Stand and Deliver

New blogs

2012-01-31T20:34:00.000-05:00

My blogroll is in serious need of updating. Part of the problem comes from me constantly discovering new blogs that I have to follow. Like the wickedly funny Labor and Deliverance, written by an OB practicing in the South. His recent post Is a Cesarean right for you? Of course it is! was spot on. Then there's The Many Colors of Changing Woman written by a Native American CNM. It's as serious and reflective as Labor and Deliverance is irreverent. (Recently many of her posts have been disappearing; they show up on my Google Reader but are gone from her blog. What's up?)

I read a lot of things besides birth blogs. I just added Design Seeds and the affiliated fresh news for color inspiration. I like Little eco footprints for ideas and inspiration about living more lightly on this earth. And Mother Wheel for the fun to seeing what happens when you mix Paganism & Mormonism.

So tell me, what blogs have you recently fallen in love with?
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Baby #4 is on its way!

2012-01-29T20:28:00.001-05:00

It's coming some time in March!

I've been involved with this book project since the 2009 Lamaze conference in Orlando, where I met two LDS childbirth educators: Beth Day and Katy Rawlins. We talked about the intersection of LDS spirituality and birth and agreed that someone needed to write a book about it. When we returned home, we connected with Felice Austin and other women, and eventually this book project was conceived.

The Gift of Giving Life: Rediscovering the Divine Nature of Pregnancy and Birth is a book written for LDS women and families. It contains collections of essays and stories connected to childbearing, including infertility, adoption, breastfeeding, prenatal/postpartum depression, pregnancy, and birth. (I contributed an essay about Heavenly Mother and a birth story about Inga's resuscitation.) The twelve chapters address these topics:

Our Legacy
The Importance of Giving Life
Personal Revelation
Patience
Preparation
Meditation
The Spirit-Mind-Body Connection
Fear
Pain
The Atonement
Unity
The Fourth Trimester

My favorite part of the book are the incredible stories we received from hundreds of LDS women. We received so many stories that we could only accept a portion of them; imagine how difficult that task was!

To get a feel for the book's content, you can read The Gift of Giving Life blog. You can also read excerpts of the book here.

This book would be perfect for LDS women and families in their childbearing years. The book's release date is scheduled for March. In the meantime, the publisher is accepting discounted pre-sales here. If you order now, you can save 10% off the list price.

New CDC report on home birth

2012-01-26T21:20:00.000-05:00

The CDC's National Center for Health Statistics just released a report on home birth (PDF) . Filled with graphics and easily understood language, this report is visually appealing and accessible to the lay public. This report, titled "Home Births in the United States, 1990-2009," has spurred a NPR report and CNN news article.

Home school or public school: What if you don't like either option?

2012-01-20T15:24:00.002-05:00

Zari is 5 years old and will be kindergarten age next fall. Ever since she was born, I've been telling myself that I'll do whatever schooling option is best for her needs and best for our family. The problem is, the right option hasn't become any clearer in the past five years. I'm just as undecided now as I was then. To be honest, I don't really want to home school and I don't really want to send her to public school. But I live in a small community with only one school system--no charter schools, no alternative schools, nothing but One-Size-Fits-Most schooling.

I find myself resisting arguments for either type of schooling. Home schooling advocates can seem so...evangelistic in their enthusiasm for home school and their implicit (or explicit) critiques of public school. I just can't buy into the "public school as prison" mentality that gets passed around. I also have serious reservations about how I'd be able to find the time and energy to home school when I have a baby and a toddler to look after (and hopefully one or two more babies down the road). I believe in having a balanced life, and adding home school would seriously skew the lovely equilibrium I have right now. If I added home school, I don't know what I could subtract to keep my commitments at a doable level.

I also get the feeling that Zari needs something more. Honestly, she's bored and antsy a lot of the time and then starts acting up in subtle ways because there isn't enough for her to do at her level. Much of my day is taking care of necessary tasks: getting children dressed and fed, walking around town running errands, cooking meals, and tidying up. As mundanes as these tasks are, they still need to be done.

There's a Christian homeschooling association in town, which could offer Zari opportunities for interacting with other children. But I'm not super enthusiastic about the Christian part (even though I am Christian, I'd prefer to keep education and religion in separate spheres).

With my hesitations about home schooling, you're probably thinking "then just send her to public school!" But I am not thrilled about that option either. Our school district moved to full-day kindergarten before we moved here, and half-day isn't even offered anymore. In addition, the district closed all of the neighborhood elementary schools. Even though we live kitty-corner from an elementary school, Zari would have to ride the bus to the consolidated mega-school that serves our entire city.

I have other misgivings about public school, some specific to our town and others in general. Like I mentioned, we have just one district so there aren't any other options or alternatives. There is one "high ability" classroom from kindergarten through high school, which Zari would likely be placed in. But that also means that she'd be with the same group of peers her entire time at school!

My general hesitations about public school stem from the inefficiency of classroom learning, from peer culture, and from the lack of time for free, unstructured play. I am reluctant to put my children in a classroom for 7 hours a day, when they could easily learn the same amount of information in just a few hours with one-on-one instruction. When I was in elementary and middle school, I was bored much of the time. I'd finish my homework in a few minutes and spend the remainder of class time reading or drawing. In middle school I'd read one or two books every day during school hours.

A common concern voiced about home schooled children is their lack of "socialization." (And I'll admit it, I've met some very, very strange, awkward home schooled children. Of course who knows if they'd be just as odd if they went to public school...) But I don't like a lot of the socialization that goes on in an institutional school setting. Besides the Big Bad Things that children learn from their peers (sex, drugs, alcohol), there's a lot of Little Things that bother me just as much: learning from peers how to be catty, to be a picky eater, how to form cliques, how you're supposed to only interact with those your own age.

I also firmly believe that children need plenty of time to just be children. This means free time to play, to wander around the neighborhood, to ride bikes, to climb trees. The 7-hour school day encroaches on this enough as it is, but then kids are sent home with homework. It's enough to ask little bodies to sit at desks for hours a day. But to send them home with even more work? Criminal.

I'm also really hesitant about having to adhere to an institution's rules. We travel a lot and I want the freedom to take our kids out of school when I want to. The public school does not coordinate its schedule with the university, so fall, Christmas, and spring breaks do not coincide. If Zari goes to school, then suddenly I am not in charge of my day anymore; I am tied to an institution's routines and hours. I resent that loss of freedom.

My ideal situation would be a school that met only in the mornings, that spent much of the time outdoors doing hands-on learning, and that never had homework. Alas, that does not exist here.

I seriously need advice.

Brand Baby

2012-01-14T20:14:00.001-05:00

From Adbusters, a spoof ad titled "Brand Baby":

Upcoming conferences of interest

2012-01-12T16:06:00.000-05:00

February 3-4, 2012

University of Utah, College of Nursing Auditorium, Rm. 2300

Transforming Pregnancy Since 1900

29–30 March 2012
Department of History and Philosophy of Science, University of Cambridge

Poster promoting prenatal care, c.1936. Library of Congress, Prints & Photographs Division, WPA Federal Arts Project Poster Collection (LC-USZC2-5511).

Around 1900, few pregnant women in Europe or North America had any contact with a medical practitioner before going into labour. By the second half of the twentieth century, the hospitalization of childbirth, the legalization of abortion and a host of biomedical technologies from the home pregnancy test and IVF to obstetric ultrasound and prenatal genetic diagnosis promised unprecedented control. New regulatory frameworks, changing relations between expectant mothers and medical practitioners and technologies for diagnosing, monitoring and intervening in pregnancy offer rich histories to explore. With scholarly writing predominantly dispersed among local studies of maternity care or focused on specific innovations, we lack a synthetic account of transformations in the management, experience and understanding of pregnancy across the whole twentieth century. This conference aims to break new ground by investigating the making, organization and communication of knowledge around pregnancy among experts and laypeople in Britain, France and the United States since 1900.

This interdisciplinary conference will bring together scholars with expertise in the history, sociology and anthropology of reproduction. Talks will be 10-minute summaries and commentaries of pre-circulated papers, followed by discussion in 50-minute slots in such a way as to promote dialogue and critical engagement between fields and approaches.

Salim Al-Gailani (University of Cambridge): Folic Acid: Making a Technology of Pre-Pregnancy
Caroline Arni (University of Basel): The Psychic Life of Pregnant Women: Early Twentieth-Century Prenatal Psychology
Tatjana Buklijas (Liggins Institute, New Zealand): Fetal Physiology, Nutrition Research and the Origins of the Barker Hypothesis
Angela Davis (University of Warwick): 'Heroes and Stoics': Women's Narratives of Maternity Care, c.1945–1990
Rose Elliot (University of Glasgow): Abortion, Miscarriage or Criminal Feticide? Medical Understandings of Early Pregnancy Loss in Britain, c.1900–1967
Ofra Koffman (King's College London): Temporary Crisis or Life-Long Disorder? Adolescence, Unwed Motherhood and Mental Pathology
Ilana Löwy (CNRS, Paris): Looking for Malformations, Looking for Risks: Fifty Years of Prenatal Diagnosis
Aryn Martin (York University, Canada): 'Something there is that doesn't love a wall': The Elusive Placental Barrier in Medical and Popular Health Discourse
Deborah Nicholson (University of the West of Scotland): 'Unseen Citizens': Ultrasonic Fetal Images and Narratives of Life Before Birth
Jesse Olszynko-Gryn (University of Cambridge): Diagnosing Pregnancy in the 1930s
Amanda Raphael (Independent Scholar): Deep Breaths and a Nice Cup of Tea: Antenatal Education Since the 1950s
Leslie Reagan (University of Illinois): Avoiding 'Monstrous' Babies Through Prenatal Care: Rubella, Girls, and Vaccination

The registration fee of £30 (£15 for students/unwaged) includes lunch and tea/coffee on both days. To register, please fill in the registration form and send it with a cheque for the registration fee (made payable to 'University of Cambridge') to:

Salim Al-Gailani
Transforming Pregnancy Conference
Department of History and Philosophy of Science
University of Cambridge
Free School Lane
Cambridge
CB2 3RH

Registration form

Organisers: Salim Al-Gailani (Department of History and Philosophy of Science, University of Cambridge), Angela Davis (Centre for the History of Medicine, University of Warwick) and Jesse Olszynko-Gryn (Department of History and Philosophy of Science, University of Cambridge).

Supported by a Wellcome Trust strategic award in the history of medicine to the Department of History and Philosophy of Science, and the Cambridge Interdisciplinary Reproduction Forum.
For further details, contact Salim Al-Gailani .

Life imitating art imitating life

2012-01-10T20:01:00.000-05:00

A reader sent me this photo of a woman nursing her baby at the Fountain of the Four Seasons. Located at Iowa State University's Memorial Union, the fountain was created in 1941 by artist Christian Petersen.

More information about the fountain (source):

Placed around a circular fountain the four seated American Indian women represent an Osage chant of thanksgiving. The four women face north, south, east and west, each demonstrating a line of the prayer: The first women is planting the seed, “Lo, I come to the tender planting.” The second bends close to the earth, “Lo, a tender shoot breaks forth.” The third holds a harvest basket of maize, “Lo, I collect the golden harvest." The forth nurses her newborn baby, “Lo, there is joy in my house.” These four sculptures are carved from bedford limestone and are placed around a circular base of terra cotta which is sculpted with a corn relief. Artist Christian Petersen took these notes during the sculpture's early stages:

Full water display symbolizes the fullness of the elements . . . arch of the sky . . . the lifegiving rains . . . the calmness of the Indians in the face of the turbulence. . . tranquil water . . . tranquility of the Indians. . . much water symbolizes elemental turbulence.

Currently reading

2012-01-08T20:23:00.000-05:00

Sometimes I come across a topic I want to know more about and start reading everything I can get my hands on. One recent interest was abortion providers. I wanted to learn why someone would choose this line of work given the violence and persecution they face. I first read Suzanne P. Poppema's book Why I Am an Abortion Doctor, followed by Susan Wicklund's book This Common Secret: My Journey As an Abortion Doctor. The writing in both books was so-so, but the stories were gripping. During my searching I also read a lecture by Dr. Garson Romalis, also titled Why I am an Abortion Doctor. I just finished the book Dispatches from the Abortion Wars: The Costs of Fanaticism to Doctors, Patients, and the Rest of Us by Carol Joffe and am still wanting to read more.

I have to say that the more I read about abortion debates in North America, the more incensed I become at the whole mess. In the past, I'd never strongly identified with either of the two ideological camps. I had understood abortion as a morally complex issue laden with shades of gray. It wasn't something I would have chosen for an unintended pregnancy after consensual sex (I've never been in that situation, so it's easier said than done), but definitely something I would have considered for other situations--rape, incest, threats to my health, etc. I've never felt that abortion should be illegal or inaccessible. There are so many reasons, so many situations, that bring women to that decision and I find it incredibly arrogant that some people want to take away that option across the board. Abortion won't go away simply by being illegal or inaccessible.

As I've been reading more, I find my feelings intensifying. I dislike how both pro-life and pro-choice rhetoric victimizes women: Pro-life groups portray women as victims of their abortions ("abortions hurt women"); pro-choice groups portray women as victims of their pregnancies and of the lack of access to abortion. Is there a way to talk about abortion without casting women as victims?

The hypocrisy of many pro-life arguments, which glorify motherhood (by wishing all women to become mothers, however unwilling) yet do nothing to actually support mothers or babies, incenses me. I'd much rather see that energy focused towards helping women avoid unwanted pregnancies; securing universal health care, paid maternity/paternity leave, affordable quality childcare, and flexible work arrangements; and ensuring that all babies are wanted and that women can become mothers willingly and joyfully. That is pro-life. Not the hateful rhetoric that values an embryo more than the woman whose body carries it.

Overall, I find the North American obsession with abortion puzzling and troubling. It distracts people from more pressing issues. It's focused on symptoms, not on underlying problems. It's like nit-picking over whether or not a bandaid is the right shape while the patient is hemorrhaging to death.

Iknow that discussing abortion will bring out the crazies, but I had to get this out. I cherish my children and my babies. I love being pregnant and giving birth. I also want abortion to be safe, legal, accessible, and, ideally, rare*--not because I don't value life, but because I value it so highly.

[Deep breath]

I remember reading a book during my graduate student years by a sociologist (or maybe anthropologist?) who spent time with both pro-choice and pro-life groups and explained the worldviews and values of both camps. I can't remember the title but it was really interesting. Any more recommend readings on this topic?

Note to commenters: Keep it civil and on-topic otherwise I will employ the Almighty Delete Button.

* Dr. Wicklund mentioned that, ironically, one goal of abortion providers is to work themselves out of their job by helping women avoid unwanted/unplanned pregnancies in the first place. But the challenges are immense: lack of access to health care and contraception, partner sabotage of birth control (including threats of violence for using birth control), our hyper-sexualized yet hyper-prudish culture, etc.

Christmas Craft #1: Felted wool sweater blanket

2012-01-04T20:45:00.000-05:00

My family likes to make things. When we get together for Christmas, we usually have a large family project. In past years, we've done silk painting, soap making, jewelry making, book binding, and fishing pole making. This years' family project was handmade wooden marble runs, one for each sibling with children. More about this in an upcoming post.

We also have lots of individual projects going on during the holidays. This year I went 100% natural and 100% recycled using felted wool sweaters. After I saw this tutorial for a felted wool sweater blanket, I started collecting wool sweaters. I've fallen in love with Goodwill Outlets, where everything is sold by the pound! Once I had enough cream and gray sweaters, I made this:

It was my Christmas present to my family. We use it every day. And it probably cost me $5!

Fine print:

I straight-stitched all of the seams, then went over them with a wide zig-zag stitch. Some sweaters felted better than others, and I didn't want anything to unravel.
I made sure that all the outside edges and corners had finished edges. Because of that, I didn't put a backing fabric on or do anything else to finish the edges.
My blanket was made of 9" squares (except for two double-sized pieces): 6 blocks wide and 8 blocks high.

10 months old!

2012-01-02T20:45:00.000-05:00

I was looking through similar posts from Dio's babyhood and getting really nostalgic. I love the baby stage so much and feel sad when it's over. I don't know how I'll ever be able to decide that I'm "done." But I don't think I'll keep on having children indefinitely, either. I'm 33 so one or two more children seems about right. Plus finding a vehicle becomes really tricky once you have more than 7 passengers!

Self-portrait

So, let's talk about what Inga is up to: she's cruising the furniture all the time, and a few nights ago I caught her standing up all by herself for about 5 seconds. I wouldn't be surprised if she walks fairly soon. Zari did at 10 months, while Dio took a bit more time and walked right before his first birthday.

Other new skills: pointing, clapping her hands, saying "mama mama" (it may or may not mean anything, though), pulling books off the shelf, "jumping" on the designated jumping bed, fast crawling, can climb up & down one stair.

Those little pointers. Picture by Zari.

Sleep: Most nights she goes to bed at 7:30 pm and wakes up to nurse twice around 3 and 6 am. Then she's up for the morning around 8 am. Because she's sleeping in, she's starting nap only once per day about half the time. It's been nice being on break from teaching an 8 am class. All of us sleep in until 8 am--lovely!

EC/diapering: Like with my other two kids, I potty Inga at regular intervals, either after naps or during diaper changes. She'll often pee for me, but lately she's been so busy that she doesn't want to sit down long enough to go. No big deal. Poops are more tricky since she usually goes in the early morning before she wakes up. Dio's been out of diapers for a while now (except for a backup one at night, but he's mostly dry at night, too).

Food: I've started letting Inga have tastes of food this month. She usually gets a handful of Cheerios and frozen peas when we're eating breakfast, then bits of fruits or vegetables during other meals. She's not a big eater, so most of her nutrition still comes from me. She likes to grind her top and bottom teeth together, just like my other two children. Sounds like she has a mouthful of rocks.

Now & Then: birth to 10 months

1 week old


10 months old

Lying down is for babies!

2 weeks old

10 months old

Those pesky legs kept coming up. Zari tried to help.

A simple Christmas?

2011-12-31T15:57:00.000-05:00

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.

Birthingown giveaway winner...

2011-12-23T16:06:00.000-05:00

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.

Birthingown Giveaway!

2011-12-17T21:19:00.003-05:00

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:

Robin Lim named CNN Hero of the Year

2011-12-12T20:45:00.001-05:00

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.

It was just a dream

2011-12-10T21:25:00.000-05:00

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."

White Paper on Cesarean Deliveries & Opportunities for Improvement‏

2011-12-09T08:55:00.000-05:00

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

Sleep miracle

2011-12-06T21:43:00.001-05:00

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!

You're Doing It Wrong: Nursing Cover Edition

2011-12-05T21:27:00.000-05:00

Thanks for your witty submissions for my nursing cover caption!

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

Close runner-up:

9 month pictures

2011-12-03T22:04:00.000-05:00

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!

9 months old!

2011-12-02T22:36:00.000-05:00

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!

Birthplace in England: A Tale of Medical Reporting

2011-11-29T21:21:00.003-05:00

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

Home birth 'carries higher risk' for first-time mothers BBC News
First-time mothers warned over home birth risks The Daily Telegraph, November 25 2011
Home births three times more risky than hospital, says study Metro, November 25 2011
Women with low-risk pregnancies 'should have birth choices' The Guardian, November 25 2011
First-time mothers who opt for home birth face triple the risk of death or brain damage in child Daily Mail, November 25 2011
Home as safe as hospital for second births The Independent, November 25 2011
Home birth risks up for new mums The Sun, November 25 2011
Home Birth Imposes Higher Risks for First-Time Mothers MD news press release
Home birth riskier for first time moms Press TV
Home Birth Can Be Dangerous for a Baby TopNews Arab Emirates
Hospital Birth Safer As Compared To Home birth TopNews United States
Home birth 'carries higher risk' for first-time mothers International News Network
Home births riskier for first-time moms: Study IBNLive

News reports emphasizing safety

Study finds home birth is safe Peterborough Today (UK)
British researchers OK birthing options UPI.com
Home Birth a Good Option for Second-Time Moms Associated Content
British Study: Half Of All Pregnant Women Could Give Birth At Home Huffington Post
England study: Low-risk births don't need hospital Aurora Sentinel

I need a guinea pig!

2011-11-25T22:38:00.002-05:00

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.

The problem with nursing covers

2011-11-22T21:14:00.002-05:00

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.

God Was My Midwife: My Interview with Shifra Mincer

2011-11-21T18:32:00.000-05:00

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.

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

2011-11-20T19:12:00.000-05:00

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

2011-11-17T09:59:00.000-05:00

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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SRSLY illustrated

2011-11-13T20:36:00.000-05:00

My little brother created this for me:

SRSLY?

2011-11-11T21:54:00.000-05:00

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

2011-11-09T16:03:00.001-05:00

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.

Join IFFC

2011-11-06T13:32:00.000-05:00

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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Zari is 5!

2011-11-02T11:30:00.004-04:00

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:

Common Ground Statements from the Home Birth Summit

2011-11-01T21:14:00.001-04:00

What Were the Outcomes of 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.

~~~~~
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.

Pregnant pumpkin gives birth, nurses baby

2011-10-31T15:25:00.002-04:00

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!"

iBirth review & giveaway

2011-10-30T21:55:00.000-04:00

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!

Caught in the act!

2011-10-27T21:04:00.000-04:00

Raiding my tupperware drawer...
not to mention standing up by herself...

Birth as Art

2011-10-26T21:42:00.000-04:00

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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Home Birth Summit

2011-10-22T22:30:00.001-04:00

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.

Home Birth Summit!

2011-10-19T14:43:00.000-04:00

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?

2011-10-19T11:06:00.001-04:00

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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Birth at 90 mph

2011-10-17T20:14:00.000-04:00

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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News and updates

2011-10-14T21:04:00.002-04:00

Clearing out my bookmarks (a.k.a. procrastinating grading my freshman composition papers):

CDC to support Baby-Friendly Hospital Initiative
This just out: the CDC has dedicated $6 million to help more hospitals adopt the Baby-Friendly initiative! Dr. William H. Dietz, MD, Ph.D. and director of the CDC's Division of Nutrition, Physical Activity and Obesity, commented: “We know that breastfeeding rates are higher in Baby-Friendly hospitals, yet only 5 percent of babies in this country are born in these facilities. We need to help hospitals improve their maternity care to better support breastfeeding. This project takes steps to do that, and it offers real solutions to improve the health of mothers and babies.”

Birth as Performance Art?
Brooklyn performance artist Marni Kotak plans to give birth in her art gallery, and the public is invited. From an interview with The Village Voice:

My performance at Microscope will begin as I install the show, setting up my own home-birth center in the space, and will span the entire duration of the exhibition. Part of giving birth is the mental and physical preparation for the event. A lot elements go into a traditional home-birth, and I received a whole list of necessary supplies from my midwife. I will be installing an inflatable birthing pool and a shower in the gallery, along with my deceased grandmother's bed, the rocking chair that my mother rocked me on when I was a baby, shag carpeting, a surround video projection of ocean waves crashing on the shores of my favorite Cape Cod beach, artwork made by my husband and the child's father, Jason Robert Bell, and a small kitchen area for food and drinks.

All of these elements are incorporated to make the labor process as smooth and as comfortable as possible. As this will take place in front of an audience, rather than in the privacy of my home, I am doing extra mental preparation at the advice of my doula (who along with my midwife will be present at the birth) to let go of my mind and totally go into my body. She told me that once I really enter active labor the body just takes over and I won't care at all what is going on around me. My focus will be on having my baby. I know it will be challenging, but I think if people give birth in the completely inhospitable environment of hospitals, hooked up to IVs and monitors and strapped with stirrups into a bed, I can give birth in an art gallery. And in giving birth in front of the audience, I am showing them, as in my previous performances, that real life is the best performance art, and that, if our eyes can be opened to it, all of the meaning that we seek is right there in our everyday lives.

Read the rest here.

Live home birth
Another woman, Canadian chiropractor Nancy Salgueiro, will be live-casting her birth. She's currently 41 weeks pregnant, so it should happen any day now. If you want to watch, you can register here.

Two VBAC stories
Accidental unassisted birth (caution: will probably make you laugh) and a hospital VBAC with a midwife & OB teaming up.

Birthing in Zion
If you're an LDS birth worker, there's a new online directory called Birthing in Zion organized by WAVE (Women Advocating for Voice & Equality).

Baby Style
My friend Desiree just wrote about baby style. I agree 100%. No rhinestones or tutus or butt pants on my little girls! My own style--if I can call it that, since 99.99% of my kids' clothes are second-hand--leans towards the slightly feminine but not girly. Some of my favorite girl's outfits are jeans and a peasant blouse. Of course, my kids wear a lot of mixed-gender clothes too! Zari's summer sandals are used boy's sandals with footballs and baseballs, and Dio's sandals are pink leather hand-me-downs.

Who is the biggest loser?

2011-10-11T22:43:00.000-04:00

My freshman composition class just wrapped up a unit of readings about food. We read a wide variety of articles and essays: classic Michael Pollan fare ("Eat food. Mostly plants. Not too much."), arguments for vegetarianism as the most environmentally friendly way to eat, advocates of conventional industrial agriculture, articles about America's obesity crisis, and arguments for genetically modified plants as the future of sustainable agriculture. We also watched Food, Inc. and had a local organic farmer visit our class as a guest speaker.

Our readings on food discussed several perspectives on obesity. Some encouraged better individual eating choices as the solution to unhealthy bodies. Others pointed fingers at US food policy that subsidizes overproduction of corn and thus floods the market with cheap corn-derived foods. Some noted that while cheap, unhealthy food isn't good for our bodies, it is deeply enmeshed in the American economy and thus will be hard to change.

Last class, I did an activity about reducing excess wordiness, which I called "The Biggest Loser." I had never seen the TV show before, so I did some "research" and watched a few episodes. I found myself simultaneously fascinated and cynical. It was incredible to see the physical transformations the contestants undergo. Despite the annoying reality TV genre, I still felt motivated when I heard the contestants' success stories. You can do it! Rah rah rah! At the same time, I felt cynical because only a tiny minority of people struggling with excess weight have access to a team of personal trainers, dietitians, and physicians--not to mention an all-expenses-paid stay at a weight-loss camp. "The Biggest Loser" both inspired me and deepened my skepticism.

Obesity has its own controversies in the world of maternity care. On one hand, maternal obesity is associated with many pregnancy & birth complications. But we don't know how much of this is simply self-fulfilling prophecy and/or care provider bias and how much is due to inherent risk of obesity itself. Should we strive towards fat acceptance and the concept of being healthy at any size? Is there some kind of reasonable BMI benchmark we should encourage women of childbearing age to reach? Will focusing on individual choices make more of a difference than trying to change systemic failures? Or will it just make overweight women feel more guilty?

Thoughts?
Links to articles you'd like to share?

Wish list...

2011-10-06T15:46:00.001-04:00

Some things I'd love to do...maybe in another lifetime

Do an underwater maternity photo shoot
I'd have to get pregnant first, but isn't this underwater photography just about the most beautiful thing you've ever seen? Here's a peek at one of the photos from Kevin Beasley Photography.

Take CrossFit classes
I exercise 3 mornings a week right after I teach. I usually do 10 minutes of rowing, then lift weights, then do an elliptical machine until Eric arrives with the kids. But I'd like to take my fitness to another level. My sister-in-law has been doing CrossFit and swears by it. She's never been so fit in her life, and she has five children now! I don't care about trying to be thin. I just want a strong, capable, athletic body. I definitely don't want to be skinny fat.

Have a dress form made from my actual body
If you've ever wondered why your clothes often fit poorly, look at the body shape used for creating clothes. I've never seen a woman who actually looks like this (size 8 or "medium")...

or this? (a "plus size" dress form)

Yeah, that's why your clothes don't fit!

What is on your wish list?
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7 months old!

2011-10-02T22:08:00.001-04:00

Even though Inga is my third baby, every new milestone is just as exciting. She smiles! She sits up! She gets teeth! Since my last update two months ago, Inga has learned how to sit up by herself, how to push herself up on hands and knees (or hands and feet in a perfect downward facing dog), and how to move herself all over the place. She hasn't technically crawled, but has done everything else short of that.

I can't get enough of her. She is seriously the most easy-going baby ever. She's content to sit and play with toys for long stretches of time. Thanks to this we've been able to get lots of home renovations done.

She puts up with quite a bit of ~~abuse~~ love from her siblings.

I'm holding off solids for as long as possible. Zari was 10 months before she had any foods, while Dio was just over 6 months. (Very typical of his personality--I could not hold him off any longer). Inga has ingested grass, leaves, and the occasional pea scavenged from underneath Zari and Dio's chairs, but otherwise she's on a strict breastmilk diet for as long as possible. I'm all about lazy parenting and nothing is as easy as nursing. Once a baby starts to eat food, you have to deal with feeding and cleaning them, finding something for them to eat, and nasty stinky diapers. Plus I want to hold off my fertility for a while longer. So lazy parenting = good all around.

When I updated two months ago, Inga was waking once, occasionally twice, a night. Now she's back to 3-4 times a night. This has happened with all three kids at around the same time. I have no idea why. If Inga follows her siblings' patterns, I'll have another 6-12 months before she genuinely sleeps through the night. As much as I like that idea, I also like keeping my fertility at bay so I'm fine with the more frequent night nursing.

Today, Eric discovered two little bottom teeth poking out! She hasn't been crabby so the teeth were quite unexpected. (And that dot on her forehead is something on my camera lens.)

I don't know how I'll ever be able to say I'm "done" having kids. I love, love, love the baby stage and the thought of never having another laughing, smiling baby makes me so sad. I think 5 kids sounds about right--probably because I came from a family of 5 siblings--but what if I have 5 and still feel the same way? Hmmmm, probably best to just focus my energy on the ones I have right now and not worry about the future.

6 months!

Anyway there's lots of happiness chez les Freezes.

Natural body products

2011-10-01T21:03:00.000-04:00

I wanted to mention several natural body products I have been using. Some were purchased, others were samples provided for me to review, and others were won in a giveaway. So here's what I have been trying out:

1. Kiss My Face products (won in a giveaway): I love the scent of the six products I received. The skin, hair, and lip products are all made with real orange essential oil, so you're smelling the real deal--not a chemical reproduction of "orange flavor."

Berry Smart Toothpaste: A sweet berry-flavored kid's toothpaste that comes in fluoride-free or regular versions. It was a bit sweet for my taste, but Dio liked it.
Orange U Smart Whale of a Soaps: I still haven't tried these out yet. I don't use bar soap very often.
Obsessively Natural Lip Balms: The lip balm was a bit on the dry side--I had to rub it quite hard on my lips. It has softened more as I've gotten lower down in the tube.
Orange U Smart Bubble Wash: Love it! My only complaint is that it seems a bit watery. We go through this way too quickly!
Self-Foaming Hand Wash: My kids think foaming hand soap is the best thing ever. No complaints when I ask them to wash up.
Self-Foaming Shampoo and Body Wash (no longer available): It's too bad this isn't available any more, since it's great stuff. It's a multipurpose foaming wash that also works as a baby shampoo. You squeeze the bottle and the wash comes out in big, foamy bubbles.

2. Bionée organic maternity skin care.

Bionée is a new company, started last year by a woman who fell in love with the bounty of the French countryside. It specializes in natural, organic, fair-trade skin care for mother and baby. I received two small samples to review: Silhouette Lotion and Body Caress. The Silhouette Lotion is supposed to tone and lift. Now, I wasn't able to verify if, indeed, the lotion could lift and tone with just a small sample. But I loved the smell and feel of it--super light and fast to absorb. (Could someone please invent a cream that lifts not just skin but also droopy boobs? I'd totally buy it!) Body Caress is a creamier lotion created to soothe and protect a baby's skin. Another lovely product that I like for my own skin as much as for Inga's.

3. Nature's Gate Fragrance-Free Lotion for Sensitive Skin (purchased).

I wanted a light, all-natural lotion with a smell that wouldn't bother me. I was ordering through my United Natural Foods buying club, so I couldn't test the lotion out ahead of time. I opted for the fragrance-free version, which I am very happy with. It's light, non-oily, and leaves no residue. I want to try the Lemongrass and Clary Sage lotion next time I order. I'm really careful about products that I put directly on my skin--lotions in particular--and I am quite satisfied with Nature's Gate. (I'm more lax with things that you rinse off right away, such as shampoos or soaps. I am super cheap, so I have to prioritize where I will spend and where I will economize.)

4. Green Body Basics Naturally Effective Deodorant (sample provided for review)

I've never used a natural deodorant before. In the past, I've either used conventional antiperspirants (during the summer months) or nothing (during the winter months). Unlike aluminum-based antiperspirants, Green Body Basics deodorants do not block the skin's pores. They are more of a true deodorant than an antiperspirant, although the baking soda absorbs moisture as well as blocks scent. I absolutely love how Green Body Basics "Stamina" smells. Love it. I want to wear it just keep smelling it. It's scented with clary sage essential oil. Somehow, I've never come across this particular scent before and I love it. It's very fresh, not too musky or flowery.

Now for a more theoretical musing about "natural" body products:

As much as I think these products are quite lovely, and that it's good to use body products that are natural, organic, and plant-based, I wonder if focusing on individual consumption will divert time and resources away from system-wide problems. At a certain point, you can't avoid exposure to environmental contaminants. No matter how many organic or "natural" products you buy, a lot of pollutants and toxins come via mechanisms that we can't control or filter out. I'm not saying that we should just put anything and everything into our bodies, but I wonder how much effect purchasing (lovely but often quite expensive) "natural" or organic products will have in limiting our overall chemical exposure. I think a better focus than individual consumption is state- and nationwide regulation of harmful substances.

Currently reading

2011-09-27T08:57:00.008-04:00

A Discovery of Witches by Deborah E. Harkness. A fun read in which an American witch and a French (well, now he's British 1000+ years later) vampire, pursuing an ancient manuscript, fall in love. Oh, and there are daemons too. It's written by a history professor, so keep your eyes open for historical references to various medical and alchemical personages. The book ended right when things were getting really interesting, so I certainly hope there's another book in the works!

The Witch's Daughter by Paula Brackston. A 300+ year saga of an English witch, pursued through time by her warlock tormentor Gideon. The story spins the tale of the dueling forces of good (the witchcraft practiced by the narrator) and evil (the sorcery and Devil worship practiced by Gideon). Lots of details about paganism & Wiccan practices sprinkled throughout the book.

The Proviso and Stay by Moriah Jovan. I read a book review of Jovan's most recent novel Magdalene and was hooked: a recently-widowed Mormon bishop who marries an former high-end prostitute? Too fun to pass up! I haven't been able to get my hands on Magdalene yet, but I did read the first two novels of the Tales of Dunham series. Her books aren't for the faint of heart--there is a lot of swearing and a lot of sex. I found myself very intrigued by the characters in her books, especially those in The Proviso. Many of them are, for lack of a better word, "Mormon misfits," the kind of people I would love to spend time with. These books are definitely not Mormon genre fiction, though; while several of her characters are Mormon, their religion isn't the central focus of the story. I liked The Proviso more than Stay, which was more of a romance than anything else. I'm less than patient when the central drama is "will they or won't they finally admit that they love each other?

Arms Wide Open: A Midwife's Journey by Patricia Harman. I expected this book to be a memoir about being a midwife, but instead it's mostly a memoir of her evolution from a back-to-the-land anti-war hippie living in a commune (who, on the side, became a home birth midwife) to a nurse-midwife married to an OB/GYN three decades later. Even as it questions the utility (futility?) of the counter-cultural movements of the 1960s and 70s, Harman's book also celebrates that hopefulness and optimism that led people to deliberately abandon their possessions and educations and live lives of voluntary poverty. I was hoping for more stories of her life as a midwife, but I'll have to read her other book, The Blue Cotton Gown, for those tales.

Either/Or into And/And

2011-09-24T17:16:00.000-04:00

Life as a parent is full of either/or's: either I let my baby cry while I shower, or I hold my baby and forego personal hygeine. Either I get dinner made on time, or I spend the afternoon outside with the kids (and then deal with hunger-induced tantrums).

But sometimes you can turn an Either/Or (either I paint the porch ceiling or I hold my baby) into an And/And situation:

The Mermaid's Muse felted wool dolls

2011-09-23T12:29:00.003-04:00

Several months ago I was browsing through Etsy and came across The Mermaid's Muse. I fell in love.

I never knew that wool could so beautifully express emotion and relationship. Don't you just love these pieces?

The store's owner, Kate, has two children. She writes:

My daughter sees mermaids in every body of water we pass. Her glorious imagination and bright interest in life provides fuel for my creativity. From the simplicity of Waldorf-inspired toys to the profoundness of a parent's first embrace, I have the chance to see the world anew through her eyes. She is my muse.

As of November 2010 I am blessed with yet another muse! A new baby reminds me of the fast fleeting nature of childhood as she grows and changes everyday. Through many of my newest pieces I relish motherhood and the bond of love for a child.

Kate sent me "Dandelions" to review: a mother and child discovering the beauty of an everyday flower. The set of dolls is about 7" high and solidly felted.

Look at these incredible details--the curly hair, the silken scarf...

If you love her work as much as I do, please visit The Mermaid's Muse. Her pieces would make the perfect gift for a new mom or mother-to-be; for a midwife, doula, or physician; or of course for yourself!

TriLight giveaway winners

2011-09-22T17:00:00.000-04:00

If you are one of these winners, please get in touch with me!

llamaofdoom (BOLD giveaway)
Still standin' (BOLD giveaway)
Rosemary (BOLD giveaway)
Alisha
Abundant B'earth

Lamaze Conference, Fort Worth TX

2011-09-21T21:21:00.001-04:00

I'm back from another Lamaze conference. This year seemed to be "all about the baby." Almost every presentation I attended (and the talk I gave) was about breastfeeding, skin-to-skin, or other post-birth baby care. Last year Linda Smith, in her plenary address, urged us: "If you want to change birth practices, get on the breastfeeding bandwagon." It seems like people have taken her advice seriously!

Thursday's plenary session was about elective late pre-term and early term inductions (before 39 weeks). The presenter, Dr. Rebecca Ewing, showed the video RISK: Consequences of a Near Term Birth, aimed at discouraging parents from choosing inductions before 39 weeks because of the risks involved. I have some serious concerns that the movie will just foster more fear and guilt in parents, rather than motivating them to avoid an early induction. It told the story of two mothers who had late preterm/early term births at 36 and 37 weeks and whose babies had serious complications from being born early. But these mothers went into labor spontaneously. The film really should have featured women who had elective near term inductions, not spontaneous preterm births!

Friday's first plenary session was by Debra Pascali-Bonaro. She heads the International MotherBaby Childbirth Organization and has helped implement Mother-Friendly birth practices in hospitals and birth centers across the world. Her presentation "IMBCI: What Does an Optimal MotherBaby Model Look, Feel and Smell Like?" showed IMBCI hospitals from high, medium, and low-resource countries. It is amazing what these hospitals have been able to do, even with extremely high patient volumes and very little money.

I spoke during the first breakout session about "A Proactive Approach to Breastfeeding." I had an aha! moment while preparing my presentation and realized that learning how to breastfeed (in our culture) is like learning a foreign language. Sure, breastfeeding is natural and instinctual and almost all women can breastfeed successfully--but only in a culture where breastfeeding is still the "native tongue." But we don't live in that cultural context any more. We are fluent in bottle-feeding, not breastfeeding. So we have to learn (re-learn) the language of breastfeeding--how to hold a breastfed baby, what a good latch looks and feels like, how often and how long to feed the baby, how to know when a baby is hungry or is satiated. These are all things that women who are breastfeeding natives might not even be able to articulate; they would just know through observing it everywhere, day in and day out.

Next, I attended Ann Grauer's presentation "Seeing is Believing: Building Breastfeeding Confidence from the Start." Fantastic. So fantastic that I am dying to have her write a guest post and explain how breastfeeding really can be so easy to learn and to teach.

The last session on Friday was a research updated on labor management, fetal well-being, and induction of labor. Liz DeMaere, who used to work as a L&D nurse in Canada and now works for Salus Global Corporation implementing safety & quality measures, explained the newest research based on the SOGC's MORE OB program. Did you know that the ACOG has approved MORE OB? That means that (in theory, if not in reality) all low-risk laboring women should received intermittent auscultation as the standard of care, that primips should not be admitted until they are at least 3-4 cms dilated and having regular contractions (no admits at 1 cm and no effacement!), and that induction of labor should occur unless the reasons are "convincing, compelling, consented, and documented"?

On Saturday morning, I watched the new film The Magical Hour: Holding Your Baby Skin-to-Skin in the First Hour After Birth. Dr. Kajsa Brimdyr (love her name! pronounced "KAI-suh"), who produced the film, led a discussion after the film. This is a companion film to Skin to Skin in the First Hour after Birth: Practical Advice for Staff after Vaginal and Cesarean Birth, which I reviewed last year. So many parents and childibrht educators were using the practical advice film (which was aimed towards care providers and more technical and pragmatic) that Dr. Brimdyr decided to produce a more parent-oriented version. It's fantastic and at less than $40, an amazing value.

Following the film showing, I attended "Listening to Newborns: What Babies Have to Say About Transitions to Life" by Linda Jablonski. It was a research update about bulb suctioning, cord clamping, skin-to-skin contact immediately after birth, and self-attachment. She works at Baystate Franklin Medical Center and helped implement the practices supported by the latest research (no routine bulb suctioning, even after cesarean section; delayed cord clamping, at least 3 mins and/or when cord ceases pulsing; immediate S2S; and self-attachment, rather than actively helping the baby latch on). Her hospital, located in western MA, has a fantastic track record with the lowest cesarean rate in the state (21%) and a VBAC rate of 42% (80% successful). Her hospital really tries to be on the front line of offering innovations. They were the first hospital in the state to offer waterbirth and PCEA (patient-controlled epidural anesthesia). I came away with a thorough bibilography of the latest evidence base for these four practices.

Next, I went to three brief research presentations about chiropractic care in pregnancy (definitely underwhelmed by the quality of both the evidence and of the presentation), about prenatal care in home birth, and about the relationship between epidural anesthesia and childbirth outcome.

I was so tired by this point that I skipped the last session of the day and had a relaxing dinner & evening at home with Inga.

Sunday had one last set of breakout sessions. I attended "Whys and Hows of Supporting Newborns: 9 Stages During Skin-to-Skin" by Jeannette Crenshaw and Kajsa Brimdyr. I told you that it was all about the babies this year!

The last plenary session had nothing to do with childbirth. Instead, it featured a motivational speaker trying to get us to "Fire Up Your Life!". I'm just not into motivational speakers. I really want to hear about pregnancy, birth, or breastfeeding at a Lamaze conference, not how to set goals or find balance in your life.

The journey home was long. I spent 8 hours in the DFW airport (I hoped to go standby on an earlier flight, but no luck). I graded papers and kept Inga amused and somehow we survived. We got home at 1:30 am; Eric had to wake up the kids and drive everyone to the airport to pick me up, so we were all pretty tired the next day.

Inga was the star of the show at the Lamaze conference. She was a total angel and stayed happy and quiet the entire four days of the conference. She loved all of the attention! In fact if people aren't paying attention to her, she will practically yell at them to catch their eye, then smile and preen once they look over.

Don't mess with Texas

2011-09-15T09:48:00.000-04:00

I'm in the lone star state for the annual Lamaze Conference. I'm staying with Desiree of Hitting My Stride. Our babies are hanging out together, we're in our pajamas, and life is good.

I was really emotional leaving my other kids yesterday--and if you know me, I almost never cry. It doesn't help that they were both crying at the airport and that Dio said all the way home "where's mama go? where's mama go?"

Yesterday Desiree introduced me Dude, Sweet Chocolate. Amazing. Their store has a lot more than what's offered online. I bought dark chocolate & blue cheese truffles and a 100% cocoa bar with sesame seeds and balsamic vinegar (yes really, they're delicious).

I need to work on my presentation. Come say hi if you're at the conference!

TriLight Health giveaway

2011-09-12T21:47:00.000-04:00

Interested in trying a product from TriLight Health? I am offering a giveaway to two more lucky winners! Each winner will receive their choice of any of TriLight's best-sellers.

How to enter:

Submit a comment about which TriLight product you'd like to review
Contest ends Friday, September 16 at 5 pm EST
Open to US residents only
Winners agree to write a review of their product within 7 days of receipt.

Labor Day Weekend

2011-09-10T21:47:00.000-04:00

Before this next weekend comes to a close, I want to write about my Labor Day weekend in NYC. First off--going somewhere with just my husband and one baby made me feel young and single again! We could watch movies! Go from Brooklyn to Manhattan and back several times in a day! We could stay up late and meet famous people! Seriously, life is so easy with just one baby. I hadn't realized how much I had adjusted to three small children until I spent three night away. It's the first time Eric and I have ever been away by ourselves (little Inga doesn't count!) since we started having kids.

We didn't even do anything super crazy. The whole fun was having so much freedom and quiet and discretionary time.

On Saturday night, we watched Midnight in Paris in lower Manhattan. My sister gave me a Fandango gift certificate, so the tickets were free. The film was fantastic--if you've ever studied the writers & artists in 1920s Paris (Hemingway, Fitzgerald, Dali, Stein, Baker, Porter, Picasso, etc), you'll absolutely love it.

We were the only people there with a baby. I didn't see anyone else under the age of 18, so we certainly got lots of stares. While the previews were running, I heard a very loud comment from a man a few rows back about "somebody bringing a baby to the show." It was totally obvious the comment was aimed in our direction. But I knew my little Inga. As soon as the movie started, I nursed her and she was out for the entire show. Not even a little squeak. So there, rude Manhattanite who assumed his evening would be ruined. I got lots of glowing comments on the way out of the theater about how angelic my baby had been.

On Sunday, I had a lovely breastfeeding moment. We attended services at LDS Park Slope Ward in Brooklyn. It's full of young families with small children. (Seriously, everyone was so stylish and hip-- pixie hair cuts, chunky glasses, slim 1960s-style suits...definitely different from my home congregation!) Anyway after the meetings were over, I was sitting in the lobby breastfeeding Inga with my top unbuttoned. No cover, of course. One of those uber-hip guys (late 20s, probably a father, skinny pants, closely cropped beard, thick-rimmed glasses, screaming "graphic designer") came up to me and said, "I'm so glad to see you breastfeeding openly!" He chatted about how he wants women to feel welcome to nurse openly, rather than having to hide in the mother's lounge. He said a lot of people still feel they have to use a nursing cover, even when they're in the mother's lounge. Crazy, huh? So that was a lovely moment.

I had a not-so-lovely moment on the metro, though. A man sat down next to me and started chatting amiably about Inga, throwing her smiles and getting her to laugh. He asked, "Is this your first?"

"No, she's my third?"

"Planning on having any more?"

"Hmmm, probably."

Then he turned from nice baby-cooing man to evil you're-what's-making-this-country-go-to-pot man. I got a lengthy tirade about how I should not have any more than three children, how if I had more than three, pretty soon we'll end up on welfare and our kids will be messed up and we will be miserable, since we obviously will not be able to provide for more than three children. This continued for about fifteen minutes. I just nodded and said yes and waited until we came to our stop. I mean, what can you say?

On Labor Day, we met at Karen's parents' apartment in the Upper West Side with other VIPs, including producer Elizabeth Mangum-Sarach (director of BirthFocus and blogger at BIRTH...from the backseat), Debra Pascali-Bonaro, and Kirsti Kreutzer & Anna Van Wagoner (from Where's My Midwife? and creators of Pregnant Mayhem). I had a nice talk with Ina May Gaskin, whom I've seen several times at conferences but never had the opportunity to meet in person until then.

Now, onto the BOLD event at the Museum of Motherhood--the reason for our NYC adventure. I arrived a bit frazzled, since the Metro ride from Brooklyn to the Upper East Side took quite a bit longer than it usually does. I nursed Inga as fast as possible (which is when this picture was taken), put on my high heels, and slipped into my seat just in time for the show to begin. It was a reading of Karen Brody's play. It was fully choreographed, except the actors had scripts. Several had memorized their parts, so much of the time it didn't feel like a reading.

I loved the play--full of real stories from real women from all walks of life. Women who chose elective c-section and loved them, women who had inductions and loved parts and hated other parts, women who had traumatic births and chose something different the second time around, women who stayed with their doctors even though they knew they should switch and women who switched providers to get the care they deserved.

I met Jill from The Unnecesarean ("Hey Rixa, I never realized you were so tall!" Jill is even taller, BTW), ICAN president Desirre Andrews, and more. Abby Epstein was there, but I never got a chance to introduce myself. I got to say some fun blurbs about my reaction to the play for the DVD they're producing.

During the play, Eric and Inga strolled around the neighborhood. Eventually he found a couch sitting on the curb--perfect place for Inga to nap. (Of course he hadn't worried about bedbugs at the time; let's hope they didn't pick any up from the abandoned couch!) After the filming was over, they joined us for the 5th anniversary birthday celebration. We got home a bit after 1 am and Inga was amazingly cheerful despite the late night and being dragged all over New York City.

Special thanks to chou and husband for letting us sleep in their living room!

Breastfeeding at the Museum of Motherhood

2011-09-07T21:30:00.001-04:00

Nursing Inga before the BOLD 5th Anniversary Event at the Museum of Motherhood in NYC. More details coming later about the weekend...

(I thought about photoshopping the nursing bra out...but I love the juxtaposition of the mundane bra and the fancy dress. Inga kept trying to pull the beads off.)

BOLD giveaway!

2011-09-04T20:50:00.000-04:00

Don't forget to register to register to view the BOLD's free webcast of BIRTH! It will be shown live tomorrow (Labor Day) at 7pm EST. If you can't watch it tomorrow, you can view it at several times throughout September.

To entice you to watch Karen Brody's play, I am thrilled to offer an interactive giveaway from TriLight Health. Here's how it works:

5 winners will receive their choice of any of TriLight's best-sellers. Each winner will submit a review of the product, which I will then post.

How to enter:

Register for the BOLD event
Submit a comment letting me know you've registered and which TriLight product you'd like to review
Contest ends tomorrow at 7 pm EST
Open to US residents only
Reviews must be submitted within 7 days of receiving the product.

More than one but not quite two

2011-09-02T09:00:00.017-04:00

Today my freshman composition students are discussing what it means to be a man or a woman, in preparation for their first major writing assignment. In honor of Inga turning 6 months old today, I decided to do the writing assignment myself. I'm sharing it with my students to give them ideas for their upcoming paper. Inga is coming with me to class today; I hope she will add something tangible to our discussion!

What does it mean to be a woman?

Dr. Rixa Freeze

September 2, 2011

In kindergarten math class, I learned that 1 + 1 = 2. In grade school, I learned to conjugate verbs. I am. She is. You are. In high school biology, I learned about meiosis and mitosis, how our genetic code divides and recombines like great spiral zippers. In college, I learned about the political theory of individualism, about Cartesian dualism, and about feminist theories of the body. Yet none of this prepared me for the seismic shock of becoming a mother and suddenly discovering that I was more than one, but not quite two.

When I was pregnant for the first time, I felt a strange sense of recognition for my expanding body. My belly stretched, my breasts swelled, my skin tightened. I felt, for the first time, entirely myself. This, I thought, is what a woman’s body really is. It was a great discovery, as if I had circumnavigated the globe and split the atom and solved global hunger in the course of an afternoon.

Still, I could not ignore the little being inside of me. It first felt like champagne bubbles, then a school of minnows, then finally, like an actual baby. I could feel head and legs and butt. It hiccuped at predictable times. It kicked and punched, stretched and rolled. (It? She? He?) There was a person inside me, hidden behind skin, muscle, and water. This person was half me and half my husband, completely reliant upon my body but entirely its own self.

We think of birth as the great dividing moment that separates mother-fetus into mother and child. I’ve heard parents and doctors say “You’re on your own now” when they cut the umbilical cord. But I think of my third child’s birth and I can’t point to a definitive moment when I (pregnant woman) became me (mother) and her (baby). When did we become not-one-but-two—was it when her head emerged from my body? Was it when her legs and toes slipped out? Was it when, a few seconds after her birth, she lost her color and I gave her the first breaths of life? Even those breaths were not hers. They were mine, passed from my lungs to hers in the most intimate and urgent embrace either of us had ever known.

So I am not convinced that the act of birth marks the line between one and two. After birth, when our bodies were no longer tied together by umbilical cord and placenta, my babies still relied upon me for survival. My breasts were literally their lifeline. My youngest baby, six months old today, is still only nursing. I cannot leave her for more than a few hours at a time. Her rolls of fat, her dimpled bottom, even her hefty double chin came directly from my body.

We are more than one, but not quite two. I haven’t discovered the calculus to describe where one self ends and another begins. I can only notice when the boundaries of personhood blur: how I can’t stop kissing the soft folds of her neck, how I wake at night moments before she does, how my body turns blood into milk into baby.

BOLD in NYC!

2011-08-26T21:11:00.001-04:00

I am super excited to announce that I'll be coming to the BOLD (Birth on Labor Day) 5th Anniversary event in New York City! Playwright Karen Brody extended a VIP invitation and I couldn't refuse the chance to see her play Birth.

If you've already seen Birth, you'll want to watch it again. Karen rewrote the script and added a birth-- and it's a VBAC!

The 5th Anniversary event will also honor 5 people or organizations who have used the arts to educate pregnant moms about childbirth, including: Debra Pascali-Bonaro for Orgasmic Birth, Ricki Lake and Abby Epstein for The Business of Being Born, Christy Turlington for No Woman, No Cry, Kirsti Kreutzer for Where's My Midwife?, and the White Ribbon Alliance for Play Your Part and Avec Nous. We will also be honoring Ina May Gaskin.

If you live in the area, you can attend the performance with me at the brand-new Museum of Motherhood. If you can't make it to NYC, you can still watch the performance online! It will be webcast live on Labor Day and rebroadcast several times throughout September (Sept 17 & 24 every 5 hours: midnight, 5am, 10am, 3pm, 8pm ET). Click here to register for the 5th anniversary webcast.

I'm also really excited for this weekend, because Eric is coming out with me (and Inga, of course). We will have the entire weekend together without the two older children. We recently had our 13th anniversary and this will be the perfect opportunity to celebrate. I even went shopping and bought a fancy dress :)

Twins to Singleton: New Ethical Dilemmas

2011-08-25T16:29:00.000-04:00

Yesterday I read a fascinating--and somewhat disturbing--New York Times Magazine article about twin-to-singleton pregnancy reductions. Formerly only used to reduce triplets, quadruplets, and above, pregnancy reductions are increasingly sought to reduce twins to a single fetus. A few excerpts from The Two-Minus-One Pregnancy:

For all its successes, reproductive medicine has produced a paradox: in creating life where none seemed possible, doctors often generate more fetuses than they intend. In the mid-1980s, they devised an escape hatch to deal with these megapregnancies, terminating all but two or three fetuses to lower the risks to women and the babies they took home. But what began as an intervention for extreme medical circumstances has quietly become an option for women carrying twins. With that, pregnancy reduction shifted from a medical decision to an ethical dilemma. As science allows us to intervene more than ever at the beginning and the end of life, it outruns our ability to reach a new moral equilibrium. We still have to work out just how far we’re willing to go to construct the lives we want....

The ability of women to control their fertility has created all kinds of welcome choices. “But the dark lining of that otherwise very silver cloud is that you make the choice of when to get pregnant, and so you feel really responsible for its consequences, like do you have enough money to do it well, and are you going to be able to provide your child with everything you think you ought to provide?” says Josephine Johnston, a bioethicist at the Hastings Center in Garrison, N.Y., who focuses on assisted reproduction. “In an environment where you can have so many choices, you own the outcome in a way that you wouldn’t have, had the choices not existed. If reduction didn’t exist, women wouldn’t worry that by not reducing, they’re at fault for making life more difficult for their existing kids. In an odd way, having more choices actually places a much greater burden on women, because we become the creators of our circumstance, whereas, before, we were the recipients of them. I’m not saying we should have less choices; I’m saying choices are not always as liberating and empowering as we hope they will be.” (emphasis mine)

Read the rest here. It's definitely worth your time.
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FEMINIST HULK SMASHES CONTRACTIONS

2011-08-24T07:48:00.002-04:00

Twitter phenom Feminist Hulk recently spoke with Ms. magazine about giving birth. Turns out she's a PhD student from the University of Iowa, where I did my degree! I've been away long enough that we've never met in person, although there's a 99% chance that I know her midwives. I miss those long afternoons at Iowa Midwives' Association meetings...

Congratulations on your baby! Did your Feminist Hulk superpowers come in handy during the 44 hours of labor that led to the birth of your child?
Hulk is all about productive discomfort–the notion that growth requires us to step outside of the familiar spaces where we feel safe. My pain during childbirth had less to do with the relative strength of any given contraction but with the attitude I brought to coping with that. When I felt vulnerable or passive, I tried to hide from the contractions, which only made it harder. My midwives and my mom really helped me dig in, get active and aggressively pursue the contractions. I would dance to bring on contractions, then get in position and say, “Okay, this is gonna fucking suck, and I’m gonna make it suck even more, because then there will be one less contraction between me and my child.” I created new comfort zones.

Why did you decide to have a home birth? What were some of the challenges you faced in making that happen?
While I value the ways that obstetrical science has made birth safer for women with high-risk pregnancies, mine was a low-risk pregnancy and I was compelled by the many studies that show the midwifery model of care is as safe as hospital birth, often with fewer interventions and post-birth complications. Unfortunately, though Certified Nurse-Midwives legally practice in all 50 states, I gave birth in one of the handful of states which still does not license Certified Professional Midwives. I am active in attempts to push midwifery licensure through our state legislature. I still chose home birth, though, and am so lucky to have labored in an environment that made me feel relaxed and safe, with a birth team that gave me tons of love and support. And for anyone who asks, “What if something goes wrong?” all I have to say is, “Something did go wrong.” I suffered a postpartum hemorrhage and lost about a quart of blood. My birth team responded with speed and skill to stop the bleeding (and they would have transferred me to a hospital without hesitation if they encountered a complication that required additional resources). I owe them my life, and I have nothing but faith in the quality of their care.

How did your pregnancy affect your views on reproductive rights?
I’m a single mama by choice. I spent two years planning before I began the insemination process. Not long after I became pregnant, state and federal law saw an unprecedented parade of anti-choice and anti-reproductive health legislative proposals. I was sick with anger when I heard the horrible and unfounded assumptions being made about women who consider abortion. I felt so blessed to have chosen my pregnancy, and I wouldn’t ever want someone to be forced to bring a child into the world who wasn’t chosen. My love for the life growing inside me made me even more committed to protecting the legal right to choice.

Read the rest here.

Thanks Babble!

2011-08-23T20:13:00.001-04:00

Read about it here.

Sunday School blues

2011-08-21T22:57:00.000-04:00

Zari got kicked out of Sunday School today.

I love saying that. And it's true. So here's the back story: we go to a 3-hour block of meetings on Sundays. The first hour is the main worship service, called "Sacrament Meeting." The second and third hours are various Sunday school classes; children go to "Primary" classes.

Anyway, Zari had been really restless and difficult all during Sacrament Meeting. She went off to Primary, and I played hooky from Sunday School and sat in the lobby with Inga. (Sometimes I just need a break after shepherding all three kids during the worship service.) About ten minutes later, I heard loud moans coming down the hallway. Zari was being carried--rather ungracefully, since she's quite tall--by one of the teachers. Apparently she had been acting out repeatedly. Finally they gave her a choice: settle down or leave. It's obvious what her choice was!

She wasn't happy about being kicked out. For about fifteen minutes, she moaned and cried: "I want to go to Primary! I want to go to Primary!" I laid her on the couch, covered her with a blanket, and waited until she began to quiet down. Then I told her she could go back if she was ready to calm herself down and be helpful in class. We took a few deep breaths together. She wiped her tears off and put on a cheerful face. She was ready. We walked down the hall holding hands, and she went right to her teacher's lap for some extra hugs and snuggles. All was well again.

I'm glad that she was kicked out. She deserved it! Now she knows that certain behaviors are not appropriate and that her teachers won't take any nonsense.

Sometimes, your kids just need to cry. Sometimes, they need to be kicked out of class, even if it's just Sunday School.

Poison ivy remedies

2011-08-16T22:22:00.001-04:00

I love my new house, but I have a love-hate relationship with the yard. When we closed a few months ago, the property looked like a jungle. Vines were growing all over the house and carriage house. Half of the back yard was a tangle of shrubs and volunteer trees. Worst of all, poison ivy was EVERYWHERE: under bushes, growing up trees, even creeping all over the lawn.

This was bad news, since I am extremely sensitive to poison ivy. Once I get it, it spreads all over my body. I've had to go on oral steroids just about every time I've been exposed. I use Tecnu Outdoor Skin Cleanser after I've been doing yardwork in infested areas.The main ingredient is deodorized mineral spirits. That makes sense; mineral spirits is a solvent used for thinning paint and dry cleaning. You could probably wash with low-odor mineral spirits from the painting aisle; you'd just smell like paint thinner for a while!

(My aunt swears by rubbing undiluted bleach on the rash as soon as it appears. Any other remedies you've heard of?)

The problem is, I don't always know where the poison ivy is--or was. Even dead leaves, stems, and roots can release the oil (urushiol) that creates the itchy rash. I've gotten into poison ivy in the most unlikely places. What I needed is something that will keep me from reacting to it in the first place.

The last time I saw my family doctor for a steroid prescription (three months ago), he mentioned that there used to be an injection for poison ivy. You would get a few shots at the beginning of the growing season. It contained small amounts of urushiol and would decrease your body's sensitivity to the oil. Unfortunately, it is no longer manufactured.

About two months ago, a friend of mine called and said she'd seen a poison ivy tincture at a compounding pharmacy in Peoria, IL. I talked to a pharmacist, who explained how and why it worked. Taken orally once a week in a glass of water, the tincture contained small amounts of urushiol and would decrease your body's reaction to poison ivy. A large portion of their customers are landscapers; they report that their reaction to poison ivy either disappears or is greatly reduced when they are using the tincture. I ordered a bottle of Preckshot Professional Poison Ivy Preventer right away (around $30 with shipping).

I've been taking the tincture (15 drops in a glass of water, weekly) for about five weeks. I wasn't about to rub poison ivy on myself to test it out, but a few days ago I got into it by accident. I saw and felt the familiar rash appearing the next day.

Would the tincture really work?

This time, the rash only spread to a few places, and only in small bumps. I had a huge smear of poison ivy inside my arm, and it never even blistered. In the past, the rash has continued to blister and spread for at least 1-2 weeks past the initial exposure. This time, the rash peaked about 2-3 days after exposure and then started to fade. I stayed comfortable using two OTC anti-itch creams and never had to go on steroids.

I'm still careful to wash with Tecnu after possible exposure, but I am much less afraid of my yard now that I am taking the poison ivy tincture. This product definitely gets a thumbs-up.

New job

2011-08-11T21:57:00.000-04:00

It's been a whirlwind past few weeks. I applied to teach a section of freshman composition, got accepted, and have been in new faculty orientation this week. Eric has been super helpful: taking the kids every morning while I'm in meetings and bringing Inga every few hours to nurse. I'm really excited to teach again. The position is just one course, so it should be doable as long as I cut back on other things.

Like blogging, for one. I simply cannot keep up my usual pace of posting daily. I've decided to post twice weekly (more often if time permits).

Classes start in two weeks. I'm browsing through piles of textbooks and working on my syllabus. I'm going to use Peggy Vincent's memoir Baby Catcher for the a segment of the class--I've used it before in freshman writing/rhetoric courses, with great success. I'll be teaching MWF at 8 am. The plan is to wake up at 7 am, nurse Inga, go to class, exercise at the college athletic facility, and return home by 10 am. I'll have some office hours on campus and some at home during naptime.

Can't wait to be Professor Freeze in a few weeks!

Looking for VBAMC stories and provider

2011-08-06T21:59:00.001-04:00

A friend of mine (actually, the friend who helped introduce me to my husband!) just wrote to me with a request. She had a vaginal birth, and then two cesareans, and is thinking of having a fourth. So far, she hasn't had much luck finding a provider willing to do a VBA2C. She lives in San Antonio, TX.

Please share your VBAMC stories and, if you know someone in the area willing to attend a VBA2C, get in touch with me!

Here's what she wrote:

Are you familiar with any birth stories of women who have done a VBA2C? I'm dreaming of another baby, and I keep thinking how awesome it would be to do a water birth. Am I crazy? My first delivery was a vaginal birth - went great, no problems (I did have an epidural which was fantastic). My 2nd I was induced on my due date (doctor's idea and I was uninformed) and it ended up as an emergency c-section due to fetal distress. My 3rd was going to be a VBAC but I never went into labor so it was a repeat c-section at 41w6d. My doctor didn't think it was wise to wait any longer, and I was ok with that.

I need to say that both of my surgical births were wonderful experiences. The recoveries were very easy (easier than the vaginal birth for sure), and I'm not necessarily opposed to a 3rd c-section. I just want to explore options and prepare for the future.

Can you send me some articles to read or any advice or links to birth stories?

Thanks for any help you can offer.

5 months old!

2011-08-02T23:11:00.000-04:00

So many changes start once your baby reaches 3 months. In the last two months, Inga started laughing (first laugh at 3 1/2 months when I was playing "patty-cake" with her feet), discovered her hands and feet, learned how to grasp objects and play with toys, settled into a predictable routine, and became mobile even though she hasn't yet crawled.

This girl is strong! She has a solid core and way better abs than I do. (Which isn't saying much after 3 children...) She's rolling and belly-scooting around in her crib and on our bed. I actually bought crib bumpers at a thrift store today because she was rolling over forcefully into the crib rails and then crying because it hurt. She loves to stand and will do so for long stretches of time, often just holding on to one of my fingers.

I won't say Inga is a "good baby," but she is remarkably chill and easy-going. Honestly, I can't imagine an easier third baby. She rarely fusses and is almost always content. She takes short naps in the morning and early evening and a long nap after lunch. She goes to bed around 8-9 pm and wakes up usually twice to nurse before she's up around 8 am for the morning. Not bad at all! She definitely likes to snooze and sleep in in the mornings, like her sister and unlike her brother.

I think Inga looks remarkably like Zari. Except Inga is definitely chubbier around the chin and neck! Sometimes I look at Zari's baby pictures and honestly almost think it's Inga. Here are some when Zari was around 5 months old:

Here is Inga at 5 months:

Now for some comparison pictures...Dio around 5 months. He definitely has the "Dio" stamp to him even back then.

Inga as a newborn and at 4 & 5 months:

1 week old

4 months old

5 months old

2 weeks old

4 months old

5 months old

And for those of you wondering what Inga's middle name is...

Let your kids cry

2011-07-31T16:17:00.000-04:00

Last summer, we traveled to Park City, Utah for a family reunion. The return flight from Salt Lake City was overbooked. We volunteered to be bumped (in exchange for $900 in airline vouchers!). The next flight didn't leave until the following day, so we spent the day in downtown SLC.

All of this doesn't really matter, except as the backdrop for the rest of the story. Eric wanted to see one of his college roommates who worked downtown. "Back in 10 minutes!" he told me. I had Dio (1 year old) and Zari (3 1/2). We waited...and waited...for him to return.

Finally we took a bathroom break in the basement of the Joseph Smith Memorial Building. Something upset Zari, and she refused to move. I had to pull her up the entire flight of stairs (while carrying Dio and being newly pregnant with Inga). Her tantrum continued unabated. I dragged her outside to a nearby park. I still couldn't get her to calm down. I probably could have, if I hadn't also had Dio to take care of and if I hadn't been frustrated by a missing husband. I was fed up with her behavior.

So I just left her there.

I sat down with Dio about thirty feet away. Zari continued throwing a tantrum. I played with Dio and kept an eye on her. Some of the other park-goers threw questioning glances at me. "Yes, she's mine," I would shrug and smile.

I've occasionally wondered if I should have done more to calm Zari down. I did get some nasty looks from other park-goers (as well as people telling me how calmly I was handling the situation!). But I read an article today that confirmed what I believe--that your children need to be allowed to feel sad, frustrated, angry, or disappointed. In How to Land Your Kid in Therapy, clinical psychologist Lori Gottlieb urges parents to back off. By being overly attuned to our children, by working so hard to ensure they are always happy and successful, we're actually doing them harm. In her practice, she encountered growing numbers of young adults who felt depressed, adrift, and unhappy, despite loving, engaged parents:

They truly did seem to have caring and loving parents, parents who gave them the freedom to “find themselves” and the encouragement to do anything they wanted in life. Parents who had driven carpools, and helped with homework each night, and intervened when there was a bully at school or a birthday invitation not received, and had gotten them tutors when they struggled in math, and music lessons when they expressed an interest in guitar (but let them quit when they lost that interest), and talked through their feelings when they broke the rules, instead of punishing them (“logical consequences” always stood in for punishment). In short, these were parents who had always been “attuned,” as we therapists like to say, and had made sure to guide my patients through any and all trials and tribulations of childhood. As an overwhelmed parent myself, I’d sit in session and secretly wonder how these fabulous parents had done it all.

Until, one day, another question occurred to me: Was it possible these parents had done too much?....

“Happiness as a byproduct of living your life is a great thing,” Barry Schwartz, a professor of social theory at Swarthmore College, told me. “But happiness as a goal is a recipe for disaster.” It’s precisely this goal, though, that many modern parents focus on obsessively—only to see it backfire. Observing this phenomenon, my colleagues and I began to wonder: Could it be that by protecting our kids from unhappiness as children, we’re depriving them of happiness as adults?

Paul Bohn, a psychiatrist at UCLA who came to speak at my clinic, says the answer may be yes. Based on what he sees in his practice, Bohn believes many parents will do anything to avoid having their kids experience even mild discomfort, anxiety, or disappointment—“anything less than pleasant,” as he puts it—with the result that when, as adults, they experience the normal frustrations of life, they think something must be terribly wrong.

When your child throws a tantrum, scrapes a knee, or fights over a toy and loses, give her some time to cry and feel entirely frustrated with the unfairness of the universe. It won't kill her. In fact, it will do her some good.

And next time you see a parent with a tantruming child, doing nothing about it, give her a sympathetic smile. It might be me.

Thanks to cjane for the heads-up.

Changing topics

2011-07-29T20:55:00.000-04:00

I solemnly swear not to write about breech...for a while!

I've been a single parent this week while Eric has been on a research trip in Alberta. Dio puked at 3 am this morning and now I am coming down with something. It's been hot, hot hot. High 90s last week, mid-90s this week and 90+% humidity. We keep our house between 80-85 degrees, so it's not much cooler inside.

Zari is soaked and happy

Do any of you dress your kids in hand-me-downs from the other gender? Dio is wearing a perfectly nice pair of Zari's pink flowery leather sandals. I don't care, he doesn't care, so we're all good.

Reply-turned-post: is banning breech at home reasonable?

2011-07-28T22:03:00.000-04:00

Over at Academic OB/GYN, Nick Fogelson reprinted a letter from Oregon direct-entry midwife Jonie Dawning. Recently Oregon considered (but ultimately decided against) forbidding licensed midwives from attending breeches at home. Jonie Dawning testified in favor of this ban.

My original comment:

In a hypothetical scenario where every community had access to vaginal breech birth in a hospital, I might be more inclined to find Jonie’s proposal reasonable. But in our present situation, banning breech at home = forced cesarean for almost all women. This topic is particularly relevant to me, since I just organized a vaginal breech training workshop with a Canadian OB who has done 300-400 vaginal breeches and a Canadian midwife who has trained in a German clinic that does mostly upright (hands & knees) breeches. I was disappointed but not overly surprised that all participants were out-of-hospital providers. Unless some radical changes occur to bring vaginal breech birth back into the hospital setting, I think the future of breech birth will be at home. Interestingly the midwife we brought down was more hesitant about breech in a home setting (she has done them in both home and hospital in the past, but now only does breeches in hospital, in part to help train residents and OBs in the dying art) than the OB was.

Dr. Fogelson replied:

So should the practice be continued at home even though there is no skilled provider present? Does attending a course give one adequate experience to provide breech birth?

I think the political issue of breech birth availability should not be addressed by providing the service in a suboptimal environment. I feel the same about VBAC.

And I wrote this:

A skilled provider is obviously optimal in whatever setting a breech birth happens. I’m just saying that there are women who would rather have a chance at a vaginal birth even in less than optimal conditions (i.e., with someone who hasn’t done a large number of vaginal breech births), rather than be forced into surgery.

I don’t think anyone was expecting this workshop to be the only training they needed to safely attend a breech. You’ve got to start somewhere, though, and simulation training with an experienced OB and midwife is a good place to start. Many of the participants had attended surprise breeches at some point in their careers and wanted more training for when/if that happened again.

I would love to see vaginal breech birth become common again in a hospital setting. But I don’t think that banning it in a home setting is the right approach. (This will further drive breech birth underground, as women either go unassisted or hire unlicensed midwives to be able to have a vaginal birth.) I’d rather find a solution that expands, rather than contracts, choices and that doesn’t limit women’s autonomy.

Come join the discussion--especially if you've had a breech baby (at home, in hospital, by c-section or vaginally).

Urgent--searching for vaginal breech providers in Nova Scotia

2011-07-26T13:58:00.000-04:00

I was just contacted by a couple from Halifax expecting their first baby, due August 2nd. The baby is frank breech and they have been unable to find a doctor willing to do a vaginal breech birth. If anyone knows a provider in Nova Scotia willing to attend a primip frank breech, please let me know ASAP!

Vintage beauty

2011-07-24T13:39:00.000-04:00

Several months ago, I bought four yards of 18" wide vintage hand-printed Norwegian linen. It was very retro, and I wasn't sure what to do with it.

Then my sister bought me several linens for my slings, and I was inspired to pair the print with a solid cream linen.

The end result has a decorative panel (also functions as a pocket) of the vintage print on the tail.

By the way, I'm open again for business at Second Womb Slings. I have lots of gorgeous new linens and silks, and more batiks to be added for my infant scale slings.

All about the breech workshop

2011-07-21T21:02:00.000-04:00

What a whirlwind weekend...

It began Friday evening with a discussion session. Participants were able to ask questions of Peter and Betty-Anne, as well as share their own experiences with breech birth as either care providers or mothers of breech babies. The conference co-organizer, Penny Lane, opened the session with the stories of her three breech babies. It's an epic story, one that I hope to tell at a later date in more detail. (I might even turn it into a book, it's that fascinating.)

Saturday's workshop was with Dr. J. Peter O'Neill. He began with two hours of instruction and advice about vaginal breech birth. He reviewed the literature, including knowledge gained from the Hannah term breech trial and more recent European studies. He explained the Canadian breech guidelines and how they were created. Finally, he explained the mechanism of breech birth and the various maneuvers to free trapped legs, arms, and heads. Then it was time to do simulations. He and Betty-Anne had each brought a simulation mannequin, complete with a snap-on vulva and snap-on abdomen. You can imagine the wisecracks coming from a room full of birth attendants. ("Hey Rixa, your vulva's hanging out!")

The participants were all writing or typing furiously, trying to catch all of Peter's instruction and commentary. He was a fabulous instructor, and we all came away feeling confident in the skills he had taught us. He has attended about 8,000 births and between 300-400 vaginal breech births. He teaches vaginal breech, among other skills, for the Canadian ALARM courses taught to physicians, midwives, and nurses. A few highlights that I can remember from his workshop:

Trust your training and your instincts. Don't blame yourself for "missing" a breech prenatally--it's highly likely you didn't miss it, as babies can flip very late in pregnancy.
Do vaginal breech births with a best friend--in other words, with someone who won't hesitate to tell you when you're not making wise decisions, when you're letting your emotions or your relationship with your client get in the way of the larger clinical picture.
Try to keep your hands off the baby unless absolutely necessary. The more a breech baby is manipulated as it is being born, the more likely it is to do the "What the F#@!" startle reflex (Peter's words), throwing its hands up and its head back.
Peter did breech simulations with the mannequins on their backs, not because he feels that is the best or safest way, but because 90% of his patients choose epidurals and are largely unable to move from that position. He emphasized that the women he attends are free to choose any position they desire during labor and birth, whether for cephalic or breech presentations.
Pay attention to the language you use. For example, he never uses "maternal exhaustion" in his records. Instead, he writes "inadequate progress despite maximum maternal effort." He feels this keeps women from feeling like they failed if labor just did not progress, and it emphasizes the extraordinary effort that all labors entail.
Don't fall into the trap of extrapolating from cephalic to breech births. What might be fine for a head-down labor might not be for a breech. He wants to see a breech labor begin spontaneously and progress steadily; in general, the time from 5-10 cms should not take much longer than 7 hours. Start-and-stop labors in a breech are a sign for caution and an indication that a vaginal birth might not be the best decision. Deciding to move to cesarean is not a failure. If certain signs suggest trouble, the decision to abandon a vaginal birth is a wise one.

I have to say that I was beyond thrilled with Peter's workshop. He was approachable, generous, and willing to engage in an open exchange of ideas and experiences. Anyone who can keep a straight face with a room full of midwives talking about placentophagy has got my vote! I think we were all wishing we had him as a physician in our own communities.

Saturday evening was a lecture on upright breech birth by Betty-Anne Daviss. She took an anthropological approach to breech birth and reviewed the history of breech birth and maneuvers. We had booked the room for two hours, but she ended up speaking for just over an hour. We were all exhausted, and to be honest as much as I would have liked to learn more, I was glad to go back to my (not-so-posh) dorm room and rest. Several of us gathered in a lounge, snacked on cookies and Chipotle Grill wraps, and talked late into the night about birth (of course!).

Sunday's workshop was on upright breech birth with Betty-Anne. She spent the morning overviewing the various breech studies and trends in breech birth throughout the US, Canada, and Europe. I enjoyed learning about how she ended up at Dr. Frank Louwen's clinic in Frankfurt, Germany. She is part of his reserach team gathering data on upright (hands & knees) breech births. They are close to submitting their data for publication. I can't wait to read their findings. Preliminary data that Dr. Louwen presented two years ago in Ottawa showed that the upright position leads to fewer feto-maternal complications, fewer abnormal heart rate tracings during pushing stage (due to less cord compression), and lower morbidity.

Betty-Anne also explained in detail the mechanism of upright breech birth. Using a flexible pelvis and cloth doll, she explained step-by-step how a breech baby descends and turns through the maternal pelvis. At that point Gail Tully (of Spinning Babies) jumped up and started illustrating what Betty-Anne was explaining. By the end of the day, we had all sorts of lovely drawings from Gail. I hope she will reproduce them!

The afternoon was spent doing simulated hands & knees breech births with Betty-Anne and Gail. A few things I learned specific to hands & knees positioning:

The baby normally presents at the vaginal outlet with the butt transverse and one butt cheek rumping first, rather than facing directly forward.
Once the baby has been born to the umbilicus, you should see a line of "cleavage" on the baby's chest. This indicates that the arms are NOT trapped and in a good position to be born. If you don't see this fold of skin, this indicates that one or both hands are behind the head. AT this point the baby's body should be turned and the baby should be facing you straight on. If the baby remains turned sideways, this again is a bad sign, indicating an inability to descend and rotate properly due to trapped arms.
"Frank's nudge" (also called the Louwen maneuver) is used once the arms are born and the head is still inside the mother. Often the baby will emerge on its own. But if the head is not born relatively soon--let's say within the next contraction--this maneuver will help the head be born. First ascertain that the baby's head is facing directly forward, rather than turned to the side. If needed, turn the baby's head to face directly posterior (right towards you, since you are looking at the mother's behind as she is on her hands & knees). Use your thumbs or first two fingers and press on the baby's shoulders towards the mother's pubic bone. (Do not press on or near the clavicles, as they are prone to breaking.) This maneuver causes the back of the baby's head to press against the pubic bone and flex forward, freeing the head.

Attending the breech skills workshop this past weekend reinforced the need for open, honest, and respectful collaboration between home and hospital based providers. Dr. O'Neill's approach to helping women was simple: do what is right for mothers and babies, without regard to political or liability concerns. If a home birth transfer occurs while he's at work, he prepares whatever the situation requires (for example, he would prepare the OR and scrub in for an urgent transport). Then he greets the woman with this simple phrase: "What can I do to help?"

Home Birth Summit update

2011-07-20T07:36:00.000-04:00

Guess who was invited to the upcoming Home Birth Consensus Summit? Me!

I am really excited to participate in this event. I am also curious to see how things play out. There's been a lot of grumbling about who was chosen and how. With a limited number of slots for each stakeholder, inevitably most of those interested (and qualified) will not be able to attend. Because of that, some have already dismissed the summit as inherently flawed. I'm not going to pass judgment on the summit, though, before it even happens.

If you have a perspective you'd like to add, please comment at the open forum for the home birth summit.

New breech maneuvers

2011-07-17T21:17:00.000-04:00

I learned several new vaginal breech maneuvers this weekend from Dr. J. Peter O'Neill, including

the Vanna White Maneuver

("Don't put this on YouTube," he'd say with a graceful sweep of his arm)

the Getting Off a Horse Maneuver

the Pringle Chip Maneuver

Learning breech birth has never been so much fun. More details forthcoming, but I wanted to say that Dr. O'Neill was a phenomenal teacher, physician, and person. I've found a new Dr. Wonderful*. If you live in Kingston, Ontario, you are lucky to have access to him.

* Other Dr. Wonderfuls include Andrew Kotaska, Robert Biter, and family practice physician "doctorjen".
.

Lecture on upright breech birth

2011-07-13T00:35:00.000-04:00

Please distribute widely! Click on the image to download the PDF flyer. Text-only version below.

Upright Breech Birth:

What We Can Learn From the Germans

Lecture by Betty-Anne Daviss

Saturday, July 16, 7pm
Pharmacy Building, Room 150
Butler University

Betty-Anne Daviss has undergone extensive training in Germany in
upright breech birth. A professor at Carleton University, Daviss has
30 years of experience as a midwife in Canada.

What is upright breech birth?
A decade ago, German obstetrician Frank Louwen began doing vaginal
breech births with women in an upright (hands and knees) position. The
results were compelling—fewer fetomaternal complications, less
umbilical cord compression during the pushing stage, and reduced need
for maneuvers, leading to lower maternal and perinatal morbidity. His
Frankfurt clinic has delivered approximately 1,000 vaginal breeches in
the past decade, 90% of which were in the upright position.

Wedding reception

2011-07-09T10:16:00.000-04:00

My older sister, whose wedding we attended this May in DC, had a wedding reception at my parents' house yesterday. It was a lovely evening in our backyard. I was able to take a few pictures before my camera died.

Zari looking angelic

my sister and her husband

flowers from the garden

tables, chairs and linens were borrowed

each of us got a set of apothecary jars to take home

individual mango-lime cheesecakes

cool drinks for a warm evening

walking violin serenade

My mom, as usual, outdid herself. My sister joked that "this was mom's party, to which I was invited." My mom planned the decorations, food, and music. She cooked half of the food and had friends help make the rest. She even wrote some of the arrangements that her string quartet and violin students played.

The evening's menu:

Finger foods

Avocado & goat cheese crostini
Double tomato bruschetta
Filipino lumpia with sweet chili sauce
Pesto ravioli on skewers
Edamame
Chicken satay with peanut sauce
Baguettes and cheeses
Fresh fruits and vegetables
Bacon-wrapped dates stuffed with Gorgonzola
Endives stuffed with hummus and balela
Swedish meatballs

Drinks

Lemon/lime infused sparkling water
Raspberry/strawberry infused sparkling lemonade

Desserts

Mango-lime cheesecake
Blueberry-lemon cheesecake
Sachertorte

Bathroom renovation: final pictures

2011-07-05T21:08:00.000-04:00

We finished renovating our master bathroom, just in time to move. It looked like this before we started and like this in the middle of renovations. We started this project when I was 6 months pregnant.

I took pictures the day before our renters (a new tenure-track professor and her husband) moved in. I love the antique vanity & mirror we found. My dad helped me refinish the wood and cut holes into the marble for the sink and faucet. We also put bun feet on the vanity to bring it up to the right height.

I had an antique silver chandelier that I had found in our house in Iowa City and had moved it with me a few times, thinking "some day I will find a use for this." (I usually don't do this, but the light fixture was really cool and I couldn't justify getting rid of it.) I used two of the five arms to make these vanity lights. I think the little shelves below the lights were for candles, back before electricity.

I miss our tub and our fancy shower...but I am sure our renters will enjoy them!

Bright Star diapers

2011-07-03T21:19:00.001-04:00

I love the huge variety of cloth diapers available to parents nowadays: prefolds, flatfolds, All-In-Ones, All-In-Twos, pockets, and wool covers. You can wrap your baby in bamboo and hemp, cotton and wool, even in silk! Cloth diapers are stylish as well as functional. I know a lot of parents who love their cute cloth diapers so much that they rarely put pants or skirts on their babies.

I had the opportunity to test-drive a Bright Star Ultimate Trim Fit All in One Diaper, thanks to Abby Flores of Itsy Bitsy Bums. Mine came in Horizon, a pale sky blue.

So what is a Bright Star diaper?
The maker of Fishnoodles diapers has created a new diaper line called Bright Star. The diapers are advertised as All-In-Ones, but actually I'd call them a hybrid diaper. It combines the elements of an AIO and a coaker/cover system. The inside soaker pad snaps into the diaper at the back. You normally leave it snapped in during washing and drying, but you can remove it for additional cleaning.

The outer part of the diaper is made of PUL and lined with a thin layer of fabric. I tried re-using the cover with a new soaker, but the inner layer of fabric does get damp enough after one use that you have to change both parts each time (which makes it more of an AIO).

The soaker pad is cleverly engineered with 7 total layers. However, it dries quickly because the layers are serged together in groups of two and only joined where they snap into the outer diaper. I like this combination of high water retention and efficient washing & drying.

Photo taken right after washing & drying...soaker is spread out to show layers

The diaper uses a side-snap closure (the front snaps over the wings). There are four sets of double snaps on each side, giving each diaper a good range of sizes.

What are Bright Star diapers made of?
The outer layer is PUL, like most modern cloth diapers. The soaker is made of bamboo and organic cotton fleece.

I love the range of colors and patterns! I'm drooling over the limited edition prints...Skully, Black Butterfly, Aloha, and Dalmatians are some of my favorites.

How do the diapers fit?
Bright Star diapers come in 3 sizes: 0, 1, and 2. Dio (2 years old, about 25 lbs) fits very comfortably into the second set of buttons on a size 2 (24-32 lbs). He probably could still fit into the last set of snaps in a size 1 (12-28 lbs). In fact, you could probably diaper your baby almost entirely in size 1s, as long as you had something else for the first few weeks.

Bright Star diapers have a very trim, smooth fit. The front goes under the belly, while the back rises to keep the diaper snugly on the waist. The back waistline of the diaper is serged, rather than bound or turned, making it even trimmer.

I've washed and worn my Bright Star diaper 20+ times. It has held up well, no staining or pilling or fraying. The only complaint I have is that the outer diaper scrunches up after it's first washed (totally normal for a diaper bound with elastic). When you lay the soaker on top of the diaper, the soaker overlaps the crotch sides. You have to put your hand on the soaker and tug the four corners with the other hand until all the soaker edges are tucked in. Not a huge deal, but definitely a design element I'd suggest changing.

For a super-detailed review of the Bright Star diaper, and a comparison to the retired Fishnoodles diaper, visit Bitsy Buzz.

$21.50 for solids, $22.50 for prints. Volume discounts available.

4 months old!

2011-07-02T22:16:00.001-04:00

Inga is already 4 months old! We drove back from Canada last weekend, surviving the 3-day trek home despite a bad coolant leak and antsy kids. Now we're unpacking boxes of books, making war on poison ivy (it's showing up all over the grass...eek!), and enjoying having my sister, her husband, and her 4-month old baby stay with us while they look for a house.

Pictures coming soon--today was super fun but too busy for pictures. Farmer's market, assembling bookshelves, helping our friends with their landscaping and then cooling off in their pool, and moving our swingset from our old house to our new house.

Stay tuned for a review of Bright Star diapers!

Autonomy, Information, and Power

2011-06-23T13:05:00.000-04:00

I find myself increasingly drawn to the principle of autonomy. It has been adopted by law or by custom in most Western countries. If patient autonomy were fully adopted and enforced, it could bring about substantial changes in maternity care. (More about this at tonight's talk.) We have a long way to go to reach true autonomy in both key areas: informed consent and the right to refuse treatment.

In a recent post on the surgical consent process, Dr. Nick Fogelson proposes that communicating risk by listing any and all possible risks in precise statistical fashion might not be the best form of informed consent. He comments that our current method of informed consent is

a bit like asking your neighbor bring your son home from school, and having her say “we may get hit by another car, I might run a red light, we may run out of gas on a train track, there might be a meteor that hits the car and kills us all…. but don’t worry I am a good driver and your son will be fine.”

The fundamental reason we do these consents is that we believe that in some way they will protect us in a lawsuit if something bad happens. For example, let’s say somehow I transect a ureter in my patient’s hysterectomy, I can say “See – I said this was a risk of the surgery… it wasn’t my fault!”

But isn’t that a bit ridiculous? Is telling somebody that something bad could happen actually a defense if that bad thing does happen? In some cases a problem is truly random, such as the development of a pelvic abscess after a hysterectomy, but in other cases it is not. There is almost no situation in which I could cause a ureteral injury and have it not be a surgical error. If it happens, I did it – and it was a mistake. Ureters are damaged in about 1% of hysterectomies, but its not like they magically get injured in 1% of cases. In 1% of cases the surgeon makes an error....

The trouble with the standard consent process is that it doesn’t deal with the real issue; errors do occur, and physicians cannot be perfect. By naming error-driven events as statistical occurrences, the process supports an expectation that surgeons will never make errors, and thus the corollary that any surgical error is a de facto breach of physician’s fiduciary duty.

Dr. Michael Klein recently co-authored several studies on attitudes of maternity care providers. He found that pregnant woman rarely have complete or accurate information on common birth procedures.

It should be noted that regardless of the type of care provider, many women reported inadequate knowledge of common procedures....When combined with evidence on the nature of obstetrical power and control, and research showing that many providers are not evidence-based in their views, (3) this suggests that even a woman with strong values and beliefs could find it challenging to assert her choices in the professionally controlled process of birth. Women, especially first time mothers, who do not have evidence-based knowledge, are likely to be particularly sensitive to negative attitudes toward birth procedures and processes, from providers and other sources.

A recent editorial by Jackie Tillett in the Journal of Perinatal and Neonatal Nursing, Politics, Power, and Birth, explores power interactions between childbearing women and their care providers. She comments:

The power relationships between women and their healthcare providers limit the choices that women may have and may even constrain the discussion of choices. If the healthcare provider believes that choices should be limited to those the provider feels comfortable providing, other choices may not enter into the dialogue.

Ideally, decision making regarding labor and birth will begin during prenatal care. The antepartum period is a time of exploration and questioning for many women. Care providers can facilitate this learning with adequate time during appointments, concern for a woman's misgivings, and encouragement. Informed consent may and should initiate a discussion of risks and benefits of procedures and routines.

However, even though informed consent implies an understanding and agreement with a plan of care, too often a woman is influenced by her perception of the healthcare provider as an unbiased expert. This is true of her perceptions of physicians, midwives, and nurses.

Later in the article, she addresses the language of allowance and how it limits autonomy:

The politics and power relationships of the labor and birth process may be seen to revolve around the word "allow." To allow is to make possible through a specific action or lack of action, or to consent to or give permission. The concept of allowance gives the power to the healthcare provider, whether physician, midwife, or nurse and makes the laboring woman dependent upon this allowance. Allowance removes some aspects of choice and consent from the woman and makes her dependent upon the actions and beliefs of the healthcare provider. To define the services one offers to pregnant women using the phrases "I allow" or "I don't allow" transfers all control to the provider.

Remember that autonomy = informed consent + right to refuse. With both of those key factors weak or missing in our current obstetric climate, autonomy exists in name only. It's time to turn rhetoric into reality. Or in Dr. Klein's words: "It is going to take a revolution driven by women to change this, as practitioners are not going to change very soon. To the barricades!"

Come to BirthTalk this Thursday!

2011-06-21T20:50:00.000-04:00

I will be giving a talk this Thursday evening in Moncton, NB as part of the BirthTalk series hosted by Natalie Arsenault. My presentation is called "Childbirth activism: where we have come from and where we are going?" I will review the various childbirth movements of the 20th and 21st century and share my thoughts on the future of birth activism.

For more details, please contact Natalie. I hope to see you there!

Now here's the back story of how I met Natalie...I was at the downtown Moncton Farmer's Market about 10 days ago and saw a stall with beautiful batik and handwoven cotton slings. Aha! I thought. I have got to talk to her! She makes slings! Yes, I am kind of dorky that way. So I headed over with Inga (in a sling of course) and said hello. We chatted for a while about slings. Then it turned to birth stuff, at which point she gave me her card and asked if I'd be around for her monthly meetings, called BirthTalk. I went to the gathering last week and enjoyed myself quite a bit. She invited me to give a presentation this week. I don't have access to most of my materials, so it will be informal but still interesting and thought-provoking.

Open forum for the Home Birth Summit

2011-06-21T17:42:00.000-04:00

Several blog readers expressed concerns or comments about the upcoming Home Birth Consensus Summit, to be held this fall. This post is an open forum for your comments/concerns/questions. I will make sure your input reaches Geradine Simkins.

If you were able to attend the summit, what would you say? What are the biggest obstacles you have experienced to home birth in general? In your own community? What would make it safer, more accessible, etc?

Speak up!

Baby gear, circa early-to-mid-1800s

2011-06-18T19:38:00.000-04:00

While we were visiting the Keillor House in Dorchester, NB, we saw several fascinating baby items. We always talk about life being simpler "back then." But even 150-200 years ago, there was plenty of baby gear for parents to accumulate.

When I was little, my parents used a Johnny Jump-Up. I have memories of kicking my baby brother while he was sitting in it. These apparently aren't new. Here's a "Jolly Jumper" from the 19th century. It is suspended from the ceiling by a rope.

I loved this multi-function chair. Now it's a high chair...

Now it's a stroller!

Finally, here's a little child-sized potty (missing the bowl underneath)

When they need it, where they want it

2011-06-13T13:46:00.000-04:00

A recent press release from the SOGC (Society of Obstetricians & Gynaecologists of Canada) shows support for women's autonomy in childbearing. In honor of the International Day of the Midwife, the SOGC released this document (PDF). Dr. Lalonde upholds pregnant women's autonomy in where and how to give birth:

“The SOGC acknowledges that it is the mother’s decision to decide where she would like to give birth,” stated Dr. André Lalonde, executive vice-president of the SOGC. “Most babies are born without serious complications. As ob/gyns, our specialized training allows us to address the unique requirements of high-risk situations. What matters is that all professions acknowledge each other’s competencies and work together to provide mother and baby with the quality care they need, when they need it, where they want it.”

What is autonomy?

2011-06-12T16:04:00.000-04:00

My earlier question asking if autonomy is just for the natural birth crowd got sidetracked into arguments about the safety of home birth. Yawn. (Is anyone else ready to move on from these worn-out debates?)

Anyway, let's talk about what autonomy is and what it means in a healthcare context. From Wikipedia (emphasis mine):

Autonomy (Ancient Greek: αὐτονομία autonomia from αὐτόνομος autonomos from αὐτο- auto- "self" + νόμος nomos, "law" "one who gives oneself their own law") is a concept found in moral, political, and bioethical philosophy. Within these contexts, it refers to the capacity of a rational individual to make an informed, un-coerced decision. In moral and political philosophy, autonomy is often used as the basis for determining moral responsibility for one's actions. One of the best known philosophical theories of autonomy was developed by Kant. In medicine, respect for the autonomy of patients is an important goal as deontology, though it can conflict with a competing ethical principle, namely beneficence. Autonomy is also used to refer to the self-government of the people.

Let's take a look at the Patients' Bill of Rights adopted by the Association of American Physicians and Surgeons (emphasis mine):

All patients should be guaranteed the following freedoms:
To seek consultation with the physician(s) of their choice;
To contract with their physician(s) on mutually agreeable terms;
To be treated confidentially, with access to their records limited to those involved in their care or designated by the patient;
To use their own resources to purchase the care of their choice;
To refuse medical treatment even if it is recommended by their physician(s);
To be informed about their medical condition, the risks and benefits of treatment and appropriate alternatives;
To refuse third-party interference in their medical care, and to be confident that their actions in seeking or declining medical care will not result in third-party-imposed penalties for patients or physicians;
To receive full disclosure of their insurance plan in plain language...

In a healthcare context, autonomy means being informed about the full range of risks, benefits, and alternatives of a proposed treatment (informed consent), and having the ability to accept or reject the treatment (right to refuse). Or for you math geeks:

autonomy = informed consent + right to refuse

While patients have the right to refuse treatment, they do not necessarily have the right to demand medically unnecessary treatments. For example, if your leg is injured and your physician recommends amputation, you have the right to refuse. However, you do not have the right to demand an amputation of a healthy limb.

In maternity care, the right to refuse and inability to demand are not always consistently applied. Women are often not allowed to refuse certain treatments, such as repeat cesarean section or IV therapy. On the other hand, many women are able to demand medically unnecessary treatments, such as elective primary cesarean or elective induction. This inconsistent application of autonomy and patients' rights has emerged from cultural beliefs in the inherent risk of labor and inherent safety of medical intervention and from concerns about litigation and liability.

So I ask again: is the desire for autonomy really a frivolous, selfish concern at best, and a potentially dangerous doctrine at worst, as implied by more than one commenter?

Home Birth Summit

2011-06-11T17:55:00.001-04:00

I've been hearing buzz about a Home Birth Summit coming some time this fall. I recently received a message from Geradine Simkins via a midwifery list I belong to with more details about the summit participants. This might assuage some concerns, such as the ones articulated at The Trial of Labor, about who is attending and how they were chosen.

Below is the letter from Geradine Simkins, president of MANA.

~~~~~

Dear Friends,

I’d like to address some of the comments about the upcoming Homebirth Summit. First of all, this is an idea that has been brewing for at least two years, some might say for two decades. No one really “owns” the idea of putting together a gathering of multiple stakeholders to have a frank and productive conversation about how to best support and care for women who chose homebirth. But after lots of conversation—the decisive one being at the ACNM Homebirth Section meeting two years ago—we decided to pursue this “project” in earnest.

Many of you may be familiar with the type of process we chose. It is not unlike what Childbirth Connection chose to use when they initiated the process for creating their seminal work, “Transforming Maternity Care: A Blueprint for Action”. They convened a Vision Team of experts in the fields of maternity care and health systems, worked in specific stakeholder groups, and developed concrete solutions to some of the most pressing issues facing the U.S. maternity care system. The result is a group of actionable strategies to improve maternity care quality and value.

It was not a conference; it was an invited work team. The Homebirth Summit will also not be a conference. Here are some details about the process and the participants:

In order to get representatives to the table who are in any way involved with homebirth, 72-80 delegates have been identified to be evenly balanced across 9 stakeholder groups (listed below).
The invitation selection process has been an iterative process with many rounds of vetting, internally and externally.
Short lists were created by subcommittees chaired by those who knew those stakeholders.
Each subcommittee of the MULTIDISCIPLINARY planning group went through a detailed vetting and weighing process and considered the balance of perspectives, ethnicities, gender, age, geography, and other factors.
After serious consideration, we hired consultants from Future Search because of their success with consensus building among groups with very disparate (and often conflicting) ideas, values and principles.
We are using Future Search Methodology, which prioritizes including participants who had authority, information, expertise, need, and resources.
We also prioritized those who were likely to respect the process by fully engaging in the Future Search methodology and open-minded dialogue.
The stakeholders are NOT ANY ORGANIZATION but rather are individuals who are defined as belonging in these nine stakeholder groups:

Consumers (from a variety of perspectives)
Consumer advocates (doulas, childbirth educators, childbirth and women’s healthcare activist)
Home Birth midwives (CPM, CNM, LM, Amish, traditional, whatever)
Obstetricians and OB family practice
Collaborating MCH providers (nursing: L&D, neonatal, pediatrics; CNMs who provide backup)
Health insurers and liability insurers
Health policy, legislators, legal, ethics
Research and education: Public Health, epidemiology
Health models, systems, administrators

In this way, the WHOLE SYSTEM is at the table. Otherwise, we will not be able to seriously come to consensus.

The point is not to debate the “right or wrongness” of homebirth, or even the safety. The goal is to establish what the whole system can do to support those who choose homebirth, and provide the care, safety net, consultation, collaboration and referral necessary to make homebirth the safest and most positive experience for all involved—moms, babies, families, communities, health care workers, hospital personnel, administrators, payors, and so on.

We have been meticulous and intentional about our process. Nonetheless, not everyone will agree with our process. With only 72-81 spots to make this a functional process, not everyone will be happy with those that are selected, and specifically, if they were not selected.

I would ask you to consider that we are working very hard and with the firm intention of making the process, the event and the outcome as optimal for mothers and infants as possible, and for the benefit of midwives serving homebirth clients.

In solidarity,
Geradine

--
Geradine Simkins, CNM, MSN
President & Interim Executive Director
Midwives Alliance of North America
president@mana.org
executivedirector@mana.org
geradines@gmail.com
275 Cemetery Rd.
Maple City, MI 49664
231.228.5857

Is autonomy just for the natural birth crowd?

2011-06-09T20:59:00.000-04:00

In response to the post about autonomy, beneficence, and non-maleficance, someone left this comment:

And, you know, if random women didn't declare their consent invalid after something *did* go wrong, docs just might be more willing to go along with your riskier ideas. One of the more annoying parts of your "trust birth" idiocy is that you want to refuse all the stuff that might let you know something is going wrong, show up at the hospital with you and the baby in distress, and then bitch blue murder about the evil docs who couldn't pull one more rabbit out of the hat and save your ass, your baby and your uterus.

Does it not cross your mind that docs don't like losing babies, and don't like being sued---because in order to be sued, there has to be a bad outcome? And a bad outcome is a dead or injured baby? Midwives have no insurance, little training and less accountability.

There are gross generalizations, false accusations, and other logical fallacies in this comment. Leaving those aside for a moment, this comment implies that only those of a certain ideological persuasion care about autonomy, and that the desire for autonomy is essentially selfish and misguided.

So what do you think? Is autonomy just for homebirthers (or those who use midwives or want a "natural" birth)? Do more "mainstream" women really not care about, or not benefit from, autonomy in their maternity care?

I'm still here, eh?

2011-06-08T21:29:00.000-04:00

We're busy getting to know New Brunswick, so I haven't been on the computer much. Here are a few pictures...

For those of you wanting to see how to fit 3 carseats in the back of a VW Golf.

We live right next to a cemetery (complete with Eric's ancestors!), so it's turned into a favorite place to go for walks.

The kids shriek "spit bubbles! spit bubbles!" whenever Inga does this

I can't stop kissing her chubby cheeks

Our first night in Moncton we made fiddlehead ferns (blanch for 1 minute in boiling water, then sautee in olive oil) and salmon en papillotte (made with what we had on hand: caramelized onions, mushrooms, carrots & sour cream). Zari keeps asking for more ferns.

Today we ate lobster from the Bay of Fundy and the kids ran around the house playing with the empty claws. I've never seen such huge lobsters before. Several of the live ones were close to 10 pounds! But the woman at the shop said, "We don't say they're big until they weigh at least 15 pounds." The rest of the lobster will turn into this pasta recipe tomorrow. Mmmmm.

1,511 miles, 3 children, and 1 small car

2011-06-05T14:33:00.000-04:00

We made the 1,500 mile (2,432 km) drive out to New Brunswick in our VW Golf. (Yes, you can fit 3 carseats in the back of a Golf, to the amazement of my SUV- and minivan-driving friends!) We broke the drive into three days: 6 hours to Eric's sister, 15 hours, and 6 hours. The second day was rough. It's hard for little kids to sit still all day. At the end of the second day, we erected a cardboard barrier between Dio and Inga to protect her from kicks and pinches.

A portable DVD player borrowed from Eric's sister helped the last two days go more smoothly. Eric was really opposed to the DVD player. "I don't want our kids to be plugged in," he said. But I insisted we at least bring it with us and use it when/if the kids became too restless. We put on movies about half the time, taking breaks until the kids started become very irritable and bored (meaning they started to hurt Inga, poor thing).

The second night, we stayed at a hotel with an indoor pool and hot tub. We swam in the morning until the kids got all their energy out. Definitely a must-do on the way home.

When we weren't watching movies, we ate snacks, sang songs, played "I spy", told stories, and listened to NPR. And somehow we survived the drive.

Our Golf performed beautifully, getting close to 50 mpg. I love my diesel VW!

Now if the weather would just warm up...it's been unseasonably cold and I didn't pack enough warm clothing.

3 month pictures

2011-06-02T22:39:00.000-04:00

We finished day 1 of driving out to New Brunswick. 2 more days to go. We are officially crazy to do this long of a road trip. Anyone live in or near Moncton? We'll be there for the month of June.

Meanwhile, some "now & then" pictures of Inga, who is 3 months old today:

2 days old

3 months old

1 week old

3 months old

2 weeks old

3 months old

Autonomy, beneficence, and non-maleficance

2011-05-31T20:50:00.000-04:00

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

2011-05-28T22:25:00.000-04:00

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

2011-05-26T23:19:00.000-04:00

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

2011-05-19T15:43:00.000-04:00

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

2011-05-15T14:20:00.000-04:00

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

2011-05-14T22:36:00.000-04:00

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

2011-05-11T19:51:00.000-04:00

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!

2011-05-10T12:54:00.001-04:00

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

~~~~~

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.

~~~~~

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.

~~~~~

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

2011-05-04T22:15:00.000-04:00

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!

Random man talks boobs

2011-04-30T18:59:00.000-04:00

I was sitting on the front lawn of our new house (like, we just bought it yesterday new) nursing Inga. I had my V-neck shirt pulled down and was nursing "from the top." An unfamliar car pulled into our driveway and a middle-aged man stepped out. He looked at me and started approaching. I was thinking, who are you random man and why are you walking towards me?

I probably stared at him a bit too forcefully, because the first thing he said was, "I have five kids and my wife nursed all of them. So don't worry, I'm used to seeing breasts."

I had to laugh. That was the last thing on my mind. I was just trying to figure out who he was and why he was at our house. The fact that I had one breast exposed was a non-issue.

I replied, "Oh goodness, I wasn't even thinking about that, especially after three kids!"

It turns out he owns a millwork shop that specializes in crafting historic reproduction wood windows. I didn't want to replace our original windows--they're in great shape other than being painted shut--but I did need storm windows made. He can do that too. So I am glad that Mr. Random Man stopped by.

Speaking of our new house, we spent the day clearing brush & volunteer trees. Some friends stopped by to help, so the adults played with the chainsaw while the kids played hide-and-seek in the house. I got into some poison ivy, which is my nemesis. Eric and I are feeling more overwhelmed than elated as we realize how much work this house needs. But it will be such an amazing house once it's all done.

Guess who is 2?

2011-04-28T20:54:00.000-04:00

Dio! His birthday was two days ago. I can't believe it's already been two years since he was born. Read his birth story here.

Dio's serious look

He got a toy airplane from my mom and has been carrying it around night and day. That, and a book about airplanes, was his only birthday present. We're pretty low-key with gifts at our house.

playing in the sump pump water...a favorite pastime this rainy spring

We made a vegan chocolate cake with cream cheese frosting and decorated it with blueberries to look like a ladybug. Kind of. The kids didn't care about aesthetics.

those are smiles, really

wearing swimming goggles after we ate birthday cake

Inga got her passport pictures

I finally painted our kitchen!