Andrew Bisits: Establishing a training course in breech vaginal birth in Australia

First Amsterdam Breech Conference, Day 2

Andrew Bisits

Establishing a training course in breech vaginal birth in Australia

Ruth Evers introduced Australian obstetrician Andrew Bisits. His hospital in Sydney sees over 4,000 births per year. Andrew is working on several initiatives to promote normal birth by establishing primary midwifery care for women. Women are traveling long distances to birth with him, because he’s the only one they can find to attend their births.

Today Andrew Bisits talked about an approach to teaching breech skills. In our current situation, we have several important obstetrical skills (breech, twins, forceps, deeply impacted head at cesarean, etc.) in a climate of decreasing skills and increasing litigation. What do we do? Right now, the pressure is towards cesareans for breech, for primips, for labor in general. That is one approach: a cesarean section for everyone. He remarked that it might sound flippant, but there is an "insidious" trend towards universal cesarean.

What we have to develop more imaginative ways of learning from:

• Simulation
• Experience
• Obstetric mannequins (such as the one at the hands-on training in Amsterdam—the mannequin was so lifelike that people were getting nervous during the simulated births!)
• Computer technology
• Reflection and discussion

We also need to focus more on being sensibly confident. The business of handling anxiety is such an important part of teaching. In our current, slightly neurotic social situation, people lose confidence despite (or perhaps because of) the numeration of all the risks.

Becoming A Breech Expert (BABE)
Andrew has developed a course for teaching breech skills called Becoming A Breech Expert (BABE) in 2012 with colleagues Caroline Homer, Anne Sneddon, and Helen Cooke. After helping organize a breech conference in Sydney in 2012, they wanted to create something useful that would further promote vaginal breech skills. It’s a multidisciplinary course between faculty and participants. It’s conducted via the AMaRE (Advanced Maternal and Reproductive Education) company of Australia. Instructors are volunteers, and course is copyrighted.

Andrew noted that this project (and, I would argue, this entire conference) is not just about breech birth; it affects the rest of maternity care and the way we care for laboring women.

How the BABE course works
The course focuses on an individual woman, “Wanda,” rather than starting with statistics and numbers. They wanted to put the focus on the reality of an individual with a breech baby.

Evidence--objectives
• Understand the evidence about breech birth
• Discuss how this informs our communication with women with a breech presentation late in pregnancy. Communicating numbers is tricky. Most people don’t add them up like a balance.
• Make use of the evidence in communicating with women.

Next they discuss ECV, since it’s part of the breech package. They show videos and make a strong plea that ECV should be enthusiastically encouraged.

They discuss the mechanics of breech birth. In Andrew's experience, once women see the mechanics, they say “aha! Now I get it. I feel much better.” It gives women an anchor from which to make a decision. They emphasize that this knowledge of the mechanics has to be hard-wired into everyone attending the birth. They talk about the practicalities of the birth (post dates, monitoring, what will happen in labor, is a breech harder or longer, do women have to have an epidural, induction/augmentation, etc.). He emphasizes that continuous monitoring is for litigation. If women don’t want it, they don’t have it.

They then watch a breech birth as a group, including things to learn from it, things he might have done differently today. He reemphasized the value of videos in learning breech skills (echoing Frank Louwen's admonitions to use videos as a primary learning tool).

They also present women’s perspectives on VBB. They have many stories of women who found it very difficult to negotiate for a VBB within the Australian healthcare system.

Dealing with the unexpected breech
They show a video of an unplanned breech home birth; the midwife was not planning on attending a breech and couldn’t transfer the mother. (The midwife showed the video at the 2012 breech conference in DC and asked for input on what she did wrong. At that conference, they gently suggested what could have been done differently.)

Creating a safe space for physiological breech birth
In this part of the course, women describe how they set up the birth space in the hospital so they felt safe. They also use the story of a midwife who traveled a long distance to have a breech baby vaginally in a hospital.

Hands-on stations
Using the Sophie obstetrical mannequin by MODEL-med, they do normal breech in different positions. They also practice abnormal breeches, including how to resolve difficulties with arms and heads. They practice breech births in many positions: semi-recumbent, H&K, and birth stool

Andrew noted that once the breech is birthing and the bitrochanteric diameter is out, the baby will birth. From the birth of the BT to the birth of the head, he’s most comfortable when the baby is out in 3 minutes. So once you see the umbilicus, give yourself 3 minutes. Once the shoulders are out, 1 minute. These guidelines aren’t dogma, but they give an anchor for people to make decisions from.

Counseling the woman with a breech
They partner up and practice counseling, with the audience interacting. They have to communicate more than numbers. It shouldn’t be all about risks, and it's important to keep positive.

The course finishes by reviewing essentials for a safe service and giving practical suggestions for providers.

They’ve done about 8 courses since 2012. The main issue is: will this make a difference, increase VBB, and make things better? He doesn’t know yet, but he’s waiting the results of one survey. He still wonders what the best way is to train providers in VBB.

Andrew's main conclusion was that breech skills can be taught. He made the analogy with shoulder dystocia. SD skills have taught very effectively with various approaches. Things have greatly improved over the past 2 decades with the systematization of training for SD. The same is doable for breech. His course is more than just mechanics. They encourage ongoing learning from each case. Even during cesareans for breech babies, he demonstrates the mechanics of VBB to show residents how it works.

~~~~~

Q: I have a question about communicating the numbers about vaginal breech birth. Yesterday, we saw different approaches of how can can do it. What is your suggestion?

A: I literally put the numbers on a simple table. The numbers I communicate are:

• PNMR for VB is probably around 1/500 to 1/700. 
• For cephalic babies, it’s probably 1/1200 to 1/1500. 
• For ECS for breech, it’s 1/2000 or less. 

I do similar things for trauma. Then I talk to that. If you want to have a good idea of the risks of breech compared to other modes of births, you have to look at a lot of numbers. I want to emphasize that these bad outcomes don't occur very often. Everyone has a different take on risk, and they will have to process it for themselves.

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My letter to Zari's teacher about homework

I just sent Zari's 4th grade teacher this letter about homework, recess, and sleep:

Dear Mrs. _____,

Hi, I’m Zari’s mom, Rixa. I wanted to share some concerns with you before our parent-teacher conference next week.

I’m concerned with the amount of homework Zari is being assigned. Her bedtime is normally 8 pm, but this year she often stays up until 9:30 or 10 pm finishing her homework. Because she’s riding the bus for the first time this year, she is also waking up a half-hour earlier, leading to her missing up to 2 hours of sleep every night. Because of homework, Zari is unable to get the 9-12 hours of sleep recommended by the American Academy of Pediatrics for children her age.

I am also concerned that Zari has had to miss recess for incomplete homework. The American Academy of Pediatrics has written about the crucial role of recess in school and strongly discourages withholding recess: “recess is a crucial and necessary component of a child’s development and, as such, it should not be withheld for punitive or academic reasons.”

On top of causing Zari to lose sleep and recess, homework is also affecting our family life. Zari is the oldest of 4 siblings, 3 of whom are in school. This means a lot of homework for me to supervise and not much time to cook dinner, read with my kids, or just spend time with them. I want to be a parent, not a surrogate teacher, when my children come home from school.

I also want my children to have unstructured play time after school: time to run around outside and dig tunnels in the dirt and make bows and arrows out of parts from the recycling bin (all activities my kids did this past week).

We are also a family of readers; I often have to pry books from Zari’s hands when it’s dinnertime or bedtime! Some of the series she’s read recently include Fablehaven, Narnia, The Golden Compass, Silverwing, and A Series of Unfortunate Events. She is currently halfway through Terry Pratchett’s Tiffany Aching (Discworld) series.

As you know, Zari is a very conscientious and meticulous student. She likes things to be perfect—sometimes to my great frustration when I’m trying to hurry her along with her homework!

Because of all of these concerns, I wanted to talk with you about opting out of homework. We did this last year after having similar struggles with lack of sleep and family time. Zari continued to perform just as well, and our whole family was much less stressed in the evenings.

I know opting out of homework might seem like an unorthodox request. But in light of the strong evidence that homework does not improve outcomes for elementary and middle-school aged children, I feel opting out would be in Zari’s best interest.

I recently asked researcher and author Alfie Kohn about the benefits of homework, and he wrote to me: “no reputable study has ever found any benefit to assigning homework of any kind in elementary school.” Other leading researchers agree with Kohn: “There is no evidence that any amount of homework improves the academic performance of elementary students.” (Harris Cooper, Duke University). “The research is very clear. There’s no benefit at the elementary school level.” (Etta Kralovec, U of Arizona.)

Based on this new research, both individual parents and schools in the US and Canada are starting to opt out of homework. Principals are writing about their positive experiences with no-homework policies.

Thank you so much for taking the time to read this letter. I admire the work you do, and I hope you understand that my concerns are not meant as a criticism of you as a teacher. I just want what’s best for Zari’s health and what’s best for our family’s well-being. I am confident that making homework optional for Zari and keeping her recess time intact is a win-win situation for all of us.

I look forward to talking with you next week.

Sincerely,

Rixa Freeze

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Welcome to Sweden

I just came across this must-read article about reproductive culture in Sweden: Welcome to Sweden: Notes on birthday condoms, home abortions, and hysterical Americans.

Author and Wisconsin midwife Ingrid Andersson writes about Sweden's approach to sex, parenting, education, and family life--a stark contrast to America's oversexed prudishness, violence, and hysterical opposition to reproductive choices.

Her son's first day at public school was a welcome contrast from their American schooling experiences:

My son’s teacher said he did not need to bring anything apart from his curious, well-rested, breakfasted self. School will supply all his school needs, including an iPad and hot meals made from scratch. His first lunch —eaten over an hour at a round wooden table, sitting on a real wooden chair, in an actual dining room filled with windows and art—is baked salmon in rich cream sauce, dilled potatoes, steamed broccoli, salad with homemade dressing, bread, butter, and organic milk, served in all-you-can-eat buffet style. The kitchen uses 30 percent organic ingredients, locally produced when possible. My seventh grader is disoriented but delighted by trusting adults and an open campus with unlocked doors. (Every morning since Sandy Hook, my son’s school in America was all locked up by the time the kids were reciting the Pledge of Allegiance.)

Reproductive information, birth control, and abortion are discussed openly and frankly and are accessible to anyone:

Any Swedish teen or adult can walk into one of the common health centers and talk confidentially with a counselor or midwife about any personal or social issue or need, including pregnancy. She or he probably will already have been introduced to a youth health center on a school class field trip at age twelve or thirteen.

Youth and young adult health centers in Sweden offer a limitless supply of free condoms, free testing and treatment for chlamydia and other diseases, and free emergency contraception. Pregnant minors are encouraged but not required to involve a parent. Counselors and/or psychiatrists meet with girls and are available to all women. Abortion is free or low-cost and available on-demand up to eighteen weeks of pregnancy. A dating ultrasound is required, and if the pregnancy is earlier than three months, girls and women can choose between vacuum extraction or pill-induced abortion and to complete the abortion at home.

Abortions are performed up to twenty-two weeks of pregnancy, but after eighteen weeks there must be a medical indication and a psychiatrist is involved. All girls and women are encouraged to include support persons. Midwives, who are prescribing professionals associated with health and wellness, support all girls and women through normal pregnancy and birth, as well as contraception and abortion choices.

Records from ancient times to the present day indicate that women tend to prefer coping with unwanted pregnancy privately and using measures within their control, or within a circle of trusted family or friends. Preference for autonomy and privacy is evidenced even when clinic-mediated options are accessible. Thanks in part to research at Sweden’s Karolinska Institutet, home abortion is now predictably safe and effective. For women from Stockholm to Nairobi, it has become a first-choice abortion method.

America stands as an exception. For American women, politically driven drug restrictions, costs, and lack of funding for education and support make obstacles to home abortion formidable....

“Publicly protesting abortion or anything related would be seen as hysterical in Sweden, not even the Christian party would do that!” says Ella, a twenty-eight-year-old hospital gynecology nurse who plans to continue studies to become a midwife.

To read the rest of the article, click here:

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First week of public school in France

Life changed dramatically for us this week. Zari, Dio, and Inga all started full-time public school on Tuesday. I love the school hours (8:30-11:30 am and 1:30-3:45 pm) and the 2-hour lunch break. We live a 2-minute walk away from the school, which is about halfway up a large hill & cliff overlooking Nice. The school playgrounds have breathtaking panoramic views of the city and ocean.

Inga did magnificently the first day. She walked in, sat down at one of the tables, and started playing with toys without giving me another glance. The only crying this week came when a classmate took her shoes :)

One thing we learned is that they give the 3-year-olds naps in the afternoon. Naps = trouble for Inga. If she naps, she will not go to bed at night until 9 or 10 pm (her usual bedtime is 7:30 pm). This means she keeps Zari and Dio up late as well, since all three of them share a room.

I want to talk to her teacher to see if they can give her quiet activities during naptime, because her wakefullness is so disruptive to our family at night. But I also don't know if this would be considered rude or out of place to ask?? I suppose the other option would be to have her go to school only in the mornings. But I like having her go full-day; she gets more French interaction, and it gives me a nice stretch of quiet time in the afternoon while Ivy is napping. I even got to take a nap today--amazing!

When I picked the kids up for lunch the first day, Dio didn't want to leave school. His teacher says he's quiet and is slower to make friends because of the language difference, but otherwise is doing well.

Zari has gone back and forth this past month between being apprehensive and excited. Right before school started, I reminded her that she had been in an accelerated program during kindergarten and first grade. During kindergarden they did both K & 1st grade, and the next year they did 2nd-grade work. She had no idea she was in an accelerated program! As soon as I told her that, all of her fears about school here vanished. "I've already done 2nd grade! It's going to be so easy!"

Zari had a few small meltdown moments this week, which I attribute to adjusting from vacation back to school schedule. She complained that "school in France is not very interesting!" and remarked that "the work is easy peasy--except for it being in French." But mostly she's enjoying herself and keeping busy learning French handwriting. School children start out right away learning a beautiful cursive and don't ever use block letters. Zari loves drawing, so she's more than happy working on her cursive skills.

I hope we can make some (adult) friends among the parents we see at dropoff and pickup. There's a delightful fixture of cultures, languages, and appearances. The overall impression is more bohemian than the average people you see on the streets in Nice. And lots of babies coming along in their carriers and strollers :)

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Students who walk or bike to school concentrate better

Eric sent me an article last night about The link between kids who walk or bike to school and concentration.  I haven't been able to get our school administrators to request a crossing guard, despite everyone agreeing that the intersection we cross is fairly dangerous for pedestrians. Zari's kindergarten has implemented drastic new security protocols since the school shooting in Connecticut, including a lock-down policy and intercom buzzer to get in the front door. My school "can't afford" to supply a crossing guard for 20-30 minutes a day total, even though we cross that street four times a day, five days a week. Yet after Newtown, her school immediately spent untold thousands of dollars to prevent a highly unlikely event. Because they "care deeply about students' safety."

So maybe the safety angle just won't work with our local elementary school. Maybe they will support students walking or biking to school if I can demonstrate that driving or busing to school  negatively affects children's concentration. 

I stand firm that we are doing Zari a favor by walking her to and from school every day. She's learning to rely on her own two legs to get her places, rather than on burning fossil fuels. She's getting 2 kilometers of extra exercise every day. She's learning that walking isn't always easy or fun in the winter, but that it's worth the effort of bundling up and getting fresh air.

For now, though, we are alone in our commitment to walking and biking our child to school.* The bike rack remains unused except for Zari's lone bicycle.

Don't you love the awesome spray paint job on her bike? Vive le Canada!

Here's the article by Sarah Goodyear from the Atlantic Cities (emphasis mine):

Every day outside my son’s Brooklyn school, no matter what the weather, you will see a distinctive pale blue bicycle locked to the rack. It belongs to a 7th-grade girl from a Dutch family whose members have stuck with their traditional practice of riding to school each day, despite finding themselves in the not-so-bike-friendly United States for a few years. This lovely blue city bike was a gift from the parents to their eldest child, who is now almost as tall as a grown woman. She has graduated from riding with her parents, and deserves a first-class vehicle to get to class each day. She is fiercely proud of it.

According to the results of a Danish study released late last year, my Dutch friends are giving their daughter a less tangible but more lasting gift along with that bicycle: the ability to concentrate better. The survey looked at nearly 20,000 Danish kids between the ages of 5 and 19. It found that kids who cycled or walked to school, rather than traveling by car or public transportation, performed measurably better on tasks demanding concentration, such as solving puzzles, and that the effects lasted for up to four hours after they got to school.

The study was part of "Mass Experiment 2012," a Danish project that looked at the links between concentration, diet, and exercise.

Niels Egelund of Aarhus University in Denmark, who conducted the research, told AFP that he was surprised that the effect of exercise was greater than that of diet:

"The results showed that having breakfast and lunch has an impact, but not very much compared to having exercised," Egelund told AFP. "As a third-grade pupil, if you exercise and bike to school, your ability to concentrate increases to the equivalent of someone half a year further in their studies," he added.

...In an article about the Danish study from the Davis Enterprise, Egelund says that he thinks there is a deep connection between the way we move our bodies and the way our minds work:

“I believe that deep down we were naturally and originally not designed to sit still,” Egelund said. “We learn through our head and by moving. Something happens within the body when we move, and this allows us to be better equipped afterwards to work on the cognitive side.”

Lots of parents drive their kids to school because walking or driving on streets and roads designed exclusively for cars makes the journey prohibitively dangerous for anyone, especially children. That problem is not easily solved, especially since schools are increasingly being built on the edges of sprawling development, rather than in a walkable context. [PDF]

But many other parents drive their kids because it’s easier, or seems to be easier. They often frame it as a kindness to the child to spare them “trudging” all the way to school, even if that trek is only half a mile long. As these short driving trips become the societal norm, it gets more and more difficult for families to deviate from them. School traffic begets school traffic.

So what could turn the trend around? The connection between active transportation and better physical fitness is well-documented and intuitively easy to draw, and yet apparently not compelling enough....Nationally, as of 2009, only 13 percent of kids in the United States walked or biked to school, down from 50 percent in 1969.

But if more parents realized that packing the kids into the back seat actually affects their ability to learn, would they change their ways? Advocate for building schools in more walkable locations? Demand improved bicycle and pedestrian infrastructure? Or simply make the time and effort required to get to the kids to school under their own steam, accompanying them if need be?

Many parents pay for test prep and after-school enrichment programs to make their kids more academically competitive, and go to great lengths to schedule time for those activities. Imagine if they invested those resources instead in something as simple as helping their children to travel safely from home to school on foot or by bike, arriving ready to learn.

Read the rest of the article here. 

Other articles on this subject: 

• "Car children" learn less in school (The Davis Enterprise). In this article, researcher Niels Egelund comments: “This result means that the parents have an enormous responsibility. I have a child in third grade and a child in ninth grade. I find it a great pity to see how many students are driving to school. You see long lines of cars in front of the school; some drove a very short distance. Parents should really pull themselves up by their bootstraps.”
• Exercise before school improves concentration: study (AFP)
• Marc Schlossberg, Page Paulsen Phillips, Bethany Johnson, and Bob Parker. "How Do They Get There? A Spatial Analysis of a ‘Sprawl School’ in Oregon." Planning, Practice & Research, Vol. 20, No. 2, pp. 147 – 162, May 2005 (PDF). From the introduction: "For over 50 years, communities across the United States (US) have experienced a shift away from small, neighbourhood schools to large ones located on the urban periphery. Two effects of this type of ‘sprawl school siting’ are increased traffic congestion during school pick-up and drop-off times and decreased walking and cycling by children accessing school....When school sites are remote, and children do not walk or ride bikes to school, they are deprived of the opportunity to exercise. This, in combination with a variety of other factors (poor diets, television, the popularity of video/computer games) has lead to an increase in the number of overweight and obese children in the US."

* There are 2-3 families living in the immediate neighborhood who also walk; they don't have to cross any busy intersections because they live on the other side of the highway.
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How to get to school in style

I still haven't made any headway on getting a crossing guard near Zari's elementary school. I've talked multiple times to the school transportation department, the state highway department, the police chief, and more. Since no one was willing to DO anything, I took matters into my own hands:

With the police chief's blessing, I should add. He said he couldn't technically give me crossing guard equipment for liability reasons, but...

"But," I asked him, "there's nothing stopping me from buying my own equipment?"

"Exactly!"

The crossing guard equipment makes a huge difference. Cars actually stop for us (they're legally required to at the crosswalk, but that doesn't mean anything in our town). I get a kick out of holding the stop sign and blasting my whistle at drivers who aren't paying attention.

I'd like a more permanent solution to access to this school building, but it does the job for us.

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You're a bad parent if your kid walks to school?

We've been walking Zari to and from kindergarten. It seemed the most logical of our three options (walk, ride the bus, or drive) since we only live 1 km away. If Zari rode the bus, she'd have to leave the house almost an hour earlier, and she'd get home 1 to 1 1/2 hours later. That adds up to over 2 hours on the bus per day. Driving was out of the question; why drive when our legs are perfectly capable of getting us there?

So far we've enjoyed our twice daily walks. Eric and I switch off walking duty depending on who is teaching that day. We get time with Zari and we get extra exercise. Sounds like the perfect scenario, right?

Yes, except that we have to cross a Death Trap road on the way. It's a state highway that runs through town, and there are no stop signs or stoplights in probably a mile either direction. There's a flashing light that goes on during school hours. This means that cars are supposed to slow down to 25 mph, but no one does. Every time we cross the street, it's like we're inside a giant game of Frogger (this totally dates me!).

I first contacted the school transportation department to inquire about crossing guards. After all, the road where we're crossing is the main entrance into the elementary school and to the county fairgrounds. The reply? They used to supply a crossing guard at that intersection, but not any more. They told me to talk to the police department.

So I met with the chief of police and explained my concerns--that the school no longer provided a crossing guard and that I was having real troubles getting us safely across the street, especially during the morning rush. He sympathized with my situation and said he'd send some patrol cars out in the morning, but otherwise he coudln't do much else. He suggested talking to someone in the state transportation department, since traffic signs on that road are regulated by the state, not by the city.

This morning I spoke to a woman at the state transportation department. I explained our difficulties crossing the road and asked if they would consider doing a traffic survey to put in either stop signs or a stop light. I told her I'd already met with the school transportation coordinator and the police chief, and they both told me they couldn't do much else to help me. Her response:

"You really should have your daughter ride the bus."

I explained that this option made no sense in our situation. We live close to the school, and riding the bus would take an extra 2+ hours out of my daughter's day. Her reply:

"Well, you're the one who's choosing to put your daughter in danger. You're choosing your convenience over her safety. She has a safe option, and that's to ride the bus."

Excuse me?! When did walking your child to school mean that you're a bad, selfish parent? I abandoned any niceties and dropped my polite tone. I said that it was not just a choice between convenience and safety. After all, we're facing major obesity and pollution crises in this country. I feel very strongly that it's an irresponsible choice to put my child on a bus for 2 hours a day, or to drive her to school (as many parents at this school do), when we're perfectly capable of walking. The solution isn't just to put my daughter on a bus; it's to help us find a way to safely cross the street.

Her reply:

"In my town, I have several friends who live across the street from an elementary school, and they all have their children ride the bus because it's safer than crossing the street."

The then told me that she likely couldn't do anything to help me, and to talk to the school and the police again.

Can anyone else see what's wrong with this picture? Is there anything else I can do? (I do have something really subversive up my sleeve...more on that later!)
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First day of school

I sent Zari off to kindergarten this morning--still with some strong reservations about full-day school. She was really excited to go. On the way home she told us all about the stories and songs and treasure hunts they did.

I also wanted to wish a warm welcome to a baby born less than an hour ago in our master bedroom...a planned vaginal breech birth! Baby and parents are resting, and I am all smiles. More details when/if the parents want to share.

It has been a crazy day.
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Kindergarten starts in a week, and I still haven't decided what to do

I've written about my indecision about home school or public school. (Very short version: I don't have a burning desire to home school, but I am not thrilled about sending her to all-day kindergarten either.) Public school starts in a week, and I am still feeling terribly conflicted and undecided.

I live in a smaller town, so the possibility of finding other charter schools, getting together with other like-minded parents, or forming some kind of hybrid co-op is close to zero. And I just don't have time to start a charter school (nor would this community likely support one).

A few months ago, I learned that my state has now adopted the K12 program, which is administered as a public online charter school through a state university. I was really excited and thought that this might be the answer to some of my schooling dilemmas. If I was going to home school, I knew I'd need a pre-made curriculum. There's no way I have time to research and plan--as well as teach--a whole year's schooling. Registration was only open for a 2-week window, so I signed Zari up and felt good that at least we had that option.

Fast forward to now: we received all of her supplies a few weeks ago. The K12 program has officially started, and we've done several full days of lessons. But...but...

I still feel really unsure of what to do with Zari this year. While I can get through the full day's lessons in about 1 1/2 to 2 hours, I am worried that it's still adding too much to my plate. Eric is quite unenthusiastic about home schooling, even with the K12 program, and I would need his support to do it well. I am teaching again this fall, so he'd have to take over teaching 3 mornings a week until I get home.

To give you an idea of what I have going on in my life:

• I am raising children ages 1, 3, and 5
• I am teaching one class per semester at the local liberal arts college
• I usually travel to one academic conference per semester
• We are renovating our house
• We own and manage 3 other properties: our old house, a triplex, and a 5-plex
• I make and sell slings
• I do the majority of housework, errand-running & cooking, since Eric teaches full-time
• I blog here!

Because of my concerns about overburdening myself, I've still been open to public schooling. We brought Zari to school registration this Monday. Public school starts in a week, so I have time to get a feel for the K12 program and lifestyle before I *really* have to make a decision. I talked to the elementary school principal, and there is absolutely no flexibility on doing half-day kindergarten. None. Lots of talk about "how much work there is to be done" and "academic achievement" and "rigorous standards." I have to admit--I'm old-school. I grew up doing half-day kindergarten, and I have a really hard time accepting the need for full-day schooling for 5-year-olds.

It looks like Zari will be placed in the accelerated classroom, which has slightly smaller class sizes and works at a faster pace. I think that would be good for Zari, since she does better when something is challenging than when it's too easy and boring.

But I still have strong reservations. I have an anti-institituional streak in me about a mile wide, in case you haven't noticed. It's not that I'm anti-education. I have 2 master's degrees and one PhD! But I still resist the idea of giving my child over to an institution, with its rules and policies and culture.

On the other hand, Zari is a very talkative, active, outgoing child, and I think she would love being in public school. I am not sure that doing the K12 program this year would provide her with enough interaction and fun experiences. (And no, I can't add more to my plate and do extracurriculars on top of my schedule and on top of homeschooling. Simply too much.) That brings me back to public school.

So there you go. I can only delay this decision for another week, and then I really, truly have to commit to something. At least for a year, since I don't think you can go back into the K12 program until the following school year.

If I do choose public school, we've talked about implementing a few routines into our day:

• Eric or I will walk/bike to and from school with her. It's exactly 1 km away, so it would give us some one-on-one time with her every day. And more exercise and outdoor time for all of us!
• As soon as Zari gets home, it will be outside play time for the whole family to make sure she gets plenty of exercise and unstructured play. There are 2 short recess breaks at school (~15 min) plus 30 minutes total for lunch & recess. It's some, but not enough for an active child.

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

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.

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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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Graduation pictures

The reception for doctoral students...I'm looking a bit pale and wasted after my night of food poisoning. My parents drove down for all of the ceremonies and celebrations.

Before the commencement ceremony

The funny robes...

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The weekend of doom

We've been traveling since last Friday and just this afternoon arrived at our final destination for the Christmas holidays. The weekend neither started nor ended on an auspicious note. Let me start my story a week ago.

On Tuesday, we took our car in for a routine oil change and service. I had noticed a funny rhythmic swishing noise, and the check engine light came on about two weeks ago. I asked our mechanic to take a look at those, too, since we were leaving on a long road trip. It turns out our glow plugs, timing belt, and water pump needed to be replaced for a grand total of $900. Okay, sounds good, at least we caught those problems before we went on the road, we thought.

On Friday, we drove out for my PhD graduation. We stayed with some good friends and went out to eat at a Thai restaurant. Soon after we came back home, I started feeling unwell. At first it was just a general bloated feeling, then it progressed into an angry, hot stomach. I laid down with Zari after I got her to bed, hoping it would go away. Well, it didn't. It turned into full-blown food poisoning. I was puking and running to the bathroom until 3 am, when it finally subsided a bit. I started sipping water and orange juice to replenish all the fluids I had lost and slept fitfully until morning.

I had a full day of graduation-related activities on Saturday. I almost didn't go to them, but I finally peeled myself off the couch. My parents had traveled down and I figured this only happens once in a lifetime. So I made it through a formal reception for doctoral students. I stayed sitting down and managed to eat two crackers and three strawberries. Graduation itself wasn't too bad, since we were sitting down except for the hooding ceremony. By the evening I was feeling well enough to go to a restaurant with my parents, although I was still only able to eat a few bites.

Side note: I find the academic robes & paraphernalia quite hilarious--in any other context you'd look like an utter fool, but because everyone else is wearing the same silly robes and funny hats, it's distinguished and solemn and oh so serious. The seamstress in me was analyzing how to make the doctoral robes and hood, in case I ever go into academia and need to wear them again. There's no way I would ever pay the $700 for the costume when I could certainly make it myself!

On Sunday morning, the temperatures had dropped to below 0 (Fahrenheit) with a biting wind. And our car wouldn't start. We plugged in the engine block heater, but our battery--which had been having a problem holding a charge--just couldn't turn the engine over. Finally my parents jumped us, and we were on our way to my sister in Dayton, Ohio. It's normally an 8-hour drive. The first two hours of driving were terrible: icy roads, whiteout conditions, close to 100 cars in the ditch. Probably 1/3 of them were upside down.

Just as the blowing snow and ice cleared up, our car stopped working. Just stopped, totally. In the middle of the freeway, with temperatures below zero and the windchill around -30 F. We couldn't get the car to start, and in fact the battery wouldn't even turn over. It was completely dead.

I pulled out my cell phone (a Virgin Mobile pre-paid phone that costs only $5/month--love it!) and discovered that the battery was almost out. I tried calling our emergency roadside assistance company and got a message that due to heavy call volume we would be on hold for a while. So I called my sister-in-law and relaid what had happened, and she was kind enough to go on hold for me. Forty minutes later, she called back with bad news: the company was so busy that a tow truck wouldn't be able to come for at least 3 hours and that I should just try to find someone on my own to help us and apply for reimbursement later.

Great. So I dialed 911 and explained my situation to the operator. She relayed my information on to the local police and towing companies and said someone would be coming by to help. It was at least another 45 minutes before the police car showed up. By then we were all getting quite cold. We had our coats on and were wrapped up in quilts and blankets, but there's only so much you can do when it's below zero. The officer was a very nice man. We sat in his warm car and chatted while we waited for the tow truck to arrive. Another 45 minutes later, we were finally on our way.

The next challenge was to find a mechanic who was open on a Sunday night. The first place we tried, Wal-Mart, didn't do anything but oil changes. Fortunately, Sears' auto center was not only open, but the mechanic on duty was also certified to work on diesels (we have a diesel VW Golf). We wandered around the mall, waiting for the mechanics to take a look at our car. We suspected it was a case of frozen fuel lines combined with a bad battery and/or alternator. A few hours later, they called and said they'd replaced the battery but were still unable to get the car started. We plugged in the engine block heater and waited another 45 minutes. Finally, it started! Woohoo! As we had guessed, the car had died because of frozen fuel lines and wouldn't restart because the battery was toast.

We were on our way by 8:30 pm. We fueled up and added a diesel anti-gel supplement to prevent any more fuel lines from freezing. At this point there was no way we would be able to make it to Dayton, which was still 6 hours away. Instead, we drove to our house and arrived right around midnight. We had a good nights' sleep and were on our way the next morning.

Thankfully we have had no problems with our car (or with food poisoning) since then.

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The doctor is in!

There's a new doctor in town...guess who?

Regrettably, not this one...
I'll give you a clue--the name starts with an F and rhymes with "please."

Close, but not this one either...

This one!!! (The one on the left!)

Post-diss bliss with my dissertation advisor Dr. L

I had a fantastic dissertation defense last night, and I am now officially Dr. Freeze! (Okay, I suppose it's really official when you march down the aisle in one of those funny robes...but this is good enough for me).

My university's robe & hood. The ensemble costs a mere $694.70. Even renting one is close to $90!

My committee members asked great questions and gave me lots of suggestions for turning it into a book. And they all urged me to submit it to publishers, NOW. A special thanks to my advisor for her excellent critiques and comments as I was writing and revising.

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