, a cesarean section means a devastating loss of bodily integrity, weeks or months of debilitating pain, and a feeling of failure or incompleteness as a mother. The solution isn't to legislate one of these worldviews and ban the other. The solution is to respect patients' wishes and values, to treat them with dignity, and to uphold their autonomy. When Dr. Alvord did this with the little girl and her family, she acted as a true healer, not just as a physician.

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