Getting closer

I still need to resize the background image a bit, since the middle isn't wide enough and the top keeps getting cropped off...but I'm getting closer to a template that I really like! Stay tuned for more changes in the next few days.

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My zen wall

I finally hung up these silk paintings that I made last spring. They are based on the artwork of Australian artists Chrissy Butler; the originals were commissioned for the Trust Birth Conference. I hung them on the side wall of our bedroom, so they're the first thing I see when I wake up in the morning. The pictures make me feel happy and zen and peaceful. I should have taken pictures of them hanging against a window first, since they are even more colorful with light coming through them. I also made one other silk painting that I gave to Carla Hartley at the end of the conference.

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The root of my worries

I've been corresponding with my friend Jenne from Descent into Motherhood about my desires for this upcoming birth. We are both seeing a midwife and trying to decide what role we wish them to play in our upcoming births. She wrote to me yesterday something that perfectly sums up the root of my concerns:

Have you thought of it as a control issue? You have had an experience where you were totally in control, autonomous, and making your own decisions. And now it sounds with this particular midwife, you are going to have to give some of that decision making power to her because there will be things that she may not budge on. It's important to you that you are alone in the room, and she may not allow that to happen. Not only does that feel like your power is being taken from you, you may fear that her presence will alter your ability to birth in some way. I think I'm projecting my feelings on to you but I know that it's that reason that I would be uncomfortable with having a midwife. Maybe it's just what you've described to me about this particular midwife. Tell me if I'm wrong on that and I'll be quiet. My fears with having a midwife present are two-fold: I don't trust her to not take control of a situation in a way that overrides my autonomy. That of course is at the root of what I didn't like about my birth experience with my son and led me to consider a UC. I hated having to fight for the responsibility to make my own choices when I could choose to not have to face that fight at all.

My core concerns center on autonomy and control--not control of the birth process itself, but control of my surroundings and those people around me. It's important that I can totally relax during labor and not worry about any externals. For me, I accomplish that through careful planning and control over my birth environment. In a way, I seek to control some things before labor so that I can give up control when labor begins.

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Belly shot: 25 weeks pregnant

25.2 weeks from LMP. I'm feeling less squished and out of breath recently, as my body has adapted to having several major organs pushed in new locations.

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Blog template #1

How's this for a possible template/look for "Stand and Deliver"? I'll leave this up for a few days and then try another one.

I can't get the archives to work properly with this template (when you click on the year, it should show a list of months, but nothing happens). Hmmmm...

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New blog title?

I think it's time for a new blog title & facelift. The blog name I have now is a makeshift one I just typed in one day. And then inertia set in. I'd also love to have a more visually appealing blog layout & design.

So, here are my top two ideas:

#1) Stand & Deliver with the subheading Don't Take Birth Lying Down
This is the name of my doula business too, and I like the play on words. One downside of this title & slogan is that it narrows the focus of the blog a bit to just childbirth (not that I would change what I write about, but it makes the blog seem like it's only about birth--which is something you could say about the current title, too).

#2) I Am the Same, And Yet Different
This line comes from an inscription on this statue in Eze, France by Jean-Philippe Richard. The sculpture was titled "Justine ou Isis" and was accompanied with the following short poem:

Vous m’avez reconnue…
Je suis la même
Et pourtant autre

You recognized me...
I am the same
And yet different.

I took the picture this summer, and I would love to incorporate it into the blog template/design. I like this blog title because it conveys a thoughtful, introspective approach and can apply to all aspects of mothering, not just pregnancy.


So, which one has your vote? Any other suggestions? And, could I tempt one of you to help me design a visually stunning blog layout/template? (Possibility of a free Second Womb ring sling in exchange for your work!)

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(Anti) Public Breastfeeding Thesaurus

I haven't posted about recent breastfeeding news, such as the Facebook controversy over whether photos of nursing children should be allowed. But this op-ed piece from the Calgary Herald, "New Moms Should Travel the Mammary Lane Discreetly", takes the cake for the largest number of accusatory, denigratory remarks about public breastfeeding in the shortest space. In only 267 words, Naomi Lakritz asserts that breastfeeding in public (or defending one's right to do so) is:

• indiscreet
• immodest
• undignified
• not classy; crass; low-class (as in daytime talk show television)
• lacking decorum
• making public an intimate, private, personal experience
• voyeuristic narcissism
• indecent exposure
• a sign of a woman's lack of self-respect
• a waste of energy and time on a trivial issue
  

Whew! She just about covered every possible angle there.

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Working through some conflicted feelings

This pregnancy has been marked by a series of conflicting feelings about what I want for the birth. Zari’s unassisted birth was fantastic and really could not have been improved upon. I also felt strongly drawn to having an unassisted pregnancy and birth with her. While I of course had some doubts, fears, and hesitations along the way—doesn’t every pregnant woman at some point?—I just knew that an unassisted birth was what was right, what I needed to go through.

When I was a graduate student in Iowa and trying to conceive my first child, I was working as a doula and apprenticing with a direct-entry midwife. After we moved to Illinois, I started assisting a home birth CNM at prenatal visits and births occurring in my area. This pregnancy, I am living in a new state and for the first time in several years, I am not a part of the local midwifery community. This is part of the reason that I felt the need to initiate care with a home birth midwife here; I no longer had access to midwifery care, advice, or skills except through a formal, paying midwife-client relationship. There are a few things that I want access to: during pregnancy, I like checking my hemoglobin levels early in pregnancy and again around 28 weeks to be sure that my blood volume has expanded adequately (hemoglobin levels should drop by the 28-week check; if they are stable or rising, that is cause for concern). I want someone to check me for tears after the birth, suture/Dermabond if necessary, and to do bloodwork in case I want a Rhogam shot. While I could in theory go to a hospital for those postpartum services, it would be extremely disruptive and kind of pointless to get in the car hours after having a home birth!

I also find myself wanting the option of having skilled assistance during labor for certain rare emergency situations: shoulder dystocia primarily, and to a lesser degree rapid postpartum hemorrhage or the baby needing resuscitation (the latter is the least worrisome to me, even though it is probably the most common of the three scenarios I listed, since I am trained in neonatal resuscitation). This wasn’t as much of a concern during my first pregnancy, but I find it weighing more heavily on my mind this time. I suspect it’s because, now that I have a child of my own, the idea of losing a baby is no longer an abstraction to me. I wouldn’t say at all that I was simply being callous or naïve the first time around, just that the possibility of losing a child is more palpable to me now.

I was happy to learn that a home birth midwife lived only 20 miles away from our new house—the closest I have ever lived to a home birth provider in many years. Although I could pay out-of-pocket for a midwife, I was quite happy to find that she was a CNM who could accept my insurance. This means that instead of paying $3,600 for her global fee, my out-of-pocket expenses are around $1,000 ($500 for the deductible and another $500 for the 20% co-pay). Labwork and birth pool rental are additional; she rents out heated, jetted Spa-In-A-Box pools, but I won’t need that now that I have a free La Bassine.

I met with the midwife early on in my pregnancy to talk about what I was looking for and figure out if she would work for me. I talked about my first birth and how I was looking for a hands-off midwife who would respect my need for privacy. I had a few specifics I quizzed her about: was she willing to not listen to heart tones at all? (No; she’d like to listen every 30 minutes. But otherwise she is fine staying out of the room while I am laboring.) Was she willing to stay in another room during the actual birth? (No, she’d prefer to be in the room as the baby is being born to keep an eye on possible problems). I am actually quite fine with having heart tones checked. I understand from a midwife’s perspective why it is important to listen. If I am inviting a midwife to the birth, she does need to have a way to know if the baby is responding well to labor.

The second point is more of a stickler for me, and it’s been on my mind a lot recently. I feel very strongly about keeping the “birth bubble” intact in the immediate postpartum period. Even many home birth midwives tend to do a lot of stuff right after the birth: putting a hat on the baby, rubbing it gently with towels, speaking with the mother, suctioning the baby’s nose and mouth, taking a full set of vitals every few minutes (baby’s heart rate & respiration rate, mom’s blood pressure, etc), feeling if the placenta has detached, etc. While these activities are not terribly interventive in the grand scheme of things—after all, baby is usually still in the mother’s arms—they do “wake the mother” and take her away from that critical time in which her primary task, physiologically speaking, is to produce high levels of oxytocin to help the uterus clamp down efficiently, the placenta to detach cleanly and completely, and thus prevent a postpartum hemorrhage. In Michel Odent’s article “The First Hour Following Birth: Don’t Wake the Mother!”, he explains how midwives ought to behave in the immediate postpartum period:

They first make sure the room is warm enough. During the third stage women never complain that it is too hot. If they are shivering, it means the place is not warm enough. In the case of a homebirth, the only important tool to prepare is a transportable heater that can be plugged in any place and at any time and can be used to warm blankets or towels. Their other goal is to make sure the mother is not distracted at all while looking at the baby’s eyes and feeling contact with the baby’s skin. There are countless avoidable ways of distracting mother and baby at that stage. The mother can be distracted because she feels observed or guided, because somebody is talking, because the birth attendant wants to cut the cord before the delivery of the placenta, because the telephone rings, or because a light is suddenly switched on, etc. At that stage, after a birth in physiological conditions, the mother is still in a particular state of consciousness, as if "on another planet." Her neocortex is still more or less at rest. The watchword should be, "Don’t wake up the mother!"

Pamela Hines-Powell has written about this as well (and I interviewed her more in depth about what she does/does not do at births for my dissertation). Immediately postpartum, her default routine—what she does unless the mother requests otherwise—is to stay silent, out of the mother’s line of vision, and quietly observe the mother and baby from several feet away. No one but the parents touches the baby for the first hour or so after the birth. The midwives only step in to assist or interact once the mother initiates contact (barring, of course, an emergency situation). For example, here are a few of her common birth & postpartum practices, taken from a longer post about her midwife identity crisis:

• Routine vaginal exams - during labor or prenatally. It’s not uncommon for us to never touch a woman’s vagina - or even see her vulva - until the baby is crowning (if we can see it) or afterwards when looking for tears/lacerations.
• I’m not going to do perineal massage or even support of the perineum (some women with land births like to have some rectal counterpressure) as baby is being born…but I’m not likely to do anything at all during second stage in water births…blame it on me trying to protect my back and not wanting my shirt wet, but really it’s because the mother does it all on her own - and she knows best.
• I do not - nor does my wonderful assistant - usually touch the baby for a good hour or so after the birth. No routine checking the heart rate - we look and observe tone and respiratory effort. Only if that is in question will we come closer and do vitals or listen to heart rate.
• I typically do not do much face to face labor support, breathing reminders or talk women through labor contractions other than a very occasional gentle reminder of why she is doing this or that her body is working so well with her baby. If a woman needs more than that, I’m there, but my default is to stay in the background and support women to find their own way of laboring (and they have a tendency to breathe pretty well without instruction, too!) .
  

I have found myself fretting unproductively (since I haven’t had the chance to actually talk these things over with the midwife yet) about whether or not I would be able to have an undisturbed labor, birth, and especially third stage with a midwife present in the room. It’s this fruitless feedback loop of worry and anxiety that has been weighing heavily on me. On the one hand, I have had an unassisted birth and can’t really see how it could be improved upon. On the other hand, I have felt a need this time around to have access to a midwife, and I need to respect that as much as I listened to my need to have an unassisted pregnancy and birth with Zari. How can I reconcile my desire for an undisturbed birth with the presence of outsiders at my labor, when even having my own husband in the room felt distracting to me, made me feel self-conscious, like I was being watched, like how it feels when someone reads over your shoulder?

I talked over these things at length yesterday with my good friend Jen, who has experience both giving birth and attending births. She had her first baby in a birth center, her second at home with a CNM, and her third unassisted, with a midwife hired as a photographer. She is also apprenticing with a home birth midwife, so has seen birth from the other end of things, so to speak, including several more complicated/complex births. At the end of our conversation, she suggested that I, or this new baby, might need something that this midwife can offer. Perhaps my task this time is to learn how to move past my fears about having a midwife and to embrace this pregnancy and this birth journey for what it needs to be, rather than always comparing it against Zari’s pregnancy and birth. I think she was very wise to say this. Maybe there’s something unexpected that will arise during this pregnancy or birth that is spurring me to seek midwifery care. Maybe I need to learn how to let people into my life and accept assistance. I am a very independent, self-reliant person, and I always want to do things by myself. I have already proven that I can give birth alone, that I can do it all without assistance. Perhaps I don’t need go through that particular rite of passage this time.

I am eager to talk through these issues with the midwife the next time we meet, since I need to move beyond the unproductive anxiety that I have been feeling. I don’t like that this pregnancy has been so dominated by these unsettled concerns. Now that my birth is drawing nearer, I need to turn my emotional and mental energy in a more positive, productive direction, towards creating the birth that I desire rather than worry that it might not work out the right way. I know that my concerns are minor in the grand scheme of things—you know, compared to people dying of AIDS or extreme poverty or domestic violence or whatever—but they are still real and important to me.

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Fascinating article on pumping breast milk

In this week's The New Yorker, Jill Lepore explores the phenomenon of breast pumping in her article "Baby Food: If breast is best, why are women bottling their milk?" It's definitely worth the time to read. I have already come across commentary to the article, including this post from the Motherwear Breastfeeding Blog. Read both and share your thoughts!

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We have furniture!

We sold our living room furniture with our last house (the sellers fell in love with both the house & the furniture and we were happy to have a buyer so we said okay). Things have been feeling a bit bare until early this week, when our new furniture arrived. Now all the room needs are some pictures on the walls, something with lots of color to break up the green.

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Belly shot: 24 weeks

24.2 weeks from LMP. I'm measuring around 26-27 cms, which is a few centimeters larger than my last pregnancy. But my weight gain has been slower so far this time around, which I find curious. No major complaints, just feeling quite squished and out of breath at times.

And I think it's time to change to a maternity shirt soon! This one is so snug now that you can see where the waistline of my maternity jeans presses into my stomach.

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Born Free: Unassisted Childbirth in North America

My dissertation is online and publicly available!

I've been waiting for ProQuest to put my dissertation online. In the meantime, here is a link to the manuscript, Born Free: Unassisted Childbirth in North America (PDF document). It's actually a more recent version than the one I submitted to ProQuest, since I have recently changed several typos and made a few minor corrections. I'll be periodically updateding the manuscript as I find more typos or small items that need clarification or correction. Like any published book, the dissertation is copyrighted so, obviously, no quoting passages or paraphrasing without an appropriate citation.

I would love to have detailed feedback, comments, and/or criticism on the manuscript. Feel free to email me about anything from typos to major conceptual or organizational issues. My next project is submitting a proposal to publishers, so I would especially appreciate input related to turning the academic dissertation into a book.

Happy reading!

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Sewing up a storm

I made Zari a ring sling yesterday to match mine. She loves it.

Zari in "mama's sling" when she was about four months old.

A sling I sewed yesterday for my sister-in-law, who had her fifth baby a few weeks ago.

A recent Second Womb order:

And a sling I made today, just for kicks. I like it so much I might need to make another one for myself! It's white embroidered linen with a black linen band at the end of the tail. It has black sling rings and black embroidery across the pleats.

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Quack quack

One of Zari's Christmas presents was duck towel, made by her aunt Brittany (& uncle Ben). The hood of the towel has two eyes and a duck bill. Her cousins got duck & frog towels.

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UC Davis confirms sharp rise in autism rates

A recent study of autism rates in California, led by UC Davis researchers, found a "sharp rise" in autism rates even after accounting for higher rates of diagnosis and the inclusion of milder forms of autism. From an article in the Press-Enterprise, which covers Riverside and San Bernadino counties:

UC Davis researchers who analyzed 16 years of records concluded that California's dramatic rise in autism cases since 1990 cannot be blamed on population increases or the way the disability is classified or diagnosed.

The study's authors, from the university's MIND Institute, called for a switch in research emphasis from a genetic cause to possible environmental triggers including chemicals, medications, fertility treatments and childhood vaccines.

The incidence of autism in children 6 or younger increased from less than nine per 10,000 children born in California in 1990 to more than 44 in 10,000 children born in 2000.

Read the rest of the article here.

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Study on Hyperemesis Gravidarum (HG)

The University of Southern California is conducting a study on the genetics of HG (excessive vomiting during pregnancy). If you have suffered from HG, you may be eligible to participate:

HG Researchers need your help! This study is designed to identify individuals affected with HG, to study epidemiologic factors via an online survey, to collect DNA samples from saliva through the mail at no cost or travel for you, and to search for genes and risk factors that may be potentially associated with this condition. To be eligible, you must have suffered from HG and had treatment for your HG that includes i.v. hydration, TPN or other form of non-oral feeding (ie nasogastric feeding), OR both, and are able to recruit a friend with at least 2 pregnancies who has NOT suffered from HG to serve as a control. If you live in the United States and are interested, please contact Marlena Schoenberg Fejzo, PhD at nvpstudy@usc.edu or 310-210-0802. Download the USC Consent Form (108 Kb PDF) for more details about the study.

If anyone needs a "control friend," I would be happy to sign up with you! To learn more about the study and the Help HER foundation, click here.

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Back home

We arrived back home on Wednesday night after almost three weeks of traveling to Iowa City, Dayton, northern Ohio, and Pittsburgh. We had no car problems on the way home, for which I am very thankful. It's nice to be home again and to sleep in my own bed (with a new 4" thick memory foam topper...mmmmm). Zari was around hordes of cousins, aunts, and uncles the whole trip, and now I fear she may go through cousin withdrawal.

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Anyone with graphic design/web design skills?

I've been wanting to open a real, professional-looking website for my Second Womb Slings. I recently purchased a domain name (www.secondwomb.com) and am ready to put a website together. Is there anyone out there with graphic design/web design skills who would be interested in helping me design a website template and/or logo in exchange for a beautiful handmade sling? Once I have a good template, logo, and overall "look," I can design the rest of the web pages with the web design software I have. I want something that's sophisticated, hip, and beautiful. Nothing too cheesy or cutesy.

If you're interested in trading skills, please email me!

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Belly shot: 23 weeks

23.2 weeks from LMP:

I'm feeling great, although quite stretched out all over. I already feel like I'm running out of room and, obviously, have a ways to go still! I have to sit up very straight otherwise I feel like I can't breathe. I'm feeling tons of movement all over the place, although it's more often in the lower uterus or cervix. I wonder if my placenta is quite high on my fundus, since I feel the least amount of movement there. Or it could be that this baby prefers to be head-up right now.

I've got varisocse veins for the first time. I first noticed them once I arrived at my sister's house after about five days of traveling in the car. They're all over both of my lower legs. Ugh. I don't care so much about the looks (although they are ugly) but they ache and throb at times. I ran out of fish oil a few weeks before we left for Christmas break. I bought more fish oil last week and the varicose veins have been bothering me much less ever since I started taking it again. Coincidence? causality? who knows...

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Journey into Motherhood

Sheri Menelli has recently made her book, Journey Into Motherhood: Inspirational Stories of Natural Birth, available for free as an e-book. Click here to download it as a PDF. Of course, if you can spare the money I'd still suggest buying a new copy so she receives royalties for her hard work. I haven't read this yet and am glad to have something new to read.

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