Some fun ads

This ad made me laugh. There are quite a few in the "First Kid, Second Kid" series, all quite clever.



For the record I cloth diaper 95% of the time. I use generic store-brand disposables when we're traveling.

I saw this ad for RONA tools when I was in Canada this summer. I love anything to do with power tools. The last two I bought were:

• Rockwell Sonicrafter
• 1/2" dual speed Milwaukee hammer drill

What are some of your favorite ads?

Who has the right to speak for the baby?

Please welcome guest blogger Roanna Rosewood! I met her at the Human Rights in Childbirth Conference in the Netherlands. She spoke eloquently about her own experiences giving birth and about who has the right to speak for the baby. Below are her remarks from her presentation and letter to the conference. 

If you like Roanna's writing, keep an eye out for her upcoming book Cut, Stapled, and Mended: A Do-It-Yourself Birth. Forthcoming spring 2013.

I’ve been preparing for to the responsibility speak for my unborn baby since long before anyone else considered it. While my brother play-battled with swords, I sat next to my mother as she nursed, and I nursed my own “baby doll” imagining the day when the baby that I held in my arms would pulse sweet milk dreams and curl his toes around the touch of my fingertips as I rocked him.

Twenty some-odd years later, my belly as round as the moon, I could barely contain my excitement. “I love you.” I told him. I repeated it again and again, not out of doubt, but because I knew – even then, that I would fail him. I would make mistakes. “I love you” was the one thing that I could offer unconditionally. No matter what hardships he would face, he would never doubt my love.

Believing it was best, I willingly surrendered our bodies to the hospital. I was wrong. They coerced me into what I would later learn was an unnecessary cesarean.

I remember watching as they lifted him up over the operating curtain. I caught a glimpse of his black hair. I waited for them to hand him to me. They didn’t. They carried him away. He wailed loud, uncontrollable screams, one on top of the other. I wondered how he could breathe.

Every instinct in my body demanded that I get up and go to him, that I sooth him with the same simple words he had heard me repeat since his perfect ears had formed inside of me. I couldn’t. I was tied down. My womb was sitting outside of my body. There was vomit dripping down my cheek.

There was no reason for them to take him from me. My son was healthy. His distress was emotional, not physical. The doctors were so bloated with power that their routine more important than his well-being. While he screamed, they took his footprints, cleaned him, and measured him.

Why must a baby be measured at birth?

How much can he grow in an hour?

To them, the cesarean was routine. To us, it was everything. It cost fifteen-thousand dollars. I was forced to leave my newborn with others and returned to work early to make payments. Nightmares of being tied down and cut open that haunted my nights.  Where I used to rub and caress my belly with love, it is now cold and numb to the touch. Though it’s been twelve years, my eyes tear at the memory of failing my son. The sound of him screaming his first and simplest request of the world will forever echo through my body. I’ve tried to make it up to him. A million times I’ve told him that I love him. But there is no way to heal my son’s introduction to the world – his first breath, his first sight, and his first touch were filled with fear, pain, and disregard.

Pregnant again, the doctor I chose would have allowed a trial of labor but administration refused it. The decision was made by people who would never look into my eyes or see my baby’s entry to the world. Their business choices overruled both her medical expertise and my constitutional right to bodily integrity.

Why have others been given the power to deny me a basic bodily function? We are each of us, here right now, because a woman opened and bled for us so that we might live. The people and institutions managing birth have nothing to do with impregnating us. Our babies are a gift from something bigger, stronger, and more important than they are. The way that we choose to give birth is between us and the powers that entrusted us with this child.

I have deep respect and appreciation for birth professionals and the important work that they do in the world. But I would like to, not so humbly, remind everyone that women and babies are not products. We are consumers. Birth providers work for us. Their expertise in birth is no more important than our expertise in our bodies. Nobody can guarantee good outcomes. Medical errors continue to be a leading cause of death here and in other developed countries.

In spite of everyone’s best intentions, some mothers and babies will die surrounding childbirth. If there is a mistake to be made, let it be made by the one who has already proven her commitment to this child by willingly putting her very life on the line in choosing to give birth to him, let it be the one who will live with the resulting disability or death for the rest of her life. Let it be the one who will grieve and pray. Let it be the mother.

I was created to give life and speak for the interests of my baby. I cannot separate from it. It is who I am. It’s in the breadth of my hips that widened on their own volition to cradle them. It’s in the curve of my breasts, heavy with milk to sooth them. Every month, my womb aches in preparation to receive life because, as a woman, it is my responsibility, my honor, and my choice to bring new life into the world. I alone have earned the right to speak for my baby’s interests.

Midwife memoirs from the UK

I've discovered a bundle of recent UK midwife memoirs. I was reading retired midwife Sheen Byrom's reflections on the Human Rights in Childbirth Conference and noticed she'd written a memoir called Catching Babies. From there, I found several other midwife memoirs, none of which I had heard of before. Any others I've missed?

• Catching Babies: A Midwife's Tale by Sheen Byrom
• Tales of a Midwife by Maria Anderson
• Journal of a Student Midwife by Ellie Ryan
• Midwife on Call by Agnes Light
• Call the Midwife: A True Story of the East End in the 1950s by Jennifer Worth
• Farewell to the East End: The Last Days of the East End Midwives by Jennifer Worth
• Twelve Babies on a Bike: Diary of a Pupil Midwife by Dot May Dunn
• It Shouldn't Happen to a Midwife! by Jane Yeadon
• Bundles of Joy: Two Thousand Miracles. One Unstoppable Manchester Midwife by Linda Fairley (biography)
• The Midwife's Here!: The Enchanting True Story of One of Britain's Longest Serving Midwives by Linda Fairley (biography)

Human Rights in Childbirth: Panel 6

Panel 6:

Cases on the Edge: 
Controversial Birth Choices in the Netherlands

Panelists:

• Monique Severijns: mother, Netherlands
• Arie Franx: professors of obstetrics & gynecology, Netherlands
• Rebekka Visser: midwife, Netherlands
• Robert Kottenhagen: professor of law & ethics, Netherlands
• Wilma Duijst: forensic doctor and criminal law researcher, Netherlands
• Joke Meulmeester: Chairperson, VVAK, Netherlands
• Sandra Bruin (moderator): mother, Netherlands

The panel began with Monique Severijns telling the story of why she chose a (repeat) cesarean. From how she began her presentation, I expected this would be about choosing a primary elective cesarean with no medical indication. Instead, it was a story of a traumatic first birth that ended in cesarean and in her decision to choose a gentle, empowered cesarean the second time around. Her presentation spoke volumes about the normality of VBAC in the Netherlands, since she framed her choice as such a radical, controversial one in need of defending. Very different from the US, where most women in her situation a) would not see her choice as controversial at all and b) would not even have the choice not to have a repeat cesarean.

Next, Arie Franx spoke about controversies surrounding elective cesarean section (ECS) and "risky" home births. He noted that an OB who performs an ECS may be violating the Hippocratic Oath. He was the co-author of the 2011 Dutch obstetric guidelines, which noted that "term vaginal birth is a fact of nature and does not require consent." ECS is rare in the Netherlands; there were 69 performed in 2006 and 233 in 2011. Next, he addressed "risky" home births (twins, breeches, and VBAC). The Dutch maternity care system is based on a triage risk strategy, with 1st, 2nd, and 3rd lines of care based on the level of complication and complexity. The last of my notes reads, "He strongly disapproves of this." I think I was referring to his disapproval of "risky" home birth, but my notes aren't entirely clear.

Rebekka Visser, a Dutch midwife, explained why she attends breeches & VBACs at home. She gradually learned to respect and understand undisturbed birth. Over time, she started doing less and less during births. Now a primary interest of hers is understanding and promoting physiological birth. She argued that we shouldn't use the Dutch obstetric guidelines as the low or as a tool to coerce women. Rather, use them as a starting point for disucssion and keep care individualized. In her letter to the conference, she argued strongly that birth is a human rights issue and that "women themselves are the best advocates for their babies' interests. Period." During her time as a midwife, she has seen childbirth empower women, but she has also seen it inflict lifelong damage to a woman "if authority is taken away from her." 

Robert Kottenhagen, a law professor, addressed ethics & the legal status of the unborn. He noted that is most cases surrounding disagreements about home birth, "there is not a mother-fetus conflict at all, but a mother-doctor conflict." He examined the Dutch Civil code and the Abortion ACt of 1981 and concluded that under Dutch law, the unborn fetus does have some legal protection, but how far the fetus' rights may go when put into conflict with the mother's is unclear. Currently, "a doctor can act against the will of the mother to prevent severe damage or death of the unborn," according to the Royal Dutch Medical Association. However, these situations are fairly limited in scope. He concluded by noting that most often, there is not a mother-fetus conflict at all, but a mother-doctor conflict. "If the relationship between patient and doctor could be improved in such cases," he wrote in his letter to the conference, "the legal fight would probably be over."

Wilma Duijst, a forensic physician and law researcher, noted that her conclusions differ from Kottenhagen's. By law, a Dutch midwife cannot abandon a woman at home who refuses transfer or treatment. She advised against using coercion or threats on pregnant or laboring women.

Joke Meulmeester, who works at the Advice and Reporting Center for Child Abuse (AMK) and is chairperson of the VVAK (Association for Child Abuse Counselors), noted that controversial birth choices rarely initiate investigations within her agency. She can think of only 1 case in his agency's history. In her letter to the conference, she commented, "Most reported cases around birth are the outcome of a multi-problem situation, with either serious medical and social problems." She noted that respect and communication are important. (As a side note, she had a home birth in the US in 1980).

Joke noted that the Dutch Obstetric Indication List or VIL (Verloskundige Indicatielijst) is a guideline, not a law. The VIL is a list of obstetric indications for risk selection to the appropriate care provider & birth location. The Netherlands has contradictory Supreme Court decisions about how binding medical guidelines are. In one legal case, medical guidelines were enforced, but in another they were not.

Some notes from the post-panel discussion:

• Raymond de Vries noted how a "society makes you desire the very things it limits you to." Fascinating. 
• We have created a culture of blame by dichotomizing choices and by standardizing choices and care.
• Why, if we grant rights to the fetus, does it make us so flippant about the rights of the mother? In other situations we'd never imagine doing such things to other (non-pregnant) people.

If you were present at Panel 6 and have anything else to add, please share in the comments section!
.

Cochrane Review: "all countries should consider establishing home birth services"

A new Cochrane review of home birth has concluded that that "that all countries should consider establishing home birth services with collaborative medical back up and offer low-risk pregnant women information about the available evidence and the possible choices."

Besides examining the evidence, the reviewers also address the interplay of autonomy and concern for fetal rights. Having recently participated in similar discussions at the Human Rights in Childbirth Conference, I was excited to see the following commentary:

This review shows that there is no strong evidence to favour either planned hospital or planned home birth for selected, low risk pregnant women. From an autonomy-based ethical perspective the only justification for practices that restrict a woman’s autonomy and her freedom of choice, would be clear evidence that these restrictive practices do more good than harm (Enkin 1995), as we stated in the previous version of this review (Olsen 1998). A decade later, the European Court of Human Rights in Strasbourg handed down a judgment stating that “the right to respect for private life includes the right to choose the circumstances of birth”. Thus, no matter what the level of evidence is, European governments are not allowed to impose, e.g. “fines on midwives assisting at home births” as it “constitutes an interference in the exercise of the rights ... of pregnant mothers” (Registrar 2010). On the other hand, the ethical concept of the fetus as a patient (Chervenak 1992) may lead some to state that “Obstetricians have an ethical obligation to disclose the increased risks of perinatal and neonatal mortality and morbidity from planned home birth in the context of American healthcare and should recommend against it” (Chervenak 2011) and that “In clinical practice it involves recommending … aggressive management (interventions such as fetal surveillance, tocolysis, Caesarean delivery)” (Chervenak 1992). In this ethical perspective recommendations about interventions are acceptable even when they are not supported by randomised controlled trial (RCT) data. The lack of strong evidence from RCTs and an autonomy-based ethical perspective lead to the conclusion that all countries should consider establishing home birth services with collaborative medical back up and offer low-risk pregnant women information about the available evidence and the possible choices.

One of the limitations of a Cochrane Review of home birth is the very small number of RCTs on home birth. I highly recommend reading the chapter on home birth in Amy Romano and Henci Goer's new book Optimal Care in Childbirth. They examine a large number of high-quality studies that the Cochrane Review does not include. (My review of this book is forthcoming.)

The updated Cochrane Review is significant for those working to reform American maternity care policies. Notice the language supporting autonomy, accurate information, integrated home birth services, and professional collaboration from last year's Home Birth Consensus Summit. The new Cochrane recommendations should make it easier to translate these consensus statements into action:

• We uphold the autonomy of all childbearing women....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 1)
• 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 2)
• Effective communication and collaboration across all disciplines caring for mothers and babies are essential for optimal outcomes across all settings. (from Statement 6)

For more information on the Cochrane Review on home birth:

• University of Copenhagen: Birth is no reason to go to hospital
• Full text (PDF) of the review

Barbie has a home birth

Beach Birth Photography did a photo session of Barbie having prenatal visits, going into labor, giving birth, and breastfeeding. Love it!

Actually what I liked best was the implicit commentary on the trope of birth photography. You know...the tender moments captured between the woman and her husband, closeups on hands or hair or bellies, the midwife applying hot packs to the woman's sacrum, the alternations between color and black & white, the older sibling's excitement and awe. I don't know if it was meant to be a bit tongue-in-cheek, but I certainly read it as such.

Go take a look; I think you'll enjoy it!

(I'm super curious...how did the photographer make Barbie's pregnant belly?)

Back in business

Second Womb Slings is up and running again! I decided to stay open until I sell out. Closing for a semester sounded like a good idea, until I realized that would mean a flood of holiday orders right at the end of the semester. Not good :)

If you have your heart set on buying one of my linen or silk ring slings or infant scale slings, don't procrastinate too long.

Professor breastfeeds in class: What's the big deal?

Why do we need feminism? Aren't we, like, so over that?

Here's a story sure to make your jaw drop:

American University professor Adrienne Pine woke up to teach the first day of her feminist anthropology class. Her infant daughter had a cold and a fever, which meant she could not go to day care. This professor was a single mother with no one else available to watch her baby on short notice. She weighed her options: cancel the first day of class (which would disrupt the class schedule and could negatively affect her tenure evaluations) or bring her baby to class. She chose the second option. When her baby became fussy, the professor breastfed her baby, who promptly fell asleep.

Now this has turned into a major controversy, with several students remarking on how "unprofessional" it was to nurse a baby in front of them. One male student--who later dropped the class--commented: “I found it unprofessional. I was kind of appalled.”

How twisted is it that this is even a controversy! You'd think that students in a feminist anthropology class titled "Sex, Gender & Culture" would embrace this as a fantastic opportunity for discussion and exploration.

When I was a graduate student, one of my fellow students brought her newborn to class. All of us, including the professor, were happy to have her baby present. After all, it was a Maternal/Child Health class--hard to imagine a more appropriate setting for a breastfeeding student!  I loved watching her nurse and care for her baby while actively participating as a student. She was a great role model for me (and later became a close friend).

What I find most remarkable is the absence of discussion on the most pressing issues: The lack of options for working parents who suddenly find themselves without childcare. The inherent sexist bias that labels lactating as "unprofessional."  Nope, we can't think that far ahead. All we can focus on are...gasp...The Breasts. Sexism and gender bias continue to thrive, keeping us mired in these infantile (ha!) debates about breastfeeding.


For further reading:

• Professor Adrienne Pine's explanation of what happened in Exposéing My Breasts on the Internet
• Washington Post article: American University professor breast-feeds sick baby in class, sparking debate

.

Uh oh

Look who got into the chocolate...

At least it was the good stuff--85% cocoa. I want her to learn young!
.

18 months old!

Inga has definitely earned the title "toddler." Goodbye, baby. Hello, little girl. She's one of the pack now, following her siblings around and imitating whatever they're doing.

New words since last month:

• juice
• baby
• cup
• push
• shoe (said the right way with much emphasis--she loves wearing shoes!)
• Dio (dao)
• ball
• moi ("me" in French)
• num (when she wants to eat)
• toes
• no
• yay
• cheese
• apple
• pastèque ("watermelon" in French) 
• wow
• ow
• thank you

Many of these words are hard for others to distinguish, but at least we know what she's saying. I remember that Zari, unlike Inga, enunciated her words perfectly from the start.

No other big changes to report. Inga's still nursing 2-3 times a day. Still haven't caught a single pee or poop. She's really interested in pottying, though. She signs "potty" whenever one of us is going, and often she'll want to sit on her potty, too. I just wish she hadn't forgot how to go!

She's started wanting to run and walk everywhere, rather than ride in her stroller. On a typical day she'll ride half the time and run the rest. This can add up to a mile or more of running every day. She's going to be a very fast kid if she keeps this up.
.

Book Review: The Midwife of Hope River

I recently had the pleasure of reading Patricia Harman's third book and first novel, The Midwife of Hope River. The novel follows a fledgling midwife during the Great Depression. Fleeing from her troubled past as a union organizer, Patience Murphy moves to rural West Virginia to begin a new life. She finds herself on her own--as a woman and as a midwife--after her midwife mentor dies.

<iframe width="560" height="315" src="http://www.youtube.com/embed/Gr2Gpts57n8" frameborder="0" allowfullscreen></iframe>

Conditions in rural West Virginia are so primitive that Patience might have been living in the 17th or 18th century. Patience is one of two midwives in the county; the other is an old black "granny midwife" and well on her way to permanent retirement. Only the very wealthy can afford the county's sole obstetrician, so Patience finds herself with a rising caseload. Births were much the same as they would have been centuries previously; with hospital backup all but impossible for most residents, Patience has to learn how to handle just about everything herself.

The book isn't just about childbirth and midwives, though. It's a story about race relations, about American labor & union activism, about the development of obstetrics and the relegation of midwives to poor and rural populations. Most importantly, The Midwife of Hope River is a story of a woman coming to terms with her past and learning how to live--and love--again.

The book was a fun, absorbing read. If you love curling up with a good book, then you won't want to miss Patricia Harman's latest work!

Available at Amazon , Barnes & Noble, and Indie Bound. To meet Patrician Harmon in person, go to one of her book tour events! If she isn't coming to your area, you can follow her virtual book tour.

For more about Patricia Harman's writing, visit her website, Facebook page, or Twitter account. You might also be interested in my review of her memoir Arms Wide Open. 

Dio's weaning party

When Zari finished nursing at 3 1/2, we threw her a "nursing party" to celebrate. Nursing parties are now a family tradition, and Dio has been waiting his turn for the past several weeks. Finally we got around to making a cake.

At his request, he wanted a "race car cake." Then he added, "a Lightning McQueen cake!" (He spent a few weeks this summer with a Cars-obsessed cousin.) I wasn't about to go overboard and try this. Instead we made a decent replica with M&Ms.

I love you, Dio, and I'm so proud of you!