Vintage beauty

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.

Read more ...

All about the breech workshop

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?"

Read more ...

Home Birth Summit update

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.

Read more ...

New breech maneuvers

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". 
.

Read more ...

Lecture on upright breech birth

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.

Read more ...

Wedding reception

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

Read more ...

Bathroom renovation: final pictures

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!

Read more ...

Bright Star diapers

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.

Read more ...

4 months old!

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!

Read more ...

Autonomy, Information, and Power

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!"

Read more ...

Come to BirthTalk this Thursday!

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.

Read more ...

Open forum for the Home Birth Summit

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!

Read more ...

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

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)

Read more ...

When they need it, where they want it

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.”

Read more ...

What is autonomy?

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? 

Read more ...

Home Birth Summit

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

Read more ...

Is autonomy just for the natural birth crowd?

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?

Read more ...

I'm still here, eh?

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.

Read more ...

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

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.

Read more ...

3 month pictures

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

Read more ...

Autonomy, beneficence, and non-maleficance

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.

Read more ...

Breech workshop in the UK

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!

Read more ...

Special discount for upright breech workshop

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.

Read more ...

U-Suck

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.

Read more ...

Home renovations with small children

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.

Read more ...

Random man talks homebirth & homeschool

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?

Read more ...

The wedding

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

 

 

Read more ...

3 surveys--please participate!

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.

Read more ...

2 months old and off to her first wedding

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!

Read more ...