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 ...

Random man talks boobs

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

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

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

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

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

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

Read more ...

Guess who is 2?

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

Dio's serious look

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

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

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

those are smiles, really

wearing swimming goggles after we ate birthday cake

Inga got her passport pictures

I finally painted our kitchen!

Read more ...

Ergos for 50% off

There are Ergo carriers for 50% off at BabySteals. They'll probably be gone in a matter of hours if not minutes, so act quickly! I love my Ergo.

Read more ...

What if something goes right?

I love reading birth stories where everything goes right. Where mothers plan and prepare and get what they want. Where their wishes are respected and they feel elated at what they accomplished. Where things work out perfectly in the end, even if labor throws them a curveball or some initial plans have to be abandoned.

Here are a few such stories I'd like to share:

First off, my youngest sister whose son was born two days before Inga. She had care with a hospital-based midwifery practice and also hired a doula. She hoped for a spontaneous, unmedicated vaginal birth--and that's what she got! Read all about it here at Grayden's birth story. Way to go little sis!

baby Grayden, from low-maintenance.blogspot.com

Next is the story of Busca's fourth child and second home birth. Busca blogs at Birth Faith. This was her longest pregnancy, going to 41.1 weeks. Her other three children were all 5-10 days early. She also had a much different labor pattern this time, hardly feeling any pain or intensity until the last few minutes. Read her story of Surrender in four parts: part 1, part 2, part 3, and part 4.

Busca with her newborn baby, from birthfaith.org

And you've probably heard that Gina, aka The Feminist Breeder, just had her third baby! It was her second VBAC and first home birth. Gina also had a different labor pattern than her first two. After lots of prodromal labor, Gina finally got labor to kick in using a combination of sex, breast pumping, and AROM. She even took a nap at around 9 cm dilated (and still wasn't feeling much pain at that point). Gina, you rock! Read the story of Jolene's birth here. She also had a friend who live-blogged the birth, where you can watch video clips of labor and pushing.

Gina & Jolene, from TheFeministBreeder.com

And finally, Desiree of Hitting My Stride had her baby Sofia! We started corresponding during our pregnancies and have become friends along the way (and she's letting me stay with her during the Lamaze conference this September!). She has two serious clotting factors, which meant heparin injections twice a day throughout her pregnancy. It also meant induction if she didn't go into labor by 38-39 weeks. She was induced at 39.2 weeks with a very favorable Bishop score and had a fantastic birth. Her birth story comes in four parts--Suck Ball City, Labor Faces, The Mirror, and After Birth.

All I can say is: a Pitocin induction with no pain meds? Amazing! She also sent me her birth video, and I was amazed at how non-medical it felt. The atmosphere in the room was calm and quiet. No shouting or coaching or anything, just her pushing and vocalizing when the urge hit.

Desiree, Drew, & Sofia from desireesdaydreams.com

A big congratulations all around. And here's hoping for many more birth stories where everything goes right.

Read more ...

Baby smiles

Baby smiles help me feel less sad about how quickly newborns change. Inga has been giving us smiles for the past two weeks. I still haven't captured a huge grin on camera, but these come close.

Thinking about it...

Almost...

Ta-da!

.

Read more ...

You know home birth is mainstream when...

...Pampers shows a home waterbirth in their ad:



This isn't an endorsement of Pampers--I love my cloth diapers--but it is pretty darn cool to see a very large, very mainstream company include home birth.

Read more ...

Milan Maternity giveaway winner..

...is "cat13"

To claim your prize, please email me within the next 48 hours.

Thanks to everyone for entering!

Read more ...

3 before 33

When I was growing up, I remember planning to be done having children by time I was 30. Maybe 31 or 32 max. Because, you know, being in your 30s is So Old. Yeah.

I knew a woman whose plan was to have Five by Twenty-Five, and she did it. Too ambitious for me.

It's my birthday today, so at least I can say I had Three before Thirty-Three.

The oldest 3 (of 5) in my family

Read more ...

Molten lava science experiment

A few days ago, I was browsing through some clearance bins at the grocery store and saw a package of Betty Crocker Decadent Supreme Chocolate Molten Lava Cake mix. I haven't made a cake from a box in decades (I think cake mixes taste disgusting, and making something from scratch doesn't take much longer anyway.) But it was marked down about 75%. Perfect for doing a science experiment.

I had a group of friends coming over that night for a wine & chocolate night (or as we like to call it, wine & chocolate--and sparkling juice for the Mormons & pregnant women--night). It's basically an excuse to stay up way too late, eat lots of chocolate, and have girl talk. I had originally planned on making a dark chocolate tart, but when I saw the molten lava mix, had a better idea: a blind taste-test of the boxed mix versus a homemade version.

I had a hard time choosing which molten lava recipe to use. They all are variations on the same theme--chocolate, butter, flour, sugar, & eggs--but which one to use? The one with 3 eggs or 6? Do I bake at 350 or 400 or 450? 8 minutes or 14 minutes? I ended up combining two recipes and came up with this:

8 oz dark chocolate (60% cocoa)
1 cup butter
1/3 c sugar
1/2 c flour
4 eggs
2 egg yolks
pinch of salt
1 tsp vanilla extract

I put the cake mix into 9 muffin tins and the homemade version into 12 ramekins.

I baked both at 400. The cake mix version was in muffin tins and the "real" version in ramekins. The mix baked for 11 minutes and the ramekins for 13. I baked them until the tops just started to puff up (which in retrospect was too long).

The verdict:
The cake mix version was less overbaked and had a bit of the "molten lava" texture in the center, whereas the homemade version was way overdone and the centers were entirely firm. The homemade version was also very eggy tasting--so I'd definitely go for a recipe with about 3 eggs, not 6.

During the blind taste test, many of the people said they preferred the texture of #1 (the mix) but the richer, less sweet taste of #2 (the homemade version). It was pretty easy to tell which was which, because #1 was so, so sweet. It tasted just like brownies from a mix, just runnier. Total sugar shock on your tongue. Plus my friends know that I like really dark chocolate and that I would never make something so sweet.

It's ironic that this molten lava mix even exists. The process is almost identical in both recipes: melt butter & chocolate together, add eggs & dry ingredients, and bake. The boxed version has a bag of dry ingredients (sugar, flour, & cocoa powder), whereas the homemade version has you scoop the flour and sugar yourself. Such a difficult task, isn't it?

Lessons learned from this science experiment:

• Take the molten lava cakes out of the oven before the tops start to puff up.
• Don't underfill the ramekins or muffin cups--I should have put the homemade version into 8, not 12, ramekins. 
• Choose a recipe with 3 eggs per 8 oz of chocolate, rather than 6 eggs
• Ramekins release the cakes much better than non-stick muffin tins (I greased both before putting the batter in)
• Don't skimp on the sugar. Even if you're totally addicted to super-dark chocolate--I eat 85% and even 70% tastes too sweet to me--you need enough sugar to make the cakes taste right. 1/3 cup might have been a bit too little; I might up it to 1/2 cup.

I'm ready now to make version #3, which I hope will be the ultimate chocolate molten lava cake. All in the name of science, of course. Stay tuned for the results.

Read more ...

6 week pictures

When I said Inga was chubby, this is what I meant...

 

And some now & then shots...

1 day old

6 weeks old

1 week old

6 weeks old

2 1/2 weeks old

6 weeks old

Read more ...

6 weeks old already?!

Every time I have children, I experience intense feelings of sadness and loss as my newborns disappear and turn into roly poly babies. The newborn stage only lasts about two weeks and then it's gone forever. Sigh...

We're back in the swing of things at the Freeze household (although I still have a few more dinners coming--thanks to everyone who has made us meals!). Inga has adapted quite well into our family. She's pretty easygoing. When she fusses, it doesn't last long and she can be settled down quickly. She's learned how to sleep on her back and how to nap by herself. She loves the sling and will nap quite soundly in it, so sometimes I leave her in and go about my tasks. Although she has no predictable rhythm yet with her sleeping and awake periods during the day, I usually get at least one good stretch of time every day that allows me to get stuff done. Things like making dinner, sewing slings, or playing outside with the other kids. I'm also resetting my expectations for how much I can accomplish in a day.


We close on the new house at the end of this month. I've started packing for our move, which will probably be in about a month. I'm so excited! We found a renter for our current house, a new tenure-track hire. It's just her and her husband, and she seemed to love the house (and she likes gardening!). We keep walking by our new house, taking surreptitious glances as we go by. I'm trying to plan where my gardens will go, since I hope to transplant many of my plants: asparagus, fruit bushes (honeyberries, juneberries, gooseberries, red currants), rhubarb, strawberries, & raspberries. I also want to plant several dwarf fruit trees at our new house.

Speaking of sleep, I feel SO well rested-ever since I gave birth. A million times better than when I was pregnant. I've never found the newborn stage particularly exhausting. My babies (almost) always wake up to nurse every 2-3 hours at night and then go right back to sleep. Now that Inga will sleep swaddled on her back, things are especially good. She often has a 4-5 hour stretch when she first goes down. I try to take advantage of that and go to bed at the same time.

Inga is super chubby now. Her double chin is so big that it wraps around her head, spills over onto her shoulders, and totally hides her neck! I don't know how much she weighs, but she was 9 lbs 6 oz at 3 weeks old. So she's probably close to 11 lbs now, I'd guess. She's done a total 180 with her cousin who was born 2 days before her. He weighed almost 2 pounds more than her at birth, but now he's a slim baby (it runs in his dad's side of the family) and she is a chunker. Go figure!

I anticipated that Dio would have difficulty adjusting to a new baby in the house, but Zari has had a much rougher time. She's finally found her equilibrium in the past week or two. Dio seems pretty unfazed by Inga. The biggest different is that he asks to nurse more frequently. I don't blame him, now that there's lots of milk! He doesn't nurse all that often, usually once a day.

A friend gave me her old Ameda Purely Yours breast pump (she forgot to send the bottles; they should be arriving soon). I hope to start pumping once a day so I can donate like I did with Zari. It will take dedication, but I really want to do it.

Read more ...