Birth options and recommendations in the D.C. area

A blog reader recently asked me for recommendations for providers and birth locations in the Washington D.C. area. She lives in Falls Church, VA and is open to considering all of her options, from home to birth centers to hospitals. She had her first children with epidurals and would really like to have her next baby unmedicated (although she's a bit nervous about how she's going to do it!).

Please add your recommendations in the comments or, if you'd like to keep things more private, via email.

Thanks so much!
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Pregnancy: Month 5

November was filled with breech-related activities: planning a vaginal breech and ECV workshop for next June, preparing my presentation "Connecting the Dots: The Future of Birth Advocacy," attending the 3rd International Breech Conference in D.C., and writing up summaries of the conference sessions.

In honor of breech babies and breech-friendly providers, I created this quilt block to represent my fifth month of pregnancy. It's the logo of the Coalition for Breech Birth and is simply named "Breech." 

I didn't have any cobalt blue fabric, but this deep purple linen was close enough to evoke the same feel.

I love the design of this logo. It captures the deep love and connection mothers have with their babies and the desire to protect and nurture their little ones, born or unborn. We have to keep this in mind when we talk about breech birth and about what options are "safe" or "acceptable."

~ Soapbox over ~

I hope you're having a wonderful time preparing for Christmas or whatever other holidays you celebrate. Our house smells of lebkuchen (German spice cookies) and caramelized onions (for tonight's French onion soup) and fresh paint (yes, I've been busy repainting before this baby arrives). We have a houseful of family and have more arriving on Wednesday.
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Pregnancy: Month 4

I first started feeling movement at 11 weeks. It began with faint flutters and bubbles, the kind that you're pretty sure are baby...but not entirely. By 15-16 weeks, it was definite. At this time, it really felt like a fish flopping around inside me. If you've ever held a live fish in your hands--something the size of a sunfish or crappie--you'll know what I'm trying to describe.

So this quilt block for the  fourth month of pregnancy reflects the sensations of movement. I named it "Quickening."

Christmas wish list

I'd love to get a female pelvis model and cloth doll to practice & study the cardinal movements. Anyone selling a spare set? What suppliers sell the best cloth dolls?

A good portrait lens with a low aperture setting (1.4 or 1.8). This one would work with my  camera. I like bokeh!

The book Making More Plants

A Yepp Mini bike seat. It mounts on the front of the bike, right on the handlebar stem.

And this GMG Junior bike seat for the back of one of our bikes Too bad it isn't sold in the US! Maybe a Dutch reader could help me buy & ship a used one? They are everywhere in The Netherlands. I'd probably need the adapter too.

The WeeRide Co-Pilot bike trailer looks like fun!

I'd like to watch the documentary Catching Babies.

What's on your wish list? 
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26 weeks pregnant

My weekly pregnancy silhouette has turned into a biweekly one! The weeks go by too quickly to get a picture taken every time.

Inga at 28 weeks
Dio at 26 weeks
Zari at 27 weeks (25 weeks gestation)

Now some details for those of you who care:

I've been measuring ahead for as long as I could take reasonably reliable measurements. There was some uncertainty about dates initially, but it was in the other direction (i.e., possibly being 22 weeks at this point rather than 26). With my 3 other pregnancies, I have always measured spot-on for dates, no matter how much or little I was showing. So here are some figures from this pregnancy:

• 18 weeks: fundus at umbilicus
• 21.3 weeks: 25 cms
• 24 weeks: 27/28 cms (I sometimes measure twice, keeping my eyes closed so I'm not "cheating")
• 26 weeks: 31/32 cms

This is making me go "hmmmmm....is there just one baby in there or two?" I have my next prenatal visit on Monday and we'll discuss possible causes. I'm not opposed to having an ultrasound if there's a sound reason.

Everything else is looking good. Weight gain is similar to other pregnancies (+14 lbs). Blood pressure is nice and low. Baby is nice and active. I've been sleeping reasonably well and hope that trend continues.
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Tenure! (and something fun to read)

Eric just had his tenure review meeting yesterday...and he passed! We are so thankful for job security in this era of economic uncertainty.

Are any of you subscribers to the Journal of Perinatal Education? You might have seen Eric's essay "Freebirth" in the most recent issue (Volume 21, Number 4, 2012, pp. 202-205). It's worth the read :)
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Complicated Breech Scenarios: Heads Up! Breech Conference

Day 3

Breech Birth Scenarios

Diane Goslin

Diane Goslin, who serves a large Amish & Mennonite population in Pennsylvania, described several complicated breech scenarios she has encountered. Gail Tully helped by illustrating the situations with a doll & pelvis. Diane then invited conference participants to share their own less-than-textbook breech births--this included footling and kneeling presentations, slow labors, long second stages, babies that did not rotate to anterior, and nuchal arms.

After learning from Jane Evans the signs of a normal, physiological breech birth, it was very enlightening to learn how to recognize and respond to abnormal breech situations. After all, that's really what breech attendants really need to know. Much of the time, breech babies emerge on their own. But what if they don't? That's when a cool head, skilled hands, and the ability to think on your feet can be lifesaving.

The main things Goslin has learned over the years:

• A lot of patience and a lot of monitoring. A breech is not the kind of birth where you go sleep on the couch. You need enough help in case the mom, dad, or midwives are exhausted. 
• Be able to picture your baby well and visualize how it's inside the mother. Become confident and competent with how the baby is positioned inside the pelvis. 
• Think outside the box. As much as we might love H&K, for example, we have to be willing to try whatever works to help get the baby out.  
• You have to be flexible and  see what's working. You can't just have one formula for getting these babies out. We don't like doing manipulations, but it there is trouble, it's better than a brain-damaged or dead baby. You need to know the maneuvers and know when & how to do them.

Jane Evans commented that British midwife Mary Cronk taught her a lesson about getting a stuck object out. Mary had a messy kitchen drawer that would often get stuck because some object was wedged and in the way. Mary's husband would shut the drawer a bit, wiggle the objects around, and then open the drawer easily. The same goes with breech birth. If you can resolve the obstruction, then the baby can descend easily.
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Pregnancy: Month 3

I hit a rough patch between the 5th and 11th weeks of pregnancy. The usual suspects--constant queasiness, no appetite, extreme fatigue, dizziness. I've never actually thrown up in early pregnancy; I just feel nauseated the whole time. Each pregnancy has gotten successively worse with its "morning sickness" symptoms. (Whoever decided to call it morning sickness anyway? Mine is all day and all night, and if anything gets progressively worse as the day goes on.)

The challenge for this quilt block was how to depict the third month of pregnancy. How do you visually represent exhaustion or queasiness? I thought and thought. I googled various search terms in conjunction with "quilt" or "block" but found no inspiration.

Finally, I decided to represent not the exhaustion or nausea, but what helped me get through it: reading books. As long as I was reading, I could ignore how icky I was feeling. So as soon as Eric came home, I would lie down, grab a book, and check out for the rest of the day. (And I did my share of reading during the day, too, while the kids were playing.)

I named this quilt block "Saved By The Books."

ps--some of you Second Womb Slings customers might recognize your sling fabrics :)

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Boob Hell: A book review

I've never been to boob hell. Not really even to boob purgatory, except for the plugged ducts I kept getting when Zari was around 4 months old. My experience with breastfeeding has ranged from mostly boob Omaha* to occasional boob paradise.

So I had mixed reactions to Rebekah Curtis' book Boob Hell. It's a memoir of breastfeeding her first baby, and it's filled with tortured descriptions of the pain and embarrassment she endured while trying to figure out how to nurse. This wasn't your ordinary sore-nipples-for-a-few-days kind of pain, it was close to 3 months of constant, excruciating pain, even when she wasn't nursing. She had a nipple so deeply cracked that it essentially split in two. She couldn't hold her daughter or bear to have anything brush against her breasts. Turns out she had a raging thrush infection and (my interpretation here) a baby who didn't latch on right. Between those two, she endured more than I think I ever could have. But Rebekah doesn't set herself up as a hero or even a warrior. She feels like she's failing no matter what she does: "I was failing at breastfeeding, and failing at quitting breastfeeding. Human history had never known a more stupendous failure."

Besides the physical pain of a bad latch, cracked and bleeding nipples, and a thrust infection, Rebekah also endures another form of hellish punishment: shame, embarrasment, and loneliness. At times, I felt impatient with the narrator. Newly postpartum, she has a houseful of family staying over. She feels trapped and overly self-conscious. So she ends up nursing her baby on a folding chair in her bedroom, completely miserable yet unwilling to either A) just nurse the baby and let others deal with it or B) ask the unwanted guests to leave. Yes, I know that it's hard to field friends and relatives when you're newly postpartum, but it's even worse to be "nice" and then suffer for it (and then complain/cry in secret).

Even after she's been nursing for a while, she still feels terribly awkward and embarrassed to breastfeed in front of anybody. Here's a scene when she's visiting her mom and grandma (referred to as "Grandma" and "Great Grandma"). 

     I positioned Baby to start on the safe boob. I had her burpie, a fresh nursing pad, and my receiving blanket. But when It came to the feature presentation, I found myself stalling, making unnecessary adjustments. I just didn't want anyone to watch me feed the baby; not my mom, not my grandma, not anybody. I grimly draped the blanket over my shoulder and Baby, reached underneath it to unhook my bra, and tried to hold her in the appropriate range, but she started flailing and gasping and soon the blanket was tangled around her head and arm, and my face was burning. Was Great Grandma still watching? I didn't want to look.
     "Come on, Baby," I muttered desperately, pulling the blanket back up. But she couldn't get it. Her hands flew and pulled off the blanket again and she cried in frustration. I wanted to do the same. "I'm sorry, we're terrible at this," I said angrily. "Well go upstairs and come back when we're done." I reassembled myself and hauled Baby upstairs where we could sequester ourselves in a bedroom.
     Dad [Rebekah's husband] knocked on the door a few minutes later and stuck his head in. "Doing OK?" he asked.
     "Why do they say you should just feed the baby wherever you are? Why don't they tell you that babies can't figure out how to eat without you being totally exposed? Why do they make you think that it's totally no problem to feed a baby under a blanket? Don't their babies kick and squirm and cry? I hate all those people, whoever they are!"

 Or this scene at a friend's house, where she and three other moms are gathered for lunch:

     We sat around Christine's table while the bigger kids ran and screamed. The lady with the newborn started nursing her, not with as much subtlety as I preferred to employ. I wasn't sure if I should look away. She didn't seem to be trying to make a point (no need in this group); apparently she just didn't care. It was distracting: although I wouldn't normally be looking at her chest, I now had to look consciously elsewhere. I struck me that this was how polite men must always feel around women in boob sweaters or short skirts.
     Baby also had lunch coming. But with Other Mom doing the deed at the table, I could hardly excuse myself to the living room. It would even feel rude to try the blanket trick, since she hadn't. My inner anchorite muttered, See, this is why you don't go out with people. I dug through my diaper bag at length as a signal that I was about to need everyone's eyes to be considerately averted. I straightened, unhooked, helped Baby latch, and hoped that my face wasn't as red as it felt. The other girls dutifully conversed around me.
     "Are you OK?" asked Christine after I started laughing at their comments again to signal my return to group interaction. "I mean, is it going OK?"
     "Yeah, it's no biggie," I said, smiling tightly.

Rebekah's character is aware of these inconsistencies. One time, she is sitting in her husband's office nursing her baby. A woman walks in, looking for Rebekah's husband. Rebekah's immediate reaction is to feel uncomfortable and embarrassed, even though the woman doesn't mind and hardly notices the nursing. Turns out the woman has been struggling with infertility. Rebekah reflects:

Why had I spent all this time angry about nursing mothers being forced out of society to feed their babies, and then when someone who doesn't have a problem with me feeding my baby shows up I get mad and scared?

Reading Boob Hell made me wonder how we ought to talk about breastfeeding. Should we teach that it's something that many or most women can accomplish with the right information and support? Or is talking about breastfeeding in a positive and encouraging way setting women up for failure? Should we instead focus on the potential problems and difficulties so we're not painting an unrealistic picture for new mothers? I understand the reasons for both approaches. Rebekah definitely feels duped by all the breastfeeding books she read. To her, breastfeeding is hard and painful, period. Anyone who says otherwise is simply not telling the truth: 

     Baby and I were in the middle of a feeding when my aunt stopped by to inspect the newest family member. "How's it going?" she asked me.
     Kind of rough," I said.
     "Rough how?"
     "Feeding."
     She nodded. "Yup, that's the way it goes."
     Maybe if we all know this, we could give each other a little warning? I thought. "Everybody at the hospital and all the books say that you might be sore for a day or two at first but after that you'll be fine as long as you're doing it right," I said.
     My aunt snorted and rolled her eyes. "Anybody who's ever done it knows that's not true," she said. "But at least you can drink again, right?"
     Can I?" I asked.
     "Oh, sure," she said, "You just can't get hammered."

On top of feeling shell-shocked at how difficult breastfeeding was, she can't even be honest about how she is actually doing:

     A friendly grandpa-type asked me how we were doing that Sunday at church. Just fine, I prevaricated.
     "You know, at this age, they pretty much just sleep and eat and cry!" he observed jauntily. "And the sleeping you don't mind, and the eating you don't mind, but that crying can sure wear you out!"
     I nodded, smiled. He patted me on the back and moved on. I stumbled into my husband's study so that I could get the crying over with before another caring person tried to be friendly. Why did I have to lie about this? Why did I have to pretend that I wasn't in the darkest valley of my life? Didn't anyone know, didn't anyone suspect that things might not be that great for a new nursing mom? Why were we all keeping up this act? I could only conclude that every acquaintance who'd talked to me since Baby's birth had no experience of breastfeeding, because if they had, their words to me would surely have been less presumptuous. The eating you don't mind. The eating you don't mind. The eating you don't mind.

Rebekah finally emerges from boob hell almost 3 months postpartum. Her constant pain between feedings finally dissipates and then, at a friend's urging, she tries gentian violet for her thrush infection. It does the trick after lots of ineffective remedies and useless advice from doctors and lactation consultants.

Boob Hell is self-published. I caught the occasional error and found her usage of titles rather than names confusing (her daughter was named "Baby," her husband was named "Dad," and her mom was named "Grandma"). The writing style is so-so, but her story is positively wrenching and at times frustrating. Frustrating that women go through so much suffering--whether undeserved, unexpected, or self-inflicted. Frustrating that she received so much bad/ineffective advice from numerous health care professionals Frustrating that she couldn't be open about her struggles with mothering and nursing.

I haven't ever been in Rebekah Curtis' shoes. And she's never been in mine. Towards the end of the book, she writes: "I don't understand the people who claim to have no problems and no pain, but I'll take their word for it since one of them was my grandma." I am hesitant to pronounce that breastfeeding WILL be hard and painful and difficult. Or that if you do everything right, you'll NEVER have problems. I know that it CAN be hard, and is for many women. But I'm still uncomfortable with spreading the idea that is is MEANT to be that way.

For those reasons, I'm not sure if I would recommend this book to someone who has never breastfed before. It's simply too overwhelming and discouraging. However, Boob Hell would be great for breastfeeding veterans--especially those who have faced and overcome challenges. Or for those postpartum moms who feel lost and isolated, whether they're cruising along in boob Omaha or stuck in the seventh circle of boob hell.

Paperback available at Lulu ($9.49) and Amazon (paperback & $2.99 Kindle). 

* Pleasant, nothing terribly remarkable, hum-drum (phrase borrowed from Rebekah Curtis)

24 weeks pregnant

I'm starting a weekly photo series of my pregnancy...with a little twist.

How to make a pregnancy photo silhouette:

• Stand in front of a large window during the day and have someone take a photo. Wear a swimsuit, tight-fitting clothing, or your birthday suit for best results. (I wore a bikini for this photo. Since Eric doesn't usually come home until dusk, I set a tripod on top of a steamer trunk at the foot of my bed. I stood in front of our bedroom window and coaxed Dio, my 3-year-old, into taking several photos.)
• Use the pen tool in Photoshop to create a vector silhouette. It's faster to simply do image>adjustments>threshold, but the results will look sloppy.
• Find a digital picture frame. The frame I used was originally from a real photo, so the edges aren't as smooth as a vector photo frame. Turn the frame into a new layer so you can put your silhouette "inside" (underneath).
• Insert your silhouette.
• Using the text tool, type any numbers or text you'd like to appear on the frame.
• If you're going to do a series of images, save your work first as a Photoshop document so you can reuse the photo frame. Simply delete the old silhouette layer and add the new one each week or month. 

Pregnancy: Month 2

We were in Alberta this summer during my second month of pregnancy. I made a "Waterton National Park" quilt square since we spent a lot of time there. I started feeling really exhausted in Alberta and couldn't figure out why :)

This picture was my inspiration. I still have to embroider the Prince of Wales hotel onto the hill in the foreground...

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Pregnancy: Month 1

I've been a looking for a different way to document this pregnancy. I've done weekly belly shots, a belly cast, maternity photos, and henna belly paintings. What else could I do to create a record? I can't say this with 100% certainty yet, but this baby might be our last. I've seen some fun ideas on Pinterest, but many of them are too doctored, too elaborate, or just not me.

I love what Baby Makin' Mama's been doing, but honestly if I tried to do anything resembling a fashion shoot, I would bust out laughing. Plus I'd run out of outfits after about 3 pictures:

from http://www.babymakingmachine.com/category/pregnancy

Cool idea, but I don't have a professional photographer to follow me around:

from blog.hannamac.com

I also didn't want to copycat someone else's ideas. So this Amazing Pregnancy Journal had to be free, realistic to accomplish, and meaningful to me--even if it wasn't professionally done or repinned a thousand times on Pinterest.

I've made birth quilts for both Dio and Inga, so I thought I'd continue that tradition and make a month-by-month pregnancy quilt. Each block represents something significant or memorable from that month of pregnancy. It will have nine blocks for the pregnancy plus three for the "fourth trimester" (and to be honest, 12 worked better than 9 to fit crib-size quilt dimensions).

So here's Month One. I call it "Head in the Clouds" because I had no idea I was pregnant at first. Between a likely early miscarriage and then a super light period (that probably wasn't a period after all), it took me a while to even think of taking a pregnancy test.